Abbas Zavar and Karim Keshavjee

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ITCH 2017 Feb 18, 2017Victoria, BC

Link to Open Access Paper:

The Problem The Solution Prototyping of the solution User acceptance testing UTAUT questionnaire Findings Conclusion

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Current EMRs are not able to

Capture standardized data across EMRs

Transmit data to a central repository

Present guideline recommendations at point of care

Generate dynamic forms that

▪ Are customized to patients with multi-morbidity

▪ Can be updated on the fly, as evidence becomes available

Allow A/B testing of forms for usability and efficacy of CDSS

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…we could design clinical forms that were usability tested

(with researchers, policy makers, patients and providers)

met evidence-based clinical requirements and

incorporated into EMRs instantly or almost instantly?

Independent of the EMR vendor

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We co-designed a web-based form for the management of patients with 8 vascular diseases

The Form has 5 major functionalities The provider clicks on a link in their

EMR to retrieve the Form

The Form is automatically pre-populated with patient data

Form expands or collapses automatically, based on the diseases a patient has

Form provides guideline advice at the point of care

Form automatically tags instances of medications into their class

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OSCAR(Ubuntu)

Data Extraction Server

(Windows)

Clinical Form(Linux)

User

2. User Clicks on form link in EMR

1. Overnight Extract over SSL

Db Extract

3. Request for Data Extract

4. Request for Pre-populated Form

SSL Connection

5. DisplayPre-populated Form

UI

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The Unified Theory of Acceptance and Use of Technology is a highly respected and validated model of technology uptake

It allows implementers to predict whether a potential user will actually use a new technology and the drivers for that uptake

Behavioral intent as identified by the UTAUT predicts 70% of actual use.

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Performance Expectancy

Effort Expectancy

Social Influence

Facilitating Conditions

Behavioral Intent

Attitude

Anxiety

Self-Efficacy

Actual Use

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Performance Expectancy

54%

Effort Expectancy

67%

Social Influence

31%

Facilitating Conditions

55%

Behavioral Intent

67%

Attitude 43%

Anxiety 15%

Self-Efficacy 67%

Actual Use (Predicted)

47%

70%

N = 12

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Performance Expectancy - 54%

Form is Useful – 67%

Allows me to Accomplish Tasks – 58%

Helps Increase Productivity – 33%

Allows Better Patient Management –58%

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Social Influence -- 31%

People who influence my behavior think it is important – 25%

People Important to me think it is important – 17%

Sponsor is Helpful– 25%

Sponsor Will Support my use –58%

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Facilitating Conditions -- 55%

I have the resources to use the Form– 36%

I have the knowledge to use the Form– 67%

Form must be compatible w/ other systems– 92%

Assistance is available for use –25%

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Attitude –43%

Form is a good Idea– 64%

Makes Work Interesting – 33%

Form is Fun– 33%

I like working with Form–42%

One Flow Sheet versus Multiple Flow Sheets

Covers larger number of patients and covers patients with more than one disease.

Everything in one spot

Easy to Use – Easy to Understand - Easy to Fill Comprehensive content Multiple Key Features including:

Integrated CDSS

Drug Classification

Shrinking & Expanding Flow Sheet

Resource Linkages

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• Collect structured evidence-based data on multiple diseases from all EMRs

• Send to data repository in real-time

• Real-time guideline advice to practitioners and patients and families

• Standardized calculation of quality indicators including patient experience

• Rapid updates as new evidence becomes available

• Ability to monitor knowledge translation effectiveness

• Support new models of care and Chronic Care Model

• Faster and less expensive ways of updating forms and guideline knowledge across all EMRs in Canada

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The Form Prototype is a very good first attempt at a multi-morbidity form that is evidence-based and continuously updatable Has good Acceptance and Use characteristics

Can be used for A/B testing for form improvement AND for CDSS improvement

We identified many areas for improvement in terms of integration, the form itself, clinical decision support, marketing and support and training

Future projects need to address better user interface integration in the EMR and 2-way data integration with additional EMRs

Overall, it appears that the Form is usable by clinicians19