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May 27 th , 2013 Jonn Wu, MD FRCPC John Waldron, CPHIMS. Assessing the Role of Mobile Solutions in Clinical Workflow and Access to Clinical Information in Oncology. A Catalyst for Innovation and Collaboration at BCCA. eHealth 2013 Ottawa, Ontario. Faculty/Presenter Disclosure. Faculty:
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May 27th, 2013 Jonn Wu, MD FRCPC John Waldron, CPHIMS Assessing the Role of Mobile Solutions in Clinical Workflow and Access to Clinical Information in Oncology A Catalyst for Innovation and Collaboration at BCCA eHealth 2013 Ottawa, Ontario
Faculty/Presenter Disclosure • Faculty: Dr. Jonn Wu, BC Cancer Agency John Waldron, Provincial Health Services Authority • Nothing to disclose
Outline Assessing the Role of Mobile Solutions in Clinical Workflow and Access to Clinical Information in Oncology A Catalyst for Innovation and Collaboration at BCCA The Impetus for Change Phase I – Mobility Project Dr. Jonn Wu Evolving and Evaluating Mobile Phase II – Acting on Key Findings John Waldron
Outline – Dr. Jonn Wu • The Impetus for Change • Phase I – Mobility Project • Paper Charts, Desktops • Clinical Requirements, Proposed Solution • Study Methodology • Results
CAIS: Cancer Agency Information System Paper Chart vs CAIS
Solution: CAIS via Citrix, iPad Small, Mobile Easy to Use Secure Existing Infrastructure Existing Software Tablet iOS, CAIS Citrix, read-only, MDM Campus-wide Wifi Citrix, CAIS
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 improved computer and EHR access. access to up to date patient records. mobile tools for use in patient rooms.
Phase I - Methodology 34 Radiation Oncologists Pre-Usage Survey: 16 Questions 3 Months (April 1 – July 1, 2012) Post-Usage Survey: 36 Questions Interview
Phase I – Results – Pre-Survey • Radiation 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
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
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
Phase II: Evolving and Evaluating Mobile Acting on Key Findings • Provide access to relevant clinical information • Action: Source data from the 2 primary EHRs, Rx • Address usability • Action: Use iPad with native iOS app • Address privacy and security requirements • Action: MDM server, PIA, STRA • Evaluate utility of mobile solution in variety of clinical settings and workflows • Action: Oncology, acute, ambulatory • Complete research-based evaluation
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.
Phase II: Baseline • Key Observation: • Desire to use mobile for patient care activities.
Phase II: Post Implementation Satisfaction • Key Observation: • Device (iPad) and application were very well received at BCCA.
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.
Phase II: Solution Usage • Key Observation: • Most of the respondents reported using solution daily with an average of 9.2 and 8 (times/day) respectively.
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.
Phase II: Conclusions • Critical Success Factors: • Clinician driven initiative • IMITS act as an enabler • Multi-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
Acknowledgements • Project 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. Ramirez • Participants • Physician champions • 50 Radiation and Medical Oncologists • Super users across 6 BCCA sites • 40 Users at C&W (pending)