Real-time analysis and display of quantitative measures to track and improve clinical workflow

PURPOSE: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety. MATERIALS AND METHODS: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient\u27s care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system without the creation and maintenance of a separate database or duplication of work by clinical staff. Performance measures of workflow were calculated. RESULTS: The dashboard implements a standardized clinical workflow and dynamically consolidates real-time information queried from multiple tables in the EMR database over the following views: (1) CT Sims summarizes patient appointment information on the CT simulator and patient load; (2) Linac Sims summarizes patient appointment times, setup history, and notes, and patient load; (3) Task Status lists the clinical tasks associated with a treatment plan, their due date, status and ownership, and patient appointment details; (4) Documents provides the status of all documents in the patients\u27 charts; and (5) Diagnoses and Interventions summarizes prescription information, imaging instructions and whether the plan was approved for treatment. Real-time assessment and quantification of progress and delays in a patient\u27s treatment start were achieved. CONCLUSIONS: This study indicates it is feasible to develop and implement a dashboard, tailored to the needs of an interdisciplinary team, which derives and integrates information from the EMR database for real-time analysis and display of resource utilization and clinical workflow in radiation oncology. The framework developed facilitates informed, data-driven decisions on clinical workflow management as we seek to optimize clinical efficiency and patient safety

Linking a relational database of biological features to computer-aided reconstruction of tissue.

The many branches of biological science, from basic to clinical, use anatomical illustration as a daily work tool. Often the rendering is used as a substrate for other information such as functional mapping as in brain research or chemical uptake as in PET scans. An improvement over current anatomical visualization systems would allow for the storage and manipulation of biological features within a relational database (RD) framework. With current systems, adding new features requires large expenditures of time and effort, since they are usually built to display one biological feature. Workstation based, mechanical computer-aided design (MCAD) tools often have the facility to calculate internal variables such as temperature or stress. Methods already exist within these tools for impressing these data onto the image of an object for illustration. The present project centers around determining the elements necessary to harness the power of a standard MCAD system for anatomical illustration and linking ancillary biological information to this display using a commercial RD. A visualization system has been developed which demonstrates the ability to query and display features, found within tissue, as pseudo-colored distributions without the need for reprogramming. Development of this system has shown that the solids modeler does not provide an adequate algorithm for computer-aided reconstruction of tissue from serial sections. We also have found that the complexity of biological structures mandates automatic triangulation of the interior of reconstructed solids, if development is to proceed to three-dimensional displays of distributions. Furthermore, contour point decimation is essential to confine computational loading to interactive time spans. We also note that a relational record structure does not lend itself to manipulation of multidimensional information and does not provide the necessary tools to maintain database consistency. Encapsulation of data features with their linked geometry along with development of an appropriate operator space is necessary to obtain consistency.Ph.D.Applied SciencesBiological SciencesBiologyBiomedical engineeringBiophysicsNeurosciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128647/2/9116235.pd

Real‐time analysis and display of quantitative measures to track and improve clinical workflow in Journal of Applied Clinical Medical Physics

PURPOSE: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety. MATERIALS AND METHODS: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient\u27s care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system without the creation and maintenance of a separate database or duplication of work by clinical staff. Performance measures of workflow were calculated. RESULTS: The dashboard implements a standardized clinical workflow and dynamically consolidates real-time information queried from multiple tables in the EMR database over the following views: (1) CT Sims summarizes patient appointment information on the CT simulator and patient load; (2) Linac Sims summarizes patient appointment times, setup history, and notes, and patient load; (3) Task Status lists the clinical tasks associated with a treatment plan, their due date, status and ownership, and patient appointment details; (4) Documents provides the status of all documents in the patients\u27 charts; and (5) Diagnoses and Interventions summarizes prescription information, imaging instructions and whether the plan was approved for treatment. Real-time assessment and quantification of progress and delays in a patient\u27s treatment start were achieved. CONCLUSIONS: This study indicates it is feasible to develop and implement a dashboard, tailored to the needs of an interdisciplinary team, which derives and integrates information from the EMR database for real-time analysis and display of resource utilization and clinical workflow in radiation oncology. The framework developed facilitates informed, data-driven decisions on clinical workflow management as we seek to optimize clinical efficiency and patient safety