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
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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
Tablet
Easy to Use
iOS, CAIS
Secure
Citrix, read-only, MDM
Existing
Infrastructure
Campus-wide
Wifi
Existing
Software
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.
2.
3.
improved computer and EHR access.
access to up to date patient records.
mobile tools for use in patient rooms.
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Phase I - Methodology
34 Radiation Oncologists
Pre-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-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
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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
Acting on Key Findings
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
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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 Usage
Key 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 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
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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)
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