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Use of Failure Mode and Effects Analysis for Enterprise-Wide Implementation of Cloud Based Treatment Planning Infrastructure

A Kubli1*, M Kirk2, T LaCouture3, E Gressen4, N Degregorio1, A Harrison1, (1) Thomas Jefferson University Hospital, Philadelphia, PA, (2) Jefferson Asplundh Cancer Center, Willow Grove, PA, (3) Jefferson Health New Jersey, Sewell, NJ, (4) Jefferson Aria Hospital, Philadelphia, PA.


(Sunday, 7/12/2020)   [Eastern Time (GMT-4)]

Room: AAPM ePoster Library

Purpose: To identify potential issues with an enterprise-wide transition to a cloud based treatment planning (CBTP) infrastructure, a failure mode and effects analysis (FMEA) was performed. FMEA was utilized to compile and address staff concerns with this CBTP implementation, and to work with information technology (IT) to abate them.

Methods: First, the scope of expected work for the CBTP upgrade was defined. Processes affected by the Cloud were determined. Failure modes within each of these processes were identified by a multidisciplinary team. Once identified, a FMEA survey was sent out across the enterprise, and each failure mode was scored from 1-5 across three parameters: occurrence, severity, and detectability. These metrics were used to calculate a risk priority number (RPN) ranking each failure mode. An RPN analysis was performed in order to determine the most significant failure modes as determined by clinical and technical staff. Results were used to validate that quality assurance processes addressed all significant failure modes.

Results: 37 potential failure modes were identified. The RPN values across all responses (10% of our total clinical team) ranged from very low risk (1) to very high risk (100). Distribution of RPN values discovered high risk failure modes that may have been overlooked by the implementation team (physics and IT). Among the most significant failure modes were partial or incorrect transfer of DICOM data, slow IT response time after system failures, and unintended modification of patient or plan information within the CBTP. Once identified, failure modes were utilized for design and implementation of the CBTP including acceptance and commissioning of the cloud systems and upgrade software.

Conclusion: FMEA is validated for IT implementations as a tool to anticipate major issues. Use of FMEA helped identify and address employee concerns, CBTP failure modes and QA processes in our new workflow.


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