Evidence Access on the Front Lines of Healthcare: Harnessing the Potential of

Wireless Devices

CADTH Symposium 2015Mollie Butler, RN, PhD. - Eastern Health

Sheila Tucker, M.L.I.S., B.Ed., B.A. (Hon), CPAD. - CADTH

Disclosure – Sheila Tucker & Mollie Butler

Relationship with Commercial Interest:• Grant/Research Support: None• Speaker Bureau/Honoraria: None• Consulting fees: None• Memberships on advisory committees, boards: None

Other Affiliations:• Sheila is a CADTH employee independently located in

Newfoundland Labrador• Mollie is an Eastern Health employee.

Objectives

Discuss the use of Health Technology Assessment (HTA) in policy review and update.

Describe how we used the reports.

Share what was found.

Share our current status and lessons learned.

Four Regional Health Authorities

Eastern Health Region

http://www.easternhealth.ca/Map.aspx#results

Background

Overview of the issue at Eastern Health• Call from a practitioner • Manager was following policy• Policy was dated (2009) – required a review

Initial Awareness of CADTH• Meeting between EH senior staff and CADTH• Information exchange• Connection with CADTH Liaison for NL

Defining the Problem and Deliverables

Safety and Risk

Request to CADTH for a Rapid Response

Informal cross country scan

Wireless Device Use and Patient Monitoring Equipment in Any Healthcare Delivery Setting: A Review of Safety and Guidelines (January 2013)Benefits:• Facilitate inter-professional communication;• Access to online library resources, evidence, electronic

patient data, electronic health records.

Risks:• Privacy • Increased risk of system malfunction due to viruses• Electromagnetic interference (EMI)

Q 1. What is the evidence that wireless devices interfere with patient monitoring equipment in any healthcare delivery setting?

Synopsis of Findings:

• Interference occurs when devices operate in a shared radio spectrum which is congested.

• Likelihood of interference increases with:– Increased transmitter powers;– Lower frequencies;– Shorter distances between devices.

Q 2. What is the evidence for the safe use of wireless devices when in the vicinity of patient monitoring equipment in any healthcare delivery setting?

Synopsis of Findings:

• Clinically significant interference in the functioning of medical equipment induced by wireless devices is rare and occurs at very short distances (mostly less than 3ft / 1metre) between wireless devices and medical equipment.

• Medical equipment may be significantly protected from EMI induced by wireless devices if its designated radio frequency spectrum is not shared by commonly used wireless devices.

Q.3 What are the evidenced-based guidelines for the use of wireless devices in any healthcare delivery setting?

Finding:

• Literature search for this report did not find any evidenced-based guidelines for wireless device use in health care settings.

Guidance Derived from this Report

• Healthcare administrators can work with experts to select equipment that are less predisposed to EMI.

• Equipment inventories can be a useful reference to advise new device acquisitions, and shape policy.

• Policies to regulate wireless devices used in highly instrumented areas in a healthcare environment.

Implications for Decision Making

• Benefits significantly greater than the risks.• Need for policy update to guide new practice– Existing RHA policy no longer relevant,

problematic• Evidence reframed the issue– From “No Use” to “Optimal Use”

• No evidence-based guidelines– Further investigation required – Outreach to other health systems

Informal Scan

Are there current jurisdictional policies governing the transfer, use, and storage of patient digital images used in healthcare delivery?

Results:• Limited• Need for new policy development on this topic.

Knowledge Exchange and Linkages

Identified need for outreach and knowledge exchange with other health organizations in NL and elsewhere in Canada.

Interagency collaboration• Opportunity identified to partner with CCHL-NL to

share findings and exchange knowledge• From a locally identified issue to pan-Canadian

dialogue• CCHL-NL Chapter Webinar

Informing policy on appropriate use of wireless devices in healthcare settings: a review of CADTH

evidence and discussion of policy options

• Webinar delivered on February 14th, 2014• Hosted by the Newfoundland & Labrador

Chapter of CCHL• Presentations from Eastern Health and CADTH• Objectives:– Highlight the issue and share evidence/findings.– Promote inter-jurisdictional dialogue

Impact Assessment

• CCHL webinar highly evaluated by participants• More linkages - snowball effect– Western Health

• New evidence requests to CADTH– Appropriate use of hand held wireless devices in

healthcare: guidelines (May 2014)– Personal wireless device use for wound care

consultation (May 2014)• Interest and use of reports in other jurisdictions

Current Status

Inter-Agency Working Group • Eastern Health • Western Health Authority • CADTH• Memorial University• NL Centre Health Information (NLCHI)

Deliverable • New RHA policies to guide practice

Lessons Learned to Date

Eastern Health• Importance of collaboration, partnerships and

sharing

CADTH• Benefits of the customer as a collaborator.• Tangible benefits of interagency collaboration

Acknowledgements

Katherine Chubbs, Vice-President and Chief Nursing Officer, Eastern Health

Chris Kamel and the Rapid Response Team of CADTH that worked on project RC0513

Dr. Kwakye Peprah, PhD, MBA(Fin), B.Pharm Clinical Research Officer, CADTH

Amy O’Brien, Canadian College of Health Leaders

For Further Information

Eastern Health - http://www.easternhealth.ca To discuss RHA policy - Contact Dr. Mollie Butler at Mollie.Butler@easternhealth.nl.ca

CADTHRapid Response – http://www.cadth.ca/en/publication/4097 Outreach – http://www.cadth.ca/en/cadth/knowledge-exchange

Thank you!