1. 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 27 th, 2013 Jonn Wu, MD FRCPC John Waldron, CPHIMS 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. 3 Outline The Impetus for Change Phase I – Mobility Project Dr. Jonn Wu Evolving and Evaluating Mobile Phase II – Acting on Key Findings John 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

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

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

6. 6 CAIS, Desktops: Office Area

7. 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. 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 1.improved computer and EHR access. 2.access to up to date patient records. 3.mobile tools for use in patient rooms.

9. 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. 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. 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. 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. 13 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

14. 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. 15 Phase II: Baseline Key Observation:  Desire to use mobile for patient care activities.

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

17. 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. 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. 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. 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. 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)