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Saolta University Health Care Group modernizes their oncology treatment pathway

In 2013, it seemed inevitable among medical and administrative officials at Saolta University Health Care Group (Galway, Ireland) that their LANTIS Oncology Information System (OIS) would soon be overwhelmed by the demands of their rapidly growing health care system. In use since 2005, LANTIS had mainly functioned as a competent record-and-verify system for University Hospital Galway (UHG), and as an electronic oncology patient record for patients from Saolta’s six hospitals.

Increasingly, however, the medical centers realized they needed a comprehensive and open OIS solution for both radiation therapy and medical oncology/haematology. Because of the existing OIS’s functional limitations, Saolta officials knew they needed to change to grow.

“There were several operational and technical reasons that made it essential to modernize,” recalls Margaret Moore, UHG’s Head of Radiotherapy Physics at University Hospital Galway (UHG), one of Saolta’s six centers. “Upgrades to LANTIS would no longer be offered and it also was no longer possible to purchase additional user and scheduling licenses, which meant that expansion of the system in line with the growth in clinical demand couldn’t be achieved. By 2015, we had upwards of 320 active users throughout the Saolta Group on the system.”

Another issue was that LANTIS could not be configured as a multi-department system, adds Moore’s colleague, Stephen Coyne, Service Manager, Radiation Therapy Department.

“This caused daily problems associated with data collection and scheduling – as only one consultant could be assigned to a patient,” he explains. “In addition, issues began to crop up due to LANTIS’s incompatibility with newer versions of Microsoft Server and Microsoft Office.”

To address these issues and to support Saolta University Health Care Group’s comprehensive OIS needs, the healthcare provider developed a specification document in July 2013, officially launching an OIS tender and evaluation process.

Demanding job requirements

Saolta University Health Care Group had specific and demanding objectives that would have to be achieved in a new OIS, which would be either Elekta’s MOSAIQ® system or Varian’s ARIA OIS. A fundamental requirement was that the OIS must have full capability to be a complete electronic patient oncology record for use by radiation oncology, medical oncology/haematology, and the multi-disciplinary team working within oncology care.

“We also required complete assimilation – or transferability – of existing patient information stored within the existing LANTIS database, including all stored images, photographs, documents, medical oncology protocols and record-and-verify information,” Moore says, adding that this would encompass the records of about 29,500 active and inactive patients. “Additionally, we needed full capability to interface current Siemens ONCOR linear accelerators as a record-and-verify system and to current and future linacs from all vendors available for purchase over the next 10 years.”

The replacement OIS would need to be accessible to users across the geographical area supported by Saolta University Hospital Health Care Group, Coyne adds.

“Among the most important criteria, however, was the requirement that we have minimal clinical downtime during the changeover from LANTIS to the new OIS,” he says, “including a comprehensive training program for all OIS users, before, during and after the switch.”

“It was critical that the new OIS be able to import all patient data from LANTIS,” Moore observes. “MOSAIQ was the only OIS that could do this. We had decided that all of our patient data, both legacy and active, would be easily accessible on the new OIS.”

MOSAIQ also satisfied the group’s desire for a rapid changeover with little or no disruption to the clinical schedule.

“Our transfer happened over a weekend,” Coyne notes. “Both medical oncology/haematology and radiation oncology were working clinically on Monday. Radiation oncology treated over 70 patients on three linear accelerators on that day and were back up to full capability by Wednesday of that week. Likewise, medical oncology/haematology were at full capacity by Wednesday.”

Smooth MOSAIQ implementation

“We were very pleased with the speed of implementation,” Moore says. “One factor that helped enormously during implementation was being able to test and configure the MOSAIQ sequencer interface with our Siemens linacs in conjunction with the Siemens engineer in advance. This allowed us to develop protocols for treating and also to train the staff in advance.”

Once MOSAIQ went live in November 2015 the health group’s “superusers,” – expert OIS operators – spent the next two weeks addressing the expected user issues in all areas.

“This was due to a number of factors,” Coyne notes. “Some modifications in configuration were required and also some extra training of various professional groups. Overall, staff are pleased with using MOSAIQ. The increased functionality has streamlined a number of processes. For example, scheduling appointments can now be done in groups. Also, MOSAIQ® IQ Scripts are now in use to streamline our patient pathways.”

“MOSAIQ has additional verification steps,” Moore acknowledges. “But these steps make treatment on the linac safer, so it’s a worthwhile trade-off.”

Both Moore and Coyne appreciate the impact that the high level of communication between Saolta and Elekta had on streamlining implementation.

“We collaborated well,” Coyne recalls. “We had weekly teleconferences with the Elekta project manager and our project team. These were a good conduit for issues.”

“We found that on-site support was a much superior and faster method to resolve technical issues arising in the MOSAIQ operational environment,” Moore adds. “Our linac configuration is quite unique in that the [Siemens] machines at University Hospital Galway are 13 years old and not upgradeable.”

Year 2 of the MOSAIQ era

Saolta University Healthcare Group began 2017 with a full year’s experience of MOSAIQ, an OIS that has transformed the way Saolta cancer care providers access patient information and orchestrate patient treatments.

“MOSAIQ is used extensively at Galway University Hospital, Sligo University Hospital and Mayo University Hospital,” Moore says. “In these areas, staff have full access in a single system to the patients’ radiation oncology and medical oncology/haematology details. This allows informed decision making for the medical staff when dealing with patients during treatment and for follow up afterwards.”

“MOSAIQ has enabled us to provide more efficient and comprehensive care,” Coyne adds. “Moving forward, we will continue to develop smart ways of working with MOSAIQ and exploiting its full functionality.”