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)