Frequently Asked Questions

About Heartsmap

  • 1. What is HEARTSMAP?

    HEARTSMAP is an online psychosocial assessment tool developed by the Divisions of Pediatric Emergency Medicine and Pediatric Psychiatry at BC Children’s Hospital (BCCH). HEARTSMAP helps emergency department (ED) clinicians assess and manage children and youth presenting with mental health complaints (i.e. depression, anxiety, eating disorders, etc.).

    HEARTSMAP is composed of 10 psychosocial domains:

    • Home
    • Education and activities
    • Alcohol and drugs
    • Relationships and bullying
    • Thoughts and anxiety
    • Safety
    • sexual health
    • Mood and function
    • Abuse
    • Professionals and resources

    Each of these sections is allocated a score:

    • 0 for no concerns
    • 1 for mild concerns
    • 2 for moderate concerns
    • 3 for major concerns

    Validated among ED clinicians at BCCH, HEARTSMAP is currently the psychosocial assessment tool used for all mental health presentations at the BCCH ED.

    To learn more about the HEARTSMAP tool, visit our homepage: www.heartsmap.ca. Our HEARTSMAP training video can also be found here: https://heartsmap.ca/resources/

    HEARTSMAP is an online psychosocial assessment tool developed by the Divisions of Pediatric Emergency Medicine and Pediatric Psychiatry at BC Children’s Hospital (BCCH). HEARTSMAP helps emergency department (ED) clinicians assess and manage children and youth presenting with mental health complaints (i.e. depression, anxiety, eating disorders, etc.).

    HEARTSMAP is composed of 10 psychosocial domains:

    • Home
    • Education and activities
    • Alcohol and drugs
    • Relationships and bullying
    • Thoughts and anxiety
    • Safety
    • sexual health
    • Mood and function
    • Abuse
    • Professionals and resources

    Each of these sections is allocated a score:

    • 0 for no concerns
    • 1 for mild concerns
    • 2 for moderate concerns
    • 3 for major concerns

    Validated among ED clinicians at BCCH, HEARTSMAP is currently the psychosocial assessment tool used for all mental health presentations at the BCCH ED.

    To learn more about the HEARTSMAP tool, visit our homepage: www.heartsmap.ca. Our HEARTSMAP training video can also be found here: https://heartsmap.ca/resources/

  • 2. How does HEARTSMAP differ from other psychosocial assessment tools?

    HEARTSMAP is able to provide patients with a tailored disposition plan to meet their most urgent needs. Scores from each HEARTSMAP section map to one or more of the following domains: Social, Function, Youth Health, Psychiatry, and Abuse. Individual section scores, cumulative domain scores, and whether a care plan is in place for any highlighted concerns are all used to determine the most appropriate recommendations for patient management. This approach allows HEARTSMAP to delineate between social, behavioural, and psychiatric concerns, providing clinicians with specific outpatient recommendations appropriately matched to the severity and/or urgency of identified concerns.
  • 3. What are some recommendations for management that HEARTSMAP provides?

    Recommendations for management range from acute psychiatric consultation in the ED to outpatient referrals to community mental health services such as crisis response teams, social workers, youth health specialists, substance abuse services/detoxification programs, or redirection to an established care team (if applicable).
  • 4. How long does an assessment take when using HEARTSMAP?

    Typically, an assessment using HEARTSMAP will take 10-30 minutes to complete; however, this will vary depending on how forthcoming the family is with providing information and your history taking style.
  • 5. Has HEARTSMAP undergone pilot testing?

    Yes. HEARTSMAP was piloted at the BC Children’s Hospital pediatric ED in September 2014. ED clinicians at BC Children’s Hospital provided feedback during this pilot period, allowing us to refine tool’s scoring criteria, provide additional sample interview questions, and adapt the user interface to improve user experience. HEARTSMAP has since been adopted as the standard psychosocial assessment tool used at the BC Children’s Hospital pediatric ED.
  • 6. Has the HEARTSMAP tools inter-user reliability been evaluated?

    Yes. HEARTSMAP’s inter-user reliability was evaluated among pediatric ED clinicians locally at BC Children’s Hospital in 2014, and among ED clinicians in general EDs in 2016.

    At BC Children’s Hospital, data from 104 ED mental health presentations was extracted to construct clinical narratives. A panel of ED clinician evaluators reviewed each of these narratives. The panel included: 2 pediatric emergency medicine physicians, 1 nurse practitioner, and 1 bedside nurse. The results below summarize the agreement among the clinician reviewers with regard to consulting psychiatry in the ED:

    Comparisons Kappa Value Interpretation¹
    Pediatric ED physician vs. Pediatric ED physician 0.7 Substantial Agreement
    Pediatric ED physician vs. Nurse practitioner 0.6 Moderate Agreement
    Pediatric ED physician vs. Bedside nurse 0.5 Moderate Agreement

    Eleven ED clinicians from 5 health authorities – Provincial Health Services Authority, Providence Health Care, Vancouver Coastal Health, Fraser Health Authority, and Interior Health Authority validated the HEARTSMAP tool in 2016 (3). These ED clinicians, including physicians, social workers, and psychiatric liaison nurses, were asked to use the HEARTSMAP tool to evaluate 50 fictional narratives describing a variety of pediatric mental health cases. Their agreement with regards to consulting psychiatry in the ED or referring to a community based program such as a Crisis Response Team, a Child and Youth Mental Health Team (CYMHT), social services through the Ministry of Child and Family Development, or a youth health clinic, is summarized below:

    Resource Kappa Value Interpretation²
    Psychiatry consultation in the ED    
    Outpatient Crisis Response Team    
    Outpatient CYMHT    
    MCFD Social Services    
    Youth Health Clinic/Substance & addiction services    

     

    1. Viera AJ, Garrett JM. Understanding Interobserver Agreement¿: The Kappa Statistic. Fam Med. 2005;37(5):360-363.
    2. Hallgren KA. Computing Inter-Rater Reliability for Observational Data: An Overview and Tutorial. Tutor Quant Methods Psychol. 2012;8(1):23-34.
    3. Virk, P., Stenstrom, R., & Doan, Q. (2018). Reliability testing of the HEARTSMAP psychosocial assessment tool for multidisciplinary use and in diverse emergency settings. Paediatrics & Child Health, 1–6. https://doi.org/10.1093/pch/pxy017
  • 7. How accurately can HEARTSMAP predict psychiatric admission?

    During our HEARTSMAP pilot implementation at BC Children’s Hospital, we prospectively enrolled 62 patients presenting with mental health concerns to determine whether the tool could correctly predict which patients required a psychiatric admission. During the pilot implementation, users were asked to user HEARTSMAP to guide their assessment; however, the patient’s ultimate disposition was at the ED clinician’s discretion. The results are summarized below:

    Patient Disposition
    HEARTSMAP Recommendations Admitted (n=13) Discharged (n=49)
    Admit 13 33
    Discharge 0 16

    HEARTSMAP had 100% sensitivity, correctly identifying all 13 patients that required a psychiatric admission. HEARTSMAP’s specificity was 32%, recommending discharge for 16 of the 49 patients that were ultimately sent home. Nevertheless, our initial results at BC Children’s demonstrated a trend toward reducing wait times and the odds of requesting a psychiatric consult as a result of implementing HEARTSMAP.

HEARTSMAP Provincial Expansion

  • 1. Is this project funded or sponsored?

    This project is funded by the Specialist Services Committee – a joint collaborative between Doctors of BC and the BC Ministry of Health.
  • 2. Where will HEARTSMAP be implemented?

    HEARTSMAP will be implemented at 50 EDs across 5 British Columbian health authorities – Provincial Health Services Authority, Providence Health Care, Vancouver Coastal Health, Fraser Health Authority, and Interior Health Authority.
  • 3. Is HEARTSMAP's impact on ED flow and patient outcomes being evaluated as part of this provincial expansion project?

    Yes. Health authority visit data for all pediatric mental health-related presentations will be collected. Data from the pre-HEARTSMAP implementation period will be compared to data from the post-HEARTSMAP implementation period. These data sets will be used to determine whether HEARTSMAP can reduce ED length of stay for these patients, and whether the tool can decrease the proportion of return visits made to the ED within 30 days of the initial visit.

Registration and Training

  • 1. Who can register to use HEARTSMAP?

    HEARTSMAP is designed for ED clinicians such as physicians, nurse practitioners, registered nurses, social workers, etc. who typically assess and manage children/youth presenting to the department with mental health complaints. Registration to use HEARTSMAP is also available to medical trainees, such as medical students, residents, and subspecialty fellows. HEARTSMAP is not intended for general public use.

    Registration is required for all users.

  • 2. What is required for registration?

    If these three sections are not sufficiently completed, you will not be able to continue on to the next HEARTSMAP section.

  • 3. Are there any associated costs with registration?

    No. HEARTSMAP is free for all registered users.
  • 4. Can I save and come back to the 3 training cases at a later time if I'm unable to complete them in one sitting?

    Yes. You can select “Save & Return Later” at the bottom of the training case page. You will then be provided with an 8-character Return Code. When returning to your case, you will be prompted to enter this code.
  • 5. I've successfully scored my 3 training cases. Where will I find my username and password?

    An email containing your username and temporary password will be sent to the email you used for registration. You will be prompted change your temporary password within when you first login to use the tool.
  • 6. Can I receive CME credits for completing HEARTSMAP Training?

    Yes. The University of British Columbia Division of Continuing Professional Development (UBC CPD) is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME) to provide study credits for continuing medical education for physicians.  This course has been reviewed and approved by the UBC Division of Continuing Professional Development.  This Group Learning course meets the certification criteria of the College of Family Physicians of Canada and has been certified by UBC CPD for up to 1.5 Mainpro+ credits. This activity is an Accredited Self-Assessment Program eligible for up to 1.5 MOC Section 3 credits (1.5 credit hours) as defined by the Maintenance of Certification Program of The Royal College of Physicians & Surgeons of Canada. Remember to visit MAINPORT ePortfolio to record your learning and outcomes (credits are automatically tripled).  Each physician should claim only those credits he/she actually spent in the activity.

Using the HEARTSMAP Tool

  • 1. What information is required for each of the HEARTSMAP sections?

    In order to ensure complete documentation, each HEARTSMAP section requires:

    • Assessment Notes
    • A score (0-3)
    • An indication of whether resources are in place to address any highlighted concerns (for scores 1+).

    If these three sections are not sufficiently completed, you will not be able to continue on to the next HEARTSMAP section.

  • 2. Why am I asked to provide my own impression for patient management at the end of the assessment?

    This data will be used for quality improvement purposes. Clinicians’ own impressions for management will be compared to the recommendations generated by the HEARTSMAP referral algorithm. Over time, we will analyze whether clinicians’ practice patterns fall more in line with HEARTSMAP’s evidence-based referral algorithm.
  • 3. Does my disposition plan have to correspond or match the HEARTSMAP tool's recommendations for management?

    Patient care ultimately resides with the ED clinician. HEARTSMAP is intended to guide users through a psychosocial assessment, but should not replace clinical judgment. Your disposition plan does not have to match the HEARTSMAP tool’s recommendations for management. How clinicians decide to access services, or consult psychiatric specialties, is to the discretion of the clinician.
  • 4. How do I print out the HEARTSMAP Report?

    On the report page, select your Health Authority from the drop down menu, and then select either “Download Report to Print” or “Email Report to Me”.

    Download Report to Print: Once the report shows up, click the printer icon in the top right corner of the web page. Your device will need to be connected to a printer in order to print the report.

    Email Report to Me: Once selected, the report will be emailed to the email address you used to register (your health authority or institutional email). Go to your email, open the report, and select Print from the File menu.

  • 5. Download Report to Print - Enable pop-up

    If you select “Download Report to Print”, but nothing downloads, your web browser’s pop-up blocker may be blocking it. To prevent this, click the pop-up blocker notification (found in or under the URL bar for most web browsers — see below) and select the allow pop-ups from tool.heartsmap.ca option.

     

    Google Chrome:

    pop-up-blocker-google-chrome

    Firefox:

    pop-up-blocker-firefox

    Safari: Go to Preferences under the Safari menu. Click on Security, then uncheck the box that says Block pop-up windows.

    pop-up-blocker-preferences-safari

  • 6. Can I deactivate my account if I no longer practice in BC?

    Yes. To deactivate your account, please contact us at heartsmap@bcchr.ca.

Access and Logging in

  • 1. How can I access HEARTSMAP?

    After registering to use the tool, users can access the tool by clicking on the “HEARTSMAP TOOL” button on our homepage: https://heartsmap.ca/. Please ensure that you are connected to a health authority network when accessing the tool.

    We recommend using the most current versions of the following browsers when accessing HEARTSMAP:

    • Google Chrome
    • Mozilla Firefox
    • Safari
    • Internet Explorer 10
  • 2. I've forgotten my username or password. How can I retrieve my username or reset my password?

    Your HEARTSMAP username is your institutional email address that you provided for registration. This username is not active until you have completed all three training cases.

     

    To download the following instructions on a PDF, click here.

    If you forget your password, click the “Lost your password?” link below the Log In button:

    Once you enter your email address here and hit “Reset”, you will receive an email with a new password.

    To change this password, log in to the HEARTSMAP tool (it is easiest to copy/paste the new password from the email) and follow the directions to below to change your password.

  • 3. How do I change my password?

    To download the following instructions in PDF format, click here. (instructions begin on page 2)

     

    Once logged in to the HEARTSMAP tool, click on the “Profile” tab in the top right hand corner:

    On your profile, click the “Generate Password” button:

    This will generate a new password, which can be edited to your preferred password:

    1. Enter your new password into the text box
    2. Select the check box to “Confirm use of weak password” (if applicable)
    3. Click the “Update Profile” button at the bottom of the page to update your password. Use this new password the next time you log in to the HEARTSMAP tool

  • 4. What should I do if I can't access HEARTSMAP?

    Check that you are connected to the Health Authority network (HEARTSMAP cannot be accessed from non-Health Authority networks). If you are connected to the network and still cannot access HEARTSMAP, please contact us at heartsmap@bcchr.ca