Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Topic
Summary
A digital treatment workspace was developed, creating a digital chart for patients receiving radiation therapy at Cancer Care Services (CCS)' RBWH to replace pre-existing paper-based processes.
Dates: 1 January 2025 - December 2025
Implementation sites: Royal Brisbane and Women's Hospital
This was a Poster presentation at CEQ Showcase 2026 (PDF, 1.4MB).
Aim
To replace paper treatment documentation with a safe, efficient digital system for the RBWH Radiation Therapy department.
Outcomes
- Improved efficiency by eliminating printing, scanning and manual handling of treatment records.
- Utilised and innovated with existing systems, saving costs of purchasing a new solution/system
- Implemented a single digital workflow spanning four clinical areas and more than 20 critical steps in every patient's care pathway.
- Maintained all required safety checks and quality assurance processes within a secure digital environment.
- Reduced errors associated with manual transcription and duplicated data entry.
- Improved real-time access to patient information, supporting clearer communication across clinical teams.
- Reduced administrative burden at treatment completion.
- Staff satisfaction improved following implementation.
Background
The Radiation Oncology Department of Cancer Care Services, RBWH, delivers treatment to approximately 140 cancer patients each day, representing a high-volume, high-complexity clinical environment where precision, documentation accuracy, and coordinated multidisciplinary workflows are critical to patient safety. Despite the technological sophistication of Radiation Therapy delivery systems, the department historically relied on a heavily paper-based treatment sheet and documentation process to support daily treatment verification and communication.
Over time, this paper-dependent model became increasingly misaligned with contemporary clinical governance standards and the complexity of modern Radiation Oncology practice. Each patient's treatment pathway involves at least four key operational areas within the department and more than 20 critical procedural steps, requiring seamless communication between Radiation Therapists, Radiation Oncologists, Medical Physicists, and administrative staff. In such a multifaceted environment, even minor inefficiencies or documentation inconsistencies can propagate risk across the patient care continuum.
Incident reporting data within the department repeatedly identified manual data entry and transcription processes as a contributing factor to documentation errors and workflow inefficiencies. These risks included duplication of information across systems, delayed accessibility of treatment records, version control challenges, and increased reliance on physical chart handling. While safeguards were in place, the persistence of manual processes created avoidable opportunities for error in a setting where accuracy is paramount.
The Radiation Therapy department already utilised the oncology information system, MOSAIQ for treatment management. However, its capabilities were not fully leveraged to support structured digital documentation workflows. This underutilisation represented a significant opportunity: an existing, secure clinical platform with integration potential was available, yet core treatment sheet processes remained paper based.
The department had the potential to create a solution that would strengthen documentation integrity, improve real-time accessibility across treatment areas, enhance auditability, and reduce transcription risk, all without introducing additional workflow burden to frontline staff.
The central question underpinning this project was therefore:
Can we design and implement an intuitive, clinician-friendly digital workflow to replace a complex, multi-step, multi-area paper-based treatment sheet process within a high-volume Radiation Oncology department?
Addressing this question required more than digitising a form; it required reimagining how documentation flows through a complex clinical ecosystem. The challenge was to create a system that preserved the safety checks embedded in existing processes while improving efficiency, traceability, and governance alignment.
This need for modernisation, risk mitigation, and workflow optimisation formed the foundation for the Digital Treatment Sheet (DTS) Solution Project.
Methods
The DTS Solution Project was delivered through a structured, staged implementation approach grounded in workflow analysis, stakeholder engagement, and iterative refinement.
A small project team was established through an EOI process to ensure motivated frontline representation. This promoted ownership, transparency, and broad departmental engagement from the outset. The team included
Radiation-Therapists from key clinical areas, with regular consultation from department leadership and specialist staff.
Weekly project meetings were held to review progress, identify risks, and refine design elements. In parallel, key milestones and prototypes were presented to management for feedback and governance oversight. This ensured alignment with organisational digital strategy and patient-safety standards while maintaining clinical practicality.
The first phase involved comprehensive mapping of existing treatment sheet processes. All documentation pathways, procedural steps, and handover points across all operational areas of the department were analysed. Over 20 critical procedural steps within an individual patient's journey were examined, identifying duplication, manual transcription points, version control vulnerabilities, and areas prone to error. Internal audit themes were reviewed to ensure the redesigned workflow directly addressed previously identified risk areas. This mapping phase clarified which elements required redesign rather than simple digitisation.
Using the existing MOSAIQ oncology information system, the project team developed a structured digital workspace tailored to treatment delivery areas. Rather than replicating paper forms, the DTS solution introduced:
- Standardised and targeted digital assessment fields
- Consolidated "at-a-glance" patient information displays
- Task-assigning functionality aligned with departmental responsibilities
- Reporting and tracking tools to support accountability
- Direct entry digital communication between multiple systems
- Real-time documentation capability across treatment areas
MOSAIQ specialist staff within the department were consulted to maximise system functionality. Innovative use of configurable features, including dashboard-style widgets, allowed automatic collation of critical patient data from multiple areas within the system into a single, easily viewable interface for treating staff. This significantly reduced the need to navigate between screens or manually transcribe information.
Where possible, data entry points were streamlined to enable direct integration from other clinical systems, including dosimetry planning software, reducing duplication and transcription risk.
A staged rollout was undertaken to support safe adoption. Initial pilot implementation occurred within a controlled clinical setting (single treatment unit), allowing real-time troubleshooting and refinement. Staff training was delivered through multiple formats, including one-on-one coaching, small group workshops, and department-wide in-service sessions.
Members of the project team acted as "change champions" embedded across department areas during implementation. This peer-support model enabled immediate troubleshooting, reinforced consistency, and promoted confidence in the new workflow. Ongoing feedback mechanisms incorporated throughout the rollout ensured responsiveness to frontline concerns and iterative improvement of the DTS solution.
Through structured design, collaborative engagement, and staged deployment, the project transitioned the department from a legacy paper-based system to an integrated digital treatment documentation workflow.
Discussion
The success of the DTS Solution Project was dependent on strong organisational support, clinical engagement, and a structured change management approach. Departmental management endorsement was essential; enabling protected time for weekly project meetings, prototype development, and iterative review. Leadership visibility throughout the process reinforced the legitimacy of the change and supported alignment with broader digital governance priorities.
Equally critical: frontline engagement. The development of structured training resources, including quick-reference guides and standardised scripting, supporting face-to-face education, ensuring consistency of messaging and reducing variation during rollout. Embedding project team members as "change champions" provided real-time troubleshooting, peer reassurance, and visible support during transition.
Several limitations were encountered. Full departmental implementation required additional hardware procurement and minor physical workspace refurbishment to support the required digital access. While most treatment units successfully transitioned, DTS rollout to a small number of areas remains ongoing due to infrastructure constraints.
Additionally, highly complex and infrequently delivered procedures required further system configuration and workflow redesign. However, the demonstrated success and stability of the initial DTS rollout provided the confidence and governance support necessary to expand the solution into these complex treatment areas during subsequent project stages to come.
As with any major process redesign, early implementation was associated with temporary workflow disruption. A small increase in data entry errors was observed in the immediate rollout phase as staff adjusted to the new system. Importantly, these issues were rapidly identified through monitoring and feedback mechanisms, and error rates reduced significantly as familiarity and confidence increased. This reinforced the importance of staged implementation, visible support, and responsive troubleshooting.
The strengths of the DTS solution lie in its ability to consolidate and clearly display critical patient information in an accessible, structured format. By drawing directly from multiple clinical systems, the solution significantly reduced reliance on manual transcription and data duplication; addressing one of the original risk drivers identified through incident reporting. Additionally, the elimination of paper-based processes reduced administrative burden associated with printing, collating, scanning, and shredding treatment documentation at the completion of care.
Opportunities extend beyond workflow efficiency. The DTS solution enhances auditability, supports real-time governance oversight, and positions the department for future digital integration and data analytics capabilities.
This model has strong scalability potential across Queensland Health. Any department utilising MOSAIQ and operating within a paper-based documentation environment could adopt and adapt this framework to modernise treatment documentation workflows while maintaining local flexibility.
Future directions include completion of the full departmental rollout, incorporation of additional complex treatment pathways such as Total Body Irradiation, Superficial/Orthovoltage Therapy, and Brachytherapy, and continued refinement of the digital workspace to further enhance usability and safety.
Ultimately, this project demonstrated that significant system-level transformation is achievable when existing technology is leveraged innovatively, staff are supported through change, and patient safety remains central to design decisions.
References
n/a
Key contact
Jemma Walsh
Senior Radiation Therapist
Metro North Hospital and Health Service