An Oncology Digital Companion for Patient-Reported Outcomes with Electronic Health Record Integration. Dr Zachary Tan

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1 An Oncology Digital Companion for Patient-Reported Outcomes with Electronic Health Record Integration Dr Zachary Tan

2 A Diagnosis Of Cancer Is Devastating Shocked Confused Disorganized Alone

3 The Digital Companion Traveling With Patients Diagnosis Treatments Survivorship

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5 CancerAid App Information Organiser Champions Community

6 Symptom Management in Oncology Care 50% Patient Symptoms Missed in Routine Oncology Care 1 Poor Symptom Control Avoidable Morbidity & Healthcare Costs Patient-Reported Outcomes (PROs) Missing Link 1 Laugsand et al., Health Qual Life Outcomes, 2010

7 Randomised Evidence Has Validated Symptom Tracking Basch et al. JAMA advanced cancer patients received standard care & follow-up Vs. 441 advanced cancer patients received web-based symptom reporting tool Standard Care Doctor print-outs & Nurse notifications 26 months overall survival 31 months overall survival 30% more chemotherapy Reduced ED and readmissions Improved patient quality of life CancerAid is the first commercially available mobile application to replicate this model of care at Cedars-Sinai Medical Center

8 Cedars-Sinai Medical Center

9 The Challenge CHALLENGE Multi-Specialty, Multi-Site Academic Health Centre Collect Patient Symptom Data to Improve Clinical Care Samuel Oschin Comprehensive Cancer Institute Integrated Data Access Within the Electronic Health Record Open 24 Hours Per Day 9000 Patients Per Annum Patients Enrolled in 5 Separate Sites

10 Planning Enterprise Information Services Technical Implementation Clinician Champions Multi-Disciplinary Meetings Clinician Engagement Workflow Mapping Integration into Processes Patient Engagement

11 Implementation ClinicianLink: CancerAid Integrated within Epic Two-Way Data Communication with FHIR APIs Patient App Profile Linked to EHR Patient Chart (MRN) Web Interface within Hyperspace Symptom Tracker Quantitative and Qualitative Data Pulled Into ClinicianLink Symptom Severity Warning HealthKit Integration for Patient-Generated Health Data HIPAA-Compliant Privacy by Design 2-Factor Authentication for App to EHR Linking Client, Transit, Server-Side Encryption Audit Controls and Consent and Privacy Policy

12 Linking CancerAid to Epic

13 CancerAid Symptom Tracker CancerAid ClinicianLink within Epic

14 HealthKit and Patient-Generated Health Data Patient physical activity integrated via CancerAid and presented within Epic using ClinicianLink. Patient performance status potentially correlated with activity levels.

15 Challenges for Implementation Workflow Integration Patient Engagement Clinician Engagement App Distribution Where to Integrate Who & What to Educate Who & What to Educate Where & When Suitable Patients Education Resources Education Resources to Download Who to Enrol Patients Empowering Clinicians Epic Linking to Counsel Patients Download Support

16 App Distribution Incompatible Smartphone Forgotten Apple or Google ID or Password Poor Wifi Connectivity Wifi Access Poor Cellular Connectivity

17 Go-Live Deployment Late May 2018 Staged Implementation Clinician Training Plan Education Resource Development CancerAid Support In-Person Support Support & Contingency Plans Phone and Support Lines Analytics Weekly Progress Reports Weekly Cedars-Sinai Meetings Iterative Product Improvements and Hypothesis Testing

18 Initial Results

19 Future Features Alerts Clinician Alerts for Deteriorating Patient Intervention Prescribable Patient Reminders Validated Surveys Patient Reported Outcome Surveys Quality of Life, Symptom Burden, Patient Distress Remote Clinician Survey Prescribing

20 Reflections Technology is Designing for Clinical Digital Health Apps CancerAid UX is Difficult to Build Workflows is as Difficult are Tools Key Focus Consider Carefully for User Experience and Engagement by Design Implementation Education Key for Community and Engagement Champion Support Networks are Key Drivers

21 CancerAid Journey

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24 Special Thanks to the CancerAid Team

25 Special Thanks to the Cedars-Sinai Team

26 Next Steps Evidence Generation Validating CancerAid Ethical Approval for Prospective Study at Chris O Brien Lifehouse Product Development EHR Agnostic Integrations via SMART on FHIR Mobile Application Development Seeking Australian Hospital Partners Australian Startup Australian Innovation Helping Australian Patients

27 Dr E: