1. Real World Benefits and Challenges of Deploying Mobile Applications in an Acute Care Setting e-Health 2013: Accelerating Change Sandra Moro – Senior Manager, IMT SickKids May 28 th, 2013

2. Faculty/Presenter Disclosure Nothing to disclose 2

3. The Hospital for Sick Children Founded 1875 Tertiary Care University Hospital 350 Paediatric beds Annual: 14,092 Admissions 386,864 Clinic Visits 58,761 Emergency Visits 11,340 OR Cases Inpatient 6,248 Day Surgery 5,092 3

4. Specialty Areas 18 Bed Med/Surg ICU 18 Bed Cardiac CCU 48 Bed Neonatal ICU Haem/Onc - 35 beds 275 new cancer cases annually (20 per cent of all new Canadian paediatric cancer cases) Other Specialities 4

5. Electronic Record Laboratory results 1970’s Computerized Provider Order Entry 1992 PACS 1999 SCM Phase 1 - 2005 Patient Lists – Labs SCM Phase 2 – 2008 Order entry Nursing Care Plans and eMAR Clinical Documentation – limited ICUs on SCC – Order entry on Paper Hybrid Electronic/Paper Record 5

6. Core Electronic System Allscripts – SCM version 5.5 (Upgrade to version 6.0 Summer 2013) Ambulatory Clinics (2013/2014) Critical Care (2014) Patient ADT System (Fall 2013) Pharmacy bi-directional Interface (2014) Modules: SCM Acute Care Order Reconciliation Manager (ORM) Rx Writer Health Manager Secure Health Messaging Facility Tracking Board Registration & Scheduling Point of entry for clinical information Platform for the hospital wide Electronic Patient Record: Order entry Laboratory results Clinical documentation Access to data from other sources Radiology reports and images EPC Clinical decision support 6

7. Mobile Application Strategy Mobile Application Framework A five-step process, which outlines how to get started with key contacts, development guidelines, developer resources, and instructions for mobile device use Industry experts are recommending that all organizations develop a framework as it is important to ensure alignment with the organization strategic directions and the IMT strategic plan For key clinical applications, work with vendors to understand their strategy and roadmap for mobility For other applications (do not exist), develop in-house or partner with third parties Agile development approach is used to develop applications as quickly as possible Due to the dynamic environment which is rapidly changing with respect to both hardware and software, development approaches have to change Currently have 48 mobile solutions at various stages of development 7

8. Mobile Application Deployment - Pilots Two vendor supplied clinical applications were deployed as part of the mobile efforts at SickKids: GE Centricity Mobile Access (Mobile PACS) and Allscripts Sunrise Mobile MD Both applications were implemented and deployed in a pilot phase, to clinicians across the organization The goal of each project was to assess the ease-of-use and intuitiveness of the specific mobile application, and to assess the integration of mobile technology/devices into the clinician workflow at SickKids 8

9. Mobile PACS Provides access to view radiology images and reports from Centricity PACS Supports a broad range of modalities Facilitates consultation with colleagues, review of information with patients/parents, and access to images during rounds Application was piloted with a group of 15 clinicians in the Diagnostic Imaging department Collaborated with the vendor and volunteered to be the beta site which resulted in getting a better version of the application SickKids was the first hospital in Canada to implement 9

10. Mobile MD Integrates with Sunrise Clinical Manager (SCM) Provides users with access to patient information and lab results Initial deployment view-only Pilot deployment included 20 participants from a cross- section of health care providers Physicians Nurse Practitioners Pharmacists Dieticians 10

11. Approach Standard project management methodology was used to deploy mobile clinical applications Information Services collaborated with Diagnostic Imaging and clinician leads to leverage existing technology already proven, and in-use at SickKids The clinician leads were instrumental in promoting the application to other clinician users which resulted in quick adoption and acceptance The applications had to meet the clinician requirements and address requirements for security and privacy Project management methodology and integrated quality management processes provided a robust structure to help the project team achieve the desired result and meet deadlines 11

12. Benefits Access to information at the point-of-care Intuitive, easy to use Portability Real-time access to information from anywhere in the hospital; improved efficiency Facilitates inter-professional collaboration in the delivery of care Supports resident teaching workflows Increases ability to discuss and review information with patients and their families Compliance with privacy legislation; no data retained on mobile device 12

13. Challenges Health care provider expectations Mobile version of the application should have all the functionality available on the desktop version Health care sector should be aligned with other sectors given the proliferation and use of mobile devices and apps Hospital’s wireless infrastructure should be ubiquitous Pressures on health care application vendors to rush to market their mobile app Limited functionality is available on the mobile version Need for flexibility with application design Rapidly changing and expanding mobile market (multiple device vendors, multiple platforms) 13

14. Lessons Learned & Conclusions Deployment of mobile technology has become an organizational priority and a necessity to provide superior services, effectively respond to evolving patients and care givers needs and achieve strategic goals of the organization Successful introduction of new mobile technology requires: Organizational focus on key priorities Meaningful staff involvement and teamwork Collaboration with internal and external stakeholders Effective communication Smart technology and smart devices provide organizations the opportunity to implement innovative solutions to optimize the delivery of patient care Need to leverage smart mobile technology and the opportunities it brings to deliver higher quality care, more efficiently and effectively, which will enable “the right care, at the right time, and in the right place”, and ultimately improve the health system overall 14