Session Name: e-health (collaborative)

Session Name: e-Health (collaborative)

• In accordance with the policy of The Royal Australian and New Zealand College of Radiologists, the Australian Institute of Radiography and the Australasian College of Physical Scientists and Engineers in Medicine the following presenter has indicated that they have a relationship which in the following presenter has indicated that they have a relationship which in the context of their presentation, could be perceived as a real or apparent conflict of interest but do not consider that it will influence their presentation. The

nature of the conflict is listed:

Session Name: e-Health (collaborative)

• The presenter has advised that the following presentation will NOT include discussion on any commercial products or service and that there are NO

financial interests or relationships with any of the Commercial Supporters of the 2014 Combined Scientific Meeting.

The Electronic Medical Record

Utilising the data available

Andrew Do

Paul Fenton

Paul Fenton

Epworth Radiation Oncology

The Electronic Medical Record (EMR)

Utilising the data available

• The EMR setup at Epworth Radiation Oncology (ERO) • Demonstrate uses:

• Improve workflow and efficiency Quality Assurance

• Quality Assurance

• Analytics
Decision making • Trials, Studies, Projects

The EMR in Radiation Oncology - History

EMR contains medical & clinical data

• First computer-based record & verify systems in late 1970’s • Evolved into computer- & network- based planning systems • Patient management systems

Pros & Cons well discussed

• Accessibility of information • Productivity

Epworth Radiation Oncology – EMR Setup

• Electronic (“paperless”) since 2012 • Centralised EMR – ARIA® software

Epworth Freemasons Epworth Richmond

ARIA

Servers

• Centralised EMR – ARIA® software

(Varian Medical Systems, Inc.)

• Access anywhere using Citrix® software

(Citrix Systems, Inc.) Anywhere

with Internet

Servers

Activities / Billing Staff / Patient / Doctor Scheduling Imaging

Information Stored in the EMR

In 1,200+ tables, there are details on over: • 200,000 appointments • 5,000 registered patients Course of Treatment / Plan Data / Diagnosis Brachytherapy Devices / Machines

ARIA Database schema. Varian Medical Systems

5,000 registered patients • 80,000 images

• 330,000 delivered external beam radiation fields

Extracting & utilising data

Extracting Data • ARIA reports

• Custom Reporting

• InfoMaker® software (Sybase Inc.)

Input of Data

• Automatic ‘capture’ of information

• User ‘input’ of information _{• InfoMaker® software (Sybase Inc.)} • Write ‘queries’ to

• Run ‘Custom Reports’ to extract information from database

• Printable & exportable to CSV, Excel, PDF (as designed)

EMR: Efficient Work Practice

• Enter information once

• Use same information

in multiple ways

in multiple ways

EMR: Efficient Work Practice

• Enter information once

• Use same information

in multiple ways

in multiple ways

EMR: Work Practice in Medical Oncology

• Recent introduction of ARIA for Medical Oncology at Epworth Healthcare

• Conducting review of • Conducting review of

EMR: QA

From Eclipse (plan) data for given field

• Record measurements, verify against ‘planned’ measurements

Read & entered on treatment console

Calculated automatically

EMR for analytics

• Analysis of previous performance(s)
insightful decisions

• Following examples demonstrate how analysis is used:

used:

• Work practice

• Managing workload • Business intelligence

EMR for analysis: Treatment Times

Actual Treatment Times Comparison by Department Department 1 Department 2 0 5 10 15 10 20 10 20 20 20 10 20

Boost Treatment Breast - Tangent New Case Primary Breast New Case Primary Prostate Prostate Daily Treatment

EMR for analysis: Treatment Workload /

Scheduling

Analyse Machine Workload & Scheduling Compare:

1. Scheduled workload

10000 12000 14000

Minutes Monthly machine usage: Scheduled vs Actual Linac - Minutes Scheduled Linac - Actual minutes used

1. Scheduled workload 2. Actual workload 0 2000 4000 6000 8000 10000

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2013 _{Month / Year} 2014

4% longer than scheduled in December 2013

6X 35.0% 10X 63.8% 6E 9E 0.35% 12E 0.23% 15E 0.13% 18E 0.04% Electrons 1.2%

External beam - Energy Usage

EMR for analysis: Linac Usage / Breakdown

• Machine usage: Energy output, delivery type, complexity

35.0% 6E 0.44% 1 2 3 4 5 6 7 8 9 10 11 12 Breakdown Time Month Breakdowns Linac A Linac B

• Review breakdowns, scheduled services & part replacement

EMR for analysis: Geographic info

• Patient’s Geographic information • Enter data into ‘mapping’ software

• Referral patterns • Referral patterns

• Set up programs: “Stay In Touch” • Identify rural RT patients

EMR: Studies / Projects / Clinical Trials

List & track patients enrolled into trials

Access & monitor information to: • Course of treatment

• Course of treatment • Patient Notes

• Toxicity data (NCI CTCAE)

EMR: Ongoing projects

VICTORIAN RADIOTHERAPY MINIMUM DATASET (VRMDS) • Aide service planning, waiting time analysis, funding 24 data items per course of treatment

• Demographic • Diagnosis • Diagnosis

• Hospital & Campus

• Course of treatment information

o Target Site o Dose

o Start/End dates

Lessons

For accurate, easy to retrieve data:

• Learn the DB: how everything is stored and linked • Take advantage of the system:

• Capture everything, record everything else

• Consistent & Conventional: use of naming, use input • Consistent & Conventional: use of naming, use input fields

• Incorporate EMR in workflow

Thank you

• From demonstrating a sample of our work:

• Benefits to EMR being realised currently

currently

• We are continuing to discover and explore benefits of EMR

Acknowledgements

• Entire ERO:

• Constant feedback

• Support

• Following protocols

• Following protocols

References

1. International Atomic Energy Agency, Record and Verify Systems for Radiation Treatment of Cancer: Acceptance Testing, Commissioning and Quality Control, IAEA Human Health Reports 7, 2013

2. Al-Shorbaji, N , Health and Medical Informatics: Technical Paper WHO Cairo, 2001

3. Mohan R, Podmaniczky KC, Caley R, Lapidus A, Laughlin JS. A computerized record and verify system for radiation treatments. International journal of radiation oncology, biology, physics. 1984;10(10):1975-85. 4. Kirkpatrick JP, Light KL, Walker RM, Georgas DL, Antoine PA, Clough RW, et al. Implementing and

4. Kirkpatrick JP, Light KL, Walker RM, Georgas DL, Antoine PA, Clough RW, et al. Implementing and integrating a clinically driven electronic medical record for radiation oncology in a large medical enterprise. Frontiers in oncology. 2013;3:69.

5. Layman E. Health informatics: ethical issues. The health care manager. 2003;22(1):2-15.

6. Cesnik B, Kidd MR. History of health informatics: a global perspective. Studies in health technology and informatics. 2010;151:3-8.