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

Introduction to Radiation Therapy II Electronic Charting and Image Mgmt 1 What is a Medical Record? ◎ Accounting of patient’s presenting symptoms; details of observations & discussions with patient ○ Lab tests ○ Imaging studies ○ Trea...

Introduction to Radiation Therapy II Electronic Charting and Image Mgmt 1 What is a Medical Record? ◎ Accounting of patient’s presenting symptoms; details of observations & discussions with patient ○ Lab tests ○ Imaging studies ○ Treatments related to patient care 2 Purpose ◎ Providers ○ Provides history of symptoms, diagnoses, and treatments ◎ Insurance companies ○ Historical record 3 EMR ◎ Electronic Medical Record ◎ Specific programs for Radiation Oncology Oncology Information System (OIS) Allows information to flow between OIS and accessory equipment and systems, such as linac and TPS 4 What does the OIS do? ◎ Early versions: ○ R&V ◎ Current versions ○ Guide and monitor ◎ Billing ◎ Facility management ○ Nursing, MD, Therapy, etc. 5 Goal of EMR ◎ Collection and storage of patient information ◎ Facilitates patient encounter ○ Providing team with relevant information ○ Improves care by: ◉ No hunting down charts ◉ Notification within department of when patient is waiting for provider 6 Medical Record (History) ◎ Hippocrates ○ Wrote down patient observations in chronological order ◎ Patient centered medical record (1907) ○ Mayo Clinic ◎ SOAP format (Weed, 1960) ○ Subjective, Objective, Assessment, Plan 7 Limitations of paper charting systems 1. Multiple providers 2. Logistics 3. Colleagues a. Handwriting b. Missing or ambiguous data c. Time to find necessary data d. Access (one at a time) e. Storage space f. Lost charts 4. Fire, flood, time- wearing of data 8 More disadvantages of paper systems 5. Security a. Locked storage 6. Copying data takes time/resources 9 EMR Benefits 1. Digital form 2. Legible and orderly presentation 3. Information disseminated between systems 10 Electronic Medical Record (EMR) def. -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. 11 Meaningful use ◎ Promises shared information across healthcare facilities across the lifetime of individuals as they experience independent episodes of healthcare ◎ Goal: Promote use of EMR in US healthcare 12 Benefits of meaningful use ◎ Consumers ○ Patient controls who accesses information ◎ Employers ◎ Payers ○ Insurance companies 13 National Health Insurance Network (NHIN) Meaningful use (Set of standards) 1. Must install and integrate EMR into practice 2. HITECH act gives incentives for meaningful use (2009-Health Information Technology for Economic and Clinical Health) 3. Defined by CMS a. Hospitals and providers earn incentives by meeting criteria 14 Clinical Information Management ◎ EMR collected by many sources ○ Equipment in clinic ○ External physicians and facilities ◉ Ex. labs, pharmacies ○ Forms: ◉ Text ◉ Images 15 Format of information ◎ Narrative is most flexible form ○ Consult note, etc. ◎ Structured forms with explicit data entry options ○ Diagnosis, etc. ◉ Makes later research easier 16 Treatment planning and delivery equipment ◎ Data collected and shared with peripheral systems ○ Simulator ○ Treatment Planning System (TPS) ○ Treatment Machine ◎ Central database necessary ◎ Integration of images 17 Workflow ◎ def- assembly of tasks to accomplish a goal ◎ Tasks range from general to specific ○ May involve one or many individuals ◉ Can be separated by space or time ◎ EMR can suggest actions based on match criteria or triggers 18 Workflow management in decision making ◎ Series of events ◎ Pathway is followed ○ Facility specific ○ Changing over time ◎ Formalized process ◎ Single point data entry ◎ Core component is CPOE ◉ (Computerized Physician Online Order Entry) 19 Benefits of CPOE ◎ Minimal human handoffs ◎ Documents completed tasks ◎ Includes E-prescribing Safety check Drug interactions Allergies Legible 20  Series of events 1. Consultation a. Nursing assessment b. MD 2. Decision to treat 3. Simulation 4. Verification 5. Treatment delivery 6. Monitor of Response 7. Follow up 21 Radiation Oncology workflow system ◎ Record & Verify ○ Fast set up and delivery of treatment fields ○ Assures parameters approved by physics are used in patient treatment ○ Physician can access dose delivered ○ Image access (DICOM) at terminals ◉ Physician notified that images need approval ◉ Therapists notified that images need review 22 Decision support & E prescribing ◎ Decision making optimized by access to information ◎ Options based on knowledge of disease, understanding of treatment options ◎ Rules applied to input data yields suggestions for care ◎ Link to research journals ◎ Errors quality of care 23 Data Compilation ◎ “Evidence based care” established from best research evidence, clinical expertise and patient values ◎ “Standards of care” relates to consensus derived from professionals from the practice ◎ Cancer registry 24 Research & data mining ◎ Computer framework for compiling and analyzing data ◎ Research systems integrated into EMR ○ Increase in efficiency, speed and safety of research ◎ Trial matching ◎ Informed decisions based on data gathered 25 RTOG ◎ Radiation Therapy Oncology Group ○ Multi-centered research organization ○ Tests therapy approaches and makes recommendations ○ Clinical research component of ACR ○ Funded by the NCI ○ Integrating with other surgical and medical oncology groups since 2014 ◉ Formed “NRG Oncology” 26 Cancer registry ◎ Computer system which collects, analyzes and manages data on persons with cancer ◎ Legally required to report data for lifetime of patients with cancer ○ Practices must report annually ◎ Looks for trends ◎ Information used to allocate funds to screening programs, etc. 27 Types of registries ◎ Institutional ◎ Central ◎ Special purpose registries ○ Specific types of disease 28  Information Systems ◎ Secure, stable and dependable ○ Password protection, backed up, downtime ◎ IT department required ◎ System analyst ○ Can set up system specific to the institution using it ○ Supervisor with primary responsibility for system management, design, implementation, software maintenance, configuration of components/settings 29 Access to information ◎ Restricted to qualified and authorized individuals ○ Password protection ○ Privileges given according to job title ◎ Security of transferred data ○ Assigned correctly once received 30 Security and privacy ◎ HIPAA ○ Exchanged information needs to be secure ◉ Info that identifies an individual restricted except to those given consent ◉ Legal consequences for individuals and institutions that breach confidentiality ◉ Full disclosure extended for treatment decision making ◉ Exceptions: public health needs, law enforcement activities, QA and some research 31 Networking ◎ Centralized information: distributable access ◎ Supports informed decision making ○ EMR software implemented by: ◉ Installation on a main computer server, and a shared LAN (Local Area Network) ◉ Hosted on an ASP (Application service provider) ◉ Accessible through web access ◉ Software coordinates with other devices, laptops, computers, portable devices 32 WAN (Wide Area Network) ◎ Can join 2 or more locations to use the same LAN ○ WLAN (wireless local area network) ◉ Most commonly used wireless connection ◉ Can include bedside charting, facility management apps ◉ Separate networks for families and patients ◉ Must have access points coverage can be limited ◉ Location and shielding affect coverage 33 Wireless broadband ◎ Wireless access to data through mobile broadband ○ Access to data at remote locations Ex. doctor’s office, home, etc. ○ Coverage may be limited in rural areas 34 Backing up ◎ Backing up ○ Must be automatic and on a secure server Local backup ○ Remote backup ○ Ideal backup protocol involves a combination of both local and remote systems 35  Connectivity/Interoperability ◎ Systems may not be able to communicate with one another ○ Linked systems improve process and safety ◉ No duplicate entries of data ◎ Interface-allows the data to be transferred from one system to another ○ System may not store or present data the same way ○ Maps message to be recorded and presented accurately between systems 36  Interfaces ◎ Proprietary interfaces-developed and owned by private or commercial entities. ◎ Standard interfaces-governed by international committees ○ ANSI (American National Standards Institute) ○ ISO (International Standards Organization) ◉ require a longer process to come to a standard ○ Become published as public domain ○ Offer more efficiency; require less interaction between developers 37  HL7 ◎ Health level 7-current interface platform ○ ANSI accredited ○ Clinical & administrative data ○ Framework & standard for exchange, integration, sharing, and retrieval of PHI that supports clinical practice, management, delivery and evaluation of health services ○ Information (admission, demographics, transfer) is entered once ○ Updates disseminate from a single entry point through system 38 DICOM (Digital Image & Communications in Medicine) ◎ Digital Imaging and Communications in Medicine (DICOM)-international standard for representing image data ◎ Mid 1990’s began to include radiation oncology images (DICOM RT) 39 DICOM RT ◎ Produced by NEMA (National Electrical Manufacturers Association) and the ACR ◎ Manufactured single internationally accepted format for connectivity between systems in the industry ◎ Information types called IOD’s Information Object 40 DICOM 3 Definitions ◎ Describe types of information: ○ RT Image-sim images, drr’s, portal images ○ RT Dose- dose distributions, isodose lines, DVH’s ○ RT Structure Set-contours from CT images ○ RT Plan-test information describing treatment plans, rx and fractionation, beam definitions ○ RT beams & RT brachytherapy-treatment sessions for EBT, and V&R ○ RT treatment summary- cumulative summary information to be sent to hospital EMR 41 IHE-RO ◎ Integrating the Healthcare Enterprise for Radiation Oncology (IHE) ○ goal to evolve from connectivity to interoperability 2004 IHE-RO (Radiation Oncology), incorporate HL7 and DICOM through coordinated use of established standards ○ Clinical workflows and technical requirements share data between disparate yet critical component systems 42 Example: IHE-RO ◎ Ex. CT simulator to TPS, TPS to Linac ○ “Connectathons” meetings where manufacturers meet with clinicians to make platforms that work the way we need them to ○ Solutions that have been validated allow approved vendors to demonstrate them to the clinical community (ASTRO, ASRT conference) 43 Clinical challenges to IHE-RO ◎ Imaged based 3D treatment planning ◎ Exchange & storage of image registration, radiation therapy structure sets, radiation therapy doses, & special registration ◎ Exchange of data needed for planning of computer-controlled accelerators in external beam treatment 44 User interface ◎ User interface/experience-what a system looks or feels like ○ Many systems have same functional characteristics ○ Preference for one over another has to do with how the user interacts with the systems ○ Includes graphics, textual information, auditory information presented by the program and the input methods 45 Human factors & safety ◎ Design of interface can affect effort in learning and using a system ○ Usability-the degree to which the design of a particular user interface takes into account how that piece of the software fits into the overall patient visit and the logic needed by the user to figure out how to use it ◉ Errors are inevitable ◉ Swiss cheese Model of organizational accidents Levels of defense have holes caused by poor design, senior management decision making, procedures, lack of training, limited resources, etc. 46 Electronic Medical Record (EMR) ◎ Implementation and Continuing Education Implications ○ Education to staff is the most effective method of maximization of technology ○ Role and responsibility to accept and adapt to technological changes ○ Education needs to take place before utilization of new software and technologies ○ Continuing education necessary 47 Questions?? 48