Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role

IntroductionOnline MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers.MethodA purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied.ResultsThirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: ‘Current MRIgRT’, ‘Training’ and ‘Future Practice’. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers.ConclusionRadiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge.Implications for practiceRole development and changes in education for therapeutic radiographers.     

Evaluation of an Enhanced Role-Based Access Control model to manage information access in collaborative processes for a statewide clinical education program

BackgroundManaging information access in collaborative processes is a critical requirement to team-based biomedical research, clinical education, and patient care. We have previously developed a computation model, Enhanced Role-Based Access Control (EnhancedRBAC), and applied it to coordinate information access in the combined context of team collaboration and workflow for the New York State HIV Clinical Education Initiative (CEI) program. We report in this paper an evaluation study to assess the effectiveness of the EnhancedRBAC model for information access management in collaborative processes when applied to CEI.MethodsWe designed a cross-sectional study and performed two sets of measurement: (1) degree of agreement between EnhancedRBAC and a control system CEIAdmin based on 9152 study cases, and (2) effectiveness of EnhancedRBAC in terms of sensitivity, specificity, and accuracy based on a gold-standard with 512 sample cases developed by a human expert panel. We applied stratified random sampling, partial factorial design, and blocked randomization to ensure a representative case sample and a high-quality gold-standard.ResultsWith the kappa statistics of four comparisons in the range of 0.80–0.89, EnhancedRBAC has demonstrated a high level of agreement with CEIAdmin. When evaluated against the gold-standard, EnhancedRBAC has achieved sensitivities in the range of 97–100%, specificities at the level of 100%, and accuracies in the range of 98–100%.ConclusionsThe initial results have shown that the EnhancedRBAC model can be effectively used to manage information access in the combined context of team collaboration and workflow for coordination of clinical education programs. Future research is required to perform longitudinal evaluation studies and to assess the effectiveness of EnhancedRBAC in other applications.     

门诊医生工作站应用探讨

门诊医生工作站能有效改变门诊就医流程,提高工作效率.介绍了门诊医生工作站的工作流程,分析了其在运行工程中遇到的常见问题,提出了解决方法,并对门诊医生工作站的应用效果进行了讨论.     

Use of a human factors approach to uncover informatics needs of nurses in documentation of care

PurposeThe success of health information technology implementations is often tied to the impact the technical system will have on the work of the clinicians using them. Considering the role of nurses in healthcare, it is shocking that there is a lack of evaluations of nursing information systems in the literature. Here we report on how a human factors approach can be used to address barriers and facilitators to use of the nursing information system (NIS). Human factors engineering (HFE) approaches provide the theoretical and methodological underpinning to address these socio-technical issues.MethodsThis study investigated the use of an NIS, a module of the electronic health record (EHR) previously implemented throughout the hospital system. The study took place in two hospitals (760 beds and 300 beds) within a three-hospital health system. Earlier in the year, the NIS was implemented throughout the health system. We applied a scenario-based evaluation technique in order to understand the barriers and facilitators to nurse use of the NIS as part of improving the healthcare delivery system. The scenarios were designed to have the nurses interact with the major components of the NIS. The research team developed the standardized scenarios to cover the major functions of the system.ResultsTwelve nurses completed the study and results show that documentation within the NIS was hindered by several aspects of the interface. This paper discusses the themes associated with the usability of the NIS interface analyzing them using usability heuristics. The team also identified facilitators to use and proposed avenues to support or enhance these facilitators.ConclusionsThis study examined the use of an NIS to standardize care and documentation in nursing. It used scenario-based usability testing, applying the “think-aloud” protocol technique to assess the use of the NIS in documenting patient care. This method of usability evaluation exposed an understanding of how nurses use the NIS and their perspective on the system. We hypothesize that this method will offer key insights into how the usability of the NIS not only impacts use but also informs redesign opportunities. In addition, this is one of the few rigorous studies of NIS and provides direction and recommendations for informaticians, developers and nurse decision makers.     

Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology

Background

A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments.

Methods

The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as “not in use.” Once it was handed to the surgeon, it was considered to be “in use.” Temporal miscounts (incorrect number of instruments “in use”) were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation.

Results

A total of 110 distinct instrument applications (“in use” versus “not in use”) were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54).

Conclusions

The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future.     

基于IHE技术框架实现工作流集成

探讨基于医疗信息系统集成（IHE）技术框架实现医院工作流集成。北美放射学会（Radiology Society of North America，RSNA）和医疗卫生信息与管理系统学会（Healthcare Information and Management Systems Soeietv，HIMSS）联合发起的IHE项目从工作流集成的角度出发，基于医疗标准制定了在各种医疗信息源间交换数据的技术框架。我们利用这个技术框架，从放射科的实际工作出发，尝试在复杂而异构的医院环境中实现信息集成与工作流集成。基于IHE技术框架，通过协调各种医疗设备和信息系统，实现了放射科的工作流集成。在复杂而异构的医院环境中，基于IHE技术框架能实现工作流集成，同时对IHE技术框架在我国的应用前景进行了展望。     

The Enhanced Workflow and Efficiency of the Wireless Local Area Network (WLAN)-Based Direct Digital Radiography (DDR) Portable Radiography

With the implementation of the PACS in the hospital, there is an increasing demand from the clinicians for immediate access and display of radiological images. Recently, our hospital has installed the first wireless local area network (WLAN)-based direct digital radiography (DDR) portable radiography system. The DDR portable radiography system allows wireless retrieval of modality worklist and wireless transmission of portable X-ray image on the console to the Picture Archiving and Communication System (PACS), via WLAN connection of wireless fidelity (Wi-Fi). The aim of this study was to analyze the workflow and performance between the WLAN-based DDR portable radiography system and the old practice using conventional portable X-ray machine with computed radiography (CR) system. A total of 190 portable chest X-ray examinations were evaluated and timed, using the conventional portable X-ray machine with CR from March to April of 2012 and using the new DDR portable radiography system on December of 2012 (n = 97 for old system and n = 93 for DDR portable system). The time interval of image becoming available to the PACS using the WLAN-based DDR portable radiography system was significantly shorter than that of the old practice using the conventional portable X-ray machine with CR (6.8 ± 2.6 min for DDR portable system; 23 ± 10.2 min for old system; p < 0.0001), with the efficiency improved by 70 %. The implementation of the WLAN-based DDR portable radiography system can enhance the workflow of portable radiography by reduction of procedural steps.     

Standards for Business Analytics and Departmental Workflow

Efficient workflow is essential for a successful business. However, there is relatively little literature on analytical tools and standards for defining workflow and measuring workflow efficiency. Here, we describe an effort to define a workflow lexicon for medical imaging departments, including the rationale, the process, and the resulting lexicon.     

DEWEY: The DICOM-Enabled Workflow Engine System

Workflow is a widely used term to describe the sequence of steps to accomplish a task. The use of workflow technology in medicine and medical imaging in particular is limited. In this article, we describe the application of a workflow engine to improve workflow in a radiology department. We implemented a DICOM-enabled workflow engine system in our department. We designed it in a way to allow for scalability, reliability, and flexibility. We implemented several workflows, including one that replaced an existing manual workflow and measured the number of examinations prepared in time without and with the workflow system. The system significantly increased the number of examinations prepared in time for clinical review compared to human effort. It also met the design goals defined at its outset. Workflow engines appear to have value as ways to efficiently assure that complex workflows are completed in a timely fashion.