1. Evidence Access on the Front Lines of Healthcare: Harnessing the Potential of Wireless Devices CADTH Symposium 2015 Mollie Butler, RN, PhD. - Eastern Health Sheila Tucker, M.L.I.S., B.Ed., B.A. (Hon), CPAD. - CADTH

2. Disclosure – Sheila Tucker & Mollie Butler Relationship with Commercial Interest: Grant/Research Support: None Speaker Bureau/Honoraria: None Consulting fees: None Memberships on advisory committees, boards: None Other Affiliations: Sheila is a CADTH employee independently located in Newfoundland Labrador Mollie is an Eastern Health employee.

3. Objectives Discuss the use of Health Technology Assessment (HTA) in policy review and update. Describe how we used the reports. Share what was found. Share our current status and lessons learned.

4. Four Regional Health Authorities

5. Eastern Health Region http://www.easternhealth.ca/Map.aspx#results

6. Background Overview of the issue at Eastern Health Call from a practitioner Manager was following policy Policy was dated (2009) – required a review Initial Awareness of CADTH Meeting between EH senior staff and CADTH Information exchange Connection with CADTH Liaison for NL

7. Defining the Problem and Deliverables Safety and Risk Request to CADTH for a Rapid Response Informal cross country scan

8. Wireless Device Use and Patient Monitoring Equipment in Any Healthcare Delivery Setting: A Review of Safety and Guidelines (January 2013) Benefits: Facilitate inter-professional communication; Access to online library resources, evidence, electronic patient data, electronic health records. Risks: Privacy Increased risk of system malfunction due to viruses Electromagnetic interference (EMI)

9. Q 1. What is the evidence that wireless devices interfere with patient monitoring equipment in any healthcare delivery setting? Synopsis of Findings: Interference occurs when devices operate in a shared radio spectrum which is congested. Likelihood of interference increases with: – Increased transmitter powers; – Lower frequencies; – Shorter distances between devices.

10. Q 2. What is the evidence for the safe use of wireless devices when in the vicinity of patient monitoring equipment in any healthcare delivery setting? Synopsis of Findings: Clinically significant interference in the functioning of medical equipment induced by wireless devices is rare and occurs at very short distances (mostly less than 3ft / 1metre) between wireless devices and medical equipment. Medical equipment may be significantly protected from EMI induced by wireless devices if its designated radio frequency spectrum is not shared by commonly used wireless devices.

11. Q.3 What are the evidenced-based guidelines for the use of wireless devices in any healthcare delivery setting? Finding: Literature search for this report did not find any evidenced- based guidelines for wireless device use in health care settings.

12. Guidance Derived from this Report Healthcare administrators can work with experts to select equipment that are less predisposed to EMI. Equipment inventories can be a useful reference to advise new device acquisitions, and shape policy. Policies to regulate wireless devices used in highly instrumented areas in a healthcare environment.

13. Implications for Decision Making Benefits significantly greater than the risks. Need for policy update to guide new practice – Existing RHA policy no longer relevant, problematic Evidence reframed the issue – From “No Use” to “Optimal Use” No evidence-based guidelines – Further investigation required – Outreach to other health systems

14. Informal Scan Are there current jurisdictional policies governing the transfer, use, and storage of patient digital images used in healthcare delivery? Results: Limited Need for new policy development on this topic.

15. Knowledge Exchange and Linkages Identified need for outreach and knowledge exchange with other health organizations in NL and elsewhere in Canada. Interagency collaboration Opportunity identified to partner with CCHL-NL to share findings and exchange knowledge From a locally identified issue to pan-Canadian dialogue CCHL-NL Chapter Webinar

16. Informing policy on appropriate use of wireless devices in healthcare settings: a review of CADTH evidence and discussion of policy options Webinar delivered on February 14 th, 2014 Hosted by the Newfoundland & Labrador Chapter of CCHL Presentations from Eastern Health and CADTH Objectives: – Highlight the issue and share evidence/findings. – Promote inter-jurisdictional dialogue

17. Impact Assessment CCHL webinar highly evaluated by participants More linkages - snowball effect – Western Health New evidence requests to CADTH – Appropriate use of hand held wireless devices in healthcare: guidelines (May 2014) – Personal wireless device use for wound care consultation (May 2014) Interest and use of reports in other jurisdictions

18. Current Status Inter-Agency Working Group Eastern Health Western Health Authority CADTH Memorial University NL Centre Health Information (NLCHI) Deliverable New RHA policies to guide practice

19. Lessons Learned to Date Eastern Health Importance of collaboration, partnerships and sharing CADTH Benefits of the customer as a collaborator. Tangible benefits of interagency collaboration

20. Acknowledgements Katherine Chubbs, Vice-President and Chief Nursing Officer, Eastern Health Chris Kamel and the Rapid Response Team of CADTH that worked on project RC0513 Dr. Kwakye Peprah, PhD, MBA(Fin), B.Pharm Clinical Research Officer, CADTH Amy O’Brien, Canadian College of Health Leaders

21. For Further Information Eastern Health - http://www.easternhealth.cahttp://www.easternhealth.ca To discuss RHA policy - Contact Dr. Mollie Butler at Mollie.Butler@easternhealth.nl.ca Mollie.Butler@easternhealth.nl.ca CADTH Rapid Response – http://www.cadth.ca/en/publication/4097 http://www.cadth.ca/en/publication/4097 Outreach – http://www.cadth.ca/en/cadth/knowledge-exchange

22. Thank you!