Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY
S. Ganguly1,2, R. Ma1, C. Polvorosa1, J. Chang1,2, Y. Cao2,3, and J. Baker2,4; 1Northwell, New Hyde Park, NY, 2Physics and Astronomy, Hofstra University, Hempstead, NY, 3Northwell Health, New Hyde Park, NY, 4Northwell, Lake Success, NY
Purpose/Objective(s):The goal of this study was to reduce discrepancies, promote synchronization and ensure consistency within clinical workflows of our clinics, which is crucial to the quality of radiation treatment delivery of a modern radiation oncology department. Wehave implemented a standardized treatment workflow across multiple sites, incorporating stratification based on treatment sites, modalities, and techniques. This standardization is reinforced by providing role-based access to patient information seamlessly integrated with Oncology Information System (OIS), offering an innovative unified platform to create, prescribe, and maintain patient-specific clinical directive information.Materials/
Methods: To enhance clinical efficiency, we systematically categorized 174 directives, encompassing 304 unique prescriptions, as mCODE data elements within an HL7 FHIR R4 compliant database. Adhering to CodeX specifications, structures were formatted using AAPM TG-263 nomenclature and SNOMED-CT codes. Tasks have assigned roles suggested by the ASTRO Safety is No Accident Framework. Patient journeys were segmented into single tasks and monitored through a web-based user interface connected to the Oncology Information System (OIS) via REST APIs (Application Programming Interface). Directive elements such as prescriptions, special physics consults, simulation instructions, dose constraints, on-treatment imaging, patient care instructions, and references were systematically organized into distinct data tables. Combining contributes to a comprehensive treatment directive linked to multiple prescriptions. The tables can further be grouped by entity relations with multiple data tables based on treatment parameters through a dynamic web-based admin panel managed by the directive committee. Results: The initial implementation has highlighted the applications efficacy in harmonizing the care process and maintaining consistent institutionalized quality, irrespective of the treatment location. With minimum intervention clinicians can assign tasks and instructions to care team. This accomplishes an imperative requirement of diminishing variations in planning quality across diverse treatment modalities. Ensuring data safety in transport layer, care has been taken to utilize secure communications for transferring patient-specific clinical treatment information. This application is interoperable with all Treatment Planning Systems (TPS) using HL7 FHIR standards. Conclusion: The Directive Application directly addresses challenges associated in the standardization of clinical workflows, contributing to the enhancement of the quality and consistency of cancer care. Furthermore, the ability to incorporate external clinical protocols establishes a structured framework for evidence-based treatment planning & care delivery.
