• 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.

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    Presentation Date(s):
    • May 26 - 29, 2019
    • Total Presentations: 245
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    EP07 - Application / Implementation 1

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 5
    • Type: ePoster Session
    • Track:
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      EP07.01 - Emergency Department Discrepant Radiology Workflow

      13:15 - 14:15  |  Author(s): Daniel Rosenfield

      • Abstract

      Purpose/Objectives:
      Discrepant diagnostic imaging reading between radiologists and emergency department (ED) physicians is a cause of morbidity in the pediatric population. Most EDs order dozens of diagnostic imaging studies for review per day and clinical actions are typically enacted based on initial ED physician review with subsequent radiology oversight (often hours to days later). Individual ED physicians are medicolegally responsible for following up any test they order (regardless of when the results are available), which is often not practical. Typically therefore a system of shared responsibility between ED providers exists to support following up of radiology reports. Breakdown in this complicated workflow therefore can result in missed test results and harm to the patient. We describe a technology-enabled system to assure that no clinically important findings are missed, while acknowledging the reality that the individual clinician will rarely be able to follow up all of their own test results.


      Methodology/Approach:
      Working closely with radiologists, ED providers, EMR analysts and others, we created, refined and finalized an electronic workflow to identify discrepant results and assure their followup. This was subsequently piloted, tested and utilized at go-live using an enterprise-wide EMR.


      Finding/Results:
      After any plain film x-ray is completed on an ED patient, an “interpret” button appears in the EMR next to the study. The ED physician is forced to input a preliminary interpretation prior to being allowed to discharge the patient. Subsequently, the radiologist will see this interpretation when they over-read the film. If their interpretation is discrepant, an electronic report is generated into a pooled list, which is followed up the next day for all non-critical results. Discrepant results deemed critical by the radiologist are still communicated directly by phone to an ED MD. Specific providers are assigned daily to review the list of discrepant results. Once the result has been identified and rectified (ie. by calling the family, arranging for referrals, etc), the discrepancy is electronically ‘resolved’, and it drops out of the report list. Films that are not discrepant (ie. the ED physician and radiologist agree), normal films, and films that contain information irrelevant to the chief complaint are not put in the discrepancy workflow. Using this workflow, approximately 10-15 discrepant films are generated per day. This workflow has eliminated the possibility that discrepant test results will ‘fall through the cracks’, improving patient care and minimizing medico-legal risk to ED clinicians. Ongoing auditing of discrepancy reports occurs to ensure data integrity.


      Conclusion/Implications/Recommendations:
      All physicians in Canada must follow up the results of any test they order. This is not always practical in the ED however, as many radiological studies are not formally reported until well after an individual ED physicians shift. As such, it is impractical to require ED physicians to follow these tests. A technology-enabled solution is the ‘discrepancy’ workflow described, enabled by an enterprise-wide EMR. This system assures that the radiologist is aware of the ED physician’s interpretation, and allows ED providers to followup any necessary discrepancies, resulting in improved patient care and risk mitigation.


      140 Character Summary:
      We describe an electronic method to track and address late arriving or discrepant radiology results in ED patients when the ordering clinician is not available.

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      EP07.02 - Canary Clinical Alerting: Infinite Possibilities

      13:15 - 14:15  |  Author(s): Laurie Macdougall Sookraj

      • Abstract

      Purpose/Objectives:
      Teams at University Health Network have successfully implemented a highly configurable system for generating notifications about clinical events. The purpose of this talk is to describe the solution, technology stack, and lessons learned, to highlight the benefits of the solution and to share knowledge about the possibilities for creating such a system at other sites.


      Methodology/Approach:
      The solution went through several iterations from its initial release to the current version, each time restructuring how it was put together. Through monitoring usage by clinical users and how they interact with the system and feedback collected from clinicians, as well as monitoring the type of support requests we got from users, we have been moving towards a better system each time. We've grown from a small group of beta users to notifications that are used across the entire organization for both clinicians and patients, and have plans to expand out customized notifications to the entire organization as well. This talk follows that journey from initial go live to future projections.


      Finding/Results:
      Canary is a clinical alerting and notifications system built at University Health Network. It receives HL7 feeds from multiple source systems, looks at every message to determine if it should trigger a notification, and if so, records it and sends it out. This system is incredibly powerful, because, firstly, it triggers in real time, so there's no lag between the event being documented and the notification going out, secondly, it can reach into other systems to get additional context - if you want to know the value of a test result from a year ago, or what type of surgery was done, but that's not in the message, we can go get it, and finally, the possibilities for configuring a rule are literally infinite, any combination of factors that you can imagine can be used. Here are some of the current uses for the system:

      1) UHN Patient Portal subscribers receive email alerts on any new or updated appointment booking at UHN, as well as real-time or daily batch emails about new or updated results available.

      2) Infection Control Practitioners are notified any time a result comes back MRSA positive, or a previously MRSA-positive patient returns to the hospital, so they can take action to isolate the patient. Notifications are directed to the appropriate infection control practitioner based on which area of the hospital they are responsible for monitoring.

      3) Project RED (Health Links) receives a notification for any patient that repeatedly comes in to the ED and has no family physician on record, to follow up with the patient about getting appropriate care.


      Conclusion/Implications/Recommendations:
      University Health Network has developed a very powerful system for configurable notifications based on clinical events. We think this method of watching HL7 feeds for specific trigger events is something that could be applied at any hospital, although the actual implementation at this time is specific to UHN systems. Delivering the right message to the right person at the right time is a step towards delivering the best possible patient care.


      140 Character Summary:
      Canary is a notifications system built at University Health Network. It allows infinite possibilities for alerting physicians and patients about clinical events.

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      EP07.03 - Case Study:  Clinical Standardization for a Regional Clinical Information System

      13:15 - 14:15  |  Author(s): Elizabeth Nemeth

      • Abstract

      Purpose/Objectives:
      Nursing Leaders and client providers have an opportunity to improve the quality of care provided by reducing unnecessary variation. Current evidence and expert consensus can be used to develop a standardized model that can be used by all members of a clinical team. Process management and continuous quality improvement can be applied to measure process, health, and patient satisfaction outcomes (Lavelle, Schast, & Keren, 2015). However, there still seems to be a gap in the adoption of standards and best practices. Clinical standardization and the interchange of information can facilitate early diagnosis, variations in treatment, decrease re-admissions and improve operational efficiency. Best practice and evidence in the development of standards results in improved care, accountability, reporting/bench-marking and interoperability of information.


      Methodology/Approach:
      When investing in a regional HIS, there is a greater necessity to support clinical adoption involving nursing leaders and client providers in the development of standardized, evidence based tools. There are a number of objectives for HIS implementation such as: (1) to increase the quality and efficiency of care; (2) to reduce the operating costs of clinical services; (3) to reduce the administrative costs of running the healthcare system; and (4) to enable entirely new models of healthcare delivery. As a result, a level of standardization is required and is pivotal for the above objectives to be realized. Rocha & Rocha (2014), describe the added value created by the adoption of nursing practice standards. As well, Adler-Milstein, Ronchi, Cohen, Winn, & Jha, (2014) highlight the value of comparable data between countries stating the lack of consistent terminology and approach has made cross-national comparisons and learning difficult.


      Finding/Results:
      Through a case study, which led 24 hospitals through clinical standardization, the authors will describe the pivotal role nursing leaders and client providers have in HIS implementation, the trials and tribulations of establishing effective governance structures and decision making frameworks required to support high levels of clinical standardization; tactics to support engagement; and meaningful approaches in the development and implementation of evidence based standardized content.


      Conclusion/Implications/Recommendations:
      Nursing Leaders and client providers need to have understanding of their role in design and implementation of HIS and the impact of embedding best practice and clinical standardization in electronic documentation tools, templates and interventions. Outcome of Presentation 1. Understanding of the role of nursing leaders and client providers in peer group review of best practice and development of clinical standardization of nursing documentation tools/templates and interventions. 2. Knowledge and awareness related to governance structures and decision making frameworks to support a standardization. 3. Sharing lessons learned in implementing clinical standards and impact on design and build of a regional HIS.


      140 Character Summary:
      Nursing Leaders and client providers have an opportunity to improve the quality of care provided by reducing unnecessary variation in clinical documentation.

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      EP07.04 - Operating Room Workflow and New Electronic Health Record – Simulation-Based Study

      13:15 - 14:15  |  Author(s): Elaine Ng

      • Abstract

      Purpose/Objectives:
      Background The transition from a hybrid, yet predominantly paper-based system to an integrated electronic health record (EHR) system in the operating room (OR) can be challenging, and the impact on workflows may not be fully understood or elucidated. Simulation-based assessments in the workplace allow users to perform real world tasks and workflows in a controlled, reproducible and observable environment with no impact to patients. Objectives To determine the impact on our current workflows in the OR with the new EHR using simulation.


      Methodology/Approach:
      Areas of concerns for OR workflow were identified by key stakeholders in the operating room. Key informants representative of the interprofessional healthcare workers were invited to participate in simulated scenarios that were created based on real life cases. The scenarios were conducted in the real work environment. Results were collected by mixed method approach including observations, self assessments including the NASA-TLX index and qualitative interviews, results of which were analyzed to generate themes.


      Finding/Results:
      Two main areas were identified for simulation study: 1. Key informants from nursing and anesthesia participated in simulation studies in a busy OR area, 2. trainees in anesthesiology were observed in a simulated OR. In both areas, the EHR imposed a high cognitive load resulting in divided attention and near misses even though the participants did not report a high task load index. Simulation was considered a safe place to reveal our gaps in workflow familiarity and for learning with a coach. As a result of the simulation studies, a new workflow was recommended for the busy OR area and a simulation-based orientation process is being introduced for trainees.


      Conclusion/Implications/Recommendations:
      Simulation provides a safe environment for assessment of workflow and fluency with EHR which revealed areas of concern. This in turn allowed us to promote a new workflow for safe patient care with introduction of EHR. Orientation and familiarization with the new EHR and workflow is ideally obtained by repetitive practice with a coach.


      140 Character Summary:
      Simulation-based assessments in the workplace informed the impact of the transition to an integrated electronic health record system in the operating room.

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      EP07.05 - Building a High Performing Epic Team with Local Talent

      13:15 - 14:15  |  Author(s): Sarah Muttitt, Diane Salois-Swallow, Robert Slepin

      • Abstract

      Purpose/Objectives:
      During 2015 and 2016, both Mackenzie Health and The Hospital for Sick Children (SickKids) made independent decisions to migrate their EHR platforms over to Epic. These were the first two enterprise-wide Epic implementations in Canada, and both needed support locating certified Epic talent. Upon deciding on Epic, the health systems were immediately faced with a series of challenges to fill Epic’s recommended staffing levels for the implementation team, and meet their targeted Epic training dates. Both health systems were interested in utilizing local talent to meet the recommended staffing levels. Our panelists will discuss their experiences and lessons learned with rapid recruitment, hiring, on-boarding and training talent. The panelists will outline how both Mackenzie and SickKids were concerned about the process for selecting the right talent to ensure they assembled a high-performing teams. The Panelists will outline how they needed to quickly and efficiently develop a cost effective and sustainable certified Epic workforce. Collectively the two health systems needed to identify over 70 Epic certified analysts from the local labor market – and this all needed to be completed within a tight time period.


      Methodology/Approach:
      Both hospitals utilized a screening and baselining process to assess the performance characteristics of their internal talent. The recruitment delivery team conducted baselining interviews of internal employees to measure the aptitudes, behaviors, competencies and desires of the top-performing talent within Mackenzie Health and SickKids. From there, they utilized the baseline data to screen local talent interested in joining their Epic team. The recruiters used this data to interview and select the highest performing external talent to join the Epic implementation.


      Finding/Results:
      Mackenzie Health: Internal Mackenzie employees placed onto the project: 49 External local candidates placed onto the project: 44 External local candidates converted to full time: 39 SickKids: Internal Sickkids employees placed onto the project: 49 External local candidates placed onto the project: 36 External local candidates converted to full time: 31


      Conclusion/Implications/Recommendations:
      The Epic implementation teams at both Mackenzie Health and SickKids, comprised mostly of local candidates, brought the hospitals to an on-time and within-budget go-live. Over 70 local jobs were created between the 2 health systems. Furthermore, both organizations avoided potentially millions of dollars in expenses from using an overabundance of experienced, U.S.-based Epic consultants. With appropriate planning and forecasting, Epic health systems in need of certified Epic talent can consider building their own local workforce of certified talent. Epic’s implementation methodology speaks to training the end-user and avoid using high priced external consultants. Using a local talent pool builds a long term strategy that is fiscally responsible, creates local jobs, allows the health system to convert the external talent into full-time status, as needed.


      140 Character Summary:
      Enhancing the Epic implementation methodology while creating local jobs: Building a high performing Epic team with local talent

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      EP07.06 - Integrating Operational IT Service Desk at Go-live

      13:15 - 14:15  |  Author(s): Nour Alkazaz

      • Abstract

      Purpose/Objectives:
      SickKids implemented the Epic EHR on June 2nd, 2018. We planned for a 24/7 technical Command Centre for a period of 4-weeks post-live. The goal was to integrate the Operational IT Service Desk as part of the Command Centre issue triage process to support transition from go-live to operational issue logging processes.


      Methodology/Approach:
      We adopted the MyTSM service management tool and worked with the Service Desk team to create Epic-focused consoles and categorization structures. Members of the Service Desk team attended two training workshops. A decision support aide was developed to support appropriate issue triage, and underwent iterative improvements during go-live.


      Finding/Results:
      Integrating the Operational IT Service Desk as part of the go-live command centre offered a first-hand, learning opportunity for the Service Desk agents that is invaluable. Lessons learned from the integration helped inform the transition from command centre mode to operations. Next steps are to further expand the Service Desk team’s knowledge and understanding of the Epic EHR, and enable the Service Desk agents to offer some level of Tier 1 support.


      Conclusion/Implications/Recommendations:
      Integrating the SickKids Operational IT Service Desk with our Command Centre processes offered invaluable learning opportunity to the Service Desk team and enabled a smooth transition from Command Centre mode to day-to-day operations.


      140 Character Summary:
      Leveraging your Operational IT Service Desk offers learning opporutnities and benefits in transitioning from Command Centre to operations post EHR go-live.

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    EP08 - Application / Implementation 2

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Area 6
    • Type: ePoster Session
    • Track:
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      EP08.01 - MyDovetale – Bringing Care Providers Closer to the Patient’s Story

      13:15 - 14:15  |  Author(s): Tara Coxon

      • Abstract

      Purpose/Objectives:
      In 2018 St. Joseph’s Healthcare Hamilton (SHH) introduced a patient portal (app and web based) to its patients and care providers in the mental health and transplant programs. MyDovetale aimed to: •Provide patients with the ability to self-schedule, self-monitor and enhance self-care •Show a change in reported outcomes and experiences •Demonstrate innovation in the provision of care and the interaction between care teams and patient stories mydovetale.png


      Methodology/Approach:
      MyDovetale provides users with the following functionality: •Patient/ proxy access •Secure Messaging •Scheduling workflows •Access to health information (including lab results, medications, questionnaires and active health issues) A benefits evaluation was conducted, including the administration of a survey. The evaluation assessed the impact of MyDovetale on quality, productivity and access.


      Finding/Results:
      Quality Benefits: 1. Self-Scheduling: •Patients found the ability to request appointments beneficial and easy 2. Self-Management & Self-Efficacy •88% of patients feel that MyDovetale allows them to better self-manage their care •Care Team Providers agree that MyDovetale improves the quality of care provided Productivity Benefits: 3. Patient Travel Time & Costs •Some patients expressed that they saved 2 – 3 hours of travel time and $40+ in expenses 4. Participation •Care Team Members agree that MyDovetale enhances their ability to coordinate continuity of care •All patients agree that MyDovetale makes accessing care more convenient Access Benefits: 5. Future Functionality •Patients expressed interest in the addition of e-visits, prescription refill requests and direct scheduling 6. Overall Satisfaction •All patients are satisfied with MyDovetale •75% of care providers agree that MyDovetale makes providing care more convenient Patient Qualitative Responses •“Messaging to my providers is great and so is the access to appointments” •"Love the lab results feature as I am able to review results in between appointments. The med listing is very useful"


      Conclusion/Implications/Recommendations:
      Time Savings & Ease of Use – Clinicians can send questionnaires, such as the PHQ-9, to their patients, and have their patients complete them ahead of their appointments. The results are viewable electronically from within the SJHH EMR upon completion. Patient Efficacy & Self-Monitoring – Serving the patient community is enhanced further with notifications that are sent to the patients for upcoming appointments, new lab results and for new messages from their care team. Patient Safety – Providing a list of current medications is beneficial, and provides practical patient safety benefits. For example, a patient had confusion over medications at a pharmacy and prevented a medication prescription fill error by sharing their MyDovetale information with the pharmacist for follow-up. SJHH is working to expand the implementation of MyDovetale, and to expand its functionality withn features like video visits.


      140 Character Summary:
      MyDovetale (St. Joseph's Patient Portal) was implemented to enhance the patient-provider relationship, empower patients, and support care between visits.

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      EP08.02 - Patients’ Perception of the Electronic Referral Process and Email Notification

      13:15 - 14:15  |  Author(s): Lori-Anne Huebner

      • Abstract

      Purpose/Objectives:
      Patient-centred care (PCC) is currently identified as one of the essential elements of an efficient healthcare model. PCC warrants patients’ easy access to healthcare services, short wait-time to access care, and timely feedback on their referral processes and outcomes. The System Coordinated Access program (SCA) supports the development and deployment of an innovative eReferral solution, which aims to increase efficiency and improve patients’ access to care. The use of the solution not only streamlines the referral process for healthcare providers (HCPs) and improves their communication, it also offers an enhanced experience for patients who can now receive email notifications on the status of their referral and communicate directly through Self-Referral. This presentation will focus on outlining patients’ perception of the electronic referral process and email notification system.


      Methodology/Approach:
      The SCA program assessed patients’ experiences with the eReferral process and notification system using an ongoing online survey questionnaire. Beginning in November 2017, all patients of HCPs using the system who provided their email address received an invitation to complete a satisfaction survey embedded within the confirmation email of the booked appointment. Note: Only patients who provide their email address will receive email notifications of their booked appointment through the solution.


      Finding/Results:
      To date, more than 10,000 patients were referred for different health services using the eReferral solution. The mean age of patients referred electronically was 56.7 (±24.8) years, 63% were females and 37% were males. Currently, 80% of the referred patients have a booked appointment. Of those, 33% have received email notification of their booked appointment. Of the patients who received email notification of their booked appointment, 355 have completed the patient satisfaction survey (response rate 10%). Overall Satisfaction Overall, 88% were satisfied/very satisfied with their experience using the electronic referral process. Moreover, 94% agreed/strongly agreed that the electronic referral process was easy to follow. Compared to their past referral experiences, 82% of patients agreed/strongly agreed that they felt more informed throughout this electronic referral experience and that they were able to get the needed care within a reasonable time. Furthermore, 95% of patients agreed/strongly agreed that receiving a confirmation email about their booked appointment improved their experience with the referral process. Patients’ overall qualitative themes of the critical successes of the electronic referral system emerged from the survey’s open-ended questions and were categorized as follows: (a) electronic system is quick and rapid, (b) system is efficient and simple, and (c) empowers patients.


      Conclusion/Implications/Recommendations:
      Evidence from our survey shows that the positive effect of the eReferral system on patients’ experiences with the referral process is linked to their ability to track their referral for routine healthcare service and receive alerts and timely feedback from their HCPs. Using patients’ feedback, the program aims to improve the implementation of technology in healthcare, ultimately enhancing efficiency and access to care.


      140 Character Summary:
      The SCA program supports a convenient, innovative eReferral solution. It empowers patients and improves their experience with access to care.

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      EP08.03 - Engaging Patients in Design and Development of Online Patient Education

      13:15 - 14:15  |  Author(s): Ilana Bayer

      • Abstract

      Purpose/Objectives:
      Design thinking provides a structured approach that can enable educators to empathize with end-users (i.e., patients) to uncover challenges and explore innovative solutions to best meet the needs of patients. This approach was used to guide the development of an online education course on medicinal cannabis for patients with non-chronic cancer pain. Patients were engaged in the design, development and testing processes of the online course.


      Methodology/Approach:
      The core stages of the design thinking approach are: empathize, define, ideate, prototype and test. In the empathize stage, data was gathered from a variety of sources including semi-structured interviews, patient surveys, physician and subject matter experts surveys, and course evaluations from in-person classes. The data was used to conceptualize the end-users (i.e., target patients who will take the course) through “empathy” and “as-is” scenario maps. In the define stage, “How might we” questions were developed based on the themes that emerged from the maps allowing the identification of key challenges and opportunities. In the ideate stage, innovative ideas to address challenges were generated and prioritized based on impact and feasibility. Prototypes were then developed and tested. During the development process, patients engaged through a focus group, provided input on the prototypes as well as the course goals, key messaging and content areas. The feedback from the focus group session was then used to inform the final prototypes that will be incorporated into the online course.


      Finding/Results:
      The collected data was used to create empathy maps that represented end-users. Data from the empathy maps was then used to develop “as-is” scenario maps which illustrated examples of what the end-user may do, say, think and feel during different stages of the scenarios (e.g., patient taking an online course, patient talking to their healthcare provider about medicinal cannabis, patient taking medicinal cannabis for non-chronic cancer pain, etc.). “How might we…?” questions (e.g., How might we engage patients in a meaningful way?) were generated based on themes that emerged from the “as-is” scenario maps. Two key prototypes that were developed included patient characters that represented end-users (based on the empathy maps) and e-learning modules. Through patient engagement the course goals, key messages, key patient questions and key content areas were refined and additional resources (e.g., patient handouts) and components (e.g., FAQ section and anonymous online forum) were identified. Patient input also led to refinement on how the characters would be used within the e-learning modules to engage end-users in an authentic and relevant learning experience. Qualitative feedback from the focus group participants was also gathered providing process evaluation information.


      Conclusion/Implications/Recommendations:
      A design thinking approach can lead to the development of an innovative patient education program that can best meet the needs of patients. Engaging patients through the use of this approach provides the opportunity for the patient voice to be incorporated into patient education initiatives. Process evaluation information provides insight into patients’ experiences in the process and can be used to improve future patient engagement activities.


      140 Character Summary:
      Engaging patients through the use of a design thinking approach can lead to the development of innovative patient education that can best meet the needs of patients.

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      EP08.04 - Using Advanced Algorithms to Identify Physician Time Wastage

      13:15 - 14:15  |  Author(s): Karim Keshavjee

      • Abstract

      Purpose/Objectives:
      Canada has a shortage of physicians. Yet, available physicians see all patients who wish to be seen, even if they could be served without a visit. This creates wasted visits. There are many options for providing patients with on-line and telehealth services, yet patients continue to be seen in person. We aimed to develop a system that will identify low risk patients that can be served safely without an in-person visit, assisting office staff in triaging high risk patients to be seen in the clinic and low risk patients to be provided virtual services.


      Methodology/Approach:
      We engaged key stakeholders to identify types of waste that are currently experienced. One idea was to provide virtual services to low risk patients. Stakeholders identified 5 characteristics that make an individual low risk:


      Finding/Results:
      Stakeholders identified the following characteristics: 1) Low (or intermediate) risk for future adverse events using a risk prediction algorithm, 2) on a low risk medication (e.g., not on opioids), 3) seen in clinic in the last 6 months, 4) If intermediate risk, must be younger than 65 and 5) physiological parameters are well-controlled (e.g., normal blood pressure). Using the criteria identified, we have been able to identify a substantial number of low risk patients who can get their medications safely renewed without seeing the physician. This increases patient convenience and satisfaction while increasing physician time to see higher risk patients. We were able to identify approximately 200 patients in a typical 1800 physician office who would be eligible for this service.


      Conclusion/Implications/Recommendations:
      Identifying low risk patients is one way of identifying patients who do not need to see their doctor for a repeat prescription. This saves physician time and opens up appointments that can be used for higher risk patients. Several provinces do compensate physicians for seeing higher risk patients who may take up more time than lower risk patients, which makes this approach feasible for immediate implementation.


      140 Character Summary:
      Physicians can see more higher risk patients with new algorithms, increasing access and quality at the same time.

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      EP08.05 - Establishing Outcome Driven Care at CAMH: Assessment Standardization and Governance

      13:15 - 14:15  |  Author(s): Anindita Bose

      • Abstract

      Purpose/Objectives:
      The Centre for Mental Health and Addiction (CAMH) is working to standardize the reporting of patient data to better facilitate the characterization of our patient population and coordinate services to meet our population’s needs. This initiative includes three phases: 1) gathering an inventory of current clinical assessments, 2) standardization and implementation of core assessments, and 3) establishment of a governance structure to ensuring oversight and appropriate selection of tools for future use. Our objectives are: - Equitable and accurate alignment of service delivery - The ability to measure what works and identify areas of improvement - Release time to care through assessment rationalization


      Methodology/Approach:
      In order to conduct a thorough review of assessments, meetings were organized based by clinical domain (e.g. anxiety, depression, etc.) and guided by an evaluative framework (Table 1). The framework categories were chosen to reflect the values of standardizing validated assessments within the organization and to showcase the efficiency and alignment of assessment with the organization’s goals and objectives. A Standardization of Care Committee (SCC) was established with the authority to steer strategic direction by ensuring alignment with CAMH’s strategic plan and oversee the standardization of clinical tools across all department at CAMH. For the implementation phase, the SCC will act as champions to support the project by communicating decisions to clinical directors and actively engage the Electronic Health Records (EHR) technical team as needed. Table 1: The Evaluative Framework consists of four subcategories and 27 questions pertaining to evidence-based literature. Below is a sample of some of the questions. Criteria Sample Considerations Psychometric Properties Is the tool established, peer-reviewed for diagnostic purposes? Ease of Use What is the structure of the questions and how are scores calculated? Accessibility Are there alternative methods of completion? Operationally Aligned Is the data easily extractable to support organizational and clinical decisions?


      Finding/Results:
      To date, the project team has completed a current state analysis of clinical assessments used on inpatient and outpatient units. Results revealed that 567 unique assessments are in use across the hospital.


      Conclusion/Implications/Recommendations:
      The SCC has completed a review of 7 domains and selected validated assessments to be used across CAMH (Table 2). The first assessment to be implemented across CAMH WHODAS 2.0. From an analytics perspective, the data from WHODAS 2.0 can be used to pull outcomes and assess our population. Table 2: A list of the 7 selected assessments to be implemented across CAMH. Category Assessment Anxiety GAD-7 Depression PHQ-9 Alcohol Use AUDIT Psychosis BPRS Function WHODAS 2.0 Cognitive MOCA Pain BPI-Short


      140 Character Summary:
      CAMH is working to standardize and implement a core assessment set to improve patient outcomes and develop Canada’s first mental health Learning Healthcare System.

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      EP08.06 - Interoperability by Design: Selecting Integrators that Deliver Value

      13:15 - 14:15  |  Author(s): Matthew Maennling

      • Abstract

      Purpose/Objectives:
      This presentation will outline three key capabilities that enable vendors to advance interoperability in a healthcare organization, and thereby deliver clinical and financial value to their clients. Today’s vendors must look beyond their own technology and services, and understand how they can help healthcare organizations integrate their solutions in the ecosystem within which they will operate. This means: 1. Ability to integrate their solutions to other solutions through private or public cloud infrastructure 2. Enabling APIs and supporting modern data standards and interchange 3. Ensuring a patient focus in all solution offerings


      Methodology/Approach:
      It is no longer sufficient to look at procuring a new digital health solution as a stand-alone transaction, but rather it is important to maintain a sustained partnership to ensure the desired value and benefits are accrued. To achieve these benefits and value outcomes, healthcare organizations need to evaluate vendors’ capabilities in three domains: 1. SaaS / Cloud / Managed Services capabilities 2. Support for modern and emerging data standards and access to open APIs 3. Patient-centric focus and design


      Finding/Results:
      When vendors adopt interoperability by design, there are three key components to achieve meaningful outcomes: 1. Managed Services i.e. SaaS in private or public cloud space. Benefits include: - Provides interoperability between systems - Eliminates or reduces expensive hardware and maintenance of on premises systems - Takes on full responsibility for a customer's integration solution - Establishes a competitive pricing model - Enables highly available deployment and service recovering from failures automatically while minimizing downtime 2. Open APIs and modern data standards, including FHIR, HL7, and support for clinical terminology services. Vendors that provide open access to data models, and interchange data via HL7 or APIs reassure healthcare organizations that future solutions can be built that access their data, even before those needs are understood. Canadian EHRs, for example, provide a broader view of longitudinal health data across the care continuum, typically with a clinical portal viewer as the access point. 3. Patient-centric focus. Start by providing patients with access to their digital health information using a validated, authorized account. The patient is then invited as a decision-making participant in their circle of care and maintains control over access to their digital health record. This includes: - Access any time, anywhere on any device - Bi-directional communication with care providers/care team - Possibility for substitute decision-makers and family members to access patient data as part of the extended care team, or in an emergency - Reconciled medications list and curated problems/procedures/test data - Support and integration for consumer health devices


      Conclusion/Implications/Recommendations:
      There are multiple levels and layers connected to business, clinical, patient/public and financial concerns that digital health vendors must consider. A successful vendor must be fully invested, understand its clients' priorities and predict and articulate those needs through interoperability by design. From this perspective, a vendor becomes responsible for the short and long-term sustainability and the commitment to service level agreement targets of the solutions, and most importantly, the ongoing interoperability of the solution within the healthcare ecosystem.


      140 Character Summary:
      This session will discuss three key components to a successful “Integration By Design” solution: 1. Managed services, 2. Open APIs and 3. Patient-centric focus.

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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): Jennifer Cordeiro

      • 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): Ellie Yu

      • 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): Stephane Borreman

      • 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, Lori Rutherford

      • 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): Heather Harps, Chris Michel

      • 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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      OS21.02 - Getting to Digital Delivery through Big Data Management

      13:15 - 14:15  |  Author(s): Malina Iftimie

      • Abstract

      Purpose/Objectives:
      To explore how CIHI plans to evolve by creating an enterprise data management architecture capable to govern and integrate health data in one place and simplify and standardize how users interact with our data. The vision is to free-up value in health information by making it available, explorable, usable, comparable and meaningful to all consumers while keeping it secure and traceable.


      Methodology/Approach:
      Making data available to stakeholders, including the public, is a key function within CIHI’s mandate. In addition, with the emergence of open data policies and digital transformation, there is an urgent need to improve our stakeholders’ experience in finding and using CIHI data. Through a digital delivery model, product management and a multi-year roadmap, CIHI will design and build a front-end platform, called the Product Hub and a back-end platform called the Data Hub. The Product Hub will allow our users to interact with our data through governed products and will depend upon the Data Hub to provide integrated and comparable, meaningful data. CIHI will achieve this by using an enterprise architecture program designed to support current needs but with strong focus on future growth, including continued advancement in data governance, advanced analytics and artificial intelligence. To achieve these goals, CIHI will evaluate and take advantage of Big Data technologies.


      Finding/Results:
      CIHI makes a vast amount of data publicly and privately available to stakeholders through our website(s). Through stakeholder engagement and environmental scans CIHI has learned about our main challenges in making data available in a user-friendly way. Examples include difficulties with search, navigation, standardization in visualization, data in one place (e.g., data and metadata), etc. Much of this can be attributed to our back end data management flows and processes as a result of siloed systems and outdated technology. A cost benefit analysis was conducted to highlight the continued reliance on manual processes demonstrating inefficiencies and creation of difficulties to scale. Research was conducted and proof of concept work completed with multiple vendors in the big data management space to decide on a technology platform that makes sense for CIHI. This will support continued work on the overall design of the Data Hub and Product Hub.


      Conclusion/Implications/Recommendations:
      CIHI remains committed to our mandate to continuously improve the digital experience of our stakeholders and provide value to the Canadian health care system. To do this we need to implement a comprehensive enterprise health data management and access platform based on an enterprise data model, using Big Data/BI/data visualization technologies that eliminate the restrictions that come with traditional approaches.


      140 Character Summary:
      CIHI will share plans to advance our digital delivery model that includes a comprehensive view of health information powered by a Big Data Management Platform.

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

      13:15 - 14:15  |  Author(s): Gillian Sweeney, Andrew Evans

      • 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:
    • +

      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, Trevor Jamieson, Onil Bhattacharyya, Rebecca Yang

      • 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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    EP09 - Health Policy / Strategy / Analytics

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Area 6
    • Type: ePoster Session
    • Track:
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      EP09.01 - Assessment of Strategic Approaches to e-Health in Kazakhstan  

      14:30 - 15:30  |  Author(s): Yerbol Spatayev

      • Abstract

      Purpose/Objectives:
      In the past 15 years, the Ministry of Health of Kazakhstan had launched two nationwide projects on digitalization of health care. The first project, Unified Health Information System (UHIS), did not achieve its goals, largely due to the absence of integrated strategic approach that considers institutional development, potential and incentives that affect project participants. The second project, implemented in the framework of the Concept of e-Health Development of the Republic of Kazakhstan for 2013-2020, has not yet been completed, but is already showing significant results. Purpose / Objectives Harmonization of the national strategy for the development of e-health with the needs and strategic directions for development of the health system of Kazakhstan.


      Methodology/Approach:
      1. Evaluation of interim results of e-health development Concept 2013-2020 implementation (Concept 1.0); 2. Development of proposals for updating the vision, goals and ways to achieve the Concept 1.0.


      Finding/Results:
      Evaluation showed that the measures for institutional development of e-health in Kazakhstan were almost fully implemented, including the creation of necessary organizations and involvement of stakeholders, as well as the development and approval of the regulatory and normative framework. Medical information systems and mobile applications are being introduced actively. At the same time, measures to create nationwide tools for interoperability of medical data and health processes, including the national EHR. 1. Significant institutional reforms in healthcare, including strengthening of Public Health Services and transition to mandatory social health insurance require updating the current visions, goals and directions in the Concept 1.0. 2. Revision of the Concept should consider international experiences and technological advances such: artificial intelligence, mobile health, big data, augmented reality, etc.


      Conclusion/Implications/Recommendations:
      1. Literature review demonstrates growing role of ICT in healthcare and including it into national strategies has become a necessity. Amid rising ICT costs and expectations from their implementation, WHO calls for attention of the Member States for almost complete lack of a systematic approach to monitoring and evaluating national e-health programs. 2. Evaluation of the current status on achievement of final results stipulated by the Concept 1.0 demonstrates the need to update the final results and the vision, strategic goals and ways to achieve them. It should take modern advances in healthcare and strategic need of the system into account as the conceptual architecture of the Concept does not address a number of critical issues, including digitalization of the mandatory health insurance system and Public Health Services. 3. Based on the vision set out in the Concept, the result of its implementation should be a comprehensive integrated information infrastructure that provides necessary information to all participants of healthcare. While recognizing the significance of ICT in health, instead of assigning them a passive, supporting role, efforts should be taken to “digitalize” not just the data, but also the processes through the use of digital technologies to change the business model and provide new opportunities for generating income and values.


      140 Character Summary:
      Desinging strategies to create environment conducive to technology development in e-healthcare.

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      EP09.02 - CPT®: A Key Step Along the Path of Digital Health

      14:30 - 15:30  |  Author(s): Dean Parisi

      • Abstract

      Purpose/Objectives:
      Locally-defined physician service descriptions have several underlying challenges in Canadian provinces and territories. Attend this session to learn how and why the Current Procedural Terminology (CPT®) product suite consisting of a set of clinical terms including clinician, consumer and long descriptors along with thorough documentation and guidelines for their use (hereafter referred to as the Suite), is a strategic, innovative digital health solution for a recognized pan-Canadian problem: the lack of a physician-based universal clinical terminology to describe, record and report physician services. 1. State why a single terminology for physicians’ services reporting across Canadian provinces and territories eliminates identified challenges 2. Define the characteristics of a clinical terminology for physicians’ services and how CPT clinical terms addresses them 3. Explain the clinical and interoperability benefits of the Suite as a Canadian digital health solution for reporting of physicians’ services 4. Identify how the CPT framework can facilitate digital health initiatives


      Methodology/Approach:
      The American Medical Association (AMA) completed a cross-Canada environmental scan in 2018. Objectives of this effort were to assess current challenges with the reporting of Canadian physicians’ services as well as exploring the potential use of the Suite as the reporting solution across Canadian provinces and territories. The environmental scan execution included: ? A review of physicians’ manuals and fee schedules for each of the provincial/territorial jurisdictions. ? Formal interviews across Canada including provincial/territorial governments, medical associations, clinical or performance measurement programs, national associations, and electronic medical record vendors. ? Follow-up meetings to share a summary of the environmental scan results. Next, the AMA proposed a CPT implementation framework along with the creation of resources needed to assist with CPT implementation.


      Finding/Results:
      There are a number of clinical and interoperability benefits of implementing the Suite as a Canadian digital health solution for physicians’ services reporting. For example, CPT clinical terms support innovative clinical practices and technologies. Furthermore, several CPT use cases already exist in Canada. Hospitals in several provinces participate in the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®). CPT clinical terms are used to monitor patient outcomes following surgery with the goal of improving the quality of services delivered and reducing adverse outcomes and complications. Five years ago, the Nova Scotia Department of Health and Wellness and Doctors Nova Scotia began the process of adopting up-to-date clinical terminologies for reporting physician diagnoses and procedures. The Suite was selected as the clinical terminology solution. Recognized as a common language utilizing a uniform methodology for representing clinically relevant physician service terms, additional uses of CPT clinical terms are possible as well.


      Conclusion/Implications/Recommendations:
      Implementation of CPT clinical terms, a physician-based clinical terminology, offers a strategic, innovative digital health solution for Canada. The Suite addresses the pan-Canadian need for a clinical terminology for physicians’ services and can capture what a Canadian physician does in the current health care environment. It also has the ability to adapt to the evolving digital health environment. Resources to support implementation, such as maps and educational materials, are also accessible to those who require them.


      140 Character Summary:
      Bold Action in Digital Health: Implementing the CPT product suite as a strategic, innovative solution to describe, record and report physician services in Canada

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      EP09.03 - Improving BCMA: Closing the Loop with OMIE

      14:30 - 15:30  |  Author(s): Chris Byczko

      • Abstract

      Purpose/Objectives:
      This presentation demonstrates a practical framework for strategically improving scanning compliance in the closed loop medication administration process for the organizational and unit level. In June 2018, SickKids went live with a new information system and shortly there after achieved HIMSS EMRAM level 6. A criteria for achieving this level is the implementation of closed loop medication administration process (or also referred to as Barcoded Medication Administration, BCMA). BCMA is a proven process that helps to reduce medication and patient identification errors. A key factor for BCMA's success to improve patient safety is contingent on scanning compliance by front line staff. There currently is a lack of a conceptual framework to practically guide healthcare institutions to improve BCMA compliance after implementation of the technology.


      Methodology/Approach:
      A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses’ perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


      Finding/Results:
      A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses’ perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


      Conclusion/Implications/Recommendations:
      The OMIE Framework is an effective and useful conceptual framework to practically guide hospital initiatives in improving BCMA compliance rates. Utilizing the OMIE Framework to derive unit-level BCMA improvement strategies demonstrated effectiveness in increasing BCMA compliance rates at both the organization and unit level. Healthcare facilities can consider the use of the OMIE Framework as a conceptual framework to improve BCMA compliance rates on their journey to enhancing patient safety. Further exploration of contextual factors that hinder or enable implementation of BCMA improvement strategies is needed.


      140 Character Summary:
      A practical framework for improving scanning compliance in the closed loop medication administration process for the organizational and unit level.

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      EP09.04 - A Global Platform to Solve Healthcare Challenges; UNLEASH Model

      14:30 - 15:30  |  Author(s): Alaa Qari

      • Abstract

      Purpose/Objectives:
      To highlight experiences and lessons from UNLEASH lab which is a global innovation lab that took place in Denmark, August 2017.


      Methodology/Approach:
      One thousand talents from 129 countries gathered in UNLEASH innovation lab. Participants were grouped into different teams according to the Sustainable Development Goals of the United Nation. Teams systematically solved some global challenges following the innovation process of design thinking that include: problem framing, ideation, prototyping, testing, and implementation. The lab facilitated the connections between global participants through this immersive experience and maintained it after the program through social media, email newsletters and UNLEASH online platform where participants could share global opportunities and challenges.


      Finding/Results:
      This model facilitated and mainteined fruitful connections that lead to innovative and promising health projects globally. This helps to achieve the United Nations global agenda for better future for the world.


      Conclusion/Implications/Recommendations:
      The model could be adapted in different contexts and settings as in conferences. Taking the opportunity of global attendees, organizers could facilitate small engaging sessions to foster the connections between attendees according to their interests.


      140 Character Summary:
      Experience & lessons from UNLEASH innovation lab. Facilitating connections of global expertise via physical and virtual platforms help solve global challenges.

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      EP09.05 - Modernizing Hospital Supply Chain Management: A Digital Health Case Study

      14:30 - 15:30  |  Author(s): Alistair Forsyth

      • Abstract

      Purpose/Objectives:
      NYGH has one of the busiest operating rooms in the Central LHIN and operates one of the largest cataract centres in the province. As such, its operating room (OR) relies on a large inventory of medical equipment and supplies to provide care to its patients. Due to funding constraints and other factors, the OR has developed highly manual and fragmented supply chain management processes and uses a number of disparate technology systems for inventory tracking. This has created significant challenges in maintaining appropriate inventory levels, cost control, data analysis and quality improvement. Our hospital is on a modernization journey that will transform our inventory management processes and technology for perioperative services by leveraging private and public partnerships.


      Methodology/Approach:
      This is a two year project that will be delivered in three phases: Phase 1 will represent the foundational stage and will focus on project planning, developing baseline metrics and future state workflows. Phase 2 will deliver data cleansing, space renovation, technology build/implementation and end-user training. Phase 3 will focus on outcomes evaluation against key performance indicators and knowledge translation. Through a partnership with the University of Toronto's faculty of Healthcare Engineering and Plexxus Shared Services, NYGH has established a diverse team of clinical, supply chain, technical and quality improvement experts to achieve the project's goals.


      Finding/Results:
      The expected results of this project are to: -Reduce inventory levels by 5-10% -Reduce surgical instrument waste by 10% -Improve process efficiency resulting in a 5% decrease in OR turnaround times -Enable highly accurate surgical case costing and reduce variability Key performance indicators (KPIs) will be developed to measure our success in achieving these goals and to support ongoing quality improvement.


      Conclusion/Implications/Recommendations:
      While this project will focus on improvements to the OR supply chain, the results of this project can be scaled to provide value to other areas of the hospital and to the broader health sector. Being able to transfer the technology we implement as part of this project throughout the hospital in improve efficiency and effectiveness through the standardization of processes. NYGH will work with the University of Toronto to translate the knowledge gained from this project into useful analytical tools that can be utilized by other hospitals. Additionally, our partnership with Plexxus Shared Services will provide a channel to disseminate our learnings to leadership at other Plexxus hospitals. This project represents an opportunity to produce significant cost savings for the broader health cate system through digital health technology, while enhancing patient experience and outcomes, reducing waste, enhancing the quality of data for provincial reporting and allowing clinicians to spend more time caring for their patients.


      140 Character Summary:
      Transforming inventory management processes and technologies in a community teaching hospital by leveraging public, private and academic partnerships.

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      EP09.06 - NLCHI Data Warehouse Project

      14:30 - 15:30  |  Author(s): Robert Trask

      • Abstract

      Purpose/Objectives:
      The Newfoundland and Labrador Centre for Health Information (the Centre) provides quality information to health professionals, the public, researchers and health system decision-makers. This is done in part through the development, implementation and operation of confidential and secure eHealth solutions. The Centre also operates an enterprise Data Warehouse (DW) where data is securely extracted from provincial clinical source systems connected to the EHR as well as various healthcare administrative data sets. The Centre has recently initiated a DW project to enhance the existing solution and integrate additional datasets to define, design and setup access for internal and external users of these data. The objective of this central repository of health information is to capitalize on the EHR rich data set, and other provincial health data sets, to enable one of the most advanced and comprehensive provincial-level health data environments in Canada.


      Methodology/Approach:
      Through the funding aid of the Atlantic Canada Opportunity Agency (ACOA), additional data sets such as the Medical Care Plan (MCP) have been acquired and linked with the existing foundational EHR data. During this project phase significate data modeling activities were undertaken to create a master data framework ensuring future data sets housed within the DW are linkable. In addition, an automated de-identification process was developed for secondary data use and metadata templates were created for data set users.


      Finding/Results:
      The outcomes to-date provide the Centre with advanced in-house analytic capacity to more quickly, and to a higher degree, meet the growing needs of its stakeholders. With the EHR and MCP data sets in place, along with the ground work laid for future data set incorporation, the Centre is currently focusing on activities to significantly expand the data holdings of the DW. Major data sets that are now targeted for incorporation include the regional health authority data sets (Meditech data), medical clinic data that comprises the Electronic Medical Record (EMR), and possible future incorporation of genetic related data.


      Conclusion/Implications/Recommendations:
      With a comprehensive central repository of health information as a cornerstone of the Centre, not only is there an increase in analytical capability within the centre to respond to the needs of stakeholders, but the possibilities for future secondary use of the health information is expanding. Activities are already underway at the Centre to develop a private and secure external researcher environment, which would draw on the rich DW data sets for analytical research purposes. Furthermore a layer of business intelligence (BI) tools, and application program interfaces (APIs), are being built on top of the data sets to foster the creation of dashboards and apps to improve access to health data and ease of analysis for decision makers within the health system.


      140 Character Summary:
      NLCHI has developed a healthcare data warehouse enabling researchers, dashboard users and app developers to access provincial data.