Unlocking Clinic Efficiency, Improving Patient Experience by Optimizing Digital Oncology Tools | Varian

When the Royal Marsden Hospital (RMH) decided to digitalize its patient pathway, it collaborated with Varian’s Advanced Oncology Solutions (AOS) team to create a customized ARIA CORE oncology information system, in turn enabling increased efficiency and multidisciplinary communication.

AOS provides professional and clinical services to help cancer clinics accelerate the adoption of oncology-specific technology including integrated oncology network platforms for secure collaboration between oncologists across the health system, paperless forms to optimize the electronic health record, cloud-based remote and on-site treatment planning, and coding and compliance review services.

“The AOS specialists provided solutions and offered many different options to give us as much choice and information as possible,” said Katie Jones, RMH Operational Superintendent Radiographer. “We had our pathways laid out to accommodate the paperless transition, but we needed someone to tailor this process for us, bringing out the best in our staff and multidisciplinary team. By working with AOS, we were able to create a workflow designed by the Marsden and customized for the Marsden.”

The experience at RMH, which serves patients in London and Surrey, illustrates how AOS is able to help clinics leverage digital oncology solutions to unlock efficiency, improve clinic operations and improve patient experience, explained Selina Elliott, Varian’s Senior Director, Product Marketing, for Multidisciplinary Oncology.

“Our AOS team was able to bring its broad market experience to help RMH implement the right digital oncology tools to build a customized approach to support an efficient operation that puts patient experience first,” Elliott said. “By streamlining operations, providers are able to spend more time focused on what matters most: patient care.”

Chasing paper in an inefficient system

Operated by the National Health Service, RMH provides comprehensive cancer care for more than 6,010 adult and pediatric patients a year across two sites, Chelsea (London) and Sutton (Surrey) – about 150 patients daily.

Prior to working with AOS, RMH relied on a paper-based workflow, which led to significant inefficiencies and risks for error and delay as paper treatment cards were transferred between multidisciplinary departments along the patient’s journey. As treatment plans changed, old information was crossed out, and re-transcribed with new instructions, often making it difficult to read.

“It was incredibly inefficient. You’d be running up and down four flights of stairs trying to retrieve cards from our patients,” said Zankhana Jani, Digital Lead Radiographer for RMH.

Visibility into the patient pathway across the multi-disciplinary team was limited, and there were constant delays waiting for key information, such as referrals.

Going paperless would be key to streamlining operations, but the RMH team quickly realized they needed to bring in additional expertise. The already-complex project coincided with an ambitious project by the National Health Services Foundation Trust to convert patient files into digitalized records on a national scale and came with strict delivery deadlines.

Internal planning studies demonstrated that additional support and guidance would benefit RMH with the efficient delivery of this transition. “We needed guidance to deliver the project as efficiently as possible,” Jones said.

Building an optimized, tailored digital workflow

Working with AOS, the RMH team mapped the existing clinic workflow to create a nuanced understanding of operations that could be effectively translated to ARIA CORE. Processes were systematically tested, optimized, retested, and reoptimized, integrating staff feedback along the way to ensure they could achieve the needed efficiency while maintaining clinical safety. The AOS team worked closely with the RMH core team to translate the change into the ARIA CORE system, enabling that core team to build expertise and experience so they could make any needed changes later.

Optimization efforts followed the patient pathway, starting with scheduling, enabling the team to hone each step before moving to the next to ensure a seamless experience once the system went live.

Bi-weekly meetings with the core team, along with monthly meetings with AOS, helped the team maintain momentum, while updates at regular staff meetings created a forum for feedback and an opportunity to implement change management.

Training began with a core team, rolling across to the broader team through a series of in-person and online training sessions.

Working with AOS enabled the RMH team to hone each element of the project to suit its unique practice needs.

“Every decision made felt like an educated decision,” Jones said. “Training was delivered by the AOS team and bespoke workflow training guides were created to ensure implementation and go live was clinically safe. We were able to adapt this process right up until the point of going live.”

Maintaining quality protocols was another challenge, with so many changes required. As new workflow processes were finalized, the team updated the relevant quality documents to ensure RMH maintained compliance.

Before the new digital workflow system went live in February 2023, the team tested it on a staggered basis, implementing the digital workflow for half of the patients initially so that staff had a chance to acclimatize to the new system without having to reduce service levels. Representatives from the core team and AOS monitored each case using the new system, troubleshooting and helping staff as questions arose.

“By the time we went live, all staff across the departments had seen multiple paperless patients and were more comfortable with the process,” Jones said.

Benefits

Optimizing and digitizing the patient’s workflow netted many benefits.

Care teams can access a complete and up-to-date patient treatment status at a glance, with a clear picture of next steps through customized workspaces. Clinicians can easily identify any tasks assigned to them, manage any overdue tasks, review treatment plans, and create and sign off prescriptions remotely, reducing delays.

“It is easy to see where every patient was in the pathway. When patients are replanned or rescanned, the doctors are able to keep track of patient progress much more effectively through care path than having to come into the department to look for the paperwork to sign,” Jani said. “Additionally, there are no more late nights searching for paperwork for patients who’d been held up in clinic. With all our clinical communications easily found in workspaces in ARIA like Journal, there is a streamlined patient pathway which lends itself to optimal patient care. I don’t think we could ever go back to using paper again.”

Increased transparency into where each patient was on the pathway has also helped streamline weekly multidisciplinary team meetings. Tasks are easy to track in ARIA workspaces, with urgent or overdue tasks easy to identify.

“Communication across the multidisciplinary areas has improved significantly,” Jani said, adding that instead of relying on phone calls and emails to track down referrals and information, “it was all in the system. You could pick up a task at any time and know what needs working on. We can now give our undivided attention to the patient on the treatment couch purely due to reducing the number of phone calls and emails and less paperwork chasing we are having to manage. Having an ARIA CORE task-driven workflow to follow is efficient and simple to use. Staff from all disciplines, from the administrative teams to the clinicians, find it easy to use.”

Following its engagement with AOS, having built the experience and expertise to navigate and customize the system to meet organizational needs, the RMH team was able to further refine its system following implementation.

“Increased efficiency throughout our workflow and the ability of accessing the patient information and documents remotely, means key tasks such as contouring and treatment plan approvals are done much more quickly, resulting in shorter delays to treatment,” Jones said.

Keys to success

The collaboration underscored some key components to project success. Understanding the workflow is step one, and having key stakeholders engaged in the project is the critical second step.

“You don’t have to understand ARIA, but you do need to understand your workflow,” Jones said.

Communication throughout the process was also key to ensuring staff were engaged in the process and had opportunities to offer feedback, leading to the creation of a very customized pathway.

Another important lesson was balancing the desire to include a representative group of voices, without involving so many people; “you’d end up debating topics for a really long time if this wasn’t the case,” Jones shared.

Implementing a thoughtful change management strategy was also important, and the AOS team played a valuable role in building trust and sharing their experiences in other clinical settings to help staff recognize the need for change. With its broad clinic perspective, AOS brought a nuanced operational and technical expertise, Jani said. “We learned things from AOS that we would not have otherwise considered.”

• Learn more about how Varian’s Advanced Oncology Solutions services can help your team implement and optimize digital technology solutions.
• Check out our recent webinar to learn more about the Royal Marsden Hospital team’s experience working with AOS.