• 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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    PS04 - Breaking the Silos: It's Not All About Technology!

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Area 1
    • Type: Panel Session
    • Track:
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      PS04.01 - What Are We Waiting For? Engaging Patients / Closing “The Loop”

      10:00 - 11:00  |  Author(s): Mary Jane McNally

      • Abstract

      Purpose/Objectives:
      A key objective for Osler is to enable patient activation and engage with patients as true partners in their care. Encouraging patients to direct their system of care increases their confidence and ability to self-manage their own health condition. Commencing with an eReferral, key fields are electronically captured leading to a complete and thorough appointment booking. At home, automated appointment reminders (Voice, Text, Email) are sent 48 hours prior to an appointment. Patients can request to cancel, re-schedule or check-In to their appointment using their smartphone. When they arrive at the hospital, self-serve kiosks register patients and provide them with printed directions to their clinic appointment. Reports and test results are published in Osler’s patient portal (MyChart); which a patient can choose to share with his primary care physician.


      Methodology/Approach:
      Methodology and Approach: Initiating Savience’s appointment management and kiosk system was key. The overall design was iterative, beginning with a basic fit-for-purpose system that was followed up by subsequent improvements based on real-time feedback from patients, their families and staff. In parallel, an in-house proof of concept eReferral system was being developed for the Peel Memorial Centre - Urgent Care Centre (UCC) and Sunnybrook’s MyChart patient portal system was acquired and customized for Osler’s patient population. Constant communication among the project managers leading each of the different projects along with consultation with Osler Patient and Family Advisors was critical. wohc.png


      Finding/Results:
      Osler has optimized the eReferral, appointment and results process. Osler strives to create systems of care that are truly patient centric thereby compelling staff to collaborate with patients and their families, leading to both a more meaningful and engaged patient and provider experience. 1. Nearly 82% of total check-ins were performed via kiosks; used by all ages and cultures 2. Increased appointment attendance rates (i.e. reduced no-shows) via appointment reminders 3. Reduced time spent registering patients (i.e. 70 seconds per kiosk registration on average) and reduced patient registration queues 4. Overall improved patient engagement and patient satisfaction 5. Overall improved staff/physician engagement


      Conclusion/Implications/Recommendations:
      Osler strives to empower patients with a seamless interaction between home and their hospital care. Follow along Osler’s journey as they close “the loop” by implementing a series of related projects; beginning with a registration, appointment management and queuing system (Savience UK), developing an in-house eReferral application and acquiring a user-friendly patient portal (Sunnybrook’s MyChart). The patient experience will be illustrated through actual patient testimony.


      140 Character Summary:
      Follow Osler’s journey as they close “the loop” by implementing Reg, Appt Mgmt and Savience UK Queuing, dev in-house eReferral apps & acquiring Sunnybrook’s MyChart

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      PS04.02 - Implementing an e-Safety Program

      10:00 - 11:00  |  Author(s): Chris Hobson

      • Abstract

      Purpose/Objectives:
      In 2013, Digital Health Canada conducted extensive research across Canada and around the world, in collaboration with a host of subject matter experts, to develop the e-Safety Guidelines. Input from eight leading healthcare organizations’ trial use of the resource was used to document and maximize its relevancy and usefulness in real-life situations. e-Safety, in the guidelines, is classified into 8 principles 1. Accountability 2. Safety and Culture 3. Quality Management 4. Human Factors 5. Security Safeguards 6. Risk Management 7. Effectiveness Response 8. Reporting This panel will discuss the application of these guidelines and risk management techniques to reduce the probability and severity of key risks materializing in clinical practice. Additionally we will review insights from a survey and interviews of key stakeholders from across Canada


      Methodology/Approach:
      To identify gaps in the implementation and success of the e-Safety Guidelines, an initial survey of health care practitioners across Canada was conducted. Every effort was made to reach Digital Health Canada members from all jurisdictions, however the responses were relatively limited in number. In order to further explore the results, and provide additional understanding of the gaps, individual interviews with key stakeholders occurred. Key stakeholders include Canadian Patient Safety Institute, Canadian Medical Protection Association, Several major jurisdictional and hospital e- safety representatives


      Finding/Results:
      From the initial survey, it was identified that: 40% of the responders stated that their organization had no e safety program at all and no obvious plans to introduce one Of those who did have a program almost all were at an early stage of the COACH Maturity model (2013.) Only one facility had a structured program The major barrier to advancing e safety was listed as inadequate resources 1. 40% said they did not have a person in their organization who was accountable for e safety 2. 40% said they did not have a formal mechanism for staff to report any adverse events or near misses During the interview cycle, the following key risks were identified: 1. Technology does not eliminate and, in fact, can increase existing process and communication issues. 2. Identifying critical information, such as planned procedures, allergies and medications can be difficult. 3. Technology can create alert fatigue for clinicians


      Conclusion/Implications/Recommendations:
      It was identified in the interviews that implementing an e-Safety system and working to follow the e-Safety guidelines can significantly reduce the risk associated with technology implementations. The panel will discuss best practice for the implementation of an e-Safety Program. This will include discussion around: 1. Implementation and process improvement 2. Identification and remediation of technology risk 3. Incident and near miss reporting standards and management systems 4. Clinical and data governance best practices


      140 Character Summary:
      This session will discuss the benefits, implementation and risk management associated with implementing an e-Safety Program drawn from pan Canadian observations

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    OS17 - Engaging Me, the Client

    • Type: Oral Session
    • Track:
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      OS17.01 - Clinically Enabled Provincial Electronic Medical Record with Patient Engagement

      13:15 - 14:15  |  Author(s): Blair White

      • Abstract

      Purpose/Objectives:
      Our Electronic Medical Record(EMR) journey in Newfoundland and Labrador has been clinic and clinician focused to date, Patient engagement has been a vision of our provincial EMR implementation within Newfoundland and Labrador. Our journey has matured to the point where we have begun this engagement. Our presentation will outlined our clinic and now patient engagement journey, what we offer, clinical adoption progression, what has worked and what has not worked for lessons learned. The clinically enabled Electronic Medical Record within Newfoundland offers the following standardized clinical functionality to clinicians; • Demographic dashboard including roster and panel information • Diabetes, COPD, screening care-plans and dashboard reports • Integrated billing functionality • Integrated patient order results distribution into the EMR • Electronic Prescribing pilot sites • Patient in context launch to the provincial EHR viewer for electronic ordering, electronic consult, viewing provincial medication & Immunization profiles • Secure electronic communications across EMR instances throughout the province • General office functions - patient and clinician scheduling • Vendor provided clinical templates The above requires constant education with the existing clinics on our program. Patient engagement functionality includes; • digital appointment reminders • Online appointment booking • sending of tasks to a patient in advance of the appointment to be completed, for example Laboratory order We will outline our journey to date and where we are heading.


      Methodology/Approach:
      Our approach has been enabled via a multi-stakeholder governance structure. The governance is a tri-party model consisting of the provincial Ministry of Health, provincial Medical Association, along with the Newfoundland and Labrador Center for Health Information (ehealth provincial organization). Under this governance model we have been able to implement working groups to manage the various stakeholders and topics around our EMR program called eDOCSNL. We have representation from the tri party governance organizations along with each Health Authority within NL on our three working committees; • Clinical advisory committee • Data governance advisory committee • Regional Health Authority primary care committee The other key to our success has been constant educaiton to clinicians in multiple facets. Face to face in clinics, conferences.


      Finding/Results:
      Our results have been increasing demand for adoption as well as enhancing the mature use model of our provincial EMR. Our findings have shown us increased education to the clinicians is requied and it is not a one time thing. Education is a constant process required by the program. We presently still have a demand for more clinics to come onto the EMR program as well as our existing clinics are looking for us to enhance the clinical functionality within the software and move up the EMR maturity model.


      Conclusion/Implications/Recommendations:
      Our conclusion is the central multi-party governance model including the working groups are the key to our advancement. Implications are this progress has created a resource constraint as meeting the demand requires an increase in resources such as capital money and people with the appropriate knowledge on staff. Recommendations include working towards governance models, as well as continuous clinical engagement in any forum available within your province.


      140 Character Summary:
      Our EMR journey within NL has been a great learning environment for EMR implementations. We would like to share our experiences along with time for QA.

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      OS17.02 - Patient and Provider Experiences with Mobile Technology and Health Apps

      13:15 - 14:15  |  Author(s): Sarah Harvey

      • Abstract

      Purpose/Objectives:
      This study focused on the use of mobile health and wellness applications (apps) in chronic disease management in a cardiac rehabilitation patient population. There are over a hundred thousand health apps available that patients can download from public app stores and an increasing number of patients are choosing to use these apps. These include apps in key areas of focus for chronic disease management such as exercise and diet. However, there is little evidence on patient use (or desired use) of these health apps to support self-management of chronic conditions. The study objective was to describe patient and provider experiences with publicly available health apps and perceived impact on self-management, the patient-provider relationship and care processes.


      Methodology/Approach:
      An exploratory mixed methods design was used to gain an understanding of patient and provider perspectives and experiences. The study was conducted in a cardiac rehabilitation program in Ontario, Canada. A quantitative survey (n=242) focused on patient demographics and technology use profiles. Patient interviews (n=30) and a provider focus group (n=8) were conducted to explore perspectives on mobile technology and health app use as a part of self-management and the patient-provider relationship.


      Finding/Results:
      Results from this study describe an aging patient population with a range of cardiac diagnoses and co-morbidities. Ninety-two percent of patients in this study used mobile technology and 50% of those with mobile technology were using health apps. Most patients and providers felt that health apps can support chronic disease management, particularly with respect to tracking progress against exercise and diet goals. Patients and providers also felt that they needed more support in using health apps and integrating them into care processes. This included the need for education on how to use apps as well as access to information on app accuracy and how to choose or recommend health apps given the large number available. Participants also emphasized the desire for health apps to connect patients and providers during and after the rehabilitation program. Health apps were mostly used by patients in the study in the absence of provider recommendations and without connectivity between patients and providers. Findings highlighted the need for health care practices to leverage and support health apps as a part of care during and after rehabilitation for patients self-managing in the community. While this study supports the use of health apps in practice, future care that includes the use of apps should ensure equitable options of care for those that choose not to use them as there was a portion of study participants that did not want to, or, could not use health apps.


      Conclusion/Implications/Recommendations:
      Approximately half of all patients in cardiac rehabilitation are choosing to use publicly available health apps, however, these apps are not supported by practice standards and are not connected with providers. Health policies are needed to support the use of health apps as they pertain to key areas of chronic disease management such as diet and exercise. This would set the stage for development of health app standards and connected virtual care in the community.


      140 Character Summary:
      This study describes patient and provider experiences with publicly available health apps. Results support use of health apps if integrated with care practices.

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      OS17.03 - Patient Engagement in Home Health Monitoring Research

      13:15 - 14:15  |  Author(s): Helen Novak Lauscher

      • Abstract

      Purpose/Objectives:
      Patient engagement in health research has gained traction in recent years in Canada as evidenced by the movement toward patient oriented research. Research has shown that patient engagement improves the quality and relevance of health research. TEC4Home, a four-year project studying home health monitoring to support the safe transition of heart failure patients from hospital to home is implementing a provincial randomized controlled trial (RCT) in 19 hospitals across four BC health authorities. This presentation will describe patient engagement in TEC4Home, along with reflections of both researchers and patient partners on learnings to date, including practical approaches for meaningful engagement.


      Methodology/Approach:
      Patient and family caregiver partners participated in the grant proposal process. During the feasibility trial phase patient partners were members of governance and implementation committees, contributing to decisions in clinical, evaluation, and technology streams. Patient partners helped develop and review all patient-facing materials such as information brochures and surveys, and participated as actors during recruitment dress rehearsals. TEC4Home’s committee structure was expanded for the RCT. Working with the BC Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit, Heart Life Canada, and Patient Voices Network, a provincial Patient Advisory Committee (PAC) was formed. A full-day workshop was held in Vancouver to form relationships, provide orientation on all aspects of TEC4Home, and build understanding about health research in general amongst patient members. The PAC, co-chaired by patient partner and TEC4Home’s principal investigator, has eight members with patients and family caregivers living with heart failure from three geographical regions of BC. The terms of reference stipulate PAC is responsible for advising on decisions concerning TEC4Home including reviewing, informing, and ratifying patient materials. PAC members also sit on other TEC4Home committees. The participatory approach includes an ongoing focus group for PAC and project team to reflect on quality of engagement and help adjust as needed.


      Finding/Results:
      The PAC has been instrumental in ensuring readability of research materials, and in quality improvement during implementation. The PAC supported the analysis of patient care pathways in receiving HF management, identifying where key opportunities and challenges lie. Patients and family caregivers with lived experiences shared their personal stories of the importance of autonomy and not losing their own identities during recovery, and how they would like to see health services improve. These insights helped shape TEC4Home; PAC continues to make significant contributions to knowledge dissemination activities, for example producing a patient- and family-centred summary of feasibility trial findings. The PAC will participate in ongoing evaluation of their engagement in TEC4Home. This will include documentation of patient partners’ goals, and collaborative efforts to ensure their experiences are rewarding and productive.


      Conclusion/Implications/Recommendations:
      From grant proposal through to the ongoing RCT, patient engagement has been key. Patient partners contribute to foundational and practical aspects of research alike. It is important to adopt a patient-oriented stance from the outset, and grow the project with patient and family input. Patient partners must be supported through ongoing collaborative reflection to address issues such as power, and to determine tangible ways to value patient partners for their contributions.


      140 Character Summary:
      Patient engagement in all phases of a multi-sectoral research initiative contributes to effective and robust processes and outcomes.

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      OS17.04 - Patient Engagement and Access to Digital Health Services Amongst Canadians

      13:15 - 14:15  |  Author(s): Simon Hagens

      • Abstract

      Purpose/Objectives:
      Patient engagement is a crucial component of high-quality healthcare services (Forbat, Cayless, Knighting, Cornwell, & Kearney, 2009). Yet despite its primacy, there remain substantive variation in the level of patient engagement with healthcare providers. The purpose of this study is twofold. First is to differentiate demographically characteristics of patients within each of the levels of engagement patients have with their healthcare providers. Second is to conduct correlational analysis on the relationship between patient’s perception of engagement with healthcare provider and access, utilization and interest in e-services in Canada. Reference: Forbat, L., Cayless, S., Knighting, K., Cornwell, J., & Kearney, N. (2009). Engaging patients in health care: An empirical study of the role of engagement on attitudes and action. Patient Education and Counseling, 74(1), 84–90. https://doi.org/10.1016/j.pec.2008.07.055


      Methodology/Approach:
      This study uses self-reported data from Canada Health Infoway’s 2018 Annual Tracking survey: Access Digital Health 2018. Access Digital Health surveyed 2,406 Canadians on their attitudes, utilization, perceptions and expectations regarding digital health services in Canada. The sample was recruited from Harris Poll Online (HPOL)—Nielsen’s proprietary panel—supplemented with sample from other Nielsen-vetted partner panels. The survey instrument was available in both English and French, administered online. Weighting has been applied to reflect the natural incidence of Canadians 16+ by age, sex and province. Perception of engagement with health care provider was determined by a combination of patient’s involvement with their health care providers and confidence to participate with their health care providers for health care management and decision-making. The relationship between patient engagement and patient access, utilization, and interest in various e-services were investigated controlling for demographic variables.


      Finding/Results:
      Four-in-ten Canadians (42%) report that they are engaged with their health care provider in the management of their health. Approximately one-third (33%) report being non-engaged and one-quarter (25%) report having partial engagement. Engagement with health care providers increases with age, and is particularly high among 54+ (52%). Engaged patients are also more likely to have a regular health care provider (93%), take more prescription medications, and have a chronic health condition (65%). Preliminary results indicate that engaged patients are more likely to have access, use and show interest in certain types of e-services such as electronic prescription renewal and visit health care provider virtually online by video.


      Conclusion/Implications/Recommendations:
      Preliminary analysis of this self-reported patient survey suggests that patients who perceive themselves to be more engaged patients are more likely to access, use and show interest in various types of electronic health services. The positive correlation between patient perception of engagement and digital health service utilization indicate that patient engagement may be a promising factor in improving the uptake of electronic health services and improving health service delivery and quality. Continual efforts in patient-centered care and efforts to improve patient engagement are vital steps toward changing the landscape around digital health utilization and lays the foundation for improved health quality and system performance.


      140 Character Summary:
      Results suggest that engaged patients are more likely to have access, use and shows interest in certain types of e-services.

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    OS18 - Increasing Digital Access for Patients

    • Type: Oral Session
    • Track:
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      OS18.01 - Patient-facing Health Information Technology for Decision-making: Evidence/Implications for Design

      13:15 - 14:15  |  Author(s): Selena Davis

      • Abstract

      Purpose/Objectives:
      Today there is growing interest in patient-facing health information technologies (HIT) that engage self-management decision making. Shared decision making (SDM) is an optimal and collaborative approach to decision making between the patient and care provider. It is neither about convincing the patient to follow the provider’s recommendation nor about leaving a patient to decide on his/her own 1. SDM is fundamental to person-centered care, increases patients’- and providers’ satisfaction, improves quality of life and clinical outcomes, and fosters a better patient– provider relationship 2, yet it has been difficult to embed into clinical practice 3. Personal health record (PHR) technology is a promising approach for overcoming its implementation barriers 4. SDM has been conceptually framed to include four sequential elements - Acknowledge, Consider, Decide, Act – and mapped to patient-facing HIT functionality 5. The purpose of this research was to validate, from the perspective of the user, a functional model for an integrated patient-facing HIT that enables SDM.


      Methodology/Approach:
      Functional requirements analysis is widely accepted to be the most crucial part of system design and indeed implementation success can largely depend on how well this activity is carried out. In this research, the user-centered design approach allowed the patient and providers’ needs and interests to influence system design process. The mixed methods included an SDM task to PHR function mapping exercise followed by a semi-structured interview to collect the system functions that each user requires for the different tasks that they perform. User-centered design is argued to increase the likelihood that the system will fit with users’ expectations and preferences and ultimately promote usability, effective use, and sustained usage 6.


      Finding/Results:
      The research developed an enhanced SDM–PHR (e-PHR) functional model justified by patients and providers (n=22) with a moderate level of agreement (Cohen's kappa 0.60-0.74). Located within an interconnected EHR ecosystem and accessible across mobile computing platforms, e-PHR integrates 23 PHR functions for the SDM process, described as an action of the patient, and characterized as foundational, essential or optional. Many notable design implications were also identified and will be presented, such as notification functionality, tracking the decision-making process, intelligent decision support tools, integrated support networks, cultural safety, health literacy, structured vs. unstructured and manual vs automated data entry.


      Conclusion/Implications/Recommendations:
      It has become increasingly important to implement patient-facing HITs that are designed for self-management decision making, such that the patient and their care team stay better connected and informed, share in the decision-making process and improve care and outcomes. Together, the e-PHR functional model and other design aspects identified may be translated into detailed system design, implementation and operational requirements. The failure of EHR systems to provide patients access to their health information, incorporate patient self-reported data into interconnected systems, and enable the collaborative SDM process, may have undesired consequences for patient health. Just as PHR technology designed on an interconnected architecture with the required functionality has the potential to enable SDM, so too does the integration of the SDM process into the PHR have the potential to drive its value and adoption.


      140 Character Summary:
      User-centered design investigation of a functional model for an integrated patient-facing health information technology that enables shared decision making

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      OS18.02 - Patient Empowerment: A Review of Current and Emerging Approaches

      13:15 - 14:15  |  Author(s): Brian Lefebvre

      • Abstract

      Purpose/Objectives:
      Consumer health is a burgeoning field and many organizations and governments are seeking to empower patients and improve outcomes by providing electronic access to health information and health systems. This review examines both the academic and grey literatures for evidence regarding the use of personal health records (PHR) and patient portals. Key functionality and critical functions for these approaches were identified. The literature was further examined to understand what constitutes an optimal approach to provide a patient-centric solution for patient access and engagement.


      Methodology/Approach:
      A rigorous literature review was undertaken to identify and outline theories, narratives, ideas, and themes from a variety of studies. Additionally, an advisory panel consisting of senior healthcare leaders was established to review and validate findings of the literature review.


      Finding/Results:
      It is clear from the literature that the evidence that PHRs or portals will lead to better health outcomes for patients is not convincing. However, there is ample evidence suggesting the use of portals and PHRs will facilitate enhanced patient-provider communication, patient engagement, and a positive change in health behaviours. Much of this benefit is dependent on patient characteristics such as health and computer literacy, demographics, and current illnesses. There is a lack of research that fully considers the patient perspective. Much of the research available looks at solutions designed as extensions of electronic health record (EHR) or electronic medical record (EMR) solutions, with minimal patient input into design and functionality. Several portal and PHR solutions are provider- or product-centric and don’t fully appreciate the full spectrum of patient information needs. In addition, research shows there are several barriers to and facilitators of these solutions. The literature indicates that patients want access to a wide range of functions including scheduling appointments, renewing prescriptions, communicating securely with health care providers, viewing health records, and journaling about health status. Many of the functions desired by patients may be partially available in the current PHR and portal solutions, but there currently is no approach that takes into account the wider context of patient-centric solutions. A significant part of this review looked into potential solutions through a patient-centric lens. It was evident that neither portal nor PHR approach would provide the optimal solution for patient engagement. Limitations of these approaches include dependence on the availability of the host system in the case of the patient portals, and the effort required by the patient to input or acquire information in the case of the PHR.


      Conclusion/Implications/Recommendations:
      With this in mind, an emerging concept referred to as open digital solutions was seen as the optimal approach. Open digital solutions is an approach wherein the information needed by a patient is borderless and not tethered to one particular system. Open digital solutions are focused on providing information through the use of applications and standards that are not tied to any one product or provider. This is a product-agnostic solution and has the ability to provide for a patient-centric approach.


      140 Character Summary:
      A review of evidence regarding the use of personal health records and patient portals to identify an optimal and patient-centric approach for empowering patients.

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      OS18.03 - Engaged and Empowered: SK Citizen Health Portal

      13:15 - 14:15  |  Author(s): Lillian Ly

      • Abstract

      Purpose/Objectives:
      Citizens often do not have enough personalized health information to take an active and meaningful role in managing their own health care. In 2014, a Citizen Health Portal (CHP) was identified as a strategic breakthrough initiative aimed at providing individuals with access to their health system information and empowering them to participate in achieving better health outcomes. By providing individuals with access to their health information, it helps improve the health literacy of Saskatchewan citizens and allows for proactive conversations about their health with their care teams. Saskatchewan’s consumer health solution, CHP, is a web-based service designed for citizens to access their personal health information. It provides opportunity for input of self-generated information, as well as interactive tools that enhance lifelong health quality for individuals and their families. eHealth Saskatchewan (eHealth) went into the pilot with a focus on speed to deliver, cost and benefits evaluation of a citizen centric portal. The portal leveraged existing assets from the provincial repositories such as lab results, immunization history, prescription history and visits to acute care facilities, to provide citizens with valuable health information in CHP. Based on the results from the pilot, it is eHealth’s intent to proceed with a full implementation of CHP. A full production rollout of CHP could result in a transformative change within the health system. CHP could be leveraged by health and other partners to be the gateway for citizens to health information and services.


      Methodology/Approach:
      CHP Phase 2 will be looking to scale from a pilot group of about 1,100 citizens to the general Saskatchewan population. The estimated timeframe for the project is 24 months, which includes the: design and development phase, soft launch or technical go-live, and provincial go-live followed by benefits evaluation activities. Highlights include: Account and Access Management - Revamp the registration process to provide a seamless user experience, while integrating the provincial client registry to offer alignment with identity management in SK. A mobile interface will also be offered for those accessing their CHP accounts via tablets and smart phones. Personal Data Entry & Tracking - Optimize the workflow and work effort of data entry and personal tracking by offering direct integration to wearable devices and mobile health applications so that linked data seamlessly populates citizens’ CHP profiles. Integrated Data Sources - Design and architecture for provincial repository integration will be improved using FHIR which will allow for flexibility to scale to target adoptions and not negatively impact other integrated services. Provincial data sources will include lab results, medical imaging report, immunization history, hospital visit history, and prescription information. Citizen-Provider Interactions - Features and functionalities that offer services and tools that bring together shared care plans to improve health and wellness through collaboration with providers via secure messaging, provider directories, and interactive shared widgets.


      Finding/Results:
      CHP Phase 2 is anticipated to go live in 2019, and so findings and results are not available at this time.


      Conclusion/Implications/Recommendations:
      CHP Phase 2 is anticipated to go live in 2019, and so conclusion/recommendations are not available at this time.


      140 Character Summary:
      SK’s consumer health solution is an online service designed to help improve the health literacy of citizens and promote proactive conversations about their health.

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      OS18.04 - Selling a No-Brainer

      13:15 - 14:15  |  Author(s): Stewart Cameron

      • Abstract

      Purpose/Objectives:
      In 2016 the government of Nova Scotia announced the intention to provide a personal health record (PHR) to all its citizens, the first province to do so. The “MyHealthNS” portal offered patients secure online access to their health summary, their test results, appointment booking and two-way secure communication with their provider (eMessaging). Providers could also send confidential communications to each other. There is evidence that such portals can improve patient safety, satisfaction with care and clinical outcomes.


      Methodology/Approach:
      The provincial rollout followed a very successful 2 year demonstration phase. Patients and physicians had expressed high levels of satisfaction with MyHealthNS. Physician participants advised that widespread adoption of this technology would require integration with practice EMRs and a physician funding model for the provision of virtual care. In response, the Department of Health and Wellness mandated that approved EMRs must integrate with MyHealthNS. However, the newly minted Master Agreement did not make provision for physician payment. Stakeholders agreed that a limited implementation would be presented. It would offer the eResults function but would leave eMessaging as optional. MyHealthNS was offered free to all. Providers choosing to use it received one-time compensation for their training and set up. As in the demonstration phase, patients were enrolled by the online practices.


      Finding/Results:
      After six months, family physician adoption plateaued at about 21%. Patient enrollment by physician offices was less effective than was seen in the demonstration phase. On average, each provider only sent 2-3 new invitations to patients to connect with their practice each month. Most providers were not using all features of the portal. Only a very small number of family doctors chose to activate the eMessage capability of MyHealthNS. A new pilot program was announced by government in March 2018 with improved funding for fuller use of the platform. To be eligible, physicians were required to offer an open invitation policy to their patients, share results and reports to the portal and to enable the eMessage function. After considerable delay in implementation, the pilot went live in August. Two months after the launch, only 135 of the province’s 900 family physicians had signed up. While this tripled the number of physicians using MyHealthNS for patient messaging, there has been feedback from non-participating doctors expressing concern about the potential for increased workload. Some felt patients might experience harm from accessing their reports. Some physicians regarded the recommended two business day response time for eMessages as unacceptable. Many physicians were migrating their EMRs and prioritized this over the portal adoption.


      Conclusion/Implications/Recommendations:
      The majority of citizens and their doctors still do not have access to the benefits of the PHR. For a number of reasons the program has not been fully embraced by the provider community. As well, the plan to have patents enroll through their providers has proven to be problematic. A permanent physician funding model will be needed. Only when these issues are addressed will the full benefits of the portal be available to the population.


      140 Character Summary:
      Lessons learned and barriers encountered in implementing a province-wide patient portal in Nova Scotia

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    OS19 - Using Analytics/AI to Improve Care

    • Type: Oral Session
    • Track:
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      OS19.01 - A Learning Health System for Breast Cancer: Pilot Project Experience

      13:15 - 14:15  |  Author(s): mark Levine

      • Abstract

      Purpose/Objectives:
      *Background: In oncology, frontline clinicians need reliable and timely information on treatments administered to patients and associated impact on patient outcomes e.g. tumor shrinkage, side effects and quality of life (QOL). Currently, timely information is not easily accessible. In 2007, the Institute of Medicine described a Learning Healthcare System (LHS). This was a new paradigm on the critical role information played in the delivery of health care services to meet the health needs of populations. The LHS creates a continuous cycle or feedback loop in which scientific evidence informs clinical practice, while data gathered from clinical practice and administrative sources inform care and scientific investigation. Stage III breast cancer presents with large bulky breast tumors breast and was chosen as the clinical model for our pilot study. There is variation in the treatment of this cancer because physicians differ in their interpretations of research evidence. Objective:* To develop and validate a prototype LHS platform based on IBM Watson technology that can describe the clinical course of patients with Stage III breast cancer over a 24-month time period. In doing so the pilot project had two-dimensional proof-points: to characterize the patient related outcomes while at the same time validating Watson Natural Language Processing (NLP) technology.


      Methodology/Approach:
      A sample of 50 patients with Stage III breast cancer who presented to the Hamilton Health Sciences (HHS) Juravinski Cancer Centre (JCC) between 2013 and 2015 was identi?ed. Clinical information from these patients e.g. tumor stage and characteristics; treatments received; side effects; and disease status (cancer recurred or not) were extracted from several clinical data systems: MEDITECH (in-hospital notes, imaging, lab results); MOSAIQ (JCC notes, radiation); OPIS (chemotherapy); and ESAS (QOL) and used to create the LHS. De-identi?ed electronic health record data extracts were provided by HHS and imported into IBM Cloud-based AI systems. IBM developed specialized NLP annotators in support of this pilot project to extract medical concepts from unstructured clinical text and transform them to structured attributes. The algorithms developed during the first phase were then applied to 18 additional Stage III breast cancer patients from the same years in a validation phase. The data extracted by the NLP annotators from theses patients was compared against the data in the medical chart (gold standard) for 9 indicators.


      Finding/Results:
      The project demonstrated that HHS has the necessary data to build a view of the patient journey and that it is possible to extract, read and combine this data in a way that helps unlock the potential value and derive insights for clinical decision support. The natural language process had a high degree of accuracy and agreement with the gold standard data: there was disagreement for 6 of 171 pieces of information, 3.5% (95% confidence interval=1.3% to 7.5%).


      Conclusion/Implications/Recommendations:
      Our Breast Cancer LHS pilot study has shown the ability to take HER data from a number of sources, harness it in real time and make it accessible to clinicians. This approach could also be applied directly to other cancers and diseases as well.


      140 Character Summary:
      Pilot research experience on the application of analytic and cognitive capabilities in support of creating a Breast Cancer LHS.

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      OS19.02 - Using AI to Improve Access to Mental Health Services

      13:15 - 14:15  |  Author(s): Colleen McDowell

      • Abstract

      Purpose/Objectives:
      Even with access to effective services, many people struggling with mental and life challenges do not seek timely support. This talk will share lessons learned as we applied AI technologies to the mental wellness space. I will discuss how AI can help with early detection of cognitive changes by providing access to safe, stigma free, and non-judgmental space to help people lead better lives and connect them with assistance sooner. This talk will explore how we are using AI technologies in an innovative way to help people lead better lives and connect them with assistance sooner. I will share the story of how we are leveraging IBM's Watson APIs and custom machine learning to work alongside counseling staff to provide assistance and make a deep impact in this global issue.


      Methodology/Approach:
      Citizens and employees no longer accept lengthy paperwork, complicated processes, and organizations centered on procedures and tradition as the norm, especially when it comes to personal health and wellness. I will speak about how IBM has created a Cognitive Assistant tool, harnessing IBM Watson to connect Canadian IBM employees to internal and external mental health and wellness resources and how this is not only being rolled out across IBM Canada, but is being developed for public, military and higher education facilities.


      Finding/Results:
      IBM used the most cutting edge cognitive technology, powered by Natural Language Processing capabilities, to build a Virtual Assistant (VA), trained to guide IBMers to existing services and resources to help with work, health, family, and life challenges. Working closely with counsellors and subject matter experts to ensure that the responses were optimized to provide a supportive and informative response, the anonymous and confidential VA allows IBMers to ask questions in a safe and private space, away from shame, fear, and societal or associative stigma. Today we have all IBM Canada employees connected with services to help them live better lives. Additionally, our solution has enabled those who would usually suffer silently and never call a help line, get anonymous and immediate access.


      Conclusion/Implications/Recommendations:
      Cognitive solutions, services and innovations are enabling the future for healthcare and life sciences. With healthcare data growing exponentially, much of it unstructured, IBM has developed a new class of cognitive systems to augment the human capacity to understand — and constructively intervene into — our complex, emergent health systems, while building a cloud ecosystem for discovery, innovation and advancement to tap into new data sources to make the healthcare system more integrated and effective.


      140 Character Summary:
      Demand for counselling is outpacing capacity. Hear how AI can provide self-service capabilities and guide those who need it to human care

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      OS19.03 - Impact of a Redirection Program on Emergency Department LWBS Patients

      13:15 - 14:15  |  Author(s): Alexandre Messier

      • Abstract

      Purpose/Objectives:
      Emergency department patients who leave without a medical examination, or leave without being seen (LWBS), account for about 10% of the 14,000,000 annual ED visits in Canada, and few solutions to this problem have been identified. The redirection of patients from the emergency department to nearby clinics has been proposed to reduce the proportion of LWBS patients. The purpose of this study is to document the impact of the redirection program on LWBS patients.


      Methodology/Approach:
      This prospective cohort study was conducted using a convenience sample of patients recruited in an academic center. No interventions performed by clinicians or through the program have been modified by this research. Patients gave verbal consent for the research, previously accepted by the ethics committee, and then completed a questionnaire adapted to the context of the redirection program. Feasibility was assessed based on the proportion of potentially eligible patients with a contraindication preventing participation, and acceptability based on the proportion of patients who accepted redirection. The results are presented as the proportion of patients with a confidence interval (CI) of 95%. The Hôpital du Sacré-Coeur de Montréal (HSCM) project is unique in that it requires simple technology and is not based on patient selection using the triage levels 4 and 5 of the Canadian Emergency Department Triage and Acuity Scale (CTAS). *Patients are selected using a medical algorithm created for this purpose only and integrated in the application. The algorithm has proven to be safe following the redirection of 30,000 patients in three Montreal hospitals. The triage staff have direct access to the availabilities of front-line clinics and can book appointments for ED patients* directly through the application. The entire process takes an average of 30 seconds.


      Finding/Results:
      During the period studied, 554,474 visits were analyzed and 49,239 (8.9%) patients left without being seen. The regression curves before and after implementation of the program were in the order of 6 with a pre-program R2 of 0.49 and post-program R2 of 0.43. An LWBS rate of 11.6% was observed just before the program was implemented and 7.5% immediately after (absolute difference of 4.1% [CI95% 3.4-4.8], p<0.001; relative difference of 35%).


      Conclusion/Implications/Recommendations:
      An ED patient redirection program has resulted in a significant decrease of more than a third of the proportion of LWBS patients. The number of patients who leave without being seen, as well as the wait time for ambulatory patients, decreased significantly from day one; the 48-hour return rate is low (less than 4%) and there are no adverse health consequences for patients. With regard to costs, most experts believe that it costs 3 to 4 times more to treat the same patient in the emergency department than in a front-line clinic. All research on the solution was carried out by the Hôpital du Sacré-Coeur de Montréal's Emergency Medicine Research Centre before any involvement of a private company.


      140 Character Summary:
      The medical algorithm integrated to the technology allowed to safely redirect 30,000 patients in 3 Montreal hospitals by not using the triage levels 4 and 5 of the CTAS

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      OS19.04 - Activate Your Content with Enterprise Search

      13:15 - 14:15  |  Author(s): Laura Hall

      • Abstract

      Purpose/Objectives:
      Alberta Health Services is deploying an enterprise-wide, medical records search capability that unlocks the value of historical patient records with the potential to save lives and improve patient outcomes by radically reducing the time needed to retrieve critical patient information. The search capability also reduces the cost of retrospective cohort studies used by physicians to improve the standard of care. This presentation will showcase the hospital’s journey to drive operational excellence for the CancerControl program. Digitizing paper records to enable contextual, key word searches drives process improvement and organizational efficiencies. The objective of this session is to share this journey such that other organizations can apply the same technologies, methodologies, and lessons learned.


      Methodology/Approach:
      While keyword search capability has become ubiquitous on the web and in many other industries, stringent privacy regulations regarding patient information access have hindered the development and implementation of similar search capabilities in hospitals. AHS found technology tailored to medical records that preserves patient privacy and maintains medical records integrity while providing the search paradigm we have learned to expect from tools like Google. AHS was experiencing particular problems in Alberta Health Services CancerControl where an advanced search search capability on static scanned documents was deemed a potential for clinical improvement. A pilot project was developed focusing first on these problems.


      Finding/Results:
      The CancerControl program realized multiple operational efficiencies, improvements to staff satisfaction, and overall improvement to the patient experience. This presentation will detail the before and after state of key performance indicators.


      Conclusion/Implications/Recommendations:
      AHS will share implementation challenges and lessons learned along with their next steps to rollout the enterprise search tool to other areas of the organization. The benefits to AHS will be demonstrated through Oncology use case and a brief video.


      140 Character Summary:
      AHS's enterprise search system will unlock the value of historical patient records with the potential to save lives and improve outcomes.

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    OS20 - Integrating Circle of Care

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 2
    • Type: Oral Session
    • Track:
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      OS20.01 - Community Paramedics and Remote Monitoring in BCs Rural /Remote Communities

      13:15 - 14:15  |  Author(s): Jeff Kingdon

      • Abstract

      Purpose/Objectives:
      The evaluation of innovative care delivery models to address inequities in health service access is a priority. Access is a particular issue in rural and remote communities across the country. In BC, community paramedics (CPs) are boldly tackling one of Canada’s biggest health delivery challenges: providing equitable access to health services for older people living in rural and remote communities. By introducing home health monitoring (HHM), CPs aim to: 1. Reduce the likelihood of patients experiencing exacerbations resulting in ED visits or inpatient stays 2. Empower CP patients with the assurance and confidence that their chronic illness is being monitored on a regular basis Perhaps one of the more significant challenges facing CPHHM adoption is ongoing stakeholder engagement with clinicians and administrators from regional BC health authorities. The introduction of Community Paramedicine was a departure from standard model of care.


      Methodology/Approach:
      In August 2017 BC introduced Community Paramedics (CPs) to improve access to care. By March 2019, approximately 110 CPs will have access to Home Health Monitoring (HHM) solutions to better serve the populations in 99 rural and remote communities across the province. CPs install the HHM equipment at the patient’s home and help them enter their first day’s data. Then patients enter their metrics daily for about 90 days, or sometimes longer. Daily monitoring may provide the patient’s care team with early warning of a deteriorating condition, perhaps before the patient even notices symptoms. The opportunity for the care-team to course-correct may result in avoiding a more serious intervention and reduce the strain on the healthcare system. Additionally, the CP will provide continued education to the patient on how to better manage their illness. The CP will also share progress reports with the referring provider on a regular basis. Once monitoring is done, the CP will discharge the patient from the program and a member of the project team will contact the patient to capture their experience with CPHHM through a survey.


      Finding/Results:
      Initial feedback from patients is that they feel more connected and safe being monitored remotely. CPs are quickly becoming proficient with – and trusting of – this new service provided to their patients. The success of CPHHM will be evaluated against factors that include: 1. reduced emergency department visits 2. reduced (or avoided) patient hospital admissions 3. increased patient self-management 4. improved coordination of care and communication between patients and care providers 5. increased effectiveness and efficiency of the initiative itself. Findings/results are expected in time to be presented at eHealth in May.


      Conclusion/Implications/Recommendations:
      The results of CPHHM are expected to demonstrate a positive patient experience, increased overall health of the CP patient population and a reduction in both acute and community healthcare utilization. The primary benefit is that through HHM, CPs will provide patients with tools to better understand and manage their own illnesses. We recommend that clinicians and administrators continue to be engaged to understand the CP scope of practice and where CPs and CPHHM can continue to add value in the continuum of care.


      140 Character Summary:
      Home health monitoring delivered by community paramedics improves outcomes for patients living with chronic illness in rural and remote communities.

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      OS20.02 - Expanded ClinicalConnect Data Integrations Create a Powerful Patient Care Tool

      13:15 - 14:15  |  Author(s): Dale Anderson

      • Abstract

      Purpose/Objectives:
      This presentation will showcase the latest features of ClinicalConnect, the regional clinical viewer for south west Ontario. Since 2005, ClinicalConnect has grown to become the single, common portal used by tens of thousands of healthcare providers across a wide geographical area. Providers in multiple sectors use ClinicalConnect to gather patient data in real-time, resulting in quicker diagnosis, treatment and improved patient care and safety. ClinicalConnect's evolution has been fast-paced, and the past year has seen key enhancements, resulting in an even more fulsome view of patient records. Perhaps most significant is that diagnostic images/reports from community-based Diagnostic Imaging clinics – known as Independent Health Facilities (IHFs) – are now available. Historically, this was an information gap, given that approximately 60% of ultrasounds, x-rays, etc. are conducted in community clinics, not hospitals. This IHF data is now in ClinicalConnect, complementing the images and reports available from hospitals across Ontario, via direct integrations, or integrations with the Southwestern Ontario Diagnostic Imaging Repository and the Diagnostic Imaging Common Service provincial repository. Other updates include: - New Cardiology Module and how images and reports display - Data display enhancements in the Digital Health Drug Repository (DHDR) to enhance the clinical user experience - Provincial Client Registry integration, augmenting data matching for patients who haven’t had a non-SW Ontario hospital visit - Expansion of Home & Community Care Data to include data from HCCs operated by LHINs outside of SW Ontario - New enhanced mobile user interface with intuitive layout and enhanced navigation, providing remote access to patient records di cc image.png


      Methodology/Approach:
      Health Information Technology Services (HITS), a division of Hamilton Health Sciences, is the solution provider deploying ClinicalConnect across south west Ontario, and HITS’ eHealth Office manages enhancements, often based on requests from ClinicalConnect users. Enhancements made to the portal follow a standard Change Management methodology, leveraging repeatable integration processes as much as possible.


      Finding/Results:
      Presenters will discuss how the portal’s new features and intuitive design are supporting increased usage, including portal metrics. The presenter will recount real-life examples of how ClinicalConnect has supported smoother transitions between care settings and having to rely less on patients/families to recall information about their healthcare; just two of many benefits afforded to patients themselves.


      Conclusion/Implications/Recommendations:
      Since ClinicalConnect was last presented, audiences will see its evolution and work undertaken to maintain a leading-edge digital health tool that consolidates patient information from disparate health information systems, into one viewer. Not only that, but how a growing a growing number of community-based providers too are using ClinicalConnect, launching the portal directly from their EMR, to support the delivery of care outside of hospitals.


      140 Character Summary:
      Latest ClinicalConnect updates give doctors access to diagnostic imaging data from community clinics, plus other exciting functionality, expanded data sets.

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      OS20.03 - Increased patient engagement and team continuity in Community-based care 

      13:15 - 14:15  |  Author(s): Jeff Mackay

      • Abstract

      Purpose/Objectives:
      Calgary Foothills Primary Care Network (CFPCN) has a membership of 450 family physicians and serves more than 379,000 patients. CFPCN launched its health home community (HHC) initiative in 2014 to enable local partnerships and better meet patients' health needs. Access to timely relevant patient information is essential to providing good patient care. The current state of fragmented communication systems in Alberta creates barriers to continuity of care. Patients play a vital role in the management and coordination of care; however, the current system essentially denies patients access to their own health information and limits their ability to communicate with healthcare providers in modern ways. As part of the HHC initiative, CFPCN has implemented a test of Brightsquid secure messaging within the Health Home Community to: 1. Improve information continuity and collaboration across health and cross sectoral teams. 2. Improve the patient experience and engagement through interaction with their care team providers and access to personal health information and education resources.


      Methodology/Approach:
      Community Social Workers (CSW) are community-based team members who assist patients with navigating community resources related to meeting basic needs surrounding the social determinants of health. The CSW works closely with the patient, the patient’s family physician, other teams co-located in the health home and community agencies to facilitate a patient centered approach to care. The CSWs are using secure messaging with patients, family physicians, other health providers, and community partners to unite the entire patient care team through one secure and convenient communication channel for the exchange of information. The project is using the Prosci ADKAR change management method to implement in stages with minimal disruption to the provision of care and the functioning of the HHC. ADKAR stands for Awareness of the need for change, Desire to support the change, Knowledge of how to change, Ability to demonstrate skills and behaviours, Reinforcement to make the change stick.


      Finding/Results:
      While the project is ongoing, preliminary results show enhancements in the communication between patient and provider, and amongst the provider team which has created efficiencies in the coordination of care. The typical patient invitation acceptance rate on the Brightsquid system is 70%, through adaptations, this program has achieved a 90% patient invitation acceptance rate. Secure messaging usage data is being collected throughout the program, outcome measures for patient experience and engagement, accessibility to care, improved coordination and integration of care and improved communication between physicians and CSWs will be collected at the program end in February of 2019. Early usage shows that CSWs have added roughly 3 additional contacts or more convenient contacts instead of in-person visits (which helps with treatment adherence) per patient participant in a 6 month period.


      Conclusion/Implications/Recommendations:
      Based on initial findings secure messaging in community care can improve continuity of care and patient engagement. Patient acceptance is high and care team access is increased. These benefits, while still being quantified, will create system efficiencies and a better patient experience when used more broadly across the PCN and the healthcare system.


      140 Character Summary:
      The use of team-based secure messaging to improve patient experience and engagement through remote interaction with care team members.

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      OS20.04 - Videoconferencing to Support Intraoperative Surgical Coaching: Are We Ready Yet?

      13:15 - 14:15  |  Author(s): Caterina Masino

      • Abstract

      Purpose/Objectives:
      Intraoperative coaching between peer surgeons can support the professional development of surgeons in an increasingly complex surgical environment. However, this activity can be time intensive as surgical coaching requires the physical presence of a surgeon coach in the operating room. The use of a telementoring platform may be a less intrusive form where the coach participates virtually. This pilot study aimed to evaluate the feasibility of introducing a telecoaching program to facilitate intraoperative surgical coaching activity.


      Methodology/Approach:
      Telecoaching was implemented using the Karl Storz VisitOR1® remote presence system with two way live audio and video communication. Technical quality was assessed using a modified Maryland Visual Comfort Scale. Exit interviews were conducted with the participating surgeons and the operative teams that were present during the telecoaching sessions. Two independent reviewers coded the interview data using a conventional content analysis method.


      Finding/Results:
      A total of two out of six telecoaching events were completed during a 12-month period. Logistical issues with timing and scheduling coordination was the top barrier identified by the surgeon participants. For the completed sessions, 16 participants from two OR teams formed part of this feasibility study. Exit interview response rate was 75%. Participants interviewed included the surgeon coaches, surgeon mentees, operating room nurses, anesthetists, surgical fellows, and surgical residents. The overall technical quality was rated as average by surgeon participants (3.5/5 for coaches and 3/5 for mentees). Participants identified privacy and consent, internet connectivity, and optimal unit positioning in the operating room as important factors to consider for future implementation. Operative team participants did not find that the videoconferencing equipment had a negative impact on their work environment and viewed the intervention favorably as a learning tool. Overall, participants felt that videoconferencing during surgery has potential benefits for learning in complex cases as well as facilitating intraoperative consultations between peer surgeons.


      Conclusion/Implications/Recommendations:
      This pilot study demonstrated that is it feasible to use videoconferencing to support intraoperative surgical coaching. Operative team participants viewed the intervention favorably and identified practical considerations for its continued use in an operating room environment. Lessons learned and practical considerations for the design of a telecoaching program will be shared.


      140 Character Summary:
      The implementation of a pilot telecoaching program to facilitate intraoperative coaching is technically feasible but the surgical culture may not be ready yet.

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    OS21 - Big Data Provision for Providers

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 3
    • Type: Oral Session
    • Track:
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      OS21.01 - The HQCA Provincial Primary Healthcare Patient Panel Reports – Going Digital

      13:15 - 14:15  |  Author(s): Walie Aktary

      • Abstract

      Purpose/Objectives:
      The Health Quality Council of Alberta (HQCA) produces Provincial Primary Healthcare Patient Panel Reports that provide meaningful and relevant information to primary healthcare providers, teams, and primary care networks across Alberta. The reports contain aggregate information about patient demographic characteristics, health status, and aspects of patient management and utilization patterns across the healthcare system. User feedback collected as part of a return on investment (ROI) analysis demonstrated that the reports influence primary healthcare providers by offering new information about patients and is useful in identifying quality improvement opportunities. The reports have historically been sent out to recipients electronically as static documents; however, user feedback suggests that there is a need to expand the reporting modality of the reports to a digital platform where reporting is dynamic. Therefore, the HQCA explored how to digitalize the reports to create a new and interactive tool.


      Methodology/Approach:
      The HQCA used a two-stage collaborative approach to digitalize the panel reports and build an online reporting platform. The first stage consisted of building a pilot environment through an agile scrum process with experts familiar with digital reporting software. The scrum process is an iterative approach to software development where development occurs incrementally. The pilot process took place over a 1-month period and a 2-week post-production period was used to beta test the pilot environment. The second stage will consist of a full-scale build that is currently in process. The HQCA will conduct the full build over a 6-month period where development will be guided by a design working group consisting of report stakeholders. This working group will be comprised of report users, healthcare team members, and HQCA developers. The full build will follow an alpha testing model where the design group will identify bugs in test versions of the environment. A final round of beta testing will occur prior to deployment with external stakeholders.


      Finding/Results:
      Usability testing provided positive feedback regarding the introduction of a digital environment. The findings highlighted areas for improvement regarding user comprehension as well as provided a basis for future development. Test findings suggested that the environment could be more user-friendly by focusing on the language used to describe system features, such as the functionality that enabled users to focus on clinical populations of interest through data filters. Users identified the ability to customize the comparators used in the reports as a significant strength of digital reports as compared to the current reporting modality. Group feedback also indicated that the HQCA proceed with a full build suggesting that the pilot environment build was successful.


      Conclusion/Implications/Recommendations:
      Early indications suggest that the digital reports will be more clinically relevant and actionable. The new reporting platform for the panel reports will aim to provide users and their care teams with a mechanism to identify opportunities for improvement as well as areas of success to strengthen the patient's medical home by improving panel management, continuity, access, and quality of care for their patients.


      140 Character Summary:
      The HQCA is working with primary healthcare stakeholders to build an online reporting platform for providers, teams, and primary care networks across Alberta.

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      OS21.02 - Establishing a Predictive Analytics Unit in a Canadian Hospital

      13:15 - 14:15  |  Author(s): Jeremy Petch

      • Abstract

      Purpose/Objectives:
      While many hospitals have implemented business intelligence tools, few have been able to leverage their data holdings to go beyond descriptive and diagnostic analytics (What happened? Why did it happen?) into the predictive space (What will happen? How do we make it happen?). Moreover, even retrospective analysis of data in typical business intelligence environments is frequently lengthy; such that many hospital leaders may not always receive the information they need in time to inform their decisions. This session details how an academic hospital addressed these challenges by establishing a rapid-response advanced analytics unit that leverages data science techniques, such as machine learning and simulation modeling, to provide rigorous analyses to the hospital’s clinical and executive leadership. The development of this analytics unit and its technological architecture has yielded a number of insights and lessons learned that will be of interest to other hospitals seeking to leverage advanced analytics at their own organizations.


      Methodology/Approach:
      This session provides a case study in the development of the business and technological architecture involved in establishing a rapid-response advanced analytics unit at an academic hospital, with an emphasis on insights and lessons learned from our research and experience. The session will also demonstrate one of the key tools we have developed to facilitate this approach, our analytic algorithm tool.



      Finding/Results:
      First, the analytics unit has been able to boost operational efficiency of analysis at our institution through the implementation of our analytic algorithm tool.
      Second, the analytics unit has developed a number of predictive models to inform departmental management and clinical decision making. I will highlight the ED early-warning system, which uses a neural network that integrates hospital data with other data sources, including geo-mapped local event data (marathons, concerts, etc) and weather data, to predict Emergency Department volumes by hour with a less-than 4% error rate six-hours out, and less-than 10% error rate three days out.


      Conclusion/Implications/Recommendations:
      1. With the right business architecture, hospitals can begin to expand their use of data beyond traditional BI, to include open source advanced analytics tools, such as R, Python and TensorFlow.
      2. Organizations interested in pursuing this course may need to push back against vendors’ use case-based approach to warehouse development, given the need for large amounts of varied data.
      3. Organizations contemplating investments in data architecture should consider the opportunities offered by advanced analytics, but also be mindful at the procurement stage that advanced analytics may have additional or different technological requirements than traditional BI.


      140 Character Summary:
      How a Canadian hospital established anadvanced analytics unit that leverages data science techniques to inform clinical and executive decision making.

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      OS21.03 - Digital Pathology Across Provinces - Multi-Jurisdictional Telepathology, Year One

      13:15 - 14:15  |  Author(s): Emma Housser

      • Abstract

      Purpose/Objectives:
      The Multi-Jurisdictional Telepathology network is a partnership established between Manitoba, University Health Network in Ontario, Newfoundland and Labrador, with the support of Canada Health Infoway intended to connect local telepathology networks amongst the three jurisdictions. The solution, a first of its kind in Canada, went live in June 2018, connecting a scalable pathology network of specialists and sub-specialists. The vision of this solution is to create an environment where pathologists are able to obtain consultations, including speciality and sub-specialty areas not necessarily available at the pathologists respective locations, in a more timely and effective manner. Developing a solution that meets the needs of end users within a jurisdiction as well as amongst jurisdictions is challenging. These needs were addressed through the development of a solution that balanced the end user needs, system capabilities, personal health information and ongoing system management in order to maximize adoption will be addressed. This presentation will provide an overview of the solution, challenges associated with establishing a virtual multi-jurisdictional solution, ongoing maintenance and governance, as well as the value and benefits realized in the first year of operations.


      Methodology/Approach:
      In developing and implementing a multi-jurisdictional solution, it became apparent that a balance of the end user needs, the system capabilities and the ongoing system management was necessary. This implementation requires the balance of privacy, security, technical architecture, governance and ultimately clinical workflow to name a few of the considerations, not only within a province but additionally across multiple jurisdictions. Elements key to the early stages and implementation of such a solution include: Successful provincial implementations Engaged end users Privacy, security and technical subject matter expertise in each jurisdiction Governance – project and program The presentation will include results from stakeholder evaluations including a benefits and evaluation report.


      Finding/Results:
      The presentation will detail the challenges and opportunities presented with the implementation of a multi-jurisdictional telepathology solution, connecting colleagues and enhancing access to specialised services across the country. Results of early benefits and evaluation work will include: Uses for the system - consultations, education and training, continuous quality improvement. Satisfaction with the solution – majority of users feel that the removal of the solution in their laboratory would be a step backward. Perceived benefits to date - improved quality of service, harmonization of clinical practice within the laboratory, improved continuity of patient care, and an increase in the quality of patient care.


      Conclusion/Implications/Recommendations:
      The implementation of this solution connects pathologists, many working in smaller, more isolated areas – in a timely, often more efficient manner, not only within their own jurisdiction but across jurisdictions. The established Multi-Jurisdictional Telepathology network is a pan-Canadian proof of concept, including a road map and lessons learned for additional jurisdictions as well as for similar pan-Canadian implementations in the future. This presentation will highlight the implementation of such a solution as well as the benefits to date experienced by clinicians in providing quality care to Canadians.


      140 Character Summary:
      The Multi-Jurisdictional Telepathology Network, live as of June 2018, connects pathologists across NL, ON and MB. Learn about the implementation and benefits.

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      OS21.04 - Pathology Data Analytics to Optimize Laboratory Utilization by Interactive Scorecards

      13:15 - 14:15  |  Author(s): Raza Abidi

      • Abstract

      Purpose/Objectives:
      Pathology laboratories provide service to both primary-care and tertiary care providers, helping with disease diagnosis and therapeutic choices. Typically, physicians request a pathology test order which may contain multiple tests; the operational question is whether these tests are relevant and useful with respect to the patient’s profile. As service demands on pathology laboratories is increasing, there is a realization to streamline the operations with respect to clinical guidelines and local clinical workflows to optimize operational costs whilst improving order relevancy and result accuracy. A Canadian study has shown that physicians test ordering behaviour can be modified by education, personalized audit and peer comparisons. Pathology laboratories generate large volumes of clinical data that can be analyzed to monitor, manage and optimize laboratory utilization. This project aims to optimize pathology laboratory utilization by detecting superfluous (clinically irrelevant, unnecessary, repetitive) lab orders by physicians and then educating physicians about test ordering guidelines. Our specific objectives are: (1) To develop and deploy a Pathology Laboratory Utilization Scorecards (PLUS) platform that offers end-to-end pathology ‘big’ data analytics services to optimize laboratory utilization; (2) To provide primary care physicians personalized laboratory utilization scorecards so that they can examine their test ordering pattern and adjust their test orders accordingly; (3) To provide pathology laboratory managers a live dashboard showing the volume and type of orders to assist them with resource planning; and (4) To generate meaningful order-sets to improve test ordering patterns and guideline compliance.


      Methodology/Approach:
      Big data analytics approach is taken to develop PLUS that hosts a suite of health data analytics tools to (i) standardize pathology data using SNOMED-CT; (ii) integrate pathology data from feeder health information systems (such as ADT, EDS); (iii) analyze lab data using machine learning methods—clustering methods are applied to develop physician order profiles to stratify physicians with respect to their patient case-mix (as opposed to their order type and volumes) for inter-physician peer comparisons, and rule association methods are applied to generate order-sets and to evaluate test orders based on previous order patterns; and (iv) visualize analytical results as interactive scorecards—advance data visualization techniques are used to visualize the multi-dimensional physician scorecard, giving physicians the ability to dynamically interact with their scorecard to get personalized views of their ordering behaviour and comparisons with their peer-group. We performed data analytics on physician’s test orders for the period 2011-2017 with a dataset comprising around 8 million test orders from 200 physicians.


      Finding/Results:
      We have developed PLUS to optimize the pathology laboratory utilization in the central zone (Halifax) that annually performs on average 15 million laboratory tests for 200,000 patients. PLUS is securely web-accessible to physicians to privately audit their ordering profile in terms of volume of test orders with abnormal rates, repetition rates, yearly comparison and comparison to their peers.


      Conclusion/Implications/Recommendations:
      ‘Choosing Wisely Canada’ is promoting sustainable healthcare by optimizing the utilization of healthcare services. This project engages primary care physicians to help optimize lab utilization, and this will impact NSHA annual budget by reducing demand for diagnostic services whilst increasing patient safety in line with Choosing Wisely principles.


      140 Character Summary:
      A big health data analytics platform using artificial intelligence to analyze pathology lab data to optimize pathology lab utilization and increase patient safety

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    OS22 - eServices: Better Than Paper!

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 4
    • Type: Oral Session
    • Track:
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      OS22.01 - Screening While You Wait: Facilitating Primary Care Based Exercise Counselling

      13:15 - 14:15  |  Author(s): Payal Agarwal

      • Abstract

      Purpose/Objectives:
      Lack of physical activity (PA) is the fourth leading risk factor for global deaths annually. Yet, only 18% of Canadians meet PA guidelines despite known impact on mortality and well-being. Guidelines recommend that primary care providers use evidence-based screening and counselling to encourage PA during routine visits, but this is rarely implemented. Reported barriers include lack of time to appropriately discuss PA levels, lack of knowledge and training in PA counselling, and a lack of success in changing patient behaviour. This pilot trial aims to reduce these barriers by (1) examining the feasibility of integrating a technology-based physical activity counselling tool in routine clinical care, and (2) evaluating preliminary effectiveness of the intervention.


      Methodology/Approach:
      An intervention was developed through a user-centered design process. The resulting design automatically summarized results and creates 1) a customized exercise prescription in the EMR, and 2) a personalized, printable toolkit with online and local resources to increase physical activity. A pragmatic, step wedge trial was conducted at an urban academic family health team. The intervention was sequentially administered in a randomized order, with one of four cluster switching to the intervention per 6-week step, until all clusters were exposed. Eligible patients received a secure baseline e-survey prior to their appointment to assess PA levels (using Metabolic Equivalent of Task minutes (MET-minutes) per week). The difference in MET-minutes per week between intervention and control groups was assessed at four months follow-up; secondary outcomes include changes in intention and self-efficacy for PA. Process measures included patient satisfaction with PA advice, receiving the toolkit and prescription, and estimated minutes spent on PA counselling.


      Finding/Results:
      Of the 530 total patients, 82.5% provided baseline and follow-up data. MET-minutes per week in the intervention group was 10% greater than controls (count ratio, 1.10, 95% CI 0.86-1.41, p=0.44). After adjusting for baseline covariates, the effect of the intervention remained non-significant (count ratio, 1.18, 95% CI 0.90-1.53). 61.8% of patients exposed to the intervention completed a process evaluation; of these patients, 49.4% reported receiving at least a prescription, 48.9% reported spending 2-5 minutes discussing PA with their provider, and 86.8% reported being satisfied with their PA discussion. table 1-swyw.png


      Conclusion/Implications/Recommendations:
      The introduction of the e-health tool for PA was feasible to implement in a large primary care practice and in this pilot trial resulted in a non-statistically significant increase in PA. Process evaluations indicated a need for better training and modifications to ensure fidelity of implementation. Future studies require a significantly larger number of clusters to achieve significant power.


      140 Character Summary:
      This trial establishes the feasibility of an e-health tool to assess PA levels, motivators, and barriers prior to a clinic-visit for delivery of tailored resources.

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      OS22.02 - How to Maximize eConsult’s Impact?  Integrate!

      13:15 - 14:15  |  Author(s): Amir Afkham

      • Abstract

      Purpose/Objectives:
      BASE™ eConsult service has experienced tremendous traction and growth within the clinician communities across Canada. Its managed service approach has offered primary care providers (PCPs) a reliable mechanism for obtaining timely advice from specialists, which ultimately results in better care for patients. Yet the systemic benefits of eConsult are far from being realized. A PCP may decide to eConsult a specialty that ordinarily is difficult to access (long wait times, geographical constraints), and consequently the positive impact for that particular patient will be evident. However, for an overall reduction in wait times for all patients of that specialty, the option to address patients’ needs via eConsult must ultimately become embedded in its standard referral workflow. Data demonstrating the potential impact of merging eConsult into referral processes will be presented, along with key considerations.


      Methodology/Approach:
      Analysis of data across a number of specialties has been conducted, reflecting how eConsult currently represents a relatively small proportion of overall referral volumes. At the same time, research has been conducted on a statistically significant sample size of eConsult cases, demonstrating excellent average response intervals, and offering insights into the potential reductions in the number of unnecessary in-person referrals to specialists. A study of eReferral implementations that have embedded eConsult essentially as part of the triage step offers further evidence of the opportunities before us to make a bigger impact on improving access and reducing wait times.


      Finding/Results:
      A study of referral versus eConsult patterns indicated that with the current decoupled approach, PCPs on average make 250 referrals per year, compared to 10 eConsult per year. When eConsult was used, an analysis of surveys completed by PCPs for over 40,000 eConsult cases indicates that 40% of all eConsult cases were originally contemplated as an in-person referral which was subsequently avoided as a result of the eConsult step. Combining these findings with examples of integrated eReferral/eConsult processes in other jurisdictions, such as San Francisco and Los Angeles, highlight tremendous opportunities for further improvements in accessibility of timely care. Results from LA County’s Safety-Net program that has implemented an integrated eReferral/eConsult process indicate 25% of all referrals received are addressed via eConsult without the need for a specialist visit, which has also led to a 17% drop in the wait time to see a specialist. To make this possible in a Canadian setting, there are other considerations including specialist remuneration, integration with electronic medical record systems for both primary care providers and specialists, and overall better organized central intake models for referrals.


      Conclusion/Implications/Recommendations:
      Across many regions, strategies are being developed to better organize key specialty pathways, and establish/enhance Central Intake models to better, and more appropriately, distribute case loads. To make this all possible in a more automated fashion, eReferral solutions are being implemented. Inclusion/addition of eConsult as a simple option for a specialist during the standard triage phase of an eReferral will be a small process change with a significant impact on improving wait times. Governing bodies can promote, support, or even more boldly mandate this change for the better.


      140 Character Summary:
      Integrating eConsult into referral workflows will unleash its systemic benefits, significantly reducing unnecessary in-person visits and overall wait times

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      OS22.03 - Perspectives on Centralized Intake for Specialist Referrals

      13:15 - 14:15  |  Author(s): Kevin Jones

      • Abstract

      Purpose/Objectives:
      Objectives The ORGANIZATION offers a centralized referral intake service created by the PROVINCIAL Ministry of Health to facilitate timely access to specialized services for primary care physicians’ (PCPs) patients. The HEALTH REGION manages these referrals on behalf of the GEOGRAPHY. Currently, the ORGANIZATION ensures appropriate triaging and booking for sixteen specialities, with plans to include another eleven. The objective is to streamline the referral process by booking appointments based on 3 criteria: - Referral priority
      - Patient’s location
      - Named specialist The goal of this innovative approach is for all patients to be seen within priority wait time targets.


      Methodology/Approach:
      Methodology The province-wide rollout is following an iterative approach, using a group of primary and specialist care physicians to standardize referral forms, reasons for referral, priorities, and prerequisites. Each regional ORGANIZATION decided what, if any, technical tools were used to support the workflow. The HEALTH REGION selected an eReferral and Central Intake tool, as well as being an early adopter of provincial initiatives, and an innovator in tackling inefficiencies in the process (e.g., fax, provider management). Process The ORGANIZATION initially transcribed referrals from faxes into the eReferral tool and followed a multi-stage intake process designed to ensure patients received appointments within the appropriate clinical delay. The VENDOR developed functionality to support brokering the optimal appointment, including: matching to specialists where no preference was specified; distance from patient to office (convenience); wait times (relative); amongst others. Ongoing efforts to streamline the process included attempts to automate inbound referrals using Optical Character Recognition (OCR) and direct EMR integration, which were undertaken with varying degrees of success. The Ministry ultimately introduced a provincial EMR interface hub to address these challenges, which distributes eReferrals to the appropriate ORGANIZATION. The HEALTH REGION also created a self-serve portal for the specialists to self-register, specifying their practice locations, inclusion and exclusion criteria. This creates the record within the tool and decentralizes the maintenance of the thousands of practicing specialists in the region. The HEALTH REGION continues to iterate on process, technology, and expansion activities to improve the efficiency and effectiveness of the referral intake and appointment brokering process.


      Finding/Results:
      Results To date, over 170,000 referrals have been processed through the central intake office. Efforts continue to achieve the ambitious targets set by the Ministry. Future efforts to improve will include onboarding specialists to directly manage their own appointments and waitlists, yielding significant efficiencies in several stages of the current process. Continuous improvement activities are also planned to revamp the matching logic to revamp the recommendation engine at the heart of the brokering process.


      Conclusion/Implications/Recommendations:
      Conclusion The ORGANIZATION and the VENDOR will continue to focus on people, process, and technology, iterating to improve access to specialist care. As other provinces and health regions look to tackle this, important lessons can be learned from the efforts to date.


      140 Character Summary:
      A critical review and analysis of the innovative primary care to specialist centralized intake model being implemented in one province.

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      OS22.04 - Impacts of Integrating Electronic Referrals in an Ambulatory Care Hospital

      13:15 - 14:15  |  Author(s): Syed Rayyan Qadri

      • Abstract

      Purpose/Objectives:
      Faced with an aging population (65+) and growing need of specialized care services, hospitals are seeing an increase in referrals from health care providers. In turn, this is making it increasingly difficult to track, triage, and schedule faxed referrals. Handling of paper referrals continues to challenge hospitals due to incomplete documentation, filing, transcribing into the electronic health record (EHR), redirecting incorrect paper referrals, and linking referrals to scheduled appointments. This fragmented process is negatively affecting clinical/administrative staff workflows by delaying the scheduling of appointments that consequently increases patient wait times to receive care. Additionally, referral information is not easily accessible to providers causing redundancy in clinical visits (e.g. the ordering of unnecessary tests). The purpose is to present an electronic referral (eReferral) solution (CareLink) that enables Women's College Hospital (WCH) to receive/manage multiple referrals from community providers in different organizations. CareLink is integrated seamlessly with WCH's ambulatory electronic patient record (aEPR) system through a web-based application that allows community providers from various clinical organizations to submit referral information for a patient electronically, which gets directly stored in the corresponding patient's aEPR.


      Methodology/Approach:
      Referrals submitted through Care ink can be easily managed by the community providers and tracked by patients (through the patient portal) to view the referral progress from scheduling to completion. This is an innovative approach to removing paper referrals because WCH is using an extension of its aEPR system to establish a portal for eReferrals, which avoids the need for double documentation and/or printing of referral information at both ends.

      A mixed methodology will be used that includes telephone interviews, qualitative and quantitative electronic surveys, and data extracted from the system record, to assess the impact of the CareLink solution for eReferrals on the efficiency of workflows and quality of care provided to patients.


      Finding/Results:
      As an outpatient ambulatory hospital, WCH receives about 56,000 referrals a year from community providers for more than 60 unique clinical programs. The CareLink eReferral solution improves referral workflow efficiency of the clinical and administration staff, reduces wait times for patients by minimizing delays in appointment scheduling, encourages consistent referral completion/documentation, and improves the triaging and tracking of referrals. In addition, electronic referral data allows for rich data mining, analysis and detailed reporting for both WCH and the ministry. The initial response of the clinical and administrative staff has been extremely positive after embracing the idea that they would potentially get rid of the paper and faxing processes for referrals from their workflows.


      Conclusion/Implications/Recommendations:
      The use of eReferrals can greatly improve the workflow efficiency and the quality of care provided to patients, especially for an ambulatory setting like WCH. The notion of having the CareLink eReferral solution to digitally receive referrals and eliminate the associated paper-based processes between clinical organizations will improve the inefficient referral process in place and foster better connectivity across the care continuum. CareLink will require extensive stakeholder involvement through engaging dialogue, mapping of clinical and administrative workflows, and the resources to technically configure the extended web-based application to integrate with WCH’s aEPR.


      140 Character Summary:
      CareLink eReferral solution at WCH, an ambulatory hospital, will improve the efficiency of referral workflows and the quality of care being provided to patients.

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    PS05 - How We Figured Out That It Really Worked!

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 1
    • Type: Panel Session
    • Track:
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      PS05.01 - ITAC Health: The Implications of the Provincial Interoperability Scorecard

      13:15 - 14:15  |  Author(s): Derek Ritz

      • Abstract

      Purpose/Objectives:
      Evidence shows that interoperable health information exchange positively impacts care continuity, care quality, and patient safety. Interoperability is especially important in the primary care setting to support the management of non-communicable diseases (NCDs), which represent Canada’s most significant disease burden. At eHealth 2018, ITAC Health introduced the country’s first provincial Interoperability Scorecard. This presentation updates the Scorecard’s findings and engages with key jurisdictional, industry and patient-advocate panelists to discuss implications regarding: support for disease management initiatives; patient safety and quality of care; analytics and research; and future ICT investment strategies.


      Methodology/Approach:
      The research leverages datasets regarding primary care physicians’ digital health adoption rates; meaningful use of EMR data; patients’ access to and use of EMR data; and care coordination with other providers. Based on each dataset, comparative metrics are developed and reported, province by province. The 2019 Scorecard will also draw in qualitative information from jurisdictions regarding population health priorities, health system management metrics, and the alignment between digital health investment strategies and specific health initiatives.


      Finding/Results:
      The research and analysis will further the work of the provincial Interoperability Scorecard to better support comparative evaluation of Canadian health authorities in a consistent, constructive and measurable way. ITAC Health, in cooperation with academic, jurisdictional, and industry partners, will present and explore the implications of its updated findings at the eHealth Conference in May 2019.


      Conclusion/Implications/Recommendations:
      The intent of the provincial Interoperability Scorecard is to support better-informed decision-making regarding health policy and digital health investment. It provides stakeholders with a credible, comparative metric that goes beyond simple EMR adoption figures. The Interoperability Scorecard helps measure the meaningful use of digital health to support high-quality, patient safe, coordinated care.


      140 Character Summary:
      ITAC Health reports the 2019 Interoperability Scorecard. How do the provinces compare? What are the policy and investment implications?

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      PS05.02 - The Digital Health Evaluation Technology Readiness Assessment: Development and Application

      13:15 - 14:15  |  Author(s): Laura Desveaux

      • Abstract

      Purpose/Objectives:
      Strategies for evaluation, implementation, spread, and scale of digital health technologies depend on their level of maturity. Technological maturity is intrinsically linked to contextual factors, including stakeholder interests, features of the implementation site(s), evidence of impact, and the alignment between the technology and the proposed problem. This panel outlines a process for assessing technological maturity and a roadmap for identifying evaluation needs. It adopts the NASA Technology Readiness Level (TRL) measurement system as a macro-level conceptual framework to assess technological maturity, outlining the evidence requirements and relevant guiding frameworks at each stage. The purpose of this panel is to help attendees (1) understand technology readiness; (2) identify relevant evaluation objectives; (3) identify appropriate micro-level (stage-specific) evaluation frameworks; and (4) recognize which stakeholders to engage across each stage.


      Methodology/Approach:
      This work reflects the thematic consolidation of learnings across evaluations involving 33 digital health vendors, over 20 clinical implementation sites, and more than 75 digital health stakeholders in Ontario. We outline the *Digital Health Evaluation Technology Readiness A*ssessment (DTA) as a comprehensive tool to help stakeholders navigate the evaluation of digital health technologies. The DTA is focused on evaluation of digital health technologies across the innovation continuum, from development to system procurement. A rapid review was used to identify prominent digital health evaluation frameworks, which we mapped to the corresponding evaluation domain within the DTA. This panel will provide an overview of the literature followed by a synthesis of field experience. We will then present the framework, highlighting how it can be used to address the needs of innovators, evaluators, and system stakeholders using real-world examples from past and present engagements.


      Finding/Results:
      The notion of readiness extends beyond the technology itself. Digital health technology readiness must consider the intersection of the technology, its user(s), their context/site, and the nature of the problem to be solved. The extent to which these factors align determines the stage of readiness. The DTA framework (Table 1) includes descriptions of key objectives, evaluation domains, and associated evaluation process(es). Ten pragmatic evaluation frameworks emerged during the rapid review which map to evaluation domains. Table 1- Digital Health Evaluation Technology Readiness Assessment table 1.jpg DH=Digital health; HTA=health technology assessment.


      Conclusion/Implications/Recommendations:
      Health technology readiness is a product of complex interactions between stakeholders (including government, administration, clinicians, and patients), system context, and setting-specific factors. The burden of evidence required to ensure uptake extends beyond basic functionality to include feasibility, acceptability, impact, and scalability. The DTA framework provides a roadmap to help innovators, evaluators, and system stakeholders navigate the evaluation requirements from technology development to adoption.


      140 Character Summary:
      The Digital Health Evaluation Technology Readiness Assessment provides a framework to guide evaluation from digital solution development to system procurement

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    OS23 - Looking Through the Data Lens

    • Type: Oral Session
    • Track:
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      OS23.01 - Using the EMR to Rapidly Respond to Product Recalls

      14:30 - 15:30  |  Author(s): Jim King

      • Abstract

      Purpose/Objectives:
      Drug and consumer product recalls are fortunately rare in healthcare. When a recall occurs timely response to identify, remove and provide an alternative are crucial. A voluntary recall was issued in September 2018 by Abbott (for certain liquid nutrition products due to possible bacterial contamination) and in October 2015 by Sanofi-aventis (for Allerject®, epinephrine injection, for potentially inaccurate dosage delivery). The purpose of this presentation is to highlight how CHEO used the analytic capability of an integrated EMR to rapidly respond to these product recalls.


      Methodology/Approach:
      Following the announcement of each recall a product based report was generated for all the potential order ids (ERX) for both the inpatient and outpatient departments identifying both the patient and provider. The report was generated for the current order (day of) for the inpatient department and the order within the last year (time - 1 year) for the outpatient department. Relevant information for these orders including ordering provider, ordering date, and the patient address, name, phone number were extracted. An alert was then developed within the EMR and presented to the provider when ordering the recalled product. The alert provided information about the recall with hyperlinks to the Health Canada or the Canada Food Inspection Agency websites along with prescription information and a recommended alternative when attempting to order the recalled product.


      Finding/Results:
      The following table outlines the number of unique patients that were identified as having an order for the recalled product. The report was generated the same day as notification of the reporting team of the product recall. Orders Sanofi-aventis (Allerject®) Abbott Formula Inpatient N/A 94 Outpatient 21 18 Total 21 112 An alert for the recall and an alternative for the recalled product were built within the order entry system.


      Conclusion/Implications/Recommendations:
      Managing product recalls may be challenging. While it is a responsibility of the dispensing pharmacy to notify patients when there is a recall it is equally important for the ordering physician to identify and notify patients and prescribe an alternative course of therapy. In the hospital setting we have used the analytic capability of our EMR to rapidly respond to two product recalls. This allowed a quick and reliable means to identify patients and their providers and communicate quickly with our families. Also, we were able to notify prescribers with the EMR of the recall in the context of their ordering and to offer an alternative to the recalled product.


      140 Character Summary:
      Using our EMR we rapidly responded to two product recalls, identified affected patients and providers and offered alternatives to the recalled product.

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      OS23.02 - Using Blockchain To Capture Patient Consent for Genomics Research

      14:30 - 15:30  |  Author(s): Daipayan Mukherjee

      • Abstract

      Purpose/Objectives:
      The process of enrolling a new study participant in a research study is time and paper intensive. Further, the process requires researchers and hospitals to validate patient consent before sharing data for research, causing significant delays to overall research timelines (on average, it takes 60 days to onboard, enroll and receive data from study participants). Further, the enrolled study participants have little visibility into their data after providing consent. The project's objective is to use blockchain to solve these issues.


      Methodology/Approach:
      Below is f the conceptual model of the platform proof architecture.png


      Finding/Results:
      Expanding on the PoC, the Informed Patient Consent project focuses on bringing the PoC developed by PROOF from a beta version state to a market ready, commercially viable product. Key outcomes for this project are: Develop product roadmap and framework that defines the path to bring the application from a PoC state to a market ready product Complete development to move the product to a market ready product, including successful integration with clinical data from multiple parties including research organization and hospitals Determine application governance and operating model, including IP ownership, licensing model, operations / sustainment management plan, sales strategy, and revenue forecast


      Conclusion/Implications/Recommendations:
      Expected Benefits Informed patient consent and health data auditability is foundational for a secure health and genomics platform. The informed patient consent application establishes ‘trust’ and enables transparent sharing of clinical and genomic data across parties in a timely, easy, secure manner. A blockchain-based solution will remove the need for centralized consent management, such as by the researcher or hospital, facilitating decentralized record access and storage. Smart contracts, autonomous programs that run on the blockchain, will ensure that only authorized parties have access to that patient’s data. The following are key outcomes that will be derived directly as a result of this project: Blockchain is a distributed technology that brings a built-in layer of transparency and traceability, therefore removing the need for third parties such as researchers or hospitals (e.g. paper consent forms) Use of smart contracts can automatically execute transactions based on the implemented rules from all regulators which establishes trust and automated compliance amongst various stakeholders in the ecosystem Enhances visibility, transparency and control over patient consent and ensures the security and consistency of the data Creates an unfalsifiable and verifiable fingerprint on the blockchain, with timestamps corresponding to consent statuses to provide an audit trail for reporting purposes Enables long term outcomes for the participating stakeholders such as, moving discovery into innovation in action, establishing a platform for a health data commons to unleash scientific research and discovery


      140 Character Summary:
      Going beyond proof of concepts. Pilot Project: Using Blockchain To Capture and Track Patient Consent for Genomics Research

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      OS23.03 - Lessons from the Field: Nova Scotia’s EMR Migration Deadline

      14:30 - 15:30  |  Author(s): Michael Kelly

      • Abstract

      Purpose/Objectives:
      In this presentation, Christine Grimm, Senior Executive Director, Investment and Decision Support with Nova Scotia’s Department of Health and Wellness (DHW), and Michael Kelly, EMR Migration Senior Project Manager (Mara Consulting) will provide the audience with successful strategies used to implement a large-scale change in Nova Scotia’s approach to community-based electronic medical record (EMR) systems. Christine and Michael will describe how Nova Scotia responded to a vendor-initiated sundown of the provincially hosted solution. While there were several other EMRs in use across the province, approximately 70% of primary care physicians and 29% of community-based specialists in the province had adopted the provincial system. Over a two- year period, they will have moved from a provincially hosted and supported EMR – Nightingale on Demand (NOD), to a model where providers will work with and be supported by one of two existing EMR vendors certified to operate in the province. Topics will include how to: · Develop a governance structure to support a large-scale migration in a unique, complex environment · Successfully migrate over 3000 health care providers and clinical staff from a provincially-hosted EMR to one of two private sector EMR products in a two-year period · Build positive relationships with stakeholders in a multifaceted dynamic landscape


      Methodology/Approach:
      Methodology/Approach: Nova Scotia’s approach to the migration includes the following: · Building a new governance structure within an evolving digital health landscape · Completing a pilot phase to ensure EMR vendors have the capacity to comply with provincial migration and data standards · Assembling a dedicated project team of existing NOD support resources and external consultants to streamline processes and implement a comprehensive change management strategy to encourage adoption · Providing financial incentives to compensate physicians and their staff for the time spent validating patient records and training on their new EMR


      Finding/Results:
      Findings/Results: · As of October 2018, over 50% of providers had committed to migrating to a new EMR.


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations: · Stakeholder engagement is key – understanding your stakeholders’ perspectives and what else is happening in the bigger context is important to understand when building project and engagement plans · Ensure the governance structure for the project and its ongoing success within broader digital landscape includes all of the key stakeholders – representation from health care providers, government, health authorities, vendors and the medical association


      140 Character Summary:
      Nova Scotia’s key success factors in a large-scale change to EMR solutions and governance in a unique and complex digital health landscape.

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      OS23.04 - Managed Service Model: Accessing Healthcare Through a Different Lens

      14:30 - 15:30  |  Author(s): Orpah McKenzie

      • Abstract

      Purpose/Objectives:
      The Managed Service Model (MSM) project provides access to timely and culturally safe health care services to First Nations communities throughout Ontario. Keewaytinook Okimakanak eHealth Telemedicine Services (KOeTS) and Ontario Telemedicine Network (OTN) invited remote First Nations communities across Ontario to participate in the MSM project. The project is facilitated using OTNinvite, a videoconferencing feature that allows individuals external to OTN’s network, to participate in real-time video visits.


      Methodology/Approach:
      OTN and KOeTS piloted a new model for First Nations communities with a simpler and more convenient alternative to purchasing a room-based videoconferencing system. First Nations on-reserve communities with adequate internet connectivity applied to receive a secure desktop computer with videoconferencing devices (high definition web camera and an echo cancelling speakerphone) so that they could participate in video consults. Consults are enabled through a private and secure web link. In March 2017, the participating First Nations communities attended an engagement session in Kenora where they received equipment and process training. In all, 40 OTNinvite systems were distributed to the participating communities. Community engagement is continuously provided by a Regional Telemedicine Navigator (RTN), located in Balmertown. The RTN identifies and schedules healthcare providers and services to meet the needs of the community members. Funding for this project is provided through Ontario’s First Nations Health Action Plan. While the project was designed to facilitate the connection between patients and providers using OTNinvite, the feature was also leveraged as a teaching device to familiarize providers with the project. This ensured that providers and communities were comfortable with the technology and processes prior to patient engagement.


      Finding/Results:
      Communities within the project identified a demand for healthcare in areas such as mental health, oncology, and diabetes. Mental health presents the area of most potential to expand utilization within the community health centres. Awareness and partnership development with mental health partners is ongoing. Based on the identified needs, engagement sessions were held with Misaway (diabetes management centre), Waypoint Centre, SickKids Telepsychiatry program, as well as St. Michael’s Hospital and Thunder Bay Regional oncology departments. To date, the project has discovered: -There exists a knowledge gap among providers who are unfamiliar with OTNinvite and accustomed to traditional room-based telemedicine services. -Despite the connectivity available throughout the province, First Nations communities are still challenged with bandwidth issues. -The communities selected for the MSM project had no prior experience with telemedicine and so require a higher level of support.


      Conclusion/Implications/Recommendations:
      -The RTN continues to mitigate the provider knowledge gap through ongoing outreach and working with Telemedicine Coordinators (TMC). To keep their skills sharp, TMCs are encouraged to participate in OTNinvite test calls. -Where bandwidth issues are not resolvable, systems will be re-allocated to other communities. -The frequency of contact and engagement with these communities will be increased to better support their participation in the project. By encouraging health care providers and patients to use MSM, First Nations communities have access to a low-cost alternative to purchasing a video clinical system which requires OTN membership, management, and staffing resources.


      140 Character Summary:
      The KOeTS and OTN lead MSM project provides timely access to culturally safe health care for harder-to-reach Ontario First Nations communities using OTNinvite.

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    OS24 - Co-design Clinician/Patient Interaction

    • Type: Oral Session
    • Track:
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      OS24.01 - Development of a Person-Centered Patient Portal Using Stakeholder Co-Design

      14:30 - 15:30  |  Author(s): John Kildea

      • Abstract

      Purpose/Objectives:
      To share our experience in designing and developing Opal (opalmedapps.com) a person-centered patient portal for cancer patients at the McGill University Health Centre following a participatory stakeholder co-design approach.


      Methodology/Approach:
      Our stakeholder co-design approach comprised six core elements: (1) equal co-leadership including a patient, (2) patient preference determination, (3) security, governance and legal input, (4) user evaluation and feedback, (5) continuous staff input, and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of data access, all medical data should be contextualized with explanatory content, and educational material should be personalized and timely.


      Finding/Results:
      As a person-centered patient portal, Opal provides patients with access to their electronic medical records (appointment schedules, lab results, clinical notes, etc) and empowers them with automatically-personalized educational material tailored to their disease and phase of treatment. For example, it can automatically advise a patient on how to prepare for an upcoming appointment, provide a map of where to go and facilitate appointment check-in. Further, on check-in, Opal can automatically send the patient a symptom questionnaire before seeing the doctor, allowing both the patient and the doctor to focus on the patient’s needs and providing the doctor (and future researchers) with valuable patient-reported outcomes data. Opal is a unique patient portal in five important respects: (1) it was designed and developed from inside the Quebec healthcare system using a stakeholder co-design approach including patients, clinicians and other stakeholders at all levels including co-leading the project; (2) it was designed to encourage patients to submit their symptoms in real-time and/or by engaging them while they wait for appointments; (3) it has been developed with the participation of a large number of medical physics and computer science students at McGill University, thereby exposing the next-generation of researchers to real-world healthcare problems; (4) it facilitates patient self-management by personalizing and contextualizing the provision of information to patients according to diagnosis and stage of treatment; and (5) it was built in a modular way to allow expansion to include data from any EMR in any medical discipline. Presently, the Opal team, in collaboration with St-Mary’s Hospital in Montreal and the Direction générale de cancérologie de Québec, are expanding the app’s use to five other cancer centres in Montreal (St-Mary’s Hospital, CHUM, Cité de la Santé-Laval, HMR and Ste-Justine). Funding is being provided by the Canadian Partnership Against Cancer. The expansion will ultimately allow Opal to become multi-institutional such that patients who receive care at more than one of the participating centres will see all their medical data from each centre seamlessly integrated.


      Conclusion/Implications/Recommendations:
      Inclusion of all stakeholders in the design and development of patient-facing software can help ensure person-centeredness, clinician/patient acceptability, and informatics feasibility. That Opal was developed from the ground up inside a Quebec healthcare institution and is now used by patients in a pilot release is an initial measure of the success of the design and development approach followed. Further measures will be evaluated as the pilot project matures.


      140 Character Summary:
      This presentation is about Opal, a person-centered patient portal smartphone app developed in a Quebec hospital using a stakeholder co-design approach.

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      OS24.02 - A Complex Virtual Care Hub Supporting Perinatal Mental Health

      14:30 - 15:30  |  Author(s): Ian Chalmers

      • Abstract

      Purpose/Objectives:
      Leveraging Design Research and Service Design to better understand the perinatal mental health system (service/delivery/treatment) and create a digital solution offering patients and stakeholders virtual assessment, resources, and treatment.


      Methodology/Approach:
      Our user-centered design approach is informed by primary and secondary research so designers can uncover and act on opportunities to improve experiences and ensure project decisions are based on real people, their real-life scenarios and lived experience. Discovery began with a project/stakeholder team of leading Perinatal Mental Health Psychiatrists in a kick-off work-session. We identified three main users—Patients, Providers, Partners—and developed personas detailing their usage scenarios and context of engagement; who is directly impacted by the challenge/problem we’re trying to solve for; and who is experiencing the most challenges. We conducted a thorough audit of the current marketplace - the mental health system, strategic action plans (federal, provincial), academic studies/research, and any other existing services, tools, and resources that users might be used to and/or allow us to identify areas of opportunity/innovation. User interviews were conducted to better understand lived experiences with mental health in pregnancy (before/during/after), the home support system, and gain key insights of the perinatal journey. Patients: women (range of racial/ethnic/socioeconomic backgrounds) Providers: specialists (obstetrics, gynecology, psychiatry), primary care, nursing Spouses: typically men


      Finding/Results:
      Research findings were translated into a journey map identifying key users, where they are in the continuum of self-awareness; level of care/service; and ranked to prioritize who’s directly impacted. It provided a vivid but structured visualization, telling a story based on experiences while conveying all influential factors, the accompanying emotions, and detailing current/potential service interactions and touch-points. Having identified key user issues/challenges, we developed an early concept for a comprehensive perinatal mental health Virtual Care Hub that supports the needs of end-users and the researchers whose primary goal is identifying, effectively supporting and treating people with mental health concerns at all stages of pregnancy and pre and postpartum. This complex virtual care hub is comprised of: > six main components - the building blocks to improving access to services/treatments > built-in AI and data collection > a virtual care team > end-to-end user feedback gathering for ongoing evaluation/testing.


      Conclusion/Implications/Recommendations:
      Together, these 4 design outputs were the proof-of-concept and core piece of the business case needed to validate the idea and secure future funding to fully design, test & build this Virtual Care Hub. Patient Personas & Journey Map of three patients with acute, chronic, atypical signs/symptoms of mental illness, constructed from their own perspectives. Strategic Design/Product Roadmap highlighting key communication elements that clearly articulate the vision of the network concept, a detailed requirements document, and how this will function on a design and operational level. Virtual Care Hub Concept visualization articulating key users of the health system, providers delivering care, family units, and the direction/flow for use of the hub. Preliminary Wireframes/Mock-ups demonstrating how integration of the various features/functionality address and support the severity stages/need states for perinatal mental illness.


      140 Character Summary:
      A Service Design approach to better understand perinatal mental health and improve access to assessment, resources and treatment for patients and stakeholders.

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      OS24.03 - Implementing Mobile Technology in Primary Care: The Epro Tool

      14:30 - 15:30  |  Author(s): Carolyn Steele Gray

      • Abstract

      Purpose/Objectives:
      People with multi-morbidity and complex care needs face some of the greatest challenges of any patient population. These individuals struggle to manage their many health conditions, which may be exacerbated by psychological and social challenges. Primary care providers working in integrated interdisciplinary integrated teams also find it difficult to manage these patients’ multiple discordant conditions and symptoms, and their often complex social challenges. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges through supporting goal-oriented primary care delivery. Using the tool patients and providers collaboratively develop health care goals on a portal which is linked to a mobile application to help patients and providers monitor and track progress. Multiple providers on the patients care team can view patient goals and work together to care for patients. This presentation describes the technology, development approach, and findings from the exploratory trial.


      Methodology/Approach:
      User-centered co-design principles were integrated with interpretive descriptive qualitative research methods to capture user priorities, experiences, feedback and expectations through 3 phases of development and usability testing. Development was informed by patient/family and provider focus groups, and interviews to develop an initial prototype which was then iteratively modified through user-working groups. Prior to full-scale evaluation (currently underway) we conducted a 4-month multi-method exploratory trial to uncover contexts, mechanisms and relevant outcomes prior to full-scale evaluation. The exploratory trial took place in two interdisciplinary primary care practices in Toronto, Ontario from 2015-2016.


      Finding/Results:
      The iterative user-centred design approach, informed by interpretive description qualitative methods resulted in several changes in direction for the technology. Critically was the need to ensure both usability and meaningfulness of the technology which was achieved through the multi-phased approach which engaged over a dozen patients, caregivers, and providers. Eight providers and 16 patients (7-control, 9-intervention) participated in the exploratory trial, and while little changes was seen in primary quantitative outcomes of quality of life (captured using the AQoL-4D) and patient activations (captured using the PAM), qualitative data revealed important impacts at the patient and provider levels. Patients reported meeting and exceeding their goals of care (which included physical, social and mental health related goals), and providers reported an improved understanding and goal-oriented care processes. Perhaps most notably, usability concerns around efficiency (particularly around fit to provider workflows) were overshadowed by tool effectiveness. Despite the challenges of adopting the technology into primary care practice, patients desire to use the tool and their positive outcomes meant providers were more willing to modify behavior to adopt the technology.


      Conclusion/Implications/Recommendations:
      : While mobile health technologies are not yet pervasive in the primary care space, the experiences in developing, implementing and testing the ePRO tool are instructive. Developing tools that resonate with what is important to end users, in this case patients and primary care providers, can mean a greater willingness to change processes and behaviours to adopt innovative technologies. Overcoming that first hurdle can lead to greater adoption and subsequent improved outcomes at the patient, provider and system level.


      140 Character Summary:
      Exploring the development, implementation of testing of ePRO: a mobile health tool to enable goal-oriented care in primary care settings.

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      OS24.04 - Application of Virtual Care Models into Palliative Care

      14:30 - 15:30  |  Author(s): Megan Nguyen

      • Abstract

      Purpose/Objectives:
      An aging population, rising chronic disease prevalence, and desire for a quality end-of-life are increasing demand for hospice and palliative care services throughout Ontario. Virtual care solutions have the potential to reduce unnecessary travel for both patients and healthcare providers and decrease the use of costly acute health services and hospital admissions while simultaneously fulfilling the growing desire to die in-home. The purpose of this project was to identify major gaps in palliative care in Ontario that potentially could be addressed using digital health technologies. The overarching goal was to inform how a virtual care model could be implemented and sustainably scaled and spread to maximize its value at the health systems-, patient- and provider-levels. Our investigation was embedded within the context of two virtual palliative demonstration projects in two Ontario regions. The technology consisted of remote symptom monitoring, videoconferencing, and electronic medical management for patients receiving in-home palliative care.


      Methodology/Approach:
      Eighteen qualitative, semi-structured interviews were conducted with administrative stakeholders, policymakers, healthcare providers, and patients involved in the demonstration projects. Participants were identified using a purposive and snowball sampling technique whereby the demonstration project leads provided eligible contacts for interviewing. Interview questions were open-ended and exploratory to gain insight into participants’ experiences with the technology with respect to its features, aspects of implementation into existing models of care, and suggestions for improvement. A qualitative content analysis was conducted to analyze participants’ feedback and identify major themes.


      Finding/Results:
      Our interviews confirmed major gaps in palliative care including inadequate access to services, particularly among rural areas and non-malignant patients, lack of early identification of patients, and lack of communication and integration within patients’ entire circle of care. Based on the interviews, two technology features were identified as high-value: videoconferencing and remote-monitoring. Videoconferencing supports access to and efficiency of palliative care by enabling providers to interact with patients remotely. Remote monitoring (e.g. self-monitoring tools to virtually track pain and symptoms) was found to promote patient engagement in self-management of their care while also enabling the care team to remotely track and respond to important changes in patients’ health status. The evaluation highlighted critical factors for the implementation, scale, and spread of virtual palliative care including: the identification of target users that can benefit more; engagement of end-users in the design of technology; establishing a clinical model that fits into existing workflows; supporting the integration of care; determining a clear value proposition for end-users; incorporating champion leaders to drive adoption of technology onsite; and ensuring the ease-of-use and feasibility of the technology.


      Conclusion/Implications/Recommendations:
      Though the pilot project surfaced many challenges regarding implementation, virtual care models in palliative care could address scarce resources, improve access to services, and support the efficiency and quality of palliative care delivery. Our study provides a list of technological features with high potential and recommendations on implementation strategies that can increase adoption.


      140 Character Summary:
      The project aimed to inform how virtual care can support palliative care in Ontario in the context of two demonstration initiatives.