Engaging Patients, Driving Workflow Efficiency with Noona

Engaging Patients, Driving Workflow Efficiency with Noona

Centerline

With a sprawling regional footprint encompassing both metropolitan and rural communities, CancerCare Manitoba (CCMB) was looking for a digital platform that could strengthen patient engagement, including access to educational materials, symptom management, and communication with care teams.

For CCMB, which operates 23 cancer centers serving the Canadian province of Manitoba, northwestern Ontario and eastern Saskatchewan, empowering patients with an easy way to virtually access information and communicate with care teams was a priority. While most of the province's 1.38 million population are concentrated around Winnipeg and Brandon, the region includes many northern communities only accessible by train, plane, or winter ice roads, making frequent clinic visits challenging.

In 2020, CCMB launched Varian's Noona oncology-focused patient engagement solution in its Radiation Therapy Department, initially as a screening and communication tool in response to the COVID-19 pandemic. Today, CCMB cancer patients using Noona can track symptoms, view scheduled appointments, access education materials, view lab results, complete surveys, and communicate with their care teams.

The patient engagement solution, which has achieved an average patient activation rate of 99% at CCMB, is considered a core part of the care experience, not an optional service, and is an important way care teams are more deeply connecting with diverse patient communities in this expansive Canadian province and surrounding region.

Reaching that point, however, was not easy, and required CCMB teams to optimize its workflow, align stakeholders, and give patients and care teams more reasons to use it.

While CCMB had early success when it launched Noona, engagement with the solution was lagging by 2024. To better drive value for both patients and care teams, the CCMB team realized it would need to broaden clinical and patient impact, including increasing patient adoption, enhancing patient experience, and driving operational efficiency.

Barbara Kitzan, RN, a Clinical Application Implementation Manager for CCMB who led the effort, quickly identified key barriers to program engagement were due to workflow.

"We had asked our busy frontline staff to enroll our patients, who were already maxed out in the clinic with other priority tasks in caring for their patients, so Noona enrollment was on the back burner," Kitzan shared, adding, "I also realized that getting patients onto Noona was driven and influenced by the staff, who controlled the discussion and enrollment process. I wanted to build a process where patients could drive their enrollment, and where they could see what Noona offered and sign up on their own."

Activating Stakeholders

Executives had established that Noona was a key pillar for CCMB's patient engagement strategy. The first step was to strengthen organizational support. At CCMB, teams received a lot of communication about Noona at launch, but not much internal training as the months went by. Because it was considered optional, busy frontline staff often skipped over it. Kitzan and her team implemented a change management strategy to improve awareness and drive buy-in from care teams across CCMB, including training the staff on the patient experience in the app, so they could provide better coaching to bridge any gaps in understanding.

"Centralizing our registration process and providing them with the ability to register through our website means patients can request their account without having to call the clinic staff or visit one of our sites. This reduces burden on our frontline staff, empowers patients to take the lead in this service, and is especially important for our rural patients who often have to travel long distances to get to clinic."

- Marshall Pitz, MD MHS, Chief Medical Information Officer for CancerCare Manitoba

Another key change was empowering patients to initiate their own registration. The system was originally set up for staff to enroll patients, in order to connect them to their designated care team. To shift the burden off frontline staff, CCMB implemented a patient self-registration portal that triggered a notification to team coordinators who could connect the account with the designated care team.

QR codes linked to the registration portal were added to brochures, the CCMB website, and posters in clinic waiting areas. The center also added a digital navigator who could provide assistance if patients ran into issues. Within weeks, the portal was handling 85% of patient registrations, significantly easing the burden for frontline staff.

With the burden of patient registration eased, care teams were more engaged. CCMB shifted Noona to single sign-on, meaning care teams could easily access information across platforms. Another change was to ask patients who wanted to opt-out of using the app to provide a reason, enabling CCMB teams to identify potential barriers to use, such as technology or connectivity issues, in order to better address community needs.

To expand patient benefit, the team created a process to enable access to family members or guardians managing care for someone unable to use Noona themselves.

Marshall Pitz, MD MHS, CCMB's Chief Medical Information Officer, said providing patients across CCMB's system with the Noona app offered "many unique opportunities to enhance patient care."

"Centralizing our registration process and providing them with the ability to register through our website means patients can request their account without having to call the clinic staff or visit one of our sites," he shared. "This reduces burden on our frontline staff, empowers patients to take the lead in this service, and is especially important for our rural patients who often have to travel long distances to get to clinic."

Expanding Functionality

CCMB initially launched Noona with limited functionality but realized that both patients and care teams needed more if they were going to increase engagement. The team added an appointment feature for patients to track upcoming treatment information, along with access to patient education documents and videos on demand to learn how to prepare for treatment and symptom management education.

"It's giving patients the information they want right at their fingertips," Kitzan said. "Noona empowers patients and gives them a sense of control, and when patients are going through cancer, they want control where they can have it."

The change also proved valuable for staff, who could not only easily share information with patients, but also track what materials were shared and whether a patient had accessed the information.

Another change was expanding access to two-way communication between patients and care teams. While patients were always able to post questions to their care teams in the Noona app, documentation guidelines required care teams to call to provide an answer. Working with Varian's customer success manager, CCMB modified its signature line to capture the team member's qualifications, enabling them to meet documentation requirements when responding within the app and speed response times. Additionally, the communication was automatically logged into the patient's electronic record, eliminating the step of transcribing notes into the medical record.

"It's real-time documentation. If the initial nurse isn't there, another member of the care team can see all the communication that occurred verbatim rather than relying on notes to help the patient," Kitzan said.

In February, CCMB added a feature enabling patients to review their lab results, enabling patients to review information as soon as it came out rather than calling the clinic to check whether results were ready, or waiting for a call from the care team or mailed information.

CCMB continues to add functionality to the app, to deliver more value to patients and care teams.

"It's giving patients the information they want right at their fingertips. Noona empowers patients and gives them a sense of control, and when patients are going through cancer, they want control where they can have it."

- Barbara Kitzan, RN, a Clinical Application Implementation Manager for CancerCare Manitoba

Keys to success

Kitzan highlighted several factors driving CCMB's success as it re-energized its Noona program.

Dig deep. The team did a comprehensive review to understand where the program was struggling and how to address root causes, such as overburdened staff and limited functionality.

Align stakeholders. The team implemented change management to communicate support for the program and educate stakeholders at every level. Ensuring changes were implemented on a timely basis was important to maintaining support. "If you keep talking and talking, but nothing changes, people become disengaged," Kitzan said.

Start small. New programs were launched in controlled groups, enabling the team to resolve any issues prior to expanding systemwide.

Audit, adjust, repeat. The team tracked app usage closely and made adjustments where needed. "If something wasn't working, we'd move quickly to make changes and routinely shared data with the team," Kitzan said. "Engagement is huge when teams can see you're in it with them."

Learn more about Noona:

• Noona Helps Unify Cancer Care and Symptom Management for Patients
• Noona Streamlines Clinic-Patient Communications, Increasing Efficiency by 70%

Watch:

• Reports-Timely Access to the Data You Need
• Patient Satisfaction and Clinical Workflow Optimization through Noona

The statements by CCMB's representatives here are based on results achieved in CCMB's unique clinical setting. Because there is no "typical" clinical setting and many variables exist, there is no guarantee that other customers will achieve the same results. CCMB is a Varian Reference Site; however CCMB and its personnel have not been compensated by Varian for their statements.