A Clinical Information System for Oncology (Computers and Medicine)
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In Palmerston North, only radiation oncologists can approve radiation prescriptions and the linac will not deliver any radiation until the prescription is approved.
However, the log-in for use of the linac can only be provided by radiation therapists, not radiation oncologists. There are available systems that have consolidated the disparate systems into one platform. While some of their functionalities overlap, they are not equivalent. The major issue for OISs in oncology is no longer to do with hardware and networks, or even operating systems. Frequently, the OIS is changed when the linacs are replaced, with the inevitable consequence of having the choice of linac mandate the choice of OIS.
A Clinical Information System for Oncology describes a medical information system designed and implemented in a cancer center Computers and Medicine. A Clinical Information System for Oncology describes a medical information system designed and implemented in a cancer center but with broad applicability to.
However, the functionality and features of modern linacs are converging and are very similar at this time, making the choice of hardware less relevant. Therefore the real issue is the degree to which the attached OIS improves the efficiency of the linac hardware, permits implementation of complex techniques, enhances workflow efficiency and reduces workload levels within the oncology department. An OIS that provides all of this improved functionality will improve the efficiency of the whole system with tangible savings.
The selection of linacs in Palmerston North for the period has followed this logic. Not all staff are keen to consider the issue. When the efficiency benefits of technology are highlighted, there can be a backlash of opinion pointing to the necessary human elements of care. The outcomes that most medical professionals and the general public are interested in relate to the medical outcomes of morbidity and mortality.
The questions - How sick and I going to get? What are my chances of treatment success? The implementation of computers in radiotherapy systems has improved outcomes by enabling doctors to minimise side effects, while maximising the probability of cure. The typical 3DCRT field tends to be made of convex shapes.
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The superiority of IMRT rests in its ability to match concave shapes. Both techniques allow accurate definition of both cancer-affected tissues and the unaffected tissues that can be excluded from significant radiation doses. There is sufficient data to be confident that the side-effects for patients are reduced and cure rates are improved when the techniques are applied to appropriate cases.
Similar assessments are undertaken on paper by almost every radiotherapy department each week. As a proof of concept, the data for acute rectal side effects for early stage prostate cancer over a 4-month period was extracted from the database. The Kaplan-Meier survival curve showing the loss of Grade 0 toxicity is shown below Figure 1. Such comparative data is likely to cause a high degree of anxiety in medical professionals, as individual audits have not previously been presented with this comparative aspect.
The difference in side effects is not simple, as there is no comparison of cure rates, prostate volumes, methods of marking up CT scan, or a host of other factors that could lead to a difference in side effects. However, IF all possible confounding factors were accounted for AND the difference persisted, the public would expect reasonable professionals, whose techniques were resulting in more significant side effects, to undertake further training to reduce side effects without loss of cure.
In this way, the OIS can lead to small but real improvements in treatment delivery by enabling concerned departments to objectively identify superior techniques. Two further improvements derive from the implementation of a modern OIS. The modern OIS is a culmination of developments in modern software and process engineering. Medical systems may be somewhat idiosyncratic but, nevertheless, they have similarities to most other systems. While the transition to an OIS will involve profound changes in a department's organisation, the ability to customise a modern OIS to specific requirements means it is difficult to conceive of circumstances where a department's needs could not be met by the OIS.
Properly implemented, the modern OIS will have two immediate benefits. Patient throughflow will be improved and staff workload will be reduced. Processing patients using an electronic OIS is more efficient as the various tasks required in the treatment process can be notified simultaneously to all concerned.
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The notification process can be reviewed and quality assured to establish whether resource use is efficient. For example, by utilising the abilities of the OIS we have been able to notify booking staff of the need for appointments before a patient has left the consultation room at a peripheral clinic in Gisborne km from Palmerston North, so that patients can be notified of appointments within 10 minutes.
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- The Oncology Clinical Information System.;
The OIS permits a booking clerk to undertake all bookings for a patient's care at one time, thereby resolving many of the co-ordination issues inherent in paper systems. The time that medical staff members spend on the recording of routine data has reduced. The data entry pattern is structured so that data are recorded as they become available; it is also available at all times later and to all staff with access.
Previous paper-based systems had oncologists recording the same data two or three times, with the data only available to those who actually had the paper record. At the end of a patient's treatment in Palmerston North, all their relevant details have been recorded in the OIS so that a standardised report has been written to generate a discharge summary. This saves time as no input is required from the oncologist.
The OIS will lighten clerical workloads.
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For example, the time spent retrieving files stored at another location is regained. Clerical staff members become responsible for entry of data into the OIS rather than filing and collating paper. Finally the time spent by all staff in inefficient systems is time not available for caring for patients. OISs should free staff to spend as much time as possible serving the needs of their cancer patients. The caring role cannot be placed above the system, or vice versa. Both need to be operating at maximum efficiency if we are to provide our cancer patients with our best care.
K Croft, Chief Physicist, personal communication, References 1. Springer; 1st edition December 6, Publication Date: December 6, Sold by: Share your thoughts with other customers. Write a customer review. Amazon Giveaway allows you to run promotional giveaways in order to create buzz, reward your audience, and attract new followers and customers. Learn more about Amazon Giveaway. Set up a giveaway.
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Get to Know Us. English Choose a language for shopping. Not Enabled Word Wise: Not Enabled Enhanced Typesetting: In the US, insurers will accept electronic downloads of charges. In addition, the billing system must be well integrated so that the process of charge capturing is as seamless as possible. In Palmerston North, when a machine has finished a treatment, the software automatically asks whether the charge should be captured, and a simply pressing "Enter" is sufficient to achieve this. When a patient has been seen by an oncologist and accepted for treatment, the OIS must store their treatment specification as well has notify the next set of professionals that their input is now required.
In particular the radiation oncologist needs a system to inform the radiation therapist that a radiation planning appointment is required. The medical oncologist needs a system to inform the chemotherapy nurses that an appointment for chemotherapy is required. As an increasingly important efficiency, the OIS should support interchange of important appointment and task information with personal data assistants PDAs. A clerical document handling system that includes notification of dictation, correction of typing, printing of documents and document archiving and display.
Such a system should incorporate premium word processing software such as MS Word and should be enabled for database field merging, scanner input and voice recognition software. Until recently, the RTP software contained the voluming and field geometry design tools, however, there are advantages to placing these components within the OIS. A system for assessing clinical data provided by manual entry or automated download by HL7 protocol from pathology laboratories. The clinical data can consist of such items as blood biochemistry and blood cell counts but might also include histopathology reports and imaging reports.
Standardised gradings are legion in oncology. Oncologists will require the ability to enter assessments in a range of toxicities and performance measures. This part of the OIS, therefore, must be expandable and configurable to meet the needs of each particular department, and control over the software needs to be within the oncology department. A security system that permits different professional groups to maintain control over relevant parts of the system. The radiation oncologist is responsible for the radiation prescription, which must be complete before a patient can be treated.
In Palmerston North, only radiation oncologists can approve radiation prescriptions and the linac will not deliver any radiation until the prescription is approved. However, the log-in for use of the linac can only be provided by radiation therapists, not radiation oncologists. There are available systems that have consolidated the disparate systems into one platform. While some of their functionalities overlap, they are not equivalent. The major issue for OISs in oncology is no longer to do with hardware and networks, or even operating systems. Frequently, the OIS is changed when the linacs are replaced, with the inevitable consequence of having the choice of linac mandate the choice of OIS.
However, the functionality and features of modern linacs are converging and are very similar at this time, making the choice of hardware less relevant.
Design of an oncology clinical information system
Therefore the real issue is the degree to which the attached OIS improves the efficiency of the linac hardware, permits implementation of complex techniques, enhances workflow efficiency and reduces workload levels within the oncology department. An OIS that provides all of this improved functionality will improve the efficiency of the whole system with tangible savings. The selection of linacs in Palmerston North for the period has followed this logic. Not all staff are keen to consider the issue. When the efficiency benefits of technology are highlighted, there can be a backlash of opinion pointing to the necessary human elements of care.
The outcomes that most medical professionals and the general public are interested in relate to the medical outcomes of morbidity and mortality. The questions - How sick and I going to get? What are my chances of treatment success?
What are my chances of treatment success? The OCIS will support the functions of therapy planning, data evaluation, and medical record keeping; it will also be integrated with the Johns Hopkins Hospital Medical Information System. Leveson N, Turner CS. The ability to "inverse plan" and calculate "dose-volume histograms" was included. The modern OIS is a culmination of developments in modern software and process engineering. Not Enabled Word Wise: The modern OIS seeks to manage the unique oncological processes involved in delivering radiotherapy and chemotherapy by providing software options that address all component processes within an oncology department.
The implementation of computers in radiotherapy systems has improved outcomes by enabling doctors to minimise side effects, while maximising the probability of cure. The typical 3DCRT field tends to be made of convex shapes. The superiority of IMRT rests in its ability to match concave shapes. Both techniques allow accurate definition of both cancer-affected tissues and the unaffected tissues that can be excluded from significant radiation doses. There is sufficient data to be confident that the side-effects for patients are reduced and cure rates are improved when the techniques are applied to appropriate cases.
Similar assessments are undertaken on paper by almost every radiotherapy department each week. As a proof of concept, the data for acute rectal side effects for early stage prostate cancer over a 4-month period was extracted from the database. The Kaplan-Meier survival curve showing the loss of Grade 0 toxicity is shown below Figure 1. Such comparative data is likely to cause a high degree of anxiety in medical professionals, as individual audits have not previously been presented with this comparative aspect.
The Oncology Clinical Information System.
The difference in side effects is not simple, as there is no comparison of cure rates, prostate volumes, methods of marking up CT scan, or a host of other factors that could lead to a difference in side effects. However, IF all possible confounding factors were accounted for AND the difference persisted, the public would expect reasonable professionals, whose techniques were resulting in more significant side effects, to undertake further training to reduce side effects without loss of cure. In this way, the OIS can lead to small but real improvements in treatment delivery by enabling concerned departments to objectively identify superior techniques.
Two further improvements derive from the implementation of a modern OIS. The modern OIS is a culmination of developments in modern software and process engineering. Medical systems may be somewhat idiosyncratic but, nevertheless, they have similarities to most other systems. While the transition to an OIS will involve profound changes in a department's organisation, the ability to customise a modern OIS to specific requirements means it is difficult to conceive of circumstances where a department's needs could not be met by the OIS.
Properly implemented, the modern OIS will have two immediate benefits. Patient throughflow will be improved and staff workload will be reduced.
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