Introduction to Radiation Therapy II

Introduction to Radiation Therapy II

• This is a presentation on electronic charting and image management in radiation therapy.

What is a Medical Record?

• A medical record documents patient symptoms, observations, discussions with the patient, lab tests, imaging studies, and treatments.

Purpose

• Medical records provide providers with a history of symptoms, diagnoses, and treatments.
• For insurance companies, they serve as a historical record.

EMR

• Electronic Medical Record (EMR) is a system for Radiation Oncology.
• Oncology Information System (OIS) connects EMR with ancillary equipment like linac and TPS.
• This allows smooth flow of information.

What does the OIS do?

• Early versions of OIS handled registration and verification (R&V).
• Current versions guide and monitor treatment, handle billing and facility management. This includes functions for nursing, doctors and therapy.

Goal of EMR

• EMR collects and stores patient information.
• Facilitates patient encounters.
• Provides staff with relevant information.
• Improves care by eliminating unnecessary chart searching and providing notifications when a patient is waiting for a provider.

Medical Record (History)

• Hippocrates wrote down patient observations in chronological order.
• Mayo Clinic introduced a patient-centered medical record in 1907.
• Weed introduced the SOAP format (Subjective, Objective, Assessment, Plan) in 1960.

Limitations of Paper Charting Systems

• Multiple providers handling the same patient.
• Logistics of managing and accessing individual charts at a time.
• Colleagues using inconsistent handwriting, missing/ambiguous data, wasting time finding needed data, and inefficient access.
• Physical limitations of storage, loss possibility due to fire, flood and time.

More Disadvantages of Paper Systems

• Security challenges, like unlocked storage areas.
• Time and resources required for copying data.

EMR Benefits

• Digital format improves ease of use.
• Provides a legible and orderly format.
• Enables efficient dissemination of information across systems.

Electronic Medical Record (EMR) Definition

• EMR is an application or environment with clinical data repository, clinical decision support system, controlled medical vocabulary, computerised provider order entry, and pharmacy/clinical documentation applications.

Meaningful Use

• Shared information across healthcare facilities throughout a patient's lifetime.
• Goal: Promote EMR use in US healthcare.

Benefits of Meaningful Use

• Benefits include patient control over accessing information, improved services for employers, payers, and insurance companies.

National Health Insurance Network (NHIN)

• Meaningful use is a set of standards for installing EMRs into practice.
• The HITECH Act (2009) provides incentives for achieving meaningful use in healthcare.
• The Centers for Medicare & Medicaid Services (CMS) defines criteria for hospitals and providers to earn incentives.

Clinical Information Management

• EMR data collection comes from multiple sources, including clinic equipment, external physicians, labs, pharmacies, forms, text, and images.

Format of Information

• Narrative format is flexible (e.g., progress notes).
• Structured forms with explicit data entry options (e.g., structured data such as diagnosis) make research easier afterward.

Treatment Planning and Delivery Equipment

• Data collection and sharing with systems such as simulators, treatment planning systems (TPS), treatment machines, and central databases, including integration of images from multiple sources.

Workflow

• Workflow is a series of tasks to achieve a goal.
• It can involve many or few individuals.
• EMR may prompt actions based on criteria/triggers.

Workflow Management in Decision Making

• A formalized process involving a series of events, each step following a defined pathway unique to the facility.
• Changes over time may occur.
• Computerized Physician Order Entry (CPOE) is a core component.

Benefits of CPOE

• Minimal human interaction, with automation of tasks.
• Includes E-prescribing, safety checks such as drug interactions and alergie.
• Information is legible.

Series of Events

• A series of steps, including consultation, nursing assessment, MD decision, simulation, verification, treatment, monitoring response, and follow up make up the process.

Radiation Oncology Workflow System

• Record & Verify: ensures treatment setup is efficient and accurate.
• Physics approves parameters.
• Physicians access dose delivered, images, and approvals.
• Therapists review images when needed.

Decision Support & E-Prescribing

• Decision-making is improved by information access to know disease, treatment options, and rules.
• Suggestions for care can be provided and link to research journals.

Data Compilation

• "Evidence-based care" is supported by research findings, clinical expertise, and patient values.
• Standards of care derive from consensus among professionals.
• The cancer registry organizes cancer data.

Research & Data Mining

• A computer framework compiles and analyses data.
• Enhancing efficiencies, research speed and data safety by integrating research systems into EMR.
• Analysis and Matching.
• Informed decisions are supported by collected data.

Radiation Therapy Oncology Group (RTOG)

• A multi-centered research organization that evaluates therapy approaches, make recommendations, and is part of the American College of Radiology.

Cancer Registry

• Computer systems collect, analyse, and manage cancer-related information.
• Legally required for keeping a patient's data throughout their lifespan.
• Annual reporting is mandatory for practices.
• Trends are analysed to allocate funds to necessary areas.

Types of Registries

• Registries can be institutional, central, or special purpose for specific diseases.

Information Systems

• Secure, dependable systems with password protection, backups, and downtime mitigation.
• IT department and specialized personnel are required for proper functioning.

Access to Information

• Access is restricted to authorized individuals based on their roles and permissions.
• Password protection and specific access privileges are assigned to job titles.
• Data transfer security is ensured by appropriate procedures and protocols.

Security and Privacy

• HIPAA regulations ensure protected health information (PHI) is secure and confidentiality is maintained.
• Safeguards against improper disclosure.

Networking

• Centralized information facilitates access and informed decision-making.
• EMR software implementation may be on a server, a shared LAN or through an application service provider (ASP).
• Coordinate with various devices and locations.

WAN (Wide Area Network)

• Connects multiple locations to share a single network environment; WLANs (Wireless Local Area Networks) are common in facilities.

Wireless Broadband

• Enables remote data access (e.g., doctor's offices, homes).
• May have limited reach, especially in less densely populated areas.

Backing up

• Regular, automatic backups to a secure server are crucial; local & remote backups are ideal.

Connectivity/Interoperability

• Systems may not seamlessly communicate.
• Data interfaces ensure smooth transfer between systems.

Interfaces

• Proprietary interfaces (developed privately) differ from standard interface protocols (set by international standards organizations) used across the industry.

HL7

• ANSI-accredited, current interface framework allows clinical and administrative data exchange, integration, sharing and retrieving.
• Supports clinical practice, management and the overall evaluation of health services.

DICOM

• Digital Imaging and Communications in Medicine (DICOM) established standards for handling medical images, including radiation oncology images.

DICOM RT

• The NEMA (National Electrical Manufacturers Association) and the ACR (American College of Radiology) collaborated to create the DICOM RT format for radiation oncology.

DICOM 3 Definitions

• DICOM RT defines various image and data types.

IHE-RO

• The goal is to achieve interoperability between healthcare systems, addressing the evolving requirements of radiation oncology.
• Technical standards and workflows are considered crucial parts of IHE-RO.

Example IHE-RO

• Illustrates how CT simulator, TPS, and Linac systems can integrate within a facility.

Clinical Challenges to IHE-RO

• Treatment planning, image registration, data exchange, and data management are important aspects to understand when working with IHE-RO.

User Interface

• It's critically important that the user interface is easy to learn and use in practice.
• The goal of the user interface should accommodate the user interacting with the systems through visuals, text and sound.

Human Factors & Safety

• The design of the interface impacts the learning and utilisation of any given system, and should fit the needs of the patient.
• Errors are inevitable, and the Swiss cheese model illustrates how prevention layers can sometimes be faulty.

Implementation and Continuing Education Implications

• Staff education is critical for utilizing new EMR software.
• Ongoing training ensures staff adapt to the changes and the software.

Questions?

• There are questions regarding the provided information(s).