Abstract
Background: In 2013, we presented a study entitled “Multimodal document management in radiotherapy”, demonstrating the excellent routine performance of the system about four years after its initiation by evaluating a sample of n=500 documents. During this time the system saw additional developments and significant improvements: the most important innovative step being the automatic document processing. This has been completely reworked, to minimize staff-machine interaction, to increase processing speed and to further simplify the overall document handling. This improved system has been running practically without any problems for several months. Methods: While reworking the automatic document processing, we have developed algorithms that allow us to transfer documents with varying type, within a single scanning procedure, into our departmental system. The system identifies and corrects for any arbitrary order or rotation of scanned pages. Finally, after the transfer into the departmental system, all documents are in the correct order and they are automatically linked to the respective patient record. Results: According to our surveys, the error rate of the system, as in the previous version, is 0%. Compared to manual scanning and mapping of documents, we can quantify a 30-fold increase in the processing speed. In spite of these additional and elaborate processes, code optimizations yielded a processing speed increase of 20%. Pre-sorting of the documents (e.g., medical reports, or documents of informed consents) can be completely dispensed with the automated correction for jumbled documents or document rotations. In this manner 25,000 documents are automatically processed each year in the Department of Radiation Oncology at the University of Freiburg. Conclusion: With the methods presented in this study, and some additional bug fixes, and small improvements, automatic document processing of our departmental system was significantly improved without compromising the error rate.
 Keywords: Clinic management, documents, workflow, optimisation, efficiency, automation, Mosaiq, oncology informatics
Highlights
Since 2013, all data-related processes and procedures in our Department, have been digitized [1]
Background: In 2013, we presented a study entitled “Multimodal document management in radiotherapy”, demonstrating the excellent routine performance of the system about four years after its initiation by evaluating a sample of n=500 documents
With the methods presented in this study, and some additional bug fixes, and small improvements, automatic document processing of our departmental system was significantly improved without compromising the error rate
Summary
The implementation of an electronic patient record (EPR, for abbreviations see legend, table 2 ) is a prerequisite to operate an efficient digital document management [5] This prerequisite is not sufficient, as there are many types of documents that are not created directly in an electronic file. The redesign included a complete rework of the user interfaces, streamlining the configuration and administration of the system and the development of algorithms that enable the processing of various document types with arbitrary mixing of pages in a single scanning step. In our analysis of 200 samples, the error rate (i.e., documents linked to the wrong patient record) was 0% This is probably because we use the same barcode type (Codabar) and the same algorithm for checksum calculations of the Patient Identifier (PID) as our Computer Centre of the hospital (table 3). Routine clinical use of the system started in November 2016
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