Design, Customization, and Implementation of an Oncology Information System-Based Paperless Proton Therapy Workflow

Proton therapy centers present distinctive workflow challenges that demand seamless coordination, documentation, and collaboration across multidisciplinary teams. Given the limited published experience with paperless workflows in proton therapy, this study describes the design, customization, and 2-year clinical implementation of a comprehensive paperless workflow at a newly commissioned multi-room proton therapy center using a commercial oncology information system (OIS).

A multidisciplinary team of radiation oncologists, medical physicists, and radiotherapy technologists led the development and implementation of a department-wide paperless workflow with the Elekta MOSAIQ OIS. The process followed a structured 5-phase strategy and leveraged native OIS functionalities, including Quality Control Lists (QCLs) for task management, virtual locations, IQ Scripts for automation, customized assessment forms, and eScribe templates. User acceptance was evaluated via a multidisciplinary satisfaction survey conducted 26 months post-implementation.

The paperless workflow covered the entire patient pathway, from pre-planning audit to treatment completion and discharge summary generation, and incorporated 22 QCLs, 13 virtual locations, 44 IQ scripts, 10 customized assessment forms, and 2 eScribe templates. Implementation reduced the reliance on paper, improved workflow traceability, standardized multidisciplinary approvals, reduced missed tasks, and enhanced interdisciplinary coordination. A 3-tier physics plan review process ensured safety and quality assurance in treatment planning and evaluation while reducing variability among planners. The satisfaction survey (n = 36) yielded an overall mean score of 3.79/5.0, with safety and quality rated highest (3.87/5.0), while system usability identified opportunities for future optimization (3.53/5.0).

A fully paperless, OIS-driven proton therapy workflow was designed and successfully implemented using the native capabilities of the MOSAIQ OIS system. The structured, multidisciplinary approach and proton-specific checklist framework presented here provide a practical and reproducible model for other centers establishing particle therapy programs.