The Future of Echarting A Physicists Perspective

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The Future of E-chartingA Physicists Perspective

• Jagannath Venkatesan, MS
• Director Medical Physics
• Good Shepherd Hospital Radiation Oncology Center

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Good Shepherd HospitalRadiation Oncology Center

• Barrington, Illinois

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Oncology Staff _at_ GSH

• 2 Radiation Oncologists
• 4 Radiation Therapists
• 1 Oncology Nurse
• 1 Oncology Supervisor
• 1 Medical Dosimetrist
• 1 Medical Physicist
• 1 Dietician
• 3 Cancer Registrars
• Average of patients Txd / day 32

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Global Oncology Staff

• 4 Oncology Centers
• 10 Radiation oncologists
• 7 Oncology Nursing staff
• 2 Physician Assistants
• 5 Medical Physicists
• 6 Dosimetrists
• 18 Therapists
• Average of patients Txd / day 165

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Treatment Machines at GSH

• Varian 2100C dual energy accelerator with
  asymmetric and 120 multi-leaf collimators (MLC)
• Multiple electron energies.

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Global Oncology Equipment

• 6 Linear Accelerators
• 2 Kodak ACR 2000 Filmless Systems
• 2 Varian EPIDs
• 3 CT Scanners
• 2 Ximatron Simulators
• 1 Linac Radiosurgery (Radionics)
• 2 HDR units (one mobile)

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Treatment Planning Equipment_at_ GSH

• Simulators  Philips AcQ-Sim CT Scanner
• Focal-sim virtual simulation / treatment planning
  system
• FOCUS 3-dimensional treatment planning system
• Kodak Digital Filmless System

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IMPAC Multi-Access

• Impac user since 2002 at GSH (95 at LGH)
• Paperless filmless at GSH since Jan 2003
• Multi-Access features utilized at GSH
• Scheduling
• R V
• Patient charting progress notes
• Demographic referral info
• Patient Queuing
• Document Management

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IMPAC Resources Used

• Multi-Access (Charting, Code Capture, Scheduling,
  etc.)
• Sequencer connected to the LINAC (RV)
• ViewStation (Filmless review)
• Namer station _at_ Lutheran General Hospital (Dicom
  image sorter/distributor)

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Network Sites
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How is IMPAC networked?
Global Internet Access
GSH
IMPAC SERVER _at_ LGH
GSAM
IMMC
Local Network
Citrix Network
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Viewstation Image Review Process

• Therapist takes port
• Film plate is fed into processor
• Digital port is associated with DRR field
• MD Reviews either by control area or remotely
• Rejoicing throughout department if no millimeter
  moves were made

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How is ViewStation Networked?
Films Sorted in Namer _at_ LGH
CITRIX NETWORK
Local Area Network
Films taken _at_ GSH to be Reviewed by MD
Films sent to the central IMPAC database servers
CITRIX NETWORK
Total Film transit time 30-35 seconds
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Where can we expect to Access Impac from?
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Process Improvement Therapists

• Close proximity of ViewStation _at_ the Tx console
• Filmless processing time
• Real-time manipulation of images
• Networking capabilities of Dicom images
• MD/ RTT communication via IMPAC (Tx alerts)

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Process Improvement Physics

• Real time Physics Chart checks
• Remote access from LAN and Global Access
• Remote Chart round and Image review capabilities
  with MD
• Real time image manipulation, networking and QA.

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Process Improvement Overall

• Charts Paperless Virtual Chart
• X-rays Digital Radiographs
• Remote Access

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Process Improvement Virtual E-Chart

• No time lost searching for charts
• Remote access
• Multi-person access capabilities
• Decreased clutter

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Process Improvement ViewStation

• Organization (linkage of sim DRR and ports)
• Decreased storage need/cost
• Never lose films
• No film/processor costs

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Process ImprovementRemote Access
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Process ImprovementRemote Access

• Off site approvals
• After-hours information access
• Call
• Film review
• Group meetings

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Process ImprovementRemote Access

• Utilize anywhere there is internet access
• Including at home on a cold Chicago night

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Conclusions

• Staff acceptance
• Improved patient care through optimized data
  management
• IS support vital
• Physics QA integration
• MD acceptance

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