PCOR-ANZ app for iPhone and iPad

Overview: The PCOR-ANZ App provides monthly updates to invited clinicians participating in PCOR-ANZ. The app will compliment the Quality Indicator benchmark reports, provided twice yearly as a PDF clinician report. This version of the app is a “proof of concept” to establish if a mobile app is of value. Data displayed in the app is confidential and cannot be used for publication or promotional purposes.

Clinicians testing the app receive pushed monthly feedback on their patients enrolled, in a simplified format. The results focus on recruitment and key patient outcome metrics that gain improvements from the Hawthorne effect. The app has patient outcomes risk adjusted, benchmarked against colleagues and also links to related learning resources with a goal to improve patient outcomes.

The app is funded by The Movember Foundation under its Clinical Quality Research Program, supported by Monash University and the Urology Society of Australia and New Zealand (USANZ). Three PCOR-ANZ jurisdictions are participating in this trial; New Zealand, Victoria and Queensland.

How it works: Clinicians can log in to the app at any time to view their results. A secure data transfer from PCOR-ANZ will be run on the first day of each month, and registered clinicians will receive a push notification of all new cases have been uploaded to PCOR-ANZ during the previous month. Clinicians can view their ranking across Australia and New Zealand based on the number of new cases uploaded in a rolling 3-year period, and also their total number of notifications to PCOR-ANZ since joining. The app displays monthly updated data on four of the key indicators used in the 6-monthly Quality Indicator benchmark reports. These are:

1. The percentage of men with low-risk disease who have a radical prostatectomy {QI 5a}

2. The percentage of men with positive surgical margins post prostatectomy (pT2) {QI 9a + 9b}

3. The percentage of men with moderate/big urinary bother 12 month follow-up post prostatectomy {QI 10a + 10b}

4. The percentage of men with moderate/big sexual bother 12 month follow-up post prostatectomy {QI 12}

The display of the indicators differs to the QI reports in that it uses a traffic light display. The traffic light results are arbitrarily benchmarked as 75% green (acceptable), 15% orange (mid) and 10% red (bottom). These measures may be adjusted, in the future, according to agreed benchmarks.

Links to learning resources will be displayed at the bottom of each page for clinicians to activate. In this test version, these are hyperlinks only and won’t be updated.

Data security and storage: De-identified and aggregated data will be transmitted from PCOR-ANZ to the app on the first day of each month as per ethics and PCOR-ANZ Steering Committee approvals. The data will be accessed through a Microsoft account. Microsoft Active Directory is used for authentication and provides Microsoft approved security and industry best practises. All communication between the application and the server is secured via HTTPS. All data is stored securely in a Microsoft Azure SQL Database within the Australian region and is encrypted at rest. Microsoft Azure has multiple compliance standings including HIPPA, HITRUST and IRAP/CCSL.

Getting started: Invited clinicians will be uploaded by Stratos (app designers) and assigned to their jurisdiction and clinician ID in PCOR-ANZ. This will generate an invitation email to registered participants that they will need to accept. If the email address used is already a Microsoft account then they will not need to provide a new password, if it isn’t a Microsoft account then a password will need to be provided.

Evaluation: After 4-6 months a survey will be undertaken to determine the value of pushing patient results via this format. An independent value metric of the App will be the number of times the App is accessed by the urologists.