Development and Implementation of a Web-based eFI-CGA Software Tool for Points of Care Applications
At the completion of the project, we will have the web-based eCGA and eFI-CGA software tool that is ready for effective and efficient use in large-scale multi-centre clinical applications.
About the Project
The CARES program in the Fraser Health (FH) region in British Columbia (BC) aims to proactively identify seniors in early frailty with view to mitigating health deficits that can lead to frailty progression. In partnership with community General Practitioners and Nurse Practitioners, appropriate individuals are assessed using the electronic version of the Comprehensive Geriatric Assessment (eCGA), derived from a standardized CGA form in generating a standardized electronic frailty index (eFI-CGA).
In our engagement with the clinicians, it became evident very early that the eCGA needs to be accessible and that it be embedded in the workflow of the practitioners and the clinical team. To that end, we have worked with the vendors of electronic medical records (EMR) to develop the eCGA so that the practitioner can open the eCGA within a patient’s chart and pre populates with the medications and problem list as well as the demographic information, and generates the frailty levels with an automatized eFI-CGA score.
While this facilitates uptake with the practitioners, we found each vendor interaction to be time and resource intensive. We have therefore developed an EMR agnostic, standalone version of the eCGA and eFI-CGA to make EMR uptake feasible and transparent.
Whilst the standalone software is currently being executed on individual physicians’ computers, a web-based version of the eCGA and eFI-CGA software tool is highly demanded. Secure web-based tools can be used over the Internet with a web browser and secure web-server for improved usability and efficiency by first-line clinicians so that they do not have to download and install the software and likely future upgrades. Privacy and information security control and data management and usage will be well supported.
Through CFN supported research effort, a web-based eCGA and eFI-CGA computer software tool can be developed, implemented, and validated for use at points of care for improved patient care and frailty management, scaling up the healthcare innovative effort through CARES and other frailty management in community care models.
- Grace Park, MD, CCFP – Fraser Health Authority
- Kenneth Rockwood, MD, FRCPC, FRCP – Nova Scotia Health Authority
- Xiaowei Song, PhD, MSCS – Fraser Health Authority
Keywords: aging; automatized health assessment; community actions and resources empower seniors (CARES); electronic comprehensive geriatric assessment (eCGA); electronic frailty index based on comprehensive geriatric assessment (eFI-CGA); early frailty screening and evaluation; frailty index (FI); healthcare innovation; points of care; web-based computer software
CARES is an initiative that was started as an EXTRA fellowship project at the Canadian Foundation for Healthcare Improvement (CFHI). The initiative was designed to address frailty progression through early identification and intervention to mitigate frailty progression. Following a literature review and focus groups with community living seniors and caregivers, the CARES program was further developed within the Fraser Health Authority and has been continuing since the pilot that launched in the communities of Langley and White Rock BC. In January, 2014.
The CARES model partners with community family physicians to proactively identify vulnerable seniors in their practices who are at risk of losing their independence due to a medical or social event in their lives. The physicians were provided with an electronic Comprehensive Geriatric Assessment (eCGA) tool which is embedded within their EMR to assess and identify health deficits, then generate a frailty index for their patients. The physician in consultation with the patient and their family, develop a Care Plan to address the medical needs and a Wellness Plan to address their social needs. Health protective behaviors such as exercise, social engagement, and improved nutrition are discussed in the wellness plan.
The CARES project also partners with community senior services organizations and volunteers to help seniors set goals and adhere to their wellness plan and overcome any barriers. There is also a partnership with Self-Management BC program who provide peer telephone coaching for citizens suffering with chronic diseases and need support in goal setting. This telephone support provides once weekly telephone calls from volunteers who have been trained in peer support. Through motivational interviewing and setting of small achievable goals with the senior, the coach is able to suggest appropriate community programs and if necessary refer to volunteer organizations to help reduce any barriers (eg. Transportation to community activities).
- To develop and implement web-based eCGA and eFI-CGA software programs for frailty assessment that automatically generate standardized frailty scores that inform care plans.
2. To validate the efficient performance of the web-base software tool with thoroughly designed tests for accurate and robust computation algorithms, secure data storage and management, and friendly user interface.
To develop the project, we will work out several major tasks and deal with several challenges.
The major development tasks include: selecting and engaging a secure webserver; creating a website with user-friendly interface; linking the website and the standalone eCGA and eFI-CGA back-end; allowing online data storage; allowing effective search and data retrieval; building online analysis and presentation functions; testing and debugging both the system and its components; various functional and system-wide software validating.
The major challenges to overcome include: effective handling of privacy and confidentiality of patient information; multi-layers of secure data access control; managing robust distributed database functions; determining and constraining information sharing policies; effective handling web-based data quality; short and longer term system management and maintenance; deciding scope and scale of system functions and capacities.