1. Alberta’s Personal Health Record Platform www. MyHealth. Alberta
Alberta’s Personal Health Record Platform eHealth 2013
May 27, 2013

2. Agenda Demonstration Current Status User Engagement Communications
Personal Health Record Solution
Benefits Evaluation
Demonstration
Q&A 2

3. Personal Health Portal Vision
“MyHealth.Alberta is the Alberta source for trusted health information and secure on-line health services that will empower Albertans in managing their health and wellness” 3

4. Program Goals
The Alberta Personal Health Portal (MyHealth.Alberta.ca) is intended to provide the following benefits to Albertans, their health care providers and the health care system:
Albertans will have an improved ability to proactively manage their wellness and health.
Albertans will have an improved ability to access the health services available to them.
Patients and clinicians will have an improved ability to interact with one another.
Patients can more effectively participate in managing their treatment.
Albertans can more effectively engage the support of, and assist others, in treatment.
Health system efficiencies will be increased.
The health system will be more informed of Albertan’s health care experience.

5. Current Usage
Works out to 1.2 million visits a year. HealthLink is running about 1 million calls per year currently. 14 – 16 percent of the calls end up at emerg.

6. Multiple ways to provide feedback
User Engagement
Multiple ways to provide feedback 6

7. Reporting

8. Public Advisory Group Governance Review Competitive Process
Open to all Albertans
First meeting April 4th, 2013 in Edmonton
Demographic Coverage
Selection process outlined demographic coverage we were seeking. Age, education – level , ethnicity, location. We checked with our legal regarding making selections based on these criteria and based on the goals of the group we were allowed to proceed. 45 applicants, screened down to 23 interviews and 14 selections. 1 member under 30, the remainder over 40 with several members over 60. education is almost exclusively post sec with several members with masters level male-female ratio. Urban 12 members with 2 rural. 8

9. Clinical Engagement Integrated Clinical Working Group – PHP Subgroup
Physicians, Nurses, Specialists, Pharmacists, Physiotherapists, Clinic Managers, HealthLink Representation
Personal Health Portal Steering Committee
Alberta Medical Association, College of Physicians and Surgeons, College of Alberta Registered Nurses, Alberta College of Pharmacists 9

10. Communications Strategy
Public and Provider messages
Awareness of EHR
Patient rights and responsibilities
Leading up to public availability of PHR
Build on the work that Infoway has done – “Knowing is better” commercials
Awareness of things like what EHR is. The Netcare brand, etc. GPLM - Global Person Level Masking
Rights to see EHR, responsibility to maintain a secure password, etc. 10

11. MyHealth.Alberta.ca Personal Health Record
A collection of Common Off The Shelf (COTS) products
Instant
PHR
Healthvault Integrator
Netcare
EHR
HealthVault 11

12. MyHealth.Alberta.ca Personal Health Record – Identity and Authorization
Current Environment
Albertan
Microsoft
Account
Identity
Service
HealthVault
SharePoint 2010 12

13. MyHealth.Alberta.ca Personal Health Record – Identity and Authorization
Future Environment
Albertan
GoA
Identity
HealthVault
SharePoint 2010
Trust Relationship 13

14. Benefits Evaluation - Framework
Net Benefits
Quality
Patient Safety
Appropriateness/Effectiveness
Health Outcomes
System Quality
Functionality
Performance
Security
Use
Use Behaviour / Pattern
Self Reported Use
Intention to Use
Access
Ability of Patients/Providers to Access Services
Patient and Caregiver Participation
Information Quality
Content
Availability
User Satisfaction
Competency
Ease of Use
Service Quality
Responsiveness
Productivity
Efficiency
Care Coordination
Net Cost
Based on the Delone and McLean IS Success Model, 2003
Organizational and Context Factors: Strategy, Culture, and Business Process – Out of Scope 14

15. PHP BE embedded throughout the development and deployment lifecycle.
Overall, BE is embedded throughout the lifecycle of the PHP for each phase, from pre-design to deployment. This allows BE to formatively enhance the PHP, improving the PHP rather than just evaluating its effectiveness. 15

16. BE Multi-Methods Pre-Design: Design: Deployment:
Persona development / circle of care models
Design:
Usability testing and Usability inspection
Deployment:
Patient interviews and discussion groups: patient experience with use of PHR
Provider discussion groups: experience / impact of PHR on practice
PHR usage statistics: to confirm which widgets are used and frequency / timing of use
Persona development / circle of care models: The pre-release BE activities began with an assessment of the likely features that are being considered for deployment and works to define the population(s) that will most likely benefit from those features. Once the populations were defined, then 3-6 standardized patient personas were developed with representative scenarios where the PHP may be used. Validation of the personas was carried out with stakeholders. In this case, validation occurred with the iCWG PHP subgroup. 16

17. Multi-methods to assess from early adoption to later adoption benefits
For deployment evaluation, we are examining availability, use, behaviour change and outcomes. This allows us to look at early adoption that is linked to expected longer term outcomes as adoption matures over time. 17

18. Phase 1 Evaluation MyHealth.Alberta.ca Knowledge Portal
General Albertan Survey
Assessment of MyHealth.Alberta.ca Awareness
Baseline snapshot of Alberta general population health information seeking and internet behaviour
Summer of 2011
396 Participants
Results:
93% used the Internet to look up health-related information
72% agreed that online health resources provided answers more quickly than other means
75% agreed that online health resources increased knowledge of a health condition
General Albertan Study: provide a baseline snapshot of health information seeking and Internet behaviours of the general population of Alberta at the time. Nearly all respondents have safe access to the Internet (most from home) and have accessed health information online.
90% use a desktop / laptop as their primary tool for accessing the Internet. 10% use a phone or tablet. This number increases to over one-third in the respondents under age 25.
Respondents had many sources to get health information
Family physicians were the most frequently cited source of 18

19. Phase 1 Evaluation MyHealth.Alberta.ca Knowledge Portal
Alberta PHP Embedded Web Survey
Assessment of Use and Experience
Rank MyHealth.Alberta.ca pages from 1 to 5 and answer three questions to assess visitor experience:
Did this page provide you with the information you needed?
Do you feel this information will help you make better health choices?
Will this information help you when talking with your doctor or other health care professional?
Results:
September, 2012 – Present
Feedback tools used 4,925 times by 4,695 unique visitors (to date)
Overall page ranking: 3.59 out of 5
Question 1 ranking: 68%
Question 2 ranking: 70%
Question 3 ranking: 69%
PHP Web Survey: Alberta Health Services has implemented web surveys on the MyHealth.Alberta.ca website in order to augment usage data and other user statistics automatically captured by the PHP software. As part of the UVic eHealth Observatory’s benefits evaluation (BE) study, the UVic team has helped PHP develop BE related survey questions, some of which Alberta Health Services have deployed on their website. The current, page specific survey consists of a page ranking (1-5, five being highest rank) and three questions that map to visitor experience:
Q1 – Did this page provide you with the information you needed?
Q2 – Do you feel this information will help you make better health choices?
Q3 – Will this information help you when talking with your doctor or other health care professional?
Overall rating (to date) 3.59 out of 5; 68% for Q1; 70% for Q2; 69% for Q3 19

20. Phase 2 Evaluation Usability
Usability Inspection
Cardiac Persona
User Acceptance Testing
Part of internal evaluation
Usability Testing
14 Victoria participants (no previous exposure to PHR)
7 PHP participants (previously involved in PHR activities)
Focus Group
14 PHP participants 20

21. Phase 2 Evaluation Usability Results
Five key areas of improvement identified:
Information Architecture
Missing Content / Functionality
Presentation
Functionality of Existing Content
Login Process
1: The application presents a rich set of modules and tools that allow the user to enter and view their health information. While there is valuable functionality available, our primary concern is around how the site is organized. The current information structure presents these challenges.  Current deep navigation layering means users do not get information; Findability is low due to placement of widgets and tab labeling; Inefficiencies in data entry workflows occur due to placement and segmentation of widgets across multiple branches in the hierarchy.
2: In order for the user to maintain an accurate and useful PHR, the system should provide adequate tools and information to facilitate data quality. Because the functionality of the PHR is heavily weighted towards data entry, the following content requires improvements.  Additional widgets that support capture of core patient information that would be shared from patients to the majority of providers (e.g. immunizations and social history); Missing module for documenting significant medical events; Help and user guidance content; Improved clinical vocabularies for core areas (medications, conditions, and other reference lookup lists). These are currently not optimized for patients. Revising the vocabularies is technically feasible and will support user comprehension and usefulness of the PHR.
3: The presentation layer of the site is an area where significant benefits can be gained for a relatively low effort.  Identified need for: Highlighting clinically relevant information; Consistency in information presentation across the PHR; Compact information presentation - Optimized page layouts; Print report improvement.
4: Current version of the application presents certain difficulties to some users in terms of errors that users encounter. Aspects of system functionality is either missing or not working properly. Ensuring that the functionality is improved and system-specific errors are eliminated or minimized will ensure increased user satisfaction and improved user experience with the system.  Overview page does not display effective core information and dashboard defaults need to be improved; Random automatic sign-out when not idling; Lack of information validity checks (e.g., future date of birth, invalid height, invalid postal code or phone number); Mandatory complete date entry.
5: We assigned the login process to a separate category because most of the usability testing participants had issues specific to signup or login. Ensuring that users have positive experience at the very beginning is crucial because the first interaction sets the tone for the entire user experience.  Difficulty creating an account; Lack of clarity and simplicity with the login process; User perception that they are registering multiple times; Confusion with the privacy / confidentiality agreement and allowing access. 21

22. Phase 2 Deployment Evaluation
Cardiac Wellness Institute of Calgary
User experience interviews
User experience discussion groups
Provider discussion group
Follow-up user experience interviews
User experience interviews, discussion groups, and provider discussion groups: 6 weeks after the limited deployment to these users
Follow-up user experience interviews: 12 weeks after the limited deployment to these users 22

23. What’s Next Improve: Develop Login and registration process
User Experience within PHR
Search and content presentation
Personal medical device connectivity
Develop
Strategy for verification of users
Communication strategy
Mobile device support 23

24. Demonstration 24