Multidisciplinary Project Team Research Articles

Development of an Electronic Decision Aid Tool to Facilitate Mainstream Genetic Testing in Ovarian Cancer Patients.

Multigene panel testing is an important component of cancer treatment plans and risk assessment, but there are many different panel options and choosing the most appropriate panel can be challenging for health care providers and patients. Electronic tools have been proposed to help patients make informed decisions about which gene panel to choose by considering their preferences and priorities. An electronic decision aid (DA) tool was developed in line with the International Patient Decision Aids Standards collaboration. The multidisciplinary project team collaborated with an external health care communications agency and the MGH Cancer Center Patient and Family Advisory Council (PFAC) to develop the DA. Surveys of genetic counselors and patients were used to scope the content, and alpha testing was used to refine the design and content. Surveys of genetic counselors (n = 12) and patients (n = 228) identified common themes in discussing panel size and strategies for helping patients decide between panels and in identifying confusing terms for patients and distribution of patients' choices. The DA, organized into 2 major sections, provides educational text, graphics, and videos to guide patients through the decision-making process. Alpha testing feedback from the PFAC (n = 4), genetic counselors (n = 3) and a group of lay people (n = 8) identified areas to improve navigation, simplify wording, and improve layout. The DA developed in this study has the potential to facilitate informed decision-making by patients regarding cancer genetic testing. The distinctive feature of this DA is that it addresses the specific question of which multigene panel may be most suitable for the patient. Its acceptability and effectiveness will be evaluated in future studies.

An Electronic Teen Questionnaire, the eTeenQ, for Risk Behavior Screening During Adolescent Well Visits in an Integrated Health System: Development and Pilot Implementation.

Screening for risk behaviors is a routine and essential component of adolescent preventive health visits. Early identification of risks can inform targeted counseling and care. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system or to support quality improvement projects. Goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool (the eTeenQ), to evaluate acceptance of the eTeenQ, and to describe the prevalence of the selected risk behaviors reported through the eTeenQ. The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to (1) user interface and user experience, (2) the need to maintain patient privacy, and (3) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020, to August 27, 2021. During preventive health visits for adolescents aged 12 to 18 years, the eTeenQ was completed on tablets and responses were converted to a provider display for teens and providers to review together. Responses to the eTeenQ were stored in a REDCap (Research Electronic Data Capture; Vanderbilt University) database, and for patients who agreed, responses were transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported for those consenting to research. At the conclusion of the pilot, the study team conducted semistructured interviews with providers and staff regarding their experience using the eTeenQ. Among 2816 adolescents with well visits, 2098 (74.5%) completed the eTeenQ. Of these, 1811 (86.3%) agreed to store responses in the EHR. Of 1632 adolescents (77.8% of those completing the eTeenQ) who consented for research and remained eligible, 1472 (90.2%) reported having an adult they can really talk to and 1510 (92.5%) reported feeling safe in their community, yet 401 (24.6%) reported someone they lived with had a gun and 172 (10.5%) reported having had a stressful or scary event that still bothered them. In addition, 157 (9.6%) adolescents reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, and 43 (2.6%) reported they were or wondered if they were transgender or gender diverse. Of 11 staff and 7 providers completing interviews, all felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions. All 7 providers preferred the eTeenQ over the paper screening tool. Electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and well accepted among staff and clinicians. Most adolescents agreed for their responses to risk behavior screening to be stored in the EHR.

Towards a Transcultural Approach for Inter-Professional Communication in Complex IT Project Teams—Aiming to Avoid Cross-Functional and Cross-Hierarchical Conflicts

IT projects are becoming increasingly complex due to rapidly advancing technologies, the need to tackle more difficult problems, and the involvement of a larger variety of experts with different backgrounds and experiences from different countries and cultures. It is also common for these teams to often work remotely in virtual settings. In this context, besides conflicts between IT project team members, cross-functional and cross-hierarchical organizational conflicts might emerge as well. These conflicts can vary in terms of their origin, nature, and intensity. This paper is a qualitative study focused on understanding interpersonal communication-based conflicts in multicultural and multidisciplinary IT project teams. The purpose is to find a common approach that can mitigate and eventually resolve these conflicts, aiming to promote shared knowledge and ultimately reduce the gap in understanding and the likelihood of conflicts. Both secondary research (a literature survey) and primary research (involving experienced managers and experts from project teams in the Romanian IT industry) were conducted in order to reach the objectives, besides sets of lessons learned and recommendations, to develop a framework for systematic conflict analysis and to propose a practice for a transcultural framework of common team vocabulary. To achieve these, a number of conflicts were investigated in IT project teams and corresponding cases. Based on the research findings, the authors concluded that a more formal approach is needed to address the problem of conflicts. From a theoretical standpoint, this paper suggests the concept of management diversity and provides a typology of organizational conflicts. Nevertheless, the framework for systematic analysis of conflict typology (FACT) and the framework of common team vocabulary in the multicultural environment of IT organizational project teams, as well as the sets of lessons learned and recommendations, might be useful and inspiring for both scholars and managers, not only in the IT sector.

Abstract A122: Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability

Abstract Background: The rapidly growing population of older adults and racial/ethnic minorities with cancer necessitates innovative patient navigation strategies to address their unique needs. Our Enhanced Vulnerable Elders Navigation (EVEN) Program aims to increase the capacity to deliver high-quality, evidence-based oncology patient navigation services at a comprehensive cancer center, with the goal of improving equity in cancer care delivery. Methods: Based on a comprehensive needs assessment, the EVEN Program comprises three main domains: health information technology infrastructure enhancements, navigation workflow standardization, and stakeholder engagement. The primary outcome measure is time to treatment initiation. A quasi-experimental design compares outcomes of older adults with cancer who receive enhanced navigation during the implementation period to outcomes of historical controls (matched by age, race, and ethnicity) who received standard navigation during the lead-in "pre-implementation" period. We hypothesize that the EVEN Program will improve the timeliness of cancer treatment initiation among vulnerable older adults. Univariate and multivariable analyses using cox regression models will adjust for patient and health system factors. Logistic regression will assess the likelihood of treatment delay between the standard navigation and EVEN groups. Process metrics across multiple domains will be analyzed at 6-month intervals over 2 years. Qualitative interviews with program stakeholders will provide nearly real-time feedback on program implementation. Baseline Data Approximately half of newly diagnosed cancer patients (N>3000) seen at our institution's main campus in 2021 received navigation services, and at least half of those patients are estimated to be 65+. Patient navigators addressed language/communication barriers (17% of navigated patients) and social determinants of health (15%); they facilitated communication and emotional support (45%) and routinely made referrals to clinical care team members (39%) and for resource coordination (37%), such as interpreters, social work, financial counseling, and external resources. Most navigator contacts were in person (61%), followed by phone calls (34%). We found wide variation in time to initial cancer treatment across cancers, suggesting opportunities for improvement in care coordination. Conclusion: Our multi-component enhanced patient navigation program is conceptually grounded, innovative, with the potential to reduce cancer disparities among older adults from vulnerable populations. Our multidisciplinary project team includes expertise in geriatric oncology, implementation of patient navigator programs, health equity, community partnerships, and patient navigators with over 30 years of experience in compassionate coordination of cancer care. If proven feasible and effective, the EVEN Program has the potential to scale to our entire enterprise, other health delivery systems nationally, and long-term, to improve equitable cancer care for underserved older adults with cancer. Citation Format: Ana Tergas, Annette Mercurio, Lauren Cai, Lorena Gaytan, Marianne Razavi, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, William Dale, Narissa Nonzee. Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A122.

Increasing influenza and COVID-19 vaccination assessment rate in medical oncology clinics at a safety-net hospital.

437 Background: Vaccination against influenza and COVID-19 have been shown to reduce the risk of severe infection and adverse outcomes in immunocompromised individuals such as cancer patients. Consistent and accurate immunization assessment is the first step to identify patients who could benefit from these vaccines. The CDC Standards for Adult Immunization Practices recommend a vaccine assessment at every clinical encounter to ensure patients benefit from the latest recommendations. This process improvement project aims to increase COVID-19 and influenza vaccination assessment rate in new medical oncology patients within 2 weeks of their initial visit from a baseline of 6.1% - measured between 08/15/22 and 12/02/22. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX with an average of 2300 new cancer cases, of whom almost half are uninsured, and the majority belong to the racial/ethnic minorities. After mapping the assessment process and a root cause analysis, the multidisciplinary project team recommended a set of interventions with the goal to improve the assessment rate to 50%. The first PDSA cycle developed assessment policies and procedures, as well as group/individual training for clinic nurses. In the second PDSA, the weekly aggregate assessment rate was reviewed in safety huddles and a SmartPhrase was developed to document the immunization assessment in the after-visit summary (AVS). In the 3rd PDSA cycle, the immunization assessment tab was moved to nursing visit navigator in the electronic medical records (EMR) to streamline nursing assessment functions. This project is supported by the ASCO Quality Training Program and funded by the CDC/CMSS. Results: The first PDSA cycle resulted in a significant increase in vaccination rate, reaching 73.9% by week 4 (6-week average 51.9%). The second PDSA cycle resulted in the 5-week average rate increasing to 67.7%. A chart audit (included 25% of cases) showed that in 86.2%, patient’s vaccination was not up to date; however, the SmartPhrase was used in only 3.4% cases to document this in the AVS. Partial data (4-weeks) for the 3rd PDSA cycle shows an increase in average immunization assessment rate to 76.2%. In a post-intervention survey (response rate= 40.5%; 15), RNs estimated that the new immunization assessment added 1-5 minutes to their patient care time. In addition, 78.6% agreed/strongly agreed that the immunization assessment was an important part of their job, and 71.4% agreed/strongly agreed that the current process meets their expectations. Conclusions: Our interventions resulted in a consistent increase in immunization assessment for our new patients with minimal impact on clinic nurses’ time. In our next steps, we plan to further streamline the process across all patients (new and established). The ultimate goal of this project is to facilitate a high immunization rate among our cancer patients.

Using quality improvement to tackle the triple aim for children and young people with asthma: improving outcomes, experience and costs

Background/Aims Asthma in children and young people represents a substantial burden to the healthcare system, with these patients requiring frequent emergency care and having poorer health outcomes, leading to high system costs and poor patient experiences. This study used quality improvement methodology to achieve the triple aim of improved outcomes, better experience and reduced costs for those aged 0–16 years with asthma in north east London. Methods A multidisciplinary project team used quality improvement methods to implement and assess two interventions: a community high-risk asthma clinic and educational asthma-friendly school groups, both of which were delivered by a specialist asthma nurse. Population-level outcomes included asthma control test scores, accident and emergency department admissions and costs. Intervention-specific outcomes included number of clinic consultations delivered, did-not-attend rates and participant confidence ratings following the school sessions. Results Accident and emergency admissions for asthma reduced by 52%, with a 50% reduction in average monthly acute care costs. Asthma control test scores improved significantly, from an average of 18.56 to 22.34 out of a maximum score of 25 (P=0.000) following the interventions. Participants in the asthma-friendly school groups reported increased confidence in both day-to-day and emergency asthma management at the end of their sessions. Conclusions Having dedicated specialist asthma nurse input in the community and using school-based interventions can help to improve asthma care for children and young people, reducing the burden of frequent accident and emergency department admissions. Using quality improvement methods in pursuit of triple aim outcomes can help teams to work towards a shared goal.

Multidisciplinarity and teamwork in virtual real-life projects - reflection as a tool for development

Project teams will increasingly work virtually in multidisciplinary teams. The degree of virtuality varies from fully virtual to hybrid. The purpose of this study is to identify how the virtual team (VT) members experience multidisciplinary project work and team development in the context of international real-life projects in Higher Education Institutions (HEI).
 The data were gathered from student project teams´ final reports (n=7) and students´ individual reflection diaries (n= 37). Thematic content and sentiment analysis were used.
 The results showed that team members can experience professional diversity and team development in different ways. This can lead, among other things, to social isolation. However, multidisciplinarity was largely perceived as a positive factor in teamwork. The importance of team-level and individual-level reflections are also emphasized.
 The results of this study will be taken into further discussion at HEIs to ensure that the students acquire the competences needed in virtual project teams.

Improving primary care based post-diagnostic support for people living with dementia and carers: Developing a complex intervention using the Theory of Change.

The need to improve support following a diagnosis of dementia is widely recognised, but it is unclear how this can best be achieved within UK health and social care systems. A task-shared and task-shifted approach has been recommended, but there is limited guidance on how to achieve this in practice. As part of a programme of research, we developed an intervention to enhance the role of primary care in post-diagnostic care and support for people living with dementia and carers. We used the Theory of Change to develop a complex intervention informed by initial literature reviews and qualitative work. The intervention was developed through an iterative series of workshops, meetings and task groups with a range of stakeholders, including the multidisciplinary project team, people living with dementia and carers, service managers, frontline practitioners, and commissioners. 142 participants contributed to intervention development through face-to-face or virtual meetings. The intervention comprises three complementary strands of work focusing on: developing systems, delivering tailored care and support, and building capacity and capability. Clinical dementia leads, based in primary care networks, will facilitate the intervention providing tailored expertise and support. The Theory of Change proved useful in providing structure and engaging stakeholders. The process was challenging, took longer and was less participative than intended due to restrictions caused by the COVID-19 pandemic. We will next conduct a feasibility and implementation study to explore whether the intervention can be successfully delivered within primary care. If successful, the intervention offers practical strategies for delivering a task-shared and task-shifted approach to post-diagnostic support that could be adapted for similar health and social care contexts internationally.

Vietnam general contractors’ perceptions on challenges to the delivery of green building projects

This study focuses mainly on investigating differences in Southern and Northern general contractors’ perception of challenges in executing green building projects. The questionnaire survey-based data analysis results show that there is a good consensus between general contractors (GCs) from these two regions on the top two most critical challenges in delivering green building projects. They are “lacking of legal regulations and technical codes on green building”, and “more difficult to early establish a competent, integrated, and multidisciplinary green building project team”. Additionally, the Mann-Whitney U-test reveals that there are a significant difference on perception of the GCs from Northern as compared with those from Southern on the five challenges, including “shortage of reliable green building materials, technologies, and equipment in the market”, “lack of reliable suppliers of green products, materials, equipment”, “lack of appropriate tools/laboratories specific for testing, assessing, measuring, and inspecting the green performance of construction products”, “difficulty in selecting and managing subcontractors”, and “difficult in comprehending the green specifications”. The study may be beneficial not only for the central policymakers but also for the local governments, industrial practitioners and project stakeholders to gain a better understanding of the major challenges in executing green building projects at local or regional level. As a result, the study proposed many solutions specific for each of these regions to promote the development of the local green building industry.

"I don't think education is the answer": A corpus-assisted ecolinguistic analysis of plastics discourses in the UK.

Ecosystems around the world are becoming engulfed in single-use plastics, the majority of which come from plastic packaging. Reusable plastic packaging systems have been proposed in response to this plastic waste crisis, but uptake of such systems in the UK is still very low. This article draws on a thematic corpus of 5.6 million words of UK English around plastics, packaging, reuse, and recycling to examine consumer attitudes towards plastic (re)use. Utilizing methods and insights from ecolinguistics, corpus linguistics, and cognitive linguistics, this article assesses to what degree consumer language differs from that of public-facing bodies such as supermarkets and government entities. A predefined ecosophy, prioritizing protection, rights, systems thinking, and fairness, is used to not only critically evaluate narratives in plastics discourse but also to recommend strategies for more effective and ecologically beneficial communications around plastics and reuse. This article recommends the adoption of ecosophy in multidisciplinary project teams, and argues that ecosophies are conducive to transparent and reproducible discourse analysis. The analysis also suggests that in order to make meaningful change in packaging reuse behaviors, it is highly likely that deeply ingrained cultural stories around power, rights, and responsibilities will need to be directly challenged.

Attaining Individual Creativity and Performance in Multidisciplinary and Geographically Distributed IT Project Teams: The Role of Transactive Memory Systems

Contemporary IT project teams demand that individual members generate and implement novel ideas in response to the dynamic changes in IT and business requirements. Firms rely on multidisciplinary, geographically distributed IT project teams to gather the necessary talent, regardless of their locations, for developing novel IT artifacts. In this team context, individuals are expected to leverage dissimilar others’ expertise for creating ideas during idea generation (IG) and then implement their ideas during idea implementation (II), known as the IGII process. Although much has been done to explain individual creativity, the extant literature offers little theoretical understanding on how to address the double-edged effects of dispersions in both functional expertise (ExpDisp) and geographical locations (GeoDiss)—the two defining characteristics of multi-disciplinary, cross-locational IT project teams—on individual creativity and subsequent performance. Drawing on the IGII framework, we propose transactive memory systems (TMSs) as a plausible team-level solution to tackle the challenge. With a multi-wave multi-level dataset from 141 members and their supervisors from 35 IT project teams, we found that team-level TMS and GeoDiss interactively moderate individual-level IGII processes in multi-disciplinary geographically-distributed IT project teams during both II and IG, but in qualitatively different ways.

Creating a Multidisciplinary Collaboration Service-Learning Experience in Design Education

AbstractThe design process in most organizations is often collaborative and interdisciplinary in nature. Yet most institutions of higher learning do not offer students the opportunity to work in multidisciplinary teams. This study follows an experiential service-learning project over 3 years to explore the role of multidisciplinary project teams on design education outcomes. Findings suggest that the quality of designs improved over time and students consider experiential learning in multidisciplinary teams to be a valuable component in their education, increasing their job readiness upon graduation.

'Everyone is trying to outcompete each other': a qualitative study of medical student attitudes to a novel peer-assessed undergraduate teamwork module.

The centrality of teamwork in ensuring the effective functioning of institutions across all sectors is undeniable. However, embedding teamwork into higher education has been hampered due to a range of deeply entrenched practices associated broadly with the foregrounding of knowledge, beliefs about the place of skill training and routines of assessment. As a result, despite an urgent need to address teamwork, little progress has been made with respect to progressing teamwork education. We have designed and evaluated a novel teamwork module delivered to fourth‐year undergraduate medical students involving placements, a cocreated piece of work, reflection and summative peer assessment. This paper aimed to investigate whether the module increased students’ insight into teamwork, including their own skill development, and whether their perceptions of teamwork changed. Throughout the evaluation, students played a key role, with four final‐year medical students working alongside others in the multidisciplinary project team. Five distinct themes emerged from our in‐depth, semi‐structured interviews: (a) importance and meaning; (b) insight into skill development; (c) transferability; (d) peer assessment; and (e) resistance to teamwork education. Themes had positive and negative components, and student perceptions changed in multiple ways after experiencing a longitudinal educational opportunity to develop their teamwork skills. Before practice, students focused on superficial explanations and on where they might improve. In contrast, after practice, students conveyed deeper insights, contextualisation, focus on how they might improve, and shared structured reflection.

Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach.

BackgroundPersons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work.ObjectiveThis study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]).MethodsA user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups.ResultsThe reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees’ goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees’ progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface.ConclusionsThis study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting.

Concept of a design activity supporting tool in the design and development process of cyber physical system

ABSTRACT Cyber-Physical Systems (CPS) are systems that link cyberspace with the physical world by means of a network of interrelated elements (sensors and actuators) and computational engines. These different assets make it difficult to design properly and effectively with them all. Additionally, the designing of CPS requires multi-disciplinary project teams and the investigation of all activities which CPS should perform. The designers have to share their knowledge, experience and identify the assets and activities which are necessary for proper CPS functioning. The proper identification process of CPS activities allows improvement of the design process through more precise and problem-activity-dedicated knowledge and activity-design models management. This process can also be supported by dedicated software tools which enable easy access to the acquired and accumulated knowledge.

102 Virtual family-centered rounds: A collaborative necessity during COVID-19 and beyond

Primary Subject areaHospital PaediatricsBackgroundFamily-centered rounds (FCR) are the cornerstone of pediatric hospital care and have many proven benefits including improved patient outcomes, satisfaction, communication and safety. Traditionally, FCR take place in the patient’s room; however, due the COVID-19 pandemic, entering patient rooms was no longer advisable in order to maintain physical distancing and preserve personal protective equipment (PPE). Therefore, it became clear early in our pandemic response that a new process was required to ensure the benefits of FCR were maintained given their paramount importance to safe and quality patient care.ObjectivesThe objective of this study was to virtualize the in-person FCR process used by our pediatric inpatient medicine teams to improve safety and reduce PPE costs during the COVID-19 pandemic.Design/MethodsWe quickly identified available hardware (laptops, tablets) and video conferencing software, assembled a multidisciplinary project team and secured administrative and quality improvement support. Quality improvement methodology and participatory design were used to develop and refine our virtual family-centered rounds (vFCR) standard work, and on April 6, 2020 we launched our first vFCR. Over the next 3 months we engaged in a series of plan-do-study-act (PDSA) cycles to iteratively improve our process: nurse auditors attended vFCR daily then met with our project team to review data and observations, and real-time feedback was sought from patients and caregivers.ResultsData collected on 1792 vFCR between April 6 and July 31, 2020 revealed 74% of nurses, physicians and trainees were satisfied or very satisfied with vFCR and 88% felt they had a good understanding of the patient care plan after vFCR. 79% of patients and caregivers were satisfied or very satisfied with vFCR and 88% of caregivers felt like a valued member of their child’s care team. We met our target of 10 minutes per patient in 74% of vFCR with an average transition time of <3 minutes between patients. Patients and caregivers felt vFCR were collaborative, more private and less intimidating than in-person FCR, and some even preferred the virtual approach.ConclusionDuring this pilot, we achieved a standardized vFCR workflow that is safe, feasible, efficient and confidential, with high levels of stakeholder satisfaction and support. vFCR was highly valued by families and yielded unanticipated benefits. Based on current usage, vFCR are saving ~$36,000 monthly in PPE. The importance of this work during the COVID-19 pandemic is clear, but also has benefits in non-pandemic times, including allowing caregivers to participate in FCR when they cannot be at the bedside, enhancing FCR confidentiality, and improving communication and care for isolated patients. Furthermore, the vFCR process is easily adaptable to other inpatient workflows such as consults and multi-disciplinary meetings. We believe this virtual care model is both highly relevant and transferable to a variety of health care settings across Canada and beyond.

COVID-19 surveillance robot: rapid innovation for public health pandemic management

BackgroundCOVID-19 surveillance added a significant workload to the eight HSE-Departments of Public Health in Ireland. HSE-HPSC rapidly developed a fit-for-purpose robot to navigate the national infectious disease reporting system (CIDR) to automate three manual processes; laboratory records, notifications and contact-tracing data; which takes a surveillance scientist 26 minutes per case on average.MethodsHSE-HPSC managed and delivered a multidisciplinary project team to develop the rapid solution. The robot was designed to operate the CIDR system using an agreed set of rules, developed through business process analyses of the ‘first wave', stakeholder engagement and technical collaboration. Development began in April 2020, and went live in August 2020 after phases of testing, piloting, and hyper-care.Results Successful integration: The robot aligned COVID-19 surveillance data across three national HSE information systems.Degree of automation: The robot processed greater than 80% of cases just like a human. The remaining 20% are flagged by the robot for data quality checks by the regional public health teams.Time-saving: The robot operates quicker than a human, 3.3minutes per case compared to 26minutes. Therefore for every 100 cases, the robot saves 38hours per day.Out-of-hours capacity: Robots currently operate for 22hours per day, resulting in overtime cost-savings for the HSE.Surge capacity: The automation was expanded to 42 robots for ‘third-wave' surge capacity.Sustainable change in surveillance system: Robots can be expanded for surveillance of other notifiable diseases. ConclusionsThe robot: delivered a fit-for-purpose pandemic resourcerelieved the underfunded public health system of the administrative burden of COVID-19 surveillancedelivered timely data for epidemiological reporting by the HSE-HPSC to the National Public Health Emergency Team. Key messages Through rapid collaboration, the robot successfully delivered a fit-for-purpose public health resource that aligned COVID-19 data across HSE information systems and achieved time/cost savings.The robot strengthened the public health surveillance response in Ireland.

Chemotherapy roadmaps in pediatric oncology: A digital electronic medical record integrated solution.

Delivery of antineoplastic regimens in the pediatric setting is facilitated by a paper roadmap. Paper roadmaps are the key safety tool required for safe ordering. Electronic medical record systems offer technological solutions for ordering antineoplastic regimens, however, do not offer a solution that integrates paper roadmaps digitally. A multidisciplinary project team implemented real-time clinician scanning of paper roadmaps into the electronic medical record. The rate of missing roadmaps decreased from an average of 1.6 to 0.8 per week. Pharmacists gained 3 h of productivity daily. Providers spend an average of 35-45 s and a total of seven clicks each time a roadmap is scanned. Overall, the clinical systems analyst spent less than 1 h of total build time. Implementing roadmap scanning decreased the rate of missing roadmaps, increased pharmacist productivity, and required a nominal amount of analyst and provider time. In addition, this solution allows for concurrent viewing of the roadmap files from any connected computer, facilitating an easier co-signature process for providers, pharmacists, and nurses. These results suggest that implementing real-time scanning of roadmaps can improve oncology care efficiency while maintaining the same safety rigor that paper roadmaps offer.

An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach.

BackgroundDigital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs.ObjectiveThis study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health.MethodsWe comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs.ResultsWe identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE’s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service.ConclusionsAn iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively.

User‐Centered Design of a Communication Tool to Address Diabetes Disparities in African American Communities

Research ObjectiveAfrican Americans are disproportionately impacted by diabetes, with high rates of diabetes‐related morbidity and mortality. Despite the importance of addressing socio‐cultural factors in the clinical setting, many providers lack the expertise to effectively discuss these issues with patients. We examined patient and provider perspectives regarding patient‐provider communication about diabetes disparities to design a tool to facilitate discussions about diabetes health disparities.Study DesignWe used an iterative user‐centered design approach to develop a paper‐based diabetes disparities communication tool. The multidisciplinary project team included experts in family medicine, pharmacy, health disparities, public health, communications, health literacy and graphic design. We conducted a series of focus groups during 2017 and 2018: two with family medicine residents (n = 9) and four with patients with diabetes (n = 29). A semi‐structured interview guide explored participant perspectives on: (i) awareness of diabetes health disparities; (ii) patient‐provider communication about diabetes disparities; and (iii) a communication tool to facilitate patient‐provider communication about diabetes disparities. The communication tool prototype was iteratively updated and shared in subsequent focus groups for feedback on content and usage. Audio recordings of focus group discussions were transcribed, coded, and analyzed for themes using content analysis.Population StudiedFocus group participants were recruited from two family medicine practices (one urban and one suburban) with active residency programs affiliated with a large academic medical center in North Carolina. Participants included 9 family medicine residents at various stages of residency (4 female, 5 male) and 29 African American patients with diabetes (20 female, 9 male), who received care at the same practices.Principal FindingsKey themes from focus groups with residents included: (i) limited access to health disparities information; (ii) limited time to discuss health disparities with patients; (iii) need for easily accessible information; and (iv) experiential learning opportunities to build confidence in discussing health disparities. Key themes from focus groups with patients included: (i) benefit of discussing diabetes health disparities with their providers; (ii) value of a communication tool with actionable steps; (iii) use of imagery that reflects the diversity of African Americans; and (iv) community outreach to address health disparities. The final “Diabetes Health Disparities in African American Communities” communication tool provided information on health disparities statistics and social determinants of health. The tool also included a notes section to facilitate discussions about what the patient would like to work on and barriers to staying healthy.ConclusionsAfrican American patients and family medicine residents find value in discussing diabetes health disparities during the clinical encounter and perceive that a paper‐based communication tool with actionable steps can help facilitate those discussions. Both patients and residents perceive that activities outside of the clinical setting like community outreach are needed to enhance awareness of diabetes health disparities and social determinants of health, and improve community health.Implications for Policy or PracticeCommunication tools may help providers discuss diabetes health disparities with African American patients and provide the opportunity to address barriers to improved health. Future research should test this and similar tools in the clinical setting to determine effectiveness in clinical practice.Primary Funding SourceAtrium Health Center for Faculty Excellence.