START-IT was developed in response to several obstacles that were anticipated as plans were first made to expand the HARMS Program. First of all, uptake of urine drug testing is intimidating for unfamiliar physicians because of uncertainty about interpretation, as well as fears about resource utilization and what to do with the results. Secondly, data collection for research at numerous sites through manual chart reviews would require tremendous resources on our part. MFHT is a rural/remote clinic and has very limited funding for research. Most of the work done here so far has been volunteer, with the help of medical student summer grants in 2017 and 2018. Lastly, there are over a dozen electronic medical records (EMR) in Canada and sorting through data with numerous different EMRs creates an additional layer of complexity.
The perfect solution to these obstacles was to design a tool that could be used with any EMR to collect all of the data needed for the UDT, interpret that data using algorithms based on best-evidence, and then compile that data electronically in a way that the data could be easily data-mined (instead of requiring manual chart reviews). The prototype was developed and became known as START-IT – Self-report, Testing and Automated Reading Tool for Immunoassay Testing. Information is entered into a tablet PC. The tablet uses Ocean (CognisantMD) software as a platform and detailed coding algorithms to interpret, explain, and make recommendations about what the urine drug test result means for each patient. There is a standardized output for facilitation of data collection as we aim to answer our research question about the effectiveness of HARMS.
Since the idea was sprung, the START-IT tool has developed into a national-award winning, application-based software. It has been in use at the MFHT since March 2018. Plans are underway to improve it further and utilize it to expand and evaluate the HARMS Program.
START-IT Tool Demonstration
1. The opening screen on the tablet PC prior to commencing START-IT.
3. Patient reports relevant prescribed medications and last dose.
5. Patient provides a UDT sample that is dipped using immunoassay test.
Staff person enters details relevant to the HARMS Program and the results of the UDT. Acronyms here are beyond the scope of this document, however suffice it to say that the top portion of this page is data collection for patient risk level, how the patient was selected for UDT, how much notice was provided, etc. The bottom portion is for UDT results.
2. The START-IT opening screen educates patients about UDT.
4. Patient has an opportunity to report medications/drugs NOT prescribed.
6. After clinic staff person enters the results of the UDT, the last part of data-entry is where any concerns about patient tampering with the sample can be documented. Staff person pushes “Next”. A summary of the UDT, including an automated interpretation of what the results mean, are then sent to the electronic medical record (EMR).
START-IT Tool inserts information into the EMR
Below is an example of how the entire summary appears in the EMR, with the interpretation and research string being magnified and highlighted at the bottom. The research string contains all of the information from the patient and UDT so that the different variables can be partitioned and analyzed during the analysis phase.