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 1-year old son, crazy dog, and husband.
At Quantek Systems we seek to keep innovating how workflows in Radiation Oncology are implemented to increase efficiency, improve patient outcomes, and reduce costs. We’re excited to preview RO Dynamics 2.0 at AAPM in San Antonio, Tx booth # 847 to present our latest advances in workflow orchestration.
An advanced visual workflow engine to direct both human and automated tasks
Direct workflows and decisions based on treatment site, technique, and more
Visual plan list indicates the status of key plan steps including approved/rejected, and passed/failed
Brand new Workload Assistant – Visualize planner and machine workloads to aid in balanced assignment
Builtin chat to streamline communication between individuals, teams, and roles
Prior to focusing full-time on developing our digital whiteboard and workflow orchestration platform RO Dynamics, I worked as a clinical physicist in radiation oncology. I enjoyed working in radiation therapy as it allowed me to directly apply my background in physics and engineering. I was able to be part of a team helping to improve and save the lives of those who have been diagnosed with cancer in the region that I live. Cancer directly affects the lives of many of those around us, and indirectly affects many more. While there has been marked improvement in treatment, there is further to go.
Radiation therapy as a field has made significant progress since its first inception around 100 years ago. We’re still learning more every day about cancer, radiobiology, and better methods to treat cancer with radiation. The technological improvements in both the machines and software of the last 20 years has been amazing. However, one of the areas that does not receive as much attention is clinical workflow.
One of the challenges that I faced in the clinic, as do many others, is how to coordinate patient care as a team from consult to the end of treatment. Generally, this is not particularly challenging when the clinic has a single linear accelerator and doesn’t have a high volume of patients as one can keep quite a bit of information in their head or use personal methods to track what needs to be done. However, there are a variety of circumstances that can significantly compound the challenges in knowing what needs to be done, when it needs to be done, and knowing key information to get it done right. Some of the contributing circumstances include:
High patient volumes
Emergent treatments and changes to treatment plans
Patient specific information such as a pacemaker or previous radiation
Remote coverage across clinics within a healthcare system
Special Procedures (SRS, SBRT, IORT, LDR, HDR)
Projects to install, accept, commission, upgrade, and maintain equipment, machines, and software
Lack of easy to understand policies and procedures or adherence to them
Staff in and out of the department due to meetings, specialty procedures, vacation, or illness
Too many communication methods – whiteboards, excel sheets, sticky notes, email, text messages, health information systems
These circumstances can make it challenging for staff to be notified or discover important patient and treatment plan information such as:
Plans failing quality assurance
Cardiac implanted electronic devices
Cancelled or partially delivered treatments
Necessary Insurance pre-authorizations
The unintended consequences of these challenges vary, but may include:
Delays or missed task completion
Down stream staff having to rush to complete tasks
Increased probability of making mistakes ranging from insignificant to decreased tumor control, or adverse clinical outcomes
Lack of useful data to analyze processes for improvement
In order to minimize these consequences and streamline department workflow and communication, clinicians need standardized, transparent workflows that can be customized for their departments needs and automated as much as possible by software. Even though policies and procedures to document workflow typically exist, they are often buried in a document somewhere, out of date, inconvenient to locate and reference, and often in a textual form that makes the overall high-level workflow hard to understand. The result is evolving workflows that are inconsistently executed and poorly understood. Even worse, these are mostly manually executed, and not automatable by software. Where automation does exist, it is done in proprietary workflow methods with limited functionality in oncology or health information systems. The latest configuration and historic changes of such mechanisms is typically not documented clearly in procedures and often out of date. Furthermore, being proprietary, these automation mechanisms are not transferable if a department switches software vendor, having to start from scratch to rebuild workflows.
Is there a better way to document and implement workflows without reinventing the wheel? I believe there is through existing standards used widely outside of healthcare. Look no further than the business world where standards have been widely adopted and implemented. Perhaps the most widely adopted standards in the business process world that can be applied to healthcare are Business Process Model and Notation (BPMN), and Decision Model & Notation (DMN). These standards provide standardized models and graphical symbols to define business processes that are readily understandable by all stakeholders, whether the end user, manager, or technical developer. Rather than processes being buried in textual descriptions, processes are transparently understood by visual diagrams. Even better, these models are potentially executable and automated by software in a vendor-neutral manner. These standards can be applied to many areas within healthcare.
In order to solve workflow challenges in Radiation Oncology, and broader healthcare, I believe we need to adopt existing relevant standards that enable customizable, shareable, vendor-neutral workflows and clinical pathways which is why our digital whiteboard platform, RO Dynamics, incorporates both BPMN and DMN. I am not alone in this view. In fact, the organization BPM+ Health (https://www.bpm-plus.org/) was created to make this a reality, and is composed by a community of clinicians, hospitals, universities, government agencies, and vendors working together with a common vision for the future of workflow in healthcare. Let’s work together to build a better future for clinicians, and ultimately patients.
To follow our journey at Quantek Systems to provide vendor neutral shareable workflows and clinical pathways with our software platform RO Dynamics, follow our blog. If you are interested in getting involved, please reach out to us!
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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.