@karen_klassen

Transcription

1 @karen_klassen

2 Background HIV care needs are increasing in complexity due to co-morbid chronic conditions. Self-management support programmes are core components of chronic disease prevention and management. Privacy considerations are critically important in the care of people with HIV, so a successful intervention developed in partnership with the HIV community will provide an important test case for ehealth security and privacy. The level of engagement with online technologies by people living with HIV provides an insight into how people with chronic conditions may use these technologies in the future.

3 HealthMap

4 Qualitative Research Findings Health practices or behaviours were not always influenced by HIV Structure and social connectedness important Stigma an ongoing challenge Role of the clinic to discuss health beyond HIV Development of an intervention that not only reduces the risk of cardiovascular disease but also adds value to the day-to-day lives of PLHIV. 4

5 a cluster randomised trial of interactive health plans and selfmanagement support to prevent coronary heart disease in people with HIV Sarity Dodson,Karen M. Klassen, Karalyn McDonald, Tanya Millard, Richard H. Osborne, Malcolm W. Battersby, Christopher K. Fairley, Julie A. Simpson, Paula Lorgelly, Andrew Tonkin, Janine Roney, Sean Slavin, Jasminka Sterjovski, Margot Brereton, Sharon R. Lewin, Levinia Crooks, Jo Watson, Michael R. Kidd, Irith Williams and Julian H. Elliott

6 62 doctors Doctor recruitment and baseline survey PWHIV recruitment and enrolment 13 clinics (GPs, hospital and sexual health centre) 731 patients enrolled Doctor randomisation Intervention group Delayed intervention group Doctor training Surveys and interviews upon completion of programme components Baseline visit and survey 6 month follow-up survey 12 month follow-up visit and survey 12 month interviews and web analytics Doctor training HealthMap accessible to all doctors Figure 1. Flow chart of the study processes Dodson S, Klassen KM, McDonald K, et al. HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV. BMC Infect Dis. 2016;16(1):114 DOI: /s

7 Aims One of the aims of HealthMap is to evaluate patient and doctor experiences and acceptability of interactive health plans and self-management

8 1. Clinic visits with shared health record Use of the HealthMap shared health record during routine clinic visits All enrolled patient participants experience this core component of the intervention package 2. Health record and information Use of the HealthMap shared health record and health information at home All enrolled patient participants can access this portal from home as often or as little as they wish 3. Telephone and online self-management support Use of HealthMap telephone and online self-management support d Enrolled patient participants that smoke or that are identifie as mo der at e to hi gh risk of CVD will beencouraged to access self-management support 4. Online moderated group chat Use of the HealthMap group chat All enrolled patient participants can access the online group chat if they wish Figure 2. Intervention components the HealthMap model Dodson S, Klassen KM, McDonald K, et al. HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV. BMC Infect Dis. 2016;16(1):114 DOI: /s

9 Technology Brief Pathology data were imported into an online shared health record to be used by patients and healthcare providers. Team created an internal standard. Multiple sources were

10 Technology Brief Multiple methods were used: a third party client connecting clinical software data to the HealthMap database. bespoke data import programs were also created to translate site-specific data formats into a compatible format for HealthMap.

11 Technology

12 Technology

13 Challenges Diverse types of data storage formats (storage in flat files to traditional relational database structures). Flat files often did not conform to the HL7 standard, and included a wide variety of formats including PIT files. Non-standardised reporting of units and detection thresholds by different laboratories, necessitating workarounds in both display and storage of data.

14 Challenges Client-specific: many people with HIV (and other chronic diseases) attend multiple clinics and relocate frequently. Robust identification system development in a population where anonymity is valued.

15 Implementation User research during the Pilot 1 and 2 phases of the HealthMap project informed the design of the HealthMap platform. The pathology results are presented in HealthMap using interactive graphs with the previous four results displayed.

16 ipad- Barrier or Benefit Each provider mentioned the ipad as a barrier to using HealthMap Having it on a ipad works better but the logistics of having the ipad handy, loaded and charged at the time you want it might mean desktop will be easier. Benefits Patient could see the information up close. Patient could notice Actions which might not have been mentioned by the provider.

17 Graphs Graphs were highly valued by patients.

18 Pilot 1 findings 1. HealthMap was successful at facilitating a valuable conversation between the patient and the provider in each consult we observed 2. Time is critical for providers. They often run behind schedule, and any additional process/technology needs to consider this as a priority 3. The ipad was seen to be inconvenient to providers -> recommend creating a desktop version only. 4. Graphs and Actions need to be easy to read and interpret by both patients and providers. Both of these are critical to the success of HealthMap.

19 Design implementation 1. Pilot 1 findings reviewed by team (with research, clinical, design and software development expertise). 2. UI designer created final wireframes in December 2013.

20 Data integration implementation 1. Installation of 3rd party software (RecordConnect) locally at 8 GP sites 2. Development of bespoke data import systems for other sites. 1. Accessing clinic databases 2. Uploading manually entered data from a csv file

21 Traditional health record information Clinical Care Impact

22 HealthMap Clinical Care Impact

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24 Figure 3. A screenshot of the doctor s view of patient information Dodson S, Klassen KM, McDonald K, et al. HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV. BMC Infect Dis. 2016;16(1):114 DOI: /s

25 Individual Lab Results

26 Individual Lab Results Icon picture of reference range Hover description of reference range

27 Individual Lab Results Lab reference lines Action & Goalsetting prompts

28 Individual Lab Results Attention choices presented on patient dashboard Resources relating

29 Quantitative Evaluation Frequency of use of each HealthMap component Number of logins Page

30 Qualitative Evaluation Semi-structured interviews of patients, doctors and

31 Conclusion Challenges of creating a patient electronic health record. More work to be done to standardise clinical data. The HealthMap model of care aims to encourage people with HIV and their doctors to engage more actively in addressing the risk factors that contribute to the high coronary heart risk observed in PWHIV.

32 Acknowledgements Funding and in-kind support from: National Health and Medical Research Council (NHMRC Grant APP ), Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, National Association of People With HIV Australia and Alfred Health HealthMap Chief Investigators: Julian Elliott, Christopher Fairley, Sharon Lewin, Richard Osborne, Michael Kidd, Malcolm Battersby, Levinia Crooks, Aaron Cogle HealthMap Associate Investigators: Mukesh Haikerwal, Bruce Hollingsworth, Jennifer Hoy, Paula Lorgelly, John McNeil, Richard Moore, Jeffrey Post, Norman Roth, Julie Simpson, Andrew Tonkin, Marlene Velecky, Olga Vujovic, Andrew Way. HealthMap Project Team: Karen Klassen, Julia Stout, Karalyn McDonald, Sarity Dodson, Tanya Millard, Andrea Morrow, Jarrel Seah, Rick Moreira, Manolis Lamnotos, Alex Tam, Irith Williams, Matt Deeble, Nick Clements, Jasminka Sterjovski, Sean Slavin, Muirgen Stack, Tim Stern. Site Principal Investigators: Ban Kiem Tee, Bradley Forssman, Christopher Fairley, David Baker, Fiona Bisshop, Ian Woolley, Jeffrey Post, Julian Elliott, Mark Choong, Norman Roth, Richard Moore, Richard Wright, Sam Elliott Site investigators: Julie Silvers, Helen Lau, Sian Edwards, Mellissa Bryant, Cath Downs, Elizabeth Odgers, Denise Smith, Bradley Forssman, Norman Roth, Richard Wright, Janet Kidd, Mark Choong, David Baker, Jennifer Hoy, Michael Hand, Marilyn Mcmurchie, Craig Rodgers, Caroline West, Catriona Bradshaw, Marcus Chen, Katherine Fethers, Tina Schmidt, Kelvin Adams, Pauline Cundill, Christopher Sherman, Beng Eu, Tek Lim, Hsin-hua Liu, Mark O'reilly, Rebecca Overbury, Sven Strecker, Ban Kiem Tee, Nanette Presswell, Stephen Rowles, Ian Woolley, James Mcmahon, Sam Elliott, Edwina Wright, Kate Cherry, Michelle Giles, Anna Pierce, Alex Padiglione, Tony Korman, Andrew Buchanan, Benj Tarsh, Vincent Cornelisse, John Mills, Paul Cameron, Ching Thai Lim, Ivan Stratov, Rhonda Stuart, Suzan Delfendahl, Olga Vujovic, Margaret Hellard