An ePR System for Workflow Improvement in Evidenced-based Research of Proton Therapy Hypofractionation Protocol for Prostate Cancer Patient

Abstract

Purpose/Objective(s): To present system integration and workflow improvement for patient data in hypofractionation proton therapy (PT) treatment protocol of prostate cancer patients using an electronic patient record (ePR). This ePR is an effective system that provides a centralized archive for all data to facilitate outcome analysis and foster evidenced-based medicine practice to optimize treatment for prostate cancer patient treated with that protocol. Materials/Methods: We have developed an ePR system with DICOM-RT compliance that can store patient images and clinical data. The ePR system has been developed with current Web technology, including Apache web server, PHP (Hypertext Preprocessor) language for the server side and a combination of javascript, and activeX libraries for the client side. Therefore, the patient data can be visualized through web browser and distributed across multiple locations by the local area network and Internet. The system is currently under evaluation at the James M. Slater, M.D. Proton Treatment and Research Center, Loma Linda University Medical Center (LLUMC). The data collected in the system includes CT images, DICOM-RT and DICOM-RT ION objects, and clinical data before and after treatment. These data are used to develop knowledge-based decision support tools, e.g., correlation between 3D dose and 2D dose and quantify these findings to enhance decision-making process for prostate cancer patients. Data integration and workflow improvements are investigated by analyzing dataflow and workflow of PT hypofractionation treatment in current environment as well as once the ePR is deployed. Results: Currently, there are 50 patient datasets collected in the ePR system for evaluation. Time reduction and data completeness evaluation shows that there is an improvement in data collection and system integration using ePR system for new PT protocol research. The clinical examples in workflow with ePR-deployed shows that the ePR system, utilizing knowledge discovery in treatment plans and outcomes from previous prostate patients, could be used to optimize treatment plan and predict outcome for new patient treated with hypofractionation protocol of proton therapy. Conclusions: Two valuable contributions of the ePR System for prostate cancer patients are: (1) improvement and efficiency in data collection and integration to facilitate outcomes analysis and (2) utilization of knowledge in the collected data to provide decision support in treating prostate cancer patient with a new hypo-fractionation treatment protocol of proton therapy.