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    HS03 - Driving Access to Care (Infoway Session) (ID 40)

    • Event: e-Health 2018 Virtual Meeting
    • Type: HOST Session
    • Track:
    • Presentations: 2
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    OS05 - Accessing Connected Data - Front Line (ID 4)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS05.01 - Evolving Interoperability Needs for Coordination of Care: Pan-Canadian Collaboration (ID 116)

      D. Gutiw, Health Sector, CGI Group; V8W 2G2/CA
      F. Flores, Canadian Institute for Health Information (CIHI); Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: This presentation is to provide an overview of the changes that have occurred over time in the area of Canadian health interoperability. Presenters Diane Gutiw and Finnie Flores have each over 20 years’ experience in digital data exchange and have co-chaired the Infoway Standards Working Group and Community of Practice related to health care delivery and interoperability for over 5 years. These groups have facilitated collaboration and shared experiences among Canadian jurisdictions in the delivery of electronic health solutions. The objective of this presentation is to provide an overview of the evolution of interoperability focus and opportunities where jurisdictions have worked together to solve common challenges and outcomes with their technology standards and solutions. The presentation will review past pan-Canadian interoperability collaboration experiences, using examples of where collaboration on interoperability has been a benefit to jurisdictions and will identify how the focus has shifted from technical aspects of provincial and regional clinical data collection and sharing to addressing the clinical and business challenges of real time data exchange between health care providers.

      Methodology/Approach: The material for this presentation is based on a scan of focus areas of the Infoway collaboration communities over the past 5 years. Common areas of focus will be presented with specific examples for past and current challenges; the presentation will describe how collaboration is helping to develop a common approach and solutions to common problems.

      Finding/Results: While clinical data repositories are providing a benefit to health care providers, the ability to share data and information between providers related to care plans, past diagnoses and treatments remains a challenge for the day to day health care delivery. The collaborative communities have provided an avenue for sharing experiences and problem solving as jurisdictions work through common challenges in developing interoperability solutions.

      Conclusion/Implications/Recommendations: The ongoing collaboration communities and working groups have provided and continue to provide opportunities for technical and clinical resources from different jurisdictions to share common challenges and solutions. The benefit of collaboration is in the development of common approaches to address these challenges including past experiences of the collaborative communities such as the development of implementable standards to meet the real need of providers, the sharing of technical solutions that have worked as well as sharing of lessons learned from jurisdictions at different stated of interoperability development.

      140 Character Summary: Review of pan-Canadian interoperability collaboration, and the evolution from data collection to addressing challenges of real time clinical data exchange.

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      OS05.02 - Achieving Interoperability in the Community Health Sector (ID 607)

      A. Dalloo, Canadian Institute for Health Information; /CA

      • Abstract
      • Slides

      Purpose/Objectives: To demonstrate the value of incorporating interoperable clinical and functional information captured in interRAI assessments in various health care settings as part of an EHR/EMR to optimize continuity of care and potentially improve care outcomes.

      Methodology/Approach: interRAI assessment instruments, administered by frontline clinicians, are used to identify the preferences, needs and strengths of vulnerable persons. The information gathered is utilized both for frontline delivery of care and for health system use to help improve the quality of life. A foundational principle of interRAI assessment instruments is that they share a common, standardized language. A key benefit of this standardization is that a person’s clinical and functional information can be tracked and used across the different settings where they receive care. Examples include, the sharing of home care information with a primary care team, and mental health information with care teams in acute and community settings. In making information accessible for use, continuity of an individual’s care is optimized. Leveraging this conceptual design feature and supported by its new Modernizing Data Supply and Access strategy, CIHI developed and launched its new Integrated inteRAI Reporting System using the FHIR standard.

      Finding/Results: In launching its first-ever integrated reporting system, CIHI achieved interoperability with the suite of interRAI assessment instruments for the community health sector. The new system simplifies data flows, improves access to the data in near real-time for point of care decision support to health system use, and provides good quality and reliable data.

      Conclusion/Implications/Recommendations: Achieving interoperability with the suite of interRAI assessment instruments and the FHIR standard enables clinicians to utilize the rich clinical and functional information that can be made available in an EHR/EMR. Access to and sharing of comprehensive assessment data across health care settings promotes improved continuity of care, potentially fostering improved care outcomes.

      140 Character Summary: This session explores interoperable clinical and functional information optimizing continuity of care and potential for improved care outcomes.

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      OS05.03 - Demonstrating a Single Cross-Continuum EHR on Vancouver Island (ID 425)

      K. Nielsen, IHealth, Island Health; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: Island Health’s IHealth initiative seeks to advance the region towards its vision of One Person, One Record, One Plan for Health and Care in order to provide tangible benefits to quality, safety, experience and continuity of care. Following an initial activation of advanced EHR functionality in an acute setting in 2016, the second major phase of the initiative will demonstrate a complete cross-continuum EHR in the northern part of Vancouver Island by Spring 2018.

      Methodology/Approach: Leveraging a single instance of Cerner Millennium, the project utilized rapid phases of iterative design and configuration to consolidate primary care, community health services, residential care, acute and emergency services onto a single, advanced EHR. The project intentionally started with the design, configuration and activation of primary care sites, choosing to follow shortly thereafter with community, acute and residential care. Focusing on a rural area that has strong care model integration and overlapping clinical roles, provided a means to best demonstrate the value of a single record strategy.

      Finding/Results: At time of writing, the project was in the midst of initial activations with primary care teams and was actively designing the community components. As such, key results are still emerging. Key findings to date suggest that: The iterative design and configuration process provided a meaningful way for end users to be engaged in the project and positively influence and own the change Leading with primary care helped orient teams to design longitudinal, whole-person workflows and support the configuration of Cerner Millennium across the continuum A single system for rural areas, where individuals often play multiple roles across multiple venues of care, provides a stronger value proposition than separate systems with interoperability Starting in a rural area helped support direct engagement with all end users and supported more active ownership of the vision and strategy

      Conclusion/Implications/Recommendations: More robust recommendations will emerge as the project progresses, but early indications are that this first demonstration will provide a strong foundation for subsequent deployments of a single, cross-continuum EHR – especially in rural or highly integrated teams, complementing much of the parallel work on team-based care and interoperability. Presenters will focus on the immediate benefits of this first demonstration and provide key recommendations for other regions seeking to extend and reconfigure existing systems to broader care venues.

      140 Character Summary: Demonstrating a single EHR across primary, community, acute, residential and ambulatory care to provide benefits to quality, safety, experience and continuity

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      OS05.04 - Recommendations to Inform the Provincial Primary Care Data Sharing Strategy (ID 498)

      M. Cousins, The eHealth Centre of Excellence; Waterloo/CA
      T. Alexander, eHealth Centre of Excellence; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: The connecting South West Ontario Program’s Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, is enabling a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontario’s integrated electronic health record (EHR). The project is being led by the eHealth Centre of Excellence, on behalf of cSWO. The POC is being conducted with four FHTs in southwest Ontario and has two EMR vendors participating (OSCAR and Telus Health, using Practice Solutions Suite). PCDS will explore the feasibility, challenges and value of sharing patient data from primary care practices.The project will help to identify the processes, integration requirements and data standards required for primary care data sharing to demonstrate clinical and/or organizational value. The POC will inform the broader Provincial primary care data sharing strategy.

      Methodology/Approach: The project involves four Family Health Teams in south west Ontario that will contribute a sub-set of their EMR data to a provincial repository at eHealth Ontario, to then be securely accessed by other authorized healthcare providers within the circle of care through the cSWO Regional Clinical Viewer, ClinicalConnect™. The data contributed by Family Health Teams will be shared with a small, targeted number of viewing sites within their respective catchment areas. These targeted organizations include local hospitals, the Home and Community Care organization (formerly CCAC) and local Health Links. The POC will run for 6 months during which lessons learned and recommendations will be developed to help inform the provincial primary care data sharing strategy. Recommendations will include the data set, data quality improvement, the respective system requirements (data capture and data access), the technology and standards (including integration requirements), implementation and adoption and benefits realization.

      Finding/Results: By Spring 2018, the project will have developed recommendations to help inform the provincial primary care data sharing strategy, this will be undertaken in collaboration with key stakeholders, including the MOHTLC, eHealth Ontario and OntarioMD. The panel discussion will focus on these lessons learned and recommendations and answer key questions: - Do we have the right data set? - What are technology and standards to be used for the provincial strategy? - How can we improve data quality? How do we support primary care practices with tools/templates? - Are the required privacy and security controls in place? How do we support sites to move towards this? - What are the benefits of sharing the data? How are the clinicians using the data? - How do we move toward provincial scalability?

      Conclusion/Implications/Recommendations: The PCDS POC highlights the value of, and challenges associated with primary care data sharing. Outcomes of the POC will help inform the provincial primary care data sharing strategy. The panel will highlight the lessons learned, key challenges, key benefits and key recommendations from the POC. The panel will also look at challenges for provincial scalability. This multi-stakeholder initiative is a priority project for the Province of Ontario and the south west Ontario region. The panel will reflect stakeholders offering varying perspectives and insights on lessons learned.

      140 Character Summary: Outcomes from the connecting South West Ontario (cSWO) Primary Care Data Sharing Proof of Concept to help inform the provincial primary care data sharing strategy.

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    OS11 - Connected Care: A Canadian Dream (ID 13)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 3
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      OS11.01 - Supporting Physicians and Clinicians’ Access to Prescribed Medications Through ClinicalConnect™ (ID 447)

      J. Haywood, HITS eHealth Office; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: This presentation will explain how and why data from Ontario’s Digital Health Drug Repository (DHDR) was successfully integrated with ClinicalConnect, clinical viewer for south west Ontario.

      Methodology/Approach: Leaders from the Health Information Technology Services (HITS) eHealth Office at Hamilton Health Sciences, who worked with eHealth Ontario and Ministry of Health's (MOH) technical teams to integrate data from DHDR with ClinicalConnect, will describe the project’s scope and lifecycle; the first of its kind in Ontario. The presentation will overview work that began in 2016 when this repository was developed to enhance, but ultimately also replace, Ontario’s legacy Drug Profile Viewer as part of the MOH’s Comprehensive Drug Profile Strategy. We will explore how challenges, both technical and non-technical, were met during the project. Other aspects, such as how privacy training for end users would be delivered, or how temporary reinstatement of consent applied to data in the DHDR would be operationalized, will be discussed. The speakers will provide a variety of success stories about how having access to ClinicalConnect, and their patients’ data it aggregates has had a meaningful impact on their efficiency as providers and their abilities to put their patients first.

      Finding/Results: With Narcotics Monitoring System (NMS) and Ontario Drug Benefit (ODB) recipient medication data, and soon pharmacy services and OHIP+ children and youth pharmacare, having access to this data in a consolidated, one-stop-shop viewer, is invaluable in many ways. The presentation will examine usage statistics and how access to this repository, particularly in light of the current, nation-wide opioid crisis, is aiding clinicians to better manage their patients’ health care. We'll also explain enhancements underway to how data from DHDR presents and functions to better suit ClinicalConnect users, improving their ability to deliver care to patients with this, plus other personal health information integrated from hospitals, Local Health Integration Networks’ Home & Community Care Services and Regional Cancer Programs in south west Ontario, plus other Ontario data repositories. Deployment of this data set amongst existing ClinicalConnect Participant Organizations is ongoing; this graph provides a sense of number of accesses to data from the DHDR on an hourly basis. Undoubtedly, as more users are provisioned with access, these numbers will increase rapidly. dhdr.gif

      Conclusion/Implications/Recommendations: Making data from DHDR accessible to authorized ClinicalConnect users was a first in Ontario and we believe audiences will take great interest in the work completed to achieve this milestone. Furthermore, as this HITS eHealth Office continues its work to deploy the MyChart patient portal in south west Ontario, it 's hoped that future phases will see the integration of data from DHDR so patients too have ready access to their pharmacare data in an easy-to-use electronic format.

      140 Character Summary: A demonstration of collaboration to integrate data from Ontario’s DHDR with ClinicalConnect™, providing a walkthrough of work involved and success stories.

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      OS11.02 - Transforming Medication Management for Complex Acute Cancer Care (ID 326)

      S. Douglas, University Health Network (UHN); Toronto/CA
      C. Lutchman, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: As one of the top 5 academic cancer centres in the world, University Health Network’s (UHN) Princess Margaret Cancer Centre (PM) offers leading edge technical, surgical and medication based treatments available today. However, despite having an inpatient electronic medical record for 2 decades, medication management remained on paper. This presentation showcases a 3-prong approach that led to the successful design and implementation of a hybrid paper-electronic medication management solution leveraging best practices in clinically led implementations, Healthcare Human Factors (HHF) and computerized physician order entry (CPOE) system build design.

      Methodology/Approach: CPOE was implemented at 2 of the 3 UHN acute care sites in 2005. PM was not included due to complex date/time dependant protocols, and relative scheduling related to fluctuating patient conditions. These regimens could not be captured electronically in the existing CPOE solution and despite the fact that over 80% of medications were not related to chemotherapy regimens, clinicians were hesitant to support hybrid workflows. In addition, belief that CPOE would reduce time spent with patients and a high rate of infrequent physician users made clinical buy-in difficult to obtain. The following 3-prong approach led to successful implementation and adoption: 1. Integrated dedicated clinical leads on the project team were fundamental to project success. Multidisciplinary clinical stakeholders were seconded to the project team from planning to close-out, acting as advocates for patient safety and communication liaisons. They provided a front line understanding of the needs of the clinicians and patients. 2. A collaborative effort with HHF helped to refine and streamline clinical workflows, update order sets for paper-electronic medication management and pinpoint key processes that required focused training. Co-facilitated Failure, Mode and Effect Analysis (FMEA) workshops and clinical workflow simulations identified high risk practices that shaped future state workflows. 3. The project maximized system capability in build design. CPOE calculation tools for chemotherapy and anti-microbial prescribing, such as weight based dosing and weight banding allowed for customization of existing PM standards of practice to meet the needs of a complex oncology patient population. Build design not only impacted PM but also UHN’s other 2 acute sites as existing medication procedure builds and enterprise-wide policies were updated to align with current best practice standards and Accreditation Canada.

      Finding/Results: Adoption of a hybrid CPOE model at PM clearly demonstrated the powerful impact people and processes can have in designing sustainable solutions with existing technology. This approach resulted in a high adoption rate, development of fully customized, clinical co-facilitated training sessions, and increased adherence to organizational policy. With CPOE live at PM, the organization can plan future foundational initiatives to continuously enhance patient safety, patient experience and continuity of care within and outside the walls of UHN.

      Conclusion/Implications/Recommendations: This implementation was a major stepping stone in standardizing clinical practice across UHN. Securing clinical resources, working with outside teams and updating policy and practice was challenging but ultimately foundational in realizing CPOE benefits and aligning with UHN values and vision. This design model will be invaluable when planning CPOE implementation at UHN rehabilitation sites and emergency departments.

      140 Character Summary: Transforming medication management for complex acute cancer care: A 3-prong approach to designing a hybrid system

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      OS11.04 - A Physician's Time Is Precious: Bundling Digital Health Services (ID 40)

      M. Leduc, Product Strategy and Delivery, OntarioMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: We all recognize that doctors’ time is in short supply. Government and industry across Canada invest tremendous effort and resources to address this challenge, devising new and insightful ways to reduce the time it takes physicians to access and act on information for patient care. Why, then, do so many organizations collectively subject community-based clinicians to an endless barrage of engagements, readiness assessments, and introductions to “something that will make your life easier”? This presentation will examine one jurisdiction’s successful collaboration to engage community-based physicians through a bundled approach – incorporating several different products and services from multiple organizations, and relying on each organization’s strengths to deliver the best value for physicians.

      Methodology/Approach: Insurers, and telecommunications providers offer service bundles for home and auto insurance and phone/cable packages. Spas even offer service bundles for a variety of beauty and wellness services. For our customers, community-based physicians, we partnered with several publicly-funded organizations with digital health or practice efficiency products to offer physicians a package of services through a single engagement – and more value for their effort. (A physician’s time spent assessing a new solution is time not delivering care to patients, so a bundled service offering increases both time available to provide care and revenue associated with such care.) One organization has physician relationships and expertise in the EMR. Another organization delivers infrastructure such as identity services that provide a foundation for provincial digital health products. A third organization specializes in telehealth and virtual healthcare. By leveraging each organization’s strengths, this collaboration offers physicians eight distinct services and ongoing project management and change management support to implement them.

      Finding/Results: Not surprisingly, physicians loved the bundled engagement approach. One contact, one trusted advisor, and one time in their day to focus on digital health opportunities encouraged physicians to really invest the time to understand their options and maximize their benefits. To achieve this unified approach, the partnering organizations ensured that engagement processes were consistent and streamlined, and that information collected for one organization could be leveraged – with physician consent – for another service. An additional advantage of this bundled approach was that physicians were more open to learning about and trying services that would otherwise never have been considered. By funneling engagements through a single relationship, the physician was more apt to see the positives of other solutions (even from different organizations) and take a chance on a new service. This presentation will detail how deployment processes were aligned, and adoption and change management efforts were more productive as a result of the bundled service – benefitting all collaborating organizations as well as the physician practice.

      Conclusion/Implications/Recommendations: In addition to cataloguing our successes and learnings along the way, this presentation will include detailed instructions for other organizations interested in bundling services with partner organizations for a streamlined and organized deployment process that maximizes physician practice benefit and stakeholder reach, while reducing the overall cost of implementation. The proven approach used increased physician engagement, improved adoption and reduced system costs.

      140 Character Summary: Bundled service delivery among multiple organizations increases satisfaction and adoption among community-based providers while reducing system costs.

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    OS17 - Emerging Trends in mHealth: Patients' Benefits (ID 22)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS17.01 - Driving on the Right Path Towards Mobile Patient Engagement (ID 367)

      B. Holeschek, Ontario Shores Centre for Mental Health Sciences; Whitby/CA

      • Abstract
      • Slides

      Purpose/Objectives: This session will provide an overview of the lessons learned during the development and implementation of a mobile technology solution in the pursuit of innovative ways to promote, measure, and advance patient engagement. It will contribute to the body of knowledge that will help guide other organizations as they embark on this journey. Objectives: -To provide a platform for collecting patient generated data that interfaces with the EHR -To increase patient engagement and activation through interactive and patient-specific actionable interventions -To provide patients with the knowledge and skills to become activate participants and agents of change within their care through access to resources within the application

      Methodology/Approach: Building on the gains made with the implementation of the patient portal solution, the organization committed to continuing to drive patient engagement forward by partnering with a technology based company that offered a secure mobile and cloud technology platform that would interface to the EHR. With this solution, mobile remote-patient-monitoring that delivered interactive personalized interventions to individuals in support of their care plans would be enabled. The anticipated benefits of this solution were: -Accessibility-patients and clinicians not required to be connected on line to view, collect or generate data -Interactive platform-functionality includes more than a portal view of PHI. Interactive and actionable interventions that are personalized to the patient would be delivered through the mobile solution with the aim of helping patients to manage their care and have access to immediate and off-site support as needed. -Cross Platform Support (BYOD) – the solution would support a cross platform approach for devices including the support for Android, Apple and Windows devices. This encourages and supports accessibility to e-mental healthcare through the solution regardless of the device used.

      Finding/Results: The mobile patient engagement solution was implemented on 2 inpatient units and in 4 outpatient clinics. Desired outcomes around adoption and usage of the app were challenged by early issues with technological functionality including app stability, interface functionality and privacy and security concerns. Overall, these technical issues resulted in a delay in the implementation schedule, but most importantly impacted clinicians and patients perception of and their confidence in the mobile solution. Based on this experience, a number of recommendations have been developed which will guide future work in this area. -Stakeholder Engagement-early engagement of key stakeholders in the design of the interventions as well as engagement of more technically savvy patients in the education of other patient groups around the usage of the app positively impacted clinician and patient engagement. -Vendor management- clear, early communication around existing functionality required to meet scope of project -Timely communication re: planned and unplanned updates to the application is necessary to ensure good user experience -Devices- device selection should account for optimal functioning of the application and have a technical support process in place -Risk Management-clearly defined escalation process to ensure issues are addressed in a timely manner

      Conclusion/Implications/Recommendations: Patient generated personal health information is a fundamental component of patient engagement and empowerment. Selecting a mobile patient engagement solution that is integrated with the EHR, reliable, easy to use, flexible, interactive and interoperable are paramount to ensuring a positive patient experience. Equally as important is securing a solution that meets the privacy requirements necessary when dealing with personal health information. Moreover, ensuring the solution is part of the clinician’s workflow and co-designing patient- specific interventions with clinicians, as well as integrating outcomes-based research is essential to a the ultimate success of a new mobile technology strategy.

      140 Character Summary: A mobile patient engagement solution was implemented and desired outcomes around adoption and usage of the app were challenged with many lessons learned.

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      OS17.02 - An App-Based Uroflowmetry System with Immediate Symptoms Feedback Recording (ID 542)

      J. Almeida, Universidade Estadual de Campinas; Campinas/BR

      • Abstract
      • Slides

      Purpose/Objectives: Lower urinary tract symptoms (LUTS) are bothersome and impact quality of life. It is estimated that up to one third of men aged above 65 years suffer from LUTS. There are some urodynamic tools to diagnose the cause of these symptoms. The pressure-flow study is a widely-used test to diagnose LUTS but it is invasive, expensive and time-consuming. Along the last decades, new devices and methodologies have been proposed to address its drawbacks and more recently there has been a trend towards the development of non-invasive pre-screening tools. Reports about home uroflowmetry devices have been increasing but there is an absence of a feedback symptoms platform that may bring additional information for a clinical decision making. Our goal is to develop and test an app-based uroflowmetry system that may record voiding and in which the individual may report his symptoms immediately after.

      Methodology/Approach: Based on the International Prostate Symptom Score (IPSS), we are developing an Android app in which the individual may report his symptoms, such as difficult to void, straining and incomplete emptying, each time he voids. We are also developing a portable uroflowmetry device, based on a load cell, that connects to the app via Bluetooth for urine flow data recording. In a first approach, this system will be tested in a group of symptomatic individuals and, for each one, data will be collected for at least three consecutive days. The conventional uroflowmetry test and IPSS will be applied for comparison. Individuals will also be asked to answer a brief questionnaire about the use of the proposed system.

      Finding/Results: We will look at the correlation between data obtained using our app-based system and the conventional IPSS and uroflowmetry test. We expect individuals to report that the app and portable uroflowmetry device are easy to use. We also expect that most of them will recommend this test to a family member or friend.

      Conclusion/Implications/Recommendations: The results obtained with the app-based uroflowmetry system are expected to agree with those of stablished tools in urodynamics. This may open the possibility for home use which we would like to test in the future. The immediate symptoms feedback could be an alternative to the current version of the IPSS that requires the individual to remember his symptoms considering the past month. This may be a new approach for pre-screening the need to undergo invasive urodynamic tests.

      140 Character Summary: We aim at developing and testing an app-based uroflowmetry system with immediate symptoms feedback as a pre-screening tool for urodynamic evaluation in men.

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      OS17.03 - Virtual Integrated Reliable Transformative User-Driven E-Health System (VIRTUES) (ID 252)

      B. Pickard, Cardiac Arrhythmia Network of Canada (CANet); London/CA

      • Abstract
      • Slides

      Purpose/Objectives: Empowering patients and caregivers to be active partners in the management of their care, requires the development of a comprehensive user-driven clinical application. The advancement of a transformed Canadian arrhythmia care system that delivers personalized, patient-driven and integrated care will be facilitated through a key technological development supported by the Cardiac Arrhythmia Network of Canada (CANet). Through the support of the Networks of Centres of Excellence, CANet is comprised of patients, researchers, clinicians, and partners. Through CANet, one of the key technological platforms that is being developed is clinical application of VIRTUES (*Virtual Integrated Reliable Transformative User-Driven E-Health S*ystem). Through the combination of wearable biosensor technology, digital multi-media interfaces and validated analytics, VIRTUES will immediately integrate symptom-driven validated physiological data into patient-specific, personalized context and trigger an appropriate care plan from a set of plans previously co-developed with the patient.

      Methodology/Approach: A key innovative aspect of the development of VIRTUES is the integration of CANet researchers, clinicians, patients, technology industry partners who play an active role in the design and development of the clinical application. This is an intentional and significant diversion from the traditional inclusion of patient assessment taking place in refinement of the final product. The overall design, development and implementation of VIRTUES was guided by the discovery work completed over the course of the development of the initial VIRTUES Patient Mobile Health Applications and Clinical Portal Application prototypes. The overall development and implementation of VIRTUES involves a two-stage process. The first phase integrates the technological monitoring components into the current clinical care pathway. The second phase will pair advanced, cognitive analytics with Network data creating a personalized care platform.

      Finding/Results: An initial study was completed to understand core-user needs. Using an iterative design process and engaging both patients and clinicians, workshops, interviews and focus groups were completed. Patients and clinicians were asked to discuss the integration of a mhealth platform into the arrythmia care pathway, explore past clinical experiences and interact with the initial prototypes. The information collected provided patient experience and clinical situational contexts. The exploration of pre-diagnosis, condition management, patient-clinician communications provided valuable information for the enhancement of the protoypes and user interfaces. Specifically, the identification of key journey moments linked to condition management, electrocardiography (ECG) capture and communication highlighted subsequent conversations linked to privacy, the extension of personal health information and clinician work flow.

      Conclusion/Implications/Recommendations: As an mHealth platform, VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias. It is the only component that provides external touchpoints to clinicians, patients and industry partners as well as information that will be used to guide major healthcare institutions and provincial health authorities. In addition to the external flow of information, the VIRTUES interactive platform will enable the development of personalized educational material for each specific patient's medical consition and support further technology development and refinement of treatment.

      140 Character Summary: VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias.

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      OS17.04 - Evaluation of Apps for Patients at Risk of Gestational Diabetes (ID 441)

      C. Tassone, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Diabetes is one of the world’s fastest growing medical conditions that is affecting both adults and newborns. Mobile applications might be an effective way to provide education and behavior tracking tools for pregnant mothers. In this this study we evaluated mobile apps against evaluation criteria to discover their applicability for patients at risk of gestational diabetes. This study assesses how well existing mobile apps on the market meet the information and tracking needs of patients with gestational diabetes. This study also evaluated the feasibility of how to integrate these apps into patient care.

      Methodology/Approach: We conducted a search of the mobile apps in the United States Apple iTunes store for mobile apps for Apple devices, and searched the Google Play store for Android devices that contained key words related to the following concepts of nutrition (diet), tracking, diabetes and pregnancy. For each of these apps we have two reviewers to look at the description of the tools to see if they include both information on nutrition relevant to diabetes in pregnant women and if they had any tools for tracking nutrition, blood sugar or exercise. Apps were included if both reviewers agreed on the inclusion or exclusion and if there was a discrepancy we used a third reviewer. Evaluation criteria was developed to assess the mobile apps on four dimensions. These dimensions were credibility and trust, education and information, interactive tools and behaviour tracking to promote patient engagement and usability and design methodology.

      Finding/Results: As of August 4, 2017, there are 42008 Apps classified in the Health category and 79577 classified in the Medical Category in the iTunes store. A search of the keywords related to nutrition, diabetes, pregnancy, and tracking resulted in 103 apps that were manually reviewed per our evaluation criteria for content and features. Previous to this study, it was not known how many mobile health applications were specifically developed for diabetes in pregnancy, how well these apps meet the information needs of these patients and how much evidence-based information was available in these apps. It was also unclear how much functionality these apps had for tracking nutrition, exercise and diabetes (sugar level, insulin) and if the mobile apps implemented any behavioral strategies.

      Conclusion/Implications/Recommendations: We found that there are very few apps that provided both comprehensive evidence-based educational content and tracking tools. This study demonstrates the need to develop apps that have more comprehensive content, tracking tools and ability to bidirectionally share data with the patient’s primary care provider.This will require both technical adaptations and policy changes to allow for data sharing. Diabetes prevention apps for women with gestational diabetes have the potential to greatly impact patient care. Future development efforts must be made to include nutrition as a core component for diabetes prevention apps.

      140 Character Summary: This project provides an evaluation of Apps for Patients at Risk of Gestational Diabetes using evaluation criteria.

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    OS22 - Digital Health Big Data: Promises and Possibilities (ID 30)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 3
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      OS22.02 - Barriers to Testing Mitigated by an Online STI Testing Service (ID 311)

      D. Haag, BC Centre for Disease Control; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: While rates of sexually transmitted infections (STI) continue to increase nationally, many people face known barriers to accessing testing for STI and HIV (e.g., clinic access, wait times, stigma, fear of judgement). Online STI testing programs are thought to reduce barriers associated with traditional in-clinic testing, though uptake could reflect social or technology gradients. In 2014, the BC Centre for Disease Control implemented a digital health intervention called GetCheckedOnline (GetCheckedOnline.com; GCO), which allows individuals to test for STI and HIV without the need to visit a clinic. To understand the types of barriers that may be mitigated by online STI testing, we compared clients of a large STI clinic in Vancouver, British Columbia, to clients of GCO.

      Methodology/Approach: Our study was initiated one year after GCO was launched, during which time the service was promoted to STI clinic clients and men who have sex with men (MSM) in Vancouver. Clinic and GCO clients were invited to take an online survey two weeks after receiving their test results. Survey questions included barriers/facilitators of testing at individual, health care provider, clinic and societal levels.

      Finding/Results: GCO clients were older than clinic clients and a higher proportion were MSM. More GCO clients reported their reason for testing as routine and fewer reported symptoms or being a contact to STI. More GCO clients considered accessing online health resources important, but otherwise did not differ from clinic clients on technology use or skills. GCO clients were more likely to report having delayed testing in the past year due to clinic distance, less likely to agree that clinic hours were convenient or that making appointments was easy, and more likely to report long wait times to see a health care provider. GCO clients were more likely to be uncomfortable discussing their sexual history with clinicians in general and where they usually went for health care, as well as more likely to fear being judged by clinicians. Table 1: Characteristics of STI clinic and GetCheckedOnline clients client characteristics.png

      Conclusion/Implications/Recommendations: Our study in a large urban setting suggests that online testing services may effectively engage individuals with barriers to testing, leading to increased uptake and frequency of testing and more timely diagnoses. Further evaluation to verify these findings in different geographic locations (e.g., suburban and rural settings) and populations is underway.

      140 Character Summary: GetCheckedOnline, an online STI testing service in BC, mitigates the barriers that people face when accessing testing in traditional clinic-based environments.

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      OS22.03 - Health Data Integration to Enable System-Wide Palliative Care Analytics (ID 506)

      J. Schwartz, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: In 2016, a provincial partnership, was formed to provide oversight on improving palliative care across the system. As this program establishes and matures, its data and analytics needs are evolving rapidly. Building a responsive analytics and informatics solution that can grow with the program is paramount. We wish to showcase our innovative approach to building a patient-centred data repository.

      Methodology/Approach: Patients at the end-of-life receive care in many settings within the provincial health care system. We developed a data repository that links routinely collected health administrative data to better understand the patient throughout this journey. The complexity and diversity of this population presents a unique opportunity to design a patient-oriented data integration solution capable of linking patients at all stages in this journey. Our approach leverages learnings from the big data revolution, specifically around the concept of data lakes We implemented a multi-layered analytical data repository (figure 1), that enables analytics across the health system. Population-level data is imported from 13 health administrative data sources and individually cleansed and standardized. Next, concepts on health system utilization, disease identification algorithms, significant health events, treatments/interventions, assessment surveys results, co-morbidity scores and other important health information is defined and collated. Cohorts, such as the decedent and palliative cohorts, are easily derived from pre-implemented algorithms and are easily linked to the derived patient information to define analytical base tables (ABTs). ABTs are the primary data product used to support all measurement. For example, the Decedent – Last Year of Life ABT supports regional reporting, scorecard development and predictive modeling. data repository design.png

      Finding/Results: This data repository design has many benefits: ? Cohorts can be quickly derived from concepts. ? Concepts are persistent, validated and centrally governed. ? Data is housed in one environment, expediting data access and manipulation tasks. ? Centralized data and analytics workflows enables better collaboration between groups ? Data Quality and Metadata is centrally maintained. ? ABTs are the single source of truth; improving consistency, accuracy, time-to-results and encourages exploratory analysis. Leveraging the data repository has enabled: ? Rapid development of the decedent and palliative cohorts. ? Release of current state assessment within 5 months of initial request. ? A tool to provide regional profiles to the regions. ? Ongoing development and implementation of risk-prognostication tools. ? Insights through exploratory analytics and data science.

      Conclusion/Implications/Recommendations: As part of a larger health system organization, we are leveraging many of the ideas developed in this proof-of-concept to modernize our information and analytics systems. The innovation and learnings are being adapted throughout our organization’s information strategy with the goal of becoming more insights-driven.

      140 Character Summary: Data driven decision making – How an innovative new data repository is providing valuable insights into the palliative care needs of a provincial health system

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      OS22.04 - C<sup>3</sup> - Collaboration and Connection with eCASE<sup></sup> (ID 352)

      N. Miraftab, Patient Transitions, Providence Health Care; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: eCASE supports patients in the community and streamlines the patient journey by connecting primary and specialty care through technology. As a complementary service to the successful RACE telephone advice line, eCASE allows primary care providers (PCPs) such as family physicians and nurse practitioners to submit non-urgent questions to participating specialty areas. Through the ‘dr2dr’ website and mobile app, questions can include patient documentation such as a lab test or ECG to aid the specialist in providing informed advice, within a one week timeframe. The intention is for this advice to expand PCPs’ scope of practice, avoiding unnecessary specialist visits, and ensuring appropriate tests are ordered in advance of specialist visits when they’re needed.

      Methodology/Approach: A phased implementation approach was taken, given the novelty of this care model and limited nature of this prototype. Expanding from a single specialty area, we leveraged the relationships formed through RACETM to include 6 additional specialties over the first 4 months. Similarly, access to the system was expanded across Vancouver Coastal and to Nurse Practitioners and Medical Residents over the course of the prototype. We worked closely with stakeholders from the Champlain BASE™ eConsultation service in Ottawa, through a collaborative delivered by the Canadian Foundation for Healthcare Improvement, to tailor our implementation approach.

      Finding/Results: Data has been gathered through the dr2dr platform, as well as through surveys sent to the referring provider and consulting specialist after every conversation. 56% of conversations avoided a face-to-face referral, while 20% resulted in a previously unconsidered referral. eCASE was viewed positively by both primary care providers and specialists; when asked whether they would recommend eCASE to their colleagues, primary care providers averaged 4.4 on a 5-point scale from ‘Strongly Disagree’ to ‘Strongly Agree’, while specialists averaged 4.1 on this same scale. Challenges related to fee codes for remuneration, and a sustainable technology to facilitate the conversations, are key to sustainability and are currently being addressed.

      Conclusion/Implications/Recommendations: eCASE has proven effective at streamlining the patient journey by connecting providers through technology. Our metrics closely mirror those attained by the Champlain BASE™ service over their 7 years of operations, demonstrating the potential of this model in our local BC context. The eCASE team will resume the recruitment of additional specialty areas to provide greater value to primary care, and continue to socialize this model to community providers through further expansion. Specific change ideas will be generated through evaluation interviews with both primary care providers and specialists, and these will be implemented to the greatest degree possible over the next Phase of this project. Specifically, direct integration into provider EMRs would eliminate the need for these conversations to take place in a separate system, resulting in fewer necessary steps to ask a question or provide a response. We believe that this efficiency would serve to direct primary care providers away from referrals, and hence away from unnecessary patient transfers. The team is currently investigating ways to influence the implementation of fees, and embedding this process within providers’ existing systems.

      140 Character Summary: eCASE is a non-urgent email advice service connecting primary care providers with specialists, which is effective at streamlining the patient journey.

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    OS30 - Enabling High Value Analytics (ID 44)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS30.01 - Using Business Intelligence for Insights into Healthcare Data (ID 128)

      W. Haque, University of Northern British Columbia; Prince George/CA

      • Abstract
      • Slides

      Purpose/Objectives: Healthcare organizations gather large volumes of data which continues to exist in legacy formats making it difficult to analyze or use effectively. Over the last few years, we have engaged in collaborative research projects to apply business intelligence (BI) techniques for integrating, analyzing and reporting on such data. The projects have spanned areas of Critical Care, Services Availability, Ambulatory Care, Patient Transfer, and Trauma. Services availability is guided by population, patient and case mix group profiles. While population profiles focus on demographics, the patient profile provides an overview of health-related metrics within selected regions by showing information such as births, commonality of chronic conditions, and prevalent or vaccine preventable diseases. Comparative reports are generated at various levels of hierarchy ranging from health service delivery areas to individual facilities. Adequate analysis of ambulatory care sensitive conditions results in preventable hospitalizations and enhanced patient care. In addition, predictive analytics models were built to guide resource allocation based on the forecasted trends. The inter-facility patient transfer dashboard uses BI techniques to analyze data related to healthcare infrastructure and services, and provides a web-based system to quickly identify optimal destinations for inter-facility transfers. The solution is now being extended for province-wide adoption. Finally, the trauma project is intended to provide data-driven perspective of incidences, mortality and transportation along several dimensions.

      Methodology/Approach: Our agile methodology consists of building multi-dimensional online analytical processing (OLAP) cubes and render reports using business intelligence tools. Intuitive navigation eliminates the need for training or user manuals; this is further enhanced by mapping tools, customized shape files and embedded objects. Data visualization, adhoc reporting, and ease of use has been the key factors in rapid adoption and deployment of these solutions. Aesthetically pleasant and interactive dashboards display KPIs with ability to navigate at finer granularity using multi-level drill-down and drill-through reports. Parameterized reports allow selection of multiple dimensions simultaneously and are rendered in a matter of seconds while sifting through years of data. The performance is further enhanced by connecting selected reports directly to optimized backend data warehouse. User-friendly web forms safely constrain future data entry and ensure consistency. For existing repositories, integration modules are developed to cleanse and upload data from disparate sources. Data anonymization and aggregation is used where warranted. For privileged information, access controls have been implemented. Our designs are modular and allow for incremental development.

      Finding/Results: The benefits are multi-faceted with the audience ranging from managers and physicians to strategic decision makers. In some cases, this work has also yielded unintended benefits. For instance, the critical care and services availability dashboards have been used for orientation of newly recruited physicians.

      Conclusion/Implications/Recommendations: Our objective is to share our findings from several years of demonstrated success with peer groups and demonstrate the effectiveness of our approach. Most development occurs in an academic setting working closely with partners in the healthcare organizations. The presentation will consist of numerous dashboards, web forms and reports. The challenges encountered will also be discussed.

      140 Character Summary: Analytical processing techniques can immensely accentuate healthcare data making it more valuable. This will be demonstrated via dashboards, forms and reports.

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      • Abstract
      • Slides

      Purpose/Objectives: Leveraging the advanced analytics capabilities inherent in a fully integrated EHR, the hospital is piloting an analytics solution with the goal of improving capabilities to predict and clearly identify clinical aggression (CA) and enhance staff capacity to respond effectively to risks of future CA from a diverse patient cohort. Objectives: -Reducing incidents of CA, harm to others, and restraint/seclusion use while increasing therapeutic engagement -Increase confidence and competence of staff in identifying and managing the antecedents of CA -Improve safety for both clinicians and patients

      Methodology/Approach: A number of risk assessment tools for imminent aggression and discrete data are captured in the EHR; however, they have limited predictive power with respect to indicating when a patient could become aggressive. Additionally, the predictive utility of these scales are in the very near term; and the ideal predictive model would be able to predict CA risk days prior to its occurrence to have time to implement robust interventions. To address this, we have partnered with an expert to create a neural network predictive model that will leverage data found within unstructured and structured data sources in the EHR. If the model is successful at predicting CA, the implications for next steps are vast, including ability of clinicians to be alerted to become proactive to improve patient outcomes. Validation of the predictive model was completed over 2 months with a pilot focusing on the predictive models ability to accurately predict CA incidents with current data over a four month period. Pre-implementation data will be utilized to compare prediction performance rates with implementation groups. A comparison of expected verses actual number of CA incidents will be conducted utilizing reports which identify the total number of CA incidents against the expected number of CA incidents. Control charts reviewing trends for the CA incidents, harm to others, and restraint & seclusion use (incidents and duration) will be utilized to evaluate. A chart audit of CA occurances will be conducted to identify what the care planning intervention.

      Finding/Results: Implementation of the predictive model is still in progress. An evaluation framework has been developed and the predictive model will be evaluated along the following domains: -Model Performance- How accurate is the model in predicting CA? -Outcomes-Are there any improvements in key outcome and balancing indicators: Incidents of CA, harm to others (incident data – harm to staff or patients), and restraint & seclusion use All findings from the pilot will be presented at the 2018 eHealth conference.

      Conclusion/Implications/Recommendations: The implications of creating a predictive tool for CA are vast. This approach will allow staff to identify dynamic risk factors that contribute to the risk for CA and subsequently facilitate proactive refinement of care plans to mitigate or address the risk and potentially reducing aggressive incidents and restraint and seclusion use. Moreover, from a risk management and operational perspective, implementation of a predictive alerting tool for CA has the potential to positively impact patient incidents as well as staff injury rates related to patient aggression, and the subsequent sick time and costs to the healthcare system associated with these events.

      140 Character Summary: This predictive solution has the potential to reduce clinical aggression and restraint/seclusion use which would improve patient outcomes and staff safety.

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      OS30.03 - The Impact of Leveraging Analytics to Drive Adoption and Engagement (ID 582)

      E. Keller, OMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Three organizations are working together to support the implementation of a province-wide service to provide clinicians with faster and better access to specialists via eConsult. The complex, multi-faceted initiative involves technology implementation and evaluation, business process design and the establishment of a program governance framework. This oral presentation will showcase the important role that analytics has played in the successful adoption of this provincial digital health service, and in driving effective engagement with the initiative’s stakeholders. Presenters will highlight key elements of the analytical framework (methodology, tools), and share lessons learned which can be leveraged for other digital health initiatives.

      Methodology/Approach: Dashboards were developed to support project team members, field staff and key stakeholders through an evolutionary journey that focused on clinician recruitment, target setting, adoption and process optimization. Since launching as an Excel pivot table-based solution offering static single-view content, the dashboards have evolved to adopt a dynamic, multi-view format that aligns with the changing needs of stakeholders and evolving priorities of the provincial initiative.

      Finding/Results: The dashboards provide key stakeholders and project staff with the ability to analyze, drill down and observe patterns in different geographic areas, to develop individualized change management and practice improvement plans for clinicians participating in the initiative. The dashboard provides timely access to stakeholder-specific research and reporting and on important topics including: • Usage patterns: Analysis of past eConsult usage data, and the ability to sort users into various adoption categories. • User interviews: Based on adoption categories, users are identified and interviewed to build user and practice profiles. • Registration processes: Leveraging the usage pattern analysis, populations of inactive users can be identified. When engaged, these populations often cite registration delays as a cause for their low/non-existent usage patterns. • Targeted recruitment: Monitoring the flow of eConsults helps partners to identify specialty-based priorities for service recruitment. The ability to quickly view analytics in the dashboards has allowed field teams to localize and target their change management and adoption strategies, increasing efficiency and outcomes. Timely access to region-specific data has provided regional partners with the information they need to become effective champions for the provincial initiative. In turn, regional partner resources have provided invaluable insight and engagement opportunities for the initiative’s field staff to consider while recruitment and adoption activities continue. Aided by the dashboard-driven analytics, the provincial initiative has successfully recruited 10,500+ primary care providers, and 550+ specialists spanning 100+ specialties, resulting in more than 56,000 eConsults sent since the initiative’s launch in January 2015.

      Conclusion/Implications/Recommendations: The data provided by these dashboards has enabled eConsult service partners to tailor adoption approaches, and has helped foster a collaborative approach to deployment. Decisions are made based on usage data, and the opportunity to aggregate eConsult data with data on other digital health initiatives has provided a deeper understanding of primary care providers’ needs and usage patterns. Through analytics, this initiative has been able to monitor progress, dynamically course correct, increase user adoption, and measure success.

      140 Character Summary: A provincial eConsult initiative is demonstrating how analytics can effectively support localized change, planning and adoption strategies.

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      OS30.04 - Predicting Personalized Surgical Outcome Through Analytics & Machine Learning (ID 145)

      K. Lane, Techna Institute, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Up to one quarter of all patients who undergo knee arthroplasty surgery are not satisfied with the operation results and can continue to experience pain and suboptimal joint function. Despite being a common procedure, no algorithms which bring together predictors in a unified model to be used at the point of care exist. Prediction algorithms provide an opportunity to identify the patients who are at risk of poor surgical response. Having these analytical models available at the point of care to predict personalized risk before the procedure enables better case selection, patient preparation and improved clinical outcomes. The arthritis data science team at the University Health Network (UHN) has developed analytical models to predict post surgical pain, function and satisfaction. Each patient assessed is provided with a personalized risk report prior to having the procedure. Machine learning allows for the identification of predictors and enables the data models developed to continually evolve.

      Methodology/Approach: The UHN arthritis data science team leveraged Microsoft’s Cortana Intelligence Suite to ingest, process and transform relevant data for the creation of predictive models and to visualize the data insights. The team leveraged 4 existing clinical databases with clinical and patient outcome data to derive predictive models for personalized risk, post surgical pain, function and satisfaction. Patient reports were created and provide a real-time personalized visualization of predictive outcomes, risk and contributing factors at the point of care. solution architecture.png

      Finding/Results: Over 9,500 records from four data sets were included in the data analysis to create the predictive models. Data included in the analysis was collected between January 2011 and August 2017. Microsoft’s Azure and Cortana Intelligence platforms were leveraged to identify the predictors of success or failure of a surgery. In addition, the probability of surgery success, likelihood of post surgical pain, function, patient satisfaction and 30-day hospital re-admission was also derived through the creation of multiple experiments and the development of models. All of the models developed were trained and scored to measure and compare accuracy. The most accurate models were visualized at the point of care by providing patients with a personalized probability of surgical success based on the derived model predictors.

      Conclusion/Implications/Recommendations: Machine learning and predictive analytics provides an opportunity to leverage large data from multiple siloed datasets and focus on outcomes in healthcare. Data scientists require keen business and data understanding to develop and train the most precise predictive models. Data Preparation and quality is essential for accurate processing and transformation.

      140 Character Summary: The arthritis data science team at UHN has developed analytical models to predict the probability of surgery success by leveraging machine learning technologies.

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      OS30.05 - Data Mining Twitter to Detect Prescribing Cascades: A New Concept (ID 522)

      N. Mehta, Women's College Research Institute; Mississauga/CA

      • Abstract
      • Slides

      Purpose/Objectives: A prescribing cascade occurs when the adverse event from a drug therapy is misdiagnosed as a new medical condition, resulting in a subsequent drug therapy, medical devices, or diagnostic tests (Figure 1). Traditionally, prescribing cascades have been evaluated using administrative data to assess recorded drug therapies. However, these data do not capture information such as the use of over-the-counter drugs, devices or tests, thus limiting the scope of our understanding of the prescribing cascade. Over 11 million people in the United States have used social media to post information about health and treatment issues. Over 600 million active users are registered on Twitter. Recently, an approach to use Twitter to detect signals of potential drug-to-drug prescribing cascades was described by Hoang et al. We explore the feasibility of using Twitter to identify expanded prescribing cascades, using dementia as an example. Figure 1: The Expanded Prescribing Cascade (adapted from Rochon & Gurwitz, 2017.)picture1.png

      Methodology/Approach: A challenge with searching social media for clinical health information is the wide variety of synonyms, colloquial terms, and informal language used to describe conditions, medications and symptoms. Clinical data dictionaries, including the Consumer Health Vocabulary, were identified, which links lay speech about health to technical terms used by healthcare professionals. Using the Twitter Application Programming Interface, a preliminary search was run to identify the level of tweeting relating to dementia. The search terms used were Dementia, Alzheimer, and Lewy body. The collected tweets were then manually explored for general sentiments and user demographics.

      Finding/Results: Feasibility testing within a five-hour window revealed 872 potentially relevant tweets, suggesting that Twitter users tweet about dementia every 20 seconds on average. Manual exploration of these tweets showed that the majority were posted by caregivers of people with dementia, or healthcare professionals. Of these tweets, 6 pertained to dementia drug therapies. We expect that other medical conditions that are more prevalent in the general population will have more relevant tweets.

      Conclusion/Implications/Recommendations: Twitter is a tool for patients, caregivers or providers to post information relevant to prescribing cascades, and drug therapies in general. This platform is an unexplored resource for identifying potential prescribing cascades, which may allow opportunities to collect previously unavailable data on over-the-counter drugs, devices and tests. These data can also inform future population-level exploratory studies about the consequences of prescribing cascades.

      140 Character Summary: We explored the feasibility of using social media meta data to identify prescribing cascades, using drug therapies for dementia as an example.

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      OS30.06 - From the Boardroom to the Bedside:  Transforming Care Through Analytics (ID 236)

      M. Muia, Information and Technology, Baycrest; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: This presentation will highlight how the implementation of a collaborative approach to performance measurement and management improved outcomes at one hospital. Specific areas of interest include the implementation of electronic unit level scorecards with cascading Key Performance Indicators, automated workflows and the roll out of a consultancy model. The objective was to enable the achievement of strategic and operational goals through timely information and knowledge.

      Methodology/Approach: Our business intelligence portal was upgraded and re-designed to provide a real-time data on how our key performance indicators (KPIs) are doing against a set of established targets. KPIs were cascaded down to program and unit levels from the corporate scorecard. To enhance transparency and accountability, all clinical and non-clinical leaders have access to the business intelligence (BI) portal and data is available at any time through the hospitals intranet page and on mobile devices. Electronic workflows were designed and implemented. These workflows facilitate tiered leadership review of the performance of all KPIs; enable the entering of comments and action plans and approval of these by the appropriate leaders. Workflows are enabled through e-mail notifications with links to the BI portal. A consultancy model of support was implemented to compliment the unit based scorecards. The consultancy model is an organizational structure where analysts from decision support, finance, human resources and quality work together to support the customer with consultation and advice to improve performance. The overall goal of the consultancy model is to ensure the leaders have access to information they need to provide quality patient care, plan the right programs and services to meet the needs of the patients and clients in an efficient and effective manner. The quality improvement team is linked in when it is identified that quality improvement initiatives are required to improve performance in a specific area.

      Finding/Results: Since the implementation of the new system, a number of corporate indicators have shown marked improvement indicating the new model is having positive effect. Two specific examples: Weight Loss is one of the KPIs monitored through the unit based scorecards. A target of 9.8 % was set. Performance of this KPI showed 13.5% of patients having weight loss. Detailed analysis by the consultants demonstrated areas of focus in order to improve performance. Quality improvement initiatives were implemented which resulted in a significant decrease in the percentage of patients who experience weight loss. Most current performance at Q2 17/18 is 2%. Weighted patient days is another one of the KPIs monitored through the unit based scorecards. Targets for this KPI were not being met. Not meeting the target for this KPI can have a significant negative financial impact to the hospital. Deeper analysis and interprofessional collaboration including process and quality improvement initiatives have significantly improved performance in this indicator.

      Conclusion/Implications/Recommendations: The roll out of electronic unit based scorecards coupled with a consultancy model significantly increased uptake and use of data and have driven up performancre across the board.

      140 Character Summary: A collaborative approach to analytics enables the translation of strategic objectives from the boardroom to the bedside and improves outcomes.

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