key: cord-1010021-232n3a81
authors: Kim, Ellen; Zhang, Haipeng; Salmasian, Hojjat; Landman, Adam
title: COVID Pass: A Case Study for Clinical Informatics
date: 2021-09-01
journal: Int J Radiat Oncol Biol Phys
DOI: 10.1016/j.ijrobp.2021.05.169
sha: 7f00079d1d64cd795f98e3b6f29f3ab71641a4a0
doc_id: 1010021
cord_uid: 232n3a81

nan

Methodology and Efficacy of Weekly SA-CME Web-Based Radiation Oncology Educational Conference in a Large Integrated Cancer Network Andrew Keller, 1 Adam H. Richman, 1 Hima Bindu Musunuru, 1 Hayeon Kim, 1 John A. Vargo, 1 and Sushil Beriwal, 1 ; 1 Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA Purpose: Following completion of residency, self-directed learning is needed to ensure practicing radiation oncologists remain up to date on relevant clinical literature and changes in the field which can directly impact patient care. We created a weekly web-based radiation oncology educational conference to help facilitate learning across our large integrated cancer network with over 25 national and international radiation oncology centers. Approach/Methods: We arranged for residents and attending physicians at both academic and community sites to present cases during a one-hour weekly session via the Microsoft Teams platform, with discussion led by a teaching faculty. Prior to each session, relevant articles were provided to all physicians, physicists, and dosimetrists across the network. During the case presentations, various aspects of the case were discussed to determine how attendees would approach treatment of the case being presented, as well as emphasize contouring guidelines and clinically relevant literature. SA-CME questions were sent out following each session to assess comprehension. A mid-year survey was sent out to assess quality of sessions and determine whether practice was changing based on newer data discussed. Results/Outcomes: 30 out of 60 attending physicians practicing across the integrated network responded to the survey. On a scale of 1-5, with 5 being the best score, median overall rating of quality of sessions was 5 (interquartile range [IQR] 4.25-5) and median rating of post-session SA-CME questions was 5 (IQR 4-5). There was adoption of newer practices based on data discussed, with 6 physicians (20%) reporting new adoption of 5-fraction regimens for early-stage breast cancer, 12 physicians (40%) reporting changes in pelvic nodal contouring, and 12 physicians (40%) reporting new adoption of hippocampal sparing whole brain radiotherapy in appropriately selected patients. Discussion: Response to the weekly web-based radiation oncology educational conferences was positive. There were changes across multiple domains in regular practice of radiation oncology following the first several months of sessions. The sessions allowed colleagues across the entire network to connect and learn from each other in a meaningful way. Significance: While self-directed learning remains essential for modern practice of radiation oncology, web-based radiation oncology collaborative conferences can help further the ultimate goals of improving patient care and ensuring participants remain as up to date as possible with modern radiation therapy treatment techniques and literature. Purpose: There is limited awareness and understanding of clinical informatics, which is the application of informatics, clinical knowledge, and technology to continuously improve healthcare systems, services, and outcomes. This is essential for modern healthcare and will become increasingly important in the future. Because of our relationship with imaging, planning, and treatment software and machines, and our evidence-based training and focus, radiation oncologists are well-positioned to join or work closely with clinical informaticians. Approach/Methods: We will start with an introduction of the medical subspecialty of Clinical Informatics, including educational opportunities for Radiation Oncology residents and attendings in the field of clinical informatics. We will focus on a specific product that will help the audience understand the broad scope, potential, and significance of applied clinical informatics. Results/Outcomes: COVID Pass 1 is a comprehensive web-based COVID-19 screening and scheduling platform at our multi-institutional academic medical center. It demonstrates several key components of Clinical Informatics: digital apps, clinical workflows, people management, electronic health records, improving quality and safety, data infrastructure, analytics, communication and collaboration among interdisciplinary teams, and leadership. Discussion: COVID Pass was urgently developed in March 2020 to easily and efficiently screen our institution's healthcare workers (HCW) for COVID-19, track HCW working on-site, and distribute personal protective equipment (PPE). It is used by >50,000 HCW daily in 78 of our hospital or clinic sites and while working remotely, and it has improved the early testing of symptomatic HCW and helped to allocate COVID-19 tests that were scarce in early 2020. COVID Pass has also been expanded to allow HCW to self-schedule elective COVID-19 tests and vaccinations, and communicate important updates and policy changes. It is available in 4 languages through 4 modes of access, including integration into our electronic health record (EHR). This web-based app exemplifies the potential for digital applications to improve the ease, efficiency, and effectiveness of workflows in healthcare. Significance: Technology is crucial in modern healthcare. Clinical Informatics is the growing medical subspecialty that combines physicians with diverse clinical, technical, and professional backgrounds who are uniquely qualified to help guide healthcare into a future that optimizes the applications of technology. Radiation Oncologists, in training and in practice, should become familiar with this growing field and opportunities to collaborate and learn from each other's expertise.

Purpose: Improving clinician communication skills has direct ramifications for cancer patient care. Previous studies have shown better communication techniques reduces cancer patient's anxiety and depression levels. 1, 2 However, delivering effective, evidence-based communication training for clinicians is resource intensive and often difficult to deliver at scale -issues that have been further exacerbated by the COVID pandemic. VR simulation provides a revolutionary opportunity for flexible, self-paced learning of communication skills in a safe environment. Students can be free to experiment and re-try difficult conversations until they have refined the relevant techniques. Methods: This project builds upon prior experience within our team, where members created an immersive, Virtual Reality (VR) simulation clinic that allowed trainees to interact with radiotherapy equipment and simulated patients. 3, 4 We sought to extend this by creating a new VR training module that allowed users to conduct extended conversations with two VR patients on emotive topics: 1) A new cancer diagnosis and 2) Recommendation of treatment cessation. This was supplemented by custommade learning materials that guided students in best practice methodology on how to handle such conversations. In the VR simulation students practice conversations with qualitative and quantitative feedback, have no time limits, and the discussion may be re-conducted as many times as the student wishes -allowing them to practice and refine their communication skills in a non-threatening, self-guided environment. Outcome: The VR simulation and training module was successfully built, with a pilot of the educational program launched in late 2020. It is delivered using a fully online platform. We plan on evaluating the program through various methods, including pathway mapping of the students' progress through the virtual consultations, to ascertain proficiency improvements over time. Trainee-reported evaluations of their confidence in dealing with such emotional scenarios post-program completion, will also be captured Discussion: Sensitive and emotive conversations with patients are a daily part of oncological practice, for example, when delivering a new cancer diagnosis or discussing prognosis. Despite this, most specialty training programs focus on teaching and assessing so-called 'hard skills', including treatment choice and technique. 'Soft skills' such as how to best handle emotional conversations are typically taught in a more ad hoc manner. As the educational sphere evolves in a post-COVID world, VR simulated learning environments such as this provide the opportunity for a scalable, personalized solution to train oncology practitioners in evidence based, best-practice communication methodology. Keywords: Communication skills, Virtual reality, Simulation, Medical Education, Oncology Education

A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage

Communication and information-giving in high-risk breast cancer consultations: influence on patient outcomes

Psychological responses of patients receiving a diagnosis of cancer

The implementation of a haptic feedback virtual reality simulation clinic with dynamic patient interaction and communication for medical imaging students

Quantification of Student Radiographic Patient Positioning Using an Immersive Virtual Reality Simulation

A Structured Approach for Training and Testing Staff in Radiation Therapy

Purpose: To create a structured approach for training and testing staff in Radiation Therapy (RT) while introducing a significantly new patient procedure into the clinic (e.g., MR guided RT). Approach/Methods: RT procedures are becoming more complex and "surgery like" with new SBRT regimens and techniques, placing new demands on staff competency. A google search for structured methods to train the RT team and test its competency resulted in no positive results. A google search for clinical competence in medicine resulted in links and references to the pyramid structure introduced by Miller 1 as a framework for assessment of clinical Skills/Competence/Performance. In this framework, the base level, "Knowledge" is defined as the collection of basic facts required for the procedure. The next level "Applied and Integrated (A&I) Knowledge" is defined as the ability to draw on the knowledge to formulate a solution for the procedure. The third level "Competence" is defined as the ability to demonstrate the A&I Knowledge in a controlled setting. The apex of the pyramid "Performance" is the execution of competency in the real world setting on actual patients. Results/Outcomes: An example of applying this framework to the implementation of MRgRT in the clinic might look as follows. Knowledge would include a detailed curriculum on basic MRI concepts, operational and safety knowledge of MR systems and MR Linac specific MRI and Linac knowledge. Test instrument would be written quizzes. A&I Knowledge would evaluate a thorough understanding of theory and institutional policies related to simulation of patient in CT and MR Linac, treatment planning, and delivering (adaptive) treatments. Test instrument would be long form questions and oral exams. Competence can be demonstrated through execution of A&I knowledge on phantoms and patient volunteers. Test instrument would be preceptor rating and accuracy of radiation e18 The Radiation Oncology Education Collaborative Study Group 2020International Journal of Radiation Oncology Biology Physics