Transforming Radiation Oncology Operational Efficiency with Elekta Healthcare Analytics Beverly Riley, MBA, CMD Administrative Director, Medical Dosimetry, MD Anderson Cancer Center

Elekta Healthcare Analytics Disclosure: Worked in collaboration with Elekta to develop electronic (EKM) Elekta Knowledge Management Dashboards

Elekta Knowledge Management Elekta Software Cancer Registry Healthcare Analytics Intra institutional Benchmarking Operational Clinical Financial Strategic & Research Registries Data Procurement Knowledge Management Treatment Management The Elekta Software hierarchy : Care Management, Treatment Management, and Knowledge Management. Knowledge Management covers four areas: Elekta Healthcare Analytics, Data Sales, METRIQ Registry and Strategic Registries.. From the perspective of the oncology data value chain, data sales represents a downstream activity and Elekta Healthcare Analytics an upstream one. Healthcare Analytics is on track to deliver Intra-institutional Benchmarking of Operational, Clinical and Financial Performance. We are in the process of selling this to our first customers as we speak. We currently have one data program, NODA, which aggregates registry today. We have been selling NODA data for almost 15 years. Care Management

Radiation Treatment Centers January 22, 2015 Radiation Treatment Centers MD Anderson Radiation Treatment Center Istanbul MD Anderson Cancer Center Cooper - NJ MD Anderson Radiation Treatment Center Madrid Arizona - Banner MD Anderson MD Anderson Albuquerque MD Anderson Cancer Center Baptist - Florida committed to clinical transformation MD Anderson Cancer Center - Houston MD Anderson Cancer Center Sao Paulo

MD Anderson: Radiation Oncology Divisional Growth It’s All About Growth

MD Anderson: Radiation Oncology Divisional Growth Personnel Growth Treatment Capacity 2005 2015 480 Employees 874 2005 2015 12 Linacs 27 Financial Growth (Operating Margin) 2005 2015 $20M $117M

MD Anderson Top Values : Safety first! Adopting rapidly evolving technology Coordinating efforts and communication Thorough Peer Review Incident Learning System – ROILS Anonymous reporting system Just Culture transformation

Operational and Quality Metrics Needs Divisional census and benchmarking Clinical activities and procedures Resource Utilization Federal Registrar reporting at your fingertips Palliative fractionation schemes Treatment planning directives compliance Pain assessment and plan of care

Operational Analysis / Reporting Challenges Existing methods of data collection were manual, insufficient and repetitive… Many systems to pull data from Manual data extraction Inconsistent data between systems – conflicting information Data manipulation – scrubbing outliers Hours of individuals time graphing Who is actually looking at month old data

Ever feel like this? Parts of your computer

Execution Overview Drives measureable performance improvement Workflow and Processes Operational Data Analytic Ready Data Analyze Solve Implement Measure Drives measureable performance improvement Enables data driven changes to processes

MD Anderson Elekta Healthcare Analytics Execution Overview Dashboards live with initial set of operational measures since May 2015 Metrics on patient demographic, divisional census, asset utilization, clinical activity and wait-times Continuous checking of the MOSAIQ database for the status of defined metrics and KPIs Values outside bounds trigger a message to the relevant individuals Provides self-service report scheduling and publishing

MD Anderson Elekta Healthcare Analytics Architecture September 30, 2017 MD Anderson Elekta Healthcare Analytics Architecture Healthcare Analytics Infrastructure EHA Data warehouse Patient Population Dashboards Machine Utilization Dashboards Billing Reporting Clinical Activity Timeliness Dashboards Patient Flow Cycle Times Analysis 7 – Facilities MOSAIQ™ Data collection and extraction Initiated pilot in January 2015 on operational performance measures for quality improvement projects. Benchmarking across selected targets including treatment times. Identification of patterns of care at different facilities Percentage of data elements captured for each patient to identify data fidelity issues Determination of barriers and outliers in different facility and staff participation Data governance involvement from clinicians and administration across Radiation Oncology Integrated MOSAIQ data sources with Elekta Healthcare Analytics for key performance measures Go-live with Operational Management dashboards in May 2015 Initiated patient flow cycle times project in June 2015 and completed in 4 months Now let’s take a closer look at the patient flow cycle times project and its relation to process metrics – key to operational improvement efficiency programs

Dashboard Overview

Patient Population Dashboard

Asset Utilization: Treatment Machines

Asset Utilization: Treatment Machines

Asset Utilization: Treatment Times

Asset Utilization: Simulation Machines

Timeliness: Clinical Activity & Wait Times

Patient Access: Simulation Appointments

Patient Access: All APPT Types

Patient Access: Appointment Volumes - Simulations

Patient Access: Non-rescheduled APPTS

Where is healthcare going?

Patient Flow: Overview

Patient Flow: Arrive in Waiting Room

Patient Flow: Waiting

Patient Flow: Start of Treatment

Patient Flow: Total treatment time

Patient Flow: AVG at specific time of day

Dosimetrists Workflow – IRIS (Integrated Radiotherapy Information System)

Dosimetrists Workflow - IRIS

From IRIS to EHA

From IRIS (Integrated Radiotherapy Information System) to EHA

Dosimetrists Workflow - IRIS

Dosimetrists Workflow - IRIS

What are the limits to pushing efficiencies?

Improving Operational Efficiencies

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Productivity Summary

Dosimetrists Workflow – IRIS Details Summary

Dosimetrists Workflow – IRIS Details Summary

DATA, DATA, DATA – Analysis Paralysis "You can have data without information, but you cannot have information without data."

Always do the best you can with what you have

Summary Eliminates manual data collection and reporting September 30, 2017 Eliminates manual data collection and reporting Provides immediate and detailed insight to operational data Enables real-time benchmarking and comparative analysis Support identification of outliers, workflow inefficiencies and resource consumption Improve patient access and satisfaction Maximize asset utilization and management Benchmark and comparative analysis across all locations Identify differences in treatment delivery Establishes analytics platform for consolidation of Financial and Clinical evidence-based outcomes

EKM – Knowledge is Power Thank You