Evaluation of Mosiaq for Record Information

Mosaiq is an electronic medical record information system used in a radiation oncology department.  In the radiation oncology field one needs a dedicated system to keep the entire patient’s demographic information, documentation, radiation plan and a record and verify system to ensure proper accurate treatment delivery.   It houses quality checklists, various assessments along with specific patient identification, positioning and site setup information. Quite simply, a radiation oncology department could not run without a customized system to provide the all the checks and balances to deliver error free care.

Characteristics of the Users of the System

Mosaiq can be used by anyone involved in the radiation oncology patient’s care.  The Radiation Oncologists are responsible for entering in diagnosis codes, staging information, radiation prescription and lab orders.  The Medical Secretary ensures that the patient’s records, demographics and insurance information is accurate.  The Radiation Oncology Nurse documents her interactions in the navigational note sections and fills out various assessments.  The Radiation Therapists send the radiation plan to the treatment machine for treatment delivery and when completed ensure that the dose was captured accurately.  They also capture the charges; complete a “time out” assessment and document and important information in the navigational note section.  In this section, briefly describe the characteristics of the users of the system.  Registered Dieticians, Social Workers, Care Coordinators and Administrators all have access and use Mosiaq.  Without the specialized record and verify electronic medical record system the radiation oncology would not be able to safely and accurately treat patients.

Features and Usage of the System

Mosaiq as many uses and features the range from demographics to documentation to radiation oncology treatments.  Some of the main features located on the tool bar include the standard file, scheduling, eChart, images, and code charge management. 

The file feature gives you access to open a specific patient.  Once a patient is opened up then in this section you can pull up their demographics.  The demographics has the patient’s name, personal information such as contact information and their address, billing accounts, diagnosis codes and their providers.  This area is customizable and other information can be added to access it easily.  Also here under file, you can go into different directories.  It brings up the section to customized assessments, enter new staff, and get to the system utilities.  It also has the normal printer settings, print specialized reports and be able to register new patients.

Scheduling is very important in a radiation oncology department and there are different areas within the department that have their own schedule.  First would be the exam room.  Here is where consultations, follow up appointments, on treatment visits and meetings would be scheduled.  There is template that is followed that helps coordinated the Physician’s schedule across multiple locations.  Mosaiq allows a user to determine how long an appointment should take and can also allow one to assign the task to one specific person.  Next there is a simulation room.  In this room a CAT scan is done for planning the patient’s personalized radiation plan.  The Physician needs to be available along with adequate staffing to complete the appointment. Then there is the treatment room schedule.  This room holds the most appointments as it has all the patients under treatment. Treatment times range from 10 minute time slots up to 40 minute.  There is also a second treatment room that does specialized high dose radiation (HDR) which required the Doctor to be present as well. All of the different types of appointments and treatment procedures are coded with the appropriate time and can incorporate the billing code or codes with it.  That way when it is complete, the appointment/treatment automatically captures the correct billing code.

The eChart is the patient’s electronic chart.  Most healthcare departments have gone paperless and this enables easy access to different sections of the patient’s chart. Some of the features listed are documents, orders, assessments, allergies, medications and D & I (diagnosis and interventions).  It also helps access the patient images that are taken for setup photos and images that are taken on the treatment machine for positioning.  There is another feature called quality check list that is quite useful.  It sets up tasks for various people and when it is done that person must complete the task.  When a user is logged into Mosaiq, these quality check lists will be presented to the user on their home page.

The code management feature is all about charging and billing.  It gives the option to bill one code at a time or multiple codes in one place.  It allows visualization of all of one patient’s charges or charges listed for a specific day.  Each charge can be checked to make sure the correct account number is being used, the correct physician is listed, the code is correct along with the date and it is being billed under the correct IC-10 diagnosis code.  Once it is checked, from this area, the charge can be exported.

Impact of the System

Mosaiq, as a whole, impacts the whole radiation therapy department.  It all begins with registering of a new patient.  This done by the Medical Secretary and if the patient has been in the same hospital before then it is as easy as imported the information from another hospital registration application directly into Mosaiq.  This makes the registration process very easy and streamlined. The Medical Secretary can then confirm the patient’s demographic information, along with their insurance.  They can use the scheduling feature to schedule their appropriate appointment.  If it is a consultation (which if it is a new patient, it will be) the Medical Secretary can conveniently complete the appointment and the correct charge will be captured.

The billing department can run an insurance verification and document into Mosaiq as to whether preauthorization is needed.  By having another department with access to Mosaiq, it gives a consistent location in the patient’s electronic chart to check that their insurance has been approved.  Then before the patient receives their treatment, it can be verified quickly.

Clinical staff relies heavily on assessments, orders, and quality checklists to verify information.  The Radiation Oncology Nurse completes a customized new patient assessment designed per site of treatment at the time of consultation.  When the patient begins treatment, a new patient assessment will be completed and throughout the patient’s course of treatment, weekly chart assessments are done.  Finally when the patient’s treatment is completed and final assessment will be done.  The same scenario goes for the Radiation Therapists, an initial, weekly and final assessment are done. The Medical Physicist again has the same assessments to complete in the beginning, throughout and at completion.  “Time out” assessments are customized dependent on the type of procedure that is being done and require two staff members to complete.  Many hospital organizations require a hard stop or time out to confirm, the right patient and right procedure.  By having these types of assessments electronically recorded into Mosaiq it aids in auditing that the proper protocols are taking place in your department. Physicians are required to electronically input any specific orders that they require. This could be the type of position or immobilization devices they would like for patient setup for the CAT scan procedure or any lab work that is required.

Mosaiq also has an area designated for image viewing.  Now this could be photographs taken with a digital camera to document the patient setup and locate any setup tattoos used for positioning.  It could also be radiographic images taken with the linear accelerator or treatment machine.  All the radiographic images should be approved by the Physician either before their first treatment when they initiate therapy or before their next treatment if they are under treatment.  Mosaiq will then assign these images that need review on a quality checklist for the Physicians to view.  After the Physician looks at the images they can either approve or reject it.  There is also a section to write comments and request a new image to be taken. 

A very important feature is the diagnosis and interventions tab.  This is where the doctor will enter in the diagnosis, staging and prescription for the radiation treatment.  The doctor must enter a care plan in with all of the dosing information.  If this information is not approved then Mosaiq will not allow the patient’s radiation treatment plan to be sent to the treatment machine for delivery.  Mosaiq will also keep track of the patient’s treatment days and the dose that they are currently at.  It is extremely important for the Radiation Therapists to check this information daily to verify that nothing has changed.  If something is detected in Mosaiq, such as a partial delivery of radiation, it will require and override by a user.  It is up to the discretion of the department as to who this should be assigned to.

A radiation therapy department heavily relies on the Mosaiq system for delivery of the treatments; however there are emergency situations where all the information that is required for treatment just is not feasible.  For example, if after hours when all the staff is gone and there needs to be an emergency treatment given and  Physicians,Physicists and Radiation Therapists all have their own approvals that must be done in order for Mosaiq to allow the radiation plan to be sent over.  All these people are not present for emergencies.  In these scenarios Mosaiq is bypassed and treatment is given off line.  It would be beneficial if Mosaiq had a feature that would allow for emergency situations.

Conclusion

Radiation therapy is a complex department that requires state of the art technology to precisely and safely deliver the patient’s individualized radiation plan.  The information system, Mosaiq, must provide an environment for the patients’ electronic medical records along with all the many features discussed in this analysis essay. Mosaiq allows departments to customize features to enable one’s level of safety in their own department. When patient’s safety is a main concern, the information system that is used must be reliable and customizable to provide a seamless flow of information in the department and Mosaiq provides that in many radiation oncology departments across the country. 

References

• MOSAIQ Oncology Management System Version 2.00 (MOSAIQ Users Guide), IMPAC Medical Systems Inc., Henderson, NV, 2010.