Innovation: Development of a Virtual Radiation Oncologist Consultation Service

Abstract

The purpose of this initiative is to facilitate timely care and increase access to stereotactic radiotherapy (SRT) services at the Juravinski Cancer Centre (JCC) for patients diagnosed with brain metastases, oligometastatic disease, and early stage lung cancer. This new service attempts to reduce transportation costs for out-of-LHIN patients by reducing the number of out-patient visits required for consultation, treatment and follow-up with the radiation oncologist. Using existing technology facilitated by the Ontario Telemedicine Network (OTN), the Palliative Clinical Specialist Radiation Therapist (CSRT) developed disease specific clinical protocols to provide this innovative service. Extensive planning and needs assessments were completed to achieve technical and clinical site readiness for patient consultations. The CSRT was responsible for the coordination and communication between the OTN Regional Manager, the director of radiation oncology, administration, management of information technology, patient referrals and registration, nursing, radiation oncology and the referring telemedicine program at the Windsor Regional Cancer Centre (WRCC). Virtual consultation has provided patients with advanced disease the opportunity to receive an expert SRT opinion without having to incur significant time and travel costs. The implementation of this new service required considerable planning and process testing. The greatest challenge continues to be the coordination and booking of an available consultation room with OTN equipment in conjunction with the availability of the radiation oncologist, the patient and family members and the referring host site. Fourteen patients who met appropriate indications have received virtual radiation oncologist SRT consultations. The distance between the referral and consultation site is approximately six hundred kilometers. Thus, each virtual consultation has provided an estimated time savings of seven hours per patient with a cost savings of one hundred dollars per patient estimated accounting for fuel, food and parking in comparison to an actual in-person SRT radiation oncologist consultation. In future, the development of a patient satisfaction questionnaire will help measure quality of life effects of this new service for patients and family members. A dedicated telemedicine suite within the JCC radiotherapy department will also minimize the difficulties with booking and coordination of all services required for the virtual consultation to occur.