Computer physician order entry (CPOE) as a strategy to estimate laboratory activity and costs associated with cancer clinical trials

Introduction: Most of clinical laboratories are not properly reimbursed for their activity related to clinical trials (CTs) conducted in their institutions due to a lack of measurement strategies. We implemented a specific computer physician order entry (CPOE) environment for CTs in order to facilitate ordering to providers and estimate the associated costs to be compared with the standard of care (SOC). Materials and methods: Four specific electronic formularies, restricted to two new virtual CTs clinical services (onco - CT and haemo - CT), were implemented in January 2015. For each clinical trial displayed in the panels there were several box-cells that contained several profiles based on the different phase of the trials. Tests included in the profiles were the tests required by protocol. Laboratory costs (€) per patient were compared between the CTs services and their regular outpatients clinical services (onco - Out and haemo - Out, considered the SOC) for three years. Results: Costs per patient were higher for CTs services and increased progressively each year (25%, 70% and 70% and 0.6%, 2.7% and 17% in 2015, 2016 and 2017 for Oncology and Haematology, respectively). Taking into account all these differences and the number of patients attending a total difference in expense of + 130,377.7 € for the period 2015-2017 was obtained between CTs and outpatients services. Conclusions: Strategies through CPOE systems based on restricted and specific profiles for CTs ordering are a promising tool that can improve laboratory associated costs estimation and provide robust evidence in reimbursement negotiation processes with CTs sponsors

Real-Time optimal scheduling for prosumers resilient to regulatory changes

The last decade marked an exponential increase in photovoltaic (PV) systems installed on the rooftop of domestic residences within Europe. This situation was basically favored by generous financial schemes such as Feed-in-Tariff and the market of green certificates. However, such governmental incentives drastically reduced, or they were already replaced with net-metering schemes which favor different scenarios: increase of self-consumption and decrease of grid-back injections. This unstable regulatory environment puts both new and old owners of PV systems under a regulatory financial risk. Recently, a regulatory resilient architecture, called UniRCon, was proposed, to overcome both financial and technical regulation uncertainties, where local battery energy storage system plays a key role. Besides the architecture we propose a real-time energy management system (EMS) that could be used for the daily operation of such systems. The real-time EMS is needed to prove the feasibility of this solution in short and long run and it could be also used as the main subroutine in the financial risk analysis. The EMS is based on a mixed-integer linear programming energy management tool that considers possible arbitrage benefits due to price difference in the energy purchased from the grid, while explicitly considering the efficiency of the power electronic interfaces (converters) according to the operation point. We prove our approach using a lab-scale experimental setup of a DC residential microgrid. The results are analyzed under realistic operation scenarios derived from one-year load and PV power output measurements