• e-Health 2019 Conference Program

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

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

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    PDF's of presentation PowerPoints are now online!

    Presentation Date(s):
    • May 26 - 29, 2019
    • Total Presentations: 245
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    RF04 - The Power of EHR's!

    • 08:30 - 10:00
    • 5/29/2019
    • Location: Room 4
    • Type: Rapid Fire Session
    • Track:
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      RF04.01 - “It’s been life changing”: Community Pharmacist Access to EHRs 

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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    RF05 - Technology Empowerment; Near and Far!

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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    OS28 - Not Without the Patient

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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      OS28.03 - Electronic Medical Records- The Next Generation

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

      10:30 - 12:00  |  Author(s): Catherine Daley

      • Abstract

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


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


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


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


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

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    OS29 - Virtual Care in Mental Health

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

      10:30 - 12:00  |  Author(s): Raza Abidi

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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    OS30 - What's New in Medication Management

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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      OS30.05 - Implementation of electronic prescribing in Quebec

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

      • Abstract

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


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


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


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


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

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      OS30.06 - Stakeholder engagement and e-prescribing

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

      • Abstract

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


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


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


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


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

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    OS31 - Interoperability; When Will We Get There?

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 4
    • Type: Oral Session
    • Track:
    • +

      OS31.01 - An Innovative eOrdering Solution With Real-time Triage-based Scheduling

      10:30 - 12:00  |  Author(s): Danielle Porter

      • Abstract

      Purpose/Objectives:
      Partnering with the Faculty of Medicine, Memorial University of Newfoundland and Eastern Regional Health Authority, the Newfoundland and Labrador Centre for Health Information is implementing new innovative technology to support provincial electronic ordering (eOrdering) processes. Funded by ACOA, the initial phase of the project builds and integrates an electronic requisition form for the vascular Imaging laboratory: the sole facility in the province for carotid artery and peripheral artery testing. Despite triage by surgeons, the time from order requisition submission to vascular testing in urgent patients is not optimal and the number of unnecessary tests is high. Leveraging and integrating with existing EHR and EMR systems, the eOrdering tool maximizes the value of existing foundational technology investments and data and is part of Newfoundland and Labrador’s strategic eHealth plan which guides province-wide eHealth priorities for the health system. As a collaborative effort between the technical project team resources and the chief clinical sponsor in the vascular lab this presentation will provide conference attendees with broad perspective and insight into an eOrdering implementation: technical and clinical workflow challenges, and benefits to the health system and patient care.


      Methodology/Approach:
      The eOrdering implementation requires a balance of privacy, security, technical architecture, governance and ultimately clinical workflow across multiple clinical settings. Key components of the system include:
      ? Digitized requisition form and intake processing to replace and streamline existing processes.
      ? Technology to independently assess and validate order urgency. The innovative, rapid electronic “scoring” of orders via the automated assessment tool applies best-practice clinical algorithms to determine appropriateness of the proposed procedure.
      ? Real-time scheduling. Patients and requesting providers will receive the appointment time as soon as they are identified as requiring testing.
      ? Multi-system integration involving the EMR, EHR, a predictive modelling system, and scheduling system.


      Finding/Results:
      Developing a solution that digitizes varied manual processes, integrates with existing technologies, and meets the needs of all users from the requisition entry and submission through to scheduling, intake and patient testing is challenging. Balancing end user needs, system capabilities, personal health information and ongoing clinical operations in order to maximize adoption and produce the desired clinical outcomes is key. The system application of clinical guidelines will enable prioritization of test requests such that patients with a more critical or time-sensitive need will be scheduled more promptly.


      Conclusion/Implications/Recommendations:
      Elements key to the early stages and implementation of such a solution include:
      ? Controlling scope to ensure key functionality is implemented successfully before bringing change to other related areas
      ? Engaged clinical and administrative users from all points in the workflow
      ? Privacy, security and technical subject matter expertise
      ? Strong project governance
      ? Strong communication and change management expertise eOrdering utilizing realtime, guideline-based triage and scheduling is a powerful tool to streamline what is currently a complex manual process. While the project design and implementation is currently still in progress, by conference dates, we will have data analysis to measure and interpret eOrdering outcomes for the vascular lab.


      140 Character Summary:
      An innovative eOrdering solution for vascular imaging in NL with EHR/EMR integration, and real-time triage-based scheduling

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      OS31.02 - Improving Information Flow to Support Continuity of Care: EMR Interoperability

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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


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


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


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


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

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

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

      • Abstract

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

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

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

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

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




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


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


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


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

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    RF06 - Patients, Communities and Technology Moving Forward

    • 10:30 - 12:00
    • 5/29/2019
    • Location: Room 5
    • Type: Rapid Fire Session
    • Track:
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      RP06.01 - Weaving Innovation into Remote First Nations Communities for Managing Diabetes

      10:30 - 12:00  |  Author(s): Leo Godreault

      • Abstract

      Purpose/Objectives:
      Reliq Health Technologies in partnership with Sioux Lookout, the Meno Ya Win Health Centre take on the healthcare challenge of creating better access to healthcare for patients living in remote and rural communities. The focus of the project is to give the tools to isolated First Nations individuals to better manage their diabetes in the home. The North West LHIN covers the largest geographic area of all Ontario LHINs (approximately 47% of Ontario) serving a population of approximately 231,000. With a population of 5000, Sioux Lookout provides care to approximately 30,000 patients annually. The majority of its patients are required to travel from the most remote areas to receive care at the Health Centre. The solution provides patients living with diabetes with an easy to use and secure digital health solution for remote patient monitoring which brings together all members of the patient’s circle of care together in one place. Unless properly managed, diabetes can lead to significant health complications such as neuropathy, poor wound healing, amputations, vision loss, kidney failure, cardiovascular issues, and even death. The implementation of bringing innovative connective devices into the homes of patients closes the gaps between the health centre and the people leading to better health outcomes and significantly reducing the cost of delivering quality care. iUGO Care is the solution which will allow patients living in the isolated Northwestern Ontario communities stay connected with their healthcare providers, have better tools to manage their care in the home, and increase patient engagement through remote patient monitoring and virtual care visits. This closes the physical gap between clinicians in multiple locations to all work together to deliver the best care plan for each patient, reducing the need for reactive medicine and promoting preventive and proactive care in the home. This project is funded in part by Ontario Centres of Excellence (OCE) and Reliq Health Technologies Inc. in support of improving access to high quality care for patients living in remote and rural communities.


      Methodology/Approach:
      The project objective looks to validate the use of Reliq’s iUGO Care remote patient monitoring and secure care collaboration technology tools by demonstrating success in reducing readmission rates, better health management, and improved health outcomes from patients living with diabetes.


      Finding/Results:
      The pilot is a project aimed at evaluating the feasibility, cost, adverse events, proactive interventions, and overall better outcomes when compared to the control group. The iUGO Care application integrated selected connected glucometers and blood pressure cuff devices for remote patient monitoring from the Health Centre and creating better patient engagement with the use of the telehealth component with iUGO’s patient- and family-app to communicate with their care team.


      Conclusion/Implications/Recommendations:
      The pilot project looks to close the vast distances between people and their care providers in this country. By giving the tools to people to not only manage chronic conditions but to excel, engage, and connect will change the outlook of healthcare from its current reactive stance to a proactive approach. Implications and recommendations will be explored with the conclusion of the study.


      140 Character Summary:
      Changing healthcare focus from reactive to proactive by connecting the Northern First Nations Communities with iUGO Care Innovations.

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      RP06.02 - Using mHealth to Support Individuals with Schizophrenia and Predict Relapse

      10:30 - 12:00  |  Author(s): Sean Kidd

      • Abstract

      Purpose/Objectives:
      Schizophrenia costs $6.85B/year in healthcare costs and lost productivity. Approximately 75% of people with schizophrenia have been hospitalized, 38% are readmitted within 1 year, and the average length of stay is 97 days in tertiary facilities and 21 days in general hospitals (at approx. $1000/day). Relative to the large investments in mHealth strategies for conditions such as anxiety and depression and the management of chronic physical health conditions, the development of technology to facilitate care and provider engagement for people with schizophrenia-spectrum illnesses is limited. App4Independence (A4i) is a multi-feature app with demonstrated feasibility that uses feed, text-based, and provider portal functions co-designed with users to enhance provider engagement and illness self-management. A feasibility study was conducted to evaluate engagement, effect on outcomes, and user satisfaction in effort to pave the way for further validation and eventual commercialization of the technology.


      Methodology/Approach:
      A4i uses interactions, usage and ambient sleep monitoring, pioneering the use of machine learning and hypothesis-driven content feed and data analysis to combine subjective and objective ambient data elements to segment intervention content in real-time. The model also collects objective usage and qualitative data points to validate a model of relapse prediction. Currently, A4i is being studied through CAMH, with the primary point of engagement being the early psychosis service. The requirements, structure, and content of A4i were all derived through a review of pertinent literatures and structured focus group engagement. Testing has included a total of 38 individuals with psychosis, primarily with schizophrenia and schizoaffective disorder diagnoses, that completed one month tests of either Android or iPhone versions of A4i.


      Finding/Results:
      We gathered a number of metrics as well as qualitative feedback, pre- and post- intervention while engaged with A4i. Our study showed sustained engagement and identied early markers of potential ‘digital phenotypes’ from app usage and behavioural/clinical data. We observed a significant reduction in several symptom domains including psychoticism and depression. Qualitative data posted to the feed captured real world experiences of patients' symptoms, struggles, and coping strategies while fostering a community of support and reducing social isolation. A4i is feasible as a means of supporting the patient and collecting real world data to shed insight on different patient profiles.


      Conclusion/Implications/Recommendations:
      During our first round of validations and iterations we learned much about patient engagement, interactivity and data capture. As part of our efforts in the last year, we’ve been iterating once again on the user experience and co-designing the clinician/provider portal and automated report generator to make key clinical data points and predictive elements available to clinicians in a timely and secure manner. Following this initial wave of feasibility study we will be moving on to trials of the outcomes of A4i in key clinical domains and the outcomes of the provider portal specifically.


      140 Character Summary:
      App4Independence (A4i) is an adaptive, data-driven digital health communication platform to support patients with schizophrenia and predict risk of relapse.

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      RP06.03 - Stroke Rehabilitation - ESC LHIN and Sensory Technologies

      10:30 - 12:00  |  Author(s): Barb Frayne

      • Abstract

      Purpose/Objectives:
      The principal goal of the eRehab program is to bring services that have traditionally been available in Erie St. Clair (ESC) in-line with the gold standard of care identified in Health Quality Ontario’s Quality Based Procedures (QBP) – Clinical Handbook for Stroke and to do so in a fiscally responsible manner that also benefits the overall health care system. Prior to the launch of eRehab, the ESC LHIN service average for patients diagnosed with an acute stroke was four to five total visits across all therapy disciplines – physical therapy (PT), occupational therapy (OT), and speech language pathology (SLP) – over a 10 to 12 week period per patient. This statistic falls significantly below the QBP recommendations of therapy two to three times per week for each discipline during a minimum of eight weeks.


      Methodology/Approach:
      eRehab was launched as a pilot project in February 2017 for patients at Windsor Regional Hospital who had experienced a mild/moderate stroke. Since that time, the program has expanded to Chatham-Kent Health Alliance. A Directing Registered Therapist (DRT), working remotely in real-time via the Ontario Telemedicine Network (OTN), will provide guidance to specially trained therapy assistants in-home. Based on the eShift platform, the DRT uses state-of-the-art electronic software and tools to monitor the patient’s progress and provide instant instructions to the therapy assistants to ensure the patient’s PT, OT, and SLP therapy needs are being met. The patient’s service planning and clinical nursing support is provided through the expertise of a Clinical Care Coordinator who supports transition from hospital to home. Through this concept of cascading delegation, the care team, along with the patient and caregiver, is able to collaboratively develop and update an individualized care plan that supports a successful rehabilitation in the patient’s home.


      Finding/Results:
      Compared to the traditional 1:1 service delivery model, eRehab results in a community savings of $552,000 and acute care savings of $80,000. This is a total of $632,000 in systemic savings per 100 patients in a 10-week program (based on pure QBP service volume standards). For ESC patients, eRehab has enabled them to achieve their goals with a reduced length of stay (LOS) to seven weeks with an average of 20 total visits; that’s a 77% increase in the number of visits and supports the provincial standard.


      Conclusion/Implications/Recommendations:
      eRehab is supporting care closer to home for patients with mild/moderate stroke and effectively improving community benchmarks to QBP standards through the use of innovate technology and an interdisciplinary team approach. The program also demonstrates substantial systemic savings and enables continuity and consistency of care. Future direction includes scalability to other patient populations.


      140 Character Summary:
      eRehab supports positive outcomes for patients who’ve experienced a mild/moderate stroke while also providing financial benefit to the health care system.

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      RP06.04 - How Digital Trust Will Unlock Innovations in Digital Health

      10:30 - 12:00  |  Author(s): Mark Rajack, Joe Mayer

      • Abstract

      Purpose/Objectives:
      Mobile technology has transformed how people organize their lives and how entire industries operate, yet we still do not see widespread adoption of the transformative power of mobile in healthcare. Despite examples of many great mobile solutions in the market, patients and caregivers in Canada do not have the means to securely coordinate, communicate and transact digitally with their care teams from their own device of choice, conveniently, at scale. Our presentation will focus on how emerging technologies and design patterns such as federated digital trust, blockchain and artificial intelligence will change how patients and providers interact with the healthcare system. The connected digital health system of the future will be driven by a truly scaled, secure ecosystem of mobile applications and services with citizen privacy at its core.


      Methodology/Approach:
      Global and pan-Canadian initiatives related to digital identity are changing how trust will be exchanged digitally. By applying unique, mobile first and blockchain compatible technology - being developed right here in Ontario - Niagara Health, in collaboration with other Ontario hospitals and health delivery organizations, is leading the way as an early adopter of a quickly approaching future of a secure, trusted, connected digital healthcare system. Using hospitals as 'Community Hubs' to host regional federated trust networks, we are implementing the technology infrastructure that will allow organizations, care providers, and patients to easily, reliably, and, most importantly, securely communicate and exchange data across the continuum of care, inlcuidng care delivery in the home and community setting.


      Finding/Results:
      We have completed a number of healthcare specific pre-market, early adoption and limited public launches of these technologies in three key regions across Ontario. We have received widespread approval and acceptance of the solution. Users have expressed their joy with the mobile experience. Test groups ranging from doctors, other providers, patients, informal caregivers, healthcare administrators and other innovators have acknowledged the need for our solution. Provincial health agencies have also expressed support for our initiatives. By the time of our presentation at eHealth Conference we will be able to report on over 6 months of production use at Ontario hospitals. We look forward to sharing the results with the audience!


      Conclusion/Implications/Recommendations:
      Canada will continue to struggle to gain widespread adoption of needed digital health solutions until the infrastructure is in place that establishes a scalable trust framework that can then deliver secure and private transactions, on any device for, all citizens. By leveraging the power of technological innovation that delivers the tools for users to be in control of their privacy and security, we can overcome this challenge. The technology exists today. It has been built and tested in Ontario. Early movers in healthcare such as Niagara Health are implementing to the benefit of their entire community. It is time for others to learn more and join in the scale out for the benefit of your own community.


      140 Character Summary:
      Learn about how solving the “Digital Identity” problem will finally enable true scale-out of digital health innovation and adoption across Canada and globally.

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      RP06.05 - Empowering Patients through Machine Learning Driven Personalized Digital Health Interventions

      10:30 - 12:00  |  Author(s): Mareena Mallory

      • Abstract

      Purpose/Objectives:
      Machine learning (ML) is more than a “buzzword”. It is a science grounded in basic mathematics and statistics that have both been around for centuries. Recent advances in technology have increased both the amount of data available and its accessibility. Leveraging ML techniques can allow for knowledge and insights to be extracted from these large quantities of data to allow for increased patient-centricity and personalization in health care. MEMOTEXT aims to solve specific, clinically driven, business requirements using disparate stores of data to achieve behaviour change objectives such as medication non-compliance, drug switching, and degradation in population health status. MEMOTEXT leverages ML techniques to improve patient health outcomes by personalizing interactive digital health solutions to patient needs and circumstances.


      Methodology/Approach:
      The MEMOTEXT Sentinel core technology consumes patient data to drive patient communications and stakeholder decision support. The MEMOTEXT technology and integration methodology enable interactive communications using population-specific media such as Interactive Voice Response (IVR), iOs/Android applications, SMS, and voice/smart assistant technology. Our distinct lines of business are 1) Precision adaptive digital engagement programs, 2) Machine learning analytics and surveillance and 3) Innovation co-commercialization with providers and academics. MEMOTEXT combines an evidence-based design methodology with a proprietary collection of behaviour-change algorithms and an enterprise scale communications platform. Disease-specific, self-learning algorithms adapt to patient biometrics, ambient phone data, wearable data, claims data, and self-reported behavioural characteristics in order to personalize content to engage the patient and collect self-reported measures in real-time and longitudinally.


      Finding/Results:
      MEMOTEXT continues to successfully use machine learning algorithms in the intervention design to target patients’ individual barriers to disease treatment/prevention. We’ve been successful in mapping medication adherence trajectories, outcomes prediction, sequential pattern analysis, and mixed data clustering for determining distinct patient types. With up to 30% decreases in annual total healthcare costs from every 10% increase in Medication Possession Ratio, MEMOTEXT’s unique solution has an over 88% retention rate and a very high ROI.


      Conclusion/Implications/Recommendations:
      MEMOTEXT plans to both expand its number of new pilots and convert existing pilots into full-scale programs. MEMOTEXT’s current sales funnel includes insurance/health plan, pharmacy, PBM, and pharmaceutical sectors. Management is content that MEMOTEXT will leverage its track record of successful implementations and win more business, eventually also expanding to direct-to-consumer offerings.


      140 Character Summary:
      MEMOTEXT successfully uses machine learning to personalize digital health solutions to empower patients, increase engagement and decreasing total health costs.

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      RF06.06 - Telehomecare Impact on Clinical Outcomes in Heart Failure Patients

      10:30 - 12:00  |  Author(s): Aleksandra Stanimirovic

      • Abstract

      Purpose/Objectives:
      In 2007 Ontario Telemedicine Network (OTN) launched pilot of telehomecare (THC) for heart failure (HF) patients residing in Central West (CW), Toronto Central (TC) and North East (NE) local health integration networks (LHINs). Phase 1 program expansion was initiated in 2012, based on pilot results indicating that THC may improve quality and access to care among HF population. Quasi experimental pre-post study aimed to assess impact of THC on health system utilization in HF patients enrolled in THC across 3 LHINs.


      Methodology/Approach:
      Primary research data was linked to National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) between July 26th, 2012 and up to March 31st, 2014. THC impact on composite outcome (ED visits and hospitalizations); and disease specific ED visits and hospitalizations was assessed for a period of 30 days and 180 days pre and post THC enrollment. Data was analyzed based on intention to treat approach using generalized linear mixed model procedures in SAS. Subgroup analysis assessed impact of THC on gender and whether the impact varied by LHIN.


      Finding/Results:
      In cohort of N=783 HF patients, average 76.93?±?10.97 years of age; 51% were females; whereas N=257 (33%); N=155 (20%); and N=371 (47%) were recruited from CW, NE and TC LHINs. Change in monthly rate in all cause health system utilization 30 days pre and post-THC Variable EDhosp visits all cause ED visits all cause hospitalizations Unplanned all cause hospitalizations HF ED visits HF hospitalizations unplanned HF hospitalizations rate before 79.3 44.0 35.2 34.2 18.5 19.0 18.6 rate after 45.0 26.9 18.1 16.9 5.5 4.3 4.1 estimate -0.5723 -0.500 -1.683 -0.711 -1.21 -1.504 -1.514 p-value <.0001 95% C.I. [-0.70 to -0.44] [-0.67 to -0.33] [-0.88 to -0.47] [-0.92 to -0.50] [-1.88 to -1.26] [-1.90 to -1.13] [-1.90 to -1.13] Change in monthly rate in all cause health system utilization 180 days pre and post-THC Variable EDhosp visits all cause ED visits all cause hospitalizations Unplanned all cause hospitalizations HF ED visits HF hospitalizations unplanned HF hospitalizations rate before 33.5 18.9 14.6 13.8 51.1 52.5 51.3 rate after 23.2 13.6 9.7 9.1 22.6 19.4 19.3 estimate -0.378 -0.354 -0.429 -0.436 -0.840 -1.017 -1.009 p-value <.0001 95% C.I. [-0.44 to -0.31] [-0.43 to -0.27] [-0.52 to -0.33] [-0.53 to -0.34] [-1.02 to -0.65] [-1.20 to -0.82] [-1.20 to -0.81]


      Conclusion/Implications/Recommendations:
      Results indicate that THC may impact health system utilization of HF patients. The impact may differ between genders; and program may be of benefit to patients residing in particular LHINs. Findings of the study merit further investigation on impact of THC, using other study designs.


      140 Character Summary:
      Results indicate a significant decrease in health system utilization among heart failure patients in 30 days and 180 days post Telehomecare.

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      RF06.07 - New initiative – Innovation, Collaboration in Mental Health by telemedicine

      10:30 - 12:00  |  Author(s): judith Boileau

      • Abstract

      Purpose/Objectives:
      It is recognized that patients in rural areas are experiencing particular health challenges, including those related to mental health, such as higher rates of addiction and suicide. Unfortunately, by the very fact of being in an isolated area, these patients have fewer resources at their disposal Objectives •Recognize the lack of mental health services available in French in rural areas •Learn about the new mental health initiative between Montfort and the Nord-Aski Family Health Team in Hearst •Understand the benefits of telemedicine for the receiving of services by patients and for the transfer of mental health knowledge for staff


      Methodology/Approach:
      A 12-week psychoeducation group for anxiety management has been offered at Montfort since 2013 by a psychotherapist and a social worker. The group generally has between 10 and 12 participants. During the last session, for the first time, two participants from Hearst , assisted by two mental health workers, joined the group each week through the Ontario Telemedicine Network (OTN) system located at the center of the Nord-Aski Family Health Team in Hearst. These patients had received an intake assessment and will be given an individual post-group session through OTN as well. The relevant materials for pre- and post-group evaluations as well as for group sessions were sent via email to the mental health workers in Hearst prior to each session. An open communication was maintained throughout between the workers at Montfort and those in Hearst. .


      Finding/Results:
      Patients in rural areas continue to experience important rates of mental health difficulties and to be marred by a lack of resources due to their remote location. The access to mental health services by way of telemedicine is a new and very promising solution to address these particular issues as it offers patients a way to access care they would not normally receive. In addition, because telemedicine is not limited by location, those who do not speak the majority language – in this case Francophones in predominantly English locales – now have a way to receive treatment in their first language, which research shows has proven to be most effective. .


      Conclusion/Implications/Recommendations:
      The benefits of telemedicine also extend to the mental health workers in rural areas, giving them access to training and other knowledge transfer resources that are unavailable in their region or too costly to consider if offered out of region. At Montfort, the initiative to deliver the anxiety-management course to the Nord-Aski Family Health Team and their patients in Hearst was not without its – mainly technical – challenges. Prioritizing solutions to these is vital, as this project was merely a first in a series of intended collaborations with this and many other organizations across the province


      140 Character Summary:
      Telemedecine allowed patients in Northern Ontario to access Mental Health Group Therapy. Telemedecine was used to facilitate training for social workers in French

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    Closing Keynote Address

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

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

      • Abstract

      Abstract not provided