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. 2018 Dec;2:1-12.
doi: 10.1200/CCI.18.00034.

Implementing an Electronic Data Capture System to Improve Clinical Workflow in a Large Academic Radiation Oncology Practice

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Free PMC article

Implementing an Electronic Data Capture System to Improve Clinical Workflow in a Large Academic Radiation Oncology Practice

Dario Pasalic et al. JCO Clin Cancer Inform. .
Free PMC article

Abstract

Purpose: To describe the feasibility and benefits of implementing a custom radiation oncology electronic data capture (EDC) system in a large academic radiation oncology practice.

Patients and methods: A Web-based point-and-click EDC known as Brocade was internally developed and implemented systemwide in 2016. Brocade captures key data elements, such as stage, histology, and patient and treatment characteristics; links this information to radiation dose data extracted from the record and verify system; and creates clinical notes that are automatically exported to the hospital electronic health record. We report the number of unique radiation episodes captured by Brocade in its first full year of implementation and describe the notes generated, toxicities captured, compliance with staging and quality assurance, and time of day in which documentation occurred with Brocade versus our prior human transcription system.

Results: A median of 756 radiation episodes per month was captured for a total of 9,283 unique episodes captured in the first full year of implementation. The most common notes were for on-treatment visits (29,913) and simulations (13,220). Stage was captured for 92.2% of Brocade episodes (8,513 of 9,236) versus 29.7% of courses pre-Brocade (3,025 of 10,170; P < .001). Quality assurance was documented for 96.3% of completed courses (7,601 of 7,892). The most common grade ≥1 toxicities were pain (10,031), fatigue (7,490), and dermatitis (6,172). Brocade implementation was associated with a reduction in off-hours documentation and increase in the proportion of documentation created between 8:00 am and 12:00 pm.

Conclusion: Brocade is a reliable Web-based EDC tool that improves clinical documentation without detracting from clinical workflow. Moreover, Brocade has the advantage of capturing data in a structured manner that facilitates real-time analytics and outcome reporting.

Conflict of interest statement

Dario Pasalic

No relationship to disclose

Jay P. Reddy

No relationship to disclose

Timothy Edwards

Patents, Royalties, Other Intellectual Property: Through employer, equity interest in Oncora Medical as part of a partnership agreement

Hubert Y. Pan

Research Funding: Varian Medical Systems

Benjamin D. Smith

Research Funding: Varian Medical Systems

Patents, Royalties, Other Intellectual Property: Through employer, equity interest in Oncora Medical as part of a partnership agreement (Inst)

Figures

Fig 1.
Fig 1.
Clinical workflow steps that integrate MOSAIQ, Epic, and Brocade. AJCC, American Joint Committee on Cancer.
Fig 2.
Fig 2.
Trend of total notes generated and total patients registered in Brocade.
Fig 3.
Fig 3.
Quantity and type of notes generated in Brocade over the course of 1 year.
Fig 4.
Fig 4.
Top 10 most-common grade ≥ 1 toxicities documented with the use of Brocade during weekly on-treatment visits.
Fig 5.
Fig 5.
Normalized histogram that compares hourly distribution of clinician time spent while creating clinical documentation.
Fig 6.
Fig 6.
Percentage of documentation accomplished in the morning, afternoon, and after hours by traditional dictation versus Brocade over the course of 1 year.
Fig A1.
Fig A1.
Brocade patient registration template for a generic palliative care patient. DOB, date of birth; Hypofx IMRT, hypofractionated intensity-modulated radiation therapy; ICD 10/9, International Classification of Diseases, Tenth or Ninth Revision; med, mediastinum; Met, metastasis; MRN, medical record number; N/A, not available; NOS, not otherwise specified; QA, quality assurance; R, right; SBRT, stereotactic body radiation therapy; SRS, stereotactic radiation surgery.
Fig A2.
Fig A2.
Brocade simulation note template. CBCT, cone beam computed tomography; CT, computed tomography; D, dimensional; DOB, date of birth; ECOG, Eastern Cooperative Oncology Group; HypoFX, hypofractionated; IMRT, intensity-modulated radiation therapy; MRN, medical record number; N/A, not applicable; QA, quality assurance; SBRT, stereotactic body radiation therapy; SIM, simulation; SPC, special physics consult; STP, special treatment procedure; VMAT, volumetric-modulated arc therapy.
Fig A3.
Fig A3.
Brocade treatment summary template. 9e, 9 MeV electron; AP, anterior-posterior; bilat, bilateral; BOT, base of tongue; DOB, data of birth; e, electron; ER, emergency room; IMRT, intensity-modulated radiation therapy; IV, intravenous; LAO, left anterior oblique; lt, left; midnk, midneck; MLB, modified lateral beam; MNB2, midneck boost 2; MRN, medical record number; PA, posterior-anterior; QA, quality assurance; rao, right anterior oblique; rt, right; SCV, supraclavicular.

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