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