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Radiation Therapy Treatment Planning Workflow in BPMN

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:

  • Prescription changes
  • Scheduling changes
  • Plan Changes
  • Plans failing quality assurance
  • Cardiac implanted electronic devices
  • Previous radiation
  • Technical mistakes
  • 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
  • Billing mistakes

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 Colburn

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.

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