A Catalyst for Innovation and Collaboration at BCCA

1. 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

2. Faculty/Presenter Disclosure • Faculty: Dr. Jonn Wu, BC Cancer Agency John Waldron, Provincial Health Services Authority • Nothing to disclose

3. 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

4. Outline – Dr. Jonn Wu • The Impetus for Change • Phase I – Mobility Project • Paper Charts, Desktops • Clinical Requirements, Proposed Solution • Study Methodology • Results

5. CAIS: Cancer Agency Information System Paper Chart vs CAIS

6. CAIS, Desktops: Office Area

7. 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

8. 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.

9. Phase I - Methodology 34 Radiation Oncologists Pre-Usage Survey: 16 Questions 3 Months (April 1 – July 1, 2012) Post-Usage Survey: 36 Questions Interview

10. 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

11. 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

12. 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

13. 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

14. 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.

15. Phase II: Baseline • Key Observation: • Desire to use mobile for patient care activities.

16. Phase II: Post Implementation Satisfaction • Key Observation: • Device (iPad) and application were very well received at BCCA.

17. 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.

18. 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.

19. 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.

20. 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

21. 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)