The use of mobile electronic prescribing to drive quality of oncology care delivery.

Abstract

586 Background: This pilot technology enhancement project set out to improve the quality of care for oncology patients by developing a mobile application for writing prescriptions (non-chemotherapy) and narcotics. We describe usage of this new mobile application and associated timeliness of care delivery, provider workflow efficiencies and patient safety metrics. Methods: Agile methodology was used to develop the workflow and software for the mobile application. Internal Patient Safety Usability Testing (PSUT) was used to assess high-risk tasks amongst potential users (n = 7). High-risk tasks were defined as those which, based on human error, could lead to potential patient harm or unsafe conditions. High-risk tasks included the ability for users to understand/acknowledge allergy and drug interactions, edit a selection, select and send to the appropriate pharmacy, and locate the record of the completed prescription within the patient’s chart through the mobile application. A pilot study was also conducted among oncologists (n = 14). A quantitative metric was measured to understand the adoption and usability of the mobile application. Qualitative feedback was also obtained. Results: 1. PSUT identified a need for improvement with recognition of interaction severity and differentiating an allergy versus a drug interaction. A design modification was also made to introduce a three-second hold to acknowledge an allergy. This was done to encourage users to take appropriate time to visualize and comprehend allergy and interaction information before advancing the workflow. 2. During the pilot study, 400 mobile prescriptions were written. After-hours writing of prescriptions in the mobile application increased (11.8%) compared to the EMR (3.5%). The average amount of time from initiation of writing a prescription to completion was 62 seconds in the mobile application. There were no high-risk patient safety incidents observed during the pilot study. Qualitative data from participants included themes around convenience, feasibility, improved access to care, and safety. Conclusions: Usage of the pilot mobile application demonstrated a safe and efficient approach to increase the quality of care delivery for oncology patients. Usage also suggests an increase in patient access to care after hours.