Wayne H Ho*, Healthcare Human Factors, University Health Network, Toronto, Canada Peter Weinstein, University of Toronto, Toronto, Canada Diane De Sousa, Healthcare Human Factors, University Health Network, Toronto, Canada Christopher Flewwelling, University of Toronto, Toronto, Canada Amna Husain, Mount Sinai Hospital, University of Toronto, Toronto, Canada Trevor Jamieson, St Michael's Hospital, Toronto, Canada Robert Wu, University Health Network, University of Toronto, Toronto, Canada Joseph A Cafazzo*, Healthcare Human Factors, University Health Network, University of Toronto, Toronto, Canada Kevin Armour, Healthcare Human Factors, University Health Network, Toronto, Canada Irfan Dhalla, St. Michael's Hospital, Toronto, Canada Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: C-Rotunda Room Date: 2012-09-15 11:00 AM – 11:45 AM Last modified: 2012-09-12

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Background: Poor communication is one of the most common underlying causes of medical error. As there is no systemized approach to clinical collaboration, complex patients are particularly vulnerable to adverse medical events due to poor collaboration across the spectrum of health care providers.

Objective: In order to address this coordination gap, the development of a secure, mobile, device-agnostic, clinical messaging system for the collaborative care of complex patients was undertaken. The intervention is cross-institutional, cross-setting, and interdisciplinary, thus enabling clinicians to communicate with each other in a timely and asynchronous manner.

Methods: The clinical collaboration system was developed by an interdisciplinary team of clinicians and human factor engineers using a three phase user-centered design methodology, consisting of analysis, iterative design and evaluation phases. The analysis phase included a review of literature surrounding asynchronous distributed collaboration tools, as well as ethnography. Homecare physicians, homecare nurses, pharmacists, and community care coordinators were shadowed to ensure that the system aligned with clinical workflows. The iterative design and evaluation phases involved applying the findings from the analysis phase to inform the development of an interactive prototype. Additionally, cognitive walkthroughs were conducted with end users during each iteration cycle to evaluate system usability and revise prototype design.

Results: The project team is in the midst of finishing the tablet-based prototype. The literature review revealed that promoting informal and less hierarchical relationships encourages interdisciplinary teamwork and that for effective asynchronous communication to exist, messages must be simple and easy to read. Major themes emerging from the ethnography include the desire for information to be shared more openly, a desire to minimize time spent reviewing communications, and the dangers associated with providers being left out of the loop. These themes informed the design of the system, which in addition to providing basic patient and provider information, allows for open collaboration and discussion of patient issues. This discussion unfolds through a series of brief messages, which can be filtered or directed towards certain providers. Feedback from the cognitive walkthrough was positive. Representative users were pleased with the flat structure, and the messaging system that encourages the use of clear and concise messages. The system is currently being further refined in order to incorporate feedback regarding improving interactions around message creation and including a notification feature to alert providers of new messages requiring their attention.

Conclusions: Future work will include a randomized controlled trial (RCT) to evaluate impact on the patient, the clinician, and health care utilization outcomes. If successful, the collaboration tool should lead to improved care coordination, improved clinician efficiency, reduced emergency department visits, reduced hospital admission rates, and reduced adverse events.