Presentation made at the ITCH 2017 conference in Victoria.

1. Abbas Zavar and Karim Keshavjee
1
ITCH 2017 Feb 18, 2017
Victoria, BC
Link to Open Access Paper:

2.  The Problem
 The Solution
 Prototyping of the solution
 User acceptance testing
 UTAUT questionnaire
 Findings
 Conclusion
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3.  Current EMRs are not able to
 Capture standardized data across EMRs
 Transmit data to a central repository
 Present guideline recommendations at
point of care
 Generate dynamic forms that
▪ Are customized to patients with multi-
morbidity
▪ Can be updated on the fly, as evidence
becomes available
 Allow A/B testing of forms for usability
and efficacy of CDSS
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4. …we could design clinical forms that
were usability tested
(with researchers, policy makers, patients and
providers)
met evidence-based clinical requirements and
incorporated into EMRs instantly or almost
instantly?
Independent of the EMR vendor
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5.  We co-designed a web-based form
for the management of patients
with 8 vascular diseases
 The Form has 5 major
functionalities
 The provider clicks on a link in their
EMR to retrieve the Form
 The Form is automatically pre-
populated with patient data
 Form expands or collapses
automatically, based on the diseases
a patient has
 Form provides guideline advice at the
point of care
 Form automatically tags instances of
medications into their class
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6. OSCAR
(Ubuntu)
Data Extraction
Server
(Windows)
Clinical Form
(Linux)
User
2. User Clicks on form
link in EMR
1. Overnight Extract over SSL
Db Extract
3. Request for Data Extract
4. Request for
Pre-populated Form
SSL Connection
5. Display
Pre-populated Form
UI

7. 7

8. 8

9. 9

10.  The UnifiedTheory ofAcceptance and Use ofTechnology is a
highly respected and validated model of technology uptake
 It allows implementers to predict whether a potential user will
actually use a new technology and the drivers for that uptake
 Behavioral intent as identified by the UTAUT predicts 70% of
actual use.
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11. 11
Performance
Expectancy
Effort
Expectancy
Social
Influence
Facilitating
Conditions
Behavioral
Intent
Attitude
Anxiety
Self-Efficacy
Actual Use

12. 12
Performance
Expectancy
54%
Effort Expectancy
67%
Social Influence
31%
FacilitatingConditions
55%
Behavioral Intent
67%
Attitude 43%
Anxiety 15%
Self-Efficacy 67%
ActualUse (Predicted)
47%
70%
N = 12

13. 13
Performance Expectancy - 54%
Form is Useful – 67%
Allows me to AccomplishTasks – 58%
Helps Increase Productivity – 33%
Allows Better Patient Management –58%

14. 14
Social Influence -- 31%
People who influence my behavior think it is important – 25%
People Important to me think it is important – 17%
Sponsor is Helpful– 25%
SponsorWill Support my use –58%

15. 15
Facilitating Conditions -- 55%
I have the resources to use the Form– 36%
I have the knowledge to use the Form– 67%
Form must be compatible w/ other systems– 92%
Assistance is available for use –25%

16. 16
Attitude –43%
Form is a good Idea– 64%
Makes Work Interesting – 33%
Form is Fun– 33%
I like working with Form–42%

17.  One Flow Sheet versus Multiple Flow Sheets
 Covers larger number of patients and covers patients with more
than one disease.
 Everything in one spot
 Easy to Use – Easy to Understand - Easy to Fill
 Comprehensive content
 Multiple Key Features including:
 Integrated CDSS
 Drug Classification
 Shrinking & Expanding Flow Sheet
 Resource Linkages
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18. • Collect structured evidence-based data on multiple diseases from all EMRs
• Send to data repository in real-time
• Real-time guideline advice to practitioners and patients and families
• Standardized calculation of quality indicators including patient experience
• Rapid updates as new evidence becomes available
• Ability to monitor knowledge translation effectiveness
• Support new models of care and Chronic Care Model
• Faster and less expensive ways of updating forms and guideline knowledge
across all EMRs in Canada
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19.  The Form Prototype is a very good first attempt at a multi-
morbidity form that is evidence-based and continuously
updatable
 Has goodAcceptance and Use characteristics
 Can be used for A/B testing for form improvement AND for CDSS
improvement
 We identified many areas for improvement in terms of
integration, the form itself, clinical decision support,
marketing and support and training
 Future projects need to address better user interface
integration in the EMR and 2-way data integration with
additional EMRs
 Overall, it appears that the Form is usable by clinicians
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