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G. Randhawa



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    EP01 - e-Poster Session 1 (ID 52)

    • Event: e-Health 2018 Virtual Meeting
    • Type: e-Poster Session
    • Track: Clinical Delivery
    • Presentations: 1
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      EP01.05 - Growing and Developing Digital Health Competencies Through Educational EHRs (ID 288)

      G. Randhawa, Clinical Improvements & Informatics, Island Health; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: To support the effective design, development, adoption, and optimization of electronic health records (EHR), there is a considerable need for Health Informatics (HI) students to have hands-on experience and training with using EHRs. However, many HI students in Canada have very limited exposure to EHRs. This lack of exposure results in student challenges with developing HI competencies that are pre-requisites for other courses, co-op work terms, and eventually the workplace. Consequently, HI students may feel inadequately prepared to design, develop, implement, and support EHRs as graduates. The integration of an educational EHR into HI curriculum is central to developing students' digital health (HI) competencies. To meet this need, McMaster University adopted an educational EHR for its Health Informatics and Health Information Management (HIM) diploma programs in August 2016.

      Methodology/Approach: As a part of the course redesign efforts for HTH 105: Information Systems and Technology, an educational EHR was adopted by the course developer and instructor. A three-hour scavenger hunt activity using the education EHR was included as a pre-requisite for the course. During the first week of the course in September 2017, HTH 105 students were asked to complete a 54-item self-assessment questionnaire based on COACH's "Health Informatics Professional Core Competencies v3.0" using a Likert scale of 1-5 (No Demonstrated Achievement to Exemplary Achievement). The course is providing students 1-2 hours of weekly hands-on exposure to the educational EHR, as well as supplementary activities to gain additional practice. To measure any changes in HI competency development at the end of the course, students will be asked to complete the same HI Competencies self-assessment questionnaire in November 2017.

      Finding/Results: The response rate for the baseline HI Competencies Self-Assessment questionnaire was 67% (n=16/24). Of the respondents, almost all s have less than one year of experience in the HI field (n=14/16, 88%). The overall average across all HI competencies was 2.66/5. Although students reported a higher self-assessment average for basic clinical terminology, they reported health information systems adoption and use, EHR architecture, and systems evaluation as their weakest competency areas. Nearly all HTH 105 students (n=22/24, 92%) have adopted the educational EHR and are completing the hands-on EHR activities. Evaluation and monitoring of the benefits and limitations of the educational EHR is ongoing until the end of the course (November 2017). It is anticipated that the educational EHR will help to significantly increase students' self-assessment of COACH competencies, especially related to the EHR.

      Conclusion/Implications/Recommendations: With the introduction of hands-on exposure to the educational EHR, HTH 105 students at McMaster University are experiencing an educational EHR's features, learning how clinical and administrative data is inputted and retrieved, observing its workflows, evaluating its usability, and making recommendations for improvements in EHR design and adoption. These skills are foundational to the development of COACH competencies for HI students. Educational EHRs should be integrated strategically into other HI courses and programs across Canada to support the applied learning of HI students. Further, there is a need to conduct pre and post-course evaluations of COACH competency development for HI students.

      140 Character Summary: McMaster University's integration of an educational EHR in Health Informatics curriculum is helping to significantly increase students' COACH competencies.

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    EP02 - e-Poster Session 2 (ID 53)

    • Event: e-Health 2018 Virtual Meeting
    • Type: e-Poster Session
    • Track: Clinical Delivery
    • Presentations: 1
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      EP02.03 - Inspiring Bold Action Through an EHR Adoption and Use Model (ID 275)

      G. Randhawa, Clinical Improvements & Informatics, Island Health; Victoria/CA

      • Abstract
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      Purpose/Objectives: The Electronic Health Record (EHR) is central to British Columbia’s eHealth strategy to increase the quality and safety of patient care. However, the implementation of EHRs is a challenging, transformational change that involves the complex interaction between health care professionals, processes and technology. To support the successful adoption, use and optimization of EHRs for the benefits of patient quality, safety and the patient/provider experience, there is a need for a comprehensive framework/model to understand the variables that contribute to EHR adoption, use and benefits realization. Currently, such a comprehensive framework/model does not exist in the literature. However, an EHR Adoption and Use (EAU) framework/model is critical to informing evidence-based planning, implementation and evaluation of EHRs at the local, provincial, national and international levels. To inspire bold action in EHR adoption and use for benefits realization, Island Health embarked on the development of an EAU Model. The purpose of the EAU model is to guide EHR adoption and use planning, as well as to inform formative EHR evaluation at Island Health.

      Methodology/Approach: A literature review of existing technology adoption/use and quality frameworks was conducted from May to June 2017. The variables/constructs and dimensions of each of these frameworks were extracted. Similar constructs and definitions were combined and an overarching framework was developed. To operationalize the model for measurement, relevant metrics related to patients, caregivers, health care providers, the health care organization and population health were extracted based on literature reviews and prior EHR evaluation knowledge for each construct. Methodologies, methods and instruments for evaluating the metrics were also identified.

      Finding/Results: Ten technology-adoption-and-use frameworks/models were included in the development of the EHR Adoption and Use (EAU) Model: (1) the Unified Theory of Acceptance and Use of Technology (UTAUT); (2) Canada Health Infoway’s Benefits Evaluation Framework; (3) the UVic eHealth Observatory’s Clinical Adoption Framework; (4) Island Health’s Quality Framework; (5) the BC Health Quality Matrix; (6) The Clinical Systems Transformation (CST) Benefits Framework; (7) the Agency for Healthcare Research and Quality (AHRQ) Domains of Health Care Quality; (8) Health Quality Ontario’s Quality Attributes; (9) Accreditation Canada’s Dimensions of Quality Care; and (10) the Clinical Adoption Meta-Model. As the most cited and rigorously tested framework internationally, the Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the core framework for the EAU Model. In total, 42 constructs and sub-constructs were included, and multiple metrics at the patient, health care provider, health care organization and population health levels were developed for each construct. The EAU Model can be seen in Figure 1. The validation and testing of the metrics and evaluation methods is currently underway. eau model.jpg Figure 1 EAU Model

      Conclusion/Implications/Recommendations: The EAU model combines evidence-based variables/constructs of technology adoption and use with universal quality and experience benefits that can be measured for EHR benefits realization. The EAU model can be used by health care organizations to guide the planning, implementation and continuous evaluation of EHRs at the local, provincial, national and international levels.

      140 Character Summary: The EHR Adoption and Use (EAU) Model is an evidence-based framework to guide EHR planning, implementation, continuous evaluation and benefits realization.

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    OS16 - Innovation in Capacity Building (ID 25)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS16.03 - Evaluating the Effects of Post-Implementation EMR Training on EMR Use (ID 356)

      G. Randhawa, Clinical Improvements & Informatics, Island Health; Victoria/CA

      • Abstract
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      Purpose/Objectives: To address the need for continuity, comprehensiveness, and coordination of care, primary care plays a key role in the management of chronic diseases, especially diabetes care. The electronic medical record (EMR) facilitates proactive diabetes care management through advanced features such as reminders/alerts. Although the majority of primary care physicians (PCP) in Canada have adopted an EMR, their use is generally limited to basic features, such as scheduling and billing. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features. However, training is an important type of EUS that the majority of PCPs currently lack, especially post-implementation EMR training. A recent Canadian study by Infoway also highlights the need to invest in training and education initiatives for current PCPs to improve their use of the EMR. The purpose of this research study is to evaluate the effects of an EMR training intervention for diabetes care management in primary care. Specifically, the study examines the extent to which the training affects the process measures for type 1 and type 2 diabetes care management, including: (a) use of a diabetes registry, (b) use of diabetes recalls/reminders, (c) ordering/viewing a patient's Hemoglobin A1C, and (d) recording a patient's blood pressure.

      Methodology/Approach: The study is set in British Columbia (BC) and includes all PCPs who use OSCAR EMR, one of the top three EMRs used in BC. This study employs a mixed methods approach and a quasi-experimental design. The study intervention is based on the internationally-recognized and evidence-based Chronic Care Model (CCM). The study intervention is a series of four online video tutorials for diabetes care management that provide training on Level 4 (Proactive Care/Data Driven Practice) of BC's Meaningful Use Model for EMRs. From June-August 2017, the video tutorials were co-designed and developed with an OSCAR EMR Physician Super-User based on best practices in the literature. Human Research Ethics Board Approval was sought from the University of Victoria in June 2017. The study was initiated in July 2017 and study recruitment was done through BC's Divisions of Family Practice until October 2017. Data collection is currently underway and includes: (1) PCP Demographic Survey, (2) Diabetes Care Management Survey (Pre-Baseline, Baseline, 3 Months, and 6 Months), and (3) Follow-Up Interviews (3 and 6 months).

      Finding/Results: In total, 23 PCPs from across BC have completed the baseline Demographic and Diabetes Care Management Surveys. Of these, 18 PCPs have received the study intervention thus far. Data collection and analysis to evaluate the effects of the EMR training are ongoing until May 2017.

      Conclusion/Implications/Recommendations: Video tutorials are a cost-effective, accessible, and convenient medium for delivering post-implementation EMR training to PCPs. It is anticipated that the video tutorial series will help to significantly increase PCPs' process measures for type 1 and type 2 diabetes care management using the EMR. The study findings can be applied to the design, delivery, and evaluation of EMR video tutorials for other EMRs and chronic diseases in Canada and internationally.

      140 Character Summary: Post-implementation EMR training delivered through video tutorials can significantly increase physicians' advanced use of EMRs for diabetes care management.

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    RF04 - New Ideas for Clinical Worker Transformation (ID 20)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 1
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      RF04.06 - Optimizing EHR End-User Support, Experience and Efficiency Through Advanced Data (ID 274)

      G. Randhawa, Clinical Improvements & Informatics, Island Health; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: Health care organizations across the world are seeking ways to optimize electronic health record (EHR) adoption and use for benefits realization. Specifically, there is a need for a data-informed tool that can inform the design and delivery of end-user support (e.g., EHR coaching, training, etc.) to optimize EHR adoption, use, experience and efficiency after EHR Go Live. Island Health is the first health care organization in Canada to adopt Cerner Advance, an advanced data analytics tool that provides expert analysis to inform the design and delivery of end-user support to achieve these goals. The purpose of this presentation is to share Island Health’s methodology, barriers, facilitators and benefits realized in using the Cerner Advance tool.

      Methodology/Approach: In May 2017, Island Health adopted Cerner Advance, a Web-based analytics tool that helps to optimize individual use of the EHR based on recognizing opportunities to create user efficiencies. The tool organizes data with multiple levels in an easy-to-use visual display that can be sorted by different views. Using stoplight coding, the tool identifies high-, medium- and low-opportunity users (i.e., opportunity to increase efficiencies in EHR use). Since June 2017, Island Health has used Cerner Advance to develop targeted EHR optimization projects to support EHR adoption/use, using five metrics: (1) Time in EHR; (2) Patients seen; (3) Computerized Provider Order Entry %; (4) Electronic Documentation %, and; (5) Adoption Score. To design an individual EHR optimization plan, the following methodology is used: (1) Review Cerner Advance data before an end-user coaching meeting; (2) Approach the targeted physician/nurse and share goals of optimization; (3) Observe the workflows of the provider/clinician using the EHR; (4) Provide suggestions that will improve EHR adoption or efficiency, and; (5) Share Cerner Advance data with the physician/nurse when appropriate.

      Finding/Results: Island Health has proactively leveraged Cerner Advance to identify “high-opportunity” users who can be provided post-implementation end-user support and optimization coaching to improve their EHR adoption/use and efficiency. From April (baseline) to September 2017, this data-driven end-user support has resulted in increased: (1) Quick Orders Selection (45% to 51%); (2) Orders via MySearch (40% to 46%);CPOE % (94.25% to 94.65%), and; Electronic Documentation (96.8% to 98.4%) for all physicians. At the same time, physicians’ active time per patient in the EHR has decreased from 5:40 to 5:11. However, limitations/challenges of the tool include (1) Targeted physicians must have seen at least 40 patients to have reliable EHR usage data and (2) EHR usage data was initially unavailable for nurses.

      Conclusion/Implications/Recommendations: Island Health is the first health care organization in Canada to use Cerner Advance, a proactive, data-driven approach to EHR optimization. In addition to targeting end users based on adoption, efficiency and organizational goals, this data-based approach to end-user support helps increase user satisfaction, as well as build capacity in understanding/applying data to EHR optimization conversations with end users. Canadian health care organizations can apply Island Health’s methodology, barriers and facilitators to their own planning, design and delivery of EHR optimization efforts for benefits realization.

      140 Character Summary: Island Health is using a proactive, data-driven approach to EHR optimization to increase EHR adoption/use and user satisfaction for EHR benefits realization.

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