• e-Health 2019 Conference Program

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

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

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

    PDF's of presentation PowerPoints are now online!

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

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    OS12 - Smart Consumers

    • Type: Oral Session
    • Track:
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      OS12.01 - Froogie - Healthy Eating Goes Global

      10:00 - 11:00  |  Author(s): Ashwin Kutty

      • Abstract

      Purpose/Objectives:
      Increasing fruit and vegetable consumption is an important target for cancer prevention. Public health goals recommend that we consume at least 600g of fruit and vegetables each day, which is the equivalent of at least five or more servings daily, but many people fail to achieve this target. In Canada, only 1 in 10 children consume the recommended intake of fruits and vegetables. Innovative ways to engage children in increasing fruit and vegetable intake for positive health benefits are therefore needed. One way to do this is through interactive smartphone apps that offer real potential for delivery and evaluation of health interventions in an innovative and engaging way. Given the ubiquity of smart phones among Canadians, apps offer the potential for enhanced accessibility, portability and interactivity to support health behaviours, like increasing fruit and vegetable intake.


      Methodology/Approach:
      As part of a broader research project, we developed a smartphone application designed to promote fruit and vegetable consumption among families with young children. The app, called Froogie (a named derived from the words fruit and veggie), was developed to engage families with young children in recognizing the importance of eating more fruits and vegetables for health. The app featured cartoon characters, called Froogies, and messaging around ways to increase fruit and vegetable intake. We undertook pilot-testing with a sample of families, prior to launch on the app store and google play. The app was designed to be self-contained and included elements of gamification to encourage engagement over a nine-week period.


      Finding/Results:
      Froogie was launched in March 2017, garnering 1000 downloads in its first week after launch, and featured on the Apple App Store as a New and Notable app in its second week. Apple also Recommended the App while also hitting over 2 Million impressions within the first month. Feedback from users highlighted the engaging nature of the app for children, as well as the opportunity to use the app characters to introduce children to different types of fruits and vegetables. Users also highlighted further opportunities for refinement of the app, for example through incorporating rewards for achieving recommendations and additional health messaging. The App garnered the attention of the Daveys and was the winner of a Gold Davey internationally placing it amongst the top 20% of all applications designed & developed for a smart device.


      Conclusion/Implications/Recommendations:
      Smartphone apps, designed to be interactive and engaging, offer one way of promoting positive health behaviours among diverse groups. Froogie therefore has great potential as a behavior change intervention. However, more work is needed to field test the app using a theoretically-driven framework and to refine the components to address user feedback.


      140 Character Summary:
      Froogie is a gamified approach to improve healthy eating by shifting the statistic of only 1 in 10 children consuming the recommended fruits and vegetables.

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      OS12.02 - Digital Service for Youth: Learnings from a National Texting Service

      10:00 - 11:00  |  Author(s): Alisa Simon

      • Abstract

      Purpose/Objectives:
      Accessing traditional mental health services can be challenging with stigma, lack of services, long waiting lists and other barriers preventing youth from connecting to needed supports. In addition, youth of all ages, are increasingly looking for e-services to support their mental health and well-being. More data is needed on the efficacy of these e-services and the impacts of implementing new digital health solutions for youth. This session will provide results for a new national texting service for youth, including how AI has been used to improve user experience, evaluation results on the impact of the service and movement towards development of Canada’s largest database on youth mental health challenges. Learning Objectives Understand the efficacy of a fully implemented e-mental health solution for youth Determine the challenges, merits and limitations of implementing e-health services for youth populations Review usage data to understand the audiences digital health solutions are attracting and where more work is needed to serve all Canadians. Discuss how e-mental health services can and need to work together to develop an integrated solution for youth in Canada


      Methodology/Approach:
      Young people across Canada are suffering from challenges to their mental health and wellbeing, including mental illness. And yet, an estimated 75% of children with mental disorders do not access specialized treatment services. And, young people are increasingly relying on emergency departments, which, between 2007-2017, had a 66% increase in visits. This is in large part to long waiting times for counselling and therapy, a confusing and fragmented system, stigma, the lack of local services and transportation and dearth of culturally appropriate services. Digital health solutions, like Kids Help Phone’s services, can play a critical role in providing accessible services to youth who, otherwise would not reach out for mental health support. The objective of this session is to present the Kids Help Phone experience as they launched and scaled Canada’s first 24/7 texting line as well as to share evaluation data around the efficacy of e-mental health solutions for youth.


      Finding/Results:
      Top 4 reasons young people reached out through texting was: Anxiety, Depression, Relationships and Isolation. · 24% - of texters spoke about suicidal thoughts Outcomes · 88% of respondents found their texting conversation helpful · 87% reported feeling less alone, less distressed, less upset, more hopeful, more confident and more-in control of their issue. · 60% said they had not shared their experience or feelings about the issue they were texting about with anyone else before. · 79% percent said had they not texted for help, they would have tried to manage the issue on their own, not spoken to anyone, or ignored the issue, hoping it got better or went away. · 7% said they would have gone to an emergency room. Crisis Text Line powered by Kids Help Phone is there for young people of diverse backgrounds, age-levels, and sexual orientation. · 11% - Indigenous · 9% - visible minority


      Conclusion/Implications/Recommendations:
      Digital e-mental health services for young people work and can provide important access points to needed mental health services.


      140 Character Summary:
      This session will provide results for a new national texting service, including how AI has been used to improve user experience and evaluation results

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      OS12.03 - Outcomes of a Heart Failure Telemonitoring Program after Two Years

      10:00 - 11:00  |  Author(s): Emily Seto

      • Abstract

      Purpose/Objectives:
      There is growing evidence from clinical trials on the potential of telemonitoring to improve heart failure outcomes, but still very few sustained programs exist as standard of care. A smartphone-based heart failure telemonitoring program, named Medly, was established at the Ted Rogers and Family Centre of Excellence in Heart Function, University Health Network (UHN) in August 2016. The objective of this evaluation was to determine the impact of the Medly Program on patient health outcomes, patient self-care, and healthcare utilization, two years after the initiation of the Program.


      Methodology/Approach:
      This pragmatic pre- and post-test evaluation included questionnaires administered to patients at baseline and 6 months. The questionnaires included the Self-Care of Heart Failure Index (SCHFI) to determine the impact of the Program on patient self-care, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to determine its impact on quality of life, and questions to determine patient satisfaction. Other outcome measures included blood test values, such as brain natriuretic peptide (BNP) which is a prognostic marker for heart function. Healthcare utilization measures included comparing the number of hospitalizations, length of hospital stay, number of visits to the emergency department, and number of visits to the heart function clinic six months before enrolling into the program and six months during the Program. Data analyses included comparing baseline and 6-month values with paired t-tests for data with normal distributions and Wilcoxon signed rank tests for not normally distributed data.


      Finding/Results:
      Approximately two years after initiation of the Medly Program, there were 232 patients who had been in the Medly Program for at least 6 months (mean age 58+/-16; 79% male). Statistically significant findings included improved self-care maintenance (4.9-point SCHFI maintenance increase; p<0.001), improved quality of life (3.8-point MLHFQ decrease; p=0.04), and improved BNP (from 626 pg/mL to 499 pg/mL; p=0.04). No differences in healthcare utilization measures were found, except an increase in the number of heart function clinic visits (from 1.9 visits to 3.8 visits over the 6-month period; p<0.001). Patients generally rated the Medly Program with high satisfaction, such as 90% of patients strongly agreeing (63%) or agreeing (27%) the Medly Program was important for managing their heart failure.


      Conclusion/Implications/Recommendations:
      Over the first two years of the Medly Program, it has been found to improve patients’ self-care management, quality of life, and heart function (i.e., improvement in BNP). The evaluation was underpowered to detect changes in hospitalization and emergency department visits, but an increase in the number of clinic visits was found. However, the cost of additional beneficial scheduled clinic visits may be a positive outcome if it results in improved health outcomes and reductions in hospitalizations. Future evaluations with a larger sample size as the Medly Program continues to expand at UHN and other sites will help determine the impact of the Program on healthcare utilization. Our current evaluation provides preliminary support for the effectiveness of heart failure telemonitoring as standard of care, particularly with the use of a smartphone-based telemonitoring system.


      140 Character Summary:
      A smartphone-based telemonitoring program improved self-care, quality of life, and heart function during its first two years.

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      OS12.04 - Closing the Circle of Care in First Nations Communities

      10:00 - 11:00  |  Author(s): Karl Mallory

      • Abstract

      Purpose/Objectives:
      Over the past year, the Closing the Circle of Care Project has made excellent progress. A partnership between Cowichan Tribes and Canada Health Infoway supports First Nations across Canada to adopt purpose-built digital health tools. 100+ First Nations are working with us to improve digital health capacity and enable patients with access to their health records. We are collaborating with First Nations and their healthcare partners to advance interoperability, clinical workflow coordination and patient access – all with the objective of closing the circle of care for First Nations community members.


      Methodology/Approach:
      Cowichan Tribes is a leader in digital health solutions and understands the challenges of implementing digital health tools in First Nations health centres. Canada Health Infoway has a long, successful record of digital health tools implementation. Combining our knowledge, we have developed a comprehensive implementation methodology that addresses the many challenges on-reserve health centres encounter when they transition from siloed, paper-based health systems towards transformative digital health tools. Our National Expansion Project works with interested First Nations across the country to enhance privacy and security capacity, address technical infrastructure gaps, migrate data, manage change, and support adoption and use of new digital health tools for both health centre providers and community members. This comprehensive approach resonates with the First Nations we’re working with and up to 137 First Nations organizations across Canada are implementing the Mustimuhw community EMR (cEMR) and Mustimuhw Citizen Health Portal (an interoperable Personal Health Record). Many First Nations have gone live and are beginning to benefit from their new digital health foundation. Many are now seeking to leverage the interoperability within their new digital health tools to create more tightly coordinated care models with their healthcare partners while increasing the scope and value of patient-accessible health records in the Citizen Health Portal.


      Finding/Results:
      Since our presentation at this conference last year, the number of First Nations participating in our project has increased significantly. As workflows transition from paper-based to electronic, many opportunities for standardization are being identified and advanced. We are working with funding and support agencies to bring efficiencies to screening activities, reporting functions, transitions of care and other areas of day-to-day operations. We are working with regional groups to explore how the growing use of these tools can support surveillance, epidemiology, program evaluation, health transformation, Nation-based capacity development and First Nations Health Data Sovereignty. But perhaps most importantly, hundreds of health care providers in First Nations health centres are now benefiting from practical digital health tools, and their patients are able to access their own health records, communicate electronically with their care providers and participate meaningfully in their circle of care.


      Conclusion/Implications/Recommendations:
      Our results continue to indicate that the implementation of a foundational cEMR and an interoperable PHR solution is a viable, practical and efficient digital health strategy for First Nations. Provincial health care partners should continue their work with First Nations communities, leverage this new digital health capacity and advance opportunities to improve circle of care coordination for First Nation community members.


      140 Character Summary:
      The Mustimuhw cEMR and Citizen Health Portal are advancing capacity and circle of care coordination for First Nations health teams and community members

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    OS13 - My Information, My Access!

    • Type: Oral Session
    • Track:
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      OS13.01 - Implementation and Impacts of a Pediatric Patient Portal Launch

      10:00 - 11:00  |  Author(s): Ellen Goldbloom

      • Abstract

      Purpose/Objectives:
      A pediatric patient portal was piloted in Fall 2014 and launched November 2016 in attempt to increase patient/family engagement in their care and provide a secure means of communication with the health care team. We aim to continuously evaluate key process indicators (KPI) and end-user feedback both quantitatively and qualitatively.


      Methodology/Approach:
      Evaluation of the pilot guided expansion of portal functionality to include messaging to the health team and patient entered information (e.g., new allergies, medications, questionnaires). Annual evaluation, KPI data and a partnership with a second pediatric hospital enhanced the value-added features for families.


      Finding/Results:
      The portal is available to all patients/families and 2-way messaging is live in 30% of teams (~800 messages exchanged each month) and expanding to all clinics. Number of accounts is increasing steadily with highest uptake in clinics with complex patients populations (e.g., 47% of complex care clinic patients). Portal-user feedback has been positive: • 94% viewed health information • 94% agreed that registration was easy and that the portal was easy to use • 92 % agreed that portal health information was accurate and 93% understood it • 91% agreed that they received test results in a timely way and 91% agreed that they were easy to understand • Of those sending secure messages, 91% felt the response was timely and 94% found it helpful • Due to the portal, 54% avoided a call to a clinic and 31% avoided a clinic visit. • 76% agreed that the portal helped them feel more prepared for next clinic visit We underestimated the profound impact on families who have described the portal as their lifeline. since it relieves their burden of compiling and cataloguing information. Integrating the use of a patient portal also required shifting the culture of how the chart is regarded – moving from a communication tool for the clinical team to a shared resource of information. Youth access needed to be contemplated ensuring that youth consent and control access to their information. Providers’ worry about the increased workload related to questions about information seen in the portal and messages received was not realized. Nurses report streamlined documentation and efficiency with messaging. Providers note that their clinical visits have been reshaped. With less time spent reviewing information, more time can be spent to address important issues and solidify care plans. Errors in the chart noted by families was a worry of providers, but have been found to build trust and ultimately increases EMR accuracy and potentially patient safety.


      Conclusion/Implications/Recommendations:
      Patient portals are becoming more common place and require a shift in culture to embrace the benefits. We expected positive patient/family feedback and clinician apprehension. We did not predict the impact that families describe or the change in the exam room. Early adopters sharing their stories can assist with change management. Pediatric patient portals provide an impetus ensure that activation strategies consider the need for appropriate proxy and youth access. Functionality that allows for communication and updates from families facilitates a truly shared communication tool that leads to empowerment.


      140 Character Summary:
      We describe launch and evaluation of a pediatric patient portal with functionality to review and add information as well communicate with the health care team.

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      OS13.02 - e-Health Portal Improves Pregnancy-Related Concerns of Inflammatory Bowel Disease Patients 

      10:00 - 11:00  |  Author(s): Reed Sutton

      • Abstract

      Purpose/Objectives:
      The impact of a mother’s chronic disease on fetal development makes dealing with inflammatory bowel disease (IBD) during pregnancy complicated. Almost 50% of women with IBD have poor reproductive knowledge; this has been associated with unsubstantiated concerns toward pregnancy, and towards IBD medications. We developed an educational e-health portal for pregnancy in IBD patients. We have previously shown it can improve knowledge acutely and in follow up. We now aim to evaluate its effectiveness for addressing IBD patients’ reproductive and medication concerns.


      Methodology/Approach:
      IBD patients aged 18-45 years accessed an e-health portal covering the topics of heritability, fertility, surgery, pregnancy outcomes, delivery, postpartum, and breastfeeding in the context of IBD and IBD medications. They completed pre-, post-, and 6+ month post-intervention questionnaires covering IBD-specific reproductive concerns, beliefs about medicines (BMQ), medication adherence (MARS), and knowledge (CCPKnow). The non-parametric McNemar’s test was used to determine if the proportion of patients who had each pregnancy concern decreased post-intervention. For medication concerns, the Wilcoxon signed-rank test was used to compare median differences between Likert scores. 95% confidence intervals and SPSS Version 23 were used for all analysis.


      Finding/Results:
      Seventy-eight of 111 patients (70.3%) completed pre and post-intervention questionnaires. Demographics for the 78 are as follows: median age 29.3 (IQR 25.6 - 32.9) years; 54 (69.2%) Crohn’s disease; 21 (26.9%) ulcerative colitis; 63 (80.3%) females, 5 (7.9%) currently pregnant and 19 (30.2%) previously pregnant. Medication history: 10 (12.8%) sulfasalazine, 67 (85.9%) mesalamine/5-ASAs, 17 (21.8%) budesonide, 63 (80.8%) steroids, 12 (15.4%) methotrexate, 55 (70.5%) azathioprine/mercaptopurine, 42 (53.8%) biologics, and 38 (48.7%) antibiotics. Post-intervention, the median number of reproductive concerns decreased from 3 to 1, and remained, 6+ months later (p<0.001*). Individual concerns are visualized in Figure 1 for all time points. The median BMQ score decreased from 28 to 25, and remained 6+ months later (p=0.032*). The median BMQ scores significantly decreased post-intervention for concerns about having to take IBD medication (p=0.006*), becoming too dependent on IBD medication (p=0.041*), and the long-term effects of IBD medication (p=0.036*). The percentage of participants adherent to medications also increased from 82.4% to 87.8% post-intervention (p=0.099). figure 1.png


      Conclusion/Implications/Recommendations:
      Using an e-health portal reduced IBD-specific reproductive and medication concerns for IBD patients. Medication adherence was high and correlated with beliefs of necessity (BMQ). Pregnancy in IBD patients should be referred to high quality (readable, interactive, up-to-date) educational resources, particularly when they are unable to attend specialized clinics / consultation. Our study suggests these may have beneficial and longstanding implications for knowledge, concern, and medication adherence.


      140 Character Summary:
      After accessing an innovative e-health portal, women with inflammatory bowel disease had lowered concerns regarding reproduction and medications.

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      OS13.03 - Online Patient Health Portals: A Survey of Public Perceptions

      10:00 - 11:00  |  Author(s): Alicia Polachek

      • Abstract

      Purpose/Objectives:
      Secure, comprehensive health information exchange among the care team—including patients—is foundational to high quality, continuous health care. Despite this, many Canadian jurisdictions do not have an integrated system that communicates health information to all care providers or allows patients to access or contribute to their health records. The use of online patient health portals is therefore being considered or implemented in various jurisdictions to enhance access to health information. Given increasing interest in online patient health portals, this study examined public perceptions regarding the use of online patient health portals to access, manage, and share health information.


      Methodology/Approach:
      Public perceptions were examined using an electronic questionnaire that was accessible from October 23 to December 8, 2017. The questionnaire included both closed- and open-ended questions regarding who should have access to their health information, what information and functions should be available in online patient health portals, how people would like to interact with their care team, and perceived benefits and concerns of using online patient health portals. The study was advertised through various electronic, radio, and print media to recruit a voluntary sample of English-speaking Albertans over the age of 18 with valid Alberta Health Care numbers. Responses were received from 1530 respondents. Quantitative data was analyzed using descriptive statistics and plots, while qualitative data from open-ended responses was analyzed using inductive thematic analysis.


      Finding/Results:
      Respondents supported the use of online patient health portals to access, manage, and share health information. Most respondents (92%) agreed that people should have access to their health information through online patient health portals, including information such as medication and medical history, specialist reports, and test results. Furthermore, respondents agreed that parents (71%) should have access to their child’s portal, as should alternate decision makers (81%) when adults are unable to understand or manage health information. Respondents also agreed that they would like online patient health portals to be used to communicate with providers (79%) and share (90%) information within the care team for the purposes of care. Respondents noted many potential benefits related to the use of online patient health portals, including improved care coordination, opportunities for patients to be informed about their health and health care, and access to one’s health information from any location, at any time. Despite overall support, respondents also identified several important concerns. In particular, many respondents (52%) were very concerned about information security and the possibility of health information being accessed by those outside the direct care team. Nevertheless, most respondents (84%) agreed that the benefits outweighed the concerns.


      Conclusion/Implications/Recommendations:
      These results suggest that the public holds positive views regarding the use of online patient health portals. Despite some concerns, the public is keen for such portals to be implemented, emphasizing that any concerns could be mitigated through careful attention to how the portals are implemented, governed, and monitored. Given this strong support, Canadian jurisdictions should continue to consider the greater use of online patient health portals that allow for improved health information exchange among the entire care team, including patients.


      140 Character Summary:
      Despite some important concerns, most Albertans support the use of online patient health portals for accessing, managing, and sharing their health information.

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      OS13.04 - Implementing a Patient Portal in Fraser Health

      10:00 - 11:00  |  Author(s): Brianne Bourdon

      • Abstract

      Purpose/Objectives:
      Fraser Health partnered with Sunnybrook Health Sciences Centre to implement the MyChart patient portal. MyChart recognizes that patients are the central stakeholders in their health care and streamlines how a patient's health record is accessed and shared. In fall of 2018, Fraser Health implemented the MyChart patient portal to the renal patient population as a targeted initial launch. The objectives of implementing a patient portal to the Fraser Health patient population were threefold: to provide patients with access to their health record, to enable patients to access to their health information from anywhere at any time, and to improve the process for release of information.


      Methodology/Approach:
      Fraser Health used a proof of concept methodology for the initial launch of the MyChart patient portal. The renal program was chosen as the targeted patient population and clinician group for the proof of concept. Renal patients are invested and knowledgeable in their health care and regularly access the renal program and Fraser Health facilities. The Fraser Health instance of MyChart used an iterative approach in which eHealth, professional practice, the renal program, and patients were partnered to design and build the system and incorporate change management at project onset. A logic model was used to design the evaluation of the proof of concept.


      Finding/Results:
      There are several findings and learnings from the project phase of the Fraser Health MyChart patient portal. Although it is a patient portal, it is important to engage clinicians early. Clinicians are advocates for the patient and improvements to patient care. The renal clinician team is excited for the patient portal and have been strong change agents supporting communications and change management activities. As well, it is important to engage clinicians early along with health records and professional practice to bring awareness to patients’ ability to view their records. This has implications to release of information and clinician documentation practices.


      Conclusion/Implications/Recommendations:
      This proof of concept will be used to inform the next phases for Fraser Health’s patient portal. Future phases will include new patient populations onboarding and enabling more features via integrations to MyChart. Two such features include integrations to the provincial lab information system and provincial diagnostic imaging viewer. This will be pioneering to provide to patients as these provincial systems are presently intended for clinician viewing. The evaluation of the proof of concept will also help inform how Fraser Health approaches subsequent rollouts of MyChart: big bang or by patient population.


      140 Character Summary:
      Fraser Health implemented a patient portal and used the renal program for the proof of concept initial launch that will inform next phases for the patient portal.

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    OS14 - Keeping Patients Healthy at Home

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Area 2
    • Type: Oral Session
    • Track:
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      OS14.01 - Using Wound Monitoring Technologies to Demonstrate System-Level Digital Health Barriers

      10:00 - 11:00  |  Author(s): Leah Kelley

      • Abstract

      Purpose/Objectives:
      WIHV collaborates with the National Research Council’s Industrial Research Assistance Program to provide advice to small-to-medium size enterprises in the digital health sector. Innovators experience several system-level barriers, including a lack of visible incentives to providers and patients to adopt such solutions. We use a collection of wound care applications accessing our program as a window to demonstrate recurring system-level barriers to their adoption.


      Methodology/Approach:
      Three digital wound monitoring applications were assessed through our program. For the purpose of this analysis, we focused on the use of wound monitoring applications in patients accessing provincially-funded homecare services. We extracted system barriers to successful clinical integration and placed these barriers within the context of current funding and incentive models.


      Finding/Results:
      Three primary system challenges to integrating a digital virtual wound care solution into the homecare setting were identified: *1) Unclear payer: There is no obvious payer for most digital solutions; incentives aligned to in-person visits so virtual care often creates cost for the user despite system savings. 2) Lack of integration with surrounding system: Key processes, such as escalation in the care pathway if adverse events occur, are poorly defined. 3) Lack of data governance models*: There are no consistent processes for defining who is responsible to capture data, who must review it, and where it should reside. The value propositions for homecare agencies and clinicians to purchase and utilize wound monitoring apps are unclear, despite potential improvements in patient health outcomes (Table 1). First, the benefits may be accrued elsewhere in the system (e.g. reduced emergency department utilization). Second, the siloing of homecare from key participants in the tool’s success (e.g. primary care providers and dermatologists), creates a system whereby homecare must try to govern processes where they have no control. It is essential to capture the value proposition of the tool for each relevant stakeholder, especially payers and users, as these value propositions may not be aligned. The challenge is to create “wins” for all core parties. A non-bundled, fee-for-service context given is a significant disincentive for institutions to adopt a virtual service model. Alternatively, outcomes-based bundles could offset some disincentives by encouraging institutions to improve outcomes through methods (e.g. virtual technology) that maximize their efficiency. Table 1. Understanding stakeholder funding and value propositions Stakeholder Payment Engagement Value proposition Homecare agency/PSW Fee-for-service (in-person) Use application to monitor healing; Escalate care as needed Fewer visits of value because high homecare demand Primary care provider Fee-for-service (in-person/e-consult) Review application data; Escalate to specialist if needed No incentive to reduce in-person visits Dermatologist Fee-for-service (in-person/e-consult) Review application data in consult No value proposition Local Health Integration Network Fixed homecare budget from Ministry Purchase application If app reduces visits, can increase patient coverage


      Conclusion/Implications/Recommendations:
      The current system creates an entanglement of complex incentives and payment models that stifle the success of digital innovations. Outcomes-based funding models, such as bundled payments to homecare agencies, would enable institutions and clinicians to utilize innovations to improve the quality and efficiency of care provision, as demonstrated by the above use case.


      140 Character Summary:
      Digital health solutions face barriers in system incentives due to funding models; use case of wound monitoring application demonstrates key challenges.

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      OS14.02 - Spreading Provider-to-Provider Remote Consult Solutions: Lessons from a Pan-Canadian Collaborative

      10:00 - 11:00  |  Author(s): Neil Drimer

      • Abstract

      Purpose/Objectives:
      Long wait times for specialist care is one of the most significant problems in Canadian healthcare. Remote consultation has emerged as an innovative approach to address this issue. Two leading Canadian initiatives, the Champlain BASETM eConsult service and BC’s Rapid Access to Consultative Expertise (RACETM) telephone advice line, are at the vanguard of enhanced provider-to-provider communication and were spread as part of the Canadian Foundation for Healthcare Improvement’s (CFHI) Connected Medicine Collaborative. CFHI launched this 18-month Collaborative in June 2017 to support 11 pan-Canadian teams to adopt and adapt RACE™ and/or BASE™ to their local contexts. This session will present an overview of the Collaborative, including an introduction to the RACE™ and BASE™ services, outline the approach used to scale and spread the innovations across jurisdictions, including methods of addressing technological and workflow challenges associated with the new systems, and to showcase Collaborative results. The session will include perspectives from CFHI, the RACE™ and BASE™ innovators as well as patients and providers who use the remote consult services.


      Methodology/Approach:
      Overall, BASE™ results show that 40% of cases in the service avoid unnecessary face-to-face specialist referral. RACE™ results show that 60% of calls avoid an unnecessary face-to-face specialist visit, and 32% avoid an unnecessary ED visit. Additionally, these services are shown to enhance the experience of care for both the provider and patient. The Collaborative aimed to support the spread of these services and produce similar impressive results through an in-person workshop, 14 interactive webinars, and direct coaching with expert faculty. Many teams designed for provincial scale or jurisdictional spread with active engagement from their respective regional health authority or Ministries of Health and key regional stakeholders. The Collaborative design and innovative technology solutions pushed towards three overall aims: 1. Support participating healthcare delivery organizations design, implement and evaluate remote consult solutions to improve primary care access to specialist consultation; 2. Improve the quality and experience of care for patients and providers using remote consultation; and 3. Build organizational proficiency and capacity in quality improvement and change management.


      Finding/Results:
      Final collaborative data will be available before the eHealth Conference. Measurement plans and data collection strategies were co-developed by CFHI and teams and include a range of qualitative and quantitative results that address topics such as: quality of care, patient experience, policy and culture changes as well as sustainability, spread and scale of the models. Preliminary data collected throughout the collaborative indicates that teams are adding specialties, the models are reducing unnecessary referrals, improving timely access to specialist care, consult requests are often being answered in less time than required, and patients and providers are responding positively to the service.


      Conclusion/Implications/Recommendations:
      The Collaborative specifically addressed issues of continuation beyond the program, including questions around remuneration policies, return on investment of the models, sustainability and spread. While we are working together to support continued implementation, we believe that these models should continue to be supported in their spread and scale across Canada, as they positively impact patient care as well as provider satisfaction.


      140 Character Summary:
      Results and lessons learned from spreading remote consult services for better patient care through a pan-Canadian quality improvement collaborative.

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      OS14.03 - Leveraging Smart Home Technology for Monitoring of Behavioural Risk Factors

      10:00 - 11:00  |  Author(s): Kirti Sundar Sahu

      • Abstract

      Purpose/Objectives:
      The UbiLab is developing an innovative health surveillance platform to improve monitoring of behavioural risk factors using real-world data collected through smart home technologies. This powerful system will be able to deliver real-time health insights to public health professionals. The purpose of this project is to explore individual- and household-level health indicators collected in the home via smart thermostats. This method enables the delivery of personalized insights to monitor individual- and population-level health behaviours.


      Methodology/Approach:
      The Ubilab partnered with ecobee, a Canadian smart wi-fi thermostat company, leveraging ecobee’s technology and data from over 10,000 households in North America collected through the Donate Your Data (DYD) program. A small pilot study (n = 8) was done to validate the use of sensor readings of movement between rooms through a cross comparison with Fitbits. The DYD dataset was analyzed for patterns using Python, pandas, Elasticsearch, and Kibana.


      Finding/Results:
      A positive association between Fitbit and ecobee data was found (Spearman’s Correlation coefficient = 0.7, p > 0.001) from 380 person hours from the pilot study. Indicators (sleep, interrupted sleep, daily indoor activity, sedentary) based on the Physical Activity, Sedentary Behaviour and Sleep (PASS) Indicators Framework from the Public Health Agency of Canada were measured using DYD data. Single occupant ecobee households in Canada averaged 7.2 hours of sleep in 24-hours, 2.1 hours of interrupted sleep, were active for 85 minutes daily, and spent 4.44 hours being sedentary. Traditionally, PASS indicators are measured through surveys including the Canadian Health Measures Survey, and the Canadian Community Housing Survey administered by Statistics Canada. Using this technology, it is possible to enable public health agencies to collect additional novel health indicators, monitor health in real-time and deliver health insights to Canadians to increase health literacy. Since presenting at eHealth 2018, we have improved data collection adding Fitbit Charge 2 HRs, upgrading to capture sleep and heart rate not previously possible with the Fitbit Zip. Adding more sensors functionality is crucial for our algorithm modifications, this includes collecting additional data via the Samsung SmartThings Hub, (presence in the home via Bluetooth), bedroom light usage, and luminance. ecobee is sharing participants and data from their own study, increasing variability within data. We have improved our data storing and analysis process, moving the big data architecture from python to Elastic Stack for real-time data streaming and analysis. We are also actively collaborating with PHAC and improving our algorithm and analysis process using their feedback.


      Conclusion/Implications/Recommendations:
      This is a key opportunity to innovate traditional data collection methods, empowering patients through education and leveraging technology infrastructures to enable healthcare and policy decisions to be made with relevant and real-time data. Lessons learned at the individual and community health levels will be shared with community members and researchers. Implications include understanding short-term impacts with minimal effort and new health policies at the community level. This awareness and improvement can help to better physical activity, sleep and sedentary behaviour which may result in improvements in overall health and wellbeing.


      140 Character Summary:
      Smart home technology platform to visualize and understand in-home health behaviours and monitor chronic disease risk at a population level

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      OS14.04 - TEC4Home COPD: Home Health Monitoring to Improve Outcomes

      10:00 - 11:00  |  Author(s): Jennifer Cordeiro

      • Abstract

      Purpose/Objectives:
      Chronic obstructive pulmonary disease (COPD) is a condition associated with high morbidity and mortality, reduced quality of life, and significant health system utilization due to frequent Emergency Department (ED) visits and hospitalizations. TEC4Home COPD is a benefits evaluation examining how Home Health Monitoring (HHM) technology can integrate into the health system to support patients with COPD at home after leaving the hospital or clinic to improve outcomes, including: 90-day ED revisits and hospitalizations, Length of Stay (LOS), quality of life and self-efficacy.


      Methodology/Approach:
      Patient participants were recruited from the Emergency Departments (ED), in-patient, and out-patient units at 3 hospital sites and various COPD community programs in an open trial study design. Upon enrollment, all participants received a HHM device kit supplied by TELUS Health, which includes a tablet, blood pressure cuff, pulse oximeter, weight scale and pedometer. Participants submitted biometric measurements (i.e. blood pressure, oxygen saturation, pulse and weight) and answered a series of yes/no questions about their symptoms (ex. I feel more short of breath today) on the tablet daily over 60 days. Monitoring data was reviewed by monitoring nurses, who followed up on signs of deterioration, shared monitoring updates with the participants’ primary care providers, and provided COPD education to participants over the phone. Pre- and post- surveys comprised of validated scales were used to collect and compare data about quality of life, self-efficacy, healthcare utilization, and overall experience. Administrative data related to ED visits, hospital admissions and LOS were accessed to assess impact on healthcare service utilization.


      Finding/Results:
      Seventy five patient participants were enrolled in the study (61% male/ 39% female; average age 71 years) over a 10-month period. Early preliminary analyses (n=31) of the administrative data showed a decrease in overall ED visits and hospital admissions, along with a decrease in the median LOS when comparing the 90-day periods before and after patient participation in TEC4Home COPD. Further, pre-to-post survey results showed some improvement (not statistically significant) in quality of life and self-efficacy regarding COPD self-management. Overall, participants expressed satisfaction with the TEC4Home COPD HHM program. Results and recommendations from the full final analysis will be shared at the eHealth 2019 conference. This will include an overall pre-to-post comparison on identified outcomes (i.e. healthcare utilization, quality of life and self-efficacy). Further, it will include a sub-analysis and comparison of outcomes for participants enrolled immediately following an exacerbation versus those in stable condition to highlight differences.


      Conclusion/Implications/Recommendations:
      This trial demonstrated improved outcomes for COPD patients using HHM, and will provide insights in to how this technology can be used for patients in exacerbation versus stable condition to best support them at home after hospitalizations or clinic visits. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.


      140 Character Summary:
      How can Home Health Monitoring be used to support better outcomes for COPD patients after leaving the hospital or clinic?

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    OS15 - Analytics Leads the Way

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Area 3
    • Type: Oral Session
    • Track:
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      OS15.01 - Enhancing Healthcare Accessibility for Canadians Through Virtual Care Technology

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

      • Abstract

      Purpose/Objectives:
      Rising costs and overwhelming demand for Family Physicians are key challenges facing the Canadian Healthcare system. Over 5 million Canadians are without a Family Physician and over 77% of Canadians don’t have access to healthcare on evenings, weekends, or holidays outside of the emergency room. Virtual Care has the potential to address these challenges by complementing existing healthcare models with new digital health technologies such as Artificial Intelligence to offer timely and efficient communication between healthcare professionals and their patients.


      Methodology/Approach:
      This session aims to provide insights into the adoption of Virtual Care technology, how Canada can stand to benefit, and will touch upon the following topics: 1) Global and Canadian trends in Virtual Care
      2) Emergence of Artificial Intelligence (AI) and Machine Learning in Health
      3) Virtual Care in practice


      Finding/Results:
      The global market for Virtual Care/Telemedicine was $21 billion in 2017, and is forecasted to reach $93 billion by 2026. Rising healthcare costs as well as adoption of 5G spectrum technologies make Virtual Care an attractive complement to existing healthcare models. A recent study by the Canadian Medical Association found that 3 out of 4 Canadians believe that new technologies could solve existing issues in our healthcare system. In Canada, favourable consumer sentiment and current fee code regulations have paved the way for the emergence of new Virtual Care start-ups along with entrants backed by established health players including Babylon by TELUS Health. The development of Virtual Care is also being shaped by innovations in AI and Machine Learning. A recent collaboration between Babylon Health, a London-based Digital Health company and the Royal College of Physicians, Stanford Primary Care and Yale New Haven Health demonstrated the powerful application of AI to interpret medical information. The wide-ranging applications of AI include triaging patients before interacting with live healthcare professionals, as well as supporting practicing physicians in enhancing patient care. In practice, Virtual Care has achieved mass adoption in countries ranging from Rwanda to the UK. In Rwanda, Babylon Health partnered with the Rwandan government to develop an SMS-based Virtual Care solution that has provided care to over 2 million Rwandans to date. In the UK, Babylon Health also partnered with the NHS to develop GP at Hand, an app-based Virtual Care solution that had over 50,000 registered users within the first few months of launch. These innovative and vastly different implementation models showcase the impact Virtual Care coupled with AI can have on a healthcare system.


      Conclusion/Implications/Recommendations:
      New technology and services are needed to empower physicians to provide quality care to underserved rural communities, Canadians living with mobility issues or those without access to non-emergency healthcare on evenings and weekends. New models such as Babylon by TELUS Health aim to reduce barriers to care while maintaining continuity with the existing public healthcare system. Developments in Virtual Care and AI present an opportunity to make a profound impact on the way Canadians access care for both end users and providers by providing increased safety, efficiency and cost savings throughout.


      140 Character Summary:
      Virtual Care technology will allow Canadians to access quality care and communicate efficiently with healthcare professionals no matter where they are located.

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      OS15.02 - Availability and Utilization of Virtual Care and e-Services in Canada

      10:00 - 11:00  |  Author(s): Chad Leaver

      • Abstract

      Purpose/Objectives:
      Digital health technologies to support patient care at a distance (virtual visits) have long been available in Canada, largely through a broad suite of telehealth programs and service providers. Innovation in some international health systems has seen citizen utilization of virtual visits grow to over 50% of annual healthcare interactions. Canada’s digital health sector and healthcare marketplace are advancing availability and accessibility options for virtual visits, yet the current proportion of care in Canada that is virtual is not currently known.


      Methodology/Approach:
      We completed two national surveys between February and March 2018. The Canadian physician survey used a multi-method promotion and recruitment strategy with direct-distribution to over 45,000 primary care and specialist physicians in Canada currently listed in the Canadian Medical Directory (CMD). Physicians could complete the survey manually or online. A general population survey of Canadians was recruited from multiple online panel sources to ensure a representative sample of Canadians by age, sex, province; and rural and remote communities. Both surveys were administered in French and English and focused on access and utilization of virtual care and other e-services in Canada. We used descriptive and cross-tabular analyses to determine the current availability and use of virtual care and to estimate the proportion care in Canada that is currently virtual.


      Finding/Results:
      A total of 2,406 Canadians completed the general population survey; and 1,393 physicians: primary care (n=799); and specialists (n=594) completed the Canadian Physician Survey. Canadian’s interest in accessing virtual care and other e-services is trending positively with significant increases from 2016 for e-Rx renew, e-view, e-booking, e-visit (e-mail and messaging), and virtual visits (+4% to +8% increase). 6% of Canadians report they can currently visit with their health care provider virtually online by video, 3% of Canadians have done so in the past year. Men were more likely than women (5% vs. 2%); and younger Canadians (<35yrs) were more likely than older Canadians to have had a virtual visit in the past year. Virtual visit coordination was either patient initiated or coordinated by regular care provider/specialist clinics. Most virtual visits (53%) were conducted at a health care facility, with the remaining 47% in the patient’s home. For patient initiated virtual visits in the past year, 49% were of no charge to Canadians; the remaining 51% were charged a one-time (per visit) fee. Of the healthcare interactions reported by respondents to our survey 1.6% of these were virtual in 2018. Results from our physician survey highlight virtual care and e-services currently provided by physicians in Canada and key facilitators to advancing physician adoption and use.


      Conclusion/Implications/Recommendations:
      Canadians are increasingly interested in accessing virtual care and digitally enabled health services, yet currently only small percentage of Canadians say they can do so. We estimate that in 2018 1.6% of visits in Canada were virtual. Greater consultation to refine our methodology and assumptions informing this estimate and future trending is warranted. In order to realize the estimated health system value of virtual care, enabling citizen access, clinical practice integration and physician remuneration will be essential.


      140 Character Summary:
      Canadians are increasingly interested in virtual care. We estimate that in 2018 1.6% of healthcare visits in Canada were virtual face-to-face consultations.

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      OS15.03 - HIMSS Analytics's INFRAM Will Change How Healthcare Views Infrastructure Forever

      10:00 - 11:00  |  Author(s): Shanti Gidwani

      • Abstract

      Purpose/Objectives:
      We hear about organizations all over the world making enormous investments in EMR implementations – millions (sometimes billions) of dollars. The EMR rollout, that’s the exciting part – the opportunity for a healthcare organization to move from paper charts to a digital modality that touts efficiency returns, broader access to patient data, comprehensive clinical workflows and more. But all too often, the infrastructure upon which these highly complex systems must ride on are neglected or even forgotten; and if it isn’t current (i.e. powerful enough to support the application), Day 1 of a new launch can be disastrous. And guess who/what the clinicians blame? The application they are using, when perhaps it is the aging infrastructure it is riding on that is causing the issue… Enter the HIMSS Analytics's INFRAM (the INFRastructure Adoption Model). This model guides organizations through a specific process and assessment, and at the end creates a bespoke infrastructure architecture roadmap. The organization can then use this to map out their specific technology requirements based on what they already have in place, and where they want to go. If you’ve heard of the HIMSS EMRAM (Electronic Medical Record Adoption Model), you will quickly realize that the INFRAM goes hand in hand with the EMRAM and its corresponding levels. So if you think your organization is an EMRAM level 4, you can verify this by undertaking the INFRAM assessment and then planning the strategic architecture to get to a level 6 or even 7 – also known to some as EMR nirvana. This talk will discuss the underlying principles of INFRAM, how it is linked to EMRAM and why health care leaders should care about this. Global announcements will be made on October 24th about INFRAM on the HIMSS Analytics website. For now, please refer to these two links. https://www.himssanalytics.org/news/infram-criteria-healthcare-infrastructure-maturity and https://gblogs.cisco.com/ca/2018/07/25/what-the-heck-is-the-infram-and-why-should-i-care-about-it/


      Methodology/Approach:
      This talk will outline how the INFRAM was developed, what it entails and why HIMSS Analytics asked for the intellectual property.


      Finding/Results:
      This part of the talk will discuss the number of INFRAM assessments done to date and how effective they have been.


      Conclusion/Implications/Recommendations:
      This part of the talk will include a call to action for those in the healthcare technology space.


      140 Character Summary:
      INFRAM will forever change how organizations can create strategic plans mapping infrastructure investments to their clinical application implementations.

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      OS15.04 - Assessing Quality of Mobile Applications in Chronic Disease Management

      10:00 - 11:00  |  Author(s): Payal Agarwal

      • Abstract

      Purpose/Objectives:
      There has been great excitement and growth in the mobile health field, with over 40,000 new health and wellness apps. However, due to a lack of regulatory systems, it is likely that many of these apps are of poor quality, posing potential risks to patients -- including privacy breaches, wasted resources and poor clinical outcomes. In order to fully realize the potential of mobile technologies to improve care, health systems require validated methods for selecting and evaluating the quality of apps. The goal of this project is to complete a scoping review of the literature exploring the criteria authors use to assess the quality of mobile health apps outside of formal experimental evaluation, particularity for chronic disease management. Through this process, we aim to help clinicians, patients and system decision makers find and support high quality apps that have the potential to improve care and impact health outcomes.


      Methodology/Approach:
      We conducted a scoping review of Cochrane and MEDLINE databases to systematically find articles that include a direct review and assessment of quality for two or more patient-facing mobile applications intended to promote chronic disease management. Our search strategy included search terms representing 2 concepts: 1) mobile applications and 2) chronic disease. We excluded studies that evaluated apps through an empiric experimental design. All abstracts were screened for inclusion by 2 trained project team members and discrepancies were resolved by the principal investigators. For each article, we extracted all utilized quality criteria and conducted a thematic analysis using an inductive coding process.


      Finding/Results:
      Our initial search resulted in 8182 potential articles for inclusion. Ultimately, 66 articles were included in the final sample. The synthesized list of quality criteria resulted in 7 broad themes: 1) behavior change, 2) evidence of impact, 3) general characteristics, 4) health information quality, 5) technical features, 6) user experience and 7) user engagement. Overall, there was significant variability in the criteria authors used to measure quality. Readily available measures, such as user ratings (n=20) and price (n=25), were some of the most commonly used quality criteria. Despite the important place of privacy and security within digital health technologies, only 10 articles used security and 12 used privacy as a measure of quality. The inclusion of user engagement features, self-monitoring in particular (n=45), was the most popular method to assess quality. However, most articles based their review on the assumption that more engagement features were related to higher quality; based on the literature, this assumption is likely incorrect. Many reviewers recognized the importance of incorporating behavior change techniques into health apps (n=27), but there was rarely the explicit use of a validated frameworks for identifying evidence based techniques.


      Conclusion/Implications/Recommendations:
      The high number of articles found for inclusion in our review suggests a strong interest in using quality criteria to evaluate mobile health apps. However, the immense variability of included criteria indicates the need for a comprehensive, standardized framework to identify health applications that deserve further support and use by the health system.


      140 Character Summary:
      A scoping review of 66 articles exploring criteria used to assess the quality of mobile health apps for chronic disease management.

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    OS16 - Unleashing Telehealth

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Area 4
    • Type: Oral Session
    • Track:
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      OS16.01 - Unlocking the Possibilities: Telehealth in Corrections

      10:00 - 11:00  |  Author(s): Linda Bridges

      • Abstract

      Purpose/Objectives:
      While most health services and some specialty health services are provided within federal institutions, the majority of specialist consultations take place in the community. In 2010 the federal offender population in the Atlantic region demonstrated a significant increase. Two thirds of this offender population were in institutions within the geographic area served by Horizon Health Network (Horizon), New Brunswick’s largest Regional Health Authority. The increase resulted in a corresponding rise in the number of offenders visiting Horizon facilities, where many of the community specialists worked. To put this in perspective, during an 11 month period, 880 federal medical escorts from Westmorland Institution and Dorchester Penitentiary, two of New Brunswick’s correctional institutions, were performed. This was an average of 80 escorts per month. Analysis of these escorts determined that 294, or one third of these could have been completed using telehealth processes and technology. That year, Horizon and Correctional Service of Canada (CSC) entered into a Memorandum of Understanding (MOU), resulting in a Telecorrections Partnership Project. The intended benefits were; to increase staff / patient safety by reducing and/or eliminating inmate transfers to The Moncton Hospital, provide an important opportunity for a broader range of medical specialists to deliver services via telehealth, and lastly to reduce security costs related to inmate transfers to and from this hospital.


      Methodology/Approach:
      Clinical and technical team members worked together under rigorous project management to review exisiting referral patterns and technological challenges.The clinical focus was the provision of medical services by plastic surgery,general surgery and ENT specialists. Expansion to other specialties within the 12 month time frame of the project ocurred as opportunities were identified and parties were in agreement. The deliverables of the project were; that both connectivity and interoperability be established between the hospital and the two CSC sites laying the foundation for future expansion of telehealth between other hospitals in the NB and CSC facilities. This came to fruition based on the results documented in the Final Evaluation Report and development of a Telecorrections Tool Kit. Both health professionals and clients reported satisfaction with this mode of safe service delivery.


      Finding/Results:
      Telecorrections has increased staff and patient safety by reducing or eliminating the need for inmate transfers to receive specialty care. Security costs and potential opportunity for elopement associated with escorts have been reduced. One tremendous advantage has been the ongoing knowledge transfer which occurs during these assessments for those CSC clinicians involved. Having these same clinicians present during sessions has been pivotal to maintain an open dialogue and general facilitation. This initiative provided the confidence and experience within Horizon to begin the recent provision of services to provincial correctional facilities as well.


      Conclusion/Implications/Recommendations:
      The Telecorrections model of care adheres to all national Telehealth Accreditation Standards and firmly established the practice of Telehealth in the CSC Atlantic Region. This presentation will describe the outcomes of this initiative and how Telehealth in Corrections continues to assist CSC Health Services in providing essential health services to offenders while contributing to public safety.


      140 Character Summary:
      Accessing scarce clinical resources to increase patient and public safety via the use of Telehealth.

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      OS16.02 - Designing Telemonitoring for Complex Patients in a NP-Led Clinic

      10:00 - 11:00  |  Author(s): Kayleigh Gordon

      • Abstract

      Purpose/Objectives:
      Complex patients are becoming increasingly prevalent throughout Ontario’s healthcare system, and yet chronic care continues to be focused on single conditions treated individually, often without consideration of greater care needs. An opportunity has arisen to address the challenges that complex patients face by combining the two innovations: telemonitoring and a Nurse Practitioner (NP)-led integrated complex medical clinic. Using a telemonitoring system in the NP-led clinic, patients will be able to monitor their multiple chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patients’ ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. However, very few TM programs are sustained as part of clinical care, and those programs that exist are restricted to single conditions. The objective of this work is to determine the needs and requirements of a telemonitoring system which assists self-management of multiple complex chronic conditions. The results of a qualitative needs assessment and iterative usability testing will be reported.


      Methodology/Approach:
      A qualitative needs assessment and usability evaluation were undertaken as part of a larger case study to determine how to design and implement telemonitoring as a single system for complex conditions into an NP-led integrated clinic model. Semi-structured interviews were conducted to determine the specific needs and requirements of complex patients and anticipated challenges of implementing telemonitoring in this model. Interviews were also utilized to iterate on the telemonitoring application. Patients and care team members were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their needs, perspectives and challenges around managing complex chronic conditions, as well as any technical needs and requirements for a telemonitoring system.


      Finding/Results:
      Eighteen patients and thirteen care team members were interviewed to reach data saturation at WOHS. Patient interviewees were particularly interested in how telemonitoring could improve access to necessary health care services, coordinate overall care needs and symptoms under more consistent monitoring by multiple health care professionals in one place. The majority of patients felt telemonitoring could be helpful for managing blood pressure, monitoring blood sugar levels, pain, and possibly even mental health concerns, such as anxiety or depression. Usability testing is ongoing and preliminary analysis has informed application development as it occured in order to be contextually relevant. Up to two rounds of formal usability testing are anticipated before the application will be operationalized in the clinic model as a pilot study in January 2019.


      Conclusion/Implications/Recommendations:
      Based on this research, a six-month multi-method pilot study will be undertaken to determine the feasibility of implementing telemonitoring into the NP-led clinic model. The potential impact of this research includes a sustained program combining telemonitoring within this model which improves health outcomes, reduces unnecessary ED visits or hospitalizations and is scalable to other healthcare institutions for complex patients.


      140 Character Summary:
      Complex patients and their clinicians perceived a smartphone-based TM system in a NP led model to be an opportunity to better manage their health and care needs.

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      OS16.03 - Telenephrology and the Elimination of Geography for Hemodialysis Patients

      10:00 - 11:00  |  Author(s): Krisan Palmer

      • Abstract

      Purpose/Objectives:
      Telehealth promotes access to those scarce clinical resources most often located in more urban settings to which patients must travel large distances to receive treatment. Prior to the establishment of Horizon Health Network’s first satellite hemodialysis unit, patients requiring this life sustaining care had to do just that three times every week. The goal in establishing satelitte hemodialysis units was to ensure safe, comprehensive and evidence based local care for this vulnerable patient population by eliminating the geography between them and their nephrologist using Telehealth processes and technology.


      Methodology/Approach:
      In order for a satelitte unit to be established, the physical, technical and clinical environment must be replicated to match those of the main Dialysis center. The same clinical standards of care that are adhered to by the Nephrology Program clinicians in the main dialysis unit must be operationalized and maintained in the satelitte unit. This includes the weekly patient rounds conducted by the nephrologist in conjunction with the nurses at the patient’s chair side or treatment station while undergoing dialysis. In order for this to occur at a distance, Telehealth must be employed. The Nephrologist at the main unit connects to the satelitte unit via a real-time interactive audio and video telehealth modality and is able to discuss the patient’s treatment plan with both the patient and the nurse together, just as it would occur if the patient was being treated in the same building as the Nephrologist. This is what has become known as Telenephrology.


      Finding/Results:
      Currently there are four satellite units established and they treat 94 patients per week. Three of them are open six days a week and one operates three days each week. This eliminates 158 round trips per patient each year.


      Conclusion/Implications/Recommendations:
      Teledialysis is a safe and patient centric healthcare delivery mechanism that should be explored by all Regional Health Authorities currently offering Nephrology services.


      140 Character Summary:
      Elimination of geography thrice weekly for Dialysis patients.

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      OS16.04 - Virtual Palliative Care: Supporting Patients in Their Home

      10:00 - 11:00  |  Author(s): Angela Nickoloff

      • Abstract

      Purpose/Objectives:
      A report released by Health Quality Ontario, Palliative Care at the End of Life (2016), advocates for early palliative care intervention as well as support for care in the location of choice. The report found that although most Ontarians prefer to receive palliative care and die at home, the majority die in hospital. The report also found that caregivers, who play a critical role for patients with a terminal or chronic illness, experience burnout which is a key contributor to trips to the emergency room for patients in the last stages of life. Evidence shows that virtual care solutions are effective in monitoring patient symptoms and that team-based care with direct patient contact significantly increases the likelihood of dying at home. The purpose of this demonstration project was to support patients with a progressive life limiting illness who prefer to receive care in their home. The objectives were to promote earlier identification of patient needs, improve patient and caregiver experience with care delivery, increase access for patients and families to resources, and improve patient outcomes.


      Methodology/Approach:
      The Ontario Telemedicine Network (OTN) worked with partners in the Champlain LHIN to co-design a virtual palliative care model that would enable a regional system with capacity for the delivery of in-home palliative care. Patients responded to a series of self-assessment surveys on a tablet from their home. Care providers received real-time feedback on the patient’s information which triggered specific events and corrective actions. Program evaluation included patient, caregiver and clinician experience and acute health service usage.


      Finding/Results:
      A total of 118 patients with an average Palliative Performance Scale score of 50% were enrolled in the project. In terms of patient satisfaction, 87% were satisfied with the experience; 85% were satisfied with the coordination of resources, use of technology, and information received; 75% were satisfied with the progress made towards care goals including location of care preference; 74% would recommend the initiative to others; and 73% agreed that virtual care saved them time by not having to travel to see their provider. Patient feedback showed the potential for emergency department usage to decrease from 68% to 27%. Family caregivers reported little to mild burden in caring for loved ones. Clinicians reported that the technology enhanced their ability to do their job, increased efficiency and allowed them to monitor the health conditions of their patient over time.


      Conclusion/Implications/Recommendations:
      Virtual palliative care, when integrated into community care models and in the hands of the patient, demonstrated effectiveness in supporting patients with palliative care needs and in decreasing acute health services utilization. There is a need to further model how patient information is consistently reviewed and managed, and how to best leverage existing palliative care teams, specialists and other healthcare providers to ensure necessary follow-up actions are taken.


      140 Character Summary:
      The project aimed to develop a virtual care model to support patients who prefer to receive in-home palliative care.

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

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

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

      • Abstract

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


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


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


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


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

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      PS04.02 - Implementing an e-Safety Program

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

      • Abstract

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


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


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


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


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

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    OS17 - Engaging Me, the Client

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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      OS17.03 - Patient Engagement in Home Health Monitoring Research

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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    OS18 - Increasing Digital Access for Patients

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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      OS18.04 - Selling a No-Brainer

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

      • Abstract

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


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


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


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


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

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    OS19 - Using Analytics/AI to Improve Care

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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      OS19.04 - Activate Your Content with Enterprise Search

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

      • Abstract

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


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


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


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


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

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    OS20 - Integrating Circle of Care

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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