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Daniel Cornejo Palma

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    OS27 - Integrating the Community Sectors (ID 43)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 6
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      OS27.01 - Understanding the Technology Needs of Clinical End-Users for Care Coordination (ID 550)

      Daniel Cornejo Palma, WIHV; Toronto, Ontario/CA

      • Abstract
      • Slides

      Rural communities are a difficult place to try internet-based technology to improve health outcomes. Part of the difficulty stems from not incorporating the concerns of clinical end-users when implementing new technology. Traditional approaches to evaluating technology implementation focus on measuring patient outcomes. The importance of understanding clinical end-user interests is traditionally downplayed. Ignoring the concerns of users has lead to technology disuse and lacklustre patient outcome improvements in the literature. To improve the understanding of clinical end-user concerns, we created the Tool+Team+Routine (TTR) heuristic. TTR is based on principles from value proposition design, in which empathy for the user underlies the first step in implementing engaging solutions. TTR aims to improve the engagement in technology implementation by defining success metrics in terms that matter to clinical end-users.

      We used TTR to define success metrics for a digital platform set up to improve care coordination efficiency in a population of rural complex care patients. During protocol development, the evaluation team discussed or observed each TTR element with coordinators. We learned from coordinators that to understand meaningful platform use (i.e. ?tool? use), we would have to track usage. Coordinators also taught us that meaningful collaboration amongst 'team' members meant having case conferences, which prompted the inclusion of case conferences as a secondary outcome. Finally, we also learned that improvement to practice (i.e. ?routines?) meant reducing communication delays between health professionals. Thus, we developed a primary outcome, time to maintenance (TTM), based on elapsed time to highlight communication delays among providers.

      *Tool: Usage of the platform was low. Half of the cohort barely used the platform. Overall, 30% of all communication on the platform occurred between care coordinators and clients ?70% was between clients and family. The tool was designed to centralize patient-related conversations among health professionals but did not do so, due to lacking engagement from other providers. Team: We observed that case conferences occurred in only 15% of patients. Care coordinators noted that a minority of clients with health teams that adopted the communication platform seemed to experience an efficiency gain in reaching their goals. Routine:* Care coordinators? claim of an efficiency gain with app engagement was supported by observed data. Video call usage, a measure of engagement, significantly reduced the coordination delay per co-morbidity. The delay observed per comorbidity was 28.7 days without platform use (i.e.< 2 calls made in six months of follow-up). If patients made at least ten calls in six months, the coordination delay per comorbidity decreased from 28.7 to 19.9 days (p=0.035).

      TTR is a simple heuristic that identified metrics that were relevant to clinical end-users. The primary outcome reflected communication delays because coordinators identified delays as a vital concern to the efficiency of daily routines. Coordinator worries about the engagement of other care team members meant we measured clinician involvement closely. TTR-based evaluation results challenged decision-makers to consider clinical end-user concerns as vital next steps to address in this technology implementation.

      140 Character Summary:
      Traditional technology implementation approaches overlook end-user concerns. We present a practical framework to understand end-users: 'Tool+Team+Routine'.

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