Doubled MOSAIQ project scope no match for teamwork

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Elekta education solutions specialists and University of South Alabama staff collaborate to meet tough MOSAIQ implementation deadline

A late 2017 project that started out with the implementation of MOSAIQ® Oncology Information System (OIS) at University of South Alabama’s new Mitchell Cancer Institute (USA-MCI) in Fairhope became more complex when the scope expanded by 100 percent. Soon after work began on the Fairhope clinic’s MOSAIQ implementation, USA-MCI officials reasoned that it would be impractical to also maintain a different OIS (Varian ARIA) at its established companion clinic across the bay in Mobile.

“We didn’t want to work out of multiple OIS systems. It would force patients to receive treatment at only Mobile or Fairhope.”

“We didn’t want to work out of multiple OIS systems,” says Hal Hopper, Manager, Department of Radiation Oncology at USA-MCI. “It would force patients to receive treatment at only Mobile or Fairhope. If a patient were to be treated in Fairhope but wanted to receive a subsequent fraction in Mobile, the doctor would need to log out of the MOSAIQ database and log into the ARIA database. We wanted to give physicians the freedom to see patients in two locations but go into a single database to find all the patient information. Bottom line, we didn’t want to divide up a patient record and maintain it in two databases.”

(l-r) USA’s Cindy Nelson, Hal Hopper, Katy Yeend

Consequently – while preparations were underway in November 2017 for the MOSAIQ implementation at Fairhope and Fairhope’s Elekta Versa™ HD linac was being commissioned – USA-MCI officials expanded the project to include swapping out the Mobile clinic’s ARIA OIS and replacing it with MOSAIQ. Moreover, a requirement was that the Mobile go-live would have to come first.

“We wanted MOSAIQ to be operational at Fairhope before Versa HD commissioning was complete and we were ready to start treating patients there,” Hopper explains. “On the other hand, we didn’t want the Mobile clinic to still be operating ARIA and trying to interface with MOSAIQ and Versa HD at Fairhope. We thought that would be a situation ripe for problems, including having to ultimately swap out Mobile’s ARIA and replace it with MOSAIQ. We wanted Fairhope to run seamlessly and without any problems – our first impression had to be perfect, so we had to do the implementation in that order and in the same time frame typically required for implementing MOSAIQ at a single site.”

(l-r) Elekta Education Solutions Specialists Carol Mason and Kelly Gross

The stage was set to implement a unified MOSAIQ OIS for both Mobile and Fairhope in just two months – when four to six months would have been the norm for a project of this scale.

Elekta tag-team

Elekta Education Solutions Specialist Carol Mason’s first visit to USA-MCI was on November 7, 2017, the date she began evaluating the center’s Current State radiotherapy workflow as part of the MOSAIQ project.

“At that point I knew it was going to be a MOSAIQ implementation at both Fairhope and Mobile clinics,” she recalls. “USA-MCI pushed the original go-live for Fairhope from early January 2018 to the end of January, but squeezed the Mobile go-live to happen two weeks earlier. A lot of work would need to be done, but I thought it would be manageable.”

Appreciating USA-MCI’s imperative to get its two locations up and running with MOSAIQ on a condensed schedule and that the job was too big for one Elekta specialist, the Elekta project planning team added Elekta Education Solutions Specialist Kelly Gross to the team.

“A big part of the success of this project was Elekta realizing that more than one resource was needed.”

“I have a fair amount of experience with ARIA flips, but ultimately two MOSAIQ trainers would help expedite the project – while one of us is doing onsite user training, another could be doing configuration work or meeting with the IT team or troubleshooting issues,” Gross says. “You can tag-team things that pop up along the way. A big part of the success of this project was Elekta realizing that more than one resource was needed.”

Elekta and USA teams collaborate

After USA-MCI configured and mapped out the necessary IT servers for MOSAIQ, Elekta’s Carol Mason officially kicked off the project with one week at the Mobile location for Current State analysis, in which she met with the lead from each staff type to learn how each staff member performs their functions and how they would interact with MOSAIQ.

“For two weeks back home, I prepared the Future State workflows, which propose how all USA-MCI staff will use MOSAIQ,” she says. “I then went back to USA-MCI to present these proposed workflows, make personalized changes and returned home to do the configuration work. This involved building items into their database that will be specific to their workflows, such as custom schedules, quality checklists and task sets, IQ Scripts and assessments. Much of this configuration work was a collaboration between the Elekta team and USA-MCI team members.”

The key USA-MCI staff that worked with Mason and Gross were Cindy Nelson, Clinical Research and Applications Manager, Katy Yeend, Clinical Applications Manager and Michelle Dobbins, Lead Therapist.

“We all shared in different tasks, whether it was completing the MOSAIQ configuration, validating the interfaces, confirming our workflows, or backfilling the data, we all pulled together so that we would be prepared for go-live from the clinical applications perspective,” Nelson says.

Yeend remembers coordinating about a dozen steps with her USA-MCI colleagues and the Elekta team.

“The implementation centered around basic planning: the types of MOSAIQ features we expected to use, reviewing our provider requirements, planning the interfaces with the Health System’s EMR, scheduling configuration, and documentation,” she says.

While Mason was heavily involved in configuring MOSAIQ with the USA-MCI group, Elekta’s Kelly Gross was acting as a troubleshooter for issues that crop up during an ARIA to MOSAIQ switch before training and go-live activities.

According to Mason, one of the keys to success was the USA-MCI team’s positive attitude and the outlook of the USA-MCI radiotherapy group as a whole.

“[USA-MCI staff] were ready for change and they were invested and very committed to the project. They spent multiple hours on their end doing just as much work as we were to make it happen.”

“They were ready for change and they were invested and very committed to the project,” she says. “They spent multiple hours on their end doing just as much work as we were to make it happen.”

Yeend and Nelson were equally impressed with the Elekta team.

“Kelly and Carol brought a high level of expertise to the table,” Nelson says. “They were both extremely familiar with their parts of the application and able to really engage with every team – from physicians, physicists and nurses to the scheduling team and dosimetrists. They were very organized with the questions they asked and based on that, it drove us to the type of configuration and functionality that we knew we wanted to build out. We just really ‘clicked.’”

“We couldn’t have done it without the two of them,” Yeend agrees. “They tag-teamed very well and while Carol was training staff members, Kelly would be troubleshooting with the physicists on the connectivity between MOSAIQ and the planning system, for instance. So, I don’t think we could have gotten a two-month implementation done without both of them.”

“They were very helpful and knowledgeable,” adds Dobbins, whose principle role was clinical set up of the departments and workflow for all clinical and treatment areas. “They were able to give multiple scenarios of how operations could be performed and allowed our team to provide input into the workflows we were trying to accomplish.”

MOSAIQ training was “fun”

After the Future State configurations were completed – and just two weeks from Mobile’s projected go-live – Masons’ mission (with Gross’s assistance) was to train approximately 40 people, encompassing six clinical staff types: front desk, physicians, nurses, therapists, physicists and dosimetrists, plus the IT department staff. Each group would receive about eight hours of training in two sessions over two weeks. When both Mobile and Fairhope clinics were operational with MOSAIQ, staff from Mobile would rotate through the Fairhope clinic to provide a full staffing complement for both centers.

“The first week of training is just showing them where the schedule is, this is where you click on this or how you do that – essentially just walking them through the MOSAIQ workflow,” Mason explains. “In the follow up class with each group we go through it again, but this time try to have as many people as possible sit in the ‘driver’s seat,’ log in and actually walk through the workflow themselves.

“Everyone I trained at USA-MCI was very open to MOSAIQ training and that was crucial.”

“Everyone I trained at USA-MCI was very open to MOSAIQ training and that was crucial,” she continues. “Resistance is the first stumbling block to someone receiving good training – I never saw anyone sitting there like a ‘deer in the headlights’ like they were thinking ‘I can’t believe I have to learn this.’ I thought they all did a great job adapting and learning. I actually thanked them for their openness and lack of grumbling. It was fun!”

By Nelson’s and Yeend’s estimation, MOSAIQ training was a big success.

“It was fabulous,” Yeend observes. “While other EMR implementations have been so complex, MOSAIQ was a real breath of fresh air – it is an extremely user-friendly and intuitive application.”

“Carol was very flexible to work with,” Nelson adds. “She performed remote sessions as well so that we could include some of our external staff, so she held WebEx sessions in addition to onsite live training.”

According to Dobbins, good training in an active clinical environment is always challenging, but that she believes all areas received tailored, individualized instruction.

“They were always willing to answer questions and fix problems that arose on-the-fly and that made the transition much easier,” she says.

MOSAIQ comes to life in Mobile, then Fairhope

Once MOSAIQ training was complete in Mobile, the OIS went live on January 15, 2018 and began treating patients under MOSAIQ the following day.

“MOSAIQ became the official OIS at Mobile and we took down the ARIA connection. ARIA is strictly a legacy system used as a database to archive records for patients needing re-treatment,” USA-MCI’s Hopper notes. “Any new patient record from that point on was inputted into MOSAIQ.”

Two weeks later, on January 29, the MOSAIQ connection at Fairhope came to life – uniting with its sister clinic in Mobile and sharing a single MOSAIQ database. Versa HD commissioning completed on January 29 and on March 7, USA-MCI’s new radiotherapy department at Fairhope treated its first patient and had six patients on the schedule almost immediately.

“The community has really embraced our presence in Fairhope and view us as Fairhope’s official radiation clinic – something they can call their own.”

“When you open a brand new facility you expect to start off slowly, but now we’re up to almost 10 patients a day. I didn’t expect a ramp up until later summer 2018,” he says. “The community has really embraced our presence in Fairhope and view us as Fairhope’s official radiation clinic – something they can call their own.

“We were pleasantly surprised with how easily the two-site project went – we’re able to exhale now.”

“Regarding the two-site MOSAIQ implementation, originally, we had worried that we might be doing too much, but we determined that we were going to ‘rip off the BandAid’ and deal with the pain rather than doing it slowly and having two different OIS’s,” Hopper adds. “We were pleasantly surprised with how easily the two-site project went – we’re able to exhale now.”

“I’m very satisfied with how the project went,” Dobbins says. “The team was great about giving options, advice and helping us through the process of implementing the new OIS and workflows.”

According to Elekta’s Kelly Gross, both Elekta and USA-MCI teams worked so diligently and cooperatively together that the process happened with virtually no hitches.

“For me, the success of this project is that without missing a beat, we swapped over from ARIA to MOSAIQ and didn’t have to take patients off of treatment for three says,” she observes. “It was a lot of work, but to the outside eye it appeared to be a seamless shift.”

As a relatively new Elekta employee with just 3.5 years with the company, Carol Mason had the opportunity to contribute in what could have been a daunting task given the tight timeline.

“For me it was a great experience,” she says. “Everyone involved was committed to success and I give a lot of credit to the commitment of the USA-MCI staff. The whole project went like clockwork and very smoothly considering the initial aggressive timelines and all of the things that had to be changed and worked out. The USA-MCI staff seem to be happy and have adjusted to their new life with MOSAIQ.”

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