Work flow Issues

Data workflow issues

There is an intimate association for the oncologist between the data that needs to be collected, the way that the data needs to be collected and how the data can be checked for completeness and then verified as accurate. OncologyProcessThe data workflow issues should derive their logic from the following basic process paradigm, with the underlying principle that it is best and most efficient if the data arising in Process (1, 2, 3 ….n) is entered into the OIS during said process (1, 2, 3 ….n). This is not to say that you have to, but it seems logical (and the Business Process people can mathematically prove to you that it is true!) and so seems a good premise to have as a basis. This schema represents the barebone of what ALL oncologists have to do. No one gets cancer treatment without a diagnosis or staging.

This is not to say that after a reasonable search has been unable to determine the exact diagnosis, we don't sometime just have to assume that its cancer and we need to get on and make the best of a poor circumstance. But then the various code systems have this catered for anyway, e.g., for diagnosis ICD-10's C80 which is used for metastatic cancer of unknown site to multiple organs; and for morphology ICD-10's M-8000/6 which is used for "Neoplasm, metastatic". Interestingly, all those little blue arrows represent appointments! This actually makes sense.

The transition from Registration to Consultation occurs when the appointment is made and the patient attends. It doesn't matter what clerical people do to organize the front office, so long as that appointment gets made. Also interesting is that there are no alternative ways of making the appointment, or having it appear on a schedule. Even "I'm free, I'll see you right now" is an appointment made with today's date and the current time!

The point being that irrespective of the differences between our departments and practices (which we all think are massive), there is an invariable similarity at the junction between our major processes which usually constitutes the appointments we make. This schema is useful for thinking about how to organize your department also. As an oncologist, I am just not interested in the minutiae of clerical processes during the Registration phase, except to say that, in my particular circumstance, there has to be:

  1. letter of referral from a properly qualified practitioner
  2. pathology report that established the diagnosis of cancer
  3. imaging reports that establish the current stage of the cancer
  4. reports from other oncology practitioners defining what has been already undertaken

since these form the primary data on which I will base all my decisions. So it just has to be there, and clinically I would be justified in not seeing a patient until these pieces of data are available to me. The patient's history and physical examination functions as secondary data with the power of negation.