IMPROVE SAFETY, QUALITY AND EFFICIENCY IN RADIOTHERAPY WITH AUTOMATED HIT SYSTEM

描述（由申请人提供）：癌症是美国第二大死亡原因。放射治疗（RT）与手术和化疗一起，是最重要的癌症治疗方式之一。患者安全是放射治疗的首要问题。在过去的几十年里，许多不同的国家和国际组织，包括IAEA（国际原子能机构）、ICRP（国际放射防护委员会）、NRC（核管理委员会）、WHO（世界卫生组织）、ASTRO（美国放射肿瘤学学会）和AAPM（美国医学物理学家协会），已经认识到放射治疗的安全问题。急救护理研究所（ECRI）将RT错误列为头号健康技术危害。在过去的几十年里，放射治疗作为一个整体一直在努力改善患者的安全，通过采用严格的临床工作流程，从以前的事件中吸取教训，并遵循上述组织发布的指导方针。然而，随着技术越来越依赖于数字通信和工作流程，基于手工审计的安全措施继续显示出其局限性和过时性。在本项目中，我们建议开发一个自动化的健康信息技术（HIT）系统，以提高放射治疗的患者安全，治疗质量和工作效率。该系统将持续监测临床患者治疗系统中患者数据和文件中的错误和不一致的痕迹，使用户意识到任何患者安全问题。预计治疗质量将通过标准护理质量检查的自动执行和临床工作流程中人为错误的最小化来提高。由于自动安全和质量检查（手动执行时通常占人工工作量的约50%），预计工作效率将显著提高。在过去的三年里，我们一直在构建这样一个HIT系统，并在我们的初步结果中展示了临床安全性和质量意义以及潜在的效率提升。在这个新项目中，我们计划从根本上改革我们目前的努力，使基于计算机的安全和质量检查更准确、反应更快、用户友好、功能强大和完全自动化。我们还计划将从初步数据中确定的人为因素整合到设计特征中，从而最大限度地提高系统对安全和质量的影响。

DESCRIPTION (provided by applicant): Cancer is the second leading cause of death in the United States. Radiation therapy (RT), together with surgery and chemotherapy, is one of the most important modalities for cancer treatments. Patient safety is a paramount issue with radiation therapy. The safety concerns in radiation therapy have been recognized by many different national and international organizations including IAEA (International Atomic Energy Agency), ICRP (International Commission on Radiological Protection), NRC (Nuclear Regulatory Commission), WHO (World Health Organization), ASTRO (American Society for Radiation Oncology) and AAPM (American Association of Physicists in Medicine) in the past few decades. RT error was ranked as the #1 health technology hazard by ECRI (Emergency Care Research Institute). The field of radiation therapy as a whole has been attempting to improve patient safety over the past decades through the adoption of rigorous clinical workflows following the lessons learned from the previous incidents and following the guidelines published by the aforementioned organizations. However, as technologies become increasingly reliant on digital communication and workflows, the manual-auditing based safety measures continue to exhibit their limitations and antiquatedness. In this project, we propose to develop an automated health information technology (HIT) system to improve patient safety, treatment quality and working efficiency for radiation therapy. This system will continuously monitor errors and traces of inconsistencies in the patient data and documents in the clinical patient treatment systems, to make users aware of any patient safety issues. It is expected that the treatment quality will be improved by automatic performance of the standard-of-care quality checks and minimization of human errors in the clinical workflow. It is also expected that the working efficiency will be significantly improved due to the automatic safety and quality checks which when performed manually often account for approximately 50% of human worker workload. Over the past three years, we have been building such a HIT system and have demonstrated the clinical safety and quality significance and potential efficiency gains in our preliminary results. In this new project we plan to fundamentally overhaul our current efforts by making the computer-based safety and quality checks more accurate, responsive, user-friendly, powerful and fully automated. We also plan to integrate human factors into the design features, which were identified from the preliminary data, thereby maximizing the impacts of the system on safety and quality.