Volume 69, Issue 3, Supplement , Page S564, 1 November 2007
Automated Review of Electronic Portal Imaging (EPI) to Facilitate Physician Quality
Article Outline
Purpose/Objective(s)
The shift from hardcopy port films to EPI enhances image review with new clinical software tools for manipulating images. However, manual analysis of radiation oncologist (RO) compliance in EPI review is time consuming. This study describes an automated chart review tool to analyze the image review process of individual ROs over four years in our institution.
Materials/Methods
In 2003, a manual analysis was made of EPI review records for random patients, and ROs were anonymously notified of their results. Recently, custom software (EPI Auditor) was developed to mine the record-and-verify database and the review process of EPI in our institution. EPI Auditor software extracted over 46,000 EPI from 2003–2007, providing EPI review status and time to review by each RO. In late 2006, a report was developed that allowed for immediate review of RO completeness and speed of EPI review over any prescribed period. These data are distributed weekly to the RO staff and are not blinded, so each RO is aware of their performance in relation to others.
Results
From 2003 to 2007, the median department EPI review improved from 77% to 97% (range 85.4–100%), with a decrease in mean time to review from 4.2 days to 2.4 days (see Table). The initial intervention in 2003–4 was moderately successful at changing EPI review patterns. However, the implementation in 2006 of the automated review tool yielded a profound change in practice. Using the EPI Auditor software, the automated chart review required ∼1.5 hours mining and extracting the data for the four year period.
Conclusions
This study quantifies the EPI review process as it evolved over a four year period at our institution. The requirement for manual data retrieval by chart review detracts not only from Quality documentation, but also from Quality performance. As has been shown in treatment delivery, automated data review is crucial to Quality practice.
Reviewed EPI by anonymized RO
| RO | 2003% | 2004% | 2006% | 2006 mean days to check | 2007% | 2007 mean days to check |
|---|---|---|---|---|---|---|
| A | 85.4 | 85.5 | 95.4 | 4.9 | 100 | 3.2 |
| B | 99.8 | 99.9 | 100 | 3.6 | 99 | 2.3 |
| C | 69.9 | 92.2 | 54.8 | 2.5 | 87.7 | 4 |
| D | 48.4 | 66.1 | 33.5 | 4.2 | 92.3 | 3.2 |
| E | 69.9 | 86.7 | 99 | 1.8 | 100 | 1.6 |
| F | 67.1 | 93.7 | 99.4 | 5.6 | 94.9 | 2.9 |
| G | 83.7 | 98.8 | 100 | 1.8 | 98.7 | 2.1 |
| H | 82.6 | 80.9 | 94.9 | 4 | 85.4 | 2.4 |
Author Disclosure: P.A.S. Johnstone, None; D.G. Cassels, None; R.S. Lawson, None; T.H. Fox, None.
PII: S0360-3016(07)03111-2
doi:10.1016/j.ijrobp.2007.07.1830
© 2007 Elsevier Inc. All rights reserved.
Volume 69, Issue 3, Supplement , Page S564, 1 November 2007
