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    OS06 - Partnership in Care and Outcomes (ID 2)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS06.01 - Show Me My Data! Physicians Demonstrate Value of EMR Dashboard (ID 584)

      E. Keller, OMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: This Panel discussion will: • Provide a dialogue around opportunities and challenges of a real-time physician EMR Dashboard • Provide a quick demo of the tool by a physician user and how it helps care for their patients • Discuss technology that will transform how physicians use their EMRs to deliver patient care • Discuss how the EMR Dashboard was experienced by physician practices; highlighting formal Benefit Evaluation findings • Discuss as a panel: • Challenges around data sharing and trust for physicians • Considerations in choosing in clinical indicators for primary care physician use • Cross-collaboration and applicability to other jurisdictions

      Methodology/Approach: The panel will discuss a provincial EMR dashboard that was demonstrated with 500 physician users that: • provides immediate clinical value to physicians, through real-time visual representation of EMR data using widely-recognized, primary care indicators; • provides the ability to drill down to patient-level data for each indicator enabling physicians to take immediate proactive steps to improve patient care; • helps physicians standardize their data entry to improve the quality of patient data in their EMR; • allows physicians to trend and compare their indicator metrics with other physicians using the Dashboard; • would scale provincially to all physicians using a certified EMR, and is easily expanded with new and evolving data quality, practice and clinical indicators. A discussion of stakeholder partnerships will highlight the benefits of collaborative engagements and value add to participating physicians and clinics An open discussion on the key findings, benefits, and recommendations of a provincial EMR Dashboard initiative that changes how physicians and clinics can proactively manage patient care, improve EMR data, and support clinical reporting.

      Finding/Results: Collaboration with provincial indicator framework representatives, EMR vendors, and clinicians resulted in overall positive findings from the EMR Dashboard initiative. The panel will discuss these findings/results to share learnings and provide a network for similar cross-collaboration. The Dashboard resulted in the development of indicators under the categories of chronic disease, preventive care, and care bonus management. • 75% of participating physicians recognized value in the dashboard through improved patient outcomes and identifying patients of interest, supporting practice needs and data quality improvements, access to real-time data and patient lists that are actionable. • 80% of physicians used the electronic opt-in feature to share metrics with the program lead and other participating physicians to access the trend/compare functionality. Phase 2 of the Dashboard initiative will be used to build on these findings.

      Conclusion/Implications/Recommendations: Using the EMR Dashboard, many participating physicians across various practice types realized the benefits in quality improvement and clinical outcomes. Partnering and collaborating with stakeholders is paramount to delivering a tool that physicians see value in using. The ability to trend and compare metrics is a key driver to quality improvement efforts. Physicians realize that change management resources would help their efforts to improve data quality and support improvements to patient care. An indicator governance structure is essential to manage the ongoing enhancement and development of provincial indicators available in the EMR Dashboard.

      140 Character Summary: Dashboard indicators on chronic disease management and preventive care support clinical need and improved patient care

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      OS06.02 - Partnering with Patients in Digital Health: Experience and Promise (ID 618)

      F. Ratchford, Canadian Foundation for Healthcare Improvement; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: Patients, along with their caregivers and family members have been advocating for themselves in the health care space for many years. Recently, digital health has played a prominent role in their advocacy, with the recognition that having access to health information and communication tools to share information with health care providers enables patients to be engaged in their care, and bring more equality to the patient-provider relationship. More recently, a movement within health care, spurred by advocacy, has sought to create a health care system where patients and their families are not only the focus, but take a seat at the table in the design and delivery of care, including through digital health. This panel will discuss the concept of patient partnership from a variety of perspectives, most importantly from that of patients and their caregivers, who will be members of the panel

      Methodology/Approach: Panellists will introduce the concept of patient partnership (sometimes also referred to as patient engagement), the conceptual frameworks that have been developed around it, its implications for organizations in the digital health sector, and describe best practices for implementation. Common myths or perceived roadblocks will also be addressed, including in the Q & A section. The panel will consist of representatives from digital health organizations that have committed to and taken action towards becoming more patient-centred, as well as patient advocates who can draw on their experience both as patients in the heath care system and as the patient partners working towards a health system that partners more effectively with patients.

      Finding/Results: The panel will situate the system-wide movement toward patient partnership within the context of the digital health sector. Digital health organizations have used a variety of tools to better adhere to the concept of patient partnering, including using patient advisory panels, vision-setting workshops, co-design with patients, etc. Panellists will present the accumulated lessons learned from the use of these tools. Patients on the panel will present their point of view as agents of change in the system and as participants in the above processes, and offer their insights into where these tools are appropriate and how they can be applied more effectively.

      Conclusion/Implications/Recommendations: Research has shown that partnering with patients is an enriching experience for all involved. Patients feel more empowered and in control of their health, and have greater satisfaction. Job satisfaction and morale has been shown to improve among health sector workers, and patient outcomes improve. Digital health can play a key role in achieving and accelerating these outcomes. This panel will enable attendees to better understand the concepts, tools, and value behind patient partnership.

      140 Character Summary: "Nothing about me, without me". Patients and health orgs discuss, what are the implications for digital health?

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      OS06.03 - Improving Emergency Care Physicians' Performance Through Laboratory Information Exchange (ID 31)

      G. Paré, Research Chair in Digital Health, HEC Montreal; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives: For hospitals, laboratory test results’ reliability, turnaround time and predictive ability are critical to the performance of hospital emergency departments (ED), and to the safety and quality of care provided by emergency care physicians (ECPs) to patients. As these results are now most often obtained by ECPs through their use of IT-enabled laboratory information exchange (LIE), the purpose of this study is to answer the following research questions: What is the actual nature of ECPs’ use of LIE, and what combination of health systems (LIS, CIS, EDIS, EHR and/or other) are actually accessed by these physicians for this purpose? What is the extensiveness of this use and most importantly, what is its effectiveness, that is, what are the clinical performance outcomes of LIE use in the ED?

      Methodology/Approach: In order to answer the research questions, a survey study was made of 163 ECPs practicing in hospitals in the province of Quebec, Canada, and having access to the province-wide EHR system (called DSQ) for LIE purposes. The majority of the sampled respondents were general practitioners (80%), the rest being specialists. The data were obtained through a web-based survey platform, and analyzed through descriptive and bivariate statistics as well as cluster analysis, using the SPSS statistical package.

      Finding/Results: The main findings of this study are threefold. First, the majority of sampled ECPs (70 %) simultaneously access two or more health systems for LIE purposes: a) their hospital’s laboratory information “viewer” (LIV) which interfaces a CIS (clinical information system), a LIS (laboratory information system) and/or a RHIR (regional health information repository), and b) Quebec’s province-wide EHR, the Quebec Health Record (QHR). Second, three LIE user profiles emerge: i) ECPs who rely extensively on both a LIV and the QHR (n = 100), ii) ECPs who rely extensively on a LIV only (n = 40), and iii) ECPs who rely extensively on the QHR only and to a lower extent on their EDIS (n=23). Third, the clinicians reporting higher performance outcomes from their LIE usage are those within the first group, that is, the LIV/QHR-reliant ECPs whose use of their hospital’s LIV is more extensive.

      Conclusion/Implications/Recommendations: The main implications of the study’s findings are threefold. First, the “laboratory” component of emergency care must be further studied in light of the growing reliance of ECPs upon information technology to enable their consultation and management of patients’ test results, that is, by explicitly incorporating effective use of LIE into ED performance models. Second, ECPS must be encouraged to make more extensive use of LIE, that is, to use their hospital-wide LIV and the province-wide EHR in combination, and to use more of the laboratory medicine functionalities available in these health systems. Third, given that the interoperability of a nation-/state-/province-wide EHR system with hospital information systems such as CIS and EDIS constitutes a necessary condition of extensive and effective laboratory information exchange in the ED, the ECPs’ requirements in this regard must be taken into account by those who design and implement these systems.

      140 Character Summary: A survey of 163 emergency care physicians in Canada allowed us to study the nature, extensiveness and effectiveness of their use of laboratory information exchange.

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      OS06.04 - For Patients and Clinicians by Patients and Clinicians (ID 539)

      M. Tuason, TELUS Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: A standard methodology that actively engages clinicians in telehomecare solution deployment is key to developing best practice care delivery models. In a telehomecare project, a clinician-centric methodology guided the setting of program goals, provided flexible clinician education and training, improved patient outcomes, and demonstrated measurable results including higher quality care, increased system capacity and improved operational efficiency. This methodology is successful under the guidance of a clinical advisory group comprised of patient partners and clinicians from vendor and client organizations.

      Methodology/Approach: Clinicians, through the Clinical Advisory Group, are engaged in the following activities (with varying levels of engagement depending on the activity): - Clinical Strategy and Thought Leadership: - Develop clinical strategy for the project - Perform literature reviews & environmental scans - Identify innovative applications of the telehomecare solution, ensuring alignment with the client’s e-health strategic objectives - Establish program evaluation frameworks in line with the client’s objectives - Contribute industry experience and knowledge to the development of the above - Product Development: - Act as client liaisons and subject matter experts in technology solution development and configuration - Contribute to the product roadmap to ensure ongoing alignment with client priorities - Advise on product testing methodology & facilitate end-user acceptance testing - Service Delivery Model & Project Implementation: - Identify target population - Develop clinical processes - Plan operational resources, recognizing professional standards, policies and guidelines for involved roles - Plan clinician and patient education and training methodology and methods - Develop evaluation plan – evaluation methodology, methods and data collection tools - Patient Interview and Data Collection Tools: - Gather requirements for data from physicians, nurses, allied health staff and administration - Research existing and/or develop patient-facing and other data collection tools - Ensure alignment to the client’s organizational guidelines and policies, as well as national standards where they exist and are applicable - Gather input from subject matter experts, frontline staff, patient and clinician partners - Sustainment: - Provide continued thought leadership for new telehomecare solutions for additional target populations

      Finding/Results: Based on a telehomecare process evaluation in 2015, we found that this methodology, guided by a Clinical Advisory Group, had the following impact: - Demonstrated strong, collaborative, client (patient)-focused teamwork among provincial and regional health organizations and the technology provider - Product improvements were identified through patient and clinician input; this input led to improved patient self-management capabilities - High clinician satisfaction: - 100% of clinicians surveyed believe that a telehomecare solution supports client self-management - There is room to further improve on clinician engagement - Patient satisfaction is high: - 98% of patients reported overall satisfaction with service - 100% of patients would recommend the service

      Conclusion/Implications/Recommendations: Better patient outcomes are experienced when clinicians are directly involved in a telehomecare solution. Success can be better achieved when engagement occurs with a Clinical Advisory Group, comprised of an interdisciplinary team with expertise in nursing and medicine, who act as subject matter experts, client liaisons, and thought leaders.Through the work of the Clinical Advisory Group, patients and clinicians are embedded in the portfolio strategy, product development cycle and project delivery.This leads to positive outcomes for the project as a whole.

      140 Character Summary: Patient outcomes improve when clinicians are involved in telehomecare projects. A clinical advisory group is key to project success.

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    OS12 - eSafety, Quality and Usability (ID 11)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 4
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      OS12.01 - Thought Spot 2.0: Optimizing an mHealth Application Through Participatory Design (ID 257)

      D. Wiljer, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Thought Spot () provides post-secondary students with an all-in-one online and mobile platform where they can geo-locate and share knowledge about mental health and wellness services in the Greater Toronto Area (GTA). The CIHR eHealth Innovations Partnership Program grant is aimed at optimizing the Thought Spot platform to more effectively meet the needs of end users. This project is split into two phases: intervention optimization through participatory design (PD) and intervention testing (RCT). This e-poster provides an overview of the optimized platform (Thought Spot 2.0) after an innovative PD process

      Methodology/Approach: Through the use of PD principles, we recruited and engaged students across the GTA to drive the optimization of the Thought Spot platform. Using these findings, a collaborative and iterative design process was followed to optimize the platform with our technology partner, QoC Health, and students. Usability testing, both in a lab and field setting, was conducted to further refine the flow and processes of the platform. Lab testing participants used the think-aloud method when performing a series of representative tasks. Field testing required the completion of a separate set of tasks on their own time over a seven-day period. Qualitative and quantitate data was obtained through observation, semi-structured interviews, single ease questions (SEQ) and the post-study system usability questionnaire (PSSUQ).

      Finding/Results: Usability testing in lab and field settings identified various usability issues, most notably, in the features of searching and adding services. These features corresponded to the lowest SEQ scores across all lab testing tasks (average of 4.1 and 4 on a 7 point scale) and the highest number of errors. The overall app quality as determined by the total average PSSUQ score for lab and field testing was 4.6 and 4.4 on a 7 point scale. Qualitative data was used to inform solutions to the usability problems observed. Key features of the platform were developed and/or refined to improve the functionality and user experience. Main improvements included: data organization; search and navigation functionalities; adding and updating spots; data hygiene for existing spots; and graphics and design. New features were also added, including adding ‘thoughts’ with a journaling component; a timeline function; and migrating to a new mapping platform, MapBox. ts video screenshot 2.jpg

      Conclusion/Implications/Recommendations: This co-design approach with end users has resulted in an innovative mHealth intervention to improve students’ ability to seek out mental health and wellness resources within their community, while contributing to the knowledge base of services and resources available through crowdsourcing and commenting. A randomized control trial (RCT) is currently underway to evaluate Thought Spot and its impact on student’s help seeking behaviours.

      140 Character Summary: Thought Spot 2.0: using participatory design to optimize an mHealth platform that allows students to locate mental health and wellness services.

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      • Abstract
      • Slides

      Purpose/Objectives: Discover how eHealth Ontario is designing, operating and governing solutions in a way that ensures the quality and integrity of digital health information. Hear practical suggestions that any organization can implement to accelerate eSafety maturity. The session will reveal how eHealth Ontario is building principles of eSafety into its existing operations by ensuring: • Governance controls are in place to proactively identify and mitigate safety risks • Consistent application of eSafety management practices through enhanced delivery frameworks and processes • Raised awareness of and consensus on the vital importance of an eSafety culture.

      Methodology/Approach: eHealth Ontario’s journey to launch an eSafety management program started with a self-assessment, using the eSafety Adoption Checklist and maturity model documented in COACH’s eSafety Guidelines. The self-assessment revealed opportunities to optimize how safety risks are identified, monitored and reported. A virtual eSafety team from across the organization was established to embed eSafety principles into existing processes and practices. Quarterly self-assessments allowed progress to be tracked and highlighted areas requiring focus and attention.

      Finding/Results: eHealth Ontario adheres to a robust governance and system development lifecycle framework which broadly addressed eSafety, but further work was required to address it more effectively. Quarterly self-assessments showed significant progress towards the target future state. eSafety use cases demonstrated the effectiveness of the processes and controls put in place and highlighted gaps and opportunities for further growth.

      Conclusion/Implications/Recommendations: As the health sector is increasingly reliant on the digital exchange of information, its vital eHealth Ontario’s policies continue to protect patient health information. eHealth Ontario is committed to ensuring a safe and reliable digital health system so that health care providers, including family doctors, nurses, emergency room clinicians and specialists, have real-time access to patient health records and are able to provide the best possible care. We have made significant progress towards our eSafety maturity targets. Critical to success was the concept of eSafety by design, whereby existing governance, risk, project delivery, and incident management processes were leveraged to ensure patient safety was considered throughout the entire lifecycle. An enterprise approach to eSafety required significant engagement from across the organization to ensure consistent application of new processes.

      140 Character Summary: Discover how eHealth Ontario designs solutions to ensure the integrity of digital health information. Session includes practical eSafety implementation tips.

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      OS12.03 - Implementing an Enterprise Approach to Data Quality Management at CCO (ID 251)

      S. Ingale, Enterprise Data & Analytics Governance Office, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Cancer Care Ontario (CCO) is the principal advisor to the Ontario government on the cancer and kidney care systems, as well as access to care for key health services. Our mission is to work together with our partners to improve the performance of our health systems by driving quality, accountability, innovation and value. As such, CCO’s board and senior leadership embarked on the development of a Data and Analytics Strategy. Key to realizing this strategy is the Towards Actionable Insights (TAI) Initiative, which has the goal of strengthening CCO’s foundation in Data & Analytics and shift the organization towards one that is capable of realizing value from its assets. Having the highest quality data is key to delivering CCO’s mission and the data & analytics strategy. The TAI Initiative identified Enterprise Data Quality Management (EDQM) as a key organization-wide project. This project will establish practices to help improve the data quality (DQ) available at CCO thus leading to better information that can be trusted for decision-making.

      Methodology/Approach: The EDQM project was launched to help define, implement, and operationalize guidelines, dimensions, processes, roles, responsibilities and technology to consistently manage data quality across CCO’s datasets. An Enterprise Data Quality Management Guideline provides a DQ work cycle that describes high-level activities, such as DQ assessment and Issue remediation that needs to be performed to plan and build effective DQ practices that are sustainable. The guideline endorses 5-dimensions of data quality (illustrated in figure 1) that are used to monitor quality at dataset, data element and record-level. The guideline will be applied to ~20 datasets over a two-year timeframe. The guideline will be refined as it moves from theory to practice. Operational plans will be developed to ensure that data quality management is an ongoing capability of the organization. dq dimensions.jpg

      Finding/Results: The Enterprise Data Quality Management Guideline will promote a common understanding and consistent application of DQ practices and tools across CCO. The processes and procedures developed through the project will ensure an understanding of roles and responsibilities resulting in a consistent and efficient approach to data quality. Overall, this will promote collaboration, understanding and transparent communication among individuals accountable for data quality management. Lessons learned, quick wins and outcomes will be capitalized to ensure the project continues to meet its objectives.

      Conclusion/Implications/Recommendations: Data quality management at CCO will reinforce users’ trust in the data and allow for confident use of the data to drive decision-making. With a solid foundation in place, CCO will further its capability to realize value from its assets and enable transformation to respond and deliver on provincial strategies.

      140 Character Summary: The Implementation of Enterprise Data Quality Management is key to CCO’s success in delivering on actionable insights for decision-making.

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      OS12.04 - A Provincial Seniors Quality and Safety Program in BC (ID 626)

      V. Lukac, West Division, Gevity Consulting Inc; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: BC Care Providers Association (BCCPA) members care for more than 16,000 seniors annually in residential care/assisted living and over 11,000 each year through home care and home support. With grant funding from the BC Health Ministry in 2017, BCCPA is developing and managing a new province-wide Seniors Quality and Safety Program. The objective of this presentation is to share lessons learned, applications deployed and key indicators of performance achieved by this program to improve seniors quality and safety in care settings.

      Methodology/Approach: The approach deployed to enable this new program will be deployed in 4 steps: The first step is to conduct a comprehensive province-wide needs assessment which serves as a baseline to feed into the prioritization of short and long-term fund allocation for all non-government publicly funded residential care homes operating within BC. The second step is to develop a provincial program process and organizational structure, analyze the needs assessment data, and develop program criteria and eligibility guidelines. (Table 1) The 3rd step is to enable the program with an app to track funding allocations for senior care homes to improve quality and safety of care for seniors. The 4th step is to measure the demonstrable benefits, improvements or impacts realized by funding and report upon them. Table 1: The five guiding principles of SSQIP ssqip.png

      Finding/Results: The results include an innovative approach in the design, delivery, implementation of a provincial program to improve Seniors Quality and Safety, with tangible demonstrated results and outcomes. This program also demonstrates innovation around people and processes to realize a province-wide needs assessment, allocate funding for senior care homes to improve quality and safety of care for seniors and measure program performance.

      Conclusion/Implications/Recommendations: B.C.’s population is aging, and a growing number of older British Columbians are living with illness, disability and/or frailty. About 853,000 seniors lived in B.C. in 2016. In March 2017, the Ministry of Health outlined an Action Plan to Strengthen Home and Community Care for Seniors. Lessons learned through this program implementation as well as the new tools used to monitor and improve the care for seniors in BC and recommendations will be shared during this presentation.

      140 Character Summary: Creating and deploying a Provincial Seniors Quality and Safety Program in BC: innovations in processes, people and performance measurement.

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