• e-Health 2019 Conference Program

    Celebrate, Grow & Inspire Bold Action in Digital Health - Toronto, ON

    This product offers access to the e-Health 2019 Keynote / Plenary Presentation Live Webcasts, the recording of these 4 sessions and access to all PDF/Presentation Slides of each conference presentation.

    Group Discounts Available for 5+ Purchases. Contact us to request group pricing.

    PDF's of presentation PowerPoints are now online!

    Presentation Date(s):
    • May 26 - 29, 2019
    • Total Presentations: 146
Filter Results:

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    Opening Keynote

    • Type: Keynote Session
    • Track:
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      Health Care and eHealth in the Age of False News and AI

      08:30 - 10:00  |  Author(s): Michael Decter

      • Abstract

      M. Decter LDIC Inc., Toronto/CA

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    OS01 - It's All About the Patient Outcomes!

    • Type: Oral Session
    • Track: Executive
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      OS01.01 - Implementing a Patient Portal in a Paediatric World

      10:30 - 11:30  |  Author(s): Sarah Lee

      • Abstract

      Purpose/Objectives:
      Provide an overview of the people and processes involved in the implementation of a patient portal in a paediatric setting. Outline the benefits and challenges of sharing the same portal across two paediatric organizations who went live on the same system at different times. Detail the strategies necessary to achieve engagement and adoption from both patient populations. Inform audience of lessons learned and provide a glimpse at the future-state roadmap planned for both hospitals.


      Methodology/Approach:
      Each organization had unique implementation approaches given they went live with varying project scope and in different years (2015 and 2018). Extensive collaboration was required between the two hospitals to review shared system settings including those impacting consent requirements, release of information (e.g., results) to portal and communication between patients and providers. Both organizations chose to implement outpatient areas in a pilot phase with a subset of clinics and form official working groups to facilitate decision making. There was heavy engagement from representative stakeholders including communications and privacy. Each organization engaged patient and family representatives or existing family advisory councils to obtain valuable feedback prior to, during and post-implementation.


      Finding/Results:
      The sequential implementation of patient portals in two organizations allowed for enhanced planning and decision making for the latter organization and facilitated re-analysis of important issues for the former organization. The pilot areas informed broader rollout strategies, both with patients/families and clinic staff. Adoption of portal differed in varying specialties (and by organization) due to patient populations and provider/clinic engagement and likely perceived portal utility. Patient portal implementation in a paediatric setting sparked interesting discussions surrounding policies around adolescent vs. parental/guardian access to personal health information. As clinic activation spread, new questions arose given the unique specialty-specific patient populations impacted. The working group membership - clinicians, patients/families, communications and privacy staff - proved to be a great resource for decision-making and facilitation of larger discussions required at an organizational level. The working group was an ideal venue to vet communication and training materials for the portal to establish consistent messaging across the organizations. Once live, the project teams had to balance resolving go-live issues with appetite from clinical and patient/family communities for advanced portal features and functionality. The working groups for both organizations continue to play an important role in defining priorities and establishing expectations beyond the initial implementation.


      Conclusion/Implications/Recommendations:
      Involving key stakeholders early on in the process was a success factor for each organization. Having working group members weigh in from the planning stage through implementation and beyond was critical to drive communication, implementation and post-live strategies. Strongly encouraging clinic champions or ‘hype’ staff proved to contribute to a clinic’s success in increased patient/family activations and engagement. Creating and providing ample communication and training material from the onset helped to facilitate each clinic activation and reduce the burden on the project team. There are benefits and challenges with sharing the same portal across two organizations. Building a solid relationship between the organizations to reach consensus on shared system settings and share lessons learned proved valuable for each hospital.


      140 Character Summary:
      Two organizations effectively implemented a shared paediatric patient portal. Keys to success were engaged, representative working groups at each organization.

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      OS01.02 - Virtual Emergency Support Service. "I've Got Eyes on the Patient"

      10:30 - 11:30  |  Author(s): Orpah McKenzie

      • Abstract

      Purpose/Objectives:
      The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to enhance support to nurses and clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner. VES has been implemented in eight First Nations Nursing Stations in Sioux Lookout Zone. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.The objective of the final evaluation is to determine if the VES service model is an effective means for enhancing urgent and emergent care in isolated nursing stations.


      Methodology/Approach:
      The evaluation is based on a limited production roll-out in the Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations and reflects service-level data and provider feedback collected between 16 March and 31 December 2017. VES Data Sources and Collection Approach: A. Nursing Feedback · Nurses summarized VES encounters by filling out a record of event · KOeHealth staff conducted short interviews with Nurses-in-Charge (NICs) on a weekly basis. · Face-to-face interviews with NICs B. Physician feedback · Eight physicians were interviewed or provided written responses about their experiences with the VES. · Three ORNGE Transport Medicine Physicians (TMPs) provided feedback about their experiences. · ORNGE shared results of post-VES surveys C. Service-level data · Nursing records of event · Logging files from OTN’s videoconferencing application for Emergency Medicine · Provincial air ambulance transport logs · Monthly VES Implementation Team meetings · Promising Practices Workshop – 4 October 2017, Thunder Bay. D. Direct engagement and observation: · Site visits to four First Nations communities.


      Finding/Results:
      Between mid-March and end of December 2017, VES resources were mobilized to manage 10.4% of the 666 medical evacuations that originated from one of the four VES First Nations. Feedback by nurses, ORNGE TMPs and Regional Critical Response Program (RCCR) confirm that VES is an effective means for enhancing urgent and emergent care in isolated nursing stations. With VES, patients living in Ontario’s most remote communities have access to the same level of clinical expertise as any other resident in the North West LHIN


      Conclusion/Implications/Recommendations:
      VES is an advanced, integrated and scalable urgent/emergent service model that is effectively supporting nurses and patient care in isolated First Nations nursing stations. Provider feedback and service-level data show promising results. Nearly three-quarters of the ORNGE TMP workforce (17 of 23) have used VES one or more times to support nurses and MDs in isolated nursing stations. Regional Critical Care Response teams have used VES multiple times to stabilize critically ill patients prior to transport, coach nurses in the optimal use of life-saving equipment, and counsel family members about the imminent death of a loved one. Service-level data and provider feedback signal successful completion of the VES pilot project and anticipate its expansion to additional isolated First Nations in the Sioux Lookout Zone.


      140 Character Summary:
      VES is urgent/emergent service model that support nurses and patient care in remote and isolated First Nations nursing stations in Sioux Lookout Zone.

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      OS01.03 - Patient-Reported Outcomes for Hip and Knee Replacements in Ontario

      10:30 - 11:30  |  Author(s): Nicole De Guia

      • Abstract

      Purpose/Objectives:
      Patient-reported outcome measures (PROMs) are essential to patient-centred health care delivery. Hip and knee replacements are procedures aimed at improving patients’ pain, functioning and overall quality of life. To support the delivery of patient-centred, evidence-based care, the Ontario Ministry of Health and Long-Term Care (MOHLTC) approached the Canadian Institute for Health Information (CIHI) and CCO to help execute a new PROMs project for hip and knee replacement patients. The PROMs project is being implemented in alignment with the bundled hip and knee replacement surgery Quality Based Procedure (QBP) program. Goals of the project included: • Piloting collection of PROMs, with intent to scale-up to province-wide. • Leveraging technology to support implementation and real-time reporting back to providers. • Developing initial comparative reports for health system monitoring. • Improving communications between providers and patients, informing treatment decisions and patient expectations. • Complementing traditional, clinical outcomes, cost, and patient experience data for a more comprehensive understanding of their relationships. • Supporting the evaluation of performance and effectiveness of care.


      Methodology/Approach:
      The MOHLTC oversees the governance structure for the project and provides leadership to ensure project alignment with the bundled hip and knee QBP project. The MOHLTC, CIHI and CCO have complementary roles in the execution of the PROMs project. CIHI is responsible for confirming data collection standards including instruments, minimum data set, and collection time points. After receiving PROMs data collected by CCO, CIHI will provide a range of comparative reports to support Ontario health system performance monitoring and evaluation (e.g., comparative reports to facilities and others, and data files to the MOHLTC). CCO has over a decade of experience overseeing the systematic collection of oncology PROMs in Ontario. Electronic PROMs collection is currently available at more than 80 oncology centres across the province and more than 30,000 oncology patient screens are completed via CCO’s e-PROMs platform each month. CCO has been commissioned to leverage and apply this expertise to the collection of hip and knee PROMs. CCO is responsible for implementing electronic PROMs collection across the province and for hospital-level data collection. CCO will regularly submit datasets to CIHI for use in comparative reporting. Based on the needs of the MOHLTC, the planned approach is a three-year pilot project which started September 1, 2017, with data collection commencing April 2018.


      Finding/Results:
      The objectives of the project are to demonstrate the value of collecting PROMs data, test the platform/mechanism for collecting PROMs data in Ontario, and initiate technological and business processes for a cost-effective scale-up to provincial implementation. Other benefits include measures of access and appropriateness, and the potential to support patient and surgeon decision-making prior to surgery. The goal of the pilot is to determine the most effective, user-friendly, and cost-effective method for collecting PROMs over the long-term.


      Conclusion/Implications/Recommendations:
      Ontario is the first province in Canada to implement the national PROMs hip and knee arthroplasty standards and electronic collection. Early learnings from an implementation, data and reporting perspective will be presented at the conference.


      140 Character Summary:
      To support patient-centred, evidence based care, a new patient-reported outcome measures project for hip and knee replacements has launched in Ontario.

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      OS01.04 - Sex Workers’ Preferences for ICT Tools for Health and Safety

      10:30 - 11:30  |  Author(s): Th

      • Abstract

      Purpose/Objectives:
      While sex work itself is not illegal, the criminalization of certain aspects of sex work in Canada increases Occupational Health and Safety (OHS) risks, including violence, stigma and discrimination. The use of Information and Communication Technology (ICT) such as web pages, Twitter, and WhatsApp as a tool for the sex worker communities to access OHS strategies is largely unexplored. The objective of this qualitative study is to explore the question: What are the needs and preferences of Toronto-based sex workers (SWs) regarding ICTs as a strategy to communicate knowledge and education about OHS risks in the workplace?


      Methodology/Approach:
      This qualitative study consists of two components, both using a community-based research approach. The first is a thematic analysis of three focus groups and three individual interviews (unpublished data from a previous research project) to provide preliminary insights into how sex workers might like to utilize ICTs for OHS. The second component will delve deeply into the needs and barriers of sex workers in terms of OHS, and their preferences in ICT use through focus groups. The findings from the first component will be used to inform the categories of inquiry for the focus groups. The second component will be conducted with Maggie's: The Toronto Sex Workers Action Project (Maggie's). Focus groups of 6 to 8 participants will be convened until data saturation is reached. Leaders from the sex worker community will facilitate the discussions. After each interview, the researcher will practice reflexivity by documenting her own observations on what took place during the interviews. Using thematic content analysis, the focus group transcripts will be analyzed by three people; this group will be composed of the researcher, a research assistant and a member of the sex worker community trained in qualitative analysis.


      Finding/Results:
      The first component revealed that sex workers would like the following OHS strategies to be available via an ICT tool: condom negotiation techniques; anonymous reporting of assault; reducing a sense of isolation; reduction in HIV vulnerability; job satisfaction; client does not attempt removal of condom; prevention of stalking, exploitation, being outed. The interviews did not provide insights into the privacy and security concerns when using ICTs and will be explored in the focus groups in the second component. The research will be completed by March 2019; results from the completed study will be presented at the conference.


      Conclusion/Implications/Recommendations:
      The research into ICT tools will support sex workers in their access to OHS strategies. As most SWs in Toronto, Canada, own a smartphone, the provision of an ICT tool for SWs to exchange OHS strategies endeavours to reduce their OHS risks, strengthen their social network, enhance their social cohesion and social capital. The findings from this research will inform a future study “What are the core components of potential ICT intervention strategies to exchange OHS information in the workplace?” Once the chosen ICT intervention has been established, another phase of research, exploring the feasibility of SWs using an ICT intervention to exchange OHS strategies in the workplace, is proposed as the next step.


      140 Character Summary:
      Community-based research with Toronto sex workers in exploring the potential of exchanging occupational health and safety strategies via an ICT tool

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    OS02 - Venues of Virtual Care

    • Type: Oral Session
    • Track:
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      OS02.01 - How Unified Communication Improves Patient Care and Safety

      10:30 - 11:30  |  Author(s): Asim Masood

      • Abstract

      Purpose/Objectives:
      Hospital communication has become exceedingly complex with multiple and disparate systems. Too often, physiological monitors, beds, IV pumps, ventilators, and other systems sound alarms or send messages to clinical staff that are not actionable. As a result, care team members often suffer from alarm fatigue and become immune sounds and alerts from these systems, which can have serious consequences. In addition, hospitalized patients are also fatigued by the incessant sound of alarms, which often disrupt their sleep and makes them and their family members feel anxious. The impact this noise has on patient, family and staff well-being has accelerated the need to understand alarms, how often they occur, how they are responded to, and how to manage them safely and efficiently. Being able to connect the right people with the right information quickly is critical to delivering safe patient care in a quiet, healing environment.


      Methodology/Approach:
      William Osler Health System implemented an intelligent alarm management solution to improve patient care, safety and experience across three sites. With the solution, alerts and alarms are automatically sent to the right care team member(s) based on workflow and escalation rules defined in the system. Clinicians can easily distinguish between alarms from multiple sources and different criticalities based on the audio and visual information sent directly to their device of choice – whether it’s a smartphone, laptop or workstation. The solution enables them to quickly prioritize alarms and respond appropriately. All alarm events and responses are date and time stamped and logged in real time, providing robust data and an audit trail to identify potential gaps in communication and processes. Analytics from the solution helps hospital leaders understand alarm trends per bed, unit, staff, alarm type, alarm density, distribution and response times. This data allows refinement of alarm filtering and escalation to reduce alarm fatigue, improve patient safety and enhance care team efficiency.


      Finding/Results:
      Integration of the alarm management solution with clinical systems such as the EHR, nurse call system, and physiological monitors has streamlined workflows and minimized the complexity of managing multiple systems and vendors. One of the most impactful alerts set up connects the communication system to a point-of-care decision-support application. The software monitors patient data gathered from the EHR system, looking for early signs of a developing infection. When the system detects early warning signs of sepsis, it automatically sends an alarm to the appropriate nurse on his or her device of choice. With early warning, hospital staff can act immediately to accelerate treatment and improve patient outcomes. These workflow integrations and intelligent codes have helped decrease code blue events and ICU transfers. Clinicians have also noted a decrease in mortality rates.


      Conclusion/Implications/Recommendations:
      In integrated approach to communication and alarm management is key to reducing alarm or interruption fatigue, increase staff response times, and improve the healthcare experience. Mobile healthcare technology that is fully integrated to workflows and with clinically relevant patient data can also lead to better patient outcomes.


      140 Character Summary:
      Intelligent alarm management can reduce alarm fatigue, create a quiet, healing environment, and improve patient care, safety and experience.

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      OS02.02 - Service Design for The Chronic Pain System of Care

      10:30 - 11:30  |  Author(s): Torey Taferner

      • Abstract

      Purpose/Objectives:
      TAPMI is an innovative program that brings together 5 unique Toronto-based pain management services under one umbrella. The multi-institutional partnership needed help rethinking the design of the existing processes in order to provide improved access for both chronic pain patients and their PCP’s. The goal was to take a service design approach to understand chronic pain patients, their PCP’s, the existing chronic pain specialty clinics and their unique processes, and the current patient experience across all touch-points. With these learnings, we created a virtual hub where their services could be virtually accessed, intake and triage procedures could be standardized, and ensure a more efficient and accurate referral process for patients and their providers.


      Methodology/Approach:
      As part of our user-centered design process, user/stakeholder interviews were conducted to better understand how key users navigate the health system and current model of care for chronic pain patients, as well as the mental, emotional, and physical impact along the way. We researched international programs innovating in the treatment and triage of chronic pain, and identified areas of opportunity for improvement. Our findings were compiled into a document/presentation with the star finding being a Patient Experience Map. The research and Experience Map further informed the content strategy and design of the website, which we rolled out in phases as the program continued to develop.


      Finding/Results:
      The Experience Map clarified where the team should focus their efforts: seeing the patient journey mapped out visually and sequentially revealed that during the patient’s longest wait times, the system was doing nothing for them. This informed strategic planning of the website and the program itself to develop pain education and self-management tools for patients, as well as resources and educational tools for primary care providers to build capacity and provider chronic pain patients with better, easier access to care. The website provides TAPMI with a virtual home, establishing who they are and the services they provide, as well as accomplishing their primary objectives. They are now able to provide a centralized referral process with one referral form into all of the 5 pain services, and both patients and primary care providers can easily access information about chronic pain, treatment options, and how to access the TAPMI program.


      Conclusion/Implications/Recommendations:
      TAPMI is providing an accessible space where patients can create their own self-management pathway. Space where they can educate themselves on chronic pain and holistic treatment methods, experiment with different techniques, set and work towards their goals — both small and large — and access support services at their own pace and from the comfort of their home. This allows for TAPMI to extend these services to chronic pain patients who live far away or may not have time to attend regular sessions in person. The efforts put forth in this project are placing patients on a successful path to begin their journey to a better quality of life. TAPMI is not only a catalyst for better self-care, but care at the primary, specialist, and system level.


      140 Character Summary:
      A Service Design approach to understanding the chronic pain patient and provider experience and inform the design of an innovative, accessible hub for virtual care.

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      OS02.03 - Breaking Down Barriers:The Perinatal Mental Health Telemedicine Program

      10:30 - 11:30  |  Author(s): Alisha Ramlogan

      • Abstract

      Purpose/Objectives:
      The literature indicates that during pregnancy and the postpartum period, women have a very high incidence of new onset mood and anxiety disorders and high relapse rates for pre-existing psychiatric disorders. However, only 33-50% of women receive services provided by existing community groups, which do not always identify, monitor or treat the mental illness. These women often end up going to emergency departments or do not access services at all. The objectives of the program are the following: 1) Increase accessibility to specialized perinatal mental health services in the community 2) Develop and promote an appropriate interdisciplinary care pathway to serve women with perinatal mental health concerns 3) Promote perinatal mental health knowledge and skills translation to community care providers through various educational activities including telemedicine 4) Strengthen collaboration of hospital and community service providers in providing community-based services 5) Improve patient and family and provider satisfaction with the delivery of an improved consultative experience using telemedicine technology


      Methodology/Approach:
      With the use of Ontario Telemedicine Network (OTN) technology, the Perinatal Mental Health Telemedicine Program has been able to provide ongoing follow-up and support for patients in their own homes. Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. It is an efficient and cost effective way for patients to access specialized perinatal mental health care without the associated costs of travel from their home environment.


      Finding/Results:
      Performance indicators include the number of unique patients who engage in the program as well the total number of telemedicine events. By the end of fiscal year 2017-2018, the total number of telemedicine events was 1326. This exceeded the telemedicine numbers during the previous year, which were 1245 events. In terms of new unique patients who were seen via telemedicine, the final count was 198. In addition to this, the program has also obtained other metrics including patient satisfaction with telemedicine. For fiscal year 2016-2017, 399 surveys have been sent out with a total of 133 responses (33.3% response rate). Based on the responses, there is a high level of satisfaction. Some of the positive feedback from telemedicine patients include: “It's very simple to use. I really like it and feel very grateful for this service. It has allowed me to receive a closer psychiatric monitoring of my health condition without adding additional stress and without spending time and money on transportation." and “An absolutely fantastic program that enables people like me who live in smaller cities to access the resources traditionally afforded to only those in large cities (without the hassle of travel)."


      Conclusion/Implications/Recommendations:
      Through the implementation of telemedicine, the Perinatal Mental Health program has been able to reach deeper into the community to evaluate, diagnose and treat patients both within the TC-LHIN and in remote locations across the province. In terms of spread, the central focus of the telemedicine program include further outreach to various community partners, including family health teams and community health centers in order to provide consultations, education and case conferences leveraging telemedicine technology.


      140 Character Summary:
      The Perinatal Mental Health Program aims to improve access to perinatal mental health services and promote capacity building by leveraging the use of telemedicine.

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      OS02.04 - Practical Apps: Evidence-Based Physician Reviewed mhealth Care Apps for Patients

      10:30 - 11:30  |  Author(s): Payal Agarwal

      • Abstract

      Purpose/Objectives:
      There has been great excitement and growth in the mobile health field; however, due to a lack of oversight, it is likely that many of these apps are of poor quality posing potential risks to patients. Previous attempts, including efforts at the National Health Service, had significant limitations or were not sufficiently rigorous to inform health system decision makers. The objective of the Practical Apps project is to leverage a comprehensive framework to develop set of credible reviews that identify high quality, patient-facing health apps that have the potential to impact chronic disease outcomes across the health system.


      Methodology/Approach:
      The first phase of this project involved the development of a methodology to review mobile health apps for chronic disease management. The research team reviewed relevant academic literature and regulatory guidelines. No current evaluation criteria were comprehensively addressed all factors relevant to real-world clinical use. Therefore, a new framework was created incorporating previously identified quality criteria from multiple resources, listed and grouped into six common themes. A group of primary care physicians were trained in using the resulting framework to review 4-5 apps related to a single common chronic condition. Reviews were posted on the site practicalapps.ca with the ability for clinicians to subscribe to receive alerts of new reviews.


      Finding/Results:
      The resulting framework integrates quality heuristics related to both clinical and regulatory needs to support the rapid evaluation of app quality, thus enabling further decisions around clinical use and scale (see Table 1). Table 1: Mobile Health App Quality Framework Dimension Details Features overall purpose, user engagement, clinical integration, data integration Clinical Effectiveness creator credibility, evidence-based information, empirical evidence, clinically comprehensive Usability learnability, memorability, efficiency, satisfaction, visual appeal, clarity Privacy/Security privacy policy, secure data storage, data sharing, permission management, password use Safety/Reliability technical performance, technical support, ongoing updates, error handling, company profile Accessibility cost, available languages, health literacy level, compatible devices, accommodates disabilities Overall 1/5=no clinical use, 3/5=potential for clinical use with limitations, 5/5= appropriate for widespread clinical use and scale The framework was utilized to review 70 apps relating to 17 different health topics. Of the apps that were evaluated, the average overall rating was 3/5 with 39% receiving a rating of 3.5 or higher. However, there was significant variation on key indicators and between topics, especially with regards to clinical effectiveness and privacy/security. Overall, the apps rated well for accessibility and usability but poorly for privacy/security and clinical effectiveness. Over one year, over 3000 people, mostly clinicians, have registered for an online subscription to the site.


      Conclusion/Implications/Recommendations:
      The Practical Apps project and framework provides an effective tool to rapidly identify and inform use and scale of high quality mobile health apps for chronic disease management. The Practical Apps website has received significant amount of unique visitors and subscribers who read the reviews. Currently, our research team is working on a scoping review to inform a more comprehensive updated version of this framework. The results of the Practical Apps can support both clinicians and health systems decisions makers in identifying and supporting high quality apps for patient use.


      140 Character Summary:
      Practical Apps is a project aimed to assess the quality of patient-facing mobile health applications for chronic disease management.

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    OS03 - Secured Communication in Circle of Care

    • 10:30 - 11:30
    • 5/27/2019
    • Location: Area 2
    • Type: Oral Session
    • Track:
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      OS03.01 - Secure Messaging and Clinical Communication Solution (SMaCCS) Across Care Continuums

      10:30 - 11:30  |  Author(s): Sean Spina

      • Abstract

      Purpose/Objectives:
      Delivering patient-centered care requires an ability to collaborate and communicate across care settings and organizational boundaries, including hospitals and community care settings. Without a secure system available, care providers (including family physicians, specialists, hospitalists, nurses and pharmacists) resort to using their personal Smartphones and non-secure applications to communicate about patient care. The SMaCCS project involved an application that was installed on a participant’s own Smartphone. The app had a user directory that included user specialty area, enabling participants to connect with other health care providers in a secure environment. The purpose of this first-in-Canada project was to determine if the introduction of a SMaCCS for use by community and hospital-based health care providers would improve clinical communication, thereby increasing efficiency and enhancing patient care.


      Methodology/Approach:
      This study used a mixed methods approach, which has been found to be useful in other examinations of secure mobile communications. A before-and-after evaluation approach was used to compare providers’ work experiences and proportion of successful contacts using existing communications methods to those achieved using the SMaCCS. The study evaluated the impacts of introducing the SMaCCS on switchboard operators, pharmacists, and physicians using a quality of experience framework to examine; the degree and nature of adoption of the SMaCCS; Effects on user workflow and experience; Effects on care provision


      Finding/Results:
      In total, 2,806 messages were sent in 636 conversations. Of these, 582 conversations occurred between care providers. According to the tracked data, 25% of provider-provider conversations that were initiated were not responded to. Overall, 53% of participants surveyed (59 of 111) reported being satisfied with the SMaCCS app. 75% of survey respondents (85 of 114) were satisfied or very satisfied with the security of the app. Interviewees (n=11) noted that the security was the biggest benefit over using a regular texting application, since it allowed them to send patient information, including PHNs and images, which supported valuable clinical conversations. Six interviewees specified that having the app allowed them to communicate when it was most convenient for them. Only a small percentage of participants (4% of survey respondents; 4 of 113) indicated that the messages interrupted their work day. When the SMaCCS app successfully connected care providers, it allowed them to share secure information to support better clinical care. Furthermore, 51% (57 of 111) agreed or strongly agreed that having the app made it easier to send or receive information that was important for patient care. 80% felt more comfortable sharing patient information using the secure communication tool, which will enable further collaboration for patient care.


      Conclusion/Implications/Recommendations:
      The SMaCCS pilot project provided valuable learnings regarding use of secure messaging between community and hospital-based care providers, and within-hospital communication. Having a secure mobile communication solution was identified as a key component of safe, connected health care system in the future. [results of a FOLLOW-UP PROJECT: *Investigation into the Cleaning Methods of Smartphones and Wearables from Infectious Contamination in a Patient Care E*nvironment (I-SWIPE) may also be presented for the first time at EHealth19 if selected]


      140 Character Summary:
      First-in-Canada research identifies how a common secure communication solution between hospital and community practice improves patient care

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      OS03.02 - Clinical Communication & Collaboration at Fraser Health – Secure Messaging

      10:30 - 11:30  |  Author(s): Sihong Huang, Aneet Sahota

      • Abstract

      Purpose/Objectives:
      Care coordination requires effective communication and the proper communication tools and channels help providers communicate, collaborate and deliver care across the care continuum. There is an emerging need for Secure Messaging (SM) from care providers. Currently, clinicians are using unsecure methods of text messaging to support clinical care by sending personal health information through text messaging on their personal devices. At Fraser Health (FH), Secure Messaging solution has been implemented to allow personnel to securely communicate confidential clinical and corporate information on their corporate and personal devices. The objective was to enable Clinical Communication and Collaboration (CC&C) and layer clinical systems integration capabilities such as, On-Call, alert notifications, MEDITECH modules and pager replacement. Without progress in this space, physicians will continue to insecurely text message colleagues to risk security of sensitive data, patient safety and fall behind in communication efficiency/effectiveness.


      Methodology/Approach:
      The approach to implement SM was to leverage Enterprise Mobile Management (EMM) platform to support mobile device management of personal and corporate smartphones. Formal project management methodology has been applied. The project first focused on the delivery of procurement, design, build and integration for SM solution in a Proof of Concept (PoC) fashion prior to expanded rollouts. With the successful completion of PoC at one of FH sites, our workflow-based phased rollout approach has been confirmed and supported by a clear Bring-Your-Own-Device (BYOD) strategy. A change management strategy to support a transformational app has been defined to support the wide range of use cases and to manage user expectations. An initial top-down communication and engagement strategy was created and executed to ensure effective rollouts across the health authority, followed by a targeted site-focused engagement so as to bolster the sense of ownership thus increase the adoption.


      Finding/Results:
      The SM solution provides a simplified process for clinical users; supports the enhanced and timely communication between care providers, the coordination of care via optimal & timely decision making between care providers and the enhanced clinical workflow by reducing the need for phone calls/faxing/chasing providers. As part of the completion of PoC, we have conducted lessons learnt and post implementation review. One of the key learnings is to ensure all stakeholders who communicate with one another need to be enrolled. Also, the complexity around supporting various smartphones and BYOD challenge has been identified. Providing SM access to non-privileged physicians presents new questions to our security, privacy, legal and professional practice policies as well as funding model. The challenge of managing expectations for those keenly interested while supporting those concerned with change needs to be balanced and well addressed, top-level executive leaderships' support is crucial and effective.


      Conclusion/Implications/Recommendations:
      Delivering a successful mobile app at an enterprise level requires effective design, implementation, engagement, adoption and use. SM is a basic functionality but could be a disruptive technology if it immobilizes users' access to information and effective communication workflows. The greatest opportunity will come as we integrate systems, interoperability between other Health Authorities and create policies to ensure professional practice are supported.


      140 Character Summary:
      Introducing Clinical Communication & Collaboration solutions to support clinicians’ mobile workflow, while effectively securing PHI on personal devices.

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      OS03.03 - Digital Health: Evolving and Disrupting the Boundaries of Traditional Healthcare

      10:30 - 11:30  |  Author(s): Krisan Palmer

      • Abstract

      Purpose/Objectives:
      Horizon Health Network is New Brunswick’s (NB) largest Regional Health Authority and is a recognized leader in implementing and sustaining innovative telehealth solutions across all levels of the healthcare system. Horizon’s Stan Cassidy Center for Rehabilitation (SCCR) has recently celebrated 60 years as a North American leader in neurological rehabilitation. SCCR’s newest initiative is another example of empowerment of patients and clinicians to facilitate timely access to scarce clinical resources via telehealth. The purpose for the development of this application was to provide secure capture, delivery and storage of videos taken of those pediatric patients referred to SCCR with significant neurological impairments. These videos obtained by families, as well as established community partners, in various non clinical settings, are critical tools through which rehab professionals at this tertiary center can now provide more timely access, recommendations, treatment and follow-up.


      Methodology/Approach:
      Horizon embraces the philosophy that technology is an enabler. The key to success is to ensure the design and selection of technology to be used is driven by clinical needs. Two clinical needs were identified by SCCR when asked to formally outline the challenges they regularly encounter while providing care to patients throughout rural NB. The first, that situational behavior cannot be appropriately assessed for treatment recommendations unless witnessed by the attending MD or therapist. Secondly, ensuring that assistive/supportive equipment prescribed is safely and correctly applied. Up to this point any attempt to send pictures or videos to the clinicians demonstrating either of these, had been fraught with barriers regarding privacy, security, size and storage. In frustration, many families found their own work around and posted them on u-tube to provide clinicians access. Using Horizon’s established telehealth browser based portal, a mobile app was developed specifically to address SCCR’s need. Patients now use their own devices to download the app from Google Play or Apple store to record and upload videos to their individual patient folder. Clinicians are immediately notified via text and / or email that something new has been added for review and can then communicate their treatment recommendations. Innovative clinical processes and technical architecture are imperative to success in any sustainable telehealth initiative and will be shared specific to this application during the presentation.


      Finding/Results:
      Early intervention by way of increased accessibility permits clinicians to be proactive versus reactive in the detection of safety and treatment requirements for this vulnerable patient population; positively impacting quality of life and overall clinical outcomes.


      Conclusion/Implications/Recommendations:
      Improved access to services that would otherwise not be available in rural or remote communities continues to be seen as the primary contribution of telehealth. However, there is evidence that telehealth can enhance quality of care by better supporting application of best practices, improvement of knowledge and skill development in local care providers, and improvement of care coordination, with decreased costs for payers. Furthermore, telehealth can improve patient/caregiver engagement and enable them to become more active participants in their own care and well-being often from the convenience of their own home, wherever that may be.


      140 Character Summary:
      Provision of a collaborative approach to patient centric rehabilitative care via the use of a Health Authority custom designed mobile app on patients own devices.

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      OS03.04 - Blockchain: Activating patients to take control in our health system

      10:30 - 11:30  |  Author(s): Selina Brudnicki

      • Abstract

      Purpose/Objectives:
      Patients, caregivers, and care teams are challenged with the fragmented health system which prevents easy movement and sharing of patient health records. This results in barriers for patients in managing and partnering in their health, and timely decision-making to determine best treatment options. Now imagine an opportunity where patients can securely control, share and monitor the use of their data! A consortium of Blockchain Accelerator Program founders representing healthcare, government and private industry is in the early stages of co-design with patient, caregiver, clinician, research and privacy representatives to deliver a minimal viable product (MVP) that will start to break down fragmented health systems. The MVP will demonstrate how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The long-term goal will be to enable patients to become more active participants in managing their health; contribute to data-driven insights to improve communication, safety and health outcomes; and support research to find effective treatments and cures.


      Methodology/Approach:
      Co-design with patient, caregiver, clinician, research and privacy representatives ensures that varied perspectives are considered to inform the design and delivery of the MVP. An architecture solution framework has been established to enable patient consent, control and access of their own health data from government, healthcare and private sector sources. This MVP demonstrates how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The project will undergo frequent Stage Gate Reviews to assess and evaluate performance, lessons learned and risks to ensure ongoing delivery of value for patients and the health system.


      Finding/Results:
      Findings and results are three-fold: 1. Delivery of a working MVP and prototype through co-design with patient, caregiver, clinician, research and privacy representatives. This ensures the creation of a usable and value-driven product, taking into account privacy and consent considerations as part of patient control of their own health data; 2. Findings, learnings and value of the project are transparent and shared with key stakeholders and the general public as the project progresses. They have opportunities to dialogue and inform future investment decisions; and 3. Future strategy and planning considerations are well-documented and range from examining and addressing identity management and authentication, to ensuring data governance and trust in a future business network. This MVP informs the next stage of the project to establish a formal Patient Control Blockchain Consortium that oversees data governance, and ensures that a future business network is transparent, trusted and secure. Grounds for further investment can then be substantiated to pilot the Patient Control Blockchain in a real-life setting and address movement of data.


      Conclusion/Implications/Recommendations:
      Through patient control of their own data, a collaborative partnership made up of health care organizations, government, and private industry can be established in order to advance health ecosystem partnerships, accelerate innovation in medical research and inform efforts to deliver value for patients and the health system.


      140 Character Summary:
      This session will share results of a Patient Control of Data Blockchain project that enables patients to securely consent, share and monitor use of their health data.

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    OS04 - Cool Tools for Digital Health

    • 10:30 - 11:30
    • 5/27/2019
    • Location: Area 3
    • Type: Oral Session
    • Track:
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      OS04.01 - Streamlining communications for better patient outcomes #securemessagingworks

      10:30 - 11:30  |  Author(s): Mona Mattei

      • Abstract

      Purpose/Objectives:
      Patient outcomes are reliant on ensuring communications between the right person at the right time. Easy right? Not always in a complex team setting across acute care sites, into community and allied health and across widely dispersed geography. When Interior Health was faced with the loss of pager supports at Kelowna General Hospital, they had to look for a new solution. Exploring beyond the needs of a pager replacement, IHIT opted for a system that addressed a broader variety of communications supports including: immediate access to the callboard for all departments, access to patient information for ADT notifications, secure messaging with upload capability. All the right information in one convenient place for all users.


      Methodology/Approach:
      Key for their selection process was: compliance with FIPAA, the integration into Meditech EMR, vendor flexibility and securing the system on IH servers. Two pilots at KGH in 2015 led to the adoption of the MicrobloggingMD messaging system at IH. Further implementations of the system proceeded in collaboration with hospital teams, Divisions of Family Practice, and Facility Engagement associations.


      Finding/Results:
      Detailed data has been collected to evaluate the uptake and engagement of the system with physicians, nurse practitioners, nursing teams. Initial super user survey feedback indicates: 57% feel the communications informs their care planning, 62.5% agree it is improving care for patients and communications between physicians.


      Conclusion/Implications/Recommendations:
      IHIT will provide an overview of the system, data on use of the system, and share their experience in implementing a new technology for teams including: - Finding and communicating with the right person, at the right time and according to their preferences, to engage in patient care. - Using secure messaging as a medium to reduce telephone tag and provide detailed patient information that will ultimately lead to well informed and improved patient outcomes. - Providing a reliable tool which means maintaining when and how a provider wishes to be paged/notified to engage in patient care. - The challenges in rolling out enterprise wide, and how they were overcome.


      140 Character Summary:
      Implementing secure messaging enterprise wide in Interior Health Authority is a leading edge project ready to share lessons and challenges learned on the journey.

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      OS04.02 - Building an e-mental health toolbox: An implementation toolkit for clinicians

      10:30 - 11:30  |  Author(s): Danielle Impey

      • Abstract

      Purpose/Objectives:
      Experience gleaned from a 2017 rapid review shows that the process of integrating e-mental health as a routine health care tool faces many challenges, is very complex, and requires significant time in most cases. When defining e-mental health, the Mental Health Commission of Canada (MHCC) borrows from the Centre for Mental Health Research in Australia: “Mental health services and information delivered or enhanced through the Internet and related technologies”. To support the uptake, use and evaluation of e-mental health in a clinical setting, the MHCC undertook the development of an implementation toolkit. The purpose of the toolkit was to collect, synthesize and present best and promising resources on how to successfully implement e-mental health into clinical practice. It synthesises evidence-informed tools (e.g. templates, fact sheets, worksheets, assessment tools, etc.) and packaged them in a clear and comprehensive way. The goal is to provide practitioners working at the point of care with guidance and support around integrating e-Mental health with their existing client populations.


      Methodology/Approach:
      The MHCC partnered with Dr. Lori Wozney and the IWK Health Centre in Halifax, NS to undertake the development of the toolkit. Building upon the findings of a 2017 environmental scan and literature review, Dr. Wozney and team undertook a scan and content audit of current e-mental health implementation resources to identify key topics, current gaps in resources and evidence-based tools relevant for the target audience. Where necessary, content was either developed or adapted for inclusion in the toolkit.


      Finding/Results:
      Although there are tools that exist which are applicable to the Canadian mental healthcare system, there continues to be gaps in tools and resources that are specific to clinical needs. Since technology is evolving at such a rapid pace, it is important to stay abreast of changing needs of clinicians. Effort was made to contextualize itself within the larger e-mental health/e-health environment to avoid duplication of tools/resources, though work to enhance the toolkit will continue through 2018, into 2019. The toolkit is available in English and French (where French tools existed) on the MHCC website.


      Conclusion/Implications/Recommendations:
      More implementation tools for clinicians are needed. By providing evidence-based and evidence-informed implementation tools, clinicians may be better-equipped to assess things like organizational readiness, change management, and workflow management as it pertains to e-mental health.


      140 Character Summary:
      Building the Toolkit for e-Mental Health Implementation, an MHCC resource for mental health professionals to implement e-mental health innovations.

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      OS04.03 - Usage of Kiosks to Improve Patient Registration Workflow

      10:30 - 11:30  |  Author(s): Dhara Hemant Desai

      • Abstract

      Purpose/Objectives:
      BACKGROUND: The use of kiosks for patient check-in will help reduce costs, reduce patient waiting time and less errors. The kiosk encourages patients to take control of their care information demographics to complete basic workflow on their own by checking in appointments, updating demographics and verify coverage (ie. OHIP), wayfinding, questionnaire and myHealthRecord (patient portal sign-up). The kiosk will help reduce the line at the front desk registration which will help reduce the wait times. OBJECTIVE: This presentation aims to contribute to an understanding of how direct patient engagement to their registration workflow affects the patients’ delivery of care, experience and reduction of admin workload.


      Methodology/Approach:
      Aim for go-live in November 2018, a mixed methodology to search patients’ identities will be used that include to scan patients unique barcode (generated by patient portal) received by email, swipe OHIP card, search by entering first name, last name and medical record number. The check-in rate and percentage will be determined by using Ambulatory Electronic Patient Record. (aEPR) reports.


      Finding/Results:
      Simulation Results: Kiosks will be live in November 2018 at Women’s College Hospital (WCH) for patient use. The proposed solution Kiosk like structure, where the information regarding patient demographics verification/patient portal sign-up/wayfinding/appointment check-ins can be easily performed by patients. Long queues to check-in with the receptionists can be avoided by using the kiosks. Aim is to have 30% patients to use kiosks during the first quarter of the year. The report generated by Ambulatory Electronic Medical Record will show the patient, the date and time of the appointment, and the appointment status, along with other information about the appointment. The Kiosk Check-In Statistics tab shows the total number of appointments by department and a graph of the percentage of appointments by status: ehealth2019_kiosk check in totals report.png Kiosk Session Exit Reason Breakdown Report: ehealth2019_kiosk session exit reason breakdown report.png


      Conclusion/Implications/Recommendations:
      The quality of the healthcare delivery will be increased, since the kiosk workflow brings together patients in front of the clinical workplace to verify patients' demographics. Strategies to expand services through wayfinding and fill out questionnaires according to the clinic visit types will deliver the tools necessary to create self-sufficient full check-in workflow for patients; consequently improving.


      140 Character Summary:
      Dhara is an Application Coordinator at Women’s College Hospital, has 3 years of experience in project management/coordination and clinical information systems.

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      OS04.04 - Surviving big bang digital disruption: rapid problem solving and innovation.

      10:30 - 11:30  |  Author(s): Bohdan Sadovy

      • Abstract

      Purpose/Objectives:
      The purpose of this panel is to share learnings from “big bang” Epic HIS implementation at a tertiary care children's hospital – SickKids Hospital, Toronto - using a Blood products case study, including: - Interprofessional team formation to deal with high risk issues - Urgent issues management - The role of process improvement in HIS implementation - End user engagement and education Following this session, participants will leave with an understanding of critical success factors and lessons learned related to “big bang” HIS implementation.


      Methodology/Approach:
      The Blood products SWAT Team was formed in the first week following the implementation of Epic to address urgent issues related to blood products impacting patient safety. Specifically, issues with the blood products ordering and preparation processes were causing significant delays in blood products administration and impacting patient care. The SWAT team included a broad range of stakeholders, including representatives from Epic project team, process improvement, laboratory and clinical staff and organization leadership. In the 4 months following go-live, the Blood products SWAT team became the first point of contact for problem solving and issues management. Through the Blood products SWAT group following activities were performed to identify root causes of issues and to develop resolutions: Ongoing monitoring of relevant safety reports Comprehensive tracking of blood products issues Shadowing of Transfusion Medicine Department and clinical staff Addressing technical and build issues in Epic and HCLL (Transfusion Medicine System) using iterative system design Obtaining feedback from Subject Matter Experts (SMEs) Providing regular touchpoints for troubleshooting issues Establishing and management of key work groups to review specific issues Establishing SWAT Oversight Committee Establishing new processes and practices to align with new workflows resulting from Epic implementation Co-designing processes with inter-disciplinary teams Ongoing communication across the organization related to blood productss in Epic – web site, presentations, email, meetings Re-education of clinical and Transfusion Medicine staff based on key issues Developing education materials The Blood products SWAT team took interdisciplinary approach to problem solving. This resulted in many departments across the organization being involved throughout the work of the BC SWAT Team, including: Blood Bank Epic Teams: Orders, Beaker, Beacon, Clin Doc, Op Time, Anaesthesia, Ambulatory Dialysis/Apheresis Haematology/Oncology ICUs Perioperative Services Inpatient Units Medical Day Care Provider Advisory Committee


      Finding/Results:
      Results are below: bb swat.png


      Conclusion/Implications/Recommendations:
      Despite being prepared, anticipate issues at go live. Importance of interprofessional engagement to identify and resolve issues post “big bang” HIS implementation. Need for additional education post HIS training. Don’t underestimate the role of processes in HIS implementation and importance of interprofessional pre- work prior to go live.


      140 Character Summary:
      Learn how we managed blood product ordering, issuing and administration issues, following implementation of a new Epic HIS and Transfusion Medicine System.

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    OS05 - Mining the Gold!

    • 10:30 - 11:30
    • 5/27/2019
    • Location: Area 4
    • Type: Oral Session
    • Track:
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      OS05.01 - Enhancing National-level Population Health Surveillance in Canada and U.S.

      10:30 - 11:30  |  Author(s): Shahab Shahnazari

      • Abstract

      Purpose/Objectives:
      The use of new methodologies and technologies such as machine learning or artificial intelligence, combined with non-traditional data sources like mobile applications and social media, provide public health organizations with an opportunity to strengthen the processes currently used to understand and quantify the health of the populations they study. But given the volume and diversity of available options as well as the specialized expertise required to critically evaluate these options, it can be difficult for an organization to identify and test the optimal and most relevant set(s), types and sources of data for use in population monitoring.


      Methodology/Approach:
      Representatives from the Centers for Disease Control and Prevention (US), the Public Health Agency of Canada, Statistics Canada, and MaRS Discovery District will discuss their approach to innovating in public health surveillance. Panelists will describe their use of an incentive-based competition to directly engage with a diverse network of innovators from across the public-private spectrum, the benefits of this approach and their experience selecting and implementing successful solutions and prototypes.


      Finding/Results:
      Representatives will share lessons learned, best practices as well as the relevance and applicability of this approach to tackling a broad range of issues and gaps at other health institutions, government agencies and ministries.


      Conclusion/Implications/Recommendations:
      New data channels and methodologies are underutilized in the public health sector. Yet the diversity of new data sources and collection mechanisms provides a rich set of options from which health and public health organizations can select and augment their current analytic processes. Within the health and public health context, data from novel sources can introduce a level of responsiveness, scalability and sensitivity that is currently lacking in many traditional reporting methodologies. More importantly, when combined with traditional data, data from these novel sources have the ability to provide researchers and public health agencies with a more detailed, comprehensive and less-episodic view into the determinants of health.


      140 Character Summary:
      Non-traditional data can supplement existing traditional public health data to enhance the process of creating forward-thinking public health policy.

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      OS05.02 - Predicting the Impact of Non-Medically-Necessary MRI Scans: Access and Demand

      10:30 - 11:30  |  Author(s): Ryan Wood

      • Abstract

      Purpose/Objectives:
      Access to Care (ATC) at Cancer Care Ontario (CCO) works in partnership with the Ministry of Health and Long-Term Care (ministry) to improve patients’ access to healthcare services. Given Ontario’s consistent MRI access issues, ATC leveraged the provincial Wait Time Information System (WTIS) and expert clinical input to evaluate the relationship between access and and non-medically necessary requisitions for Magnetic Resonance Imaging (MRI). The purpose of this presentation is to provide context on the issue of appropriate MRI care while outlining the approach for predicting the system impact of non-medically necessary scanning. The surprising results and recommended next steps for a high-performing system will be discussed.


      Methodology/Approach:
      We began with a survey of available literature and guidelines to inform indicator development for incidences of non-medically necessary scanning. A working group composed of ATC, CCO, ministry and clinical expertise leveraged this information to draft early indicators aimed at measuring these incidences (Figure 1). Using metadata from the WTIS, ATC identified MRI orders for potentially for non-medically necessary indications. Given measured incidence rates, linear regression was utilized to estimate the impact of this MRI activity both on demand and access. Figure 1: Examples of Early Draft Indicators for Non-Medically Necessary MRIs % of knee MRIs ordered for patients >60 years old % of hip MRIs ordered for patients >60 years old % knee MRI for patients who previously had a knee MRI within 7/30/180,365 days % of spine MRIs ordered for L-spine % L-spine MRI performed for patients who previously had a MRI for the same body part


      Finding/Results:
      The results were remarkable. With a focus on knee MRI, up to 18% of MRI orders were potentially not medically-necessary and significant variation in practice was noted among referrals received by 26 Ontario hospitals. Looking at MRI services as a whole, literature further indicated a range of 20% to 40% of MRI scans may not be medically-necessary. With data and clinical input, linear regressions identified a reduction in non-medically necessary scanning could have positive impacts. The potential range of improvements could support an additional 30,000-61,000 MRI operating hours annually, and the reduced demand could improve wait times by 100-150 days. capture.jpg


      Conclusion/Implications/Recommendations:
      These findings supported ministry interest in assessing the feasibility of an appropriate care framework for MRI services in Ontario. ATC is partnering with the ministry to develop key enablers and recommendations to begin this process, such as the development of a data strategy; establishment of a reporting and monitoring system; standardization of referral information; and development of tools to provide informationdirectly to physicians.


      140 Character Summary:
      Predictive analysis combined with clinical expertise demonstrates an appropriate MRI care framework has strong potential to improve MRI wait times.

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      OS05.04 - The Last 15%: Closing the pan-Canadian Emergency Department Data Gap

      10:30 - 11:30  |  Author(s): Isabel Tsui

      • Abstract

      Purpose/Objectives:
      Emergency department (ED) data is a crucial component of understanding the effectiveness and efficiency of Canada’s overall healthcare system. CIHI currently has data related to 85% of ED visits that take place across Canada. CIHI’s ED data coverage has provided our health system with valuable information on ED wait time trends at the facility, regional, provincial, peer and pan-Canadian level, as well as highly needed information to manage the opioid crisis and insights into the use/overuse of ED services. Closing the data gap on the remaining 15% of ED visits that is currently not being reported to CIHI’s National Ambulatory Care Reporting System (NACRS) will provide a fulsome picture of the valuable indicators described above, and will be an effective predictor of demand for hospital inpatient services, availability of primary and mental health services, and insights into the care being delivered in other sectors such as long-term care. This presentation will provide an in-depth look at the strategies being put in place to accomplish 100% data coverage from EDs across Canada.


      Methodology/Approach:
      CIHI is actively working with each province and territory not currently submitting 100% of their ED visit data to NACRS to design a solution for data capture that minimizes burden and leverages technologies that have been put in place within EDs or jurisdictions. This includes innovative web-based data capture tools as well as leveraging hospital and/or health authority/provincial data warehouses with modern data extraction and transformation methods.


      Finding/Results:
      Rapid expansion and uptake of data submission requires careful planning and well-thought out processes to navigate unforeseen circumstances. The learnings from successes CIHI has had in bringing in ED data from Quebec and other provinces/territories will be described during this presentation.


      Conclusion/Implications/Recommendations:
      CIHI has been focusing on designing solutions that meet the needs of data submitters and minimize submission burden to get at the last 15% of ED visits not currently being reported, and expand on the data that is currently submitted to gain more clinical insights, notably the clinical diagnoses and procedures taking place in EDs. Key areas of focus from CIHI’s strategy to expand ED coverage and success stories will be described during this presentation.


      140 Character Summary:
      Flexible strategies and solutions to gather valuable emergency department data across Canada

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    PS01 - AI and Smart Technology in Patient Safety Management

    • 10:30 - 11:30
    • 5/27/2019
    • Location: Area 1
    • Type: Panel Session
    • Track:
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      PS01.01 - Smart Home Technology Detecting Nighttime Wandering in Persons with Dementia

      10:30 - 11:30  |  Author(s): Brenda Toonders

      • Abstract

      Purpose/Objectives:
      The Wander Detection and Diversion (WDD) system is designed to assist caregivers and persons with dementia (PWD) that are at risk of wandering at night. Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the system detects when the PWD gets out of bed and automatically provides cue lighting to guide them safely to the washroom and back. It will also guide them back to bed through audio prompts if they near an exit – all without disturbing the caregiver in any way. The caregiver is only woken if the PWD opens an exit door. The system has a flexible design allowing it to be adapted to meet the needs of diverse residences and users such as protection for multiple exit doors or coverage for higher risk areas of the residence such as a kitchen or stairs. The message to the PWD is also customized both in the content and the voice. The goal of the system is to improve the caregiver’s sleep and reduce their stress while supporting the safety of the PWD.


      Methodology/Approach:
      Our team of researchers installs the smart technology devices into participants houses for a 12 week trial period. Before the installation the caregiver is asked a series of questions regarding their stress, depression and anxiety levels, as well as questions regarding how many hours of sleep in a night they are getting and how often their PWD exits the bed during the night. During the 12 weeks the participants are contacted every 2 weeks to ensure satisfaction with the technology. At the end of the 12 weeks the caregiver is asked the same questions as the date of the install, comparing their stress, depression and anxiety levels after having the system in their home for 12 weeks.


      Finding/Results:
      3 male and 1 female participant, age range from 59 years old to 98 years old, had this system installed in their houses for a 12 week trial period. There was an average depression rate of 6.5 and an average anxiety rate of 8 at the beginning of the trial, at the end of the trial the average depression decreased to 4.5 and the average anxiety rate decreased to 6.7. The only issues caregivers have had thus far in the research is that there were a few technical issues and that at the end of the 12 weeks the system had to be uninstalled.


      Conclusion/Implications/Recommendations:
      The study is not completed, however thus far, all participants have been satisfied and said that they felt less stressed, depressed and anxious. All participants were able to get more hours of sleep in a given night, and those who did not had reasons unrelated to the system and their PWD. Next steps include testing other types of sensors and looking for a private sector partner.


      140 Character Summary:
      An off-the-shelf smart home technology solution is installed in participants’ homes for a 12 week trial to detect and redirect nighttime wandering in PWD.

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      PS01.02 - Using Artificial Intelligence to Flag Laboratory Findings for Public Health

      10:30 - 11:30  |  Author(s): Karen Hay

      • Abstract

      Purpose/Objectives:
      Ontario laboratories that identify a specimen that is positive for one of 68 communicable diseases of public health significance are legally mandated to report that finding to their local public health unit to enable monitoring of the health of the community and to provide the basis for preventive action. Reporting is typically done through paper-based fax or mail, an archaic and labor-intensive process for laboratories and public health units. At the same time, most laboratories submit all results to the provincial laboratory result repository, the Ontario Laboratory Information System (OLIS). OLIS results encompass more than 95% of the province’s laboratory results originating from hospital, community, and public health laboratories; however, this system is not currently being used for reporting purposes. The project team has undertaken a project to investigate the potential to replace the current method with a digital approach that applies artificial intelligence to OLIS records to identify reportable findings and report the results to public health on behalf of laboratory operators.


      Methodology/Approach:
      Using the provincial laboratory information system (OLIS), public health information system (iPHIS) and surveillance case definitions for diseases of public health significance, the team has created a system which uses logic and machine learning, or artificial intelligence (AI), to distinguish reportable laboratory findings from large volumes of negative results. This process involves cleansing of unstandardized free text data and training of artificial neural networks. 1.png 2.png


      Finding/Results:
      AI and Boolean algorithms have been prototyped for 7 diseases of public health significance. Challenges include the data quality of unstructured, free-text laboratory results, labelling the dataset, and future changes in the laboratory process. Highly accurate identification of diseases of public health significance is anticipated, with results validated by laboratory professionals.


      Conclusion/Implications/Recommendations:
      The current system for identifying and reporting diseases of public health significance is well-positioned for an upgrade with “disruptive technology”. State-of-the-art machine learning and natural language processing technology have the potential to enable a novel approach. Further work is required to determine the applicability within Ontario’s provincial digital health ecosystem.


      140 Character Summary:
      Ontario is investigating an artificial intelligence solution for identification and reporting of diseases of public health significance.

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      PS01.03 - Detecting Depression via Multimodal Neural Networks with an Automated Evaluation

      10:30 - 11:30  |  Author(s): Ray Christian

      • Abstract

      Purpose/Objectives:
      There is mounting evidence that the technology fueled by machine learning has the potential to detect, and substantially improve treatment of complex mental disorders such as depression. We developed a framework capable of detecting depression with minimal human intervention: AiME (Artificial Intelligence Mental Evaluation). AiME consists of a short human-computer interactive evaluation and artificial intelligence, namely deep learning, and can predict whether the participant is depressed or not with satisfactory performance. Due to its ease of use, this technology can offer a viable tool for mental health professionals to identify symptoms of depression, thus enabling a faster preventative intervention. Furthermore, it may alleviate the challenge of interpreting highly nuanced physiological and behavioral biomarkers of depression by providing a more objective evaluation.


      Methodology/Approach:
      We collected data from 671 participants who performed a human-computer interactive evaluation composed of interview questions where participants were recorded by a webcam and a microphone while they responded to questions relating to their mental well-being. The evaluation also contained an anonymous demographics questionnaire (age, sex, ethnicity, etc.) as well as a brief, multiple-choice, mental health questionnaire in order to provide additional data and ground-truth validation. The evaluation took approximately five minutes, and data from the demographics questionnaire, video responses, and mental health questionnaires were stored and accessed in accordance with HIPAA compliance standards. We developed a multimodal deep learning neural network model that used video data, audio data, and word content from participants’ responses, as well as demographics and other metadata. These data were used as adjacent inputs to the model to perform binary classification on whether participants were depressed. The scores from PHQ-9 were used as the ground truth such that a PHQ-9 score of 10 was used as a threshold for depression. Computations were implemented using Keras with a TensorFlow backend. We experimented with three variations of our model that allowed us to compare performances within our framework and with results from prior work in the literature. These variations include two binary classification models as well as a regression model. The classification models were trained on 365 exams using a binary cross-entropy loss function and an independent set of 91 exams were left for a testing phase. The output of the model (predicted y) was rounded to construct a binary vector consisting of ones (depressed) and zeros (non-depressed) and was compared against the true values (true y)—another binary vector built from the PHQ-9 scores.


      Finding/Results:
      We used various metrics to assess the performance of our models, including: accuracy, AUROC (Figure 1), specificity and sensitivity. According to all metrics, our models successfully classified depressed versus non-depressed individuals well above chance level. Two representative epochs reached high specificity and sensitivity values (87.77% and 86.81% respectively) and, it is possible to adjust the threshold value at which a prediction is considered positive to achieve desired levels of specificity and sensitivity.


      Conclusion/Implications/Recommendations:
      There are significant physiological differences between individuals with depression and non-depressed individuals and our results suggest effectiveness in detecting depression with a neural network model with minimal human intervention


      140 Character Summary:
      A deep learning neural network model that observes human audio/visual responses can be used to detect depression without human intervention.

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    OS06 - Innovations to Process Non Digital Data

    • 15:45 - 16:45
    • 5/27/2019
    • Location: Area 2
    • Type: Oral Session
    • Track:
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      OS06.01 - Using Natural Language Processing for Improving Coded Data

      15:45 - 16:45  |  Author(s): Thodoros Topaloglou

      • Abstract

      Purpose/Objectives:
      Inpatient coding is a complex and tedious process that has not changed in the past thirty years. Health records departments are under constant pressure to meet tight timelines and compete for a shrinking pool of expert coders. Furthermore, the introduction of quality-based funding models increased the pressure on hospitals to improve quality of their data. Missed diagnoses are costly to hospitals. A possible solution is to leverage digital data: computational coding employs tools to “read” clinical documents to recognize evidence and make recommendations on coding of diagnoses and procedures at a higher level of specificity. Scarborough and Rouge Hospital (SRH) embarked on a journey with 3M in 2017 to introduce Computer-Assisted Coding (CAC) to improve coding productivity and data quality. A prerequisite for CAC is availability and access to clinical documentation and other data feeds in electronic and computer readable form. Coders are trained to use the evidence and recommendations made by the computational tools to select appropriate codes. A year later, we conducted a study to understand the impact of this tool on data quality. The study’s objective was to measure the accuracy of the codes captured and whether using this tool influenced weighted cases.


      Methodology/Approach:
      The study was conducted jointly by SRH and 3M, as a before and after intervention comparison of the number of diagnoses and procedures coded by coder and their impact on weighted cases. Multi-variable regression analysis used to measure differences in weighted cases based on variables: diagnosis/procedure count and coder. Charts were randomly assigned to coders pre- and post-implementation; length of stay and weighted cases of charts coded were similar across coders, before and after CAC implementation.


      Finding/Results:
      Number of diagnoses coded post-CAC implementation was significantly higher, as was both, the Comorbidity Levels and Resource Intensity Levels of charts coded. More importantly, there was a statistically significant increase in Resource Intensity Weights (RIW) and Health Based Allocation Model Inpatient Grouper (HIG) weighted cases. Impact on inpatient data (excl. Newborns, Pediatrics and Obstetrics) 6 months post-CAC implementation within 2017/18 FY # of Diagnoses Coded 7% Increase Comorbidity Level 3% shift from Level 0 to Level 2 Resource Intensity Level 4% shift from Level 1 to Level 2 Average RIW 2% Increase (up to 9% for one coder) Average HIG Weighted Case 5% Increase (up to 13% for one coder)


      Conclusion/Implications/Recommendations:
      Results showed clear increase in weighted cases through use of CAC; increase was significant from hospital funding perspective. We anticipate further improvements in coding efficiency; the limiting factor is quality of underlying documentation. The next phase of our journey is to embark on a clinical documentation improvement (CDI) initiative to bring these tools closer to physicians and provide evidence based and data driven tools to improve accuracy and completeness of documentation. Another exciting opportunity in our CAC roadmap is the benefit from advances in natural language processing (NLP) and artificial intelligence (AI) that are incorporated in CAC.


      140 Character Summary:
      Scarborough and Rouge Hospital implemented 3M’s Computer-Assisted Coding tool using NLP engine. Results shows increase in coding quality and weighted cases.

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      OS06.03 - Automated Patient Location Identification in Pediatric Emergency Departments

      15:45 - 16:45  |  Author(s): Raza Abidi

      • Abstract

      Purpose/Objectives:
      Pain, dehydration and anxiety in children are common paediatric Emergency Department (ED) diagnoses but are not well managed. In particular, long ED wait times are well known to increase the anxiety of the patients. We aim to mitigate the anxiety of patients, as well as their families, by providing personalized and location-specific therapeutic and educational interventions while visiting a pediatric ED. Our focus lies on customizing the content with respect to the child’s current location in the ED as well as the current healthcare task, as they move through the stages of examination, investigation and treatment. Using interactive adventure-based scenarios, we aim to proactively collect data about the child’s condition, reduce the child’s anxiety, and lead them to give more meaningful responses about their condition.


      Methodology/Approach:
      In partnership with a Canadian children’s hospital, we extended a mobile, game-based, e-therapeutic and patient education app with personalized and location-aware features. This app leads children and parents through a series of screens asking questions about the individual, their condition and other related information. Based on their responses, the app invokes a variety of therapeutic protocols (e.g., self-administration of Pedialyte for vomiting) and educational videos. The platform is made accessible to children and their parents using an iPad, to mitigate their anxiety, fear and discomfort while waiting in the hospital ED. By leveraging the child’s current location, as well as detected wait and dwell times, the platform is able to dynamically customize the educational content. We designed an intelligent indoor localization method based on (Bluetooth Low Energy) beacon signals, which detect the relative proximity between the iPad and detected beacons as (immediate, near, far, unknown). Based on these proximities, we applied machine learning methods to create an indoor localization model, which can accurately classify the child’s location by correlating multiple beacon signals.


      Finding/Results:
      Our intelligent indoor localization methods have been implemented and validated in a children hospital ED, where 14 beacons where deployed. Data from 29 locations were collected to build indoor localization models (classifiers). Using a hierarchical clustering approach, our approach supports merging multiple locations into cohesive regions to balance localization accuracy with the fine-graininess of indoor localization. Our indoor localization approach was able to recognize the current location of a child with 79% accuracy on average.


      Conclusion/Implications/Recommendations:
      With the proliferation of smart sensors and devices, this innovative project provides numerous opportunities to deliver personalized and timely location-sensitive services to patients.


      140 Character Summary:
      Indoor localization to personalize a mobile e-therapeutic platform for mitigating anxiety, fear and discomfort in children while waiting in the ED waiting room.

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      OS06.04 - Dementia Talk App - Empowering Dementia Caregivers through Technology 

      15:45 - 16:45  |  Author(s): Einat Danieli

      • Abstract

      Purpose/Objectives:
      Dementia Talk App: An award winning smartphone App designed to support dementia caregivers in tracking and managing challenging behaviours and in enhancing their communication with other care providers in the circle of care. Nearly 12% of Canadians are caregivers for a person with dementia. Up to 90% of people with dementia (PWD) experience significant behavioural and psychological symptoms (BPSD) that challenge and upset caregivers. Currently, there is no easy way for caregivers to manage and track behaviour-related symptoms in the care recipient, making it difficult to improve care and share information across the circle of care. OBJECTIVES: This presentation will discuss the development of a mobile application called the Dementia Talk App, designed to empower dementia caregivers to manage and track behaviours in the person with dementia as well as enhance communication among care providers. The presentation will showcase key features of the App and share highlights from beta testing results to demonstrate the importance of caregiver driven development process in creating meaningful and accessible digital solutions for clients and their caregivers.


      Methodology/Approach:
      This qualitative study involved 16 caregivers for PWD, recruited through the Reitman Centre Sinai Health System. Participants were asked to use the application for a period of 3 weeks, starting from the date that they received the link. Once the 3-week trial period is completed, a semi-structured phone interview was conducted to seek feedback from users in three main areas: 1. technology and usability 2. clarity of the content 3. The level of relevance of the App to caregivers’ concerns in dealing with behaviour-related challenges. Their responses were summarized in written notes and analyzed and organized in main themes using the “framework analysis” approach. Inclusion criteria: Age 18+; caregiver to a PWD; PWD presenting behavioural symptoms; Grade 3 literacy level; English speaking; ability to use one of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad. Exclusion criteria: Under 18 years of age; Not actively involved in caring for someone with dementia; PWD not demonstrating any behavioural symptoms; Less than Grade 3 literacy level; not English speaking; Unable to use any of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad


      Finding/Results:
      16 eligible caregivers were recruited to participate in the study, 1 participant dropped out for personal reasons. Complete data was obtained from 10/15 participants. All participants that were interviewed agreed that the content of the App was relevant to their concerns as caregivers, and most found the triggers and coping strategies to be very useful. This is a validation of the contents, as one of the most important aspects of the application for its success. Limitations: The 3-week trial period may not have been enough time to completely evaluate the usability of the app. Small sample size.


      Conclusion/Implications/Recommendations:
      Conclusions: Overall, the feedback received was overwhelmingly positive and there is great potential for the app as a meaningful tool for caregivers and other stakeholders in dementia care. Further evaluation needed to validate benefits of the application and long term impact with a larger sample size for a longer period of time.


      140 Character Summary:
      Dementia Talk App: An App designed to support dementia caregivers in tracking and managing care and enhancing communication with members of the circle of care.

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    OS07 - Spectrum of Virtual Care

    • 15:45 - 16:45
    • 5/27/2019
    • Location: Area 3
    • Type: Oral Session
    • Track:
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      OS07.01 - Lessons in Scale and Spread in Virtual Care for Maternity

      15:45 - 16:45  |  Author(s): Mona Mattei

      • Abstract

      Purpose/Objectives:
      Traditional patient care planning often involves a linear model of health care access and delivery. A particular patient with a clinical concern accesses a primary care provider (GP, midwife, nurse practitioner). The primary care provider (PCP) acts as a gate keeper to direct the patient to a specialist with expertise in the area of that particular clinical problem. The patient then sees the specialist in person or via telehealth with consult notes sent at a later date. The PCP will often recall the patient to discuss the specialist’s opinion and may need to contact the specialist again if there are further questions or a change in the clinical status. The Mobile Maternity (MOM) project is changing that traditional linear model to foster a triangular and tripartite model that provides for much greater efficiency and more comprehensive care planning. Using telehealth resources (ie: tablet and desktop computers), a patient, primary care provider and specialist can in real-time, all discuss the clinical problem at the same time. This reduces the time to relay the specialist’s opinion as the PCP will hear at the time of the initial consult what the proposed plan may be. The PCP and patient can also inform the specialist of particular challenges to the provision of care related to geography or local health resources.


      Methodology/Approach:
      Initial pilot phases of the Mobile Maternity project saw 14 tablets placed with primary care providers (PCP) (family physicians, nurse practitioners and midwives) in 8 communities across the Kootenay Boundary in B.C. These units connect with two OB/GYNs to provide patient consults inclusive of the PCP, specialist and patients. Observing the value of the model of care, an opportunity to spread the model to Vancouver Island to support remote sites on the North part of the island from Campbell River was seized and 4 tablets were distributed to PCPs and OB/GYNs to provide consults. In addition desktop units in exam rooms and work stations on wheels in emergency departments were added to the mix to provide additional access.


      Finding/Results:
      Testing a pilot with a small population base provides opportunities for proof of concept, taking that concept to scale for larger volumes of patients expands the ability to gather substantial information on outcomes and impacts of new programs. Mobile Maternity is being scaled up from one OB/GYN in Nelson to include teams in Campbell River, across the Kootenay Boundary and three new sites in the next eight months. Interviews with both patients and providers demonstrate that this model of care is a resounding success for strengthening care networks, and improving patient care.


      Conclusion/Implications/Recommendations:
      This tripartite telehealth model provides enhanced mutual education for providers and patients, removes geography as a barrier to timely access, and supports the stability of primary care networks. This pilot can become the standard model of care in integrating specialist care into rural and remote primary care networks.


      140 Character Summary:
      Mobile Maternity is changing the way physicians care for patients by engaging in tripartite care planning through telehealth technologies.

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      OS07.02 - Identifying Patient and Provider Value Propositions in Virtual Primary Care

      15:45 - 16:45  |  Author(s): Leah Kelley

      • Abstract

      Purpose/Objectives:
      The Ontario Telemedicine Network is working with local health integration networks (LHINs) to implement virtual primary care visits. Patients want to engage with physicians remotely and find the quality to be equal to or better than in-person. Previous experience shows primary virtual care can be used to manage routine conditions and reduce health system costs. Yet integration of virtual primary care visits remains low, due partly to unclear physician value and payment models. The study objective is to explore how virtual visits can create value for both patients and clinicians, to facilitate uptake within Ontario primary care.


      Methodology/Approach:
      Four LHINs across Ontario, including 138 physicians, have implemented a customized virtual visits platform. The technology enables clinicians to respond to patients’ clinical requests using either asynchronous secure messaging or an audio/video visit. We conducted semi-structured interviews with providers and patients to understand the perceived value of virtual visits. We then extracted themes of value propositions for both providers and patients.


      Finding/Results:
      There is demonstrated value for patients to engage with virtual visits, due primarily to the convenience that it offers over in-person visits. Clinicians and patients generally agreed that it was appropriate to use this platform for simple visits, but not for new diagnostic issues. The most often used modality was asynchronous secure messaging (94% compared to 1% video and 5% audio). We identified several value propositions for both patients and providers. Patient value propositions: *Convenience: Easier access to clinician was of priority. Rapid response is not needed; rather, patients valued not having to take time off work, seek childcare, or drive long distances. Access: Can improve care continuity and access for patients who have moved out of the area but still have the same PCP, and homebound or low-mobility patients. Urgent issues: Patients identified an interest in accessing a platform that would provide rapid responses for urgent issues, particularly after hours. Provider value propositions: Efficiency: Increases the number of patients PCPs can see per day, while not overwhelming their workflow. Revenue: Increases provider revenue by enabling them to maximize care bonuses, or paying them for previously unpaid work (e.g. phone calls). Care quality*: Enables clinicians to improve the quality of care they can deliver to their patients. Table 1 presents some ways to use virtual primary care technology that align with provider and patient value propositions. Provider value Efficiency Revenue Patient care quality 1) Delegate work to administrative assistants and nurses 2) Send reminders, prescriptions, and follow-ups for disease management Convenience Patient value 3) Provide care to homebound patients 4) Provide care to rural/remote patients Access 5) Provide virtual after-hours care Urgent issues 6) Enable easier preventative care via reminders, education 7) Pay for work previously unpaid 8) Enable time for PCP to make informed decision on complex issues (asynchronous) No motivating value


      Conclusion/Implications/Recommendations:
      When implementing virtual visits, it is important to align implementation design with patient and provider value propositions to encourage maximum adoption. The value propositions and potential use cases outlined here can guide future implementation.


      140 Character Summary:
      Integrating virtual visits in primary care faces provider resistance; aligning implementation with patient/provider value propositions may improve uptake.

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      OS07.03 - Virtual Visits: Delivering Primary Care Through Innovation

      15:45 - 16:45  |  Author(s): Danika Walden

      • Abstract

      Purpose/Objectives:
      Virtual visits have shown promising results in supporting a patient-centered healthcare system, with the potential of moderating primary care costs over time1. The objective of this presentation is to illustrate an approach for deployment and lessons learned from implementing an innovative virtual care technology in primary care settings, as well as to highlight the outcomes and benefits of virtual visits for both patients and providers.


      Methodology/Approach:
      Virtual care technology conveniently connects patients with their primary care provider, for appropriate concerns, over a secure, online communication system via chat messaging, phone or video, providing the opportunity to create efficiencies and improve access to primary care. Providers were engaged in the clinical model design and solution development to ensure that the technology meets their needs and is user-friendly. To support integration of virtual visits into clinical workflow and reduce barriers to adoption for providers, direct feedback from providers was continuously collected to inform enhancements to the solution. A change management framework was used with a focus on working with providers as partners to support the uptake of the technology. To better understand both the provider and patient experience with using virtual visits, user surveys were provisioned which assessed the value of virtual visits related to factors such as convenience, access, efficiency and navigation.


      Finding/Results:
      Leveraging existing relationships with providers and establishing a comprehensive approach for end user engagement was a key factor in the implementation of virtual visits. Change management support was critical to the integration of virtual visits into provider workflow and contributed to them more actively promoting the service and enrolling their patients. Within 6 months of going live with the virtual visits solution, 56 primary care providers and 30 support staff registered for the solution, over 2600 patients were enrolled and over 2100 visits completed. Preliminary results of the user experience surveys indicate that virtual visits make accessing care more convenient for patients and saved them time, while providers spoke to the use of virtual visits to enhance efficiencies in their office and increase capacity to see more patients. Providers also expressed additional value in the ability to initiate the visit with their patient for reasons such as following up on test results or following up on a previous in-person appointment.


      Conclusion/Implications/Recommendations:
      Complementary to existing workflows, the integration of virtual visits in primary care settings has shown benefits to both patients and providers related to convenience and improved access to care. Using a targeted approach to user engagement and adoption, primary care providers are able to understand how a virtual visits solution integrates into their workflows and context of their practice model, as the value proposition varied depending on organizational structure. The involvement of users throughout the design and development of the technical solution ensured user buy-in, acceptance and adoption of the virtual visits innovation.


      140 Character Summary:
      Developing and implementing a virtual care solution for primary care: lessons learned and impact on patients and providers.

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      OS07.04 - Humans Behind The Machine. Telemedicine Based Shared-Care Psychiatric Services 

      15:45 - 16:45  |  Author(s): Benjamin Fortin-Langelier

      • Abstract

      Purpose/Objectives:
      Background: The Royal Ottawa Health Care Group (ROHCG) has been a leader in the use of telemedicine to deliver psychiatric care. It has successfully integrated telemedicine in its regular clinical services and developed specific services based on technology. Those telemedicine-based services include correctional psychiatric care and shared-care (support to primary care) services. In psychiatry, shared-care refers to psychiatrists supporting groups of primary care providers. Typically, psychiatrists travel to family health teams and provide a blend of direct and indirect patient care. The rationale behind shared-care is to optimize the time of specialists and build capacity for primary care providers which then allows for more patients to receive the care they need in a location that is convenient. Purpose: We would like to present the case study of a shared-care partnership between a rural community health center where seven primary care providers support a community of 8000 and a tertiary care mental health center which was established in 2017 using telemedicine. Technology allows for patients to be assessed by a psychiatrist without travelling 250km and the humans behind the technology enable a lasting and successful partnership.


      Methodology/Approach:
      Approach: In this oral presentation, we will highlight the importance of the key players and their roles in creating a clinical service that benefits all stakeholders and allows harvesting the full potential of the technology. Preliminary contact with the community, training, in-person visit prior to first clinical consultation, iterative feedback loop and follow-up annual education visits have contributed to the success of the partnership and trust between partners.


      Finding/Results:
      Findings: In one year, we were able to set monthly psychiatric telemedicine consultations allowing 42 patients to receive care they would not have been able to access otherwise. This model has been demonstrated as effective and has been replicated in 14 other rural communities and translated for use in correctional institutions. At the moment, we observe two common mistakes in the design of consultation services in psychiatry. One is the over-reliance on technology at the expense of establishing strong relationships. In this mistake, there is a failure to establish consistent relationships and connections when rolling out telemedicine-based consultations. This creates a situation in which multiple remote communities are randomly connected with random providers at inconsistent times. It prevents specialists from understanding the context of the primary care providers with whom they consult and reduces trust as well as the quality and applicability of the consultations. The other mistake is the under-appreciation of technology. This is the belief that only in-person presence can lead to a solid relationship between primary care and specialists. While this is a reasonable model where geography permits, the drawback is lengthy travel time and the perceived impossibility to reach geographically distant communities.


      Conclusion/Implications/Recommendations:
      Conclusions: We believe we have found an effective balance between technology and human factor which enables trust and the development of sustainable partnerships. Appropriately implemented technology can lead to successful shared-care psychiatric services between geographically distant communities


      140 Character Summary:
      The Royal Ottawa will present a case study illustrating the implementation of shared-care psychiatric services using telemedicine in a rural community.

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    OS08 - The Road to Digital Health Adoption

    • 15:45 - 16:45
    • 5/27/2019
    • Location: Area 4
    • Type: Oral Session
    • Track:
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      OS08.01 - Engaging Physicians for GoLive: The Role of Physician Champions

      15:45 - 16:45  |  Author(s): Melanie Buba

      • Abstract

      Purpose/Objectives:
      Physician Champions serve as department/division-specific representatives and subject-matter experts for items relating to the EMR build and operations. They liaise between the clinical operations of the hospital while engaging and supporting their colleagues. The purpose of this presentation is to provide an overview of the important role of Physician Champions as key stakeholders and drivers of change around the decisions and processes that contribute to the optimization and clinical relevance of the EMR. Specifically, the contribution of Physician Champions to decisions affecting EMR optimization will be explored.


      Methodology/Approach:
      A review of minutes from Physician Advisory Council (PAC) meetings for a two year period from October 1, 2016 to September 30, 2018 was undertaken, and the total number of decisions made was determined. Decisions were reviewed and a decision lead was identified. “Physician-driven” initiatives were defined as having a physician as the decision lead.


      Finding/Results:
      Between October 1, 2018 and September 30, 2018, a total of 104 major clinical decisions were made. Of these, 34 (32.7%) were “physician-driven” initiatives, of which 25 (73.5%) were made in the year after GoLive (October 21, 2017 – September 20, 2018). Physician Champions also participated as leads in 10 identified high risk workflows. The overall attitude from physician end-users about the EHR improving quality of care was 28% prior to the start of the implementation, 50% one year post implementation and 74% two years after GoLive.


      Conclusion/Implications/Recommendations:
      Physician Champions have made a substantial contribution to decisions affecting EMR optimization. Physicians have led approximately one-third of these changes, with a large proportion of these “physician-driven” initiatives occurring in the year post-GoLive. At the same time we have seen a significant increase in the physician perception that the EHR was improving quality of care. An EHR governance structure that supports physicians as key stakeholders is critical to enhancing the applicability and usability of the EHR system. They provide valuable clinical input into system design, implementation, optimization and training, and as experienced end-users, have help lead a large number of improvement initiatives, particularly after GoLive. Continued involvement of physicians in EHR optimization is crucial. Further research will include the impact of Physician Champions on physician end-user overall perception, satisfaction and engagement with the EHR system.


      140 Character Summary:
      Creating an EHR governance structure that includes Physician Champions has allowed physicians to make a substantial contribution to the optimization of our EHR.

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      OS08.02 - Co-Designing Digital Technology Evaluations with Service Providers, Vendors and Evaluators

      15:45 - 16:45  |  Author(s): Vess Stamenova

      • Abstract

      Purpose/Objectives:
      The Office of the Chief Health Innovation Strategist (OCHIS) in Ontario supports a program called Health Technologies Fund (HTF). The program’s goal is to accelerate the evaluation, procurement, adoption and diffusion of health technologies made in Ontario. The program requires a partnership between publicly funded health service providers (HSPs), a technology vendor and a third-party evaluator. This partnership ensures that technology companies are supported in an implementation initiative within an Ontario clinical context by working closely with a clinical site that has an interest in the technology. The evaluation partner’s role is to conduct an evaluation that can support procurement decisions at the clinical site and provide evidence of effectiveness and potential cost-savings. The Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) has acted as an evaluation partner for three rounds of HTF competitions. The goal of this panel will be to present key learning points from the perspective of each partner: the HSP, the technology partner and the evaluation partner. The key learnings will be presented in the context of one of our projects, the evaluation of the Cloud Dx Health Kit.


      Methodology/Approach:
      The Cloud Dx Health Kit is a web-enabled remote- and self-monitoring platform allowing Chronic Obstructive Pulmonary Disease (COPD) patients to take their vital signs (oxygen saturation, blood pressure, temperature, and weight). Data is displayed on the tablet via Bluetooth and sent to a healthcare provider via a secure cloud. To determine and ensure that all participating parties’ interests are being met in the project design, we spent several months co-designing the project. The goals during this phase were to design a viable implementation plan that will have a high likelihood of adoption within the specific setting. Weekly calls between the vendor (Cloud Dx), the HSP (Markham Stouffville Hospital) and the evaluator (WIHV) were conducted. Several in-person meetings and half day co-design workshops were completed to establish viable value-proposition hypotheses and to determine each party’s interests. Qualitative interviews with patients, healthcare providers and administrators were also conducted, to test out value proposition hypotheses. The level of commitment of the vendor company and their capacity for technology modifications was also assessed at that time. Feedback received from users and administrators was directly used to make modification of the implementation plan and research study design.


      Finding/Results:
      The following key insights were gained from the above process (1) an on-site clinical lead is essential, (2) the development of relationships between all three parties facilitate progress, (3) allowing end-users to use the technology can uncover critical workflow and technology modifications that need to be well established ahead of the evaluation and (4) determining the value propositions for both users and payers is critical for adoption.


      Conclusion/Implications/Recommendations:
      In this panel discussion, we are going to provide an overview of the co-design methods we use in the planning and design of our evaluations. Representatives from each team will describe the challenges they faced in running such collaborative projects and present key learnings focused on implementation and evaluation of digital technologies.


      140 Character Summary:
      This panel will provide an overview and perspectives on a co-designing evaluations with vendors, clinical providers and evaluators.

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      OS08.03 - A Novel EMR Benefits Realization Program in the Canadian Context

      15:45 - 16:45  |  Author(s): Ken Farion

      • Abstract

      Purpose/Objectives:
      Implementing an enterprise-wide, integrated EHR solution is one of the largest and most complicated investments any hospital or health system can make to transform care and achieve better outcomes. Formally quantifying these benefits requires a structured approach against pre-established targets. As a small, independent, non-case costing academic pediatric institution in Canada, we encountered some notable barriers as we set out to establish a Benefits Realization governance structure and program that would achieve targets delineated in our Board-approved Total Cost of Ownership forecast. First, quantifiable Benefit Realization has been infrequently explored internationally in publicly funded systems where no competitive advantage to build/expand business and market share exists. Financial benefits in our environment must be gained through decreasing demand for services and efficiencies resulting in decreased costs, whether FTE’s, supplies or infrastructure. Next, Benefit Realization has typically been evaluated as part of a large system initiative as opposed to at a local level. Finally, most Benefits Realization programs succeed as a fully resourced, parallel structure to the implementation and operations team; this was not possible in our environment.


      Methodology/Approach:
      Based on best practices from other organizations, but tailored to the fiscal realities of our institution, we created a Benefits Realization governance model that was clinically led yet grounded in financial and statistical rigour. This structure was embedded within existing operational committees and targeted quantifiable clinical, operational, and academic benefits that aligned with the organization’s existing strategic directions. Where relevant, benefits that aligned to specific General Ledger cost centers were tracked and tallied against our targets. A graphicly-pleasing quarterly report to the Board of Directors dually served as accountability and as a key communication and engagement tool within the organization.


      Finding/Results:
      By creating a governance structure embedded within operations, we garnered benefit ownership and buy-in to achieve the targets. Further, by driving nine targeted core benefits while also collecting and evaluating smaller incremental benefits with rigor, the organization could rally around the effort, further reinforcing the vision and mission of both the EHR implementation and the hospital strategic directions. Tools were created that fostered operational leadership and engagement and allowed Benefit Realization to fundamentally link to and drive corporate strategy. The Board report template was repurposed to support other communication channels. Through initiatives solidly linked to the General Ledger, we demonstrated efficiencies through permanent cost reductions to meet the Benefit Realization targets within our Total Cost of Ownership. Further, we linked these initiatives to improvements throughout the organization to demonstrate the power of an integrated EHR as the foundation for change.


      Conclusion/Implications/Recommendations:
      Formal Benefit Realization following an EHR implementation is often a requirement and can be seen as an academic exercise parallel to the project and operations. However, by embedding the governance structure and linking solidly to the strategic directions of the organization, large scale and smaller incremental benefits can fuel the transformation. By sharing stories, fostering buy-in, and ensuring rigour, smaller organization can meet their Benefit Realization goals across clinical, operational, academic, and financial perspectives.


      140 Character Summary:
      Benefit Realization strategy within existing governance and linked to corporate directions to identify clinical, operational, academic, and financial benefits

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      OS08.04 - Connecting for Health with the Office of Virtual Health

      15:45 - 16:45  |  Author(s): Kathy Steegstra

      • Abstract

      Purpose/Objectives:
      In Fall 2017, the Provincial Health Services Authority (PHSA) established the Office of Virtual Health (OVH) to leverage and enhance virtual care as part of the care continuum for patients. In order to meet this mandate, the leaders of PHSA clinical and academic programs needed a clinically led organizational strategy that would see scalable virtual health solutions integrated into their existing service models. The governance structure for virtual health is directly aligned with the clinical governance, and a strategy is now being implemented by OVH. Principles of the strategy include patient-centred and clinically led, with technology partners as enablers. Solutions are focused to improve patient outcomes that are equitable, adaptable, scalable and sustainable.


      Methodology/Approach:
      The strategy of OVH includes clinically identified priority projects and enabling foundational supports. Examples of priority projects include: virtual health visits in patient homes, online cognitive behavioural therapy, and digital messaging. Enabling foundations have been created by OVH with stakeholder involvement, and include a PHSA Virtual Health Policy, clinical guidelines, communication strategy, toolkits for clinical programs, and an evaluation framework. These carefully supported projects include: patient engagement, program and patient readiness, sound project management, patient and provider education, clinical workflow redesign and evaluation.


      Finding/Results:
      The results of a governance structure shifts the governance and priority setting from technically to clinically led to deliver one system of care. Priorities, decisions and direction about the evolution of virtual health in PHSA are now being made by leaders of clinical programs. Foundations have been created that have removed barriers and created consistent, effective strategies across the organization, including an enabling risk and consent-based policy, clinical guidelines for virtual health and many tools and processes to move our agenda forward. Clinical teams and programs no longer work in silos on similar solutions. Important supports such as privacy, procurement, and information management and technology now have an integrating team to collaborate with and are able to apply their advice in an effective manner. Advancement of virtual health including “anywhere to anywhere” virtual health visits, text/email, remote patient monitoring and online therapy is occurring. These results are evaluated through a framework that is aligned with the evaluation structure and dimensions of other clinical services. PHSA is beginning to see and report how virtual health services impact in the context of all health services and their alignment with specific goals to achieve a system of virtual health that is acceptable to patients and providers and provides improved accessibility to the appropriate services in an equitable way, and results in organization wide scale.


      Conclusion/Implications/Recommendations:
      OVH is leading a system wide transformation that will see virtual health integrated into clinical services, not as a separate system but as an integrated, effective, and efficient patient-centred set of solutions that respond to the digital world we live in. The proposed presentation will describe the processes, principles, successes and challenges which have resulted in successful virtual health services and plans to increase patient preferred virtual health services across British Columbia.


      140 Character Summary:
      Integrating virtual health in British Columbia’s Provincial Health Services Authority clinical programs in collaboration with the Office of Virtual Health.