assessing the role of mobile solutions in clinical workflow and access to clinical information in...
TRANSCRIPT
Assessing the Role of Mobile Solutions in Clinical Workflow and Access to
Clinical Information in Oncology
A Catalyst for Innovation and Collaboration at BCCA
May 27th, 2013
Jonn Wu, MD FRCPCJohn Waldron, CPHIMS
eHealth 2013
Ottawa, Ontario
Faculty/Presenter Disclosure• Faculty:
Dr. Jonn Wu, BC Cancer Agency
John Waldron, Provincial Health Services Authority
• Nothing to disclose
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Outline
The Impetus for ChangePhase I – Mobility ProjectDr. Jonn Wu
Evolving and Evaluating MobilePhase II – Acting on Key FindingsJohn Waldron
Assessing the Role of Mobile Solutions in Clinical Workflow and Access to Clinical Information in Oncology
A Catalyst for Innovation and Collaboration at BCCA
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Outline – Dr. Jonn Wu
The Impetus for Change
Phase I – Mobility Project• Paper Charts, Desktops• Clinical Requirements, Proposed Solution• Study Methodology• Results
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CAIS: Cancer Agency Information System
Paper Chart vs CAIS
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CAIS, Desktops: Office Area
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Solution: CAIS via Citrix, iPad
Small, Mobile
Easy to Use
Secure
ExistingInfrastructure
ExistingSoftware
Tablet
iOS, CAIS
Citrix, read-only, MDM
Campus-wideWifi
Citrix,CAIS
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iPad Pilot Project – Phase I
A pessimist sees the difficulty in every opportunity;an optimist sees the opportunity in every difficulty.
Sir Winston Churchill
Objectives: To address the clinical need for
1.improved computer and EHR access. 2.access to up to date patient records.3.mobile tools for use in patient rooms.
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Phase I - Methodology
34 Radiation OncologistsPre-Usage Survey: 16 Questions
3 Months(April 1 – July 1, 2012)
Post-Usage Survey: 36 Questions Interview
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Phase I – Results – Pre-SurveyRadiation Oncologists - Relatively Tech Savvy•86% - use mobile device daily•78% - use mobile device in clinic
Enthusiastic, Clinician Driven•67% - will enhance clinical workflow•91% - looking forward to adding mobile device to workflow
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Phase I – Results – Post-Survey
30 Responses, 88% Response Rate
The Good:•70% - easy to carry around•63% - positive impact on workflow•76% - more current than paper chart• 96% - accessed emails•60% - installed additional medical apps
The Bad:•50% - satisfied with screen size•55% - sufficient to review electronic records•55% - text too small• 50% - appropriate screen size
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Phase I – Summary
Clinician Driven Initiative
Positive Impact to Clinical Workflow•83% - positive experience (3% negative)•73% - useful in clinical practice•Addressed: Space and access concerns
Limitations Phase II•Usability
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Phase II: Evolving and Evaluating Mobile
1. Provide access to relevant clinical information Action: Source data from the 2 primary EHRs, Rx
2. Address usability Action: Use iPad with native iOS app
3. Address privacy and security requirements Action: MDM server, PIA, STRA
4. Evaluate utility of mobile solution in variety of clinical settings and workflows Action: Oncology, acute, ambulatory
Complete research-based evaluation
Acting on Key Findings
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Phase II: Baseline Results - BCCA
Pain Points Identified:BCCA clinicians lacked access to EHR systems in: (Ie. Exam rooms, RT planning areas, conferences)Some areas don’t have access to even the paper chart. (Fairmont outpatient clinics) The mobile workforce tethered to fixed workstation
Key Observation:BCCA clinicians have adopted mobile technology.
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Phase II: Baseline
Key Observation:Desire to use mobile for patient care activities.
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Phase II: Post Implementation Satisfaction
Key Observation:Device (iPad) and application were very well received at BCCA.
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Phase II: Access to Clinical Information
85% reported reduction in their need for the paper chart 62% reported reduction in their need for desktop PCs
Key Observation:Solution used when no workstation is available.
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Phase II: Solution UsageKey Observation:Most of the respondents reported using solution daily with an average of 9.2 and 8 (times/day) respectively.
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Phase II: Service Quality
Key Observation:•Most participants (90%) agree that there were sufficient technical support and training resources, despite the fact no formal training was provided.
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Phase II: Conclusions
Critical Success Factors: Clinician driven initiativeIMITS act as an enablerMulti-disciplinary teams and great teamwork
Provider use of mobile technology and modern applications has a positive impact on clinical workflow and patient care
Access to more data from one place is desirable: medical imaging, physician’s action lists, Varian
Next Step: Procurement
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AcknowledgementsProject Team•Executive sponsors: K. Karmali, Dr. I. Olivotto, B. Rivelis•Team Members: Dr. M. Khan, J. Barnett, J. French•Project Manager, IMITS: S. Hood•Clinical Systems Lead: M. Chow•CAIS/EVE Developer: C. Leckie•Cerner Resources: D. Tourrond•Mobile app vendor: VitalHub•Researcher (UVic): S. Slager, S. Melhem, O. Shabestari•Infrastructure Support: A. Kahnamelli•CIVIC – Innovation Centre: P. RamirezParticipants•Physician champions•50 Radiation and Medical Oncologists•Super users across 6 BCCA sites•40 Users at C&W (pending)