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)