By Mike Grindstaff
This blog post is based on “Improving Interoperability Through Standardization,” an article published in Radiation Oncology News for Administrators, Vol 31, No 2. The publication is an SROA member benefit.
When I became director of radiation oncology at TriHealth in June 2017, it was a new role for the company and a new venture for me. TriHealth, an integrated health system based in Cincinnati, Ohio, is the region’s largest healthcare provider. In 2020, TriHealth had more than 27,000 patient visits to its radiation oncology clinics.
When clinics have separate stand-alone systems, often there are inefficiencies like duplication of effort, underuse of tools that can lead to errors from manual workarounds, and missing documentation. TriHealth operates five radiation therapy sites, three of which came online during the pandemic, so we needed to standardize workflows and software among all the sites. We established three priorities:
We looked at best practices and best technologies in radiation oncology across the country.
Our project committee had representation from across the department: one dosimetrist, one registered nurse (RN), one physician, one medical assistant/scheduler, one physicist, one lead radiation therapist (RT), one administrator and one coder/billing liaison. The committee gathered all the stakeholders’ concerns and figured out which vendor or vendors could help us achieve our objectives. Before the pandemic we had several meetings in which the project committee members met and stuck sticky notes (with pros and cons about software and hardware) all over our conference room walls. The project team voted on what software and hardware they preferred. It was productive to collaborate this way.
By opting to use a project manager from the vendor, we reduced by half our team’s hours of meetings and system builds. The hours were approximately 104 hours for our physicist, 25 hours for our RN, 90 hours for our dosimetrist, 60 hours for our lead RT, 25 hours for our billing expert and 160 hours for me as the administrator lead.
The project took six months to get off the ground with the vendor. To roll out the standardization, we started with a clean slate. We established an executive partnership with the vendor we selected. The vendor did an end-to-end assessment from patient referral to the end of patient care; conducted stakeholder consultations to gather the perspectives from all of our teams and departments; and looked at what software each center was using, how much it was being used, and what software was being used at our three original centers.
We started with a new database. Previously, people entered registration information manually rather than pulling it from the hospital EMR. We created a new database with all the new interfaces at our first site. As we rolled the database out site-to-site, we had the base program set. The interfaces included admissions; discharge and transfer for patient registration; detailed financial transactions for patient billing; master data management for documents to flow bi-directionally from the hospital EMR to the radiation EMR; scheduling information unsolicited for scheduling to include medical oncology appointments that our radiation patients would encounter; and observation results for daily treatment information outbound so that referring physicians knew daily where our patients were in their course of treatment.
We standardized our internal Incident Report Information System (IRIS) where staff report good catches and near misses. In 2017, there were 263 incidents in the queue to review. We reviewed the IRIS reports every Thursday at 4 o’clock. It was imperative that we created a culture where people felt comfortable reporting issues without it feeling accusatory. We’ve standardized processes, set expectations and used encounters and task lists. Now we only need to meet monthly.
We routinely monitor patient records, throughput, etc., to ensure the dearth of reports is a result of process change and nothing more. We are proving standardization reduces variation and improves workflows.
We’ve reconfigured patient data and treatment systems to standardize clinical delivery workflows across our facilities. We needed different third-party software to be able to exchange data seamlessly so we could standardize care across regional facilities and improve efficiency. We aimed to create a patient-focused,
end-to-end integrated service. We also needed to ensure data integrity within radiation oncology and the hospital system.
With our interfaces we now have information from the radiation EMR inside the hospital EMR instantly. Our billing interfaces equate to timely and accurate billing as all activities have embedded codes for billing. All documentation is streamlined and consistent, which means our team knows what documents are required for billing and for treating. We use encounters and task/care paths to ensure timely planning and treatment, which translates into satisfied customers and team members.
Now we’re using reporting data and analytics to improve the patient experience, standardize treatments and manage resources across clinics. This standardization project has improved interoperability, strengthened our team approach and enhanced our patient experiences that will ultimately lead to improved patient outcomes.
For any standardization or other large-scale project, administrators need to be adaptive. The best laid plans will change. Teamwork is also key—you have to engage your team and have them onboard.
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Radiation Oncology News for Administrators, Vol 31. No 2 - SROA Member Benefit
Society For Radiation Oncology Administrators (SROA)
The American College of Radiology (ACR)
The American Society of Radiation Oncologists (ASTRO)
The American Association of Physicists in Medicine (AAPM)