Alberta’s Personal Health Record Platform www. MyHealth. Alberta Alberta’s Personal Health Record Platform www.MyHealth.Alberta.ca eHealth 2013 May 27, 2013

Agenda Demonstration Current Status User Engagement Communications Personal Health Record Solution Benefits Evaluation Demonstration Q&A 2

Personal Health Portal Vision “MyHealth.Alberta is the Alberta source for trusted health information and secure on-line health services that will empower Albertans in managing their health and wellness” 3

Program Goals The Alberta Personal Health Portal (MyHealth.Alberta.ca) is intended to provide the following benefits to Albertans, their health care providers and the health care system: Albertans will have an improved ability to proactively manage their wellness and health. Albertans will have an improved ability to access the health services available to them. Patients and clinicians will have an improved ability to interact with one another. Patients can more effectively participate in managing their treatment. Albertans can more effectively engage the support of, and assist others, in treatment. Health system efficiencies will be increased. The health system will be more informed of Albertan’s health care experience.

Current Usage Works out to 1.2 million visits a year. HealthLink is running about 1 million calls per year currently. 14 – 16 percent of the calls end up at emerg.

Multiple ways to provide feedback User Engagement Multiple ways to provide feedback 6

Reporting

Public Advisory Group Governance Review Competitive Process Open to all Albertans First meeting April 4th, 2013 in Edmonton Demographic Coverage Selection process outlined demographic coverage we were seeking. Age, education – level , ethnicity, location. We checked with our legal regarding making selections based on these criteria and based on the goals of the group we were allowed to proceed. 45 applicants, screened down to 23 interviews and 14 selections. 1 member under 30, the remainder over 40 with several members over 60. education is almost exclusively post sec with several members with masters level. 50-50 male-female ratio. Urban 12 members with 2 rural. 8

Clinical Engagement Integrated Clinical Working Group – PHP Subgroup Physicians, Nurses, Specialists, Pharmacists, Physiotherapists, Clinic Managers, HealthLink Representation Personal Health Portal Steering Committee Alberta Medical Association, College of Physicians and Surgeons, College of Alberta Registered Nurses, Alberta College of Pharmacists 9

Communications Strategy Public and Provider messages Awareness of EHR Patient rights and responsibilities Leading up to public availability of PHR Build on the work that Infoway has done – “Knowing is better” commercials Awareness of things like what EHR is. The Netcare brand, etc. GPLM - Global Person Level Masking Rights to see EHR, responsibility to maintain a secure password, etc. 10

MyHealth.Alberta.ca Personal Health Record A collection of Common Off The Shelf (COTS) products Instant PHR Healthvault Integrator Netcare EHR HealthVault 11

MyHealth.Alberta.ca Personal Health Record – Identity and Authorization Current Environment Albertan Microsoft Account Identity Service HealthVault SharePoint 2010 12

MyHealth.Alberta.ca Personal Health Record – Identity and Authorization Future Environment Albertan GoA Identity HealthVault SharePoint 2010 Trust Relationship 13

Benefits Evaluation - Framework Net Benefits Quality Patient Safety Appropriateness/Effectiveness Health Outcomes System Quality Functionality Performance Security Use Use Behaviour / Pattern Self Reported Use Intention to Use Access Ability of Patients/Providers to Access Services Patient and Caregiver Participation Information Quality Content Availability User Satisfaction Competency Ease of Use Service Quality Responsiveness Productivity Efficiency Care Coordination Net Cost Based on the Delone and McLean IS Success Model, 2003 Organizational and Context Factors: Strategy, Culture, and Business Process – Out of Scope 14

PHP BE embedded throughout the development and deployment lifecycle. Overall, BE is embedded throughout the lifecycle of the PHP for each phase, from pre-design to deployment. This allows BE to formatively enhance the PHP, improving the PHP rather than just evaluating its effectiveness. 15

BE Multi-Methods Pre-Design: Design: Deployment: Persona development / circle of care models Design: Usability testing and Usability inspection Deployment: Patient interviews and discussion groups: patient experience with use of PHR Provider discussion groups: experience / impact of PHR on practice PHR usage statistics: to confirm which widgets are used and frequency / timing of use Persona development / circle of care models: The pre-release BE activities began with an assessment of the likely features that are being considered for deployment and works to define the population(s) that will most likely benefit from those features. Once the populations were defined, then 3-6 standardized patient personas were developed with representative scenarios where the PHP may be used. Validation of the personas was carried out with stakeholders. In this case, validation occurred with the iCWG PHP subgroup. 16

Multi-methods to assess from early adoption to later adoption benefits For deployment evaluation, we are examining availability, use, behaviour change and outcomes. This allows us to look at early adoption that is linked to expected longer term outcomes as adoption matures over time. 17

Phase 1 Evaluation MyHealth.Alberta.ca Knowledge Portal General Albertan Survey Assessment of MyHealth.Alberta.ca Awareness Baseline snapshot of Alberta general population health information seeking and internet behaviour Summer of 2011 396 Participants Results: 93% used the Internet to look up health-related information 72% agreed that online health resources provided answers more quickly than other means 75% agreed that online health resources increased knowledge of a health condition General Albertan Study: provide a baseline snapshot of health information seeking and Internet behaviours of the general population of Alberta at the time. Nearly all respondents have safe access to the Internet (most from home) and have accessed health information online. 90% use a desktop / laptop as their primary tool for accessing the Internet. 10% use a phone or tablet. This number increases to over one-third in the respondents under age 25. Respondents had many sources to get health information Family physicians were the most frequently cited source of 18

Phase 1 Evaluation MyHealth.Alberta.ca Knowledge Portal Alberta PHP Embedded Web Survey Assessment of Use and Experience Rank MyHealth.Alberta.ca pages from 1 to 5 and answer three questions to assess visitor experience: Did this page provide you with the information you needed? Do you feel this information will help you make better health choices? Will this information help you when talking with your doctor or other health care professional? Results: September, 2012 – Present Feedback tools used 4,925 times by 4,695 unique visitors (to date) Overall page ranking: 3.59 out of 5 Question 1 ranking: 68% Question 2 ranking: 70% Question 3 ranking: 69% PHP Web Survey: Alberta Health Services has implemented web surveys on the MyHealth.Alberta.ca website in order to augment usage data and other user statistics automatically captured by the PHP software. As part of the UVic eHealth Observatory’s benefits evaluation (BE) study, the UVic team has helped PHP develop BE related survey questions, some of which Alberta Health Services have deployed on their website. The current, page specific survey consists of a page ranking (1-5, five being highest rank) and three questions that map to visitor experience: Q1 – Did this page provide you with the information you needed? Q2 – Do you feel this information will help you make better health choices? Q3 – Will this information help you when talking with your doctor or other health care professional? Overall rating (to date) 3.59 out of 5; 68% for Q1; 70% for Q2; 69% for Q3 19

Phase 2 Evaluation Usability Usability Inspection Cardiac Persona User Acceptance Testing Part of internal evaluation Usability Testing 14 Victoria participants (no previous exposure to PHR) 7 PHP participants (previously involved in PHR activities) Focus Group 14 PHP participants 20

Phase 2 Evaluation Usability Results Five key areas of improvement identified: Information Architecture Missing Content / Functionality Presentation Functionality of Existing Content Login Process 1: The application presents a rich set of modules and tools that allow the user to enter and view their health information. While there is valuable functionality available, our primary concern is around how the site is organized. The current information structure presents these challenges.  Current deep navigation layering means users do not get information; Findability is low due to placement of widgets and tab labeling; Inefficiencies in data entry workflows occur due to placement and segmentation of widgets across multiple branches in the hierarchy. 2: In order for the user to maintain an accurate and useful PHR, the system should provide adequate tools and information to facilitate data quality. Because the functionality of the PHR is heavily weighted towards data entry, the following content requires improvements.  Additional widgets that support capture of core patient information that would be shared from patients to the majority of providers (e.g. immunizations and social history); Missing module for documenting significant medical events; Help and user guidance content; Improved clinical vocabularies for core areas (medications, conditions, and other reference lookup lists). These are currently not optimized for patients. Revising the vocabularies is technically feasible and will support user comprehension and usefulness of the PHR. 3: The presentation layer of the site is an area where significant benefits can be gained for a relatively low effort.  Identified need for: Highlighting clinically relevant information; Consistency in information presentation across the PHR; Compact information presentation - Optimized page layouts; Print report improvement. 4: Current version of the application presents certain difficulties to some users in terms of errors that users encounter. Aspects of system functionality is either missing or not working properly. Ensuring that the functionality is improved and system-specific errors are eliminated or minimized will ensure increased user satisfaction and improved user experience with the system.  Overview page does not display effective core information and dashboard defaults need to be improved; Random automatic sign-out when not idling; Lack of information validity checks (e.g., future date of birth, invalid height, invalid postal code or phone number); Mandatory complete date entry. 5: We assigned the login process to a separate category because most of the usability testing participants had issues specific to signup or login. Ensuring that users have positive experience at the very beginning is crucial because the first interaction sets the tone for the entire user experience.  Difficulty creating an account; Lack of clarity and simplicity with the login process; User perception that they are registering multiple times; Confusion with the privacy / confidentiality agreement and allowing access. 21

Phase 2 Deployment Evaluation Cardiac Wellness Institute of Calgary User experience interviews User experience discussion groups Provider discussion group Follow-up user experience interviews User experience interviews, discussion groups, and provider discussion groups: 6 weeks after the limited deployment to these users Follow-up user experience interviews: 12 weeks after the limited deployment to these users 22

What’s Next Improve: Develop Login and registration process User Experience within PHR Search and content presentation Personal medical device connectivity Develop Strategy for verification of users Communication strategy Mobile device support 23

Demonstration 24