Illawarra Cancer Care Centre

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2 The Audience Who? No apologies! Radiation Oncologists State of Mind Our business Our business is medical Our records are medical records Our information system is electronic medical record Primacy of our role Primary contact (process starts with what we serve up to rest) Legal responsibility Patient focus Experience of all units If you want to go electronic, doctors are the problem Ask IMPAC, Varian, Siemens,..

3 Begin at the End! What s my point? All data comes from a patient interaction SO you have mountains of data BUT the format is problematic EITHER.. Paper or Clinical Trial THUS useless or expensive WHAT IF You had a system where in the course of your normal workflow, you record your data, so that when you want to do an analysis the data s format is ready for analysis.

4 The Good News You have one. it s called IMPAC

5 The Bad News Implementing IMPAC within your department Process of Re-organisation Different look to paper Its not paper Paper is not that good Different workflow Different work paradigms 95% rule EFTPOD & data re-use No redundancy, only multiple viewing Rapid & frequent QA (education or retribution) Data Ownership (Users = Collectors & QA ors)

6 And the Oncologists said. I DON T BELIEVE YOU!

7 Demonstrate the possibilities How much data do you need to produce a paper? Let s look at a paper from a reputable centre Undertake a De-Constructive Content Analysis What is reported? What recorded dataset was it derived from? What choices were used in recording the data?

8 Demonstrate the possibilities

9 What was the utilised dataset? Diagnosis = Prostate (C61), NIDDM Histology = adenocarcinoma Gleason Score = 2-10 T stage = T1c, T2a, T2b, T2c, T3 N stage = N0 M stage = M0 PSA level Treatment intent = Curative Treatment_Protocol = MSKCC Prostate Dose Escalation Modality: Surgery = N, Radiotherapy = Primary, Hormone therapy = N/Y, Chemotherapy = N Radiation_Technique = 3DCRT Radiation_Dose = 64.8 Gy, 70.2 Gy, 75.6 Gy, and 81.0 Gy Plan_DVH_Volume (PTV) volume, length Plan_DVH_Structure (Rectum) volume, wall area, length, dose Acute Toxicity Score RTOG Acute Bowel Late Toxicity Score RTOG Late Bowel

10 How do you get this data? Discovered in clinic at first consultation Diagnosis = Prostate (C61), NIDDM Histology = adenocarcinoma Gleason Score = 2-10 T stage = T1c, T2a, T2b, T2c, T3 N stage = N0 M stage = M0 PSA level Where else is this found? Planning Request? Prescription? Discharge Summary? Letters?

11 How do you get this data? (2) Decided in clinic at first consultation Treatment intent = Curative Treatment_Protocol = MSKCC Prostate Dose Escalation Modality: Surgery = N, Radiotherapy = Primary, Hormone therapy = N/Y, Chemotherapy = N Radiation_Technique = 3DCRT Radiation_Dose = 64.8 Gy, 70.2 Gy, 75.6 Gy, and 81.0 Gy Radiation Fractionation = 2Gy/Fx Where else is this found?

12 How do you get this data? (3) Decided in Dosimetry at end of Planning Plan_DVH_Volume (PTV) volume, length Plan_DVH_Structure (Rectum) volume, wall area, length, dose BUT, can you enter this in IMPAC now?

13 No, so make a New Assessment! Plan_DVH_Volume (PTV) volume, length Plan_DVH_Structure (Rectum) volume, wall area, length, dose New IMPAC Assessment Name (GTV, CTV, PTV, Rectal Volume, Rectal Wall, ) Volume Length DVH1, DVH2, DVH3,.., DVH100 Enter data from each computer plan with marked volumes CLINICAL ASSESSMENTS infinitely expansible!

14 How do you get this data? (4) Decided in 'On Treatment Review' each week Acute Toxicity Assessment alternatives Descriptive Text 10 Nov Gy, mild-moderate bowel change, some tiredness, normal ECOG, no urinary problems. Continue. Acute Toxicity Score RTOG Acute Bowel 11/10/2006; Acute Bowel 1; Fatigue 1; ECOG 0; Acute Bladder 0; Treatment Status 0 Is there a difference in meaning? in format? [trial v clinical] in later analysis? can I turn the scores into text? Where else is this found?

15 How do you get this data? (5) Decided in Follow Up Clinic each visit Late Toxicity Score RTOG Late Bowel Same procedure as for Acute Toxicity!

16 Is this data any good? RETROSPECTIVE data or PROSPECTIVE data? VOLUME of data available? NZ data ( ) Stage 1-3 C61 per year Every weekly review has acute Bowel & Bladder toxicity measures How many observations? >6000! REAL data? ABSOLUTELY!

17 So the question is.. What else is needed to convince? That s an expensive piece of software and, by the way, it can run. Your machines Your clinics Your billing Your workflow Your clinical record Your medical record This functionality is NOT AVAILABLE in any other system that also runs machines

18 Can it improve my data? Only if you seek to own your data! QA the database Missing data Inconsistent data Immediately after entry Look for patients eligible for trial enrolment Immediately after data QA is successful! Look to see if you can do better Outcome Analysis Data managers can t do this.

19 Can it reduce my workload? Prescription Discharge Summary Departmental Report Paper Production

20 Some questions to think about? Is there any real difference between writing it on paper and entering it into the computer? Do I own my data? Does repeatedly entering the same data make it more certain? Are there enough computers to enter data anywhere that I sit? Does IMPAC have to match your procedures exactly?

21 The End! Thank you for the opportunity to relate my passion. I encourage you to think about the possibilities and to experiment with the system. If and when you want to go further, I can be contacted at alexisandrew@gmail.com.

22 Discharge Summary back

23 QA clerical back

24 QA medical back

25 Outcome Analysis back