Revving Up Radiation Oncology Workflow

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Radiation oncology is a specialty in transition. Increasingly it is depending more heavily on images, and dealing with decentralization of services. Yet the key issues that disrupt radiation oncology workflow also are universal in healthcare, says Tim McKeough, chief operating officer of Arizona Oncology Services of Phoenix.

There are basic clinical office challenges. Patient names are hand-entered multiple times, and the exchange of paper across a large department can be problematic. The results are ugly. Billing is delayed; claims are denied; and both staff and patients spend far too much time waiting.

At the same time, radiation oncology is becoming decentralized and more hospitals and large imaging centers are opening satellite clinics, which necessitates new systems and processes to facilitate communication and image sharing across multiple sites.

Finally, the widespread adoption of IMRT (intensity-modulated radiation therapy) and emerging acceptance of IGRT (image-guided radiation therapy) demand new workflow models that allow practices to efficiently integrate new treatment options that heavily depend on imaging (and image review). “IMRT requires 20 to 30 minute appointments, stringing out the schedule. If there’s one hitch, we have problems for the rest of the day, and there’s no way to catch up,” explains Brent Applegate, radiation oncology manager for Ironwood Cancer and Research Centers in Chandler, Ariz.

This month, Health Imaging & IT visits with a few sites that have deployed an array of solutions to tame the radiation oncology workflow beast.

Practice management pays

Arizona Oncology Services is the largest physician-owned radiation oncology service in the Southwest and operates eight clinics and six hospital clinics. Several years ago, COO McKeough aimed to deploy a system to streamline the practice. “Basic office paper stuff is exacerbated in radiation oncology because every patient is a referral,” explains McKeough. Radiation oncology uses an abundance of insurance codes and many clinical players exchange paper tickets before billing. Staff often couldn’t locate tickets resulting in double charges and late and missed bills. On the clinical front, scheduling a session could be three-step process. Brachytherapy, for example, requires that the room and physician must be scheduled. The practice also lacked a system to notify therapists when patients arrived, causing a fair amount of back and forth for therapists.

In April 2002 Arizona Oncology deployed NextGen Healthcare Information Systems practice management and EMR system. The new system eliminates paper fee tickets. Instead therapists use a workstation in the dosimetry room to select from a few codes based on the type of appointment, enabling same day billing.

“It’s a huge step forward for cash flow,” confirms McKeough. Double billing has dropped, and full-time chargers have been redeployed to other duties. Plus, the practice has grown. Although conventional wisdom pairs nearly one additional accounts receivable person with every new physician, Arizona Oncology Services has added eight physicians and only two accounts receivable staffers since deploying NextGen. The practice also worked with NextGen to write a custom patient estimate program. Prior to treatment, probable patient codes are loaded into the system and merged with insurance contracts. At the click of a button, a financial counselor presents the patient with a clear estimate of his or her responsibility. “The upfront estimate is good customer service, we’re sending fewer statements and we’re handling fewer calls from angry, confused patients,” notes McKeough.

The practice prepped for the new system by upgrading network connections between its sites, making sure that each site had enough computers in the right locations. The initial network upgrade consisted of system-wide T1 lines to increase speed, reliability and system performance. A second upgrade to a fiber connection delivers 30MB per second between clinics to enable central management of all systems and rapid transfer of CT images and treatment plans from clinic to clinic. The practice also purchased an entire new line of computers, adding workstations so that each department had at least one station. Multiple workstations were deployed in busier locations like the front desk, nurse station and physics room to eliminate bottlenecks. 

Uniting remote facilities

In the good old days, radiation oncology was hospital-based, and the