OIS assessment [HIMJ 2006 34(4):136-145]

Functional specifications for a modern oncology information system (OIS) in a radiation oncology department

  1. Interfaces with:
    • the hospital information system for demographic downloads
    • HL7
    • DICOM RT compatible planning systems
    • other databases
    • (The above four requirements need only be achieved through the use of third part products or natively from the OIS. In this regard, a standards compliant database and operating system is highly regarded.)
  2. Interfaces with all linear accelerators commercially available
  3. enables functioning within a single coherent clinical workspace for oncologists, nurses and radiation therapists
  4. demonstrates a manageable, coherent, cohesive entry system for medical, therapy and nursing staff
  5. acts as an electronic repository for documents and images, with the ability to:
    • file and retrieve scanned reports in popular formats which will be able to be translated into future formats
    • identify reports relating to pathology and imaging reports, letters sent and received
  6. acts as a cancer registry with the ability to enter malignant and benign diagnoses and staging data, using internationally accepted coding (ICD-10 classifications for site and histology, TNM for staging)
  7. acts as a computerised clinical database:
    • able to specify, enter and retrieve as many prognostic factors as required
    • able to specify, enter and retrieve as many biological factors as required
    • able to specify, enter and retrieve any specific oncological activities (surgical and others)
    • able to enter and retrieve outcome issues relating to:
      • death
      • local failure
      • regional failure
      • distant failure
      • late side effects of treatment
    • using internationally accepted classifications treatment outcome (symptom relief, size change, etc
  8. ability to enter a radiation prescription, which should be:
    • completed within the identified medical entry process
    • approved by oncologists alone
    • capable of preventing machine use until approval 
  9. ability to describe a chemotherapy prescription with date, type, dosing, dose reduction. The option of a complete chemotherapy delivery system (i.e., a chemotherapy Record and Verify) involving drug prescription, preparation and ordering, as well as chemotherapy nurse and pharmacy sign off is beyond the scope of this document. Integrated departments wishing to use a single OIS should pay particular attention to the separation and integration of various features.
  10. ability to store or retrieve imaging and treatment volume data from the radiotherapy planning system. This can be achieved by treating this data as a prognostic factor or by direct download as part of DICOM RT plan transfer.
  11. ability to store, retrieve and assess radiation portal imaging
  12. ability to routinely retrieve data from the schedule, charge, demographics and treatment facets of the database
  13. demonstrated ability to report on stored data for clinically relevant uses including discharge summaries,
    outcome analysis, quality assurance, resource usage and process analysis
  14. ability to manage waiting lists
  15. possesses an electronic scheduler that:
    • permits the decentralised generation of appointments
    • permits generation of reports to quantify loss of efficiency and resource utilisation
    • is able to manage all clinic sites whether local or remote peripheral clinics
    • is able to generate multiple daily appointments, and regular followup appointments
  16. possesses a format to record clinical assessments that relate to:
    • treatment side effects (early and late)
    • treatment specification (any selection of DVH parameters)
    • any selection and number of additional facets (assume at least 1000 additional individual assessments covering areas such as EPI displacement,
    • Machine QA, clinical trials which may or may not be utilised and cannot be specified beforehand)
  17. implements a management process for workflow which shows daily worklists for staff and possesses an audit
    trail of workflow possesses a dictation/transcription system:
    • that shows daily worklist for all staff involved
    • has the ability to quality assurance the dictation, transcription, proofreading and printing processes of letter/report production
  18. provides an implementation team consisting of at least an application specialist and an on-site implementation team (comprising high level radiation therapist and radiation oncologist users. Assistance in implementation in clinical departments is difficult to find, as medical staff with the requisite clinical acumen and credibility are invariably involved in clinical work rather than medium term implementation consultancy.
  19. supports multi-site installations:
    • across LANs
    • across ISPs
  20. provides secure access from off-site to the clinical record