Rebuilding Primary Care with Dr. Cleo Mavriplis
Introducing icanbewell, the only Canadian, evidence-based, bilingual mobile app for preventive care.
For this special series, HIROC is partnering with the Association of Family Health Teams of Ontario (AFHTO) to highlight the work of several amazing primary healthcare teams.
Family health teams provide comprehensive primary care and are based on a collaborative model where physicians, nurse practitioners, nurses, dieticians, social workers and many more disciplines work together.
In this episode, we speak with Dr. Cleo Mavriplis, a family physician and professor. In 2017, Dr. Mavriplis started working with an interdisciplinary team of family physicians, nurse practitioners, and students from the University of Ottawa, Faculty of Engineering on an app called icanbewell. The programming team was comprised of engineering and computer science students led by Professor Liam Peyton. The students are funded by CREATE-BEST, an NSERC grant that brings programming students and health care providers together to create the best health smartphone apps.
The app launched this year and is the only Canadian, evidence-based, bilingual, mobile application for preventive care.
What’s unique about the app is that it has a patient interface and a healthcare provider interface and both are visible to each group. Healthcare providers can search by age and gender for options on applicable preventive measures for a particular patient, and they can also access teaching materials for patients. Patients can use the tool in a similar way to learn about self-assessment and general prevention guidelines.
To see the app go to: icanbewell.ca.
Mentioned in this Episode:
- The Bruyere Academic Family Health Team
- University of Ottawa – Faculty of Computer Science
- McGill University Satellite Faculty of Medicine
- Canadian Family Physician
- Helen Monkman
- Ontario 211
Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers. A podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.
Ellen Gardner: Welcome to our second episode of HIROC's special podcast series, Rebuilding Primary Care. I'm Ellen Gardner with Philip De Souza. We're delighted to partner with AFHTO, the Association of family health teams of Ontario, to highlight the work of several amazing primary health care teams. These teams recently presented at AFHTO's virtual conference.
Ellen Gardner: Today we're speaking with Dr. Cleo Mavriplis, who has been a family physician and professor for 37 years. In 2017, Dr. Mavriplis started working with a small interdisciplinary team at the University of Ottawa on an app called icanbewell. The app launched this year and is the only Canadian, evidence-based, bilingual mobile application for preventive care. What's unique about the app is that it has a patient interface, and a healthcare provider interface, and both are visible to each group.
Healthcare providers can search by age and gender for options on applicable preventive measures for a particular patient and they can also access teaching materials for patients. Patients can use the tool in a similar way to learn about self-assessment and general prevention guidelines. With information on a wide range of illnesses including COVID-19, the app has empowered Canadians to take responsibility for their own preventive care.
Ellen Gardner: Cleo I want to start by asking you, what you do and where you work?
Cleo Mavriplis: I've been practicing as a family physician for 37 years and I've been teaching in medicine for most of that time. I'm very fortunate to work for two wonderful organizations. The first is the Bruyère Academic Family Health Team and its part of the University of Ottawa. I had started my research there on this app and I've been working on the app with University of Ottawa, computer science students.
Cleo Mavriplis: The second organization I work with, because I have cut back my clinical duties since 2019 to devote more time to these passions that I've developed through my career. So the second organization is McGill University. So surprisingly, you might not know that McGill has a new satellite Faculty of Medicine across the river from Ottawa in the Outaouais, and it's in French. And my position is Assistant Dean of Faculty Development so to help improve medical education there. So it all revolves around education basically and preventive care.
Ellen Gardner: Why was the creation of the app necessary or important in your view?
Cleo Mavriplis: So, I've been teaching preventive care. So what are the guidelines to prevent disease? And there's 50 to 70% of all illness and disease in Canada and in the world they're really due to preventive causes. So wouldn't it be wonderful if we could prevent illness? We'll never get everything prevented of course. But studies show that if you advise people and do some intensive training, that you can get about 30% of people you're talking to, to quit smoking for example or change their lifestyle. So for me, as I was teaching this I was realizing, there's so many different guidelines in so many different places and we were summarizing them for the students. When I say we, these are two nurse practitioners and myself, from Bruyère.
Cleo Mavriplis: We published an article in 2016 in Canadian Family Physician, which was a summary of all the Canadian guidelines because they're not the same as the American. And so, readers of the articles said to us, we need an app so it can be updated quickly as opposed to publishing an article every two years. And second of all they said, we really would like a tool to teach patients where in their body we're talking about when we talk about colon cancer screening, for instance. So it evolved out of all that.
Ellen Gardner: I found it really interesting in your presentation to AFHTO, the conference how you really went through some of the vignettes. And it looks like the vignettes are a crucial part of the app. Why is that an effective way of helping patients find preventive measures for their health?
Cleo Mavriplis: So the vignettes are not actually on the apps but the thing is, if you enter the app you can enter any age and gender combination. So then you can look through what would pop up for that. So it's more in explaining the app to people that I use the vignettes. Actually, we have a video that's right on the landing page. And in the video we show two vignettes of people, patients who are curious about what they could do, for instance, to prevent heart disease and a young woman who's worried about COVID. The vignette I used at the AFHTO conference was a young woman with kids who loses her job and is interested in finding out more information.
Cleo Mavriplis: So, I guess the shift now is to put more content so that people who are in marginalized populations can access information to help them stay healthy. So, there's a tool there that they can use and if we direct them there and make it user-friendly, they could take prevention into their own hands and start changing their behaviours and to really improve their health. So for me, it's an important tool and for providers too. A lot of providers don't have time to go through guidelines that are scattered all over different websites. So it's to bring it all together in one place.
Ellen Gardner: It does seem that the app is valuable for providers and working with patients, but is it easy for patients to use on their own?
Cleo Mavriplis: So interestingly, in our study we got a lot of feedback from patients. And the number one thing was, they said it was really easy to use. So our programmers and our design, and the way we present information is easy to use. What was really interesting, because this study was about a year ago, was that people are more used to Googling information about symptoms. And they also, we found out that they really go to American websites. So, when we did the interviews they were like, “oh, I didn't know that Canadian health information is different.”
Cleo Mavriplis: And that's why the app is important and it's trusted. I don't have to rely on Google. I can go to a place that has specific information that's been evaluated by healthcare professionals to be right. So they really like that. And because they were not sure about symptoms versus preventive care, we created the video to put on the landing page to really clarify that this is to help you stay healthy. And preventative care, it's like the poor sister of curative of medicine, and it's neglected so we're really trying to emphasize that.
Ellen Gardner: Are you doing promotion so that more people can know about it and use the app?
Cleo Mavriplis: That's something I really want to do. It's been a labour of love, mostly myself curating the content and the computer science students making the app. We studied it before we wanted to really launch it into the universe. So yes, now would be the time to do a promotional campaign.
COVID has really taught us about prevention. It's been a huge social experiment in preventing COVID. We've had to do these hard measures of distancing and we understand now that prevention and all these measures do work if we do them. So, I think also there's an emphasis on staying healthy so you don't get COVID. And I think also the emphasis is on helping marginalized or vulnerable populations. We've seen that we're only as healthy as our most vulnerable. So, I think now is a time to ride that wave of attention of staying healthy so that we can beat COVID, but we can beat anything. We can really be healthier in the future.
Ellen Gardner: It's been a true passion project for you. What have you learned through going through this whole experience?
Cleo Mavriplis: I have learned so much. Working with computer science people, it's so interesting. It’s so fascinating to see what you can do. I was very fortunate to be linked up, introduced to this wonderful researcher Helen Monkman, who's an assistant professor in Health Informatics in Victoria, University of Victoria. She has taught me a lot about health, e-health literacy. So, how to present the page of information so that people who are not, especially health literate. A lot of patients I had who were new Canadians, how do you present without presenting a wall of information that us doctors are used to, present little bites and then give them more afterwards? So that's been a big learning experience for me.
Ellen Gardner: The knowledge translation is a huge element here. And part of that is that it's not just doctors who are providing the information. That there's actually a huge patient and stakeholder and family component to this. So, has it been awkward or difficult to just ensure that you're always getting the best possible knowledge translation?
Cleo Mavriplis: Yes, absolutely because most of that expertise has been taught to me through this e-health Informatics professor. It’s really been just a small project up until now. It's just been me, computer science students and talking to Helen Monkman once in a while. And I haven't really had the resources, the time to go and meet with other groups and explore what would be best for them. The study was really a revelation to see what patients thought and to get comments that were super interesting. We had an app developer who said, this is Canadian and that's why it's important. It keeps changing, that's why you need an app. And that should be front and centre. So that's why we did the video because of his comments. So that's very helpful.
Cleo Mavriplis: I think your point about the vignettes is really important. And I've used them in teaching but I think it would probably be good to put vignettes on the app so people could see how it's used. And I think the other thing is, I really learned from other researchers at University of Ottawa, about socially marginalized populations and about 211.ca. 211.ca is a way, it's a website where you can find the closest food bank to you if you enter food, and your postal code, you can find housing information. So that's been a real eye-opener for me and just networking with researchers and physicians who deal a lot with marginalized populations. I dealt with them as an inner city physician, but they've made that their research interests. So that has been extremely helpful too.
Ellen Gardner: Is the app accessible through the 211 Cleo?
Cleo Mavriplis: No. But that's a really good point because apparently, this researcher at Bruyère knows I think the CEO of 211. So that's a good idea, I could approach them.
Philip De Souza: And Cleo knowing all the, I guess you've seen all the analytics of the app, what would you say are the top one or top three things that you've noticed that people are flocking to on the app and digesting and taking in?
Cleo Mavriplis: So up until now, I must say in the last six months it's been COVID. But all kinds of other things, memory was very high on the list. So older people or younger people looking at dementia, how to prevent dementia. So that was really interesting to us. And physical activity was a big one too. So, I think we can really add more tools to those ones to make them more interesting but also look at the other ones that aren't as popular and improve them.
Ellen Gardner: Cleo, what are your goals for the app right now?
Cleo Mavriplis: First things that are in the works right now are a transgender interface of the app. So I have a resident in family medicine from University of Ottawa working on this. They have to do a research project during the residency. And she's doing wonderful work, looking at the guidelines and reviewing the literature. And we're working with the computer science people to make an interface that would be acceptable to transgender and non-binary people. We really would like to develop this further.
So we're looking for maybe a permanent home and more resources because I feel that we need to promote it across Canada. Or start with the province, for instance in Ontario and then scale it up. And there's so much potential right now with, for instance, marginalized populations. We could co-design with stakeholder groups, with indigenous associations or with racialized minorities. And that's the way to go from all the things I've seen.
Cleo Mavriplis: I totally understand that you really have to go to the community and co-design it with them. So that, we would need some help for that. And I guess the other thing, the potential for translating it into languages for new Canadians would be fantastic. I have an Arabic-speaking resident who is interested in that too. So, there's lots of things that I'd love to do with this app!
Ellen Gardner: It's been great talking to Cleo and just hearing about such a dynamic and innovative approach to giving both the public information, but also helping help providers access and educate their patients.
Philip De Souza: No, that's fantastic. And I like the fact that you're saying, because it's true we often see things where it's like, are you a patient? Enter this portal and are you a provider? Enter here. But sometimes some people might have that fear of missing out like, oh, well, what's there? What am I missing?
Cleo Mavriplis: Yeah, exactly.
Philip De Souza: I can see, I think that breaking down of silos in healthcare, it's a bit different for people. So different people are like, oh, I'm not too sure about that but I'm happier. And I'm sure as more people go and download the app and look at it, and more providers give you feedback, and more patients giving feedback, you'll see what works the best. And I can tell by the team you have around you, that the agility you guys have, that you can totally make changes if necessary. But I like the fact that you have it as one.
Cleo Mavriplis: Thank you.
Ellen Gardner: I agree with that too, Philip. Yes, that as you say, it's democratic. Why shouldn't patients be able to see what their providers are looking at?
Philip De Souza: They're going to Google it anyways!
Cleo Mavriplis: Yeah. Exactly.
Philip De Souza: Why not have it for you all there, it's trusted information.
Cleo Mavriplis: Exactly.
Philip De Souza: They don't have to go and get home and be like, ‘Well, I wonder what my doctor was looking at?’
Cleo Mavriplis: It sort of been just a gut feeling for me that I want it to be very democratic and transparent. So I've kept the two there that you can look at what your healthcare provider sees. If you want to study the background behind a recommendation and the scientific study behind it, you can do that. But if you're a healthcare professional, you can take the app out and show your patient the patient's side. And you can go look for all kinds of resources for patients on the patients’ side. So I'm glad we stuck with the two interfaces on the same app.
Ellen Gardner: Thank you so much, Cleo. We just love talking to you and really wish you all the best with icanbewell.
Cleo Mavriplis: Thank you. You've made it very stress-free and very pleasant. I appreciate the reflected support and enthusiasm. So, thank you. It's very, very kind of you. I appreciate it.
Ellen Gardner: You've been listening to rebuilding primary care. A special series about family health teams, produced by HIROC and the Association of Family Health Teams of Ontario. Today our guest was Dr. Cleo Mavriplis, a Family Physician and professor with the Bruyère Academic Family Health Team at the University of Ottawa. She's also Assistant Dean of Faculty Development at the French satellite faculty of medicine at McGill University. To access the app go to, icanbewell.ca. Stay tuned for more episodes of Rebuilding Primary Care.
Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at firstname.lastname@example.org. We'd love to hear from you.