• 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: 240
Filter Results:

  • +

    Plenary Panel

    • Type: Keynote Session
    • Track:
    • +

      Data Analytics in Sports

      08:30 - 09:30  |  Author(s): Sacha Bhatia, Humza Teherany

      • Abstract

      Purpose/Objectives:
      This session will Explore investment, analytics and data science. Data helps coaches teach professional athletes how to maximize their strengths and realize incremental but important gains. Why don’t we treat healthcare providers like star athletes? Healthcare in Canada is like five people playing pickup without a coach: leaders should be able to access and analyze health data to make sure their most valuable resources - frontline healthcare providers - are able to achieve success by always playing to their strengths.

  • +

    EP06 - Data and System Governance

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 9
    • Type: ePoster Session
    • Track:
    • +

      EP06.01 - Blockchain - the Real Deal or Just Hype?

      10:00 - 11:00  |  Author(s): David Wattling

      • Abstract

      Purpose/Objectives:
      Healthcare has long been challenged to address some pretty fundamental things, specifically related to data exchange and access. Can we uniquely identify a patient? Can we link data records created in different settings? Can we integrate patient-reported data? And, most importantly, can we trust the integrity of the data, its source, and control of its access? Blockchain is a decentralized, distributed public ledger of transactions, using an encrypted, structured network of systems to run those transactions, which are recorded chronologically in growing blocks. A key feature enabled by blockchain is that of a smart contract. These contracts define and execute the rules that parties use to process transactions. Blockchain has been applied to financial transactions for some time now. The question is whether it is a fundamental underlying technology that can finally address some of healthcare’s more vexing challenges.


      Methodology/Approach:
      This presentation will highlight examples where blockchain has been applied in a healthcare setting, both domestically and abroad. It will dissect the projects to extract the lessons and applicability for broad application. The objective being to provide real world guidance on where blockchain might be a real answer to health data exchange and access challenges, vs. where it is simply a technology looking for a home. Several blockchain initiatives were examined. These spanned the US and Canada, and addressed topics of patient generated data, supply chain management for drugs and medical devices, and clinical research. For each the project objectives were checked to the results generated, key insights were examined and the broad applicability derived.


      Finding/Results:
      It is clear that blockchain has a place in healthcare. However it is no ”silver bullet” – indeed healthcare is too complex for such a notion. There are clear examples of good use cases that can propel data integration, exchange and secure access forward. These will be essential to manage those that live with chronic illness, to reduce the administrative burden on the system; to truly allow patients to be integral parties to managing their care; and ultimately to enable a system based of payment for health outcomes.


      Conclusion/Implications/Recommendations:
      Trust is needed when data is to be shared and accessed for both integrated health service delivery and health system management. Blockchain seems to provide one ingredient for enabling trust in the system. However it will require diligent application and strong governance before care providers and patients alike will be comfortable with their data being accessible and usable across the care continuum.


      140 Character Summary:
      Healthcare is challenged to integrate/ share data in a reliable and trusted way. Blockchain can enable this, moving us to a patient-centred, outcomes-based system.

    • +

      EP06.02 - Privacy and Shared Health Systems: Learnings from the Front Line

      10:00 - 11:00  |  Author(s): Kathleen Lavoie

      • Abstract

      Purpose/Objectives:
      To explore the privacy issues related to the procurement, design, development and roll-out of shared health records systems, outside of provincial EHRs. A panel made up of privacy leads from hospitals and possibly other health care providers, a privacy lawyer, and a privacy consultancy will review the lessons learned from procuring, developing, designing and rolling out shared health records systems. Among other considerations, the panel will address the cost of viewing privacy as a pre-go-live “checkpoint” instead of a factor at the planning, design and development stages, including the cost of system redesign and/or reconfiguration at a late, critical stage. The discussion will also touch on the benefits of shared records systems, for providers, patients and the health system and the barriers to fully realizing those benefits.


      Methodology/Approach:
      The panelists are seasoned professionals who have been involved in planning, developing and implementing shared health records systems in their various roles, including at Grand River Hospital and other health care organizations The participants will provide their perspectives on building in and operationalizing privacy requirements from early planning stages through go-live and ongoing operational management. The issues are likely to include: - solution procurement and development of a model for a shared health records system - the roles and relationships among system users - development of privacy and governance models, including the sharing model - the advantages of privacy program alignment among system users - addressing limitations for heath information sharing Further issues and opportunities stemming from implementation experience will be explored in the presentation.


      Finding/Results:
      The panelists will emphasize key factors for health care providers to consider in relation to participation in shared health records systems including: - Identification of the objectives for using a shared health records system - Early consideration of the sharing model to ensure it aligns with the objectives - Identification of a privacy governance model, management roles and standards - Development of accountability mechanisms (including acceptable use policies, agreements and enforcement) - Understanding how to translate the models and policies into operation


      Conclusion/Implications/Recommendations:
      Shared health records systems are complex, regardless of the number of health care providers and their agents using a system. Considering privacy in the early stages of project design may appear a low priority, but privacy can be a driver that helps clarify shared objectives and priorities. Early consideration of privacy will also help to identify and reduce risk associated with the need for legislative compliance (including permitted sharing of personal health information), encourage dialogue with clinician end users and contribute to effective program design for shared system management.


      140 Character Summary:
      Shared health records system planning should include consideration of privacy in early stages to understand options, establish goals, and limit risk.

    • +

      EP06.03 - The Initial Impact of “Let’s Talk Informatics” Grand Rounds

      10:00 - 11:00  |  Author(s): Calvino Cheng

      • Abstract

      Purpose/Objectives:
      Change management is a commonly-known element determining the success of information system implementations. This can involve internal and external human resources for education, training, and to champion the cause. Nova Scotia is embarking on the goal of pervasive health care system transformation through the “One Person, One Record” (OPOR) vision, allowing for unified health information for effective person and system care. We demonstrate the first province-wide informatics rounds in Canada, “Let’s Talk Informatics”, which has been operating since April 2016. These rounds have achieved accreditation with CPHIMS-CA and Mainpro+. The primary goal of the rounds was to increase informatics literacy of the health care sector in the province prior to and after OPOR implementation. The secondary goals of these rounds was to create a venue to identify upcoming leaders and disseminate state-of-the-art knowledge locally and globally.


      Methodology/Approach:
      “Let’s Talk Informatics” are an hour-long rounds open to clinicians, employees of Nova Scotia Health Authority, Izaak Walton Killam (IWK) hospital, primary health, Department of Health and Wellness, Government, universities, health associations, colleges and anyone in the public. Participation is done in person, via Skype or conference line. Rounds presentations are vetted by a committee consisting of clinicians and individuals from Information Management/Information Technology to ensure freedom from vendor bias. Sessions are recorded and available for future viewing. Evaluations are performed using a survey tool. The distribution list and invitations are handled through Eventbrite.


      Finding/Results:
      There have been 23 “Let’s Talk Informatics” sessions during the period between April 2016 and June 2018). Of the sessions, 3 (13.0%) were delivered remotely by speakers using Skype for Business (two were from other provinces and one was from the United States) and 20 (87.0%) were in-person. There have been a total of 2097 registrants (average 110 registrants per session; range 45-212), with three sessions missing attendance counts. Actual attendance was captured during the period of October 2017 to June 2018, whereby there were 637 registrants and only 510 attended the sessions in person, via Skype, or using the conference line for a deviation of -14.1 (less attendees than registered) per session, or a 19.9% no-show rate. Since the evaluation process began in February 2017, 287 evaluations have been completed during those 14 sessions at a rate of 20.5 evaluations per session, and the completion rate among attendees during the period of October 2017-June 2018 was 101/510 (19.8%). During this timeframe, the attendance via Skype was the most popular at 292/510 (57.2%), followed by in-person at 177/510 (34.7%) and 41/510 (8.0%) via conference line. The qualitative trend over time is that Skype attendance is becoming more popular. There have been attendees from New Brunswick, Prince Edward Island, and Alberta. There are also currently 1654 people on the regular distribution list.


      Conclusion/Implications/Recommendations:
      We demonstrate a successful low-overhead methodology to broadly disseminate health informatics knowledge within a health care system. This grand rounds methodology is something that is easily scalable and transferable to other health care systems.


      140 Character Summary:
      “Let’s Talk Informatics” rounds is a successful and scalable methodology used to disseminate informatics knowledge and facilitate system change in Nova Scotia.

    • +

      EP06.04 - A Canadian Digital Health Policy & Practices Observatory

      10:00 - 11:00  |  Author(s): Karim Keshavjee

      • Abstract

      Purpose/Objectives:
      The healthcare system in Canada continues to evolve rapidly. Investments made over the last 30-40 years have paid off: Canadians are living longer and with fewer disabilities. However, Canadians are now living with more chronic diseases than ever before, putting greater pressure on the system and placing more responsibility on them for the management of their own health. As Canada moves into a brave new world, it requires new policies, perspectives and practices that will enable it to embrace change and thrive in a rapidly changing healthcare world. The new policies and practices need to consider the complex interactions that are necessitated by a more complex stakeholder environment. The new policies and practices need to be coordinated to ensure synergies between players and ensure that all benefit from the investments and efforts put into the system. We propose to institute an academic-led policy observatory to provide an independent and objective assessment of how well Canada and its political processes are moving toward achieving important pillars and practices for the digitization of the healthcare system.


      Methodology/Approach:
      We conducted a stakeholder analysis to identify key stakeholders in the health information technology arena. We identified the key needs of each stakeholder using business analysis methods. We obtained feedback through key informant interviews and email review of a first draft of the proposal for a digital health policy and practices observatory (N=7). Ongoing feedback and discussion allowed for iterative improvements and progress with this initiative.


      Finding/Results:
      As Canada moves forward, it faces the following issues: 1) difficulty in coordinating the efforts and incentives for multiple stakeholders to move in tandem, 2) patients who lack the ability and resources to participate meaningfully in system change, 3) innovation policies that generate world-class innovations that do not reach the market, 4) an inability to kick-start interoperability projects that can catalyze system transformation, 5) an inability to procure early-stage innovative technologies at scale and 6) an inability to share data seamlessly across organizational silos for improved patient coordination and care, health system management and research. Canada needs the following practices and policies to enable system transformation: • Multi-stakeholder governance structures
      • Patient engagement and empowerment policies
      • Federal and Provincial innovation policies that support dissemination of invented-in-Canada technologies
      • An interoperability research agenda
      • Technology and innovation procurement policies
      • Policies for the governance of shared health information


      Conclusion/Implications/Recommendations:
      The Digital Health Policy and Practices Observatory will: • Establish an observatory of digital health policy and practices in Canada;
      • Develop credible, respected, transparent and easy to understand policy assessment tools;
      • Conduct and report on assessments of policies and practices that can help us move the digital health agenda forward;
      • Provide a credible, independent and unbiased source of high quality information about digital health progress in Canada;
      • Influence the development of digital health policies and practices in Canada in a manner that is consistent with the best interests of society and the stakeholders who work to make healthcare a valuable cultural asset in Canada.


      140 Character Summary:
      Digital health policy observatory provides report cards on Canada's policies for use of technology to improve patient care and outcomes.

    • +

      EP06.05 - Developing Digital Health Core Competencies for Physiotherapists

      10:00 - 11:00  |  Author(s): Katie Dyck

      • Abstract

      Purpose/Objectives:
      As EMR use increases within the physiotherapy community, development and implementation of digital health core competencies is necessary to promote digital health literacy at a grass roots level. The family medicine experience has demonstrated a need to implement digital health core competencies at minimum in parallel with adoption and implementation of clinical systems to maximize success. High rates of EMR adoption exist in Manitoba within family medicine. Despite this fact, a lack of digital health literacy has been clearly identified limiting the ability to leverage data to enhance patient care. A foundational barrier to digital health literacy is the lack of educational content within the Rady Faculty of Health Sciences at the University of Manitoba. Although digital health core competencies exist for medicine, nursing and pharmacy curricula, a lack of implementation has contributed to challenges with effective use of clinical systems. Robust digital health literacy can inform and enhance clinical practice, facilitate interprofessional communication and enhance learning and innovative research. It can play a critical role in supporting health system planning, policy development and advocacy for physiotherapy services within Manitoba’s health-care system. The purpose of this study is to better enable physiotherapists in Manitoba to adopt, implement and optimize use of digital health tools, systems and applications in clinical practice to enhance patient care.


      Methodology/Approach:
      1. To generate a baseline digital health literacy profile of registered physiotherapists in Manitoba via an online survey; 2. To identify factors and any potential relationships between factors that may influence digital health adoption, implementation, and optimization in Manitoba physiotherapists; and 3. To develop a digital health core competency framework, aligned with the existing national physiotherapy role-based framework, focused on improving digital health literacy.


      Finding/Results:
      The survey is being distributed in September 2018 to gather information about digital health awareness, knowledge, use and attitudes. Respondent data will be used to generate a profile of digital health use in Manitoba physiotherapists and as a needs assessment and gap analysis tool to target areas for education on digital health concepts. Themes identified after survey data analysis and synthesis will be used to develop a digital health core competency framework.


      Conclusion/Implications/Recommendations:
      Next phases of the research will involve development of digital health Essential Competencies and Entry-to-Practice Milestones across the seven Domains of Physiotherapy included in the Competency Profile for Physiotherapists in Canada along with a knowledge translation strategy to implement the developed core competencies into the Masters of Physical Therapy program at the University of Manitoba.


      140 Character Summary:
      As EMR use increases within the physiotherapy community, development of digital health core competencies is necessary to promote digital health literacy.

    • +

      EP06.06 - To Err Is Human, Timely Unbias Decision-Making Is Digitally Divine

      10:00 - 11:00  |  Author(s): Sarah Wark

      • Abstract

      Purpose/Objectives:
      To demonstrate how the application of innovation including machine learning and analytics to the search and retrieval of extensive literature can improve the efficiency and quality of systematic reviews to inform clinical decision makers and policy groups.


      Methodology/Approach:
      Medical errors are an under-recognized cause of death. However, newly calculated figures suggest medical errors are the third highest cause of death in the U.S. Adherence to clinical practice guidelines (CPG) is one of the simplest ways to prevent medical errors while ensuring care is appropriately aligned to a supportive evidence base. Enhancing the accessibility of CPGs represents a behavioral nudge that may increase the likelihood that appropriate medical practices are followed. In order for CPGs to be adhered to along with corresponding evidence informed practice, these tools need to be accessible and easy to use. CPGs are based on the objective evaluation of supporting evidence provide by systematic reviews. Systematic reviews provide accessible evidence to inform clinical decisions. In healthcare, they may target patients, clinicians, managers, and policymakers. The current process is time and resource intensive, requiring expenditure of human capital and potentially impeding critical decision making within the health systems suggesting that patients may not have timely access to promising new forms of treatment. Machine learning technologies can improve the usefulness of systematic reviews for healthcare managers and public policy-makers by eliminating searching, retrieving and analysing data. The EmBER solution aims to achieve the following 3 objectives: Efficiency – Achieve the minimum amount of time, money, people or other resources required Quality - Improve the precision and recall of studies Access – Increase the breadth of data and enable development of new relationships To support the development of this rapid evidence synthesis tool, a partnership has been developed to capture key knowledge competencies. Key competencies in Natural Language Processing (NLP) and Machine Learning (ML) have been provided by experts from the Alberta Machine Intelligence Institute (AMII) from the Department of Computing Science at the University of Alberta.


      Finding/Results:
      Emerging evidence from the field of machine learning suggests that algorithmic approaches to natural language processing may provide a viable solution to reducing the time required to conduct systematic reviews. Specifically, the application of machine learning approaches to process large amounts of the available evidence could result in shorter completion for evidence based clinical decision and policy making. The EmBER solution produces a marketable product and service that operates to collate, analyze, and present global research papers and recommendations to decision makers and policy makers. EmBER is anticipated to increase the efficiency and standardization of the process, and augment the analysis utilizing additional data sources.


      Conclusion/Implications/Recommendations:
      Evidence suggests that the rate of medical errors is increasing despite the large investments in patient-safety initiatives. Innovative solutions are required that allows clinicians treating patients access to immediate information. The EmBER solution shows promise to provide the right information, at the right time.


      140 Character Summary:
      Machine learning has the ability to support clinical decision making that requires integrating ever-increasing volume of research knowledge.

  • +

    OS12 - Smart Consumers

    • Type: Oral Session
    • Track:
    • +

      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.

    • +

      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

    • +

      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.

    • +

      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

  • +

    OS13 - My Information, My Access!

    • Type: Oral Session
    • Track:
    • +

      OS13.01 - Implementation and Impacts of a Pediatric Patient Portal Launch

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

      • 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.

    • +

      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.

    • +

      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.

    • +

      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.

  • +

    OS14 - Keeping Patients Healthy at Home

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 5
    • Type: Oral Session
    • Track:
    • +

      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.

    • +

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

      10:00 - 11:00  |  Author(s): Sarah Olver

      • 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.

    • +

      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

    • +

      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?

  • +

    OS15 - Analytics Leads the Way

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 6
    • Type: Oral Session
    • Track:
    • +

      OS15.01 - Enhancing Healthcare Accessibility for Canadians Through Virtual Care Technology

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

      • 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.

    • +

      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.

    • +

      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.

    • +

      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.

  • +

    OS16 - Unleashing Telehealth

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 7
    • Type: Oral Session
    • Track:
    • +

      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.

    • +

      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.

    • +

      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.

    • +

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

      10:00 - 11:00  |  Author(s): Sandra Mierdel

      • 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.

  • +

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

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 4
    • Type: Panel Session
    • Track:
    • +

      PS04.01 - It’s About Time! Engaging Patients by Closing “The Loop”

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

      • 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

    • +

      PS04.02 - Implementing an e-Safety Program

      10:00 - 11:00  |  Author(s): Chris Hobson, Pritma Dhillon-Chattha, Elizabeth Keller

      • 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

  • +

    RF02 - EMR Adoption: Are we there yet?

    • 10:00 - 11:00
    • 5/28/2019
    • Location: Pod 8
    • Type: Rapid Fire Session
    • Track:
    • +

      RF02.01 - A Human Factors Approach to Optimizing EMR User Experience

      10:00 - 11:00  |  Author(s): Catherine Dulude

      • Abstract

      Purpose/Objectives:
      CHEO, a teriary care Pediatric hospital has implemented an integrated, enterprise wide EMR. We used human factors methods to study clinical workflow and EMR user requirements for Inpatient units and ED to inform and support user experience through appropriate selection and space planning of EMR hardware. The purpose of the current investigation is to identify guiding principles appropriate to Inpatient and ED environment and commonalities with Ambulatory Care.


      Methodology/Approach:
      Multiple methods within an iterative human-centered design (HCD) framework were used to develop hardware and access solutions supporting future EMR workflows in Inpatient and ED. Context of use analysis, participatory design methods, preliminary analysis of evaluative simulations and tacit knowledge of the project team led to development of guiding principles for hardware implementation and solutions supporting just-in-time documentation within the constraints of existing facility design.


      Finding/Results:
      Key themes from the preliminary thematic analysis included clinicians’ appreciation for: 1. mobility, placement and small size of devices; 2. ergonomic features/postural supports on devices; and 3. device features that support patient relations. The study revealed concerns with the current state of some devices including: poor usability; physical attributes interfering with patient interactions; digital design interfering with patient interactions; design deficiencies impacting patient privacy; safety or organizational control features; design for IPC; and inability to fully replace cueing power of paper notes. Some of the key user needs and design requirements identified include the: ability to log in/out of the EMR quickly; ability to maintain line-of-sight to patients/family; need to support IPC; and need to provide “focus” areas. This assessment was used to develop a hospital-wide implementation strategy and unit-specific implementation plans within challenging constraints. The strategy included: addition of fixed computers in central/shared areas to support communication amongst the care team, completion of individual clinical documentation and chart review; addition of single articulating wall-mount computers in the middle of the footwall in two-bed patient rooms; providing a total number of devices exceeding the number of providers working at peak times ensuring equipment is available in locations that support clinical workflow and just-in-time documentation; and development of a secure tap-access configuration allowing providers to log in/out of the EMR on shared workstations in less than 5 seconds.


      Conclusion/Implications/Recommendations:
      Improving healthcare design through a variety of iterative or progressive methods is beneficial but also requires time and resources to do comprehensively. The use of multiple methods including observation, focus groups, co-design sessions, simulations, questionnaires and technology assessments, allowed the team to study how the EMR implementation would impact clinical workflow from multiple perspectives. Some of the challenges were related to the limitations imposed by the use of the existing space. The methods used helped the project team understand key themes, user needs and design requirements to assist with implementing EMRs within IP units and the ED. But working under the pressing realities of tight time constraints combined with limited human resources to collect and analyze information, factors all too common in healthcare design, resulted in a preliminary analysis and reliance on tacit decision-making to guide the EMR integration.


      140 Character Summary:
      Use of multiple methods within a human-centered design framework to optimize user experience and clinical workflow by supporting EMR hardware and access solutions

    • +

      RF02.02 - Learning Health Systems: Conceptualisation, Characterisation and Examplar Works

      10:00 - 11:00  |  Author(s): Scott McLachlan

      • Abstract

      Purpose/Objectives:
      Learning health systems (LHS) lack a reference framework and taxonomy within which solutions could be characterised. This gap is illustrated in recent proceedings of ICHI 2017and MIE Informatics for Health 2017conferences where only a handful of relevant works were aware of being LHS. This gap prevents formation of the critical massof research efforts on LHS. The main objectives of this work are to present and demonstrate: (1) a conceptual approach to characterise the domain of LHS; (2) investigation into a comprehensive LHS framework and taxonomy; and (3) application of the approach, framework and taxonomy to three LHS research works.


      Methodology/Approach:
      For the first objective, a conceptual approach was investigated to characterise LHS based on abstraction of the clinical learning lifecycle into a design thinking-based triad. For the second objective, we developed a taxonomy for LHS by applying concept and thematic analysis on a body (n=230) of LHS literature. The conceptual approach and taxonomy were then used in the development of an LHS framework, considering the learning healthcare organisational model. For the third objective, the approach, framework and taxonomy were applied in three significant research works in the LHS domain.


      Finding/Results:
      The approachpresented provides researchers with clear and accurate conceptualisation for LHS. Presented as a triad covering learning, predicting/deciding and practice the approach provides strong demonstration of how under-representation of one part of the triad leads to the entire health system becoming ineffective. The taxonomyunifies under one model the taxonomic knowledge in the LHS domain, providing a complete representation of all of the currently known types of LHS. Successfully validation of the entire body of LHS literature using this taxonomy led to a key secondary finding that: while each of the nine types of LHS can be found independent from others, the Cohort Identification LHS type is consistently found as a component the other types. The framework unifies health technology, the learning health organisation and LHS, identifying where each LHS type is applied and how such application leads towards the provision of precision medicine. The LHS paradigm allowed us to fully exploit the routinely collected data from the healthcare system.Thus, the development of knowledge-intensive methods for generating synthetic EHR was successful, making it easy to create collections of realistic synthetic EHR for use in secondary uses where privacy concerns prevent release of real data. Furthermore, the development of knowledge-intensive models is enabled to allow predicting patient risk for particular negative outcomes or recommending appropriate and potentially more effective treatments based on the patient’s characteristics, history and current condition.


      Conclusion/Implications/Recommendations:
      LHS are a significant evolution of evidence-based medicine. Greater awareness of LHS is required if we are to achieve success in our goal of delivering precision medicine. LHS may be used in a wide range of systems and application domains, providing benefits to all areas of health care. Use of the approach, taxonomy and framework helps address the challenges in realising all that LHS promise.


      140 Character Summary:
      New conceptualisation of Learning Health Systems (LHS) is demonstrated in three significant healthcare challenges to help in correctly characterising LHS works.

    • +

      RF02.03 - A Virtual Ambulatory Hospital: Video Visits to Enhance Patient-Centered Care

      10:00 - 11:00  |  Author(s): Andrew Schroen

      • Abstract

      Purpose/Objectives:
      Heath care is no stranger to telemedicine. However, technological advancements have created opportunities to make the health care system more accessible and all-inclusive for everyone. Improved health information system (HIS) interoperability and the Canadian government’s declaration of ‘high-speed’ internet as an essential for quality of life provides the essential requirements for telemedicine to thrive. In turn, heath care sites are looking to new models of virtual care for patient visits to change the face of access in Canada; addressing access barriers due to distance and stigma as well as patients who have mental and/or physical constraints. This presentation will demonstrate how Women’s College Hospital (WCH) ambulatory model is adopting virtual care through the use of video visits while integrating seamlessly with their existing HIS applications; (1) electronic health record (EHR), (2) patient portal, (3) community provider portal and (4) mobile apps.


      Methodology/Approach:
      The fist video visits will be scheduled for winter 2019 and will be gauged for its effectiveness using measures of patient satisfaction with their experiences with video visits. This data will gathered using a mixed methodology of interviews and electronic surveys that contain both quantitative and qualitative questions.


      Finding/Results:
      To date, myHealthRecord has continuously demonstrated a high level of interest with over a 21,000 patients using the portal. This provides WCH an opportunity to meet patient needs by leveraging a widely used tool that’ll optimize the delivery of care and enhance the patient experience by developing WCH’s partnership in patient care. Patient engagement efforts (surveys and working groups) have identified that video visits are desired amongst WCH diverse patient population. WCH’s strategic plan to build a virtual hospital will ensure appointments are patient-centered and all-inclusive. Specifically, WCH’s goal is to provide 25% of visits virtually by 2022; consults, follow-ups, addictions outreach, post-surgery monitoring, etc. Moreover, the above is feasible as a result of WCH’s successful interoperability between Ontario Telemedicine Network (OTN) and WCH’s HIS applications (EHR, patient portal, community provider portal and mobile app) that enable versatile video visit connectivity between any of the HIS applications simultaneously (i.e. allowing for 2+ participants to partake in a session from different locations).


      Conclusion/Implications/Recommendations:
      Video Visits build the foundation of a virtual care model. When integrated into the health care system, they provide opportunities that drive patients care by enabling direct and self-managed care as well as increased access and equity. The true benefits of how vide visits impact patient care is through effectively measuring the data that comes directly from patient’s feedback to ensure that on going efforts are centered at improving the functionality of video visits. Utilizing video visits to deliver a new model of technology-enabled care will build a virtual hospital, where clinicians are able to remotely care for patients as well as support locale care providers through consultation.


      140 Character Summary:
      Adopting video visits while integrating seamlessly with HIS applications; electronic health record, patient portal, community provider portal and mobile apps.

    • +

      RF02.04 - Creating Consensus with 100+ Physicians for Better and Safer Communication 

      10:00 - 11:00  |  Author(s): Donald Fung

      • Abstract

      Purpose/Objectives:
      Traditional physician communication (paging) is prone to missed or late calls and gaps that can impact patient care, safety and satisfaction. There also many other limitations of paging: one-way communication, insufficient clinical context, and no way of confirming message receipt. Therefore, a new generation of physicians are using smartphones to collaborate; and while texting has tremendous benefits, it can also pose privacy risks if not done right. To address these challenges, North Bay Regional Health Centre (NBRHC) implemented a mobile communication solution that enables secure texting and intelligent clinical workflows. Clinical and IT leaders at NBRHC felt a purpose-built healthcare solution that could be adopted by all physicians would lead to a more accountable and safer way to connect and collaborate. With a secure and flexible mobile app, physicians can use their device of choice to share contextual information that empowers them to consult quickly, easily and accurately.


      Methodology/Approach:
      Changing a traditional communication pathway and replacing deeply ingrained process required a culture and behavioral shift. Simply putting apps on physicians’ smartphones would not work; and would likely create greater gaps. Therefore, the IT team engaged physicians in the change process every step of the way with full support from the chief of staff, medical leadership and senior leadership.

      Physician, nursing and allied health influencers were identified and regularly consulted to inform many important aspects of the project—including the creation of the RFP, communication and engagement strategies, etc. This key group familiarized themselves with the technology and were then able to share the benefits, challenges and potential barriers to adoption. Through regular PDSA (plan/do/study/act) cycling, the technology and workflows were tested. When potential issues were identified resolutions happened in real time. Champions were invited to weekly strategic meetings, including physician, nurse, medical affairs IT, switchboard, and quality representation. There, training and delivery programs were created to target the unique needs of each group. By proactively supporting users in identifying solutions and removing barriers to adoption, they gained confidence and trust in the system.


      Finding/Results:
      NBRHC is the only hospital in Canada to have 100% physician adoption of this technology and to have standardized physician communication using one platform. It is now a success story for other hospitals leader to consult before evaluating and implementing an enterprise-wide communication solution. NBRHC has effectively taken the middleperson out of communication and accomplished: 100% adoption of Vocera Collaboration Suite, which enables secure texting. Implemented a single communication system for our medical staff to simplify workflows and improve collaboration 152 physicians, 24 locums, 3 physician assistants and 35 residents 11 physician services with 27 on-call groups


      Conclusion/Implications/Recommendations:
      Success was achieved because of the strong partnership between IT, quality and clinical leaders. We sought out physicians and nurses who were respected and influential among peers. These clinical leaders were able to understand how the technology could benefit clinical practice and inform how it should be implemented. They were more than sponsors; they were active participants and champions. Transformation was about more than IT improvement. It was about elevating patient care.


      140 Character Summary:
      How NBRHC got 100% physician adoption on a better, safer and secure communication platform that standardized communication and improved patient care.

    • +

      RF02.05 - Leading Change in the Face of Healthcare Technology Revolution- 100% On-Board

      10:00 - 11:00  |  Author(s): Laura Copeland

      • Abstract

      Purpose/Objectives:
      Health technology implementation and adoption is a risk for many organizations. Terrifying tales of failures of multi-million dollar projects introduce fear to all those embarking on health IT change. Simultaneously, healthcare worker satisfaction has become a recognized aim for improvement in the healthcare system and there is significant concern around the possible relationship of information technology implementation to physician burn-out. This presentation will take a closer look at change models, successful case studies and propose innovative new methods of leading health professionals through change. In preparation for transitioning the physicians at a 650+ bed hospital from their predominantly paper environment into a fully digital hospital, many change models were considered and a very careful engagement, readiness assessment, communication, training and support plan was crafted and implemented. This resulted in 100% adoption of the new systems by physicians. It also provided an opportunity for lessons learned and awareness of the need to further explore other methodologies and case studies. Objectives include: •Describe a successful change methodology •Share lessons learned from case studies and industry standards •Integrate wisdom from models that were not considered during the design, specifically focusing on the value of introducing Indigenous perspectives •Present a proposal for future implementations and research in the area of change leadership


      Methodology/Approach:
      A combination of personal experience, literature review and interviews with experts will be utilized as sources in this presentation.


      Finding/Results:
      There are many commonalities between methodologies of change across cultures, all aligning with the psychology of transition. In reviewing organizations with successful implementations of health IT systems, it becomes clear that the key success factors are positive relationships and a commitment to supporting people through change. Yet, so often this important component is set aside by those trying to create a technically functional system.


      Conclusion/Implications/Recommendations:
      If we take the time to teach the important people-centred behaviours to our IT team and organization as a whole, we can create useful systems and happy users. There is ample room for education, research and best practice sharing on this topic.


      140 Character Summary:
      Coming from an evidence and experience informed perspective, learn the best way to have a successful implementation: It's about the PEOPLE, not the technology!

  • +

    EP07 - Application / Implementation 1

    • 13:15 - 14:15
    • 5/28/2019
    • Location: Pod 8
    • Type: ePoster Session
    • Track:
    • +

      EP07.01 - Emergency Department Discrepant Radiology Workflow

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

      • Abstract

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


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


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


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


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

    • +

      EP07.02 - Canary Clinical Alerting: Infinite Possibilities

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

      • Abstract

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


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


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

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

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

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


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


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

    • +

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

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

      • Abstract

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


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


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


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


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

    • +

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

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

      • Abstract

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


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


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


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


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

    • +

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

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

      • Abstract

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


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


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


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


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

    • +

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

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

      • Abstract

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


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


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


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


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