• e-Health 2019 Conference Program

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

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

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

    PDF's of presentation PowerPoints are now online!

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

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    OS25 - You've Got Mail, But No Paper!

    • Type: Oral Session
    • Track:
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      OS25.01 - Adoption and Perceived Usefulness of Health Information Exchange

      14:30 - 15:30  |  Author(s): Aude Motulsky

      • Abstract

      Purpose/Objectives:
      Health information exchanges (HIE) are seen as an essential technology for improving healthcare quality and efficiency by allowing patient-centered data exchange over time and across organizations. The objective of this study was to describe the adoption and the perceived usefulness of an HIE in the province of Quebec, four years after its full implementation.


      Methodology/Approach:
      A mixed method study was conducted, including longitudinal descriptive analysis of usage data obtained from the Quebec Ministry of Health from Jan 1st 2017 until Dec 31st 2017, combined with in-depth case studies from 5 primary health care organizations using different commercial electronic medical record (EMR) systems. Data collected in each case included interviews with users (n=66). The number of users by role and by tool were described, as well as a detailed analysis of the weekly accesses by physicians.


      Finding/Results:
      Up to October 2017, a total number of 47 928 individuals had received a security certificate to access the HIE, including 14 127 physicians and 17 932 nurses. However, only 68% of these physicians and 48% of these nurses actually accessed the HIE in October 2017, while 86% of these pharmacists accessed it. For physician users, two types of tools were available to access the HIE, depending on their availability in their work place: an EMR integrated with the HIE, or a Web Viewer. While 50% of general practitioners and 49% of nurse practitioners have accessed the HIE using an integrated EMR, only 11 % of specialists have used an integrated EMR to access the HIE. The number of weekly accesses by physicians to the medication domain (Fig 1A) was higher when using an EMR in the outpatient setting (O-EMR). This was confirmed with the case study indicating that the advanced feature of importing granular medication data into the EMR was only possible using an O-EMR. For the lab domain (Fig 1B), the level of use was similar for O-EMR and Viewer, and lower for EMR in acute care. For images (Fig 1C), the level of use was higher using the Viewer application. This might be related to the fact that the image was only accessible using the Viewer application. Perceived benefits were reported by users across all dimensions of care performance, including accessibility, efficiency, quality and safety, as well as patient experience. capture d’e?cran 2018-10-16 a? 20.57.20.png


      Conclusion/Implications/Recommendations:
      This HIE was used by a diverse group of healthcare professionals and was able to offer concrete perceived benefits in primary care. Our results suggest that the availability of the advanced features of HIE/EMR integration was essential to stimulate adoption and perceived benefits.


      140 Character Summary:
      The adoption and perceived usefulness of Health information exchange in Quebec was evaluated four year after the full implementation of the system.

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      OS25.02 - Rearchitecting Interoperabiiity

      14:30 - 15:30  |  Author(s): Karim Keshavjee

      • Abstract

      Purpose/Objectives:
      Around the world, countries have struggled with true interoperability: standardized digitized data flowing easily from organization to organization and seamlessly being used at the point of care for improving patient care. Over the last 3 years, we have identified several barriers to the smooth flow of standardized data across organizational boundaries and its use at the point of care. Our research aims to find acceptable, feasible and easy to implement solutions to our current interoperability woes. This presentation integrates the findings from several different research projects.


      Methodology/Approach:
      Integration of several research projects which have used barrier analysis, stakeholder analysis, economic analyses, critiques of existing interoperability projects, key informant interviews with national and international leaders in health IT and information governance (N=70) and prototype testing as the methods to better understand how we can overcome the barriers to interoperability.


      Finding/Results:
      The barriers to interoperability are multi-faceted: 1) Privacy and confidentiality, 2) Program Governance, 3) Information Governance, 4) Cost and effort of standardization, 5) Cost and effort of developing new methods of understanding and using data obtained from another setting, 6) Incomplete coverage of use cases, 7) Lack of appropriate leadership, 8) Lack of compelling business cases and returns on investment, 9) Lack of aligned incentives and 10) Lack of easy to use methods to standardize data.


      Conclusion/Implications/Recommendations:
      Solutions for several of these barriers have been developed in partnership with academia, industry and clinicians. This presentation will cover: Principles of governance for data sharing, economic models for developing compelling business cases, findings from an international survey of what works and doesn’t work in other countries and methods and mechanism to align incentives. Barriers that require additional research will be highlighted.


      140 Character Summary:
      Barriers to interoperability are many, but can be overcome. Stakeholders must work together to overcome for the benefit of Canadians.

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      OS25.03 - Health Information Standards and Results Distribution in BC – Paper Reduction

      14:30 - 15:30  |  Author(s): Francois Chevallier

      • Abstract

      Purpose/Objectives:
      The Health Information Standards and Results Distribution Executive Steering Committee in BC has taken steps to phase out the delivery of paper based (Canada Post/Courier) clinical reports. This change reflects the Ministry of Health’s strategic priority of delivering a system of responsive and effective health care services for patients across British Columbia. Excelleris supported this important initiative as the purveyor of varied types of clinical health information for partner health authorities. In this panel presentation, Excelleris and members from two Health Authorities in BC will share their perspective and the results of this initiative.


      Methodology/Approach:
      A project based approach was used for this initiative. At its core was a formal communication & engagement strategy undertaken to support transition of providers to an electronic distribution channel. The joint team developed: 1) Detailed process flows, 2) Tracking systems for provider transitions, 3) Detailed procedures document for the joint project team, 4) Monthly status reports, 5) Weekly dashboard reports and 6) Technology enhancements. The team has continually applied lessons learned and focused on high-volume paper recipients to reduce operational costs as quickly as possible


      Finding/Results:
      In 2017, over 150,000 paper reports were being distributed to health care providers every month in the Lower Mainland of BC. By 2019, we expect that just over 6,000 paper reports per month will be distributed (as this initiative is still under way, exact number will be provided during the conference) Achieving a 95% reduction in paper reduction: * Brings more reliable, timely, and secure access to clinical reports (enabled through electronic distribution) * Enhances quality of patient care; * Is improving patient confidence that reports are protected, viewed and actioned in a timely manner * Leverages investments in technology and effective processes to maximize the use of health care dollars * Contributes to environmental objectives by protecting our forests and reducing carbon emissions.


      Conclusion/Implications/Recommendations:
      Moving from paper to electronic distribution required the cooperation of several stakeholders, as well as the coordination several work streams that had to be brought together and managed simultaneously. Although this was a technology driven project, the largest challenges faced by the working group were related to change management, process review and communication. A multi-disciplinary approach was necessary to achieve the goals. We will examine regional differences with technology adoption, discuss the main objections received by the working group, and review how those were addressed, and provide general recommendations for other provinces, health authority or hospitals who wish to engage in a similar initiative.


      140 Character Summary:
      Healthcare providers in BC switched to electronic reports distribution. This presentation highlights the results, challenges and learning

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      OS25.04 - HIE Adoption Lessons from International Healthcare Systems

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

      • Abstract

      Purpose/Objectives:
      The topic presented here is adoption in relation to the next phase of Health Information Exchange use. This discussion looks at two successful HIE initiatives, Northern Ireland’s Electronic Care Record (NIECR) and Alberta’s Netcare Portal, and discusses why these initiatives continue to be used heavily by clinicians. Both Northern Ireland and Alberta used disparate clinical systems and recognized the increasing amount of clinical time devoted to locating patient information, which prevented effective and timely decision-making. The solution was to include clinically relevant information, assembled from electronic systems located anywhere in the service and presented in real-time via a single, web-based, easy-to-use solution, accessible from anywhere.


      Methodology/Approach:
      Both jurisdictions took a pilot-to-production approach to rolling out their portal. In Alberta, once the initial pilots with selected physicians and clinical providers were completed, data sharing was opened up to any authorized professional interested in using it. Initial data sharing was focused on drug, laboratory, and diagnostic imaging results. With each successful integration, new components and functionality have been added to Netcare. In Northern Ireland, the initial pilot went live in 2010, joining information from two hospitals in separate trusts and GP information from two separate practices. Following the successful pilot, more information was added, with full regional rollout taking place in 2013. These examples emphasized clinical engagement and participation in the design of their solutions, to ensure that clinically relevant and useful data was presented in the portal. Both solutions were also designed to sit on top of current information systems, providing health and social care professionals with a single view of patient information, wherever the patient is.


      Finding/Results:
      In Northern Ireland, the NIECR is producing wide-ranging benefits across quality, efficiency, safety and experience: - Over 740,000 user log-ins in March 2018 - In use by >98% of medical workforce - >95% of users say NIECR saves them time It has also surpassed original project objectives to: - Reliably and correctly pull together information needed in a near-instant, easy to read patient record view - Reduce time wasted trying to access or confirm information, and increase the effectiveness of clinical encounters - Reduce unnecessary delays caused by lack of access to information, and reduce avoidable duplicate testing In Alberta, the results of Netcare Portal included: - 64,000 health professionals have active access to Netcare, with over 10,000 concurrent users at peak usage and 3,470 community healthcare provider sites accessing Netcare provincially - User access is being expanded to Optometrists, Dentists and Chiropractors - Since launch, 366.5 million screens of information in 133.6 million patient records were accessed by Alberta health professionals - Approximately 7.2 million screens of information in 2.5 million patient records accessed monthly


      Conclusion/Implications/Recommendations:
      It is essential to include clinical oversight at the beginning of an HIE engagement. This clinical oversight must be sustained throughout production use. Additionally, the pilot-to-production approach can be used as additional functionality is introduced into the solution. Finally, Medicine Reconciliation is an essential component of the pipeline and provides a single, standard interface to support medicines optimization processes.


      140 Character Summary:
      This presentation looks at two Health Information Exchange initiatives in Northern Ireland and Alberta and assesses their adoptions, uses and key learnings.

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    OS26 - Telehealth in Action

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Area 2
    • Type: Oral Session
    • Track:
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      OS26.01 - Digital Health Enhances the Continuum of care for Oncology Patients

      14:30 - 15:30  |  Author(s): Linda Bridges

      • Abstract

      Purpose/Objectives:
      The overall driving factor for provision of Teleoncology in New Brunswick is the concentration of clinical oncology specialists in the southeastern and southwestern regions of the province. Patients not in these locales, with their families or caregivers, must travel in order to interact with their clinicians. The goal of Teleoncology is to provide safe, evidence based practice in the nearest community to where the patient resides.Thus eliminating exhaustive travel for those patients already in a weakened physical and emotinal state.


      Methodology/Approach:
      Oncology referral patterns were analysed and in conjunction with the established satelitte chemotherapy clinic locations, Oncologists were approached to explore the potential use of Telehealth for patient follow-up appointments. Inclusion and exclusion criteria were established based on the clinical presentation of patients. The was determined during this exercise that Teleoncology provides the ability to deploy a wide range of services including clinical consultation, diagnostic services, knowledge exchange in the form of clinician and patient education, peer support and professional development. Exploration of access to required information electronically, such as electronic health records,was also explored to ensure that all of the required information was available, irrespective of geography. Technology plays a supportive role in that clinical needs are what drive the selection. Innovative clinical processes are the key to success in any sustainable Telehealth initiative and will be outlined specific to this application during the presentation. For example, the engagement of primary care physicians in performing the physical assessment for the specialist prior to each visit has definitely been a positive force in enhancing the patient care continuum, and physician knowledge transfer.


      Finding/Results:
      Teleoncology has facilitated the national clinical standard of patients being seen by an oncologist or a general practitioner in oncology (GPO) prior to each cycle of chemotherapy. This method of care delivery has greatly diminished the need for oncologists to visit outlying areas on a rotating basis, giving oncologists the opportunity to follow up on their own patients. As well, it now provides the opportunity for many patients to become engaged in clinical trials whereas prior to Telehealth, distance and access eliminated them as recruitment candidates. One very real challenge for the remote hospital sites is that of nursing resources. This is net new activity and must be taken into consideration. Other care delivery impacts, challenges and lessons learned will also be discussed.


      Conclusion/Implications/Recommendations:
      Teleoncology offers the potential for improved access to a wide variety of cancer support services, leading to benefits for patients and their families closer to home. It can provide wider scale access to cancer related educational programs. The provision of opportunities for patients to receive clinical and support services much closer to their home community will reduce the cost to them and their families in terms of time and finances, as well as reduce the costs to our provincial healthcare system. Currently one group of Oncologists within one urban center in New Brunswick visit over 30 sites virtually on a regular basis to facilitate their patient care delivery.


      140 Character Summary:
      Engagement of primary care physicians in teleoncology delivery.

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      OS26.02 - A Comprehensive Telestroke Solution for New Brunswick

      14:30 - 15:30  |  Author(s): Krisan Palmer

      • Abstract

      Purpose/Objectives:
      The goal of the provincial Telestroke program is to provide a solution that allows every New Brunswick (NB) citizen experiencing an acute stroke the potential to receive leading edge stroke care for this emergency event as well as thrombolysis therapy; specifically a medication known as TPA. The real issues arise with correctly identifying candidates who would benefit from TPA, as well as having a system that is equipped to respond in the rapid manner required and with the additional opportunity to provide this treatment at remote or rural locations and centers that do not ready access to stroke specialists.


      Methodology/Approach:
      Telestroke NB is built upon NB's existing Telehealth capacities, for which we have been previously recognized as a leader in using innovative technologies to provide high-quality intervention, prevention, follow-up, and educational resources to patients throughout our province. Telestroke NB links every 24 hour emergency room, which has computed tomography (CT) access, in the province to an on-demand stroke specialist in real time, regardless of the location of the patient or specialist. Neurologists connect to the hospital network using a virtual private network (VPN) from their home or office to review the CT image within seconds of the scan being completed. This system also allows them capacity to view older CT scans performed on that patient from additional NB sites. They document the necessary clinical assessment performed while connected in real time via interactive audio and video to the emergency room where the patient has presented. In this manner, benefits and risks are communicated to the patient, family and staff at the referring site who also receive advice and support for thrombolysis decisions.


      Finding/Results:
      Telestroke NB is a system that was developed cooperatively between two provincial health authorities (Horizon and Vitalité), Ambulance NB, and Heart and Stroke Foundation of NB with the support of the government of NB. This sustainable system was built to align within existing programs and all partners worked collaboratively. It is an innovative, province-wide system for delivering evidence-based acute stroke care and thrombolytic therapy. Each health authority supported the development of consistent guidelines and processes to ensure patients receive care in both official languages as mandated in a bilingual province. Emergency room staffs were integral to the program success as they developed ways to support the remote specialist with performing needed clinical assessments and dialogue with patients and their families.


      Conclusion/Implications/Recommendations:
      Telestroke NB is a sustainable program; improving health by increasing access to quality, evidence-based stroke care in the hyperacute setting. This results in better health outcomes by directly reducing disability caused by stroke. It results in cost-savings by reducing the burden of care for patients who might otherwise require longer hospital stays and long-term nursing care. It also reduces unnecessary transfers and demonstrates the power of cross regional program collaboration. Telestroke NB is one step of a truly comprehensive stroke system; moving towards using Telehealth for primary and secondary stroke prevention. It was launched in collaboration with every facet of the New Brunswick health care system.


      140 Character Summary:
      A province wide innovative technological solution to provision of hyperacute healthcare services.

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      OS26.03 - Explaining Longitudinal Patient Adherence in a Heart Failure Telemonitoring Program

      14:30 - 15:30  |  Author(s): Patrick Ware

      • Abstract

      Purpose/Objectives:
      Telemonitoring can improve heart failure outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients adhere to taking the expected physiological readings. While the literature is rich with studies exploring barriers and facilitators to patient uptake, few have studied longitudinal patient adherence to telemonitoring programs existing outside the context of clinical trials. The objective of this study was to quantify and explain longitudinal patient adherence in a heart failure telemonitoring program offered as part of the standard of care in a Toronto-based specialty heart function clinic.


      Methodology/Approach:
      A mixed-method explanatory sequential design was used to first quantify patient adherence rates over a 12-month(m) period and subsequently explain adherence using semi-structured interviews. As patients are instructed to take readings daily before noon, monthly adherence rates were defined as the percentage of completed morning readings (weight, blood pressure, and symptoms) over each 30-day period. Generalized linear models were performed to predict adherence rates using independent variables related to demographics, disease severity, and time since program start. Semi-structured interviews containing probes based on the constructs in the Theory of Acceptance and Use of Technology 2 (UTAUT2) were conducted with a subsample of patients.


      Finding/Results:
      Two years after program launch, longitudinal adherence data for 12m was available for 179 patients (mean age 58 +/-16; 80% male). Overall mean adherence over the 12m period was 70% +/-25 with average adherence rates declining from 80% +/-24 at 1m to 65%+/-35 at 12m. Time since starting the program was the only significant predictor of adherence accounting for 81% of variation in adherence over time (R2=0.81). Characteristics of interviewed patients included a range of ages (22-83), sex (70% male), time since onboarding (0-12m), and overall adherence rates (30-96%). Key themes explaining patients’ motivation to adhere include: (1) perceived benefits of the program (self-management support, peace of mind, and improvement in clinical care); (2) ease of use; (3) a positive opinion of the program from family and friends; and (4) supporting services (training and technical support). Themes explaining low and imperfect adherence include: (1) technical issues that periodically prevented the transfer of readings and/or which led to patient frustration; (2) life events or circumstances that interfered with the ability to take readings; and (3) the perception that the benefits of the program were suboptimal due to the system’s inability to adequately capture additional context related to the readings.


      Conclusion/Implications/Recommendations:
      Despite a 15% drop in adherence after one year, an overall mean adherence of 70% is considered high given our strict definition of adherence and because the pragmatic nature of this study meant that we could not account for periods when patients were unable to take readings (e.g., travelling, inpatient stay, etc.). This limitation meant that true adherence was likely underestimated. Consistent with the UTAUT2, this study found that longitudinal adherence is not so much predicted by patients’ demographic or health characteristics but rather their perception of a telemonitoring program’s benefits, its ease of use, and the presence of supportive individuals and supporting program components.


      140 Character Summary:
      Although declining over time, patient adherence to a telemonitoring program remained high and was primarily explained by patients’ perceptions of the program.

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      OS26.04 - Intra-institutional Teledermatology: Results of a mixed methods case study

      14:30 - 15:30  |  Author(s): Trevor Champagne

      • Abstract

      Purpose/Objectives:
      Historically, teledermatology’s benefits have been mostly realized through improved access to rural or underserviced areas. This study examines the benefits and the overall impact of teledermatology in an urban, intra-institutional environment.


      Methodology/Approach:
      A store-and-forward teledermatology service was created between family medicine practitioners and a consultant dermatologist in the same urban ambulatory “intra-institutional” hospital. Mixed methods analysis was then applied to chart reviews, electronic surveys to clinicians and patients, and semi-structured interviews with referring providers and dermatologists within a framework developed from the Canada Health Infoway Benefits Evaluation. Survey questions were designed to assess benefit quantitatively and interviews were subjected to qualitative thematic analysis. The final results were tabulated, triangulated, and compared against existing literature.


      Finding/Results:
      84.2% of the 76 consultations reviewed over 18 months of service were manageable solely with teledermatology. Subgroup analysis revealed that skin “lesions” had a much lower success rate – with 40.9% requiring transition to an in-person consult, as opposed to skin “rashes,” of which 94.3% were manageable through teledermatology. All patients agreed they would use the service again. Cited benefits included savings in time, money, and missed work. Referring providers were satisfied with service reliability, timeliness and quality of responses, and the educational value of the consult opinions, but it did increase their administrative time.


      Conclusion/Implications/Recommendations:
      Patients were satisfied with intra-institutional teledermatology and felt it saved them time, money, and prevented them from missing work. Providers were similarly satisfied despite the increased administrative burden. This study demonstrates strong benefits of teledermatology even when used in populations that are not underserviced or geographically restricted. Future research should include assessments of cost-effectiveness and the impact of teledermatology services targeted exclusively at subgroups such as rashes.


      140 Character Summary:
      Intra-institutional teledermatology helped patients save time and money and providers were highly satisfied with the service.

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    OS27 - Integrating the Community Sectors

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Area 3
    • Type: Oral Session
    • Track:
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      OS27.01 - Understanding the Technology Needs of Clinical End-Users for Care Coordination

      14:30 - 15:30  |  Author(s): Daniel Cornejo Palma

      • Abstract

      Purpose/Objectives:
      Rural communities are a difficult place to try internet-based technology to improve health outcomes. Part of the difficulty stems from not incorporating the concerns of clinical end-users when implementing new technology. Traditional approaches to evaluating technology implementation focus on measuring patient outcomes. The importance of understanding clinical end-user interests is traditionally downplayed. Ignoring the concerns of users has lead to technology disuse and lacklustre patient outcome improvements in the literature. To improve the understanding of clinical end-user concerns, we created the Tool+Team+Routine (TTR) heuristic. TTR is based on principles from value proposition design, in which empathy for the user underlies the first step in implementing engaging solutions. TTR aims to improve the engagement in technology implementation by defining success metrics in terms that matter to clinical end-users.


      Methodology/Approach:
      We used TTR to define success metrics for a digital platform set up to improve care coordination efficiency in a population of rural complex care patients. During protocol development, the evaluation team discussed or observed each TTR element with coordinators. We learned from coordinators that to understand meaningful platform use (i.e. ‘tool’ use), we would have to track usage. Coordinators also taught us that meaningful collaboration amongst 'team' members meant having case conferences, which prompted the inclusion of case conferences as a secondary outcome. Finally, we also learned that improvement to practice (i.e. ‘routines’) meant reducing communication delays between health professionals. Thus, we developed a primary outcome, time to maintenance (TTM), based on elapsed time to highlight communication delays among providers.


      Finding/Results:
      *Tool: Usage of the platform was low. Half of the cohort barely used the platform. Overall, 30% of all communication on the platform occurred between care coordinators and clients —70% was between clients and family. The tool was designed to centralize patient-related conversations among health professionals but did not do so, due to lacking engagement from other providers. Team: We observed that case conferences occurred in only 15% of patients. Care coordinators noted that a minority of clients with health teams that adopted the communication platform seemed to experience an efficiency gain in reaching their goals. Routine:* Care coordinators’ claim of an efficiency gain with app engagement was supported by observed data. Video call usage, a measure of engagement, significantly reduced the coordination delay per co-morbidity. The delay observed per comorbidity was 28.7 days without platform use (i.e.< 2 calls made in six months of follow-up). If patients made at least ten calls in six months, the coordination delay per comorbidity decreased from 28.7 to 19.9 days (p=0.035).


      Conclusion/Implications/Recommendations:
      TTR is a simple heuristic that identified metrics that were relevant to clinical end-users. The primary outcome reflected communication delays because coordinators identified delays as a vital concern to the efficiency of daily routines. Coordinator worries about the engagement of other care team members meant we measured clinician involvement closely. TTR-based evaluation results challenged decision-makers to consider clinical end-user concerns as vital next steps to address in this technology implementation.


      140 Character Summary:
      Traditional technology implementation approaches overlook end-user concerns. We present a practical framework to understand end-users: 'Tool+Team+Routine'.

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      OS27.02 - Clinical Value of Standardized Primary Care Data: Learnings from POC

      14:30 - 15:30  |  Author(s): Michelle Cousins

      • Abstract

      Purpose/Objectives:
      The connecting South West Ontario Program’s Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, enabled a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontario’s integrated electronic health record (EHR). A key objective of the POC was to support clinicians to improve data quality to enhance data sharing. This presentation demonstrates how structured EMR data can be used to enable clinical and organizational value for primary care providers and their patients


      Methodology/Approach:
      Data quality assessments were completed before and after investments to improve data quality that included chart reviews, surveys and EMR searches. Data quality investments included historical coding of EMR data to ensure coded patient data was current. The eCE consulted with program managers and clinicians to explore how improved data quality could generate value for each organization and developed case studies to demonstrate this value to clinicians.


      Finding/Results:
      During the POC the eCE PCDS project team learned that data quality initiatives, when positioned together with tools developed in line with clinical best practices, generate internal value for contributing organizations and clinicians. Improved EMR data quality allows primary care organizations to: identify patients with specific conditions (including patients who did not have a documented diagnosis); identify complex patients (high-users of the healthcare system); identify and understand patient population (i.e. prevalence of chronic conditions). Overall, findings demonstrated that primary care data quality improvement initiatives promote improved documentation and a more accurate depiction of the patient roster in the EMR, which has allowed primary care providers to be more proactive in the way they manage care internally to their practices as well as through better communication to community and specialist supports.


      Conclusion/Implications/Recommendations:
      The PCDS POC has demonstrated not only that data can be extracted from EMRs and viewed by clinicians across communities and the continuum of care, but generated improved value for clinicians and patients within primary care practices by improving data quality. When EMR data is up-to-date and standardized using codes, practices can identify and mobilize to care for specific patient populations. Moving forward, it is important to invest in a scalable model that can structure and improve primary care data quality and to learn more about the opportunity a high-quality dataset from primary care offers to achieve the quadruple aim (improved patient experience, patient outcomes, system cost, physician experience). For example, EMR tools that incorporate best practice guidelines could be developed in ways that enable clinicians to document specific elements in structured ways that can lead to easier more effective management of patient populations. In addition, those structured fields can be shared with specialists and community supports to support stronger continuity of care.


      140 Character Summary:
      This presentation will demonstrate how quality primary care data can enable clinical and organizational value for primary care providers and their patients.

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      OS27.03 - LTC eConnect: Supporting LTC Access to the Electronic Health Record

      14:30 - 15:30  |  Author(s): Angela Lianos

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: The LTC eConnect solution leverages the provincial EHR clinical viewers, ConnectingOntario and ClinicalConnect, to provide clinicians working in Long Term Care (LTC) homes with simple, direct access to the provincial EHR from the existing secure resident record in the PointClickCare clinical information system, which is currently in use by LTCHs. This panel presentation will showcase the LTC eConnect solution that connects clinical users’ patient information in a manner which supports their clinical workflow (i.e., with Single Sign-On (SSO) and Context Management (CM)). The project, went live with its first LTC site in March 2017, and is being delivered through a successful partnership between Canada Health Infoway, eHealth Ontario, PointClickCare and ThoughtWire with support from stakeholders across the sector, including the Ontario Long-Term Care Association (OLTCA), AdvantAge Ontario and LTC clinicians. This session will provide a demonstration of the solution, narrated by panel members, as well as an overview of project successes and lessons learned. LTC clinicians will explain how the LTC eConnect solution has benefited patient care and provided clinical efficiencies.


      Methodology/Approach:
      Methodology/Approach: Designed specifically for the LTC sector, the LTC eConnect solution provides clinicians access to the ConnectingOntario ClinicalViewer or ClinicalConnect directly from their PointClickCare EMR, while maintaining patient context. The solution was developed using Agile Methodology guided by two clinical advisory panels; one for each regional viewer. The solution was rolled out to a pilot site in each of the three regions before it was available generally.


      Finding/Results:
      Findings/Results: LTC eConnect has been rolled out to 73 Long-Term Care Homes in Ontario, and over 1,400 authorized users are now able to access residents’ health information to support care delivery. An additional 200 homes across the province are scheduled to be using LTC eConnect by March 2019, which represents nearly half of the LTC homes in Ontario. The response from clinicians who have adopted the LTC eConnect solution has been overwhelmingly positive. Clinicians have reported: Greater access to residents’ health information in real-time – especially upon resident admission or transfer Easier access to labs, diagnostics and drug data Ease of use during medication reconciliation and access to a fulsome health profile during the patient assessment period Expanded use of information among registered staff supported by the controls put in place to access personal health information directly within the PointClickCare application Easier auditing controls for monitoring staff usage and access of the electronic health record


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations Implementation of the LTC eConnect initiative required stakeholder engagement from the LTC sector to ensure the digital health solution was appropriately integrated into clinician workflow. Both the complexity of the patients the LTC sector serves, as well as the diversity of the LTC clinicians themselves required unique considerations to ensure the success of the service. The development and implementation of the LTC eConnect solution was successful because it was designed around the people it serves. By putting LTC clinicians at the forefront of the project the solution could be tailored to prioritized needs of the sector.


      140 Character Summary:
      LTC eConnect: A sector specific solution created to support long-term care access to the electronic health record

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      OS27.04 - Discharge Optimization in the Emergency Department at CAMH 

      14:30 - 15:30  |  Author(s): Gillian Saracino

      • Abstract

      Purpose/Objectives:
      The CAMH Emergency Department (ED) Discharge Optimization project will improve transitions and experiences of individuals discharged from the ED through: -Implementation of an electronic ‘PODS’ (Patient Oriented Discharge Summary) that is built within the EMR (Electronic Medical Record) and provided to patients on discharge. -More efficient completion and distribution of discharge summaries to community physicians to promote smooth transitions and continuity of care for patients. These discharge improvements have been successfully rolled out to all inpatient units at CAMH. As a result, this initiative will align with organization-wide standards and initiatives. Further, initial consultation with families as part of the ED Optimization project has acknowledged that a PODS-type discharge summary will fill a reported gap in regards to transition, safety and care planning in the emergency department.


      Methodology/Approach:
      The implementation of PODS will use Project Management tools and approaches within a Quality Improvement Science frame to plan, implement, study and improve: -The use of PODS for patient education and self-management post-ED visit -Efficiencies in completion and distribution of discharge summaries to community Physicians The project team consists of representation and expertise in Project Management, Quality Improvement, and Reporting and Analytics, wherein a measurement plan is being developed to identify current process measures as well as outcome measures. Achievements to date include: -Current state analysis, including process mapping, analysis of variation in current state process, and identification of technical challenges -Current state analysis to inform implementation of PODS in the ED discharge process -Inclusion of patients and families in the planning of PODS for the CAMH ED. -Collaboration with CAMH’s Clinical Informatics team to develop and implement solutions within the CAMH Electronic Medical Record (EMR)


      Finding/Results:
      Currently, this project is underway, with a goal of implementation by the end of the fiscal year. Baseline data collection indicates opportunities for improvement in dissemination of discharge notes from the CAMH ED. Specific areas of opportunity include usability of the EMR function for sending clinical documentation. CAMH-wide implementation of PODS on inpatient units has involved continuous monitoring through initial implementation and PDSA cycles. Currently, there is monitoring for sustainability to ensure continued success of PODS implementation. The same approach will be used for implementation of PODS in the ED.


      Conclusion/Implications/Recommendations:
      The combined implementation of PODS in the ED, and more efficient completion and distribution of ED discharge summaries, will support and maintain a patient-centred approach to promote vital transitions in care.


      140 Character Summary:
      The CAMH Emergency Department is implementing a patient-centred initiative to improve discharge processes and promote more effective transitions in care.

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    PS06 - Digital Health Innovation Across Canada

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Area 1
    • Type: Panel Session
    • Track:
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      PS06.01 - Digital Health Transformation through an Economic Development Lens

      14:30 - 15:30  |  Author(s): Dale Vandenborre

      • Abstract

      Purpose/Objectives:
      Digital Health brings the promise of transfromation to a sector traditionally challenged to embrace change. For many jurisdictions, health spending trends, increased chronic disease prevalence and aging populations are driving the need to embrace healthcare transformation and digital solutions. An economic development strategy for digital health can allow a juristions to rally around change and spur both positive economic outcomes and new health outcomes for a region. Hear how investment in innovation, specifically in digital health technologies such as Biofabrication & Medical 3D Printing, artificial intelligence and consumer apps are changing the narrative in one of Canada's poorest regions.


      Methodology/Approach:
      By - bringing healthcare subject matter expertise into the agency focused on economic development - placing increased emphasis on long term financial stability of the region - bringing all healthcare stakeholders together under a common vision, - embracing realities, both strengths and weaknesses, that define us - understading roadmaps, challenges, performance indicators and inhibotors of various stakeholders - understanding what is possible at the edge of digital disruption internationally - picking winners - partnering strategically ... we changed the narrarative.


      Finding/Results:
      We are at the early stages of our journey ... and will have findings/results to report at the e-Health conference. Early noteworthy successes/results include establishing a pan-Canadian partnership with the Health & Technology District in Surrey, BC.


      Conclusion/Implications/Recommendations:
      Economic Development agencies are not commonly considered to be such a key role player in Healthcare transformation, but ... ... (1) looking at Health through an ecoomic development lens first was a missing ingredient to acheiving digital healtcare transformation in our region. (2) it takes a community.


      140 Character Summary:
      Economic development agencies must work in lock step with healthcare agencies and vice versa, and there is no better time to do so - inside a digital health revolution.

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      PS06.02 - Focusing on What Works in Healthcare Innovation

      14:30 - 15:30  |  Author(s): Rohit Joshi

      • Abstract

      Purpose/Objectives:
      This panel will examine ways to inspire greater innovation in healthcare by discussing the existing innovation landscape in Canadian Healthcare and the barriers standing in the way of innovations that can improve the efficiency and effectiveness of care delivery. These experts will explore potential solutions based on decades of experience working within health technology innovation and studying the system.


      Methodology/Approach:
      These four experts will explore potential solutions to the problem of low rates of health-tech commercialization based on decades of experience working within health technology innovation and studying the system. Rohit Joshi - Heath tech CEO and lawyer with experience on both sides of the border who has lectured on compliance and patient privacy across North America Feisal Keshavjee - National Chairperson of the Canadian College of Health Leaders, Managing Director KWC Consulting (a boutique health strategy consulting firm), former head of Health strategy for Ernst & Young Consulting Dr. Deepak Kaura - Chairman of the Board of Directors at Joule, Chief Medical Officer at 1QBit, Founder at Imagine Innovation Framework Dr. Ewan Affleck - Family physician, Board of Directors at Canadian Medical Association, Former Chief Medical Information Officer in Northwest Territories where he was awarded the Order of Canada for his work to bring all patients and providers onto a single EMR.


      Finding/Results:
      Canada ranks 9 out of 11 top developed nations when looking at Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Canadians spent the equivalent of 10% of GDP on healthcare in 2014 while many higher-ranked countries spent less (https://globalnews.ca/news/3599458/canadas-health-care-system-lower-performing-compared-to-its-peers-study/). Commercialization of health technology innovations can create cost efficiencies and improve health outcomes. These speakers have experienced what works first hand,


      Conclusion/Implications/Recommendations:
      Examining the Canadian health innovation landscape will provide insight into what’s holding us back, and provide guidance for a strong path forward.


      140 Character Summary:
      Canadian healthcare innovation suffers from barriers in ideation, pilots, commercialization and procurement. What’s working in Canada?

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      PS06.03 - Digital Health Roadmap: A First Nations-Led Strategy in Ontario

      14:30 - 15:30  |  Author(s): Kimberly Lalonde

      • Abstract

      Purpose/Objectives:
      A foundational level of digital health capacity is a necessity for First Nations health centres to manage their service delivery responsibilities. Not only is this true simply for efficiency, client-safety and privacy, but interacting electronically is the de-facto standard for coordinating care with provincial partners – essential given the limited scope of health services available on-reserve. Recognizing the importance and urgency for digital health capacity in First Nations health centres, the First Nations Health Information Management in Ontario Initiative (FNHIMiO) developed a Digital Health Roadmap to support transition from paper-based processes and position First Nations in Ontario to access and use digital health tools best suited to their needs. Guided by a group of experienced First Nations Health Directors and clinical champions, FNHIMiO has systematically assessed requirements, identified corresponding tools, developed implementation processes and successfully supported several First Nations to build a foundation to effectively work in a 21st Century healthcare environment.


      Methodology/Approach:
      The FNHIMiO Roadmap approach follows a simple, pragmatic sequence: First Nation Health Centre Health Information Needs Review and Initial Change Management Privacy and Security Enhancement and Change Management Assist with Local System Adoption, Use and Change Management Support Access To/Use of Provincial eHealth Systems Develop and Implement Sustainment Model Key to this is the willingness of an initial group of First Nations to experiment with, refine and validate the Roadmap approach. Once validated, the approach is extended to other interested First Nations. In this way, FNHIMiO is now extending foundational P&S support to many First Nations, establishing information sharing agreements with provincial agencies, enabling immunization program coordination with provincial systems, and enabling access to provincial digital health assets.


      Finding/Results:
      The Roadmap approach is currently being followed by several First Nations across Ontario. The number of First Nations health centres who are benefiting from enhanced P&S capacity, digitally-enabled communications with provincial partners, and local digital health tools that improve efficiency, ease reporting burdens and improve client safety is steadily growing. Requests from other First Nations for assistance is similarly growing, as is support from First Nations leadership to leverage the work of FNHIMiO, and digital health capacity in general, to address inequities in health care for First Nations community members and support First Nations Health Transformation objectives.


      Conclusion/Implications/Recommendations:
      The FNHIMiO Roadmap approach is working. It is helping First Nations take a needs-based approach to build digital health capacity. By taking a methodological and pragmatic approach to integrate care processes with provincial partners, FNHIMiO is reducing overhead and enabling the adoption of standard models that can be extended and sustained. It is recommended that provincial partners explore opportunities to coordinate around the Roadmap approach and that First Nations in other regions explore its adaptability for their own benefit.


      140 Character Summary:
      A digital health Roadmap is bringing benefits to First Nations clients, providers and partners and supporting Health Transformation.

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    OS28 - Not Without the Patient

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 1
    • Type: Oral Session
    • Track:
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      OS28.01 - Otherworldly Immersion: Using Virtual Reality in Complex Wound Care 

      10:30 - 12:00  |  Author(s): Don Anderson

      • Abstract

      Purpose/Objectives:
      Virtual Reality (VR) is a computer generated immersive and interactive experience that “transports” the viewer into a 3D environment. VR has been shown to be effective for acute pain and anxiety, however, there are few reports of clinics using VR in Canada. The Rockyview General Hospital (RGH) in Calgary, Alberta is the first hospital in Canada to use Virtual Reality (VR) to address the management of pain and anxiety during complex wound care. The aim of this initiative was to explore and evaluate the feasibility and patient-reported effects of VR in a sample of hospitalized patients undergoing wound debridement treatments.


      Methodology/Approach:
      wound care and vr.jpgPrevious research has suggested that VR may be effective for pain reduction in various health settings (Mosadeghi, et al, 2016). The use of VR in a hospital environment poses unique challenges that community settings do not, including alignment with Infection Prevention and Control (IP&C) procedures and site policies. In collaboration with therapists in Allied Health Wound Care, the Telehealth team at the RGH selected and trialed a Samsung Gear VR headset, fitted with an Android phone to deliver VR images and sound during wound care. The immersive VR modules provided multisensory information that allowed patients the “experience” of escaping to pleasant locations and realities, such as a virtual lakeside campground, observing dinosaurs or swimming with dolphins.


      Finding/Results:
      Patients were asked to rate their level of discomfort and overall experience using surveys administered before and after VR (using a scale from 0-10). Measures of patient discomfort included patient-reported ratings of pain, nausea and anxiety. Measures of patient experience include patient-reported ratings of feelings about future treatments and overall experience. Initial results were extremely encouraging. Patient surveys reflected a 75% reduction in the patients’ perceptions of reported discomfort and a 31% improvement in overall patient experience during would care. No side effects were indicated and 100% of patients who used VR during wound care found it helpful. One additional unintended benefit of the application of VR during wound care was a qualitative decrease in the level of distress and tension reported by therapists delivering the treatment. The reported reduction in health-care practitioner stress during procedures was attributed to the overall improvement in the comfort level of patients during treatments.


      Conclusion/Implications/Recommendations:
      Building on the early success on this initiative, the team has expanded into other clinical environments including the Cardiac Care Unit and the Intensive Care Unit. Also under investigation are newer iterations of VR technology with an emphasis on improvements in IP&C, cost reduction and ease of use for both clinicians and patients.


      140 Character Summary:
      Rockyview General Hospital team evaluates the feasibility and effectivness of VR in a sample of hospitalized patients undergoing wound debridement treatments.

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      OS28.02 - Patients in Tech, a Digital Health Canada Community of Action

      10:30 - 12:00  |  Author(s): Michael Savage

      • Abstract

      Purpose/Objectives:
      Increasingly, health care organizations such as Holland Bloorview Kids Rehabilitation Hospital, Patients Canada, Health Quality Ontario, The Change Foundation, and the Canadian Foundation for Healthcare Improvement (to name a few) have redefined the meaning of Patient Engagement, through both the advocacy and practice of creating formal partnerships between patients and caregivers and their providers. Through these efforts, Patient Engagement now encompasses a spectrum of empowering relationships between these key stakeholders in the health care system. Patients and their caregivers drive dialogue and fuel decisions with their stories and experiences of their care journeys across the health care system; they sit on councils and committees as advisors on decisions relating to topics such as research, strategic goal-setting, and recruitment; they spearhead the design and implementation of patient and family portal technologies which democratize access to their own health information; and much more. So where (and how) is Digital Health Canada's Patients in Tech Community of Action breaking new ground? Patients, their family members, and caregivers are now regularly and authentically engaged as partners in hospitals and policy-making organizations, but their presence remains comparatively absent in digital health technology companies. A cursory look at the landscape of digital health solutions indicates that products with patient access and context are quickly becoming the norm. At the very least, these stakeholders expect to have access and control of the data and information central to these solutions. Continuing to build digital health solutions without the formal input and assistance of patients, their families, and caregivers will lead to a widened disconnect between digital health’s intended and actual value. The long-term goal of Digital Health Canada's Patients in Tech Community of Action is to help grow the presence of authentic patient partnerships and engagement programs in health technology companies (ranging from early-stage start-ups to larger, mature solutions).


      Methodology/Approach:
      The primary deliverable of the Community will be a Whitepaper which combines and presents stories, experiences, insights, established best practices, and lessons learned from subject matter experts representing four key areas: Patients; Caregivers/Families; Patient Engagement Professionals; and Digital Health Technology Leaders.


      Finding/Results:
      As of Fall 2018, interviews and conversations with the Subject Matter Experts are underway. As mentioned in the earlier sections, the results of the interviews with the Subject Matter Experts will be comprised of the lived experiences of Patients, Family Members, and Caregivers with regards to being on-boarded in advisory capacities in Health Technology organizations; the interviews with the Health Technology SMEs will provide the complementary perspectives. In which areas of the product management lifecycle were there opportunities for them to provide their insight? Which areas should organizations look to as 'untapped' opportunities for patient / family / caregiver partnership opportunities?


      Conclusion/Implications/Recommendations:
      It is the hope that this Whitepaper, serving as a spotlight for best practices, success stories, and impactful experiences of advisory and partnership relationships, will ultimately function as a call to action for the creation of formal commitments, strategies, and tools for the development of in-house, efficient, and meaningful Health Tech Patient Partnership Programs.


      140 Character Summary:
      Patients in Tech is committed to bringing the successes and best practices of Partnership Programs into the Health Technology space.

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      OS28.03 - Electronic Medical Records- The Next Generation

      10:30 - 12:00  |  Author(s): Karim Keshavjee

      • Abstract

      Purpose/Objectives:
      Purpose: More people are living with chronic health conditions and multiple comorbidities into an older age leading to increasing medical complexity and continually rising health care costs. Electronic Medical Record (EMR) systems have great potential to improve public health, increase quality, efficiency and safety of care as well as health equity. However, current EMR systems are all text-based and require physicians to parse large amounts of text. We are designing a next generation EMR that provides high quality visualizations to assist health care providers to gain deeper insights about patients faster and easier.


      Methodology/Approach:
      Methodology: We used the British Design Council’s Double Diamond method to design interactive visualization of patients' clinical and medication utilization data. These visualizations have been tested with a variety of physicians to get their feedback.


      Finding/Results:
      Findings/Results: A visualization of past history with timeline was well-accepted by clinicians. The timeline enables physicians to quickly gain a sense of how often a patient has come to visit the doctor –replacing a familiar ‘thick chart is a sick patient’ concept to the electronic chart. The 2-dimensional body image views provide clinicians with a quick history of patient diseases, their severity and recency. The visualization of ‘future’ medical history (i.e., predictive analytics) was also well-received, although there are many questions about how genomics will fit into the picture. The medication visualization allows clinicians to see current medications and reasons for prescribing, prior medications that were stopped and medication allergies. If given a new diagnosis, the medication visualization provides recommendations for new medications that will not interact with existing medications.


      Conclusion/Implications/Recommendations:
      Conclusions/Recommendations: We have developed several new visualizations of data in the EMR. The new visualizations support rapid review of past history, medication history, ‘future’ history (predictive analytics), patient engagement and team-functioning. Furthermore, it addresses emerging requirements including genomics, artificial intelligence and personalized medicine.


      140 Character Summary:
      140 Character Summary: New visualization designs point to features that will be in the Next Generation of Electronic Medical Records.

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      OS28.04 - An Analytic Framework to Enhance User Centered Digital Design 

      10:30 - 12:00  |  Author(s): Derek Risling

      • Abstract

      Purpose/Objectives:
      Purpose: There are unique challenges to the pursuit of user-centered design within the healthcare setting, yet this work is essential in advancing collaborative digital solutions. Engagement in user-centered development can alleviate barriers associated with the successful uptake, and sustained use, of new technologies. The value of interdisciplinary approaches for effective digital health design has also long been recognized, but there are difficulties in consistently enacting this. Disparate views and methods between health and computer science can create conflict when determining an ideal approach in digital design. The purpose of this project was to pursue a novel interdisciplinary approach to the development and evaluation of patient-centered technologies through the creation of a new analytic framework for these investigations.


      Methodology/Approach:
      Approach: There are foundational differences in how health and computer scientists engage potential users of newly emerging technology. Anticipating benefits for both process and user in seeking a collaborative solution to this variance, the use of an interdisciplinary framework was explored. By uniting the qualitative methodology and rigour of interpretive description (ID), originated in nursing, with an analytic framework founded on tools and best practices from the software development life cycle (SDLC), a new opportunity emerged. ID methodology was developed to address clinical healthcare questions or needs in a pragmatic and outcome focused manner. It is a qualitative approach that requires researchers to employ coding methods to ascertain a valid interpretation of the participant data. However, there is no particular prescribed analytic process. As such, the method served as an ideal foundation on which to layer a framework for analysis founded on software requirements required for successful solution development.


      Finding/Results:
      Results: The new framework has been deployed in two research projects: 1) The design of a mobile application to support pediatric patients with a specific chronic condition undergoing transition to adult care; and, 2) The development of an acute care pediatric portal for families and care partners. The analytic tool promotes potential code groupings or categories aligned with software development artifacts such as personas (amalgamated profiles of potential users), use-cases (descriptions of interaction between persona and software), and user stories. However, it also supports a full ID analysis, with the interpretations done to date providing insights into potential barriers for integrating the technology into the targeted healthcare context. The result has been an ability to take user data and determine not only the functional and non-functional requirements for a successful technological intervention, but also identify who might serve as champions during the implementation of the solution.


      Conclusion/Implications/Recommendations:
      Recommendations and Conclusions: This framework is a practical means to integrate a software perspective with an emerging health-focused interpretative description in the advancement of user-centered design. In this presentation, details of the framework development will be shared, along with data analysis examples of how it has been employed. Some interdisciplinary lessons learned, as well as feedback from patient and practitioner users will also be highlighted. Resources and recommendations on how to adopt this inclusive approach in numerous clinical settings will be provided.


      140 Character Summary:
      User-centered design in healthcare presents unique challenges. This new interdisciplinary analytic framework can be part of the solution.

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      OS28.05 - Development of a Toxicity Management Electronic Tool: Defining Functionality

      10:30 - 12:00  |  Author(s): Vishal Kukreti

      • Abstract

      Purpose/Objectives:
      Cancer treatment can result in numerous toxicities that can range from mild and temporary to severe, chronic and debilitating. Symptom burden and ineffective management of treatment-related toxicities can lead to high rates of emergency department (ED) visits and hospitalizations. Toxicities can be better managed through timely patient access to symptom screening, symptom management advice and alerts to the healthcare team via an electronic tool (eTool). In other jurisdictions, there are successful examples of tools/technologies, paired with models of care, to enable self-management of symptoms and toxicities during cancer treatment. Recent data has shown a survival benefit for patients using electronic symptom reporting during outpatient chemotherapy. To develop a toxicity management eTool for our jurisdiction, we undertook a rigorous process to define desired eTool functionality. The process included extensive stakeholder consultation to ensure user-centred design. The objective was to define functionality for a toxicity management eTool that would meet the needs of various users.


      Methodology/Approach:
      Defining “user stories” was chosen as the process to identify eTool functionality. User stories are statements of a user’s need or expectation for what the eTool must do. To elicit user stories, a standardized template was given to oncology providers who were asked to write cases from their perspective/role. The exercise was first completed with clinical leaders and directors within the cancer agency, then validated with healthcare providers from various cancer centres. Interviews were conducted to identify user stories from patients. Patients were asked open-ended questions on potential eTool functionality i.e. symptom tracking and their desired use. Interviews were done first with Patient and Family Advisors (PFAs) and then validated with a convenience sample of patients from four hospitals.


      Finding/Results:
      The user story template was sent to 27 providers: 12 completed the exercise (including nurses, physicians, pharmacists, and administrators); 11 PFAs and 27 patients from four hospitals were interviewed to understand their desired eTool functionality. In total, 133 user stories were defined and sorted into 10 clearly-defined categories: symptom tracking, symptom management advice, self-management resources, alerts, personalization, treatment information, medication adherence, local configuration, integration, data capture and reporting. Subsequently these 10 categories were further validated in a structured workshop with 106 multidisciplinary stakeholders from various care settings.


      Conclusion/Implications/Recommendations:
      The user-story exercise was valuable to understand provider and patient perspectives and thus to define eTool functionality that will meet the needs of diverse user needs. Undergoing a robust process to define the functionality of a toxicity management eTool will result in a tool that will have greater uptake and impact on patient experience and outcomes. abstract image.png


      140 Character Summary:
      Defining functionality for a Toxicity Management Electronic Tool: understanding patient and provider needs through user stories.

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      OS28.06 - Evaluation of an iPad-Based Memory Wellness Program

      10:30 - 12:00  |  Author(s): Indra Arunachalam

      • Abstract

      Purpose/Objectives:
      integratedliving Australia delivers an innovative suite of Wellness for Independence programs. It is a comprehensive range of research programs that enable older people to have an e-health enabled clinical assessment and access to a preventative health promotion program. The purpose of the Wellness for Independence programs is to build health literacy, facilitate timely diagnosis, enable early intervention and empower self-management amongst older people and their carers. The program has two components – clinic and course. Participants are screened for dementia and referred to other services if problems are uncovered. Whether or not dementia is diagnosed, the focus is on addressing risk factors to delay symptom progression, prevent complications and acute exacerbations, support and improve co-morbidities and overall health for increased quality of life. Participants are supported to take part in the eight week nurse-led Memory Wellness Program which targets dementia risk reduction through participants’ setting their own wellness goals against four domains: nutrition, physical activity, social isolation and stress reduction. The participants were provided with a Participant Guide, an iPad and data plan. This study sought to evaluate the effectiveness of the new Memory Wellness program.


      Methodology/Approach:
      In 2017 integratedliving Australia and the University of Tasmania undertook a study to evaluate the effectiveness of the first program – the nurse practitioner developed, community based ‘Memory Wellness’ program. The program enables older people to take control of their Brain Health via timely assessment, memory wellness and dementia prevention choices and actions. The purpose of the Memory Wellness Program is to enhance an older person’s brain health so that they can remain well and independent, at home. The research used mixed methodology. Pre and post clinical data was collected from 179 older people across thirteen locations in three states of Australia. Additionally, 15 interviews were undertaken in Tasmania. Post data collection was carried out three months after commencing the program. Paired t-tests were carried out on all clinical data.


      Finding/Results:
      There were statistically significant changes in cognitive scores (ACE-III) and stress level (DASS – Stress). Overall interviewees were happy with the program, and in particular working in a group with peer support.


      Conclusion/Implications/Recommendations:
      This study demonstrated that a community based wellness program such as Memory Wellness could result in an increase in cognitive function scores, and a decrease in stress levels over a three month program. Findings from this study was used to review the Wellness for Independence® program structure in July 2018.


      140 Character Summary:
      Evaluation of a community based memory wellness program for older people finds it can improve their cognition score and decreased their stress levels.

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    OS29 - Virtual Care in Mental Health

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 2
    • Type: Oral Session
    • Track:
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      OS29.01 - TELEPROM-Y: Mental Healthcare for Youth Through Virtual Models Of Care

      10:30 - 12:00  |  Author(s): Cheryl Forchuk

      • Abstract

      Purpose/Objectives:
      The Youth Telemedicine and Patient-Reported Outcome Measurement study (TELEPROM-Y) is evaluating the implementation of remote care delivery in the treatment of youth with mental health disorders using InputHealth’s Collaborative Health Record (CHR) at two large outpatient mental health facilities in London, Ontario. Youth are connected to their healthcare team through the Collaborative Health Record (CHR), which allows communication, care and engagement between youth and their healthcare provider (HCP). The CHR has the ability to: book appointments online; track quality of health and health outcome scores using mobile devices; access tailored educational content pertaining to their mental health; and engage in both synchronous (e.g. video-conferencing) and asynchronous (e.g. secure messaging) virtual visits with their HCPs. The HCPs have site-specific CHR accounts, and are able to add respective patients onto the platform who wish to participate in this method of care. The CHR’s mobile capabilities can increase communication between youth and their HCPs as well as increase access to healthcare services for youth in rural regions. TELEPROM-Y is evaluating the usage of remote care delivery in the form of patient outcome tracking and virtual face-to-face visits in the treatment of youth with depressive symptoms. The specialized mobile software evaluates its ability to: 1) improve ease of access to care; 2) monitor mood/behaviour changes for earlier intervention; 3) enhance youth/HCP information exchange; and 4) improve the patient experience. The ultimate goal is to provide supportive systems within an individual's natural environment to promote community integration.


      Methodology/Approach:
      This two-year project, currently underway, is a longitudinal study and uses participatory action research (PAR) with mixed methods research design. TELEPROM-Y is recruiting up to 120 youth research participants (16-25) from the caseloads of 23 mental healthcare providers (employed with mental health agencies in the London and Woodstock). All participants (i.e., both youth and care providers) have been invited to attend 3 focus groups throughout the study to share their experiences with and perception of the technology. Semi-structured interviews have been conducted at 6, 12 and 18 months. Measures include a demographic questionnaire, Community Integration Questionnaire-Revised (CIQ-R; Callaway et al., 2014), Lehman's Quality of Life (Lehman, 1988), EQ-5D, health and social services utilization, and perception of technology. Common qualitative items include feedback from youth on what they do and do not like about the technology, and suggestions for improvement on ethical principles. A thematic analysis will be performed on qualitative data collected from interviews and focus groups.


      Finding/Results:
      The findings will focus on lessons learned from implementation this intervention. In particular we will highlight youths’ responses to the Perception of Technology questionnaire. Qualitative findings from focus groups will also be provided to highlight similarities and differences in perceptions of youth and their HCPs regarding this intervention.


      Conclusion/Implications/Recommendations:
      It is envisaged that TELEPROM-Y will: 1) improve healthcare outcomes and patient quality of life; and 2) reduce healthcare system costs by preventing hospitalization and reducing the need for outpatient visits. However, understanding first the perceptions of HCP and youth of the technology will be an important beginning step.


      140 Character Summary:
      Potentially revolutionize how patients and HCPs interact, leading to early intervention, better patient outcomes, and a more cost-effective healthcare system.

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      OS29.02 - Innovative Approaches to Leverage Technology to Build Mental Health Capacity

      10:30 - 12:00  |  Author(s): Anne Kirvan

      • Abstract

      Purpose/Objectives:
      Presentation Objectives: Describe telehealth programming and how it proposes to address geographic disparities in access to care. Demonstrate how technology can be used to leverage scarce healthcare resources in remote areas. Explain different multi-disciplinary approaches that exist and how they can be used to build mental health capacity and collaboration in primary and community care settings. Purpose: A high proportion of mental health and addictions care is managed within primary care; however, primary care providers (PCP) have limited access to psychiatric support. The rise of telehealth programming provides one answer to this growing need; however, challenges to building mental health capacity in primary care still exist, particularly in remote and under-serviced areas.


      Methodology/Approach:
      CAMH and the University of Toronto launched the first Canadian Project Extension for Community Healthcare Outcomes (ECHO) program focused on mental health care, ECHO Ontario Mental Health (ECHO-ONMH). ECHO is a tele-mentoring model that uses a virtual community of practice to leverage scarce healthcare resources in rural communities. PCPs connect with a specialist team as well as providers practicing in similar settings to discuss complex real-world patients, share knowledge, and learn best practices in the management of complex chronic illness. CAMH has also implemented an integrated care model (ICM) of telepsychiatry that virtually embeds a dedicated CAMH psychiatrist on a community based organization (e.g., Family Health Team or Community Health Centre) via videoconference, for the provision of both direct and indirect care. This model increases access to psychiatric services; increases continuity of care for patients and providers; and enhances PCPs’ ability to manage their clients mental health needs.


      Finding/Results:
      To measure its impact on access and effectiveness of building mental health care capacity, ECHO-ONMH has adopted the use of Moore’s evaluation framework for continuing education programs. Program evaluation findings have provided evidence for Project ECHO as a model for maintaining high participant engagement, satisfaction, and retention rates while increasing mental health capacity in primary care. CAMH Telepsychiatry, as part of its ongoing efforts to improve patient care and program development, is conducting a feasibility study to compare patient outcomes between the ICM and the general model. The findings from the telepsychiatry research study will help to inform quality improvement initiatives, will contribute to the evidence-base around best practices in telemental health, and will help guide future innovations in care delivery.


      Conclusion/Implications/Recommendations:
      In this presentation, we will describe two innovative mental health outreach models in terms of capacity building, community engagement, and evaluation. Participants will engage in discussion regarding how to leverage technology to increase access to quality mental health services.


      140 Character Summary:
      In this presentation, participants will learn about two innovative and interdisciplinary approaches to mental health outreach at CAMH.

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      OS29.03 - A Mobile Early Stimulation Program Supporting Children with Developmental Delays

      10:30 - 12:00  |  Author(s): Raquel Dias

      • Abstract

      Purpose/Objectives:
      In Brazil, child developmental delays has became a major public health concern after the Zika virus outbreak. Early Stimulation Program (ESP) is a standardized intervention to treat developmental delays in children (aged 0-3 years) through a series of specialized exercises that help the child achieve the age-specific developmental milestones. Limited ESP are available in specialized therapeutic centers due to lack of healthcare resources. As such, Brazilians face significant challenges to access ESP and as a result several children do not get the required ESP and end up with permanent cognitive impairment. Our objective is to leverage digital health technologies to provide accessible, affordable and personalized ESP that can be administered by the child’s family at home. This objective is pursued by a mobile health application—i.e. BraziLian Early Stimulation System (BLESS)—that offers (a) clinical decision support to assist healthcare professionals to prescribe a personalized ESP to a child with developmental delays; (b) self-management support to enable the child’s family to administer the prescribed ESP in a home-based setting.


      Methodology/Approach:
      To develop personalized ESP, our approach is to implement the developmental milestones advocated by WHO and the International Classification of Functioning and Disabilities. These developmental milestones are being pursued by taking the “prepared-informed-motivated” approach (based on the Innovative Care for Chronic Conditions) to educate parents to deliver ESP to their child at home. Based on the Brazilian Early Stimulation Guidelines we have developed an Early Stimulation Activities (ESA) database that comprises cognitive development exercises that are classified by age, impairment level and complexity of execution. We have developed a decision logic that guides the healthcare provider to select and personalize ESA to generate a ESP in line with the child’s developmental challenges. To educate the child’s parent on how to perform the ESA, educational videos and messages about the ESA are sent to the parent’s mobile phone as per their child’s prescribed ESP. Knowledge translation strategies to engage the stakeholders (health team, families, and local experts) are pursued.


      Finding/Results:
      BLESS comprises a web-based clinical decision support platform for health professionals and a mobile health app for families. The therapist platform provides assessment, monitoring and management support, helping them to perform standardized child assessment and therapy planning in a shared care planning environment. BLESS offers a comprehensive platform for ESP, including registering patient and family; assessing child’s developmental needs and the family’s efficacy to perform ESP; selecting and personalizing ESP; and monitoring the child’s overall ESP progress. The BLESS mobile app offers ESP educational material in terms of short videos and step-by-step instructions written in the plain language); a diary for capturing child’s progress and monitoring parent’s engagement; and the overview of child’s progress.


      Conclusion/Implications/Recommendations:
      BLESS will be deployed at the Mother and Child healthcare centre in the Northeast of Brazil for a pilot study to assess the intervention impact on child’s development and parent’s engagement. BLESS is an innovative digital health based solution to administer ESP at home to overcome a child’s developmental challenges and help the child lead a normal life.


      140 Character Summary:
      BLESS is an innovative mobile system that provides personalized early stimulation program, to empower and educate parents of children with developmental delays.

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      OS29.04 - Embedding Virtual Care in the Delivery of Mental Health Services

      10:30 - 12:00  |  Author(s): Laura Prado

      • Abstract

      Purpose/Objectives:
      Mental Health and Substance Use Services on Vancouver Island embeds Telehealth into their workflows to enhance access to Mental Health Services and expand the reach of their clinicians, while improving continuity of care.


      Methodology/Approach:
      The program is taking bold steps to extend the use of the technology to support the needs of individuals attending supervised consumption sites and of those clients confined to tertiary residential mental health facilities, and their families. The Pandora Avenue Health Centre in Victoria hosts a Supervised Consumption site where Telehealth enables psychiatrists to enhance continuity of care for the at risk population. Outreach workers can take advantage of access to the technology to be able to offer access to timely services in the pursuit of improved outcomes for the clients who are unlikely to attend appointments at other facilities… or at all. Clinicians now also leverage Telehealth within the context of residential tertiary facilities. At Seven Oaks, psychiatric care is delivered through video to patients confined to the facility, even when the clinicians are off-site. In addition, the service allows for families to maintain connections with their relative, who may be a long term resident. Decision-making events can now include input and support from family members living remotely. Within the group of communities of Oceanside, Mental Health clients have historically experienced long waits for psychiatric services. With only one on-site psychiatrist available at the Oceanside Health Centre to see patients in the community, patients either had to wait or travel from their community to see a physician, making access to care difficult for Oceanside’s older and aging population. For people with less urgent conditions, their waits were even longer. Telepsychiatry was introduced at the Oceanside Health Centre April 2018. The local on-site mental health team reviews client lists and triage individuals based on their need and suitability for telehealth consultations. Eligible patients are now given the option to be treated via Telehealth. In Campbell River and Port McNeil an emergency Psychiatry telehealth support model has been operational for several years, ensuring that patients that present with a risk of self-harm, or that are deemed a possible risk to others, receive timely access to mental health assessment and support.


      Finding/Results:
      Clients at the Pandora Health Centre and those at Seven Oaks have received enhanced access to care as a result of Telehealth. At Oceanside, over 100 patients have seen a psychiatrist through telehealth, resulting in reduced wait times and improved access to service. The emergency service in the North Island has delivered timely interventions since its inception, and has provided a model for replication.


      Conclusion/Implications/Recommendations:
      The mental health telehealth program allows mental health teams to focus on delivering the most appropriate level of care possible, for clients in diverse settings, including urgent outreach and in residential care.


      140 Character Summary:
      Mental Health and Substance Use Services at Island Health leverage Telehealth to enhance access, expand the reach of clinicians, and improve continuity of care.

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      OS29.05 - Video-based Usability Testing for Healthcare IT: Making it Practical

      10:30 - 12:00  |  Author(s): Andre Kushniruk

      • Abstract

      Purpose/Objectives:
      Over the past several decades the authors have developed video-based usability testing methods for evaluation of applications ranging from research prototypes to commercial systems. An issue that has come up has been the resources and time needed to carry out such evaluations. In this presentation we discuss a suite of practical approaches we have developed for streamlining and facilitating the process of usability testing of healthcare IT.


      Methodology/Approach:
      Our approach has involved the combination of 4 methods: 1.Applying low-cost in-situ usability testing approaches – We deploy an approach where we set up low-cost recording equipment at the actual sites where the software being tested will be rolled out or where they are representative of such sites (i.e. “in-situ testing”). The advantage of this includes reduced cost as the setting does not have to be recreated artificially. In addition, in many of our evaluations we have worked to provide the ability of the organization (e.g. hospital) where the testing is done to continue and carry on once the initial study is over. 2.Integrating screen recordings from multiple devices and systems – This allows for collection of digital video data from different types of systems and applications (e.g. desktop and mobile apps) during studies. 3.Use of pilot studies – Many of our projects have started with modest proof-of-concept usability studies that have been scaled up. On selected projects we have also conducted cost-benefit analyses to demonstrate to healthcare organizations the value of doing usability analyses (particularly when doing initial pilot studies) 4.Using pragmatic video analysis tools and coding schemes – One of the ways in which we have streamlined the time and effort needed has been the development and application of pragmatic video-coding methods, in particular development of usability coding schemes that can reduce time for analysis of usability data.


      Finding/Results:
      An example of a study we have carried out applying the above approaches will be described. The study involved analysis of clinical decision support guidelines that were to be integrated into a commercial electronic medical record (EMR) at a major healthcare organization. A staged approach to usability testing was carried out, with basic usability testing first being conducted, followed by in-situ usability testing (applying low-cost mobile recording methods). It was found that applying two rounds of usability testing (one initial pilot involving recording of users reacting to artificial cases, and a second conducted as an in-situ clinical simulation) led to identification of a range of usability and workflow issues that were identified and then rectified by the implementation team. Once the optimized system was released on a wide scale, there was a high level of clinician adoption of guideline recommendation.


      Conclusion/Implications/Recommendations:
      Low-cost rapid methods for conducting usability testing now exist and should be disseminated widely to improve the use, usability and adoption of health information systems. The approach described is practical and can be applied at low cost in a range of settings. The methods can be used to improve system uptake and adoption.


      140 Character Summary:
      This presentation describes a practical approach to conducting low-cost rapid usability testing of health information technology.

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      OS29.06 - Gathering Perspectives: Strategy for emental Health Services in Atlantic Canada

      10:30 - 12:00  |  Author(s): Krista Balenko

      • Abstract

      Purpose/Objectives:
      Currently in Canada, there is a need for increased specialty and community services to meet the rising prevalence of mental illness in almost all ages and their use of hospital and emergency services. Instead, individuals with mental health problems experience great difficulties accessing high-quality services for their mental health needs. There are many reasons why access challenges exist such as cost of services, public system capacity, stigma, and user knowledge of health system. Digital health solutions can address some of these challenges by supporting citizens where and when they need mental health & addictions (MH&A) services. The primary objectives in developing a strategy for the Atlantic were to: Identify major problems with existing MH&A system Develop priorities for addressing the problems Generate eMH&A tactics for Atlantic Canadian provinces that addresses their unmet need in mental health.


      Methodology/Approach:
      Objectives were achieved through several iterative, concurrent, data collection and analysis methods. This included a review of scholarly and grey literature, then performing environmental scans of existing initiatives across Atlantic Canada. Using this information, stakeholder consultations were held in each province to identify existing services and priorities of unmet needs. Finally, this information was synthesized with the knowledge gained in additional stakeholder meetings to develop an evidence informed approach to the design and implementation of digital mental health solutions in Atlantic Canada.


      Finding/Results:
      After various consultations with key stakeholders in Atlantic Canada, the results indicate that there are problems with individuals using the Emergency Department as the first point of contact for MH&A concerns. This is driven by the issue that individuals do not know where to find care or are reluctant to seek it. A third problem was the limited availability of treatment types that results in long wait times. Four priorities emerged from these problems including: investing in early prevention, improving mental health literacy, improving access to high intensity care, and increasing choices of care options. Two tactics [F,A1] [B,K2] were proposed as an initial step for action including: (1) develop and initiative for individuals to discover and navigate MH&A services through a digital channel by providing an inventory of services using common directories; and (2) pursue an evidence based eMH&A service that will serve as an initial pan-Atlantic service


      Conclusion/Implications/Recommendations:
      Launching initiatives that help Canadians discover and navigate MH&A services through one channel providing an inventory of services using common directories, with access to tools, and a set of curated eMH&A services has the potential to increase access to services.


      140 Character Summary:
      Improving digital Access to innovative treatment options for people with mental health and addiction issues.

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    OS30 - What's New in Medication Management

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 3
    • Type: Oral Session
    • Track:
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      OS30.01 - Old Becomes New: Revitalizing Medication Ordering Practices After 15 Years

      10:30 - 12:00  |  Author(s): Marsail Wanis

      • Abstract

      Purpose/Objectives:
      University Health Network (UHN) first implemented electronic medication order entry and administration in 2004. Since then, clinical best practices and system technologies have notably evolved. However, the organization had not established formal processes to periodically evaluate 1) existing medication screens from a UHN-wide clinical perspective and 2) opportunities to implement system upgrades that optimize medication order entry. Today, medication screens have accumulated long lists of order options, inconsistent layout standards, and non-customized dosing intervals. These contribute to prescriber confusion and frustration, risking prescribing errors. In June 2017, a project focused on updating medication screens became a UHN priority. The project’s purpose is twofold: 1) to simplify existing order entry screens to support easier, clearer, and consistent prescribing of medications and 2) to implement a formal process that sustains and carries forward the benefits of this work. This abstract highlights the development of electronic medication build standards, its application and associated interim benefits, and describes the emergence of the EPR Medication Order Request for Additions & Revisions (EMORAR) Subcommittee.


      Methodology/Approach:
      Analysis of the implemented EPR system was conducted by UHN’s Data and Implementation Science senior analysts and Pharmacy Informatics specialists. Multidisciplinary stakeholder consultations informed the project’s guiding principles for improving electronic medication ordering, and new layout and display standards. These were evaluated by UHN Healthcare Human Factors team and approved by Safe Medication Practice (SMP) and Pharmacy & Therapeutics (P&T) committees. Applying the standards, prototypes are developed by project’s clinical pharmacist. UHN references (ex. policies, department specific handbooks, nursing manuals), UHN clinical tools, and UHN-wide data are used to justify modifications. The prototypes are reviewed by a therapeutic-specific Clinical Working Group (CWG) consisting of pharmacists and nurse practitioners. Subsequent iterations are reviewed by physician expert representatives. Additional stakeholders are engaged as needed. Microsoft Excel is used to document 20 metrics describing pre and post screen changes. Regular interim reporting is completed for 3 key clinical metrics from a user-perspective which includes the difference in means and percent change.


      Finding/Results:
      As of October 2018, 79 medications have been updated. The table below defines the 3 metrics and summarizes the most current results.table. percent change in order options visible to front-line prescribers.jpg


      Conclusion/Implications/Recommendations:
      UHN recognized the need to establish proper committee infrastructure to maintain electronic order entry practice in a well-kept state. A new P&T Subcommittee (EMORAR) led by clinical pharmacy and pharmacy informatics co-chairs was established. This subcommittee maintains integrity of electronic medication screens standards by reviewing change requests and overseeing initiatives involving enhanced system capabilities. New today becomes old tomorrow, hence formal processes are necessary to ensure evolving clinical best practice is supported by existing technology effectively.


      140 Character Summary:
      Old becomes new: Revitalization of medication ordering practices to meet new build standards at University Health Network’s acute care hospitals.

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      OS30.02 - Enhancing the Electronic Discharge Process for Medication Reconciliation

      10:30 - 12:00  |  Author(s): Patricia Ryan

      • Abstract

      Purpose/Objectives:
      Many complex patients experience medication-related adverse events at the time of discharge from hospital. Previous work at Queen Elizabeth Hospital (QEH) identified care gaps that potentially impact adverse events (ref). Specifically, discharge reports containing important medication information were not communicated to community care providers complicating the continuum of patient care. The primary objective of this study is to determine the feasibility of electronically providing patient discharge reports directly to community pharmacy for the purposes of medication reconciliation. The secondary objective is to determine the impact of the improved communication process on emergency department (ED) visits and readmission rates within the first 8 weeks of hospital discharge in a small pilot of patients compared to standard care


      Methodology/Approach:
      Eligible patients (n=100) identified as complex (taking >5 medications) will be consented just prior to discharge and will provide their community pharmacy contact information from a list of participating pharmacies. Participating community pharmacies will be randomized into two groups receiving either electronically transmitted discharge reports through commercially available software (Access Point Consultant, PASI) or paper copies only (standard care). Initial follow-up with community pharmacists will occur within 4 days of patient discharge to assess numbers of received discharged reports and medication issues (e.g. clarifications, corrections etc.) associated with them. Study participants will be followed to determine if they returned to the hospital at weeks 1, 4, and 8 post-discharge. Pharmacies receiving commercial software will also receive a pharmacy-connected mobile application (Your Health Report, Health QR) to offer their patients to view their complete medication profile and manage their medications. Patients will be asked to provide initial feedback on managing their medications through this platform.


      Finding/Results:
      Previous work identified only 17% of all discharge reports were received at the community pharmacy. Of the reports that were received, pharmacists reported that some information was missing or unclear prompting follow-up discussions with the hospital. The current follow-up study has gained approval from Health PEI and is currently undergoing research ethics review.


      Conclusion/Implications/Recommendations:
      This study will evaluate the feasibility of electronically providing discharge reports from a tertiary care centre, with electronic processes already in place, to community pharmacy. The impact of improved electronic communication between community pharmacy, hospital, and patients on subsequent care needs will also be assessed. Final recommendations will include considerations for fully integrated technology requirements for sustained communication between hospital and community pharmacy. References MacDonald K, Cusack M, Qiong S, Lang R, Rinco K. (2017) Care gaps in the electronic discharge medication reconciliation process at an acute care facility. Can J Hosp Pharm. 70(6):430-4.


      140 Character Summary:
      Can pharmacy-integrated technologies improve the communication of medication reconciliation directives at discharge between hospital and community pharmacy?

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      OS30.03 - Developing ActionADE: Integrated Software for Adverse Drug Event Reporting

      10:30 - 12:00  |  Author(s): Serena Small

      • Abstract

      Purpose/Objectives:
      Adverse drug events (ADEs) are the harmful and unintended consequences of medication use, and are a leading cause of emergency department visits and hospital admissions in Canada. There is a strong need to bridge gaps in informational continuity of care related to ADEs. ActionADE is a user-driven software application that enables the documentation and communication of patient-specific ADE information across a patient’s circle of care, while also meeting national adverse drug reaction reporting requirements under Vanessa’s Law. The objective of this presentation is to report on the development, build, and pilot-testing of ActionADE completed to date.


      Methodology/Approach:
      ActionADE was developed in conjunction with clinician end-users beginning in 2014. Using a participatory design and action research methodology, the design of ActionADE was informed by a systematic review of existing ADE reporting systems worldwide, extensive qualitative observations, workshops with clinicians, and paper- and web-based pilot testing in one acute care setting in British Columbia. Latest developments in this research program have culminated in the pilot testing of a standalone web-based version of the application among pharmacists. Consistent with previous phases of the research project, the research team has engaged with end-users through workshops, individual on-boarding, and qualitative data collection. This has enabled the iterative refinement of the system, identification of bugs and enhancements, and an understanding of impact on workflow. Utilization statistics were collected to evaluate use and report completion.


      Finding/Results:
      ActionADE has been designed to integrate ADE documentation into existing clinical workflow processes, enabling multiple provider groups (e.g., pharmacists and physicians) to contribute information to the construction of possible ADE reports that may be completed over time and across care settings. The design process allowed us to mitigate social issues (e.g., uncertainty) and technical issues (e.g., appropriate data fields), resulting in software that is both clinically useful and user friendly, while also producing valuable ADE data as a byproduct of enhanced care. Utilization statistics from the pilot implementation phase show high uptake among users who have significantly increased documentation of ADEs through the use of ActionADE. Field completion and report completion rates are high. Early qualitative research enabled the identification and resolution of 28 software bugs and 74 enhancements. Users are satisfied with the clinical relevance and ease of use of ActionADE. Issues concerning data sources for pre-defined pick lists and user experience have been resolved.


      Conclusion/Implications/Recommendations:
      ActionADE is a robust, user-centered software. In the near future, ActionADE will be integrated into existing province-wide clinical information systems with the support of the provincial Ministry of Health and relevant health authorities. This will enable communication of ADEs across a patient’s circle of care, closing critical gaps in information sharing, which will ultimately contribute to the reduction of ADEs by preventing the re-dispensation of medications that have previously caused harm, while also resulting in cost avoidance.


      140 Character Summary:
      ActionADE is software developed to enable the documentation and communication of ADEs across a patient’s circle of care to close critical gaps in communication.

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      OS30.04 - Digital Order Sets: Change, Challenge, and Success in NW LHIN

      10:30 - 12:00  |  Author(s): Margie Kennedy

      • Abstract

      Purpose/Objectives:
      Quality of care is a key initiative across Ontario with significant effort directed at establishing standardized levels of care and metrics for evaluation and ensuring that evidence-based support is available to clinicians and leaders to inform quality initiatives. Health Quality Ontario (HQO) is the provincial advisory body that defines quality, analyzes quality dimensions across Ontario, and creates education and practice materials to support the achievement of quality care. As part of this effort, expert advisory panels were assembled to develop comprehensive handbooks guiding Quality–Based Procedures (QBPs) to foster sharing best practices enabling improved quality, efficiency, and outcomes. The Northwest Local Health Integration Network (NW LHIN), established in June 2005, is headquartered in Thunder Bay and includes Thunder Bay and Rainy River Districts and most of the Kenora District. With the support of hospital Chief Executive Officers (CEOs), clinicians approached the NW LHIN seeking to establish a project to advance the implementation and adoption of digital order sets as the NW LHIN hospitals continue to work towards standardization of clinical pathways. Electronic order sets act as checklists that contain current evidence-based, best practice treatment options in a single document that follows the cognitive flow of a clinician and in Ontario, QBP handbooks were used to inform the development of standardized digital order sets. The purpose of this presentation is to share the journey of adopting digital order sets at Thunder Bay Regional Health Sciences Centre and across the NW LHIN.


      Methodology/Approach:
      A collaborative process of development, refinement, local adaptation and approvals is essential to success and requires a well conceptualized and executed change management approach. A change management team was established at the TBRHSC, consisting of the champion, project leader, and two part-time trainers/implementation quality resources. It took an average of 5 weeks to hit milestones and approximately 9 months overall to implement a digital order set. Essential steps in the implementation process included targeted training at convenience times, champion support, active follow up on adherence gaps, remedial training and support, and regular walkabouts to foster enthusiasm and awareness among all staff.


      Finding/Results:
      At present, the NW LHIN, together with its champions and partners, has translated more than 40 QBPs into digital order sets, with the most recent being the opioid order set currently in pilot phase. More than 83 hospitals in the LHIN are participating in the digital order set initiative. What was also discovered is that a standardized change approach is not optimal for a distributed network of hospitals that have significantly differing contexts. While the shared goals of quality are consistent, change approaches in less urban areas must be more customized and supported recognizing local resource and capacity constraints.


      Conclusion/Implications/Recommendations:
      Order sets have been shown to improve patient safety and outcomes (including a reduction in avoidable 30-day readmissions) in hospitals and outpatient clinics in several studies. Significant progress has been achieved across the NW LHIN to inspire continued effort and customization of change approaches ensuring that all sites in the NW LHIN benefit from this innovation.


      140 Character Summary:
      Digital order sets are a critical way to improve quality care through standardization, best practice, current research, and customization to the local context.

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      OS30.05 - Implementation of electronic prescribing in Quebec

      10:30 - 12:00  |  Author(s): Aude Motulsky

      • Abstract

      Purpose/Objectives:
      Since 2013, Quebec has been operating a centralized e-prescribing network allowing the electronic transmission of prescriptions between prescribers from primary care and pharmacies across the entire province. The objective of this study was to describe the implementation of the system.


      Methodology/Approach:
      A longitudinal descriptive analysis of aggregated usage data, obtained from the Ministry of Health, from July 2017 to March 2018 was performed. An observational exploratory study was also conducted in a typical pharmacy, selected from the region with the highest utilization in the province, to estimate the proportion of different types of prescriptions. All prescriptions dispensed from Monday June 11 until Friday June 15 2018 were collected from the pharmacy registry and analyzed according to their type (manuscript, verbal, fax, printed, electronic).


      Finding/Results:
      In March 2018, 3 946 prescribers sent an electronic prescription (eRx) through the system using a certified EMR. Figure 1 presents the proportion of prescriptions that were dispensed, sent electronically and retrieved electronically from July 2017 to March 2018. On average, only 11% of prescriptions were sent electronically by the prescribers. From those electronic prescriptions, 14% of them were retrieved in pharmacies, Hence, only 1.9% of all dispensed prescriptions in the province were electronically transmitted and retrieved. In a typical pharmacy of Lanaudière, 34% of all dispensed prescriptions were eRx (Table 1). Interestingly, another 20% of prescriptions were printed using a certified EMR, but were not transmitted to the eRx system, and pharmacists had to enter the prescriptions manually. This observation suggests that despite an increased adoption of the electronic prescribing system, its transmission feature might be an issue. Figure 1. Adoption of electronic prescribing by prescribers (eRx sent) and by pharmacists (eRx retrieved) in comparison to the total amount of Rx dispensed in the Province, July 2017 — March 2018 Table 1. Proportion of each type of dispensed prescriptions in a typical pharmacy in the region with the highest adoption by prescribers Prescription type Proportion (%) Manuscript 23 Typewritten form 6 Fax 15 Verbal 2 EMR generated - printed only 20 EMR generated - printed and electronically transmitted 34


      Conclusion/Implications/Recommendations:
      The adoption of the e-prescribing system is low, both by prescribers and pharmacies. This observation might be in part attributable to the incomplete implementation of the system, where pharmacists are asked to wait for the paper copy of the prescription to electronically retrieve it. Further work is needed to facilitate adoption and increase the potential of a now promising technology that has managed to overcome many of the pitfalls of such systemic networks.


      140 Character Summary:
      This study demonstrates that the adoption rate of e-prescribing by prescribers and dispensers in Quebec is still low. The transmission feature seems to be an issue.

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      OS30.06 - Stakeholder engagement and e-prescribing

      10:30 - 12:00  |  Author(s): Seema Nayani, Tania Ensor

      • Abstract

      Purpose/Objectives:
      This presentation details Canada Health Infoway’s approach in the implementation of a national e-prescribing service. As this innovation has the potential to change how healthcare is delivered in numerous settings, stakeholder engagement is an important part of its long-term development.


      Methodology/Approach:
      As part of its feasibility study, stakeholder engagement and feedback informed the service’s creation and development, and ongoing feedback from users and other stakeholders continues to inform its evolution. A governance structure was established to help develop and inform the services future advancement.


      Finding/Results:
      A feasibility study was the first step in developing the service to ensure the Canadian healthcare system was digitally enabled to support national e-prescribing. Stakeholders helped to identify and refine the service to address the challenges faced by community prescribers and pharmacists in the prescribing process and core functions and detailed specifications were further validated through a REOI and RFP process. This led to the business requirements of the service and the limited production release (lean approach) for rollout. Ensuring seamless integration into the clinical systems (EMR and PMS) was accomplished by workflow analysis onsite in the practices of prescribers and pharmacists, ahead of implementation. Once the service was initiated, support was provided via multiple avenues. Onsite support was provided, feedback was collected in end-of-day reports, follow-up calls and feedback sessions were held where prescribers and pharmacists were brought together to discuss the end-to-end experience. A formal engagement structure including working groups and task forces was then launched to ensure meaningful consultation and structure the feedback from key stakeholder groups. The service is currently live in two provinces and plans for additional jurisdictions are underway.


      Conclusion/Implications/Recommendations:
      Stakeholder engagement helped achieve successful initial implementation of a national e-prescribing service and will continue to inform its evolution. Prescribers and pharmacists are now starting to adopt the service that they helped design and that meets their community prescribing challenges.


      140 Character Summary:
      Stakeholders are helping to inform the development and evolution of Canada’s national e-prescribing service.

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    OS31 - Interoperability; When Will We Get There?

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 4
    • Type: Oral Session
    • Track:
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      OS31.02 - Improving Information Flow to Support Continuity of Care: EMR Interoperability

      10:30 - 12:00  |  Author(s): Lillian Ly

      • Abstract

      Purpose/Objectives:
      The goal of the SK EMR Interoperability Project is to build the foundation for broader information flow between providers and the various clinical information systems used throughout the province. Specifically, the project will enable the flow of clinical information from point of care systems to the provincial eHR. Data will be collected from the primary care setting (e.g. community EMRs) to the provincial eHR, as well as core clinical documents from the acute care setting (e.g. hospital CIS). The project also involves a notification solution that will notify providers using an EMR when new information is available for a patient within their circle of care. The notification solution to the EMRs will also involve the option for data consumption back to the EMR as appropriate. By doing so, this will allow providers to access the appropriate clinical information at the right time to support informed clinical decision making.


      Methodology/Approach:
      High level approach: - Minimize impact to providers’ workflow and workload through early engagement of the provider community - Work with EMR vendors to auto pull data from known workflows within the POC systems - Identify use cases in which timely notifications regarding particular information helps support the coordination of patient care - Participate in national dialogues to assess the current state relative to a standardized Patient Summary data set to determine key information to submit to the provincial eHR - Review CIHI’s PHC EMR indicators/priority subset, academic literature, etc. to support establishment of key patient data set - Leverage FHIR STU3 as industry standard HL7 specification for clinical content data exchange and RESTful API behaviors - Establish necessary FHIR repositories to support the clinical data storage and exchange - Initial focus placed on existing provinical eHR data repositories and its transformation services to FHIR standards


      Finding/Results:
      The EMR Interoperability project is expected to go live in February 2019, and so findings and results are not available at this time.


      Conclusion/Implications/Recommendations:
      The EMR Interoperability project is expected to go live in February 2019, and so conclusions and recommendations are not available at this time.


      140 Character Summary:
      SK EMR Interoperability collects data from POC systems to make it available in the provincial eHR, coupled w/ a notification sol'n to support timely information flow

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      OS31.03 - Impact Through Reach: Improving Follow-Up for Mental Health Patients

      10:30 - 12:00  |  Author(s): Elizabeth Keller

      • Abstract

      Purpose/Objectives:
      Learn how the technology barrier to communication between mental health services and primary care has been removed in Ontario using an innovative and highly scalable digital report delivery tool. The tool provides secure delivery of medical record reports directly to primary care and community-based specialist electronic medical records (EMRs) within minutes of transcription by Canada's largest mental health teaching hospital and other large mental health and addiction facilities.


      Methodology/Approach:
      The tool has added mental health and addiction facilities to the over 200 hospitals and specialty clinics already delivering medical record reports securely directly to clinicians’ EMRs. The tool’s methodology is to continue to scale it to all mental health and addiction facilities, hospitals, and specialty clinics to further augment its value to each sending facility and to each practice. The methodology is based on the positive impact of extending the tool’s reach to facilitate the fast and efficient flow of patient information to expedite treatment for patients with mental health and addiction issues. Family physicians need the patient information contained in psychiatric consultation documents, psychiatric progress notes, and psychiatric closure summaries to act more quickly than waiting for mailed or faxed reports. Using proven change management methodologies, primary care providers have adapted their workflows to handle the electronic reports and improve care transitions for patients with mental health issues and addictions.


      Finding/Results:
      Canada’s largest mental health teaching hospital and three other large mental health and addictions hospitals have fully integrated the tool into their clinical programs[HS1] [LM2] . Clinicians are providing assessment information, progress reports, consult summaries and discharge notes to over 9,000 family physicians and nurse practitioners who use the tool within their EMRs. The improved communication of patient information is resulting in better care for patients experiencing mental health issues by enabling faster and more coordinated care. The tool has also improved the privacy and security of this information. It is making care more effective and integrated for mental health patients when they transition from mental health and addiction facilities to community-based primary care. Primary care providers save time by not handling paper reports. The time saved by primary care providers and their staff now goes to patient-centred activities that result in faster follow up and more informed decision-making for mental health and addictions patients. Mental health and addictions hospitals are also saving money. A medium size hospital avoids an average of $30,000 in expenditures per year and a large hospital avoids an average of $100,000 in expenditures every year. The tool is avoiding health care system costs of an average of $15 million a year and the value of this cost savings increases every month.


      Conclusion/Implications/Recommendations:
      The report delivery tool is projected to be used by 15,000 clinicians in the next two years and will add additional mental health facilities. With 1 in 5 Canadians experiencing a mental health issue, this digital health tool allows clinicians to deliver better and more integrated care for these vulnerable patients and will allow the hospitals to better transition these patients back into their communities.


      140 Character Summary:
      Communication between mental health hospitals and primary care is more secure and faster supporting improved care for patients with mental health issues

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      OS31.04 - Is e-Medication Reconciliation Capability a Missing Link to Improving Interoperability?

      10:30 - 12:00  |  Author(s): Gerald Elysee

      • Abstract

      Purpose/Objectives:
      In a national study of 1330 hospitals, Elysee, Herrin, and Horwitz (2017) examined how three critical health Information Technology (IT) capabilities (interoperability, health information exchange, and medication reconciliation) influence one another. The objectives of this presentation are to discuss: 1. How the adoption of any one of these capabilities affects the adoption of the others 2. Why the adoption of medication reconciliation capability is particularly considered a missing link to improving health information interoperability and exchange 3. What is the role of the patients in influencing the adoption of the 3 capabilities 4. What the study findings mean to practitioners and policymakers


      Methodology/Approach:
      Our main hypothesis was that, as hospitals’ adoption of any one of those capabilities increases, so will the adoption of the others. To test this hypothesis, we conducted a partial least squares-structural equation modeling (PLS-SEM) analysis on a sample of 1330 hospitals from the 2013 American Hospital Association annual survey Information Technology (IT) supplement.


      Finding/Results:
      med rec adoption a missing link to interoperability and hie.png As displayed in the attached infographic, we found a significant, positive, and cyclic relationship between the three Health IT capabilities, suggesting the more hospitals adopt any one of the capabilities, the more they’ll adopt the others, supporting our hypothesis. However, a particularly interesting finding was the strong path (?=0.76) between medication reconciliation and interoperability capability adoption. A similarly interesting finding was that more than half of the variance (58%) in the adoption of interoperability capability is contributed by medication reconciliation capability. These findings point to the adoption of medication reconciliation capability as a missing link that could increase the demand for more usable and accessible information, necessary to drive interoperability and exchange. One other key finding was that patients’ abilities to view and download their health records are key dimensions of electronic health information exchange capability, suggesting that patients also have important roles to play in influencing the adoption of the 3 capabilities.


      Conclusion/Implications/Recommendations:
      For practitioners, the positive association between the 3 capabilities means that the currently lagging adoption of health information interoperability and exchange capabilities could impede the adoption of medication reconciliation capability, which could hinder hospitals' ability to improve patient safety and clinical efficiency. For policymakers, the strong path (?=0.76) between medication reconciliation and interoperability capabilities suggests that, while it would be great to incentivize adoption of all 3 capabilities, policymakers with limited resources should focus on rewarding maximum adoption of medication reconciliation capability, then interoperability and health information exchange are more likely to advance. Adoption of provider-patient information exchange functionalities should be encouraged to enable the patients to view and understand their medications.


      140 Character Summary:
      Medication reconciliation, interoperability, and exchange capabilities are significantly related, with 1st capability associated with the strongest impact

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      OS31.05 - VIRTUES: Towards Interoperability in Arrhythmia Care Using Blockchain And FHIR

      10:30 - 12:00  |  Author(s): Dimitri Popolov

      • Abstract

      Purpose/Objectives:
      As part of the network of National Centres of Excellence, CANet's objective is to improve care for Canadians with cardiac arrhythiias. One of the ways CANet is achieving this objectives is through design and implementation of VIRTUES - a cloud-based Personal Health Record focused on connecting all roles within an arrhythmia care team in a patient-centric manner.


      Methodology/Approach:
      Novel technologies/standards such as FHIR and Blockchain hold great promise for the creation of tryly patient-centric systems. CANet has piloted these technologies as the foundation for VIRTUES in order to realise their full potential and uncover limitations.


      Finding/Results:
      We have implemented cloud-based FHIR clinical data repository that has been used to enable mHealth applications in arrhythmia clinical studies. We have found that programming interfaces and overall level of technological maturity of the standard allowed us to 'steal the march' and implement working and interoperable system within the shortest time. FHIR data model is a good start, however a lot of custom data model development has to occur and these will have implications for interoperability with other systems. Blockchain when combined with FHIR-compliant data sources within the care team can tip the balance towards patients owning their records due to low costs of Blockchain ledger maintenance. However a large number of specific technical challenges still needs to be addressed around Blockchain.


      Conclusion/Implications/Recommendations:
      FHIR is undoubtedly a great step towards achieving higher levels of interoperability and has allowed us to progress faster with less development resources. Blockchain still needs to go through a 'demystification' process, however by piloting it we have accummulated a wealth of practical knowledge. We would argue that Blockchain's full potential would only be released when a high level interoperability between all systems participating in a ledger is achieved: at least syntactic interoperability, with semantic one being a distant target. Pror to this Blockchain might be used for specific business-oriented scenarios (payer-provider, billing/reimbursement, etc.) in healthcare, rather than for clinical ones per se.


      140 Character Summary:
      FHIR and Blockchain have a great potential for improving interoperability with FHIR being mature for implementation, and Blockchain requiring further piloting.

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      OS31.06 - Partnering our HIS for Better Outcomes for Kids in Ontario

      10:30 - 12:00  |  Author(s): Mari Teitelbaum

      • Abstract

      Purpose/Objectives:
      The concept of sharing an HIS instance is not new - as organizations merge and grow, the ability to mirror those changes in hospital information systems is becoming more common.

      However, the concept of equitable sharing of an HIS instance across multiple hospital corporations is unique.

      SickKids and CHEO identified that Epic could provide a common platform for pediatric best-practice in Ontario but had many hurdles to cross to deliver on that potential. Clinical decision making & alignment, administrative governance, IT operations and privacy legislation all had to be addressed in parallel with CHEO completing it's Epic implementation and SickKids doing a Big Bang implementation a few months later.

      Strong leadership support, additional short-term investment with the promise of longer-term savings, Board engagement, a level of risk tolerance and Epic's perspective were all needed to help address the challenges throughout the 2 year project.

      We will share the tools that were used to ensure equitable decision making, stakeholder engagement and risk management to describe the experience and lessons learned. This topic supports other international Epic customers as they explore cost-effective ways of using Epic to standardize and improve care in a variety of health systems.




      Methodology/Approach:
      A formal partnership agreement was instrumental in ensuring clarity of roles and responsibilies. An evolving but authoritative governance structure was required to ensure timely decision making and conflict resolution. The majority of the work was done by hospital staff, with advice from the HIS vendor. Governance, privacy and costing work was supported by a 3rd party consultant.


      Finding/Results:
      The SickKids CHEO partnership is a highly effective partnership despite the challenges of geography and independent corporations. A shared vision for what is best for children in the province, along with strong leadership and governance has allowed this project to be successful. There were a number of hurdles with staggered go-lives and uneven starting points but all of these were overcome thanks to effective decision making and flexibility. The tools and critical success factors that enabled this will be shared.


      Conclusion/Implications/Recommendations:
      HIS partnership is an effective way of sharing costs and enabling standardized care for a patient. While the traditional geographic clustering works for the adult population, there are specific populations where the content is specialized to the extent that the workflows, order sets and reporting are specific to the population, rather then the region. The two recognized by the MOHLTC are pediatrics and mental health. Strong governance and decision making tools, appropriate cost sharing and a shared vision have allowed this model to be successful. The majority of children in Ontario will recieve the same tertiary care regardless of which of the freestanding pediatric hospitals they attend. There are many future opportunities of leveraging that content to support other hospitals serving children in Ontario and across Canada. It wouldn't be possible without the partnerships across both organizations that this project enabled and required - physicians, clinicians, administration and IT staff.


      140 Character Summary:
      SickKids and CHEO are two hospitals, 400 kms apart, caring for kids in Ont. Sharing a single Epic instance will allow the best care for the sickest kids in the province.

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    Closing Keynote Address

    • Type: Keynote Session
    • Track:
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      From Paper to Pixels - and Beyond

      11:45 - 13:45  |  Author(s): Andr

      • Abstract

      A. Picard The Globe and Mail, Toronto/CA