Real‐time analysis and display of quantitative measures to track and improve clinical workflow

Abstract

Purpose: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety. Materials and Methods:We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient's care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system without the creation and maintenance of a separate database or duplication of work by clinical staff. Performance measures of workflow were calculated. Results:The dashboard implements a standardized clinical workflow and dynamically consolidates real-time information queried from multiple tables in the EMR database over the following views: (1) CT Sims summarizes patient appointment information on the CT simulator and patient load; (2) Linac Sims summarizes patient appointment times, setup history, and notes, and patient load; (3) Task Status lists the clinical tasks associated with a treatment plan, their due date, status and ownership, and patient appointment details; (4) Documents provides the status of all documents in the patients' charts; and (5) Diagnoses and Interventions summarizes prescription information, imaging instructions and whether the plan was approved for treatment. Real-time assessment and quantification of progress and delays in a patient's treatment start were achieved. Conclusions: This study indicates it is feasible to develop and implement a dashboard, tailored to the needs of an interdisciplinary team, which derives and integrates information from the EMR database for real-time analysis and display of resource utilization and clinical workflow in radiation oncology.The framework developed facilitates informed, data-driven decisions on clinical workflow management as we seek to optimize clinical efficiency and patient safety.

Using a Clinical Data Warehouse to Calculate and Present Key Metrics for the Radiology Department: Implementation and Performance Evaluation

“…The graphics provided by Henkel et al [ 11 ] are limited to single patients and show, for example, the history of 1 of their laboratory values. Munbodh et al [ 12 ] also provide predefined graphics for the total number of examinations of different kinds during the past month. Although they all use intermediate storage for all the patients’ data from the hospitals and RISs, no additional calculations on these data can be performed during the import, and of the 3, only the solution provided by Henkel et al [ 11 ] is not tied to a specific hospital or RIS.…”

“…Although such solutions have been implemented for many different uses cases [6][7][8][9], all of them use a fixed interface to 1 or multiple specific hospital information systems and provide the user with only a fixed selection of predefined calculations. In other systems, the primary goal is to show data from individual patients [10][11][12], which only allows for a limited amount of filtering and no user-defined queries on the data. Other approaches use a data warehouse [13,14] to unite data from several (still fixed) hospital information systems into a unified representation and therefore allow for various user-defined queries to be executed but are missing a GUI for users to specify their queries and instead have their users either use Microsoft Excel or Structured Query Language (SQL; ISO/IEC Joint Technical Committee 1/Subcommittee 32/Working Group 3) for report creation.…”

Technical Note: Improving the workflow in a carbon ion therapy center with custom software for enhanced patient care

“…The use of custom software tools has the potential to streamline institutional-specific workflows and boost clinical efficiency. Previous studies have demonstrated that electronic whiteboards [7] , [8] , [9] and carepath management systems [10] can enhance communication and task coordination in radiation oncology. To address these challenges, a team of medical physicists developed a software tool to improve the workflow at a carbon-ion facility using FileMaker Pro (Claris International Inc., Sunnyvale, CA).…”

Artificial Intelligence–Based Autosegmentation: Advantages in Delineation, Absorbed Dose-Distribution, and Logistics

“…Quality assurance, treatment precision, and patient safety are important items related to the latter, which have been historically performed by human practitioners. 2 As a part of these, a correct segmentation of organs at risk (OARs) and treatment target volumes defines a starting point for the subsequent involvement of other technological components. 3 This duty commonly lies on the professional team of an RT department and is particularly time-consuming, which could widely vary according to expertise and case difficulty.…”