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EP-1212 A COLLABORATIVE DEVELOPMENT MODEL FOR WORKFLOW (PROCESS) MANAGEMENT IN ONCOLOGY CARE
S466
Purpose/Objective: Radiotherapy process in Spain is regulated by a Royal Decree that establishes in each of its stages which are the objectives and who is the responsible for compliance. To ensure this is done in our Unit has been created from the tool 'checklist' from Lantis® Network a list of task for each physician that includes all the process steps involved. Each stage is completed once done ensuring the correct control of all patients. Our experience dealing with checklist and the results that we can get from them are the aims of this work. Materials and Methods: It has been created one checklist for each physician that includes all patients except palliatives that are included in a general list for all staff. The list begins the CT simulation´s day, and from here it has been established all stages and deadlines in which they must be made. Stages are as follow: CT simulation, OAR delineation, PTV delineation, Physics(Phy) reception, Phy planning, Physician planning OK, Phy approval, RTT verification and treatment day. Deadlines are an agreement between Radiophysics, radiotherapy and hospital chiefs.
ESTRO 31
systems’ philosophy & providing standard interfaces to external applications – as required directly by customers for multi-vendor interoperability & for IHR RO profile adherence). Clinics in N.A. & Europe participate during the entire Software Development Life Cycle (SDLC) process from requirement elicitation (Use Cases describing clinical processes) to development of core component activities, automated through scripts. Script modification & parameterization to suit local needs and script execution does not require programming language knowledge (logic skills suffice). Results: A number of core MOSAIQ elements used in clinical workflow including: Orders, Quality Check Lists (QCLs), eScribe (to standardize Physician follow-up letters using Microsoft Word templates) have been automated (in general charting and Medical Oncology area). New activities for on-the-fly plan selection (Plan of the Day) & treatment delivery have been created by a clinical collaborator. Conclusions: The clinic-vendor relationship has been extended from the traditional purchaser-supplier model to support collaborative development of both routine tasks and modern clinical protocols. Continued development including additional clinical partners will continue and lay the groundwork for safer, reproducible patient care EP-1213 HYPOFRACTIONATED ACCELERATED RADICAL BRACHYTHERAPY VERSUS WHOLE-BREAST IRRADIATION: A COST ANALYSIS STUDY D. Rey-Baltar1, A. Riveros1, B. Pinar1, I. Rodríguez-Melcón1, N. Rodríguez- Ibarria1, M. Lloret1, P.C. Lara1 1 Hospital Universitario de Gran Canaria Dr. Negrín and Instituto Canario de Investigación del Cáncer (ICIC), Radiation Oncology, Las Palmas de Gran Canaria, Spain
Results: : We decide to consult the tool every two months as from Lantis Network we can get multiple result reports, such as: -Number of patients treated by a physician, - Delays at each stage of the radiotherapy process, - who performs each step, etc. By way of example in the abstract, we include data obtained in the last 2 months evaluated, so that we can expose data in the communication from the last 6 months with information of each of the stages. Between 2nd November and 20th December 2011, 89 patients were included in check lists. We expose data from delays of one of the activities in graphic 1. As you can see, the majority of patients met the agreed time for each activity, and for those who do not, are much easier to locate them and find the cause. Conclusions: Checklist has become an essential tool in quality control of radiotherapy process. The main problem we found is filling, so it must be ensured to achieve completely reliable data. If this is correct, it is a valuable tool in the management of Radiation Oncology Unit, so it delivers critical information for proper operation. EP-1212 A COLLABORATIVE DEVELOPMENT MODEL FOR WORKFLOW (PROCESS) MANAGEMENT IN ONCOLOGY CARE R. de Boer1, H. Akhiat2, M. Broekhof1, M.A. Fortin3, B.J.M. Heijmen2, M.S. Hoogeman2, C. v.Vliet1, N. Hoad-Reddick4, N. Linton5 1 AvL, Medical Physics, Amsterdam, The Netherlands; 2 Erasmus M.C./DDHK, Medical Physics, Rotterdam, The Netherlands 3 C.I.C. Laval, Oncology, Laval, Canada 4 Elekta, Product Management, Toronto, Canada 5 Elekta, BASS Research, Ottawa, Canada Purpose/Objective: Competing pressures on health care providers include: economics, (patient) safety, throughput (aging populations, increased cancer incidence) with oncology specific elements: introduction of new technology (IGRT, CBCT) & clinical techniques (IMRT, VMAT, motion management – 4D). Future trends may include: integrated MRI-linac imaging and delivery systems, Adaptive RT (Plan of the Day selection, robust planning, scan-plan-treat strategies). We propose an Oncology Information System (OIS) EMR-centric model that includes software development in collaboration with key clinical collaborators to account for process variability between clinics. Materials and Methods: The MOSAIQ OIS was extended with a combination of the Microsoft Windows Workflow Foundation (WWF) infrastructure in .NET-4 including a rehostable workflow (script) designer (supporting deterministic, protocol based, patient care as long running workflows) and web services (continuing an ‘open
Purpose/Objective: Accelerated partial-breast irradiation (PBI) by hypofractionated brachytherapy(HB-PBI) is a new treatment paradigm for patients with early-stage breast cancer. Besides controversy about local recurrences rates, it may be cost-effective because of better tolerability and lower cost. In cases of long distances or difficult transportantions (i.e. among Canary Islands) to reach radiation oncology facilities, it sound worthy to determine the incremental cost-effectiveness of HB-PBI compared with whole-breast radiation therapy (WBRT) for old patients suffering from early-stage Luminal A molecular subtype breast cancer cases. Materials and Methods: 63 breast cancer patients suffering from early-stage Luminal A molecular subtype breast cancer cases treated in our institution from 2009 to November 2011 by accelerated partialbreast irradiation (PBI) by hypofractionated brachytherapy(HB-PBI) were included in the present study. The treatment protocol included 8 fractions of 4 Gy from Monday to Friday. Costs on Brachytherapy treatment included, first visit, Operating Room, medical and nurses cost, materials, CT scan, plannification, administration of the treatment along the week and final visit and inform. A simmulation was performed comparing cost in the same cohort of cases if they were been treated with external radiotherapy, including first visit, CT scan, plannification , administration of the treatment along the 5 weeks, weekly medical visits, and final visit and inform. No costs were considered for systemic tretaments or follow-up in any case. Transportation cost and subsidize stage in hotels and food were considered for patients from other islands or only transportation within the main island by the public health transport system. Prices of treatment and patient support were obtained from the authorized goverment agencies (Servicio Canario de Salud) at regular official prices. Results: At closing the follow-up in January 2012, all patients are alive and without relapse either in local or distal areas. Treatment cost for one week brachytherapy was 3.728,01 € and a total costs of 234.864,63€ for the 63 patients compared with 5 week WBRT with a cost of 4.003,84 € per case, allowing for a total cost of 252.241,92€. Furthermore, data considering transportation by plane and hotel/food subsidium for patients from other islands and public health system transportation for patients within Gran Canaria, resulted in a total cost of 297.752,34 € for WBRT compared with 247.285,85 € dof HB-PBI with a total saving of -50.466,49 € in 63 patients. The advantage is significant in patients from small islands (Lanzarote & Fuerteventura): 6499,84€ WBRT vs. 4419,01€ HB-PBI wich represent a saving of 2.080,83 per case. Conclusions: Besides personal, emotional and working considerations, HB-PBI treatment administration is clearly cheaper and more convinient for old patients, especially in situations of difficult acces
Purpose/Objective: Radiotherapy process in Spain is regulated by a Royal Decree that establishes in each of its stages which are the objectives and who is the responsible for compliance. To ensure this is done in our Unit has been created from the tool 'checklist' from Lantis® Network a list of task for each physician that includes all the process steps involved. Each stage is completed once done ensuring the correct control of all patients. Our experience dealing with checklist and the results that we can get from them are the aims of this work. Materials and Methods: It has been created one checklist for each physician that includes all patients except palliatives that are included in a general list for all staff. The list begins the CT simulation´s day, and from here it has been established all stages and deadlines in which they must be made. Stages are as follow: CT simulation, OAR delineation, PTV delineation, Physics(Phy) reception, Phy planning, Physician planning OK, Phy approval, RTT verification and treatment day. Deadlines are an agreement between Radiophysics, radiotherapy and hospital chiefs.
ESTRO 31
systems’ philosophy & providing standard interfaces to external applications – as required directly by customers for multi-vendor interoperability & for IHR RO profile adherence). Clinics in N.A. & Europe participate during the entire Software Development Life Cycle (SDLC) process from requirement elicitation (Use Cases describing clinical processes) to development of core component activities, automated through scripts. Script modification & parameterization to suit local needs and script execution does not require programming language knowledge (logic skills suffice). Results: A number of core MOSAIQ elements used in clinical workflow including: Orders, Quality Check Lists (QCLs), eScribe (to standardize Physician follow-up letters using Microsoft Word templates) have been automated (in general charting and Medical Oncology area). New activities for on-the-fly plan selection (Plan of the Day) & treatment delivery have been created by a clinical collaborator. Conclusions: The clinic-vendor relationship has been extended from the traditional purchaser-supplier model to support collaborative development of both routine tasks and modern clinical protocols. Continued development including additional clinical partners will continue and lay the groundwork for safer, reproducible patient care EP-1213 HYPOFRACTIONATED ACCELERATED RADICAL BRACHYTHERAPY VERSUS WHOLE-BREAST IRRADIATION: A COST ANALYSIS STUDY D. Rey-Baltar1, A. Riveros1, B. Pinar1, I. Rodríguez-Melcón1, N. Rodríguez- Ibarria1, M. Lloret1, P.C. Lara1 1 Hospital Universitario de Gran Canaria Dr. Negrín and Instituto Canario de Investigación del Cáncer (ICIC), Radiation Oncology, Las Palmas de Gran Canaria, Spain
Results: : We decide to consult the tool every two months as from Lantis Network we can get multiple result reports, such as: -Number of patients treated by a physician, - Delays at each stage of the radiotherapy process, - who performs each step, etc. By way of example in the abstract, we include data obtained in the last 2 months evaluated, so that we can expose data in the communication from the last 6 months with information of each of the stages. Between 2nd November and 20th December 2011, 89 patients were included in check lists. We expose data from delays of one of the activities in graphic 1. As you can see, the majority of patients met the agreed time for each activity, and for those who do not, are much easier to locate them and find the cause. Conclusions: Checklist has become an essential tool in quality control of radiotherapy process. The main problem we found is filling, so it must be ensured to achieve completely reliable data. If this is correct, it is a valuable tool in the management of Radiation Oncology Unit, so it delivers critical information for proper operation. EP-1212 A COLLABORATIVE DEVELOPMENT MODEL FOR WORKFLOW (PROCESS) MANAGEMENT IN ONCOLOGY CARE R. de Boer1, H. Akhiat2, M. Broekhof1, M.A. Fortin3, B.J.M. Heijmen2, M.S. Hoogeman2, C. v.Vliet1, N. Hoad-Reddick4, N. Linton5 1 AvL, Medical Physics, Amsterdam, The Netherlands; 2 Erasmus M.C./DDHK, Medical Physics, Rotterdam, The Netherlands 3 C.I.C. Laval, Oncology, Laval, Canada 4 Elekta, Product Management, Toronto, Canada 5 Elekta, BASS Research, Ottawa, Canada Purpose/Objective: Competing pressures on health care providers include: economics, (patient) safety, throughput (aging populations, increased cancer incidence) with oncology specific elements: introduction of new technology (IGRT, CBCT) & clinical techniques (IMRT, VMAT, motion management – 4D). Future trends may include: integrated MRI-linac imaging and delivery systems, Adaptive RT (Plan of the Day selection, robust planning, scan-plan-treat strategies). We propose an Oncology Information System (OIS) EMR-centric model that includes software development in collaboration with key clinical collaborators to account for process variability between clinics. Materials and Methods: The MOSAIQ OIS was extended with a combination of the Microsoft Windows Workflow Foundation (WWF) infrastructure in .NET-4 including a rehostable workflow (script) designer (supporting deterministic, protocol based, patient care as long running workflows) and web services (continuing an ‘open
Purpose/Objective: Accelerated partial-breast irradiation (PBI) by hypofractionated brachytherapy(HB-PBI) is a new treatment paradigm for patients with early-stage breast cancer. Besides controversy about local recurrences rates, it may be cost-effective because of better tolerability and lower cost. In cases of long distances or difficult transportantions (i.e. among Canary Islands) to reach radiation oncology facilities, it sound worthy to determine the incremental cost-effectiveness of HB-PBI compared with whole-breast radiation therapy (WBRT) for old patients suffering from early-stage Luminal A molecular subtype breast cancer cases. Materials and Methods: 63 breast cancer patients suffering from early-stage Luminal A molecular subtype breast cancer cases treated in our institution from 2009 to November 2011 by accelerated partialbreast irradiation (PBI) by hypofractionated brachytherapy(HB-PBI) were included in the present study. The treatment protocol included 8 fractions of 4 Gy from Monday to Friday. Costs on Brachytherapy treatment included, first visit, Operating Room, medical and nurses cost, materials, CT scan, plannification, administration of the treatment along the week and final visit and inform. A simmulation was performed comparing cost in the same cohort of cases if they were been treated with external radiotherapy, including first visit, CT scan, plannification , administration of the treatment along the 5 weeks, weekly medical visits, and final visit and inform. No costs were considered for systemic tretaments or follow-up in any case. Transportation cost and subsidize stage in hotels and food were considered for patients from other islands or only transportation within the main island by the public health transport system. Prices of treatment and patient support were obtained from the authorized goverment agencies (Servicio Canario de Salud) at regular official prices. Results: At closing the follow-up in January 2012, all patients are alive and without relapse either in local or distal areas. Treatment cost for one week brachytherapy was 3.728,01 € and a total costs of 234.864,63€ for the 63 patients compared with 5 week WBRT with a cost of 4.003,84 € per case, allowing for a total cost of 252.241,92€. Furthermore, data considering transportation by plane and hotel/food subsidium for patients from other islands and public health system transportation for patients within Gran Canaria, resulted in a total cost of 297.752,34 € for WBRT compared with 247.285,85 € dof HB-PBI with a total saving of -50.466,49 € in 63 patients. The advantage is significant in patients from small islands (Lanzarote & Fuerteventura): 6499,84€ WBRT vs. 4419,01€ HB-PBI wich represent a saving of 2.080,83 per case. Conclusions: Besides personal, emotional and working considerations, HB-PBI treatment administration is clearly cheaper and more convinient for old patients, especially in situations of difficult acces