Introduction to Radiation Therapy II
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Questions and Answers

What is a medical record?

A medical record is an accounting of a patient's presenting symptoms, details of observations and discussions with the patient, lab tests, imaging studies, and treatments related to patient care.

What is the purpose of medical records for insurance companies?

  • To provide a historical record of patient care. (correct)
  • To provide a record of patient insurance benefits.
  • To provide a record of patient billing.
  • To provide a history of symptoms, diagnoses, and treatments.

    • The EMR is a specific program for Radiation Oncology.

    True (A)

    What does the OIS do?

    <p>The OIS (Oncology Information System) is a program that allows information to flow between OIS and accessory equipment and systems, such as linac and TPS. In early versions it handled R&amp;V, and in current versions, it guides and monitors patient care, handles billing, and facility management, such as nursing, MD, and therapy.</p> Signup and view all the answers

    How does the EMR improve care?

    <p>All of the above. (E)</p> Signup and view all the answers

    What is the SOAP format?

    <p>The SOAP format stands for Subjective, Objective, Assessment, Plan.</p> Signup and view all the answers

    What are some limitations of paper charting systems?

    <p>All of the above. (M)</p> Signup and view all the answers

    What are the benefits of EMR?

    <p>All of the above. (D)</p> Signup and view all the answers

    The meaningful use of EMR aims to promote its use across the US healthcare system.

    <p>True (A)</p> Signup and view all the answers

    Who benefits from meaningful use of the EMR?

    <p>Consumers benefit from EMR because they have control over who accesses their information. Employers benefit from the use of EMRs because they can improve the overall health of their employees, which can reduce healthcare costs. Payers, specifically insurance companies, benefit from the use of meaningful use EMRs, which allows them to save money and improve the quality of care for their members.</p> Signup and view all the answers

    Describe the National Health Information Network (NHIN).

    <p>The National Health Information Network (NHIN) is part of meaningful use, a set of standards for EMRs. The HITECH act gives incentives for hospitals and providers who meet these standards.</p> Signup and view all the answers

    What are the main sources of EMR?

    <p>EMR data is collected from the equipment used in the clinic, from external physicians and facilities, forms, text, and images.</p> Signup and view all the answers

    What is the most flexible form of information in EMR?

    <p>Narrative. (B)</p> Signup and view all the answers

    What does the PACS system manage?

    <p>DICOM images. (B)</p> Signup and view all the answers

    Is a central database necessary for treatment planning and delivery equipment?

    <p>True (A)</p> Signup and view all the answers

    What is a workflow?

    <p>A workflow is an assembly of tasks that are put together to accomplish a specific goal.</p> Signup and view all the answers

    Which of the following can EMR suggest based on matching criteria or triggers?

    <p>All of the above. (E)</p> Signup and view all the answers

    Workflow management in decision making involves a series of events.

    <p>True (A)</p> Signup and view all the answers

    What is the core component of CPOE (Computerized Physician Online Order Entry)?

    <p>Single point data entry. (B)</p> Signup and view all the answers

    Describe the series of events in the typical cancer treatment workflow.

    <p>The series of events in a typical cancer treatment workflow includes: consultation, which involves a nursing assessment and MD evaluation; decision to treat; simulation; verification; treatment delivery; monitor of response,; and follow-up.</p> Signup and view all the answers

    The Radiation Oncology workflow system is designed to ensure a fast set-up and delivery of treatment fields.

    <p>True (A)</p> Signup and view all the answers

    How does the EMR optimize decision making?

    <p>The EMR optimizes decision making by providing access to information, options based on knowledge of the disease, understanding of treatment options, applying rules to input data to yield suggestions for care, and links to research journals.</p> Signup and view all the answers

    The EMR can improve the quality of care by reducing errors.

    <p>True (A)</p> Signup and view all the answers

    What is 'evidence-based care'?

    <p>Evidence-based care is established from the best research evidence, clinical expertise, and patient values.</p> Signup and view all the answers

    'Standards of care' are derived from the collective expertise of healthcare professionals.

    <p>True (A)</p> Signup and view all the answers

    What is the role of the cancer registry?

    <p>All of the above. (E)</p> Signup and view all the answers

    What are the types of registries?

    <p>All of the above. (D)</p> Signup and view all the answers

    What are the key characteristics of information systems used in healthcare?

    <p>All of the above. (E)</p> Signup and view all the answers

    Who is restricted access to medical information?

    <p>All of the above. (D)</p> Signup and view all the answers

    The security of transferred data is critical in health information systems.

    <p>True (A)</p> Signup and view all the answers

    What is HIPAA, and what is its role in healthcare?

    <p>HIPAA stands for the Health Insurance Portability and Accountability Act, enacted by the US government in 1996 to protect sensitive patient health information. It requires that exchanged information needs to be secure and mandates legal consequences for individuals and institutions that breach confidentiality.</p> Signup and view all the answers

    HIPAA allows full disclosure of patient information for treatment decision-making, with no exceptions.

    <p>False (B)</p> Signup and view all the answers

    How is the EMR software implemented?

    <p>All of the above. (D)</p> Signup and view all the answers

    The EMR software can coordinate with other devices, such as laptops, computers, and portable devices.

    <p>True (A)</p> Signup and view all the answers

    What is a WAN (Wide Area Network) and how does it work?

    <p>A WAN (Wide Area Network) is a network that can join two or more locations to use the same LAN. It can use WLAN (Wireless Local Area Network) which is the most commonly used wireless connection, and can include bedside charting, facility management apps, and separate networks for families and patients.</p> Signup and view all the answers

    What is wireless broadband?

    <p>All of the above. (D)</p> Signup and view all the answers

    What are the key requirements for backing up an EMR?

    <p>All of the above. (F)</p> Signup and view all the answers

    What is interoperability, and why is it valuable in healthcare?

    <p>All of the above. (E)</p> Signup and view all the answers

    What are the types of interfaces that are commonly used in healthcare?

    <p>All of the above. (D)</p> Signup and view all the answers

    HL7 is a current interface platform that is ANSI accredited.

    <p>True (A)</p> Signup and view all the answers

    What is DICOM?

    <p>DICOM (Digital Imaging and Communications in Medicine) is an international standard for representing image data in medicine. It was developed in the mid-1990s and includes radiation oncology images, also known as DICOM RT.</p> Signup and view all the answers

    DICOM RT is a standard format for connectivity between systems in the radiation oncology industry.

    <p>True (A)</p> Signup and view all the answers

    What types of information does DICOM categorize in Radiation Oncology?

    <p>DICOM categorizes types of information such as RT Image, which includes sim images, drr's, and portal images; RT Dose, which covers dose distributions, isodose lines, and DVH's; RT Structure Set, which involves contours from CT images; RT Plan, which includes test information describing treatment plans, rx, fractionation, and beam definitions; RT beams &amp; RT brachytherapy, which encompasses treatment sessions for EBT, and V&amp;R; and RT treatment summary, which is a cumulative summary to be sent to the hospital EMR.</p> Signup and view all the answers

    What is the goal of IHE-RO (Integrating the Healthcare Enterprise for Radiation Oncology)?

    <p>IHE-RO's goal is to evolve from a purely connective approach to a more comprehensive interoperable system.</p> Signup and view all the answers

    IHE-RO was implemented in 2004 and has since incorporated HL7 and DICOM into its standards.

    <p>True (A)</p> Signup and view all the answers

    IHE-RO's clinical workflows and technical requirements are designed to share data between disparate yet critical systems.

    <p>True (A)</p> Signup and view all the answers

    What is the purpose of “Connectathons” in IHE-RO?

    <p>Connectathons are meetings where manufacturers meet with clinicians to create platforms that work in the way that we need them to.</p> Signup and view all the answers

    Solutions developed through IHE-RO are validated and demonstrated to the clinical community.

    <p>True (A)</p> Signup and view all the answers

    What are the key clinical challenges addressed by IHE-RO?

    <p>All of the above. (E)</p> Signup and view all the answers

    What is a user interface?

    <p>A user interface is the experience of using a system and how the system looks and feels to the user.</p> Signup and view all the answers

    Many systems may share functional characteristics, but user preference is often influenced by how they interact with a system.

    <p>True (A)</p> Signup and view all the answers

    Usability is the degree to which the system is intuitive, effective, and satisfying in terms of the user’s needs.

    <p>True (A)</p> Signup and view all the answers

    The Swiss cheese Model of organizational accidents suggests that errors are inevitable in systems.

    <p>True (A)</p> Signup and view all the answers

    The Swiss cheese Model suggests that errors are caused by one single factor.

    <p>False (B)</p> Signup and view all the answers

    What is the main implication of the Swiss Cheese Model in a healthcare setting?

    <p>All of the above. (E)</p> Signup and view all the answers

    Education is the most effective method for maximizing the use of technology in healthcare.

    <p>True (A)</p> Signup and view all the answers

    Education for staff is essential before utilizing new technology.

    <p>True (A)</p> Signup and view all the answers

    Continuing education is not necessary in a healthcare setting, as technology is stagnant.

    <p>False (B)</p> Signup and view all the answers

    Study Notes

    Introduction to Radiation Therapy II

    • This presentation covers electronic charting and image management in radiation therapy.

    What is a Medical Record?

    • A medical record documents a patient's symptoms, observations, discussions, lab tests, imaging studies, and treatments.

    Purpose

    • Providers use records to document the patient history, diagnoses, and treatments.
    • Insurance companies use records as a historical record.

    EMR

    • Electronic Medical Record (EMR) is an application, including a clinical data repository, decision support systems, a controlled medical vocabulary and computerized provider order entry and pharmacy functions.
    • Specific EMR programs for radiation oncology include Oncology Information Systems (OIS).
    • Information flows between OIS, linac, and TPS.

    What does the OIS do?

    • Early versions included registration and verification.
    • Current versions also guide and monitor treatment, manage billing, and facility management.

    Goal of EMR

    • Collect and store patient information to facilitate the patient encounter.
    • Provide the treatment team with relevant information, improving care.
    • Eliminate the need to search for charts or confirm patient statuses.

    Medical Record (History)

    • Hippocrates wrote down patient observations chronologically.
    • In 1907, the Mayo Clinic created a patient-centered medical record.
    • In 1960, Weed created the SOAP format—Subjective, Objective, Assessment, Plan.

    Limitations of Paper Charting Systems

    • Paper systems have difficulties with multiple providers, logistical challenges with colleagues, handwritten entries that may be unclear or ambiguous, time spent searching for necessary data, access limitations and restricted storage space, and the physical loss of paper charts.
    • Other issues include damage from fire or flood and the potential for information to become outdated.
    • Issues with security because of locked storage and time spent copying data.

    EMR Benefits

    • Digital format.
    • Legible and orderly presentation of information.
    • Dissemination of information between systems.

    Electronic Medical Record (EMR) Definition

    • An application or application environment composed of a clinical data repository, clinical decision support system, controlled medical vocabulary, computerized provider order entry, and pharmacy and clinical documentation application.

    Meaningful Use

    • Shared information across healthcare facilities throughout a patient's care.
    • Promoting the use of EMRs in US healthcare.

    Benefits of Meaningful Use

    • Benefits for consumers, employers, payers, and insurance companies.
    • Electronic prescriptions, computerized order entry, and record-keeping of smoking status and drug interactions.

    National Health Insurance Network (NHIN)

    • Sets of standards for implementing and integrating EMRs into practices.
    • The HITECH Act provides incentives for meaningful use (2009).
    • CMS defines the standards and hospitals and providers earn incentives by meeting set criteria.

    Clinical Information Management

    • EMRs are collected from many sources like clinic equipment, external physicians, laboratories, pharmacies, and forms (including text and images).

    Format of Information

    • Narrative is a most flexible information format, including consultation notes.
    • Structured forms provide explicit data entry options such as diagnosis.

    Treatment Planning and Delivery Equipment

    • Data is collected and shared with peripheral systems; include, simulators, treatment planning systems (TPS), treatment machines, central database, and image integration.

    Workflow

    • Assembly of tasks to accomplish a goal.
    • May involve one or many individuals and be separated by space or time.
    • EMR can suggest actions based on match criteria or triggers.

    Workflow Management in Decision Making

    • Series of events.
    • Pathway is followed and is facility-specific and may change over time.
    • Formalized processes.
    • Single point data entry with core component as CPOE.

    Benefits of CPOE

    • Minimal human handoffs.
    • Documents completed tasks.
    • Includes E-prescribing and safety check.
    • Features for drug interactions, allergies and legibility.

    Series of Events (Ex. Radiation Oncology)

    • Consultation (nursing assessment, physician decision).
    • Simulation.
    • Verification.
    • Treatment Delivery.
    • Monitor of response.
    • Follow up.

    Radiation Oncology Workflow System

    • Record & Verify: Fast setup, ensures parameters are approved, and provides access to dose delivered and images.
    • Physician notification and therapist notification for image review.

    Decision support & E prescribing

    • Decision making is optimized by accessing information related to disease, treatment options, and care.
    • Links to research journals.
    • Errors affect quality of care.

    Data Compilation

    • "Evidence-based care" is established from research evidence and clinical expertise, with patient values.
    • "Standards of care" relates to consensus between professionals.
    • Cancer registry compiles data, required by law and used for trend analysis and funding allocation.

    Research & Data Mining

    • Computer framework for compiling and analyzing data.
    • Research systems integrated into EMR to improve efficiency and speed.
    • Trial matching and informed decisions to analyze data.

    Radiation Therapy Oncology Group (RTOG)

    • Multi-centered research organization.
    • Tests therapy approaches.
    • Provides clinical research and recommendations.
    • Funded by the NCI.

    Cancer Registry

    • Computer system for collecting, analyzing, and managing data on people with cancer.
    • Legally required for the lifetime of patients.
    • Practices must report annually.
    • Tracks trends used for funding allocation.

    Types of Registries

    • Institutional.
    • Central.
    • Special purpose (specific types of disease).

    Information Systems

    • Secure, stable, and dependable (with password protection, backups, and downtime).
    • Requires IT department and system analyst.
    • Specific system configurations for each institution.

    Access to Information

    • Restricted to qualified and authorized individuals.
    • Password protection.
    • Privileges based on job titles.
    • Security of transferred data.

    Security and Privacy

    • HIPAA (Health Insurance Portability and Accountability Act) mandates secure information exchanges for individuals and institutions, excluding those with explicit permission.
    • HIPAA includes exceptions such as public health needs, law enforcement, and quality assurance (QA).

    Networking

    • Centralized information with distributable access.
    • Supports informed decision making.
    • EMR software implementation using LAN, ASP, Web access, and other devices.

    WAN (Wide Area Network)

    • Connects two or more locations using a LAN.
    • Most common uses are wireless local area networks (WLAN).
    • Bedside charting and facility management may be included in WLAN networks.
    • Separate networks for families and patients, supplemented by access points and coverage considerations, are factors for location-shielding.

    Wireless Broadband

    • Wireless access to data via mobile broadband.
    • Access to data at remote locations (ex. doctor's office, home).
    • Potential coverage limitation in rural locations.

    Backing up

    • Local and remote backups are automatic and are stored on a secure server.
    • Ideal backup protocols use a combination of local and remote systems.

    Connectivity/Interoperability

    • Systems may not be able to communicate with each other because of lack of interoperability.
    • Linked systems improve process and safety.
    • Interfaces are included to facilitate data transfer between systems.

    Interfaces

    • Proprietary interfaces are developed and owned by private or commercial entities.
    • Standard interfaces for international committees (such as ANSI and ISO).
    • Process standards help create interoperability and efficiency, requiring reduced interaction with other developers.

    HL7

    • Health level 7 is a current interface platform, ANSI accredited.
    • It includes clinical and administrative data, and supports clinical practice.
    • Information is retrieved and managed for clinical management and evaluation.

    DICOM (Digital Imaging and Communications in Medicine)

    • International standard for representing digital images.

    DICOM RT

    • Produced by NEMA and the ACR.
    • Single standard for connectivity of imaging systems.

    DICOM 3 Definitions

    • Provides various classifications of digital image information.
    • Ex. structures, dose distribution, treatment plans, RT beams.
    • Includes RT treatment summary information to the hospital's EMR.

    IHE-RO (Integrating the Healthcare Enterprise for Radiation Oncology)

    • Goal of evolving from connectivity to interoperability in radiation oncology.
    • Uses HL7 and DICOM standards.
    • Data is shared between clinical workflows and disparate yet critical component systems.

    Example: IHE-RO

    • Examples of connecting CT simulators with TPS and Linac devices.
    • Demonstrations to clinical communities at specific conferences.

    Clinical challenges to IHE-RO

    • Challenges with imaged-based 3D treatment planning.
    • Exchange and storage of image registration, radiation therapy structure sets, and radiation therapy doses.
    • Need for data exchange for planing of computer-controlled accelerators for external beam treatments.

    User Interface

    • User interface and experience considerations for users to interact with the system.
    • Features like graphics and text input to make it user-friendly.

    Human Factors & Safety

    • Design of the interface impacts the learning process when using a system.
    • Interface usability is measured by the user's comfort and familiarity with the software.
    • Errors are inevitable, and organization accidents may happen due to issues with design and procedure, or from senior management, inadequate training, and budgetary constraints..

    Implementation and Continuining Education Implications

    • Staff education is the key to maximize technology adoption.
    • Education must be provided before new software and technologies are introduced.
    • Continuing educational resources are necessary for sustained learning.

    Questions

    • Open-ended questions to encourage discussion.

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    Introduction to Radiation Therapy II (Electronic Charting & Image Mgmt) PDF

    Description

    Explore the essentials of electronic charting and image management in radiation therapy. This quiz covers the importance of medical records, the role of Electronic Medical Records (EMR), and the functions of Oncology Information Systems (OIS) in patient management. Understand how these systems enhance diagnostics and treatment processes.

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