TG262

Y. Jessica Huang, PhD

Department of Radiation Oncology

University of Utah

Huntsman Cancer Hospital

Workflow and the Electronic Chart

2017 AAPM Annual Meeting

Workflow Example

Simulation

Request

Ongoing Tx QA

Physicist

Plan CheckVerification

Sim

Tx Planning

End of Tx Physics Check

SimulationVolumes and/or

Fields Approval

Tx Plan

Approval

IMRT QA

Treatment

Physician Approval

of Image

Miscellaneous Items:

MD Tx Summary

Follow-up Schedule

Workflow in RO-EMR

• Record keeping

– Approved simulation request form

– Physicist plan check form

– Portal images

• Task tracker

– Tx plan approved, pending next task physicist plan

check

• Safety catch

– Treatment prevented without approved prescription

Workflow Question 1

• Overall, how satisfied is

your practice with the

utility of the RO-EMR

environment in

management of your

clinical workflow?

25%

50%

17%

3%

1%

4%

a. Very sa.sfied

b. Sa.sfied

c. Neutral

d. Dissa7sfied

e. Very dissa7sfied

f. Our RO-EMR does not manage clinical workflow

Workflow Question 1

• Factors that seem to contribute to higher

workflow management satisfaction:

– More variety of groups included in the

committee.

– Total number of committee member.

– Time spent more in software selection, training,

and hybrid chart usage length of less or equal to 6

months.

Workflow Question 2

• Which of the following

safety barriers prevent

proceeding with the

simulation without

completion of MD’s

simulation order?

Choose the first answer

that applies.

9%

36%

40%

15%

a. Software interlock. (forcing function)

b. Time out procedure or checklist.

c. Written policy.

d. There is no barrier.

Workflow Question 3

• Which of the following

safety barriers in your

RO-EMR prevent

proceeding with the

treatment without final

approval by physics?

Choose the first answer

that applies. 67%

18%

10%

5%

a. Software interlock. (forcing function)

b. Time out procedure or checklist.

c. Written policy.

d. There is no barrier.

Importance of Physicist Plan Check

Ford, E.C., et al., Quality Control Quantification (QCQ): A Tool to Measure the Value of Quality Control Checks in Radiation Oncology. Int J Radiat Oncol Biol

Phys, 2012. 84(3): p. e263-e269.

Workflow Question 4

• How often do you

experience failures of

communication/transfe-

rring of treatment

history from your

delivery systems back to

the e-chart system?

1% 1%

9%

56%

32%

1%

a. Always (daily occurrences)

b. Usually (several times a week)

c. Sometimes (once every week)

d. Rarely (once every couple weeks)

e. Never

f. My RO-EMR does not communicate with the delivery system

Workflow Question 5

• Have you had near-

misses or deviations

because of failures of

communication/transfe-

rring of treatment

history back to the e-

chart system?

20%

66%

14%

a. Yes b. No c. Unkown

Workflow Question 6

• Do you explicitly

schedule and/or

manage the following

parts of your workflow

using the RO-EMR (i.e.

via MOSAIQ QCL, ARIA

care path, etc)?

58.2%

74.1%

90.1% 93.7%87.4%

75.1%69.5%

85.2%78.1%

52.9%61.3%

41.8%

25.9%

9.9% 6.3%12.6%

24.9%30.5%

14.8%21.9%

47.1%38.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

a. Yes b. No

Workflow Question 6

• Do you explicitly

schedule and/or

manage the following

parts of your workflow

using the RO-EMR (i.e.

via MOSAIQ QCL, ARIA

care path, etc)?

58.2%

74.1%

90.1% 93.7%87.4%

75.1%69.5%

85.2%78.1%

52.9%61.3%

41.8%

25.9%

9.9% 6.3%12.6%

24.9%30.5%

14.8%21.9%

47.1%38.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

a. Yes b. No

Workflow Question 7

• How well is the

communication within

the RO-EMR functioning

in the contexts given

below?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6.6% 6.8% 7.1% 6.6% 9.7%4.9%

9.0% 9.7%

12.0% 12.0% 12.2% 10.2%

18.2%

14.1%14.8%

18.7%

28.9% 30.2% 32.1%

21.4%

25.5%

25.5%25.1%

30.7%

30.1% 29.3% 28.2%

21.7%

25.1%

31.8% 25.1%

21.9%

16.4% 13.2% 11.4%

19.2%

17.8% 21.1%18.0%

15.1%

6.1% 8.5% 9.0%

20.9%

3.6% 2.7%8.0%

3.9%

1. Poor 2. Below Average 3. Average

4. Above Average 5. Excellent 6. Unknown

Workflow Question 7

3.6 3.5

4.0

3.3

3.6 3.5

3.3

2.5

2.7

3.2

2

2.7

2.1

1.8

1.0

2.0

3.0

4.0

5.0

Physician to

Treatment

Planning

Physician to

Treatment

Machine

Alert for

protocol

patient

Alert for

changes in

prescription

Notification of

incomplete

tasks

Notification of

incomplete

checklists

Notification of

change in

treatment

External Survey Average Internal Survey Average

Above Average

Excellent

Average

Below Average

Poor