Emily Seto*, University Health Network, Toronto, Canada Cheryl Reid-Haughian, ParaMed Home Care, Toronto, Canada Jonathan Tomkun, University of Toronto, Toronto, Canada Caterina Masino, University Health Network, Toronto, Canada Deb Mulholland, CellTrak, Toronto, Canada Joseph A Cafazzo*, University Health Network, Toronto, Canada Track: Practice Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: Mermaid Room: Room 4 - Queenshithe Date: 2013-09-23 04:00 PM – 06:00 PM Last modified: 2013-09-25

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Background: Various care models exist for individuals with heart failure in Canada. Their care can be delivered by a cardiologist, a multi-disciplinary team at a heart function clinic, a primary care physician, a homecare nursing service provider, or a combination of the above. Healthcare information technology shown to have success with one care model may produce different results in an alternative care model.

Objective: The objective of this work was to adapt and evaluate a mobile phone-based heart failure telemonitoring system for use in a homecare nursing model (ie, a nurse visits the client’s home). The telemonitoring system was originally developed and has been evaluated for patients being followed by a heart function clinic team.

Methods: A field study of homecare nursing was conducted to gain insight into the workflows, processes, and expectations associated with this care delivery model. In addition, a team consisting of representatives from a homecare nursing service provider, representatives from the technology vendor that provides a mobile clinical tool to the homecare nursing service provider, as well as researchers, was assembled to help inform and guide the work. Detailed workflow diagrams were created to inform the integration of the telemonitoring system into the current processes. Usability testing was conducted with 4 homecare nurses and 3 other homecare nursing agency staff to help ensure the end product met the needs of users. Saturation of information was achieved after usability testing with 3 heart failure patients (original client interface was only slightly modified). User acceptance testing was then performed to test the entire flow of information for the system. Presently, a clinical feasibility trial is being conducted with approximately 15 heart failure clients.

Results: From the field study and discussions with the representatives from the homecare nursing service provider and vendor, it became apparent that the telemonitoring system required extensive customization for the homecare nursing care model. Modifications to the system included changes in the instructions to the clients based on their daily physiological parameters, method to automatically alert clinicians to deteriorating health, means of viewing patient data and documenting clinical actions taken, and method of setting up of threshold values.

Nine workflow diagrams were created to map out the various processes associated with telemonitoring. The diagrams were continuously modified until the optimal process of integrating the telemonitoring system was achieved. They proved to be invaluable for understanding the complex current workflows and clarifying the processes for the feasibility trial.

The feasibility trial will conclude by the end of the summer of 2013. The trial results will be presented, including a summary of the interviews of the clinicians and clients regarding their experiences.

Conclusions: The workflow of the care model has to be taken into consideration when developing and deploying telemonitoring systems. Adapting these systems into different care models should include assembling a team with representatives from all stakeholders, detailed mapping of the current and proposed workflows, usability testing with all end user groups, and user acceptance testing.