• e-Health 2019 Conference Program

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

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

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    PDF's of presentation PowerPoints are now online!

    Presentation Date(s):
    • May 26 - 29, 2019
    • Total Presentations: 245
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    OS23 - Looking Through the Data Lens

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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    OS24 - Co-design Clinician/Patient Interaction

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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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:
    • +

      OS26.01 - Digital Health Enhances the Continuum of care for Oncology Patients

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

      • 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): Jennifer Sheils

      • 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:
    • +

      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 - Detecting Depression via Multimodal Neural Networks with an Automated Evaluation

      14:30 - 15:30  |  Author(s): Ray Christian

      • Abstract

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


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


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


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


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

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

      14:30 - 15:30  |  Author(s): Karl Mallory, 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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    RF03 - Patient Empowerment: It's about Time!

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Area 5
    • Type: Rapid Fire Session
    • Track:
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      RF03.01 - Advanced use of EMRs yields greater benefits: 2018 Canadian Physician Survey

      14:30 - 15:30  |  Author(s): Chad Leaver

      • Abstract

      Purpose/Objectives:
      Clinicians, governments and the digital health sector have all made significant investments supporting adoption, use, and interoperability of Electronic Medical Records (EMRs) and associated digitally-enabled health services. We sought to update the current use and value of digital health technologies in practice by specialist and primary care and specialist physicians in Canada. The objective of this presentation is to highlight key insights from the 2018 Canadian Physician Survey while focusing on three main themes: advanced use of electronic medical records (EMR); use of functions related to medication management; and advanced use of consumer-facing e-services such as patient access to their own health information, e-visits, and e-booking of appointments.


      Methodology/Approach:
      A total of 1,393 physicians completed the survey: primary care physicians (PCPs) N=799; and specialists N=594. The survey was conducted in French and English using a multi-method promotion and recruitment strategy. A weighting methodology, developed by the Canadian Institute for Health Information (CIHI), was applied to all responses representing the (estimated total) 78,839 of eligible physicians in Canada. Weighted and unweighted results of the survey were compared; and comparison of the unweighted demographics to the 2018 Canadian Medical Association Masterfile physician profiles demonstrated no statistically significant differences between the 2018 CPS and the CMA Master file via Chi-Square test.


      Finding/Results:
      Use of EMRs is demonstrating significant efficiency benefits for physicians and the health system as evidenced by 82% of PCPs and 77% of specialists who stated that they provide more efficient care with electronic records. However, not all physicians are using EMRs in the same way or have access to the same functionality. While PCPs frequently access lab results (80%) and diagnostic images (74%), other functions such as “generate lists of patients who are due or overdue for tests or preventive care” or “electronically exchange patient clinical notes with any doctors outside your practice” are more rarely used. Use of more advanced clinical functions such as these is correlated with higher perceived efficiency and higher satisfaction with physician EMR systems than basic use (use of just 1 or 2 functionalities). A key finding is that 84% of highly optimized PCP EMR users (using 6 to 9 functionalities) are satisfied with their EMR, compared to only 49% of PCPs using 1-2 functionalities. Similar findings were observed when correlating use of medication management functions such as generating an electronic prescription with an EMR and use of electronic warnings for drug interactions and perceived efficiencies. Additional findings related to physicians’ use of virtual care and consumer-facing e-services were also captured in the survey.


      Conclusion/Implications/Recommendations:
      A majority of primary care and specialist physicians use EMRs and have access to connected patient information from care settings outside their main practice. The methods of electronic access to clinical data from connected health information systems differs across jurisdictions and community-based and hospital care settings. Furthermore, there are various levels of integration with point-of-care EMRs such as viewers, in-context single sign-on, and direct data feeds. Altogether, these findings show growing adoption of digital health across physician practices.


      140 Character Summary:
      The 2018 Canadian Physician Survey maps use of EMRs in primary care and specialist practices. Advanced use is correlated with higher efficiency and satisfaction.

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      RF03.02 - Deploying Ontario’s Largest Regional Patient Portal: Keys to Success

      14:30 - 15:30  |  Author(s): Mark Berry

      • Abstract

      Purpose/Objectives:
      This presentation offers an update to what was presented last year about the massive, first-of-its-kind patient portal deployment in south west Ontario – an initiative led by the HITS eHealth Office at Hamilton Health Sciences, leveraging Sunnybrook Health Science Centre’s MyChart solution. MyChart was officially introduced to patients at select Hamilton Health Sciences and London Health Sciences clinics in the fall of 2018. A significant collaborative effort from project stakeholders preceded MyChart’s deployment, including the intricate data integration into MyChart from ClinicalConnect, a regional clinical viewer utilized by 40,000+ authorized providers practicing in south west Ontario. Panelists will each bring their own unique perspective on managing a complex, multi-stakeholder technology transformation project – the largest regional deployment of a patient portal platform in Ontario – sharing lessons learned, challenges, and opportunities.


      Methodology/Approach:
      Part 1 of this project was to complete technical work to allow reports from hospitals and regional cancer programs, and LHINs’ Home & Community Care Services, to flow through ClinicalConnect to MyChart. Part 2, actively underway at the time of abstract writing, is to deploy MyChart to patients registered at the hospitals whose data now also viewable in MyChart. mychart graphic.png


      Finding/Results:
      A deployment of this magnitude presented challenges that could be categorized as cultural, technical, clinical and legal. Some key findings from each: Cultural - Gain regional-buy in through a shared vision and inclusion of stakeholders from LHINS, hospitals, and MOH in project decision making - Educate organizations and health professionals regarding the evidence of benefits noted from Canadian and international patient portal deployments Technical - Determine limitations of systems to understand confines of what was possible - Educate stakeholders about limitations to ensure expectations managed - Co-design technical architecture with solution vendors (Aptean and Sunnybrook) - Usability review and testing Clinical - Comprehensive stakeholder consultation, including: - Patients and families - Clinicians - Pan-Canadian industry review - Health records policies and procedures - Legislative reviews (PHIPA) Legal - Develop a collaborative agreement framework, outlining roles and responsibilities Note: An overview of number of registered MyChart users/usage stats to date will be presented and will be current up to the conference.


      Conclusion/Implications/Recommendations:
      This project compiled patient information from acute sites and worked to integrate more data sources to give patients a fulsome view of their health information as it phases in information from provincial assets and primary care. The result has been an effective integration of a vast amount of personal health information from hospitals across south west Ontario, in addition to giving patients data access they may have at other existing partner sites (i.e. MyChart’s non-SWO data contributors).


      140 Character Summary:
      Integration of south west Ontario hospitals’ personal health information, via ClinicalConnect, with Sunnybrook’s MyChart for patients and their caregivers.

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      RF03.03 - In Pursuit of Patient Empowerment: Collaborative Advances in Measurement Design

      14:30 - 15:30  |  Author(s): Tracie Risling

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: Patient empowerment has emerged as a crucial element in the ongoing evolution of healthcare delivery. Connections have been established between patient empowerment and improved engagement in care, commitment to healthy behaviours, and more active participation in shared decision-making. Research supports patient empowerment as a means to improve outcomes and lower healthcare costs. The challenge in advancing empowerment interventions however, is a lack of clarity regarding how best to capture the concept in a comprehensive and scientifically sound measure. The purpose of this research is to collaborate with patients to address this urgent measurement need in empowerment research. This presentation includes results from the first year and phase of this research where Q methodology was employed to engage participants in identifying priority aspects of patient empowerment for inclusion in a newly designed measure.


      Methodology/Approach:
      Methodology: This study is being conducted in three phases, each with a distinct methodological focus. In the first phase, Q methodology was used to support patients in sharing their views of empowerment as well as prioritizing key characteristics of the concept for operationalization. Q methodology unites the strengths of qualitative and quantitative research to capture personally held subjective views often expressed by attitudes, appraisals, or through reflections on life experiences. In this approach, participants form a P set, and rank order statements contained in a Q set that is then subjected to factor analysis. The Q set for this project was drawn from past pilot work on patient empowerment, led by members of this study team, with patients who had been given access to their electronic health record (EHR,) and through an extensive review of the literature on empowerment, engagement, and activation.


      Finding/Results:
      Results: More than 100 patients completed the Q-sort exercise representing a broad range of ages, reported health status, and a self-identified technology adoption using Rogers’ Diffusion of Innovation Theory. In addition to completing the Q-sort exercise, participants provided a 5-minute digital download interview where they spoke to choices made during the sort. This interview data was coded and themed using a qualitative approach. The Q-sort data was processed with software specifically designed for the method, producing factor analysis results which were then used to identify essential elements for a new patient empowerment measure.


      Conclusion/Implications/Recommendations:
      Recommendations and Conclusions: Patient empowerment is a key aspect of the trifecta of patient empowerment, engagement, and activation, and yet there are significant deficiencies in existing measurement for this concept in particular. This first phase of this research has revealed patient selected essentials for measuring patient empowerment within the digital health context. These elements and the emerging measurement tool will be detailed in this presentation, along with qualitative commentary from patients themselves on the important role of empowerment and digital health in their daily lives.


      140 Character Summary:
      Patient voice was needed to correct deficiencies in empowerment measure and this presentation includes patient identified essentials in developing a new approach

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      RF03.04 - Uncovering the Mysteries of Electronic Medication Reconciliation

      14:30 - 15:30  |  Author(s): Kristie McDonald

      • Abstract

      Purpose/Objectives:
      Electronic medication reconciliation (eMedRec) is a complex process. For some, medication reconciliation is a new concept; for many, the first implementation of eMedRec within Island Health Authority’s Nanaimo Regional Hospital may have had unintended consequences on ordering practices, end user experiences, and the delivery of patient care.


      Methodology/Approach:
      An Island Health Authority interdisciplinary Think Tank was formed to closely examine eMedRec. Think Tank participants consisted of clinical informaticists, providers, pharmacists, pharmacy informaticists, medication safety and professional practice consultants, and educators. Workflow analysis and detailed testing were conducted over a series of four workshops. Simulating clinical and provider BPMH and reconciliation workflows, participants observed the flow of data and how it ‘behaved’ differently when using different synonym orders. As participants shared stories and knowledge, risks were tracked and analyzed, education and practice gaps were uncovered, and mitigation strategies unfolded. Through didactic conversation, open dialogue, and interprofessional discourse, knowledge from multiple perspectives was shared. This supported a deeper understanding of why the data behaved differently; some of the mystery and unknowns were uncovered.


      Finding/Results:
      Throughout the workshops, the Think Tank experienced data behaving in a seemingly mysterious or unpredictable fashion. Through a lens of curiosity and focused effort, members of the Think Tank identified three of the most challenging components to navigate: 1. Search struggles with result returns when searching for medication orders: 2. Conversion confusion regarding auto conversion and failure resolution: 3. Prescription paralysis related to difficulty with prescribing:


      Conclusion/Implications/Recommendations:
      Prior to the Think Tank sessions, understanding of synonyms and conversion logic was only understood by Pharmacy Informatics. It was through the common and vested interest of the Think Tank that several recommendations are underway. These include but are not limited to: -Conduct a third party vendor analysis of system parameters that might impact on auto conversion rates and ordering practices -Review Think Tank recommendations with Executive Steering to determine which will be actioned -Develop a plan for implementation of Think Tank recommendations -Host change management events -Provide education to fill current state gaps -Establish a governance structure that will clearly outline roles, responsibility, monitoring, and accountability -Implement and support front line users with changes -Create a permanent Working Group to continue to enhance eMedRec process -Build provincial networks to share ideas related to eMedRec While eMedRec continues to be a complex process within the CIS, it is vital to remain curious and unrelenting in uncovering remaining challenges. A Think Tank or small working group can provide further insight through interprofessional discussion and discourse, testing of system enhancements, and providing end users with the ability to provide ongoing feedback. Patients’ care remains at the heart of why healthcare exists; unsolved challenges of eMedRec should not result in a discharge medication list that is a ‘mystery’ to providers or patients. Patients deserve to have a clear understanding of which medications they should be taking following discharge in order to stay safe.


      140 Character Summary:
      A Think Tank seeks to understand why end users experience challenges documenting home medications, managing conversion failures, and writing prescriptions.

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      RF03.05 - SmartMom: Delivering Prenatal Education Through Text Messages in British Columbia

      14:30 - 15:30  |  Author(s): Pooja Patel

      • Abstract

      Purpose/Objectives:
      Only one third of women attend childbirth education classes in Canada. Women living in rural and remote areas of British Columbia (BC) cannot always access in-person education in their community. Pregnant women increasingly use the Internet and mobile apps for pregnancy and childbirth information, and we are cognizant that these are often developed by lay groups or for-profit organizations, which can be unreliable. SmartMom is Canada’s first evidence-based prenatal education program delivered by text messaging. SmartMom provides women with accurate, timely and relevant information based on their stage of pregnancy and directs them to local resources, all reacted by a group of researchers, clinicians, and allied health professionals. The program is endorsed by the Society of Obstetricians and Gynaecologists of Canada, BC Ministry of Health, and Optimal Birth BC. The main goal of SmartMom is to improve health literacy and motivate health behaviour change among pregnant women. Currently, it is implemented in the Northern (NHA) and Fraser (FHA) Health Authorities in British Columbia.


      Methodology/Approach:
      Women who are pregnant, have access to Short Message Service (SMS) communication, and understand English can enrol in SmartMom. Pregnant women can enrol in SmartMom at any time during the pregnancy and can opt out at any point as well. They are invited, and asked for consent, to provide demographic information, complete a knowledge quiz and standard surveys about fear of childbirth and depression. An interim descriptive statistics analysis was conducted.


      Finding/Results:
      As of August 9, 2018, 48 women living in the FHA and 210 women living in the NHA were enrolled in SmartMom, totalling to 258 women completing the enrollment surveys. In both groups, most women owned smartphones (FHA=100%; NHA=97.6%) and the average age of participants was twenty. Knowledge gaps were demonstrated through questions most often answered incorrectly, which included healthy weight gain during pregnancy (% incorrect: FHA=71.1; NHA=80.7) and the safety of caesarean section vs. vaginal birth for both mothers and babies (% incorrect: FHA=55.6%; NHA=54.4%). Participants’ fear of childbirth, on a scale with a maximum of 66, averaged 34. Valuable information has been obtained highlighting knowledge gaps about childbirth and pregnancy and general confidence in labour and childbirth.


      Conclusion/Implications/Recommendations:
      Using innovative and patient-tailored approaches, the SmartMom program can address the knowledge gaps and childbirth fear identified in our analyses. SmartMom delivers reliable prenatal education in a format that meets the needs of pregnant women in British Columbia and beyond, especially for those living in rural and remote communities. Equitable prenatal education access remains an issue in Canada, and creative technology facilitates greater access and increased knowledge. Expansion and scaling-up of SmartMom is currently ongoing to other British Columbia health authorities and the Northwest Territories and is met with positive feedback from patients. Supported by clinicians with evidence-based roots, pragmatic and simple harnessing of technology can fill gaps and meet patient needs for prenatal education for pregnant women using SmartMom.


      140 Character Summary:
      British Columbian women are using SmartMom, Canada’s first evidence-based prenatal education program delivered by text messaging.

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    Keynote/Plenary Session

    • Type: Keynote Session
    • Track:
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      Artificial Intelligence in Today’s Health System

      16:00 - 17:00  |  Author(s): Trevor Jamieson

      • Abstract

      Purpose/Objectives:
      Artificial intelligence (AI) has become the buzzword bingo term in healthcare today. Everywhere from health care conferences to organizational strategic plans tout the benefits of AI for addressing health outcomes, efficiencies, and cost barriers we face today in health systems. Exciting as it may be, how do we square this with the current state of health care in Canada? Do we have the quality and quantity of data required to optimize clinical care? Can we implement these tools into existing systems? What are some instances of AI being used today in Canada and what impact is it having? And importantly, where do our policy and regulatory frameworks stand in terms of readiness for AI tools in medical practice. Today’s panel hopes to spark a conversation about what’s required to make the most of AI, and be realistic about the practical approaches we need to take to implement these tools.

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    RF04 - The Power of EHR's!

    • 08:30 - 10:00
    • 5/29/2019
    • Location: Room 4
    • Type: Rapid Fire Session
    • Track:
    • +

      RF04.01 - “It’s been life changing”: Community Pharmacist Access to EHRs 

      08:30 - 10:00  |  Author(s): Jenny Gritke

      • Abstract

      Purpose/Objectives:
      The landscape of community pharmacy is changing across Canada. The roles and responsibilities of community pharmacists are expanding beyond medication dispensing to encompass medication counseling, targeted medication reviews, and disease state management.1 Pharmacists are considered the “medication management experts of the health care team”.2 Along with an expanding pharmacy role comes the need for additional patient information to ensure patient safety and avoid adverse drug events. Beginning in January 2017, community pharmacists in south west Ontario (SWO) are now eligible to access patient electronic health records (EHRS), after completing access requirements, through the cSWO Regional Clinical Viewer, ClinnicalConnectTM. The purpose of this project is to explore the clinical and organizational value of community pharmacy access to patients’ electronic health records.


      Methodology/Approach:
      In this project, two methods were employed to understand the benefits and barriers experienced by community pharmacists accessing patients’ electronic health records, including: Semi-structured interviews conducted with five community pharmacists with access to electronic health records (2 of these interviews also focused explicitly on the value of the digital health drug repository (DHDR) in community pharmacy). Semi-structured interviews lasted between 30-45 minutes. Use of ClinicalConnect tracked through an in-practice data collection log with 25 community pharmacists in SWO. During their day-to-day practice, participants documented the module accessed, the reason for use, the outcomes, and any benefits derived. Tracking time varied amongst the participants from 2 weeks to one month.


      Finding/Results:
      A number of benefits were derived from community pharmacists accessing patient EHRs. Clinical benefits included: adverse event avoidance, improved medication adherence, more informed recommendations to prescriber, improved ability to work to their full scope-of-practice, and improved patient experience. Additionally, the DHDR information, accessed through the Pharmacy module, HomeMeds view, has enabled community pharmacists to identify patients receiving narcotics from multiple pharmacies, enabled medication reconciliation for new or transient patients, informed education/counseling encounters with patients, increased confidence in dispensing and enabled compliance with standards of practice. Organizational value includes a more streamlined workflow with a reduction in faxes and phone calls to prescribers. Lab data, hospital notes/transcriptions, and acute pharmacy data are frequently accessed by community pharmacists. Participants noted that the DHDR would be used more often if it included all medication information for all Ontarians. In addition, one of the challenges experienced by some community pharmacists is timely access to hospital discharge notes, as many patients go straight from hospital discharge to pharmacy to pick up prescriptions. Thus, the time to transcription is a limitation which impacts meaningful use of ClinicalConnect in some instances.


      Conclusion/Implications/Recommendations:
      Community pharmacy access to EHRs is an important step forward in improving the quality and safety of patient care. Access to this information enables pharmacists to confidently make recommendations to prescribers and better implement medication management and patient education. Organizationally, this information improves efficiency of day-to-day operations, reducing phone calls and faxes to hospitals and physicians and also enables community pharmacists to work to their full scope-of-practice, ensuring that their skills and education are fully employed in the circle of care.


      140 Character Summary:
      Community pharmacy access to EHRs via ClinicalConnect is an important step forward in improving the quality and safety of patient care.

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      RF04.02 - Data for Insights Using a Primary Care EMR Clinician Dashboard

      08:30 - 10:00  |  Author(s): Darren Larsen

      • Abstract

      Purpose/Objectives:
      This discussion will: - Provide an overview of a recently-concluded proof of concept demonstrating the clinical value of a *REAL-TIME* EMR-integrated clinician dashboard - Discuss the identification and development of key health indicators incorporated into the dashboard to align with health system priorities such as preventive care and opioid management - Provide proof of concept findings and participant feedback to demonstrate the dashboard’s value in helping to drive improved clinician data entry, practice workflows and population health management - Explain the importance of providing clinicians with hands-on change management and practice support to realize full value from the dashboard - Discuss next steps in making the tool available to clinicians and important considerations related to scaling the solution provincially


      Methodology/Approach:
      The presenter will discuss a provincial EMR dashboard proof of concept that took place in Ontario over the course of approximately two years. The proof of concept included participation of health system partners, EMR vendors and approximately 500 participating clinicians. It also built upon learnings from other jurisdictions in Canada and is replicable by other jurisdictions. The proof of concept used qualitative and quantitative data to demonstrate that the dashboard: - Provides clinicians with immediate clinical value through real-time visual representation of EMR data using widely-recognized, primary care indicators; - Offers clinicians the ability to drill down to patient-level data for each indicator included in the dashboard and take proactive steps to improve patient care; - Helps clinicians easily understand the quality of their patient data, and take steps to standardize data entry; - Allows clinicians to trend and compare their indicator metrics with other dashboard users, offering a more complete picture of population health metrics across the system; and - Can be scaled provincially, adapted for use by all EMR product offerings, and expanded to include new indicators that align with evolving data quality, practice, clinical and system priorities.


      Finding/Results:
      The presenter will discuss combined findings from phases 1 and 2 of the proof of concept, which showed that: - A majority of participating clinicians saw clinical value in the dashboard through improved data entry, practice workflow, and population health management; - Effective collaboration with a broad cross-section of health system stakeholders, EMR vendors and clinicians resulted in the development and implementation of dashboard indicators that align with clinician practice priorities and provincial objectives; - Clinicians are generally comfortable opting in to share metrics with the program lead and other participating physicians to access the trend/compare functionality, enabling a more complete picture of system-wide population health; - Access to hands-on practice support in conjunction with use of the dashboard tool helped participating clinicians realize more clinical value from the dashboard; - Importance of a provincial strategy and approach that addresses requirements to support clinical adoption and vendor participation


      Conclusion/Implications/Recommendations:
      Participating clinicians across various practice types realized benefits in quality improvement and clinical outcomes. Stakeholder collaboration, ongoing hands-on support and the ability of clinicians to trend and compare metrics are all essential elements to a dashboard tool that drives tangible improvements in quality care.


      140 Character Summary:
      Results of a proof of concept demonstrate the value of an EMR dashboard tool in population health management and quality of care.

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      RF04.03 - EHR Implementation: Supporting Staff for Go-live Success

      08:30 - 10:00  |  Author(s): Helen Edwards

      • Abstract

      Purpose/Objectives:
      The June 2nd 2018 EHR go-live event at SickKids was only a milestone on a journey of clinical transformation at SickKids. The implementation was planned to ensure that support for end users was provided in a number of ways.


      Methodology/Approach:
      A 24/7 command centre was staffed by the project team along with vendor consultants to investigate and resolve reported issues. Round the clock coverage ensured immediate resolutions to urgent issues. Super Users provided at-the-elbow support to end users to ensure safe and timely patient care. Structured huddles and meetings were essential components to ensure top issues were prioritized, with operational leadership and project staff aligned to develop resolutions, which included striking “SWAT” teams to focus intently on major issues. As a clinical transformation project, not an IT project, operational leaders were required to be present and support the implementation activities. In addition to the standard Director and Executive on-call, a parallel structure of an additional Director and Executive on call ensured that EHR go-live issues had top leadership oversight without impacting the resources supporting clinical oversight.


      Finding/Results:
      Empowering clinical leaders to work across clinical areas and alongside the technical team enabled effective and efficient collaboration to investigate and resolve issues at go-live.


      Conclusion/Implications/Recommendations:
      Defining roles and responsibilities and creating opportunity for sharing of experiences and challenges were crucial to stakeholder engagement and go-live success.


      140 Character Summary:
      EHR implementations require significant operational leadership support to ensure issues are prioritized and addressed, maintaining safe patient care.

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      RF04.04 - Lessons Learned from a Big Bang EHR Implementation

      08:30 - 10:00  |  Author(s): Helen Edwards, Karim Jessa

      • Abstract

      Purpose/Objectives:
      Implementing an EHR is a clinical, not an IT project, and introducing a project of this magnitude at the Hospital for Sick Children (SickKids) required an entirely new approach to ensure success and prevent patient safety and quality of care issues. This presentation will focus on the key factors and lessons learned that led to its successful implementation.


      Methodology/Approach:
      A structured framework was applied that ensured significant participation and decision-making from front-line staff as well as a robust change management strategy to engage all staff in this hospital-wide project. Decision-making forums included meetings with departmental and discipline-based groups: operational manager meetings, ensuring they were equipped to have staff both participate in the decision-making forums and also transition to the new practices and workflows once live; physician advisory committee accountable for making hospital-wide decisions regarding provider practices; and inter-professional committees that discussed impacts to workflows that crossed disciplines and departments. Key to these forums were designated stakeholder leads, including Champions (Physician, Non-physician, Corporate), Managers/Readiness Owners, Subject Matter Experts, Clinical Educators, Quality Leads etc. Change management strategies included a wide variety of forums and tools aimed to ensure that staff were aware of and ready for the changes to workflows and practices prior to the go-live. Forums included Town Hall meetings, Go-Live Readiness Assessment meetings and a variety of communication tools that would “grab” interest, including: a theme that carried through the project, Workflow Walkthrough , Dress Rehearsals (table top exercises with detailed outlines of new workflows), Clinical Simulation exercises , Day in the Life Cards, Big Change Cards etc. In addition to the project team, go-live support was provided by a large group of internal and external Super Users, including hospital staff, specially trained university students and expert staff from other hospitals using the same EHR. ehr - shared governance structure.jpg


      Finding/Results:
      Challenges we encountered included anticipating and helping staff understand the key workflow changes that would be experienced with the new EHR in place. It required repeated interactions with staff for them to fully comprehend the granularity and the impact of the changes. Emphasis on Change Management activities and a nimble and agile communications strategy was required for effective dissemination of information. Using creative and fun ways to communicate to staff results in engagement and participation, both key to success.


      Conclusion/Implications/Recommendations:
      A formal governance structure with established guiding principles was crucial for timely decision-making. All clinical and relevant corporate departments were represented in the project activities, with frontline staff making up more than 80% of the membership across all groups. Few decisions required escalation to a leadership body for arbitration.


      140 Character Summary:
      Implementation of a hospital-wide EHR is a clinical, not an IT project, and requires formal change management activities and a robust shared governance structure.

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      RF04.05 - Evaluating a Novel EMR Query Builder for Primary Care Pharmacists

      08:30 - 10:00  |  Author(s): Jamil Devsi

      • Abstract

      Purpose/Objectives:
      Electronic Medical Records (EMRs) contain critical information that is relied upon to improve clinical and administrative outcomes, including panel management, prioritization of patient recalls and other quality improvement metrics. Data extraction from EMRs can be done manually as time-intensive chart reviews, or electronically through the use of queries to the database. Database queries are limited by barriers such as user understanding of databases, availability of IT personnel, or expensive vendor-created reporting mechanisms. Innovative solutions, including the implementation of a query generator, should be tested for clinician acceptability, ease of use, and sustainability. An application was developed to aid clinicians in this task and was tested for user ease of use, efficiency and accuracy.


      Methodology/Approach:
      We conducted a scoping review of EMR database extraction techniques and a naturalistic inquiry focusing on the clinical workflow, data needs and utilization of clinicians at an innovative pharmacist-led primary care clinic that uses the OSCAR EMR. We reviewed privacy/security regulations, good-software design principles, created a database map of OSCAR, and interviewed clinicians on desirable data to be extracted. A prototype application (App) was developed that generated queries for use in OSCAR and was subsequently tested for speed, accuracy, and user ease of use. We stratified these results based on clinician self-reported digital health literacy using a validated tool. We also used a standardized usability scale and tracked the time taken to generate a report. Accuracy of the App was confirmed by comparing to manual data extraction and an existing comparable query. User testing of the App followed a two-step process: (1) a user-friendly query to populate relevant database table information for importing in the App and (2) the use of those labels to create specific queries within the OSCAR reporting system.


      Finding/Results:
      We confirmed that for maximal ease of use for front-line clinicians and risk mitigation, our App needed to be accessible to the typical user, avoiding access to the database by potentially untrained users. Complexities of defining table structures were exacerbated by a lack of an authoritative database schema, that can be problematic for open source software. Full results of our evaluation was not available at the time of abstract submission deadline, however we will report on trends and correlations seen in clinician digital health literacy compared to performance during user testing of the app, compared to the usability scale ranking of the App.


      Conclusion/Implications/Recommendations:
      Using electronic data extraction with a user-friendly query generator enables clinicians to access health data in a rapid, secure, and efficient way. Improvements in clinical and administrative metrics can be more readily achieved when clinicians have easy access to data within their EMR. An innovative App designed for OSCAR users has broad applicability across primary care users and other EMR products. The relationship between digital health literacy, usability, and overall perceptions of the App is helpful in better understanding the implementation and design of future products. Ongoing development of the App will include expanding the ability to create complex reports, building a visual dashboard component, and testing its use with other EMRs.


      140 Character Summary:
      Evaluating a novel , user-friendly query generator enables clinicians to access health data in a rapid, secure, and efficient way.

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      RF04.06 - SK and CHEO; Living in the Instance 

      08:30 - 10:00  |  Author(s): Jim King, Karim Jessa

      • Abstract

      Purpose/Objectives:
      In 2016 SickKids & CHEO agreed to work together on a single instance of Epic for closer organizational partnership, technical efficiency and optimized care through clinical alignment. The purpose of the presentation is to provide an overview of the governance structure for decision making and the outcome of the clinical workflow and content sharing between the organizations.


      Methodology/Approach:
      While sharing the same instance of Epic, SK and CHEO have had different enterprise wide implementation staregies. CHEO has been engaged in a rolling implementation startegy since 2012 while SK went live with a 'big bang' implementation in 2018. Both institutions are live with EpicCare Enterprise 2017 edition. CHEO has obtained HIMSS EMRAM Stage 6 and SK has obtained HIMSS Outpatient EMRAM Stage 6. A mixed-methods review of the shared workflows and clinical content across 12 integrated clinical information system applications took place in April 2018. Descriptive statistics are presented for for both the workflow and clinical content shared within each application.


      Finding/Results:
      Workflow and Clinical Content were reviewed across 12 applications. The percentage of build shared between the two organizations is presented in the table. Further to the information shown there was complete sharing between organizations for MyChart patient portal, Medication records, Dosing Rules, eCTAS, Synopsis views in Endocrine, ENT, Orthopedics and Standardized views of I&O and vital signs. Application WorkFlow (%) Clinical Content (%) Inpatient Orders 75 30 Inpatient Clin Doc 50 15 Emergency 70 15-20 Ambulatory 45 15 Surgery 45 15 Oncology 25 10-15 Pharmacy 70 10-15 Reporting N/A 80 HIM N/A 20 Lab N/A N/A Radiology N/A 20 Patient Access and Revenue Cycle N/A 20


      Conclusion/Implications/Recommendations:
      Overall, given the complexity of the partnership, the initial results are encouraging. We identified more workflow overlap (45-70%) than content overlap (10-30%) with less content overlap overall. In many cases, less sharing is due to the nature of the application itself rather than the install. As expected, the level of overlap is higher in those areas where we have had a closer working clinical relationship (ED, Pharmacy, Inpatient and Ambulatory Care). The initial analysis occurred early in the content review process; now that both organizations have stabilized post go-live we believe that the shared workflows and clinical content has increased and we are planning to repeat the analysis. Further, we have started to align the application leadership teams at both organizations to further enhance the partnership and sharing of information.


      140 Character Summary:
      In a single instance of Epic, shared by SK and CHEO, we explore the shared workflows and clinical content of 12 integrated clinical information system applications.

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      RF04.07 - E-Safety and Safety Reporting: Go Live and Beyond

      08:30 - 10:00  |  Author(s): Sandra Moro

      • Abstract

      Purpose/Objectives:
      E-Safety best practices keep patients and staff safe in the use of digital health solutions. This becomes particularly important when a hospital utilizes integrated information systems. The Hospital for Sick Children redesigned how we monitor the incidence of IT-related safety events for the Epic go-live. Our case study will demonstrate how a legacy practice (safety reporting) can coalesce with an emerging and evolving discipline (E-Safety) to bolster an IT transformation. This session will provide an overview of our E-Safety Analysis Program. We will walk through the business case for this program that capitalizes on the safety reporting system to drive improvements in patient safety surrounding digital health solutions.


      Methodology/Approach:
      E-Safety best practices keep patients and staff safe in the use of digital health solutions. This becomes particularly important when a hospital utilizes integrated information systems. The Hospital for Sick Children has redesigned how we monitor the incidence of IT-related safety events in time for the Epic go-live. Our case study will interest the attendees as it demonstrates how a legacy practice (safety reporting) can coalesce with an emerging and evolving discipline (E-Safety) to bolster an IT transformation. This strategy is applicable to all modern hospitals as it is one way to create stability in this dynamic environment. While safety reporting is common to most hospitals, many fail to assess the efficacy of the reporting system upon major transformation, such as an Epic implementation. There are many steps from the point when a clinician reports an event to actually experiencing improved safety in that regards. For this reason, a hospital may overlook the urgency of revisiting the safety reporting system for an IT transformation. Our experience with developing this program illuminates several gaps that can emerge during an Epic implementation or any other IT transformation. This session will dive into the three key components of this program to touch on the gaps and discuss our solutions: 1- Standardized root cause analysis framework 2- Data analysis and reporting 3- Ongoing E-Safety implementations


      Finding/Results:
      - Increased volume of safety events marked as IT-related for 6-8 weeks after go-live - Significant decrease in such safety events within 4 months of go-live - Focus on urgent/high priority reports - Challenges reconciling between ticketing system and safety reporting system - Investigation of each safety report is very time and resource intensive - Follow-up and communication to writer of safety report, Quality Lead or Clinical Lead challenging - Anticipated long term decline in IT-related safety events. The standardized root cause analysis will provide valuable insights, and executive sponsorship will enable minimal lag to solution implementation.


      Conclusion/Implications/Recommendations:
      Like many initiatives in any large organization, there can be a gap between recommendation and action. We address this gap in the E-Safety Analysis Program by structuring several levels of engagement into the program. Safety reporting insights are escalated to the program sponsor (CIO) to gain support for implementing the E-Safety recommendations. After the stabilization period, the focus is on proactive E-Safety practices as prioritized by insights drawn from the data. .


      140 Character Summary:
      A legacy practice (safety reporting) can coalesce with an emerging and evolving discipline (eSafety) to bolster an IT transformation.

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    RF05 - Technology Empowerment; Near and Far!

    • 08:30 - 10:00
    • 5/29/2019
    • Location: Room 5
    • Type: Rapid Fire Session
    • Track:
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      RF05.01 - Engagement and Collaboration to Locally Implement a Provincial Solution

      08:30 - 10:00  |  Author(s): Maricris De Los Santos

      • Abstract

      Purpose/Objectives:
      The implementation of electronic Coordinated Care Plan (eCCP) enables members of a circle of care from varying health service settings, to collaborate securely and efficiently, by creating, sharing, updating and viewing a client’s Coordinated Care Plan electronically. This initiative involved working with a cross-section of stakeholders across the province, including; local community health service agencies, a regional health authority sponsor, a provincial solution provider, and neighboring regional health authorities. Strategic engagement of and active participation of stakeholders were keys to successfully developing a Coordinated Care Planning process that is well supported by an electronic solution. For this presentation, the project delivery partner will demonstrate the unique engagement approach that facilitated collaborative business process design and implementation of the electronic Coordinated Care Plan.


      Methodology/Approach:
      To facilitate this partnership, the project team engaged stakeholders in various settings and levels. Local At the local level, engagement objectives were focused on understanding existing CCP business processes and challenges to determine where the electronic solution could support increased efficiency and collaboration. A project governance structure was established to enable a process design and decision making pathway. To ensure a broad range of perspectives were captured in developing business processes and inform solutions to implementation challenges, health service providers and program subject matter experts were engaged to participate across each of the governance groups. To address competing priorities and busy schedules, various methods were applied to encourage participation, including in-person working sessions, teleconferences and electronic engagement such as web-conferences and online surveys. Regional At the regional level, working collaboratively with the regional health authority and sub-region leadership was key to facilitating alignment of best practices. This group actively participated within the governance structure and provided insight to define opportunities for alignment and where sub-regions required a more unique approach. In addition, existing regional committees were kept informed to facilitate consistent project messaging and leveraged to garner recommendations. Provincial At the provincial level, working with a provincial solution provider and other regional health authorities at various stages of implementing eCCP, required the development of partnerships with key individuals or teams to be able to obtain updates, garner learnings and surface considerations for cross-regional processes or opportunities for provincial alignment.


      Finding/Results:
      By engaging and involving stakeholders from multiple health service providers, subject matter experts and leadership at all levels, the team was able to design and implement an electronically enabled business process that supports sub-region, regional and provincial coordinated care planning. Health service providers and sub-region leadership contributed to improving coordinated care planning processes to better support client care. The regional decision-making body was instrumental in providing project oversight and pathways to provincial groups. Provincial stakeholders were key in providing insight and learnings. As a result, the project team was successful in designing and establishing the Toronto Area eCCP business processes.


      Conclusion/Implications/Recommendations:
      Participants at this session will learn about the engagement approach to facilitate active participation, business process design and implementation of the electronic Coordinated Care Plan. In addition, insights will be shared regarding lessons learned from implementation efforts.


      140 Character Summary:
      Robust engagement of stakeholders at local, regional and provincial levels contributed to successful implementation of the electronic Coordinated Care Plan.

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      RF05.02 - Technology-enabled Collaborative Learning to Support Mental Health and Addiction Nurses

      08:30 - 10:00  |  Author(s): Jos, Ramona Bavington

      • Abstract

      Purpose/Objectives:
      Geographic distances, limited availability of specialists, and limited resources are barriers to providing consistent professional development opportunities for Mental Health and Addiction Nurses (MHANs) across Ontario that support them in providing effective care for children and adolescents with mental health problems. The presentation will provide an overview and insight on how a technology-enabled program, “Project ECHO® Ontario CYMH”, overcomes these barriers while ensuring a collaborative learning experience specifically designed for MHANs.


      Methodology/Approach:
      The ECHO® Ontario Child and Youth Mental Health (CYMH) is a co-created pilot project between the Local Health Integration Networks (LHINs) and the Project ECHO team located at the Children’s Hospital of Eastern Ontario (CHEO). Project ECHO Ontario CYMH, the Hub Specialists (psychiatrist, psychologist, substance use and mental health social worker, and systems navigator) and MHANs will share experiences, expertise and resources across the province. Over several weeks, MHANS will attend a series of TeleECHO Clinic sessions, an interactive learning model using video-conferencing, to gain the skills and knowledge to support children and youth with mental health problems in their own communities.


      Finding/Results:
      The presentation will demonstrate how Project ECHO® Ontario CYMH will help close the distance, enabling face-to-face training and learning from virtually anywhere in the Ontario. The presentation will also demonstrate how Project ECHO® Ontario CYMH overcomes barriers to education while ensuring a collaborative learning experience specifically designed for MHANs. It will highlight the challenges, existing barriers and proposed/implemented solutions.


      Conclusion/Implications/Recommendations:
      Project ECHO is a learning and guided practice model that transforms healthcare education and increases workforce capacity to provide best-practice specialty care and reduce health disparities. The heart of the ECHO model™ is its hub-and-spoke knowledge-sharing networks, led by specialists who use multi-point videoconferencing to conduct virtual clinics with MHANs. In this way, MHANS gain the skills and knowledge to support children and youth with mental health problems in their own communities. About ECHO: www.echoontario.ca About MHAN: http://healthcareathome.ca/central/en/Getting-care/Getting-Care-at-School/mental-health-and-addictions-nurses


      140 Character Summary:
      Project ECHO® Ontario CYMH overcomes barriers while ensuring a collaborative learning experience specifically designed for Mental Health and Addiction Nurses.

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      RF05.03 - Creating electronic access to specialist expertise (EASE) in the Interior

      08:30 - 10:00  |  Author(s): Mona Mattei

      • Abstract

      Purpose/Objectives:
      Access to specialist colleagues is key for managing patient needs in primary care settings. Using secure messaging to create a virtual team for care planning, physicians can have quality communications, build relationships, receive timely decision support while supporting patients at home. Shared Care / Divisions of Family Practice collaborated with Interior Health IT to use their secure messaging system to improve physician communications and patient care planning. The aim is the use of secure messaging as a tool for decision support linking primary care teams with specialist for real-time advice. Connecting with specialists can often be challenging, especially for quick consults on critical patient care. Secure messaging creates the opportunity to openly communicate about patients, eliminate phone tag, and improve relationship between specialist and primary care providers.


      Methodology/Approach:
      The initial pilot took place in the Kootenay Boundary region where the messaging software replaced a RACE phone line for specialist advice. Based on their successes, a Health Authority wide committee comprised of four Divisions of Family Practice, Facility Engagement leads, IHIT, and physician leaders moved forward introducing MicrobloggingMD (MBMD) as a remote consultation tool. Learning from each other as the project unfolded, the team functioned as a mini-collaborative to support engagement and uptake of the service.


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


      Conclusion/Implications/Recommendations:
      Lessons can be shared about collaborative spread of a project, using multiple engagement options for successful uptake, challenges around high level leadership vs. grassroots development, systems options for remote consultations and overcoming technology adoption hurdles.


      140 Character Summary:
      Using secure messaging as a tool for decision support linking primary care teams with specialist for real-time advice creates EASE of access for patient outcomes.

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      RF05.04 - Project Management Insights on Agile Innovations: eOrdering Project

      08:30 - 10:00  |  Author(s): Jill Grant

      • Abstract

      Purpose/Objectives:
      Demands for innovations in healthcare are increasing at an astounding rate. Driven by fast-paced technological advancement, healthcare organizations are managing increasing demands for innovation from patients, healthcare providers, and policy makers to enhance the level of care and enable better outcomes. With the explosion of digital health solutions and an enhanced level of interoperability connecting key data domains across the continuum of care, organizations are now armed with a solid foundation to meet these demands. Meeting the demands however, also means a change in how people and process operate in their current environment. This was evident in a recent eOrdering innovation whereby an agile approach was required to implement new technology to support new electronic ordering processes in a key clinical area, thereby replacing an existing paper/fax based ordering system. This project involved several innovative components including the prioritization of incoming procedure requests where guidelines were imbedded within the solution to verify the appropriateness of the procedures being ordered. To support the innovation and ensure successful delivery, the project team was forced to re-evaluate and adapt its more traditional approaches to project management and become more nimble to an agile, rapid paced environment.


      Methodology/Approach:
      From the early stages of the project, the project took on a highly iterative agile approach. The project team was comprised of highly engaged clinical champions and various technical and business subject matter experts in healthcare technology. A strong partnership was also developed between the project team members and the technology vendor creating a unified approach to solution delivery. The project management approach also placed strong emphasis on Change Management expertise and partnered with the vendor on various training and education initiatives.


      Finding/Results:
      While agile approaches to innovative projects have significant benefits, it is important that the fundamental aspects to project management methodologies are not lost. For the eOrdering project, it was key not to lose sight of the importance of the future sustainability and scalability of the solution. This was particularly evident when the solution was preparing for the broader provincial rollout. New discoveries were unveiled and significant changes were required. Other challenges encountered included: - Clinical workflow differences across the Health Authorities in the province - Adoption uptake was slow where clinical champions were not as prominent - Competing priorities and availability of staff The project team is currently underway with the provincial rollout. A full evaluation and benefits realization will occur in April 2019 for the eOrdering solution within the Cardiac Catheterization Lab. It is expected that a reduction in wait times in addition to less time spent in hospital leading up to tests ordered will be realized due to the digitization of the ordering processes.


      Conclusion/Implications/Recommendations:
      To keep pace to the increasing needs of innovation in healthcare, organizations must shift from a more traditional project methodology to an agile approach. Key considerations when implementing innovative solutions: Sustainability and Scalability Key Clinical Champions Vendor ‘Partnerships’ Responsive and Nimble to constant feedback Facilitate/Enable quick decision making Encourage out of the box thinking Acknowledge mistakes are inevitable in innovation


      140 Character Summary:
      This abstract discusses the key learnings of an innovative eOrdering project as it relates to the approach of traditional versus agile project management.

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      RF05.05 - Why You Need to Diversify Your User Engagement Strategy

      08:30 - 10:00  |  Author(s): Greg Hallihan

      • Abstract

      Purpose/Objectives:
      The purpose of this presentation is to spur a dialogue within the e-Health community regarding the benefits of diversifying our User Engagement strategies. The reason we engage users is to derive insights that we can't infer simply by 'thinking like the user', these insights must then be incorporated into relevant user-centred process. Historically (reflecting on e-Health 2016, 2017, and 2018) discussions of engagement have focused on incorporating patient perspectives on design teams and advisory committees. However, a diverse User Engagement strategy could include methods from usability testing to literature review. For example, from a product development perspective the implications of software being classified as a medical device may drive your User Engagement strategy towards usability testing for regulatory purposes; however understanding the user experience may be at the core of a strategy to differentiate your product from competitors. As a hospital system, User Engagement could be about creating communities and governance models where the patient's voice is truly represented, however when it comes time to purchase a new technology the representativeness of these voices needs to be contextualized in the complex work environment that the technology will be used in. This presentation seeks to expand the dialogue of User Engagement at e-Health by discussing other academic and applied disciplines, relevant professional and regulatory guidance, and case studies from the presenter's own experience in healthcare.


      Methodology/Approach:
      The proposed approach is rhetorical, based on the assertion that there is a gap in the e-Health dialogue around User Engagement as a means to drive innovation, adoption and implementation, and organizational decision-making. This will be highlighted by discussing: Guidance from relevant professional bodies such as the User Experience Professionals Association (UXPA); from academic disciplines such Human Factors via the Human Factors and Ergonomics Society (HFES); from other industries such as e-commerce; and from pertinent regulatory and standards organizations like Health Canada and the International Organization for Standardization (ISO). These other sources of knowledge will be contextualized through the presenter's own professional experiences and research.


      Finding/Results:
      This presentation does emphasise original research, however the presenter will discuss case studies involving usability testing, eye tracking, and user experience.


      Conclusion/Implications/Recommendations:
      We engage users to obtain un-inferable insights that help us design better products, policies and processes for the people that will use or be affected by them. These insights are subject to the same considerations as any other qualitative or quantitative research data, namely how do we know the individuals we sampled are representative of the population we are trying to better understand (Representativeness) and how do we know we are gaining a better understanding of the situation in the real world (Validity and Generalizability). This presentation is meant to change the way attendees view User Engagement, and to think more critically about a User Engagement strategy geared towards driving decision-making. The question/answer period will provide those in the audience that feel they already have a diversified approach, or feel User Engagement is already well informed at e-Health, to contribute this perspective and enrich the dialogue.


      140 Character Summary:
      A well-planned User Engagement strategy is critical to sucessful e-Health innovation, make sure the approach you choose can actually inform the decision you face.

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      RF05.06 - Supporting Clinical Interfaces Using Natural Language Processing and Machine Learning

      08:30 - 10:00  |  Author(s): Chris Hobson

      • Abstract

      Purpose/Objectives:
      This research involved development of software tools, prototypes and user interfaces for improving access and understanding of unstructured healthcare data that today does not support effective information seeking by clinicians. At least 60% of the content in most clinical records consists of free text, and is either unstructured or very lightly structured, typically in non–standard templates. In most electronic clinical records, documents are manually filtered and displayed using basic document metadata such as date, category, service author, encounter, to categorize the data in the user interface. While this is helpful, metadata does not reveal much about the actual content and therefore clinical value of the document. Long documents such as initial clinical assessments and discharge letters are good targets for searching manually yet can be the hardest to properly evaluate in acute clinical settings with tight time frames. From a clinician perspective, one of the biggest challenges is knowing whether reading through a long document will reveal the information being sort, or will be a waste of precious clinician time. Natural Language Processing (NLP) techniques have been shown to support automated analysis of clinical documentation and data retrieved can be used for instance in clinical quality measure reporting. However little is known regarding techniques for using NLP derived data to assist clinicians in the process of clinical care delivery.


      Methodology/Approach:
      In 2016, the New Zealand government seeded a collaborative research based effort to advance precision health with more than $30m in initial funding. A wide range of projects were undertaken by a collaborative of organizations from healthcare, technology and academia. As one of several projects within the precision medicine initiative, Clinical Document Semantic Search was established to use NLP techniques to retrieve relevant information in a user friendly format from an EHR. Our approach utilized two streams of work in parallel: 1. Design sprints which adopted design thinking methodologies and co-design workshops with Clinicians, Product Management, Developers, User Experience and Data scientists. This ongoing iterative design process steadily refined the prototype in support of clinical time savings which will be demonstrated. 2. Evaluation of NLP and SNOMED CT tagging tools by clinical subject matter experts to compare the precision, accuracy and specificity with the ML derived outputs. Software tools for machine learning included a mix of open source software, self-built software and commercial products.


      Finding/Results:
      This project provided clinicians with tools to search for information and navigate effectively across clinical documents that include structured and unstructured text about a patient, using the latest machine learning techniques and Snomed terminologies. The prototype was able to sit easily within the existing overarching electronic patient record, and enabled clinicians with a summary of the patient’s overall clinical status as well as a timeline view of events and diagnoses.


      Conclusion/Implications/Recommendations:
      Enhanced information retrieval will produce tangible advancements in health outcomes through improvements in workflow and efficiency. This project sets foundations for other beneficial applications including machine learning techniques for precision medicine and enhanced decision support tools.


      140 Character Summary:
      The presentation explores the journey, approach, lessons learned and a discussion of the prototype solution to support clinical users navigating patient records.

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      RF05.07 - Demonstrating the Impact of AI and ML on Community Health

      08:30 - 10:00  |  Author(s): Diane Gutiw

      • Abstract

      Purpose/Objectives:
      With the increasing availability of Big Data through Open Data, consumer/citizen data mining, and data sources within and across organizations, the ability to leverage Artificial Intelligence (AI) and Machine Learning (ML) for informed decision-making has become a reality. AI and ML technologies are now packaged with out of the box analytic toolsets on multiple platforms and the interfaces are designed for business and clinical users rather than technical resources or data scientists. This presentation proposes that the ease of use of these technologies can now place data driven predictive modeling closer to decision makers to provide a benefit to communities and citizen health. With the correct data governance and information modeling, decisions that help understand the health and future makeup of communities, the clinical and services demand and the flow of people across communities can drive decisions that prepare for the future needs, safety and improved patient outcomes. This presentation will provide an overview and will provide examples of how data can be mined, managed and modeled to identify the changing needs and health of our communities and will indicate how clinical and citizen/patient services can use this information to plan for the future needs over time.


      Methodology/Approach:
      The presentation will provide real time demonstrations of geospatial and big data analytics, machine learning and artifical intelligence solutions that help describe the future communities and services using OpenData. The OpenData exploration may include an exploration of the changes of communities over time, predictive models on the future needs of communities and community health services, and the current and predicted flow of people across geographies as populations age, and what the potential impact will be on the health services infrastructure.


      Finding/Results:
      The outcome of the presentation will demonstrate the power of OpenData and the ML and AI tools for understanding community health. The presentation will show the power of data visualization and geospatial analytics in helping decision-makers understanding cause and effect of community changes.


      Conclusion/Implications/Recommendations:
      The recommendations resulting from the presentation and demonstration suggest that existing data can be overlayed to show powerful cause and effects of a changing community. Important factors for consideration in leveraging big data for predictive analysis, ML and AI include: Data Governance (to ensure the data is complete, correct, current and accurate); Data Visualization (demonstrate the impact of community changes using data that would not normally be linked); and Data Science (which is coming closer to the hands of the clinical decision makers with the transformation of analytic and big data tools currently available to health organizations). The presentation will conclude with a discussion of different use cases that can be explored to help understand how the health care system can leverage this knowledge to better prepare for the changing communities and population to improve patient outcomes and community health.


      140 Character Summary:
      This presentation willcdemo how Artificial Intelligence and Machine Learning can help predict the impact of future communities, clinical demand and citzen flow.

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      RF05.07 - The Disappearance of Back End Transcription at Sick Kids Hospital

      08:30 - 10:00  |  Author(s): Pakizah Kozak

      • Abstract

      Purpose/Objectives:
      Many acute care and academic teaching hospitals have struggled over the years with the cost and volumes of traditional back end dictation. Keeping to the 24 hour turn around times needed for back-end dictation to ensure accurate and safe patient records is often challenging. At the Hospital for Sick Children, using a combination of Epic tools and MModal front end voice recognition, we saw back-end dictation almost disappear. How did we do it? Come join us and find out.


      Methodology/Approach:
      Coinciding with the rollout of our new Health information system on Epic in June 2018, SickKids introduced M*Modal, a high-accuracy front-end speech recognition solution. An enterprise wide license for MModal was purchased and over 600 remote microphones were strategically placed in inpatient areas and outpatient clinics and some providers’ offices. With the implementation, clinicians were given the ability to dictate notes directly into Epic, make any edits and sign off on their notes in one streamlined workflow. Clinicians also had the ability to use their smart phones to dictate using MModal directly into Epic allowing for even more convenience.


      Finding/Results:
      Comparing back end dictation jobs in June 2017 to the month of implementation of June 2018 showed a dramatic drop in back end dictation. Three months post implementation told an even better story with a smaller number of op notes and clinic notes being dictated and some weeks having no back end dictations at all.


      Conclusion/Implications/Recommendations:
      Although the hospital was originally cautiously optimistic around the impact to back end dictation, a mere few months after implementation of both Epic in combination with MModal Front End Voice Recognition showed a dramatic drop of more than 95% in back end dictation (up to date graphics will be presented in the session).


      140 Character Summary:
      In June 2018, SickKids introduced Epic and M*Modal's front-end speech recognition solution which resulted in a dramatic drop in back-end dication & transcription.