Radiation Oncology Workflow Exchange with HIS

1. Proposed Workitem: Radiation Oncology Workflow Exchange with HIS

• Proposal Editor: Sam Brain
• Editor: Sam Brain
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiation Oncology

2. The Problem

This use case addresses three areas where problems arise because of lack of information exchange between the Radiation Oncology Information System (ROIS) and the Hospital Information System (HIS). The data flows in question are:

(1) Inbound Patient Registration or Demographics information (ADT)

(2) Outbound Billing information

(3) Outbound Radiation Oncology scheduling and treatment summary.

3. Key Use Case

How it currently works:

1. Patient registration and demographics information.

During the Radiation Oncology clinical process, clinical staff typically enter patient registration and demographic data multiple times. For example: into the ROIS at the patient's initial visit to the Radiation Oncology department; at the imaging modality; at the treatment planning workstation.

The patient information is often read manually from patient information displayed by the HIS application, and then typed into the Radiation Oncology application(s), a time-consuming and error-prone process.

In addition, if any of the patient's information changes in the HIS (for instance, medical record number, family name), there is no well-defined mechanism for propagating those changes to the ROIS.

2. Billing.

Billing information is often generated when scheduled procedures are manually or automatically completed, for example at modality, simulator, or accelerator. The billing information is stored in the Archive.

The billing staff extract this billing information from the Archive, review it for accuracy, and enter it manually into the Hospital Billing system.

This method of manual data entry is error-prone and such errors can lead to loss of revenue or might cause the claim to be queried or refused by the medical insurance provider.

3. Radiation Oncology schedule, and Treatment summary.

The schedule of Radiation Oncology treatments reside only in the ROIS, and are not available to other clinics in the hospital. This can lead to scheduling conflicts if a Radiation Oncology patient has appointments in other clinics as well as Radiation Oncology clinic.

In addition, it would be of use if some summary information about the radiation treatments was available in other clinics, in order that clinical staff be aware of any radiation-related issues to be considered in treating the patient.

This would be particularly true if a current or previous radiation oncology patient suffered trauma and was admitted to the ER. Access to all aspects of the patient's medical history, including radiation treatments, would be crucial to diagnosis and treatment of such a case.

How it should work:

<In this discussion, the "ROIS" is a little vague, and probably means multiple agents, depending on the scenario number, 1, 2 or 3. >

Most of the interaction between the ROIS and HIS is expected to use the HL7 protocol (Version 2.x)

1. Patient registration and demographics information.

To keep the discussion simple, we assumed that the patient registration and demographics is first entered into the HIS.

The first time the ROIS is queried for the patient's information (typically on the patient's initial visit to the Rad Onc clinic) it is found not to exist in the Archive. This triggers an HL7 query, either to the HIS if it supports a query/retrieve model, or to an (as-yet undefined) Actor, an "HL7 archiver", whose function is to listen to the HL7 ADT broadcast traffic directed to it, and store it in medium-term storage.

Either the HIS HL7 server, or the "HL7 Archiver" would respond to the HL7 query/retrieve and supply the patient registration and demographics to the ROIS, which would store the data in the Archive.

Any changes which occur to patient registration and demographics data in the HIS triggers an HL7 "update" sent from the HIS HL7 to the ROIS HL7 agent, which updates the information in the Achive.

2. Billing.

The billing information is stored in the Archive. The billing staff extracts this billing information from the Archive, reviews it for accuracy, and send its electronically using HL7 interface to the The billing information is stored in the Archive.

The billing staff extract this billing information from the Archive, review it for accuracy, and enter it manually into the Hospital Billing system.

3. Radiation Oncology schedule, and Treatment summary.

<To be filled in>

4. Standards & Systems

Existing HL7 transactions types for ADT and Billing

5. Discussion

This use case is similar to proposal Radiation Oncology Schedule Work Flow (ROSWF) (from IHE-JRO)

<Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>

<What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>

<What are some of the risks or open issues to be addressed?>

<This is the brief proposal. Try to keep it to 1 or at most 2 pages>