An electronic whiteboard and associated databases for physics

workflow coordination in a paperless, multi-site radiation oncology

department

L Brewster Mallalieu, A Kapur, A Sharma, L Potters, A Jamshidi, J Mogavero, J Pinsky

North Shore - Long Island Jewish Health System

Motivation for Physics Process Control

• FMEA analysis: physics tasks among the

highest risks

• Process delays cause potential safety risks

• Coordination of physics activities in a multi-

site department challenging

Commercial EMR system provides:

• Process flow mapping with customized Quality

Check Lists

• Task completion checked and dated

EMR system doesn’t provide:

• Summary views of physics task status for all patients,

all physics staff

• Efficient determination of root causes of delays in

physics tasks

• Statistical analysis of process control with

performance metrics

Tools for Process Control

Issue Addressed Database Tool Physics work coordination Physics Whiteboard

Root Cause Analysis of delays QA Monitoring Database

Machine problem monitoring Machine Whiteboard

RCA-based changes to department policy

Policies and Procedures Database

Physics whiteboard

• MS Access user interface to SQL database

• Monitors all planning tasks in summary view

• Coordination of planning assignments, staff

workload tracking

• Delays flagged with an ON HOLD status

Physics whiteboard

Whiteboard reporting and analysis functions

• Staff workload distribution

• “Slip Days” metric for Six Sigma analysis:

mean, standard deviation, histograms

• Analyze delays by plan type, disease site, staff,

etc.

Slip Days Analysis of Physics Tasks2nd Plan Check Slip Days

0

0.5

1

1.5

2

2.5

3

3.5

4

Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11

mean

std dev

Plan Completion Slip Days

-2

-1

0

1

2

3

4

Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11

mean

std dev

1st Day Physics Check Slip Days

0

0.5

1

1.5

2

2.5

Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11

mean

std dev

IMRT QA Slip Days

-0.5

0

0.5

1

1.5

2

2.5

3

3.5

Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11

mean

std dev

Machine whiteboard: track

and analyze equipment issues

QA monitoring database

• QA incidents reported by staff

• Cross-functional QM team analyzes incidents

to determine root causes and suggest

improvements

• Reviewed incidents broken down using a

hierarchical causes data structure

QA Monitoring Incident Review

Identification of root causes for “Plan not ready for treatment start” incidents

Planning procedure delays

Contouring delay: 46% Plan modification: 33% Insufficient time: 20%

Image fusion 43% Recontouring 45%

Rx or constraint mod. 29%

Tx machine issues 11%

MD scheduling issue 37%

MD peer review 13%

Policies and Procedures• QM analysis leads to

new policies

• Database for policy

documents, review and

editing by staff

• New policy disseminated

to staff via in-service and

department blog

Conclusions

• EMR doesn’t easily provide workflow coordination and

RCA forensics

• Additional database tools have provided process

control data analysis for ongoing streamlining of

physics workflow

• Future: Consolidated, web-based, with electronic

interface to EMR data