The first two posts in this series showcased how to build a basic workflow, or process as it is referenced in BPMN terminology, and how to expand upon an existing workflow. In this post we will take what we have covered and show how BPMN is used within RO Dynamics and how to get a workflow to be applied within RO Dynamics. If you missed our previous posts in this series they are linked at the end of this blog post.
There are several general Radiation Oncology workflows that automatically ship with RO Dynamics, one of which is the Treatment Planning workflow. All workflows and workflow changes are done within the Orchestration Module. Ideally there will be only a few department leads that will have access to this module due to the impact that any changes to a workflow can have on a department. Once in the Orchestration Module, all available workflows for your department will be located to the left in the Workflow list.
One of the nice features of RO Dynamics is that we store all versions of a workflow, that way you are able to migrate plans between different versions of the same workflow as well as see how many plans are currently running in each workflow version. Within RO Dynamics, all the tools that were used in the previous Shareable Clinical Pathways tutorials that were demonstrated using bpmn.io, can also be found in RO Dynamics.
In this tutorial, we are going to walk through the process of making a workflow compatible with RO Dynamics. The Treatment Planning workflow is divided into 2 lanes that consist of the Radiation Oncologist and the Planner roles. The workflow begins with a start event labeled “Start Planning” followed by a parallel gateway that will execute the ICD Dosimetry Eval workflow at the same time the treatment planning task will become available for those in the planner role. Once the Treatment Planning task is completed the MD Plan Review task is available for the Radiation Oncologist to then approve or reject the plan and give comments. If the MD Plan Review task is rejected, then the workflow reverts back to the Treatment Planning task along with the comments on what the Radiation Oncologist would like to have changed in the plan. If the MD Plan Review task is approved, then the workflow moves forward and the “Plan Approved” end event is completed.
Beneath the RO Dynamics workflow editor is where all task, activity, flow and other properties may be edited. Most workflow items need to have an ID and it is always considered best practice to give an ID name that describes the item. In our blog post, Advanced Care Team Tasks for Automation we covered all the task options that are available in RO Dynamics. The task type and assigned groups may be edited in the task properties.
In the Treatment Planning workflow, after the two tasks we hit an exclusive gateway. The direction of the workflow through an exclusive gateway is determined by previous data such as task decisions and external information systems. In this example, it is based on the answer to the MD Plan Review task. For all exclusive gateways, a default flow must be selected. Typically, this is the flow that most often the workflow will naturally go down unless there is a special case to handle. For the MD Plan Review task, the rejected flow is defaulted since you don’t want a plan to ever be marked as automatically approved without review. If the task is rejected, then the workflow is reverted back to the
Treatment Planning task for the Planner to make any necessary or requested changes and then submit it back to the Radiation Oncologist.
One of the advantages of BPMN is it visually documents your clinical workflows and is easy for everyone to understand and learn. At the same time, with more work the workflows can be automated to implement your clinical workflows and not just document them. This not only makes your departments workflows clearer but improves clinical efficiency.
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 our previous blog, we discussed patient tags, which should only convey information specific to a patient regardless of plan information. Plan tags are just the opposite and complete the collection of tags in RO Dynamics. Plan tags should only convey information for a specific plan. While they can be manually duplicated or copied over if you are creating a secondary plan or boost off an existing plan, they will not do that automatically since the new plan may need different tags.
Plan tags have endless applications and possibilities. They can be used for things such as treatment devices, imaging modalities, techniques, and anything else that your oncology system may need. These tags make it easy to track and gain analytics on different aspects of the plan and devices used. The analytics pulled from the plan tags has the power to help departments really concentrate or validate the need for equipment or training.
Much like the patient tags, these are quickly and easily viewable using either the plan details view or by opening the patient dialog. Each tag and tag group are able to be customized within the Administration Module and can be color-coded to your needs. Between the plan tags and the patient tags, staff members are quickly able to see the “highlights” of a patient and their treatment plan depending on how your oncology system chooses to utilize this tool. The wonderful thing about tags is that it is fully up to the user on how they are utilized. There is no right or wrong way to utilize the tags. At Quantek Systems, our only goal is to help you to improve your processes so that you are better able to focus on the needs of the patient and their treatment.
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.
Tasks do not always fall into simple complete or incomplete categories. Sometimes more information is needed such as “did this plan pass the first QA”, “was this plan rejected”, and “does this patient need insurance authorization?” This list could go on and on. To help organize the treatment planning process and streamline the flow of information, RO Dynamics has created four different task types:
Standard Complete Task
Yes or No Task
Approve or Reject Task
Pass or Fail Task
Our first task option is a standard task. This is a task that only needs to be completed such as a “Submit IMRT Pre-Auth” task. The only information that plan care team members need is to know is if it has been done or not. There is always the option to add in comments when you complete the task in case there is something unique that needs to be documented.
Our second task option is a yes or no task. This can be applied towards many different tasks that could be in your workflow such as determining if deep inspiration breath hold will be performed. Often this decision needs to be made after simulation once analysis has been performed to determine if the patient would benefit from breath hold, for example by comparing the heart sparing between free breathing and breath hold CTs. By having the ability to create yes or no tasks, workflows can direct the appropriate clinical pathway based on simple decisions.
Our third task option is an approve or reject task. Typically, this task will be used mostly by radiation oncologists, for example in plan approvals. This task is similar to a pass or fail task, in that if a task of this type is rejected a comment must be entered in as to why it was rejected. This provides valuable feedback to the necessary plan care team members as to what needs to be revised, and the workflow engine automatically redirects the plan to treatment planning so that the corrections can be made.
Our final task option is a pass or fail task. This task has many applications depending on how you to choose to customize RO Dynamics but the main person who will become very familiar with this task type is a physicist or possibly a radiation therapist. This task can be applied to many of the daily responsibilities of a physicist or any of the morning warmup procedures done by the radiation therapists. This task is unique in that it is the only one where failure or error messages may be selected. When an error is selected, the workflow will then be redirected as necessary so that the appropriate staff member is made aware of the problem and able to correct it.
Not all departments or tasks are created alike, having multiple task options allows you to further cater and customize RO Dynamics to the lingo and workflows of your department. This is the heart behind Quantek Systems, to come alongside your oncology system to help support and streamline your workflows to enable the best work environment and patient experience possible.
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 this post we are building off of our Shareable Clinical Pathways Tutorial Part 1- Basic BPMN Events, Tasks, and Gateways (https://quanteksystems.com/shareable-clinical-pathways-tutorial-part-1-basic-bpmn-events-tasks-gateways/) post linked here. We will be building off of the workflow that was created in that tutorial so it would be beneficial to review that before reading this post.
In our initial introduction to BPMN and building a simple workflow the ideas of events, tasks and gateways were introduced and a workflow depicting the Radiation Oncologist consult workflow was created. Events, tasks, and gateways are connected together using sequence flows or flows, which consist of a line with an arrow indicating the direction of the sequence. In this post we will build off the Radiation Oncologist Consult Workflow and incorporate additional staff roles with the use of lanes and also covering the editing options that are available.
We will begin with the workflow that we originally created as our starting point. Which is shown below. To create the workflow yourself follow the tutorial using a BPMN modeling tool such as at bpmn.io. (create link) If you need help, watch the video beneath where we show the entire model creation.
Step 1: Add additional lanes for nursing and simulation therapists.
Lanes add an additional level of readability and organization to a workflow. You are able to add lanes above, below or divide the current lane into divisions of two or three by selecting the original lane and using the tools to the right of the lane.
Tip: Tools to edit workflows (Add formatting for tips some how?)
Symbols in BPMN are able to be relocated by dragging and dropping in many cases. When tasks are added and removed it can create a disruption in the aesthetic of the workflow. Our modeler within RO Dynamics, as well as other BPMN modelers have a “Create/Remove Space” tool that can be utilized in these cases located in the tool menu on the left.
Tip: To insert between two existing symbols, it is often easiest to delete the sequence flow(s) in between and then branch new symbols off of the previous symbol.
Step 2: Relocate the start event and add a “Pre-Consult” task
Since the first task of the consult workflow will now belong to Nursing, that is why the start event is relocated to the nursing lane along with the additional nursing Pre-Consult with Patient task. The sequence flow now needs to be corrected with a flow going from the Pre-Consult to the Consult with Patient task in the “Radiation Oncologist” lane.
Step 3: Adding a “Schedule Simulation Appointment” task for the simulation therapist
Once the decision for the “Determine if Radiation Therapy Indicated” task is determined as “Yes” then the next symbol is a signal event that will start the radiation course workflow. After this signal event but before the patient consult ends, a “Schedule Simulation Appointment” needs to be added in the simulation therapist lane. Once this is completed, then the Patient Consult workflow is completed and ends with the “Patient Consult Ended” end event.
Now we have worked through how to expand upon an existing workflow. It is evident that the use of BPMN allows you to be flexible as your department needs change over the course of time.
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.
There is certain key patient information that will always been necessary when treating any patient. These are the answers to the questions that every patient must answer almost as soon as they walk through the door of any medical facility and will be most likely asked repeatedly. Instead of having to copy notes over to each course, simulation, or plan; RO Dynamics has created patient specific tags.
These are a group of tags that apply to a patient and all plans associated with that plan. Patient tags can be customized based on the needs of your department. RO Dynamics comes with two standard patient tags that include: Previous Radiation and Pacemaker. For each of these tags and all custom additional tags within RO Dynamics, tasks and workflows are able to be started once a tag has been selected and saved to a patient.
For example, the pacemaker tag triggers a workflow that is based off the latest standard in the AAPM TG-203 guidelines released in 2019. By adding the pacemaker tag at any point during the treatment planning process, a workflow will be triggered which will then send out tasks to the responsible parties. Not only does this guarantee that this does not get missed but also that you are following the latest standards that have been set forth.
The location of the patient tags makes it easy to always see. Whenever you simply click on the patient, task, plan, or simulation you can see it in the plan details view or when you double click and open the patient dialog. In other systems, while this information may be listed it is not always readily shown or has to be copied down in multiple locations which allows human error to easily take the front seat.
Patient Tags in the Plan Details viewPatient Tags in the Patient Dialog
Through the use of our advanced workflow engine, tags are no longer simple labels, they are able to automatically trigger emails, tasks and workflows that pull together all needed staff roles to streamline your patient care approach. Patient tags are yet another way that you are able to customize RO Dynamics to the needs of your department as well as simplify the incorporation of new standards in patient care.
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.
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.
