Radiation Oncology is an industry, like many, that has a lot that needs to be accomplished behind the scenes before a patient is ready to get their first treatment. This process involves multiple staff members and sources of information to come together in complete cohesiveness. Awareness of all the needs of that patient and their plan(s) has to be made known to multiple plan care team members. This does not work out well when everyone has their own independent task list and priorities. Workflows in radiation oncology intersect with all members of the plan care team at different points. It can get complicated to know the state of a plan when there is not a singular task list. That is why RO Dynamics has a consolidated worklist view that has important features not found in other oncology information systems. Here are just some of the highlights of the worklist view capabilities:
Tasks filters default to focus on what you need to do first
Only see tasks that are specific to you and your staff role
Color coded due dates
Dynamically searchable with many filter options
Tasks are able to be reverted back to incomplete state
Tasks are associated with a plan
Completion of different task types (standard, yes/no, approve/reject, or pass/fail)
Quick chat with care team members
The worklist view is what can be referred to as the “home page” of RO Dynamics. This is where you will see all the tasks that apply to you and the order that they need to be done in. This means that you will only see tasks on your worklist that are ready to be completed by you or pending assignment to a member of your staff role. You can rest assured that no task was missed in getting to this step because the workflow engine directs the tasks, and you are able to see a history of all the completed tasks and any comments that have been made in association with any task in the plan details view.
Each task is color coded; red indicates that a task is past due or due today, yellow indicates that it is due tomorrow and the standard background color indicates that you still have time to complete the task. These colors can be customized to your department’s preference. There are many filters that can be applied to see different tasks that are not specific to you based on patient information, plan care team information or plan information. If by chance something was completed by accident it is easily able to be reverted back in the workflow so it can be corrected. When questions arise, there is a chat feature that is associated with all the tasks that will directly link you to a chat with the member of the plan care team that you need to speak with.
The worklist provides order to something that otherwise can easily become complicated and overwhelming. No more questioning where a plan is, what state it is in or what needs to be done. Patient care is now broken down into a simple format so that you are able to focus on what you do best and provide the best experience for your patients while having peace of mind that nothing was missed or forgotten since RO Dynamics will have it covered.
Hannah Shappell is an ARRT certified radiation therapist with years of clinical experience who graduated with a Bachelor of Science in radiation therapy from Texas State University. She now currently resides in beautiful Central Oregon where you will typically find her outside trying to keep up with her two sons, crazy dog, and husband.
In the paper beneath, we present the need for shareable clinical pathways in healthcare. If you want to get involved, contact us and also join our mailing list!
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Gabe strives to create innovative solutions to solve real-world problems effectively. Currently he’s focused on improving Radiation Oncology and healthcare workflow and interoperability, with previous experience in the defense industry, quantum computing, and healthcare. He holds a B.S. in Engineering Physics from Colorado School of Mines and an M.S. in Medical Physics from Oregon Health & Science University. He is also certified by the American Board of Radiology in Therapeutic Medical Physics. He resides in Bend, OR where he enjoys the beautiful outdoors hiking, climbing, and camping with his wife and kids.
We will first begin with modeling shareable clinical pathways using the Business Process Model and Notation (BPMN) standard. If you want to follow along, please see the introductory post to this series for links to free modeling tools you can immediately use.
In this tutorial we will model a basic radiation therapy consult workflow from the perspective of the radiation oncologist. The final end result of the workflow is shown beneath.
Basic Radiation Therapy Consult Workflow in BPMN
To create the workflow yourself follow the tutorial using a BPMN modeling tool such as at bpmn.io. If you need help, watch the video beneath where we show the entire model creation.
Please note that in BPMN the term “process” is used, rather than workflow. We may use the terms interchangeably throughout this series, but in the BPMN terminology we use processes to implement the workflows.
One of the great aspects of BPMN is it makes workflows transparent, and easily understandable by even those without training in BPMN. If you have no experience in BPMN, you can probably understand the workflow in the diagram. Even better, is the workflow isn’t hard-coded and embedded in software code that is not available to the user, and would be difficult to understand even if it were available.
In this process we have a single lane denoting the radiation oncologist as the participant. We could have other participants with their own lanes, such as the patient, and other clinical staff such as nurses. For now we will stick with one participant.
Step 1: Create a lane and name it “Radiation Oncologist”.
This process starts with a New Patient Consult Started event. In BPMN events are depicted by a circle. In this case we have a start event, denoting the start of the process. In a process being executed by software, the start event could be triggered manually through a user interface, or automatically when a patient checks in for their consult. Once started, the workflow executes.
Step 2: In the lane create a start event and label it “New Patient Consult Started”.
Once the process starts the first step is a consult between the radiation oncologist and the patient. This is modeled as a user task in BPMN. Tasks of various kinds all have a rounded rectangle. The person icon indicates this is a user task, to be performed by a person. The process waits until this task is complete before proceeding. In software this could be completed manually from a task list, or it could be completed automatically when the patient checks out from the consult. These are implementation details beyond the current scope.
Step 3: Create a new user task, and label it “Consult with Patient”. Make sure the start event is connected to this task.
Once the consult task is complete, the radiation oncologist must determine if radiation therapy is indicated. In the present example we will assume that if radiation therapy is indicated the patient also decides to undergo radiation therapy. In a more realistic model we would also handle the decision from the patient. The decision if radiation therapy is indicated would be selected by the radiation oncologist in a user interface as a simple Yes/No choice.
Step 4: Create a new user task and label it “Determine if Radiation Therapy Indicated”. Make sure the consult task is connected to this new task.
Once the decision is made regarding if radiation therapy is indicated, there are two different flows. BPMN uses gateways with a diamond shape to direct flows within a process. Decisions are not made in gateways, but must happen before the gateway. In this example an exclusive gateway, also know as XOR is used, which only allows one path to be executed out of the gateway.
Step 5: Create a new XOR gateway, and connect the previous task to it. Set the label for the gateway to “Radiation Therapy Indicated?”.
In the current example if radiation therapy is not indicated, we end the consult and for the sake of this example, assume there is nothing further to do in this workflow. If radiation therapy is indicated, a Start Radiation Therapy event will be generated, using a BPMN signal event depicted by two circles with a solid triangle in the middle. Signal events broadcast to other processes to react to. In this case a separate process could be triggered from this signal to start a new radiation course workflow automatically. Finally, once the signal is generated, the process ends with an end event.
Step 6: Create an end event beneath the gateway and label it “Patient Consult Ended”. Connect the gateway to the event, and mark the flow as the default. Finally, label the flow “No”.
Step 7: Create a signal event to the right of the gateway and label it “Start Radiation Therapy Course”. Finally, create an end event and label it “Patient Consult Ended”.
Your workflow should now look like our diagram, and you have created a basic clinical workflow. To make it executable, one would normally add a few more details, such as the candidate group for the task (radiation oncologist), as well as create the implementation details for the start new radiation course signal.
In this tutorial you have been introduced to the following BPMN symbols: lanes, start/signal/end events, user tasks, and XOR gateways. To learn more, follow our blog and we also encourage you to sign up for our mailing list.
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We will never send you spam and you can unsubscribe anytime.
Gabe strives to create innovative solutions to solve real-world problems effectively. Currently he’s focused on improving Radiation Oncology and healthcare workflow and interoperability, with previous experience in the defense industry, quantum computing, and healthcare. He holds a B.S. in Engineering Physics from Colorado School of Mines and an M.S. in Medical Physics from Oregon Health & Science University. He is also certified by the American Board of Radiology in Therapeutic Medical Physics. He resides in Bend, OR where he enjoys the beautiful outdoors hiking, climbing, and camping with his wife and kids.
When walking through any type of hospital or even watching a hospital-based TV show you are bound to see a dry-erase whiteboard hanging up. Traditionally these have been used all across hospitals and health systems for years and while they still can hold an important purpose, many systems are starting to feel the growing pains of the digital age where staff now functions off site and patient numbers are ever increasing so the need for more information for more patients is at an all-time high and the board can only fit so much.
RO Dynamics is a web-based digital whiteboard platform with one of the views specifically designed to be the “whiteboard” of the department or oncology system. In the whiteboard view, key workflow check points are displayed and with the use of four easy to interpret icons and numerous filters to narrow down your search, you are able to easily access an abundance of status information with minimal clicks. You are able to see all the plans that are currently being worked on along with what stage they are in and if a task has been completed, passed, failed, rejected or handed off to the appropriate staff members. You are also able to see all of the standard patient demographics, plan information and plan care team members without having to waste an additional click.
This view can be very convenient for team meetings such as chart rounds, so you are quickly able to glance and see every plan’s status that is currently being worked on and even filter the list to only show the patients that are associated with a certain location or physician for example. It also allows for all staff working off site to quickly know what is happening in the department and with their patients.
This view is what drove the concept of a digital whiteboard and can be a workhorse for any department. All the information you would need in one easy to see table while still being able to dynamically search for specific information as needed, keeping you connected in all circumstances.
Hannah Shappell is an ARRT certified radiation therapist with years of clinical experience who graduated with a Bachelor of Science in radiation therapy from Texas State University. She now currently resides in beautiful Central Oregon where you will typically find her outside trying to keep up with her two sons, crazy dog, and husband.
Quantek Systems will be attending the first-ever virtual American Association of Physicists in Medicine from July 12th – July 16th, 2020. We will be available through a chat feature or you will have the option of requesting a one on one meeting with our staff to learn more in depth how RO Dynamics can work for your Oncology System. Quantek System’s clinical and technical workflow expert, Gabe Colburn, will be available from 7:30am-5pm PST to meet with you to discuss any questions you may have about RO Dynamics or the workflow solutions we offer.
We offer many tools that can be customized to fit the need of your growing cancer center from single linear accelerator sites to multiple satellite locations.
-Revolutionary Applications of Business Process Modeling Notation to Automate Workflows
-Vendor Neutral Customizable Web Platform
-Advanced Department Analytics
-Remote Communication through in Web Application Chat and coming soon Smart Phone and Smart Watch App.
-Worklist with Color Coded Tasks based on Due Dates
Please come visit our booth to get more information or contact us through our website!
Before starting our tutorials on creating shareable clinical pathways, hopefully you have already read our post on A Vision for the Future of Workflow in Healthcare. If not, you should check it out to set the context of the standards we will use in these tutorials such as Business Process Model and Notation, Decision Model and Notation, Case Management Model and Notation, and Fast Healthcare Interoperability Resources to create shareable clinical pathways. The models in these tutorials may be deployed and executed in our RO Dynamics platform, or in other commercial or opensource BPM tools. For more information visit our product page at https://quanteksystems.com.
In this series we will work with examples in the context of Radiation Oncology, which uses radiation to treat cancer. The goal is to help those involved in healthcare to understand how to read and create basic workflows using BPMN. Knowledge of radiation oncology is not required, but will make the workflows more interesting. We will start with simple workflows, and over time get more elaborate to handle the nuances of real-world workflows.
Often the best way to learn something new is by doing it. Perhaps the easiest way to get started is using the free web-based modeler at http://bpmn.io. To create a new BPMN model you may use this link: https://demo.bpmn.io/new. Alternately, you may download a free modeler such as the Camunda Modeler.
Let’s now dive in to creating shareable clinical pathways. As more tutorials are added, they will be accessible beneath for easy navigation.
Stay in the know about our new products and updates:
We will never send you spam and you can unsubscribe anytime.
Gabe strives to create innovative solutions to solve real-world problems effectively. Currently he’s focused on improving Radiation Oncology and healthcare workflow and interoperability, with previous experience in the defense industry, quantum computing, and healthcare. He holds a B.S. in Engineering Physics from Colorado School of Mines and an M.S. in Medical Physics from Oregon Health & Science University. He is also certified by the American Board of Radiology in Therapeutic Medical Physics. He resides in Bend, OR where he enjoys the beautiful outdoors hiking, climbing, and camping with his wife and kids.
