Recommendations for Hosting a Virtual MDC
In order to transition from a traditional to a virtual MDC framework, we suggest using the “Model for Improvement” created by the Associates in Process Improvement23. This methodology entails a cyclic four step process: plan, do, study, and act. This will help to ensure the reliability and accuracy of a virtual MDC setup. Summarized below are the corresponding sections for each process step.
  1. Virtual MDC Planning The dedicated MDC organizer should meet with the institution’s IT staff to brainstorm ideas for the virtual MDC. Questions to consider include the cost of implementation, necessary IT infrastructure, security measures, number of participants anticipated, feasibility, ease of collaboration across MDT, and approximate timeline for implementation. Once these essential topics are addressed and discussed with MDT leadership, the organizer should proceed to hosting a few trial MDC sessions in lieu of the weekly traditional meetings. A simple survey addressing the ease of communication, participant preferences, and comments may then be conducted. This will help to gauge the degree of buy-in from MDT members at the onset of the project. Based on the survey responses, we encourage discussion within the MDT regarding the specific advantages and disadvantages to implementing a virtual MDC. We anticipate that if there is a significant preference for one format, there will be strong support from MDT leadership to institute such a system.
  2. Virtual MDC Implementation There are several factors which affect the degree to which MDT members can interact in a virtual setting: time, ability to hear colleagues, visualize case imaging, and see other MDT members24. The organizer must find the best time to host the virtual MDC so that as many MDC members can participate as possible. In addition, all MDT members need adequate time to prepare for case discussions; thus, new case submissions and the meeting agenda should be finalized at least a day in advance permitting same-day case additions if needed. On the matter of virtual MDC workflow in comparison to traditional meetings, Kane and Luz found that teleconferencing was associated with a greater time spent per case (147%), increased participant turn duration and total attendance, decreased number of total participant turns per minute and percent of informal conversation25. Patients with advanced T and N staging will require more discussion and time allocation as compared to those with early stage disease whose treatment may be planned via a protocol26. Thus, it would be beneficial to prioritize discussion of advanced stage and complicated cases earlier in the teleconference when all members are available. Virtual MDC can be set up to allow either one or more MDT members to talk at once. However, it is often the case that there is one MDT member who has the floor at any given time while other participants are muted in order to reduce background noise. In this way, the speaker’s dialogue is easily understandable. Sometimes, in traditional settings, there is risk of multiple people speaking at once or poor voice projection across the room (i.e. room acoustics or variable seating arrangements) that may make the meeting’s sound quality inconsistent. With the virtual MDC, participants may have to wait a bit longer to respond to discussions rather than speaking in freeform, which would be the standard in traditional meetings. If the teleconference connection quality is reliable, there should not be any problems with MDT members hearing their colleagues. We recommend a virtual MDC setup in which individual MDT members can share their computer screen with others. In this manner, the MDT radiologist should be able to access individual patient scans and share them on a single centralized display. This tremendously improves the ease of use for the radiology team. The radiologist can prepare the pertinent imaging slides ahead of time and be ready to share this information rather than having to reload all the images on a new computer at the meeting hall. In a similar fashion, the pathologist may be able to share the final pathology report, stains, or any pertinent microscopy findings with the entire team. If there is any need to verify case information, participants can check the electronic medical record in real time as well. In terms of seeing other MDT members, individuals can choose to utilize videoconferencing, but the informal conversations in a traditional meeting are hard to replicate in a virtual setting. If interested, MDT leadership may choose to hold a once monthly or quarterly in-person meeting to support the team camaraderie.
  3. Assessing Virtual MDC Performance In order to evaluate the quality metrics of a virtual MDC, there must be proper, systematic data collection. It is vital that each case discussed at the MDC have documentation linked with the patient’s electronic medical record. This information should be accessible to all MDC participants in case specific members are unable to attend a session. The documentation system should be design in a systematic manner and be goal-oriented27. If data recording is standardized, the MDC case database will serve as a central resource for reviewing patient diagnostic pathways, treatment plans, outcomes, and guideline adherence. This has immense implications for analyzing patient data across the spectrum of care including survivorship. There are a few options for building a virtual MDC documentation database. Rangabashyam et al . utilized the REDCap web application, Research Electronic Data Capture (https://www.project-redcap.org/), in order to document each aspect of MDC case presentation: scheduling, biodata, diagnosis, presentation, imaging, histopathology, management plan, MDC discussions and decisions28. This system proved to be efficient as it could be embedded into the existing electronic medical record system. A few institutions have developed methods to independently assess MDC. Harris et al . implemented an MDT meeting observational tool (MDT-MOT); this rating system allowed observers to evaluate ten different teamwork domains pertinent to the MDC and had good criterion validity29. Virtual MDC can be assessed in terms of process and outcome measures30. Process measures include time interval to case presentation from initial request, percentage of relevant member participation, and overall attendance. Outcome measures include percentage of cases following MDC recommendations, correlation of MDC recommendations with guidelines, time to treatment initiation, disease-specific and overall survival, and patient quality of life and satisfaction. Regardless of the methodology in assessing virtual MDC, the underlying principle is to have each institution critically review its own MDC and the outcomes associated with its discussions.
  4. Process Modifications Based on data analysis from the virtual MDC sessions, quality improvement projects can be appropriately tailored. There are many areas to focus on including preventing delays in treatment or referrals and improving adherence to MDC recommendations. The expectation is that each of these new quality improvement projects will also follow the “plan, do, study, and act” process. Furthermore, adjustments can be made to the virtual MDC setup if data analysis shows that there is a specific area of weakness that can be addressed.