By Nancy Heifferon
How many times have you heard people say of some technology, “I didn’t know it could do that?” The Varian Consulting Services organization can help to eliminate that question by providing optimization services tailored to help medical and radiation oncology clinics take full advantage of what Varian technology can do for them. In this article, Centerline profiles two centers on opposite sides of the Atlantic that utilized Varian Consulting Services to meet specific challenges through optimized use of the ARIA® oncology information system.
Implementing optimized workflows in a new center: North West Cancer Centre, Londonderry, Northern Ireland
It isn’t often that cancer care professionals get to realize their vision of an ideal working environment. So when the opportunity presented itself, the radiotherapy staff of North West Cancer Centre embraced it with enthusiasm and a commitment to optimize the practice for everyone. North West Cancer Centre is a new center in a unique position. It was conceived and built to improve access to radiation therapy and enhance existing cancer care already delivered at Altnagelvin Hospital, part of the Western Health and Social Care Trust. It provides radiation therapy for cancer patients living within the west of Northern Ireland and the north west of the Republic of Ireland.
The cross-border services commenced in November 2016; and, when fully operational, North West Cancer Centre expects to accommodate 1,500 patients annually. “Because we are a completely new center, we decided up front to adopt an integrated management approach. Although we have three discrete departments—radiography, physics, and oncology—the idea was to have a common management environment across them all, based on best practices,” says Andrew Reilly, head of radiotherapy physics. The goal was to establish a management infrastructure that would scale and grow with the facility. “We didn't want to open our new department using merely default techniques. We wanted to use the ARIA system properly from the beginning because we knew that if we didn’t, it would be very difficult to move on and improve in the future,” he added.
With a staff of more than 200 professionals, there was no shortage of ideas about how things could and should be done. However, to harness that collective wisdom, the project team recognized the need for a seasoned, objective arbiter and advisor with a broad view. “We were quite keen for a consultant who would help us to make sure that everyone who is involved in the patient care path is considered and has a part in developing the service,” says Elaine Reilly, radiotherapy service manager. The team found that resource in Varian consultant Laura Butler.
What can a consultant such as Butler contribute that the internal team may not be able to accomplish for itself? Many things, according to Andrew and Elaine.
For one, the consultant acted as a coach. The North West staff came in every level of experience: some were familiar with Varian systems, while some were not. Butler’s weekly coaching helped everyone to get on the same page and speak the same language. The coaching consisted of demonstrations and step-by-step hands-on experience. “She also helped people review what they did, which brought everybody up to a high level of expertise quite quickly,” says Andrew.
For another, the consultant acted as a facilitator. “Where there were difficult discussions, for example, Butler could speak from a position of knowledge and experience that was separate from any one partisan group. That became very useful for us,” adds Elaine.
Butler also helped make the possible practical. “We could see what was possible but not always be able to decide on the best way to get there,” recalls Andrew. Where there were competing ideas, Butler created virtual workflow simulations so that the Northwest team could test their ideas and make decisions with greater confidence.
In summary, the benefits of using Varian consultants are access to their deep knowledge of ARIA capabilities and their independence. Consultants work with their clients, rather than for them. It’s an important distinction. Instead of doing the work and leaving, Butler helped the North West team gain confidence to add and change workflows and push the boundaries of the system to accomplish their goals. “We are working on solutions that I know other centers have tried but given up on. The difference is that we have the information system to support us and the confidence to evolve it as we see the need,” says Elaine Reilly.
Implementing an optimized Quality Payment Program in an established center: Edwards Comprehensive Cancer Center, West Virginia, U.S.A.
Across the Atlantic in West Virginia, the Edwards Comprehensive Cancer Center (ECCC), a long-time Varian customer and ARIA user, enlisted help from Varian Consulting Services for a different challenge—implementing the Oncology Care Model (OCM). The OCM is an advanced care delivery and payment option developed by the Centers for Medicare & Medicaid Services (CMS) to improve the quality of oncology care while reducing cost to the US government.
While the OCM applies specifically to Medicare, Edwards Comprehensive Cancer Center expects the process improvements to benefit all cancer patients. “Participating in the OCM is a great opportunity that will truly impact quality,” says Leann Ross, who brings 30 years of experience in oncology nursing and clinical trials management to her role as Oncology Care Model quality manager. It’s her mission to oversee the implementation—and it isn’t an easy one. “The project is causing us to look at care from a different perspective. It is allowing us to provide enhanced services to these patients, but there have been many process changes involved to meet the OCM requirements.”
Of the six practice redesigns required by the Oncology Care Model, ECCC was already compliant with several. For instance, patients have round-the-clock access to appropriate clinicians who have real-time, remote access to the electronic health record (EHR) system. That wasn’t a problem, says Ross, but there were other gaps to fill. “We formed teams to look at these issues and find solutions. That’s when we called Varian, because many of the changes depended on the ARIA information system, and Varian has an OCM optimization service that can be tailored to our situation.”
One area that ECCC worked on, with Varian assistance, was patient navigation. “We already had some patient navigation in place, but we had to broaden it and make it more robust. Varian helped us create the templates and questionnaires that the navigators use. These changes enable us to scan the electronic chart quickly and easily for the notes that document the navigation of the patient through the care path,” says Ross. “As care givers, we often do things that may not show clearly in the EHR. We are working on providing very specific tools that our staff uses consistently to capture and document navigation processes, such as intakes and follow-ups.”
The most significant result of the project, according to Ross, has been automating the generation of patient care plans. Pulling together the care plan used to be a manual process of scanning the patient record, finding each of the 13 required elements, and copying them one-by-one into a Microsoft Word document that would be printed and handed to the patient. Now care plans are generated automatically within ARIA.
ECCC has developed a custom workflow in ARIA for informed consent. “We translated the informed consent form for chemotherapy into a questionnaire in ARIA,” explains Ross. The completed questionnaire, which lists prescribed medications, is printed, signed by the patient, and scanned in with the signature. ARIA reaches into a database of clinical drug information and pulls guidance on potential side effects and symptom management into the patient’s care plan. “This has been a huge benefit for patients and for staff,” says Ross.
Ross says that, working with Varian Consulting Services, her team was able to expedite development of the tools and reports they needed to meet the OCM requirements established by the CMS.
“Implementing OCM has been a transformative experience for ECCC,” she says. “The program has the capability of helping us to enhance and elevate the quality of care we're giving to all patients, because it's providing us with an opportunity to look at all of our processes very carefully.”
Consulting services that tame the complexity of technology:
Varian provides customized consulting services to customers worldwide to help them:
- Adopt new technologies with change management
- Optimize best practices and improve workflow and care path efficiency
- Enhance product utilization
- Develop workflows and data extraction processes with the ARIA oncology information system in order to comply with US government regulations
- Create customized reports and dashboards using AURA and InSightive to meet data analytics needs
- Evaluate treatment delivery costs and optimize processes with the opportunity to reduce redundancies