Radiation Oncology Report (Turn-Around Time)

1. Radiation Oncology Report (Turn-Around Time) Committee Members: Najeeb Mohideen, MD Autis Speights, Manager Radiation Oncology Preston Bricker, Sr. Systems Analyst Patricia Lenkart, Transcriptionist

2. Opportunity Statement and Desired Outcome • Report turnaround time for reports was approximately 4 weeks,causing a problem with reports not being available when patients returned for follow-up visits in Radiation Oncology. • Our goal is to ensure that all dictated medical documents are transcribed and distributed in a timely manner inter-departmentally as well as externally.

3. Most Likely Causes for Current Opportunity • Transcription staff and faculty were located at different facilities. (Dictation tapes were transported via courier) • Computer System: Antiquated (No ability to share information electronically) • Workflow based on delivery date of tapes (Not date of service) • Staffing level not sufficient: (Ratio of transcription to physicians was 1 to 9)

4. Solutions Implemented • Initial backlog of dictation was outsourced while team was working on a more streamlined process. • Transcription relocated closer to physician offices. • Tape submission/courier pick-up deadlines were reengineered to accommodate physician routine. • Reduced number of drop off locations for physicians. • Physician work room and transcription mail box. • Increased number of courier pick-ups @ Loyola Clinic. • Work flow based on date of service. • Monitored date of service and delivery time. • ROIS system was purchased and installed. • Radiation Oncology Information System (IMPAC) • Staffing level was adjusted • Decreased transcription to physician ratio, 1 to 4

5. Progress to Date Original Process Process Improvement Step #1: Physician dictates initial consult Physician dictates initial consult (Loyola Clinic) Loyola Clinic/Cancer Center Step #2: Places dictated tape in courier location Physician deliver tapes to transcription (Loyola Clinic) McGuire Bldg Step #3: Transport to Hines V.A. clinic Hines dictation transported from Hines One a.m. / One p.m. pick-up and drop off clinic to transcription room @ Loyola. Step #4: Transcription pick-up tapes Dictation tapes transcribed by service date Multiple locations Step #5: Transcribed by delivery date Documents available in IMPAC First in First out Step #6: Documents transported back to Loyola Electronic physician approval Physician correction and approval Result: 4 or more weeks to final approval Result: More efficient process and patient chart

6. Results and Analysis Report Availability and Distribution (following ROIS implementation) 35 30 25 20 15 10 5 0 Before After Before and After Intervention Delivery Transcription Approval

7. Conclusions • Change to date of service workflow reduced overall TAT. • 24-32 days to 10 days • Streamlining key points in processes helped to further reduce TAT. • 10 days to average of 5-7 days • Implementation of ROIS system (IMPAC) allowed us to reach our goal of complete transcribed documents within 24 hours of the date of service and filed in patient record within 5-7 days. • On-line viewing/edits of documents • Electronic approval and signature • On line access to completed documents by clerical staff

8. Next Steps • Make Radiation Oncology documents available to other physician groups through utilization of electronic medical record. • Refine existing processes so that electronic and paperless environment can be fully implemented. • Continue to improve TAT at Hines V.A. clinic.