Making Work Flow in Radiation Oncology

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Dolly Chesnut, RRT, and John Buatti, MD, of the University of Iowa’s department of radiation oncology look at images at the therapist’s workstation, which includes Siemens Lantis and Coherence, both of which are based on the Siemens syngo software platform.Streamlining radiation oncology workflow and boosting productivity are no longer ifs but whens in progressive facilities and departments large and small. Leaders are steering away from paper charts, and focusing on an all-digital environment to ease the flow of data from imaging device and planning system to highly accurate treatment. A large part of the job is automating the transcription of patient data and allowing constant chart accessibility, as well as the seamless transfer of information across facilities — with reduced risk and error.

At Florida Radiation Oncology Group (FROG) — a group of five freestanding clinics associated with Baptist Medical Center in Jacksonville — they are using three Computerized Medical Systems (CMS) XiO platforms to manage their secure broadband network.

The XiO is a comprehensive 3D/IMRT treatment planning platform that delivers automated image fusion, flexible planning functionality, and dose accuracy. The focal system enables FROG to share resources and knowledge across multiple networks, allowing for better coverage, says Scott Simmons, director of dosimetry.

Using a T1 line, clinics can pick up workflow from other clinics that are short-staffed or overrun with patients, and patients can easily be transferred. “The workflow never stops,” Simmons says. Previously FROG was unable to transfer records between clinics, which meant they couldn’t transfer patients. But using the XiO interface, FROG has mastered standardization. “Before we had five clinics [filing records] five different ways. Now all five clinics are on the same page,” Simmons says.

Guarding against human error

Transcription errors were a frustrating disruption for radiation oncology staff at Waukesha Memorial Hospital in Pewaukee, Wis., says Eric Hendee, chief physicist of radiation oncology. To improve workflow, Waukesha gravitated to a fully electronic radiology department, using Impac software version 8.3 to manage and monitor data from more than 125,000 exams every year.

Impac grants physicians access to a list of documents requiring review and approval that they can access anywhere, anytime. Approval status can be checked by staff to determine if there are any outstanding treatment plans, Hendee says, but it prevents treatment from being initiated unless the physician has approved it. “All technical staff can easily compare the approved treatment plan with the treatment parameters on the linear accelerator prior to initiating treatment,” he adds.

Radiation therapists previously entered information manually. “Most radiation oncology centers used elaborate forms with redundant information that made the process of getting data from treatment planning to delivery rather clumsy and inefficient,” Hendee says. Impac organizes data and automatically detects mistakes, alerting the radiation therapist if something doesn’t match up.

Chart flexibility in the facility

In the past, physicians at the University of Iowa’s department of radiation oncology always seemed to need the paper treatment chart when therapists were using it.

But no more. They left paper behind in the fall of 2004, going online with Siemens Lantis Oncology Information Management System and Coherence, based on the Siemens syngo software platform. They also installed four Oncor Avant Garde linear accelerators with onboard cone beam imaging and respiratory gating.

They first determined where information would go in the electronic record, and after months of meetings and examining flow charts, they were able to move patient information to Lantis and Coherence.

Here’s how the paperless workflow works: After patient quality checklists are completed, the patient is scanned using CT, MRI, or PET. On syngo, physicians track each patient’s progress. Then dosimetrists design a treatment plan, which is loaded into Lantis and approved by the physician. Upon approval, the treatment plan is sent to the linear accelerator that delivers the radiation treatments. All charts are accessed electronically by physicians.

“Now we are able to be in one area and stay in that area and do our job,” says Dolly Chesnut, RRT, chief radiation therapist.

Speeding the process

More effective communication, reliable transcription, and flexible accessibility are the keys to improving radiation oncology workflow for physicians and dosimetrists in our nation’s hospitals and clinics. By adopting digital workflow, hospitals can now speed throughput and focus on improving patient care.