key: cord-0751502-htjvpuls authors: Sepehri, Katayoun; Low, Hilary; Hoang, Jenny; Park, Grace; Song, Xiaowei title: Promoting early management of frailty in the new normal: An updated software tool in addressing the need of virtual assessment of frailty at points of care date: 2022-02-10 journal: Aging Med (Milton) DOI: 10.1002/agm2.12198 sha: d44792c42afb1f6034727746bbd46d948c89c6b6 doc_id: 751502 cord_uid: htjvpuls INTRODUCTION: Frailty is a state of diminished physiological reserve and can be assessed using the frailty index. Early management of frailty is crucial for preventing adverse outcomes. Intended for assessing home‐living older adults, the initial release of the eFI‐CGA software was prior to the coronavirus disease 2019 (COVID‐19) pandemic. METHODS: In addressing the increased need of virtual assessment, the eFI‐CGA was upgraded to version 3.0. In this paper, we introduce the updated electronic frailty assessment tool, reporting the newly developed features and validating its use. RESULTS: End‐user experiences with the previous versions are discussed. The updated features include a search function to resume disrupted assessments. The improved user interface enabled clinicians to record care management details. CONCLUSION: This study represents an example of software solutions in moving from disruption to transformation, benefiting healthcare for older adults during this challenging time. form and automates data recording, storage, processing, and eFI calculation. 9 The standalone eFI-CGA allows uptake of the eFI-CGA in the electronic medical record system feasible and transparent. 10 The current distancing measures due to the coronavirus disease 2019 (COVID-19) pandemic have resulted in demands for virtual assessments and care, presenting new challenges for software solutions. Challenges include connection interruptions, disturbance at patient homes (vs in-person appointments), and barriers with use of tele-care technologies. We upgraded the standalone eFI-CGA with several new features addressing the challenges and released the eFI-CGA version 3.0. Here, we introduce the updated software tool and discuss its use at the point of care. The standalone software and all additional updates use the WinForms library and are coded in C# programming language. Upon download, the software runs on any Windows machine. From its initial release (version 1.0) 9 through the current version 3.0, requirements were obtained and evaluated with the research partners and clinical end-users. Upgrades included search and retrieval functions and improved usability, as detailed below. Figure 1A ,B,C) on top of the previous release. 10 Users were previously unable to make further changes to assessments after closing the software. This concerned the users if an assessment session was interrupted due to disruptions associated with remote access. Further, clinics adopting a team-based care approach can request one provider from the patient's care team to complete some assessment items prior to another provider completing other assessment portions. Having the option of reopening saved assessment forms would make this process seamless. The updated data search, retrieval, and edit functions ( Figure 1A) enabled the users to reopen and make changes to an assessment after the assessment form had been closed, by searching for an existing "Patient ID". The algorithm performs a reverse sequential search of the patient ID in the data file and retrieves the latest saved record associated with the specific ID. Then, the software loads the data into the user interface, enabling editing and resaving the record. This updated implementation prevents read/write conflict and data loss by adapting automatic saving every 5 minutes. Users can perform the search as demonstrated in Figure 1A . Users could not make edits to text boxes, such as "specify occupation," once moving on from the initial page to the main page of the software. Allowing adjustment of specifics on the assessment form can help the user input the needed information more conveniently. The text fields, such as "specify occupation," were added to the main assessment page and made editable ( Figure 1B -Top section). Users have the option of making modifications to this field rather than facing fixed values carried out from the initial page. Other items in the top section of the page were re-arranged for a clear layout. Users commented that the meaning of certain assessment items were ambiguous and requested clearer labeling. Labeling was clarified with several assessment items. For example, "Lower Proximal -Hip Flexor" was clarified as "Isolated Lower Proximal -Hip Flexor." Similarly, "Problems" was clarified as "Medical Problems" ( Figure 1B ). Users hoped that the software could help facilitate a more comprehensive way of documenting medications and changes in medication status. New text boxes were added alongside the existing fields. "Added alongside the associated "Medication Names" ( Previous versions of the software did not provide a designated area for the user to record care planning notes. Entering the information via the software can encourage detailed care plan making. A new "Care Planning" textbox was added to the assessment form ( Figure 1B -bottom section). This field further enabled end-users to record detailed care plans for individual patients in relation to the frailty assessment and management for effective follow-up to benefit multidisciplinary team-based care. Users requested more flexibility in text-data inputted in text-boxes, without any imitation with using special symbols. For example, in the previous release, when the user pressed the return key, the inputs would be saved as a new line by the inherited defaults of the text file. Rather than being limited to a number of compatible symbols, users wished to input any sensible text. The requirement was addressed through an upgraded data saving function, which allowed the special symbols to be typed into the text fields. To facilitate this, the updated function searches the original user input and converts any incompatible characters to text-file friendly ones. The function then reconverts the characters to the original user input during retrieval, which appears as the original user input. Users expressed wanting to be able to easily review, edit, and download the care planning notes that were inserted into the form, for the convenience of monitoring the patients' health problems. A text file that records the care plan is now saved ( Figure 1C To allow pre-entering and post-updating information in the assessment form and to accommodate for interrupted/stopped assessments 2 Data Entry "Specify occupation" text field added to main assessment page To allow users to make modifications to this field on the main page 3 Item Labeling a. "Lower Proximal-Hip flexor" → "Isolated Lower Proximal -Hip Flexor" b. "Problems" → "Medical Problems" To reduce ambiguity 4 Record Medications New free-text boxes for detailed medication records: "Added Medications" and "Stopped Medications" To support medication management (2) user inputs data into the eFI-CGA form and closes the program or saves the data; (3) user reopens the program and inputs the previously created patient ID; (4) the patient data is retrieved from the data file and the user can continue editing and saving. Panel B, Updates to the standalone eFI-CGA version 3.0 with explanation (boxes in green). Panel C, The action required text file is linked to the patient ID and allows for a quick access to the care plan. Data presented were adapted from de-identified realworld CARES patient assessments with modifications clicks on "Save Records," or automatically at 5-minute intervals, or at the closure of the assessment form. All the features were thoroughly tested using the test cases and validated by applying a set of assessment data (Table 2A,B) . In this paper, we introduced the newly updated software tool -the (Table 3) . 10 As a Windows standalone application, the software tool has several limitations. First, the software only runs on Microsoft Windows computers and excludes other machines running MacOS and Linux. In addition, assessment data are stored on the local machine with simple text file format. Although this makes data security and retrieval easy to achieve, it can prevent widespread data access. Creating web applications of the frailty assessment tool can be an effective solution to this problem, which is being addressed in our ongoing efforts. In conclusion, we have enabled eFI-CGA version 3.0 software tool, which can assist frontline care providers to more conveniently acquire CGA data digitally, automate the deficit accumulation-based frailty What was already known on the topic: The authors declare that the research and the manuscript preparation were conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Board (FHREB2018-080). 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Front Public Health Using an electronic comprehensive geriatric assessment and health coaching to prevent frailty in primary care: the CARES model Promoting early management of frailty in the new normal: An updated software tool in addressing the need of virtual assessment of frailty at points of care