# Use of Process Modelling for Optimization of Molecular Tumor Boards
## 3 Results  
The BPMN representation of the workflow of an MTB at the UCCH revealed a high workload for the MTB physician regarding administration, documentation, and interpretation (Figure 2A). The developed simplified process, in which custom IT solutions have been provided, shows a significant reduction in workload (Figure 2B). The following describes in detail the MTB process alongside its corresponding optimization. Since workload reduction for the physician was the driving force behind these optimizations, we show the BPMN process from the perspective of the MTB physician. All processes that are not part of the MTB physician's work are shown as abbreviated sub-processes, which are expanded to the whole process in detail in Supplementary Materials Figures S1 and S2. Figure 1: Used BPMN elements in this work: (**A**) events, (**B**) tasks, (**C**) swimlanes, (**D**) gateways, (**E**) flow objects, and (**F**) artifacts. Figure 2: The Process of a Molecular Tumor Board from the physician’s perspective in the current (**A**) and optimized (**B**) form at the University Cancer Center. Hamburg (UCCH). The tasks performed by the physician, in blue, show a significant workload reduction. The process of an MTB at the UCCH begins with the request for a personalized therapy recommendation for a patient diagnosed with cancer. The attending physician contacts either the UCCH reception or the MTB physician directly as they are often already in possession of their contact details. In this case, the MTB physician subsequently passes the information concerning the request to the UCCH reception for the patient data to be entered into the clinic's admission system. This creates a patient case in Soarian, the UKE's hospital information system. Without a software solution in place to track MTB patients, the MTB physician must write down all such cases by hand in a notebook. As the molecular pathology department is not linked to Soarian, the MTB physician must submit the diagnostic requests by fax. In addition, the physician arranges for the biospecimen transport to the molecular pathology lab and then sends a fax as a notification of the sample transfer to the department. All these steps are performed manually without the help of any administration software. In the suggested simplified process, the entering of patient data into the clinic's admission system by the nurse at reception creates the patient case not only in Soarian but also in the MTB Software, which then displays all patients in the pipeline. The physician can now request a molecular diagnostic via a structured selection mask and/or request an MTB for a patient. The MTB software will then send necessary requests for sample shipment and molecular diagnostics automatically, resulting in a significant administrative workload reduction for the physician. After the molecular pathology department receives the molecular diagnostic request and the biospecimen, Next-Generation Sequencing can be performed. The molecular pathologist then generates a pathology report containing identified molecular alterations. In the current process, the physician needs to manually check if the pathology report has been completed and uploaded to the Soarian Health Archive as there is no notification. Then, the physician begins to generate the MTB report, which is written as free text directly in Soarian and is written by the MTB physician alone. The MTB report contains the sections Pre-Diagnosis and Pre-Therapy, Current Diagnosis, Scientific Background, and Procedure. Pre-Diagnosis and Pre-Therapy are transferred by hand into the report from the doctor's letter. For the Current Diagnosis, the identified variations are transferred manually from the pathology report. Subsequently, each variation is checked for its therapeutic relevance using various public genetic, pathway, and literature databases. These results are then noted in the Scientific Background section. Finally, a therapy recommendation based on findings from drug databases is documented by the MTB physician in the Procedure section.