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Ingenious Award is “a wonderful recognition” for all the hard work and “a tremendous partnership” between clinicians, project management experts and technical specialists, says Vicky Ramirez, Senior Project Manager for IT Transformation at UHN and a member of the project team. (Photo: UHN)

A UHN-created mobile tool for obesity that has improved efficiencies and shown dramatic behavourial and health benefits for patients, has won a national award.

The UHN Advanced Clinical Documentation (ACD) mobile tool, which combines an iPad and a comprehensive clinical treatment application, comes from UHN’s own Bariatric Clinic, Centre of Excellence, at the Toronto Western Hospital (TWH). And, last night, it was recognized with an Ingenious Award from the Information Technology Association of Canada (ITAC) at a gala event at the Four Seasons Toronto Hotel.

"This is a wonderful recognition of a lot of hard work and a tremendous partnership between clinicians, project management experts and technical specialists," says Vicky Ramirez, Senior Project Manager for IT Transformation at UHN, and a member of the project team.

The ACD tool is an example of how the Bariatric Clinic at TWH is driving the digital and innovation healthcare agenda with leading edge mobile assessment tools in a busy, ambulatory clinic. It not only digitizes a complex multi-clinician process but transforms it along the way.

The Ingenious Awards program celebrates enterprises that demonstrate measurable evidence of productivity improvement, efficiency gains, revenue growth, overall business transformation or other organizational outcomes through the use of technology. Nominations come from across Canada and represent a broad cross-section of organizations in the private, public, and not-for-profit sectors.

At UHN, and in Canada, there has been an increasing need for comprehensive, integrated care models to address complex and chronic healthcare conditions.  Obesity has been recognized as a national epidemic resulting in $1.6 billion in healthcare cost annually in Ontario.

Image of Ingenious Award Illustration
Prior to implementing the UHN Advanced Clinical Documentation (ACD) mobile tool tool, clinicians used non-standardized paper-based forms that were often repetitive, illegible or incomplete, and not readily accessible for timely patient care. (Graphic: UHN) ​

The Ontario Ministry of Health and Long-Term Care responded to this care gap and funded the creation of the UHN ACD mobile tool with the ultimate goal of increasing treatment capacity, providing efficient, integrated delivery of health services and improving patient outcomes. 

The tool is a combination of a device (iPad) and a comprehensive clinical application that support integrated obesity care across the treatment continuum.  For the implementation, UHN put together an integrated team composed of experts in medical and behavioral health, project management, technical specialists and human factors engineers.

Moving Away From Paper

The solution had to capture the complexities of a patient's condition using an easy-to-use tool while at the same time balancing the unique requirements of UHN's interprofessional care team and remaining patient-centred.  Prior to implementing the tool, clinicians used non-standardized paper-based forms that were often repetitive, illegible or incomplete, and not readily accessible for timely patient care.

Michael Caesar, Senior Director of Information Management at UHN, explained that UHN didn't simply want to digitally replicate existing paper-based forms. 

"This project scraped away the old way of doing things and looked at it in a different way," Michael said.  "We examined what information the care providers need to care for the patient, when they need it, and what they have to capture during their interaction with the patient.

During the design phase, focus groups were held with team members to collect thousands of data points mapping the entire continuum of care; this resulted in a broad systems view of the patient and data flow.  New processes were designed to ensure the flow of information aligned with clinicians' workflow and care practices.

"This is a life-changing process for a patient," explained Vicky. "The preparation involves everything from dietary changes to monitoring patient's mood and sleep patterns.  All of those steps, and hand-off between those steps are critical and had to be designed accurately and safely."

Equipped with a well-designed process, the team optimized and consolidated documentation forms and process and built smart, standardized templates using an agile approach.  Clinicians were trained in UHN's Human Factors lab to simulate a true-to-life pre-and-post surgical assessment.  Clinician feedback was rapidly incorporated into the design allowing them to immediately see and evaluate changes.

Digitizing the Patient Journey

The end result was a comprehensive, innovative digital tool that:

  • Captures a patient's entire story: The structured, standardized templates capture a patient's journey pre-and post-surgery.  The standardization minimizes the documentation complexity and variation across five medical professions.
  • Supports collaborative integrated care: The tool enhances interprofessional practice alignment, care coordination and communication across the continuum of care as critical information is accessible anytime, anywhere.
  • Focuses on enhancing patient outcomes: Patients are followed for multiple years in clinic; patient history and progress are presented in trending graphs and support early intervention to manage risk.
  • Helps make better decisions: The tool facilitates a structured interview model that supports a clinician's cognitive process while documenting evaluation and care.  Built-in decision support tools use logic-based algorithms to generate diagnosis and calculate clinic scores.

"UHN succeeded in incubating clinical innovation by deploying an easy to use point-of-care mobile tool that provides integrated care to patients with complex needs" Vicky said.

Measurable Results

The project was completed in 2014, and the team has since had time to evaluate its results. It found a 33 per cent increase in the number of patients seen on surgeon clinic days.  The system has helped lower wait times from 128 to 63 days.  Trending data captured over three years has shown dramatic behavioural and health status benefits such as improvements in depression and anxiety scores.

Thanks to a stellar, dedicated team, UHN has created an example of how it should be done. ​

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