2016-Oncology-Case-Study

Redeﬁning ConsulƟng. Transforming Healthcare.
ONCOLOGY IT SERVICES
A Critical Service Line in Today’s Healthcare Market
white paper
written by
Dana Alexander, RN, MSN, MBA Divurgent Vice President of Clinical Advisory Services, Divurgent
Deborah Hood, MBA, Divurgent Oncology Services Executive Consultant
Gerrit Helbig, RN, Sr. Director, IT Clinical Departmental Applications, Banner Health

Redefining Consulting. Transforming Healthcare. ©2016 DIVURGENT. All rights reserved. | 1
Introduction
In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Cancer
continues to be the second leading cause of death in the country, just behind heart disease.1
Efficient and effective cancer
diagnosis and treatment centers add to a healthy bottom line for today’s health systems and further emphasize the strategic
importance of the Oncology Service Line.
In a 2007 survey conducted by The Health Academy’s Oncology Forum, Oncology leaders identified their biggest challenges
to growth as physician alignment (90%), information technology (IT) systems (85%), and competition (75%). Almost a
decade later, the IT challenges for integration and data extraction continue for Oncology.
The vast majority of cancer care takes place in the fragmented outpatient environment. Adding to this fragmentation, in
many markets there are disparate IT systems and providers, all trying to marry the business requirements with the patient
needs for this service line. In most cases, getting a coherent cancer record is not possible. For this reason, many hospital
systems overlook the IT needs of this large service line, focusing primarily on the inpatient Oncology services imbedded
within the hospital.
Until recently, most hospital Electronic Health `Record (EHR) vendors did not provide software that could adequately
meet the needs of active cancer centers. These outpatient facilities were looking for integration of diagnostic, clinical
research, surgical services, chemotherapy, and radiation treatment information along with improved ease of entry for
cancer registries. These operational needs cannot be met with a single software platform today; thus, there continues
to be a need to interface various platforms (including the inpatient hospital EHR), modify fields to collect information
required by quality and accrediting agencies adequately, and provide longitudinal data for outcomes and research analysis.
The Evolution of Oncology IT
Radiation Oncology treatment machines use highly precise software programs that operate the machines and deliver
high doses of radiation to specific tumor sites throughout the body, including the brain. Until about 10 years ago,
departmental physicists provided much of the technical support in Oncology, not only for the treatment machines, but
also for the treatment planning (dosimetry) software systems. These professionals, along with the machine vendors, kept
the department functioning and monitored the quality of the treatment results. While physicists interacted with hospital
IT around servers and network issues, they were reluctant to turn over the technical support function to general IT teams
due to the highly specialized software and the risk of patient harm if radiation doses and locations were not precise.
As the need for increased security, privacy, and disaster recovery evolved, more and more of this technical support and
maintenance transitioned to general hospital IT teams. While specialized hospital IT teams exist, they are most often
focused on inpatient or non-Oncology physician practices. For many cancer centers, it has been a challenge to address the
specific needs of not only radiation therapy, but also the rest of the Oncology services. Some have relied upon expensive
vendor management services, while others continue to utilize hospital IT, physicists, and other cancer professionals to
meet the needs. The need for Oncology software support continues to increase and evolve particularly in health systems
with locations across states or even spanning multiple states.

www.divurgent.com | 757.213.6875 | info@divurgent.com ©2016 DIVURGENT. All rights reserved. | 2
A growing trend is to form dedicated Oncology IT teams as a subset of the hospital IT department. The most successful
systems have invested in training and education specific to the Oncology needs so that there are readily available, day-to-
day services that rely less on the vendor. However, even those cancer centers that have implemented dedicated Oncology
IT teams need to ensure that they operate efficiently and document their work.
Note: The Oncology IT is not the same as Biomedical Engineering who may provide in-house repairs and maintenance of
the radiation equipment. The two work closely together, but have different knowledge and skill sets with separate training
needs.
Connecting to the Hospital Electronic Health Record
Radiation Oncology software vendors, Elekta and Varian Medical Systems, continue to develop highly specialized software
that not only operates the linear accelerator treatment machines, but also provides electronic health records that are
integrated with the Medical Oncology (chemotherapy) side of care. These systems support the unique operating needs
of both Oncology areas and are highly beneficial in the care of patients receiving both modalities of treatment, allowing
physicians and nurses to view all aspects of care documented in both disciplines. This software, however, can be challenging
to integrate with the hospital EHR.
Even in health systems where a hospital EHR is used as the patient record for radiation and Medical Oncology, there
are integration needs. Unfortunately, there is no single software platform that can successfully serve both needs. Thus,
interconnectivity is required. There are two choices:
1. Use a hospital (EHR) for OP radiation and Medical Oncology, modifying where possible to meet the operational
needs of these departments and integrating with the radiation treatment machine software to record treatment
parameters.
2. Use the specialized Oncology vendor software as the EHR and integrate with the hospital EHR to transfer
Oncology summaries for use in the inpatient, emergency room, and medical records arenas. Other integration
points may include the hospital pharmacy if that department is providing, mixing, or staffing the outpatient
chemotherapy in Medical Oncology physician offices.
In all cases, specialized knowledge of both the Oncology software and the hospital EHR software is required to utilize both
systems to maximum capability.
Skill Sets/Composition of a Dedicated Oncology IT Team
There are varieties of skill sets that lend themselves to a strong team. Whatever the skill set, it is clear that a dedicated
team needs both highly technical team members, as well as team members with clinical knowledge of Oncology.
Clinical Informaticists (CI) are a key team member that should not be overlooked. Ideally, this position is filled by a nurse
with an Oncology background and works effectively with clinical teams and Oncology leaders. The processes for collecting
information should not be onerous for nurses and physicians, but CI’s also ensure that information is collected in a manner
that allows extraction from the software. The CI position is relatively new; so in most cases, organizations are not going to
find someone already experienced in clinical informatics who is also strong in Oncology. Training will be needed to fill in
the missing areas of expertise. However, even with an experienced team member, there is a steep learning curve in most
institutions.

These individuals need to be comfortable embedding themselves in operations and learning the software in order to
maximize efficient usage and take advantage of all the bells and whistles available. Just like with word processing software,
anyone can type and print a document, but to utilize tables, field codes and advanced formatting takes education and
practice. The CI’s greatest benefit is reducing clinical inefficiencies and working with others to build systems that allow for
data extraction for research, registries, outcomes analysis, and data warehouses.
CI’s are the intermediaries between the practicing clinicians and the technical support. They are not the ones that usually
change/add fields, but communicate those needs. Oftentimes, these individuals are used to develop protocol strings
or template concepts that can be applied across the network with the technical team members making the software
modifications.
On the technical side, some organizations are lucky enough to find someone who previously worked for the vendor of one
of the Oncology software products being used. If not, vendors (for a price) offer in-depth training on software or are willing
to assist with training/mentoring. Again, most places are not going to find technical IT staff with an Oncology background,
but the clinical information they need can be learned on the job.
For any team member, training and education are keys to success. For large systems, team composition is also a matter
of specialization with cross coverage over the main software programs in use for patient treatment. At some point, the
softwarevendorcanbethefallbackforcomplexordifficultproblemresolutionaslongastheyareabletoprovideacceptable
turnaround times. Most vendors today continue to feel pressure to adequately meet the needs of all their customers.
The final team ingredient, to no one’s surprise, is an adequate number of Super Users who train new staff and can help on
a day-to-day basis with software usage, freeing up the technical team for more complex issues.
Making the Team Effective
As mentioned above, an adequate training budget is needed for new employees, as well as to refresh veteran team
members on new updates and changes.
In addition to technical or clinical skills, team members need to be strong communicators in order to build a cohesive team
and maintain high customer satisfaction levels. Being willing to dig into the software and operations demands will better
adapt the software to the needs of users. Communication, however, is not limited to Oncology. Team members need to
work closely with other IT teams from the servers to disaster recovery. In particular, they need to partner with the specialty
IT teams on the hospital EHR side to ensure that Oncology needs are met. An ongoing dialogue between these two teams
is critical to ensure both sides are aware of changes that could affect Oncology or hospital operations and interfaces.
Internally, an Oncology Advisory Council consisting of regular users in key disciplines allows fixes and enhancements to be
prioritized to benefit the largest number of users. For large systems on single or multiple platforms, it can also be a tool to
standardize protocols and processes across the entire Oncology Service Line.
Finally, a strong dashboard of quality and productivity indicators needs to be developed and tracked. There are multiple
ways of measuring productivity. There are even more metrics that can be tracked to show the value of the team to the

bottom line of the organization. Unfortunately, there are no national benchmarks for Oncology IT productivity. It is,
however, possible to develop guidelines that meet the needs of the organization over time.
Benefits of a Dedicated Team
It is obvious that the more specialized and knowledgeable the IT team is, the better they can keep a cancer center
operating efficiently. Operational delays in Radiation Oncology due to software downtime with the linear accelerators
can cost systems thousands of dollars not only from the inability to perform and charge for procedures, but also from
additional staffing time/overtime, patient dissatisfaction, and concern over treatment interruption. Frustration and lack of
confidence can build among highly accomplished physicists, physicians, nurses, and treatment staff when IT members with
limited experience in healthcare try to address the issues and do not understand the need for speedy resolutions.
Organizations with dedicated Oncology IT teams become embedded in the clinical fabric of the cancer center. They are
included and consulted in discussions regarding upgrades, new purchases and strategic expansions. With their knowledge,
they are able to point out needs and pitfalls to the clinical team. Within large systems, they can be the intermediary
between the vendor and hospital IT teams and can better handle large networking needs, remote planning, and efficient
utilization of highly specialized staff, such as dosimetrists and physicists.
Hospital systems with cancer centers will need to provide support for software programs, whether through vendor
management, general hospital IT teams, or dedicated Oncology IT teams. The solution that will most effectively meet the
needs of their cancer centers and professional teams is the latter.

Banner Health is one of the early adopters of Dedicated Oncology IT with a highly devoted, collaborative, and hardworking
team. However, as the system grew, adding more cancer sites, staffing levels did not increase accordingly. Divurgent was
able to assist in the following ways:
• Evaluating standardization and consolidation strategies
• Prioritizing and project governance for existing and future projects
• Optimizing Oncology IT team
• Developing productivity and quality metrics
This work was needed to manage current expectations and provide adequate support for the Oncology Service Line.
However, an additional need was for the Divurgent team to provide structure and justification for estimating and requesting
future resources of Corporate and IT leadership as the organization continued to expand. A proactive approach was
required to maintain an optimal number of well-trained technical support, particularly given the long lead-time required
of new staff to gain expertise and confidence. Clinically focused support also needed to be included in resource planning
in order to round out the team.
Along with operational recommendations, Divurgent developed a metrics dashboard and new reports, as well as a tool
for measuring staff productivity. This tool determined appropriate work ratios and current and future resource needs.
Monthly trends serve as potential warning signs, while quarterly results indicate meaningful changes to the demand on
resources. This particular product was so well received that it was validated and adopted by non-Oncology IT Directors
within Banner Health.
“Divurgent not only provided us with productivity metrics and a tool to use with managing the Oncology IT team, but
also gave us recommendations for governance and organizational changes. I expect these recommendations, along
with our growth and standardization strategy, will improve our ability to serve cancer patients throughout our entire
system.” - Gerrit Helbig RN, Sr. Director, IT Clinical Departmental Applications, Banner Health
Conclusion
Healthsystemswithcomprehensivecancercentersinmultiplelocationswouldbenefitfromthedevelopmentofadedicated
Oncology IT team. This team can lead to more efficient and effective utilization of specialized Oncology software programs
used by this vital service line. Oncology IT teams provide reliable and experienced support, as well as dedicated time
to enhance automation, standardization, data extraction, and operational processes needed by today’s cancer centers.
Appropriate staffing and development of teams are an important first step; but, to be as effective as possible, they also
require appropriate governance structures, productivity indicators, and tracking of metrics.
CASE STUDY: BANNER HEALTH

References
1. Cancer Statistics, 2016. CA: A Cancer Journal for Physicians. Siegel, Rebecca L.; Miller, Kimberly D.; Jemal, Ahmedin. January 7, 2016.
American Cancer Society.

ABOUT THE AUTHORS
Dana Alexander, MSN, MBA, RN, FAAN, FHIMSS. Dana, Divurgent’s Vice President of Clinical Advisory Services, is a
recognized industry thought leader, with concentrated expertise in population health, accountable care, strategic planning,
and clinical transformation. She is currently the HIMSS Board of Directors Chair, and extremely active in the healthcare
industry. Possessing a strong clinical background in Nursing, Dana brings decades of experience in the clinical environment
paired with executive-level experience.
Dana utilizes her industry expertise and clinical experience to work with Divurgent’s clients to implement transformative
clinical and business strategies that allow for the collection, measurement, and application of data toward improving
the safety, effectiveness, efficiency, and delivery of patient care they provide. Dana’s expertise in population health and
analytics, patient engagement, and patient safety, arm Divurgent’s Clinical Advisory Team with the client-focused solutions
that improve health outcomes and clinical efficiencies. Divurgent’s Clinical Advisory practice provides our clients with
services related to population health management, patient centered medical home, accountable care, transitions of care,
Meaningful Use, clinical service line optimization, and other clinical transformation initiatives vital to today’s healthcare
providers.
Deborah Hood, MBA. Deborah Hood is a proven leader in the development of oncology processes and systems, new
models of care, and comprehensive diagnostic and treatment programs. Previously Ms. Hood held the position of Vice
President, National Oncology Service Line at Catholic Health Initiatives. Her experience has realized demonstrated results
to solve specific business and care delivery challenges, increased clinical research, and achieved quality outcomes for
oncology services. She is experienced in Oncology Electronic Health Records and software as well as cancer registry
configurations. She has assisted community and academic cancer centers as well as employed and independent physician
practices. Ms Hood is a national speaker, advisor, and accomplished author.
Gerrit Helbig, RN. Gerrit is the strategic leader of clinical departmental applications for Banner Heath spanning seven
states. He is responsible for 85+ clinical applications across various clinical service lines including Oncology. He leads a
multi-state team of IT Clinical System Analysts, IT System Analysts, IT System Engineers and PACS Specialists collaborating
with the clinical service lines across the Banner Health enterprise.

COMPANY OVERVIEW
Divurgent is not the typical healthcare consulting firm. As a nationally recognized company, we are committed to healthcare
evolution and the strategies and processes that make it possible. We help our clients evolve in payment and delivery
reform, as well as patient engagement, providing higher quality of care, lower cost of care, and healthier communities.
Focused on the business of hospitals, health systems and affiliated providers, Divurgent believes successful outcomes
are derived from powerful partnerships. Recognizing the unique culture that every organization offers, we leverage the
depth of our experienced consulting team to create customized solutions that best meet our client’s goals. Utilizing best
practices and methodologies, we help improve our client’s operational effectiveness, financial performance, and quality of
patient care. For more information about Divurgent, visit us at www.divurgent.com

REDEFINING CONSULTING. TRANSFORMING HEALTHCARE.
Divurgent is committed to healthcare evolution and the strategies and processes that make
it possible. We help our clients evolve in payment and delivery reform, as well as patient
engagement, providing higher quality of care, lower cost of care, and healthier communities.
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