1. An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster Mallalieu, A Kapur, A Sharma, L Potters, A Jamshidi, J Mogavero, J Pinsky North Shore - Long Island Jewish Health System

2. Motivation for Physics Process Control FMEA analysis: physics tasks among the highest risks Process delays cause potential safety risks Coordination of physics activities in a multi- site department challenging

3. Commercial EMR system provides: Process flow mapping with customized Quality Check Lists Task completion checked and dated

4. EMR system doesnt provide: Summary views of physics task status for all patients, all physics staff Efficient determination of root causes of delays in physics tasks Statistical analysis of process control with performance metrics

5. Tools for Process Control Issue AddressedDatabase Tool Physics work coordination Physics Whiteboard Root Cause Analysis of delays QA Monitoring Database Machine problem monitoring Machine Whiteboard RCA-based changes to department policy Policies and Procedures Database

6. Physics whiteboard MS Access user interface to SQL database Monitors all planning tasks in summary view Coordination of planning assignments, staff workload tracking Delays flagged with an ON HOLD status

7. Physics whiteboard

8. Whiteboard reporting and analysis functions Staff workload distribution Slip Days metric for Six Sigma analysis: mean, standard deviation, histograms Analyze delays by plan type, disease site, staff, etc.

9. Slip Days Analysis of Physics Tasks

10. Machine whiteboard: track and analyze equipment issues

11. QA monitoring database QA incidents reported by staff Cross-functional QM team analyzes incidents to determine root causes and suggest improvements Reviewed incidents broken down using a hierarchical causes data structure

12. QA Monitoring Incident Review

13. Identification of root causes for Plan not ready for treatment start incidents Planning procedure delays Contouring delay: 46% Image fusion 43% MD scheduling issue 37% MD peer review 13% Plan modification: 33% Recontouring 45% Rx or constraint mod. 29% Tx machine issues 11% Insufficient time: 20%

14. Policies and Procedures QM analysis leads to new policies Database for policy documents, review and editing by staff New policy disseminated to staff via in-service and department blog

15. Conclusions EMR doesnt easily provide workflow coordination and RCA forensics Additional database tools have provided process control data analysis for ongoing streamlining of physics workflow Future: Consolidated, web-based, with electronic interface to EMR data