IHERO UseCase ROSWF

1. Proposed Workitem: Radiation Oncology Schedule Work Flow (ROSWF)

• Proposal Editor: MUKAI Masami(NIRS-MIS) mailto:m_mukai@nirs.go.jp
• Editors: ando_y@nirs.go.jp; kawaguti@rad.med.keio.ac.jp; tsukamot@saitama-med.ac.jp;seki@global-for.com;akihiro.toshimitsu@toshiba.co.jp;

• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiation Oncology

2. The Problem

In Japan, the electronic medical record (EMR) is an OP, and it issues a radiotherapy order to start treatment. A radiotherapy department determines the irradiation region and the number of delivery in a series of radiotherapy, and changes these parameters if necessary. The determined information is notified to EMR. Other departments within a hospital (outpatient departments, wards) require information about the progress of radiotherapy, such as whether daily delivery has completed or not and the number of delivery has completed. Therefore, the information needs to be notified to EMR promptly after implementation. At present, there is no standard communication procedure between the EMR and radiotherapy management systems. The communication is negotiated by each hospital for each vendor. As a result, different vendors of EMR use different communication procedures. The information contents are different for each hospital. The manufacturers, who must mount the EMR with a different procedure for each hospital, require more time and expense, thus wasting labor, time and expense. There is no great difference in the information that is exchanged in each hospital between EMR and the radiotherapy management system. If a standard communication is available, it can be used widely with minor customization. In the case of standard communication, information should be used HL7, not used private protocols. This profile intends to present the standard procedure for communicate information, such as first treatment order, daily delivery order and each delivered information.

3. Key Use Case

Doctors in charge of other departments place a radiotherapy order, which describes disease name, primary tumor, region to be irradiated, previous illness, and present illness. (The disease name, primary tumor, previous illness, and present illness may come from the pre-registered information of cancer). An oncologist uses the EMR or an ordering system, and inputs a radiotherapy order and CT order for treatment planning. The patient's basic information (name, sex, birth date, etc.), clinical history (disease name, irradiation region, etc.) and treatment information (a patient's posture, symptom, reference image, etc.) of the prospective patient are sent to a radiotherapy management system. An oncologist or a radiation therapist uses the radiotherapy management system to make treatment schedule. A schedule is an all delivery date, which includes planned and duration time of treatment period (start treatment to end treatment).

The schedule determined by the radiotherapy management system is sent to EMR. Moreover, if any changes in the condition of patient or the treatment policy where changes in delivery date, number of delivery or delivery time, the radiotherapy management system makes modification and notifies to EMR.

The status change (notice) at the end of radiotherapy shall be given by a doctor or a radiation therapist who is supervised by a doctor.

The status (start, in progress, end) of delivery at each time is notified from the radiotherapy management system to EMR. Moreover, the current status of radiotherapy (unapproved, approved, in progress, pause, to be resumed, end, etc.) is also notified to EMR.

EMR users can know the schedule of delivery (date and time) and the progress of delivery (the number of times completed and the number of times remaining).

4. Standards & Systems

<List existing systems that are/could be involved in the problem/solution.>

EMR, CPOE, RIS

<If known, list standards which might be relevant to the solution>

DICOM, HL7

5. Discussion

One course of radiotherapy consists of one or more delivery. One or more radiotherapy orders are issued for one radiotherapy order. It is necessary to specify where one or more delivery orders should be issued and sent. The radiotherapy department determines the details of delivery, such as the region to be irradiated, the number of times of irradiation, etc., and makes any changes if necessary. Therefore, if the department system uses Filler Order Management and issues an order, then the procedure agrees with the actual workflow.

• The usual workflow (determination of number of times, date and time of irradiation) EMR (OP) issues a parent order and transmits it to the radiotherapy management system (TMS). OF receives a user's input, and returns one or more orders to OP as child orders (individual orders for each time of irradiation). Whenever daily delivery is performed, TDD uses UPS to send delivery status to TMS. Then, TMS sends, the order status update information, which corresponds to a child order to OP.
• The workflow for change of delivery counts and date time of delivery. Radiotherapy consists of one or more delivery for one course of treatment. The treatment period is usually several weeks. The plan may be changed, depending on the changes in a patient's symptoms and the treatment policy. In that case, a doctor/therapist inputs any changes from the radiotherapy management system. Between OP and TMS, TMS (Treatment Management System) can issue each irradiation order more easily than OP can. This workflow is realized using Filler Order Management. All the transactions use OMG of HL7. It is recommended that OMG's comment about the implementation of information of individual irradiation (including the accounting information of radiation therapy) includes, in text format, the contents to be displayed in EMR. For example, "The 15th irradiation out of the total 30 irradiations has been finished", etc.