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    PS01 - Leveraging New Innovation Pipelines (ID 5)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 2
      • Abstract
      • Slides

      Purpose/Objectives: Canada is in the midst of an extraordinary demographic transformation --1 in 4 citizens will exceed the age of 65 by 2036. Existing approaches cannot meet this challenge. Governments cannot build enough long-term care facilities, employ enough healthcare professionals or sufficiently tax the diminishing proportion of our labour force. A new approach must be taken which levers technology and partnerships to meet the real-world needs of older adults in a scalable and affordable way. The Centre for Aging and Brain Health Innovation (CABHI), led by Baycrest Health Sciences is a national solution accelerator focused on driving innovation in the aging and brain health sector. Established in 2015 with $124 million funding, CABHI is the largest investment in brain health and aging in Canadian history, and one of the largest investments of its kind in the world. CABHI brings together front-line healthcare providers, scientists, and industry to address the most pressing real-world challenges in the care of older adults. This presentation will highlight CABHI’s unique innovation strategy through case studies which detail the successes and challenges of working with seniors, their care providers, healthcare professionals and progressive companies.

      Methodology/Approach: CABHI provides millions of dollars of funding, mentorship, management and knowledge mobilization services to project-teams across North America. CABHI's four, well-funded programs are overlaid along our innovation pipeline, which has a purposeful “leaky” design so that new technology and service innovations can enter and exit the pipeline as evidence is gathered and refinements are applied. innocation-pipeline[1].jpg

      Finding/Results: After two years of operation, CABHI has supported more than 60 projects levering more than $30M. Evidence is emerging showing CABHI's impact in the following areas: - reducing unnecessary emergency department visits for older adults living with dementia - preventing falls and reducing fall-related injuries in older adults living with dementia - providing better management of complex conditions in home settings for older adults living with dementia - improving brain health and cognitive fitness in older adults Performance data also show changes in the culture of innovation in the older adult sector. Equally important, data is showing the economic impact on companies in Ontario, Canada and around the world.

      Conclusion/Implications/Recommendations: There is concensus that existing elder-care service models cannot scale to meet the increasing demand. New, innovative approaches are necessary to drive solutions through technology and partnerships linking the private sector with clinicians and scientists. The unprecedented scale of investment in CABHI by Federal and Provincial Governments and by industry in CABHI is now bearing fruit -- evidence is emerging that the private, public and academic sectors are coming together to meet the challenge.

      140 Character Summary: The Federal, Provincial & private sector investment of $123M in the Centre for Aging + Brain Health Innovation is creating new clinical solutions & economic impacts.

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      • Abstract

      M. Chang1, S. Isaacksz1, S. Goyal2, R. Wilson3; 1University Health Network, M5G 2C2 - Toronto/CA, 2University Health Network, M5G2C4 - Toronto/CA, 3Ontario Telemedicine Network, M3B0A2 - Toronto/CA

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    PS02 - Patient-Centric Solutions (ID 14)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical Delivery
    • Presentations: 2
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      PS02.01 - Electronic Communications to Drive Connected, Collaborative Healthcare (ID 394)

      S. Wilson, Neurology and EMG; Calgary/CA
      K. Lemoyne, TELUS Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The panel explores how accelerated electronic communication among a patient’s care team can support and sustain a truly integrated healthcare ecosystem that is more efficient for clinicians and more personalized for patients.

      Methodology/Approach: This moderated session brings together a panel of experts from across the healthcare ecosystem to provide a broad perspective on the challenges of communication among healthcare professionals and the solutions that exist on the market: - Dr. Scott Wilson, an Alberta-based neurologist, will present his use of a patient-centric solution for referrals, pre-appointment communication, consultation and results reporting. - Katie LeMoyne, TELUS Health will discuss the value of clinical communication across the primary care ecosystem to enable eReferrals, eConsults, ePrescriptions and other clinical messaging.

      Finding/Results: A recent survey of 150 Canadian physicians revealed that phone (85%) and fax (65%) are the top two means physicians use to share patient information and critical medical data with other healthcare professionals. This continued reliance on outdated tools makes for unnecessary inefficiencies and stress for clinicians who are already overwhelmed by demand. To begin addressing this challenge, an eReferral solution was embedded in a leading EMR solution and launched in BC in 2010. The solution quickly grew to over 214 participants by 2017, with an average of 2400 exchanges per month, and a total of more than 200K+ exchanges to date. The success of this solution is driving the development of a national, EMR-agnostic platform that aims to expand comprehensive communications among primary care physicians, specialists, and allied healthcare professionals. This includes access to health records, the ability to contribute to those records, and channels to communicate virtually with clinical providers, ensuring that patient data is available when and where it’s needed to support continuity of care. The solution chosen by Dr. Wilson is being used by 30,000 healthcare professionals in North America sending over 35,000 messages per month. The key learnings from a community family practice of 18 family physicians and 25,000 patients and a study of patient-centered communication for 150 headache referrals and the successful implementation in a specialist clinic will be presented.

      Conclusion/Implications/Recommendations: It is essential that more efficient and timely communications are enabled in the context of the patient’s record. Using electronic tools, significant efficiency is enabled through immediate communication among providers and patients. By opening up electronic communication opportunities, elements of a patient’s chart can be attached to a communication, achieving unprecedented record portability. And, structured messages could be used to enable highly complex clinical workflows between different clinical settings and, in some cases, with the patient themselves.

      140 Character Summary: Healthcare providers need the right tools to achieve a higher standard of care that is more accessible and better attuned to the need of their patients.

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      PS02.02 - Convenience in Health Care Delivery: Imagine the Possible (ID 476)

      M. Nenadovic, Canada Health Infoway; Toronto/CA

      • Abstract

      Purpose/Objectives: Imagine being empowered to book or change a medical appointment from your device rather than languishing “on hold” every time you call your health provider’s office to do the same. Imagine virtual visits and secure messaging in place of the time required to travel and wait for a few fleeting moments with your care provider. Imagine anytime, anywhere access to your complete digital health record rather than the current state where your record is likely distributed across providers, organizations and provincial repositories that are not, or only partially, accessible to you. Imagine health and wellness tracking devices and apps contributing data so that your personal health record is more comprehensive and representative of your wellbeing. Imagine artificial intelligence leveraging your health and activity data to personalize health and wellness coaching interventions for you. Imagine if all of these conveniences and many others are accessible to you from a secure, “one stop shop”. A future where the simple, routine health care interactions and processes – the ones that demand so much of your time -- are transformed by an ecosystem of innovation. A future where governments, the private sector, providers and patients convene to continuously create and sustain convenient consumer centric digital health solutions and services.

      Methodology/Approach: What will it take for this future state to be realized? Subject matter experts drawn from government, the innovation sector and the digital health vendor community will share their insights and frank assessments of the value proposition for patient engagement platforms and integrated services. Panelists will discuss their views on sustaining business models, the readiness state of technologies, governments and other market participants to disrupt the current state in order to improve the patient experience as envisioned in this future state.

      Finding/Results: Patient engagement technology platforms and integrated applications hold the power to drive convenience in an increasingly connected health system for both consumers and clinicians. They will support locally driven priority areas including chronic disease self-management, care in the home, mental health services and palliative care. Consumer platforms will anchor an expanding system of innovation where third party developers can create solutions that address patient and provider needs for improved convenience, efficiency, and patient outcomes.

      Conclusion/Implications/Recommendations: Integrated patient engagement technologies will: – Obtain further value from the foundational digital health investments – Harness the innovation creativity of the private sector to address Canada’s healthcare priorities and encourage the development of solutions that are consumer centric – Improve speed to market and scaling with lower cost and risk to developers and jurisdictional governments – Enable patients to access a consolidated and comprehensive health record in a privacy protective manner

      140 Character Summary: Integrated patient engagement technology to improve access, convenience and innovation in Canada’s health care systems; it’s time!

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    PS03 - Driving Governance and Mobile Health (ID 23)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical Delivery
    • Presentations: 2
      • Abstract
      • Slides

      Purpose/Objectives: There is a growing consensus that a consistent and comprehensive approach to information governance (IG) is required to support Canada’s health systems successfully implement digital health solutions capable of supporting both primary and secondary use priorities. This need is felt at local, jurisdictional and national levels. As such, it can be best addressed through joint development of a common IG framework that incorporates and clarifies roles for various stakeholder groups (ministries of health, regional health authorities, clinical/business/IT teams, care levels and sectors, vendors, etc.). Leadership on national coordination can make the local IG efforts more efficient by providing a common foundation to build from and guiding vendors to develop nationally aligned and locally relevant digital product and services. A national approach to IG is proposed as an essential support to achieving digital health goals across Canada.

      Methodology/Approach: This panel presentation, led by CIHI, will bring together digital health leaders from across the country to share their insights and expertise on the value of a comprehensive and aligned information governance strategy and on approaches being taken in various provinces. Specifically, each representative on the panel will highlight the approaches, challenges and progress being made in their respective jurisdictions (panel members will include Greg Webster, CIHI; Kathleen Addison, Alberta Health Services/CHIMA Board; Yoel Robens-Paradise, Providence Health Care). In response to the need for stronger national IG and consistent with CIHI’s role as a trusted source of standards and quality data, CIHI will describe how we can work with digital health leaders from across the country to develop a common approach to IG.

      Finding/Results: The combination of a robust information governance program and strong standards are foundational to achieving Canada’s digital health goals. In the absence of effective IG, digital health solutions typically incur higher costs and slower implementation due to the need for locally customized solutions. Establishing an effective and common approach to IG for broad use leverages broad expertise and resources to develop IG and makes it more efficient for all stakeholders to align with an effective approach, while still allowing some room for local customization. Information Governance is the combination of roles, responsibilities, and processes for the clear ownership, accountability and direction of data assets. Views from CIHI and provincial leaders on IG will be discussed and audience input encouraged.

      Conclusion/Implications/Recommendations: A successful national information governance program is needed to support digital health implementations across Canada. It should be: -Supported – by a range of digital health leaders from across Canada -Sustainable – like any other change management initiative sustainable information governance needs ongoing organizational commitment -Embedded – information governance should not be treated as something extra that needs to be done any time data is being managed. It needs to be thoughtfully incorporated into existing processes (e.g. the architectural gating process) -Measured – you need to know what the measures of success are for your information governance program to be a success.

      140 Character Summary: Leaders from across the country discuss insights and expertise on the value of a comprehensive and aligned information governance strategy.

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      PS03.02 - Mobile Health Solutions: Evaluation at the Speed of Implementation (ID 260)

      R. Wilson, Ontario Telemedicine Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Ontario Telemedicine Network (OTN) pilot tested three new models of care supported by virtual applications in the area of diabetes, mental health, and chronic kidney disease. To determine efficacy and potential for scale, OTN partnered with the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) to rapidly evaluate the tools and inform a provincial roll-out. The tools included: - a mobile application designed to improve self-management and lower HbA1C among individuals with type 2 diabetes - an online mental health support to help with anxiety and depression - a mobile application providing remote monitoring support for individuals receiving in-home peritoneal dialysis

      Methodology/Approach: WIHV used a mixed-methods approach, combining the rigour of a quantitative trial with in-depth qualitative assessment. The approach aimed to address: 1. How does it work? (Realist Evaluation) 2. How is it implemented? (Consolidated Framework for Implementation Research) 3. What is the impact? (RE-AIM Framework) Also integrated was the Institute for Healthcare Improvement’s Triple Aim focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs, thereby informing a sustainability model on a provincial scale.

      Finding/Results: An innovative, non-traditional approach was applied to the evaluation, which was integrated and multi-stakeholder. Both the evaluation and implementation teams met regularly to ensure that the goals of all stakeholders, from partners to funders, were met. The evaluation was an active piece of the implementation, in place of the typical analysis that takes place at pilot conclusion. Efforts were made to generate the data as quickly as possible. Learnings and data sharing also occurred across the pilots. The panel will share key clinical outcomes, as well as what conclusions were drawn to inform next steps. Practical rapid cycle evaluation as an approach was shown to offer broad utility and support effect decision making. In some cases, implementation continued according as anticipated however in some instances, data served to support a change in direction. The value of real-time evaluation was the potential to course correct in some instances or identify different value propositions altogether.

      Conclusion/Implications/Recommendations: The evaluation underscored the following: - Health technology that is used to help patients better manage their chronic disease should integrate with clinical care. - A patient-centred approach to implementation focused on building and maintaining engagement is important. - Rapid and rigorous evaluations of technology implementations are necessary not only to assess efficacy of technology, but also to know how best to optimize its utilization in practice and potential funding models. - Implementation strategies should have a strong focus on clinical engagement and change management. - Both the implementation strategy and its execution influence the effectiveness of new models of care

      140 Character Summary: Bigger than research: Real-time evaluation strategies for mobile app implementation

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    PS04 - Health Information Systems: Making Gains (ID 31)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 3
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      • Abstract
      • Slides

      Purpose/Objectives: Follow the journey of a successful HIMSS Stage 6 implementation in a large community hospital within the province of Ontario. From the initial vendor selection process guided by clinician input and engagement to the rapid 15-month implementation, the new electronic medical record (EMR) provided the opportunity for the organization to be transformative and innovative to further its smart hospital vision. Crucial to the process was establishing solid governance and guiding principles, as well as reinforcing that this was not an Information Technology (IT) project, but rather a clinical transformation project. This approach inspired members across the organization to believe in the project and contribute to its success.

      Methodology/Approach: A rigorous project management framework was established to guide the work of the Project Team, which included subject matter experts, operational leadership and a skilled clinical informatics team. Together, they built a foundational system, based on demonstrated evidence, that allowed the hospital to build the first EMR of its kind in Canada and transform the way care is delivered in its community by adopting best practice functionality to improve the care of the patient. A state-of-the-art system, the EMR makes it possible for the care team to spend more time with patients, provides physicians with exactly what they need to make important health care decisions quicker and empowers patients with easy access to their health records. Although the project was challenging and presented a number of obstacles, the Project Team, with the exceptional support of the Executive Sponsor and Senior Leadership Team, maintained its clear focus throughout the journey. Engaging stakeholders both from within and outside the organization was paramount to the rapid success of adoption, fostering an all-hands-on-deck approach. A solid training and support plan was established. Help/Assistance for end users included Super Users, as well as At-The-Elbow Student Support, which provided staff and clinicians with the peace of mind and comfort that they were indeed supported through the whole process.

      Finding/Results: One of the most rewarding benefits of the implementation was watching the project evolve from an IT project to a clinical transformation project fully supported by the hospital operations team. The adoption and acceptance of the new system by clinicians to the new system was swift, with the system becoming the new normal within weeks of it being launched. We have been able to achieve successful adoption rates including 87% CPOM, 92% BCMA (patients), 89% BCMA (medication) and 84% for Discharge Medication Reconciliation. Testament to the successful implementation is also the fact that the hospital received the EMR Adoption Model (EMRAM) Stage 6 designation from HIMSS Analytics within 32 days of Go-Live and life returned to the new normal very quickly. Following the successful implementation, planning has begun for the enhancement and optimization stage. This will help to ensure that the system continues to evolve and improve patient care, as well as contribute to the hospital’s vision to create a world-class health experience.

      Conclusion/Implications/Recommendations:

      140 Character Summary: Follow the journey of a successful Clinical Transformative HIMSS Stage 6 implementation in a large community hospital within the province of Ontario.

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      PS04.02 - Becoming a Data-Driven Organization: The Journey to HIMSS Stage 7 (ID 327)

      D. Jankowicz, Centre for Addiction and Mental health; Toronto/CA
      N. Frias, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Over the last five years, a leading Canadian mental health organization has transformed itself into a data-driven organization. The purpose of this presentation is to provide an overview of the strategic and tactical elements used for this transformation and the results of these endeavors. This presentation will be given in the context of a Journey to HIMSS EMRAM Stage 7, which was achieved in June 2017.

      Methodology/Approach: The transformation to a data-driven organization began with the implementation of its clinical information system (CIS). The implementation of dashboards and a revitalized data analytics model has allowed information generated within the CIS to be used in research and quality improvement initiatives. Many other approaches were also used. Specifically, the implementation of computerized provider order entry (CPOE) has provided data to support research, quality improvement, and patient care initiatives. Closed loop medication administration was implemented in an effort to reduce preventable medication errors and improve patient outcomes. A Suicide Risk Dashboard was created that allows clinicians to view information about care plans and assessments for each patient. Care plan tasking ensured that automatic tasks were suggested for patients with a high or moderate risk for suicidality. Physician alerts / risk flags implemented include drug-drug interactions, drug-allergy interactions, cumulative dosage, and others. Clozapine-induced myocarditis monitoring and prevention protocols were deployed for all patients initiated on clozapine to reduce the risk of serious complications associated with Clozapine administration.

      Finding/Results: New incidence rates of Clozapine-induced myocarditis were determined. Eighteen patients were removed from Clozapine due to early warning signs of myocarditis. Orders data has supported research activities and provides accountability for providers. CPOE rates have been over 90% since December 2016. Medication errors are decreased as providers have discrete order options. Over 90% of patients have a suicide risk assessment completed within 24 hours of admission. Over 85% of patients showing a high or moderate risk for suicidality have a care plan created compared to 20% prior to interventions. Alerts are reviewed by an interprofessional team when overridden by an ordering provider. Drug-allergy and care planning alerts have changed practice by providing additional information. Medication scanning rates have been above 95% since December 2016. The number of scanning-related medication administration alerts has increased while self-reported preventable medication errors have decreased. High quality data for research studies and quality improvement initiatives is readily available to researchers, clinicians, and quality improvement professionals. This information can be used to track the performance of quality improvement initiatives. A capstone outcome has been the achievement of HIMSS EMRAM Stage 7, an environment where paper charts are no longer used.

      Conclusion/Implications/Recommendations: Implementation of a CIS must be clinician-driven to drive effective care practices and adoption. A value-driven approach to data collection and use is necessary to ensure that improvements and practice changes are realized. It is important to initiate an organizational culture shift prior to initiatives when shifting into a data-driven model. The organization has positioned itself with the complete vision to lead this paradigm shift into the future where there will be a true integration of care, research, and education.

      140 Character Summary: A leading mental health hospital has transformed into a data-driven organization. Strategic and tactical elements driving the transformation will be discussed.

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      • Abstract
      • Slides

      Purpose/Objectives: In October 2016 SJHH formally kicked off project Dovetale - the movement of the hospital from a primarily paper based environment (HIMSS EMRAM 1.29) to a fully electronic environment. During this panel presentation, members of the SJHH implementation team will review - A litte goes a long way - Opportunities for Standardization and other pre-initiation activities that pay off in dividends during a rapid install - Who moved my paper? - Reaching the masses and tailoring change management approaches for all system users. - Keeping up with the Intakes - Implementation approaches for teaching hospitals - what worked, what would we change. - A Focus on Bench to Bedside - Designing a system for an Academic Research Environment - Its Time for Results! - A Benefits Driven implementation was our matra - we will return to present our outcomes achieved (our approach with a benefits driven install was previously presented at EHealth 2016 and 2017)

      Methodology/Approach: The change initiative at St. Joe's was rapid and big bang requiring a different approach to project planning and change management. We began this journey by clearly defining our project scope and objectives which lead to the creation of our project governance structure and establishment of our project and decicion making guiding principles. Both of these were invaluable in achieving our identified level of standardization, guided our system configuration, supported our research driven data rich focus and change management benefits driven implementation approach. Leveraging the Epic lessons learned and standardized templates, St. Joe's customized processes to our organization's specific needs and pushed the boundaries of typical project processes with creative ways of engaging all levels of the organization. Our cross functional interdisciplinary teams, benefits focused approach and strong executive leadership lead us to a successful go-live in a mere 13 months.

      Finding/Results: St. Joe's is 44 days to go-live at the time of this submission. Our governance structure and decision making guiding principles have been used to ensure our system has been standardized where possible to best practices, developed to ensure rich data collection for use by research and aligns with our organizational best practice and priorities specifically excellence in patient care using data and research driven approaches to quality of care. Our change management strategy has empowered our front line staff to become change leaders and has pushed us as an organization to learn new ways of engaging our staff and leveraging their expertise and passion. At the time of presentation, we will be able to confirm our successful implementation and will be working towards our HIMSS level 7 designation.

      Conclusion/Implications/Recommendations: At the time of presentation we will have successfully implemented across all inpatient areas, our urgent care and emergency departments. We will be part way through our project's post-live optimization phase and working towards our HIMSS level 7 designation. We will share real lessons learned and strategies for succussful implementations using a big bang approach in an academic and research focused teaching hospital and join one of the few fully digital healthcare organizations in Canada.

      140 Character Summary: Focus of our panel discussion is to provide the perspectives of our project leadership team on how were were able to achieve project success from varying perspectives

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    PS05 - Making EMR’s Work for Physicians and Patients (ID 38)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Health Business Process
    • Presentations: 3
      • Abstract
      • Slides

      Purpose/Objectives: Playing a critical role in the health system, the TC-LHIN (one of the 14 regions that manage local funding and healthcare initiatives in Ontario) identified primary care as a strategic focus area. Putting the clinician experience front and centre, the LHIN engaged PCPs to understand key pain points and gaps in needed tools. Feedback from PCPs indicated that many of required tools were available, however, highlighted the need to invest more efforts to drive adoption. This presentation outlines how UHN, delivery lead, worked in collaboration with key partners OntarioMD and eHealth Ontario to develop an innovative approach to increase PCP adoption of digital technologies. After initial success, this approach is now being replicated by other regions across Ontario.

      Methodology/Approach: With a clear understanding of the most pressing tool and information needs for PCPs, the project partners recognized an opportunity to bundle a set of digital tools as one service offering and to then focus on developing one onboarding experience to reduce the administrative workload and registration period. Presenters will share insights garnered in a three-phase process, including how the project was able to secure the necessary clinician input that is so critical to project success: 1) Consolidate and streamline the onboarding process This step required the project team to consolidate and streamline processes for four services from two delivery partners. 2) Engagement and adoption planning Drawing on clinician experiences and expertise, the project gathered input from the five sub-regions within TC-LHIN to guide local engagement planning and delivery. While a standardized approach was developed, the ability to customize support to address sub-region nuances was critical to success. 3) Onboarding Success of this step required significant coordination from all project partners. While partners were supportive of the overall objectives, extensive effort and commitment was required to take into consideration different organizational priorities, structures and resources.

      Finding/Results: As the start of a multi-phase program, the project was able to onboard hundreds of PCPs within a few months. Lessons learned will be used to refine the process and key success factors maintained as the approach is rolled out more broadly. The success of the project included: 1) Maintaining a focus on clinical needs first and foremost – ensured that all work actually brought clinical value. 2) Ability to customize implementation approaches – maximized the effectiveness of engagement efforts since each sub-region had different nuances and priorities. 3) Investing in a team to conduct registration activities for clinicians – helped address concerns of clinicians by supplementing with resources and decreasing administrative time.

      Conclusion/Implications/Recommendations: In conclusion, this approach has proved to be effective in addressing pressing needs for primary care. When working with different service offerings from different organizations the project has been able to improve the onboarding process in the first phase and will move into a second phase with a more ideal state. With its initial learning and experience other regions in the province are now leveraging the approach and processes to better support the thousands of primary care providers across Ontario.

      140 Character Summary: University Health Network (UHN) successfully streamlined the onboarding process for 4 healthcare services and piloted it for 300 Primary Care Providers (PCPs).

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      PS05.02 - Effective Supports for EMR Optimization Enhance Use and Patient Outcomes (ID 581)

      J. Littlejohn, OntarioMD; Toronto/CA
      D. Larsen, OntarioMD Inc.; /CA
      D. Daien, Primary Care, Trillium Health Partners; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Most primary care practices have adopted electronic medical records (EMRs), but while physicians are aware of the benefits EMRs hold for their practice and patient outcomes, many have not tapped into the technology’s full potential. While this is due to a number of factors – including financial, technical understanding and time – in many cases, clinicians simply “don’t know what they don’t know” about optimizing their EMR. This presentation will demonstrate the success of an EMR practice enhancement program in providing on-site support from a team of EMR experts to improve data quality, workflow and EMR-led patient outcomes.

      Methodology/Approach: The EMR practice enhancement program uses advisors who are experts in diagnosing barriers to efficient EMR use. In a typical engagement, practice advisors work with clinicians to conduct a gap analysis, workflow analysis and mapping, review the quality of a practice’s EMR data, and recommend an action plan for improved EMR use. Practice Advisors also help clinicians understand and reconcile discrepancies in their patient rosters, which can affect the ability to accurately monitor patient adherence to prevention and screening routines, and to help patients co-manage their chronic conditions. In the action plan stage, clinics are given achievable, concrete tasks to improve the quality of data in their roster and meet their EMR use goals. This presentation will showcase six case studies to illustrate how the program has helped improve practice efficiency and patient outcomes through EMR optimization.

      Finding/Results: Approximately 500 clinicians in community-based practices have ‘graduated’ from the EMR practice enhancement program with marked improvements in roster variance and EMR data quality. Before these engagements, roster variance for participating practices were as high as 26% compared to Ministry reports; in most cases, after the engagements, variance was reduced to 1% or less. The case studies will demonstrate the program’s clinical value through dramatic improvements in roster data for cancer screening, immunizations, smoking status, and diabetes monitoring. The following post-engagement improvements will be highlighted: • Up to 22% increase in cervical cancer screenings • As much as 90% decrease in problem list errors for suspected diabetes • Up to 34% improvement in childhood immunization capture • Up to 39% increase in smoking status capture

      Conclusion/Implications/Recommendations: Working together, clinicians and the program’s advisors can realize significant improvements in roster data quality, which provides clinicians with the information needed to improve patient support and outcomes. Practices profiled in these case studies have capitalized on the improvements made through the program to begin such initiatives as offering a nutritional consultation program for diabetic patients, and using a diabetic toolbar in the EMR to display up-to-date information (lab results, graphs) during patient visits for more thorough care. The program has been in effect for two years. Clinicians who have had positive experiences with the program have recommended it to others, creating new opportunities for the program to demonstrate value to community-based primary care and improve patient outcomes.

      140 Character Summary: Case studies show that an extensive EMR practice enhancement program can lead to dramatic improvements in data quality and patient outcomes.

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      PS05.03 - Regional Integration: Physician Perspectives on EMR Use and Impact (ID 435)

      S. Raji, Western University ; London/CA

      • Abstract
      • Slides

      Purpose/Objectives: Regional initiatives in the Canadian health care context typically involve governance models used by provincial governments to administer and deliver health care services, organized along geographic boundaries or operational units (e.g., regional health authorities, local health integration networks). Similarly integration of Electronic Medical Records (EMR) and health information flow in these health regions has been continuing across Canada, yet the use and impact of regionally integrated EMRs are not routinely assessed. Are the stated goals of simplifying connection of electronic health data managed by multiple service providers being met? What are physicians’ perspectives on the use and impact of a regionally integrated EMR? This presentation will describe key factors influencing the integration of EMRs and accessibility and use of health data within the region of southwest Ontario and the perceptions of physicians in family medicine and general practice who use them.

      Methodology/Approach: This research project was designed to discover key factors that influence the use and impact of regional integration of eHealth resources. It involved a detailed scan and review of literature on EMR integration initiatives and experiences; observation and shadowing of physicians using a regionally integrated EMR; and analysis of survey data from a large sample of doctors in the region. The research project applied qualitative and quantitative research methodologies, using both grounded theory and principal components analysis to observe, discover, describe and analyze the use and impact of EMR regional integration. Data were acquired from two sources; semi-structured interviews and self-administered questionnaires. Respondents were drawn from a random sample of primary health care physicians within four Local Health Integration Networks (LHINs) in southwestern Ontario who had various levels of involvement and experience with integration of electronic health information in the region.

      Finding/Results: There are clear and present challenges to regional integration of electronic records. Although integration initiatives such as the implementation of ClinicalConnect, a clinical viewer in South West Ontario, continue to expand, physicians still face challenges related to adoption, implementation, support, and more meaningful or enhanced use of the EMR. Additionally not every patient has access to their data and patient portals are often not integrated with physician and/or health facilities. Based on our data analysis, we propose a six-stage maturity model to apply to and routinely map the stages or levels at which primary health care practices within a region integrate their EMR with associated health information resources.

      Conclusion/Implications/Recommendations: This study describes and explains the current status of EMR use in a regional setting, which is critical to understanding both the benefits and drawbacks of EMRs and a better understanding of the problems and challenges of evaluation of regional integration of electronic health information. It can assist those who are working in the field of primary health care to understand more fully the use and impact of EMRs over time and space. This new model of eHealth evaluation incorporates a maturity process specific to primary health care and provides a better understanding of the effective use of electronic health information in primary health care.

      140 Character Summary: Regional integration is a fundamental requisite to promote use and improve impact of EMR in an interconnected primary health care system.

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    PS06 - Digital Health Engagement Through Benefits and Data (ID 45)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 3
      • Abstract
      • Slides

      Purpose/Objectives: Effective, timely sharing of patient health information among care providers is central to quality of care. Important progress has been made in the implementation, adoption, and use of electronic systems that are connecting health care providers with the information they need to provide care. In Canada, jurisdictions have created connected health information through interoperable electronic health records (iEHRs) which provide access to drug, lab, diagnostic imaging, immunization information, as well as clinical reports from multiple care settings. The objective of this panel is to discuss how connected health information is transforming health care in Canada. More specifically panel members will discuss: 1) the current landscape of connected health information; 2) impact of connected health information against expected benefits; 3) jurisdictional experiences with use and optimization of systems; and 4) how to sustain and spread the value of connected health information to transform healthcare.

      Methodology/Approach: In 2017, Canada Health Infoway undertook a study to understand the adoption, use and impact of connected health information across Canada. This study, based on national clinician studies, project research and evaluation, valued the effects of the foundational iEHR infrastructure as accessed through different point of care solutions in different care settings. Panelists will address a number of key activities that were undertaken as part of the study: measurement of the adoption of the iEHR; assessment of the benefits accruing from connected health information through review of available evidence; and key informant interviews with provincial/territorial stakeholders to understand the current and future use of connected health information nationwide.

      Finding/Results: The pan-Canadian Study on Connected Health Information calculated benefits accruing to health care system stakeholders (patients, providers, health system). Benefits substantiated by evidence include reducing duplication of lab and diagnostic imaging tests, enhancing timeliness of care, more effective ambulatory care and emergency department interactions, optimizing scope of practice for clinicians and improving equity in care through the availability of health information. Financially quantifiable benefits were driven by improvements in clinician and clinical practice productivity; avoided health system utilization due to improved patient safety; reduced patient time and expense, and reduced duplication of diagnostic tests. Equally as important but difficult to quantify are benefits related to improved access to information for clinicians. A majority of clinicians now have access to connected patient information either through integrated point-of-care systems or through separate web-based viewers. In some jurisdictions integrated iEHR viewers are available where clinicians are accessing connected patient information through a single solution such as their main clinical record system. Over 300,000 health care providers across Canada are currently accessing the iEHR through one of these methods, compared to 170,000 two years ago.

      Conclusion/Implications/Recommendations: Panelists will provide clinical and health system leadership perspectives on what has contributed to the impact seen to date and how health leaders can move forward to sustain, spread and achieve further value through the use of iEHRs. Discussion will focus on priority focus areas such as interoperability, advanced functionalities that enable e-referral, e-consults, and the use of the foundational iEHR infrastructure to support patient portals and analytics.

      140 Character Summary: Connected health information is transforming care in Canada. More than 300,000 health care professionals and their patients are realizing widespread benefits.

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      PS06.02 - Txting for #youthmentalhealth: Provider and #ptexp (ID 621)

      F. Ratchford, Canadian Foundation for Healthcare Improvement; Ottawa/CA
      A. Simon, Kids Help Phone; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: It is estimated that 1.2 million Canadian youth suffer from mental health issues, yet only 20% receive treatment. Yet delivering services to young people can be difficult. There are many reasons young people in need of mental health services may not wish to, or be able to, access traditionally-delivered mental health services. These include the desire for privacy, lack of local services or personal transportation to them, lack of acceptability of using cell phones for talking, limited data plans or bandwidth, etc. Digital health can play a key role in providing accessible and appropriate services to this population. The objective of this session is to provide an overview of the current state of digital mental health in Canada, present the experience of one provider offering a new 24/7 crisis texting line to youth in Canada, and amplify the patient point of view by presenting the patient experience in their own voice. These presentations will inform discussion during the question period around best practices for digital mental health solutions, engaging youth, and adopting a patient-centred approach.

      Methodology/Approach: Youth are increasingly less likely to use telephone or online chat when seeking help. Yet cellphones are nearly ubiquitous, and the use of texting is more acceptable to young people. For this reason, a bilingual, 24-hour, anonymous crisis text service, launched in 2017, provides an opportunity to address this accessibility gap. The crisis line provides service to youth without significant wait times. Using texting eliminates the need to download an app or use a cellphone data plan. The service is available in remote areas and areas that are typically underserved. A texting service allows an easier entry point for a youth in crisis, allowing them to be connected to on-the-ground resources including emergency services and child welfare after engaging with the texting service. The technology platform can be continually improved and lends itself to rigorous monitoring and evaluation. The solution can be integrated into other platforms, such as social media (Facebook, Snapchat, etc.).

      Finding/Results: Data from an initial release across one province will be presented. The data will inform local and national actors on trends and patterns, as well as add to the knowledge base of how young people experience mental health issues, and which words or concepts may be leading indicator for crisis. The data will also show usage patterns and areas of demand, which will provide lessons for scale-up to the national level. The effectiveness of outreach and engagement activities associated with the limited production release will also be assessed. Data from this implementation in Canada will be compared to the experience of other countries.

      Conclusion/Implications/Recommendations: The use of texting is an innovative way to provide services for youth in crisis. Its success has implications for how health services are delivered, whether to youth or others. It is a tool with the potential to improve patient experience, the health of the youth population, and contribute to health care system efficiencies.

      140 Character Summary: Digital mental health can be more accessible, acceptable and effective for youth. 24/7 texting crisis service is an opportunity for kids to get help the way they want.

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      • Abstract

      Purpose/Objectives: NASA, municipalities, airports and the military all operate “command centres,” in which people, analytics and actionable insight come together in one physical space with the goal to routinize very high levels of performance. Large scale command centres are now emerging in healthcare at a time when the system is precariously congested and resource-constrained. These centres of gravity play mission critical roles in the orchestration of patient care activities by shining a light into the “dark corners” of operations to de-risk, prioritize and synchronize patient care delivery.

      Methodology/Approach: The panelists will describe the healthcare command centre journeys they have been on, including the problems they are tackling, their implementation approach, results achieved and lessons learned. One panelist will describe how a hospital turned vision into reality when it leveraged its vast digital infrastructure and opened Canada’s first hospital-wide command centre in 2017 as part of its quest to become a high reliability organization. Today, the command centre is ingesting data elements in real-time from multiple source systems across the hospital to trigger actions in the moment that reduce length of stay, mitigate delays in care and expedite patient flow. Another panelist will discuss its organization’s goals and approach for implementing a regional command centre that optimizes how capacity is utilized across multiple locations in its network. A third panelist, that is partnering with hospitals and health systems around the world to design, build and activate healthcare command centres with deep capability, will provide a compelling look at the scalability of command centres across different problem spaces from patient flow, length of stay and access to quality, safety and patient experience.

      Finding/Results: The vast amount of data that is being generated at every turn in a healthcare organization is overwhelming for most caregivers. Command centres are demonstrating this data can be put to good use and results in significant benefit when it is carefully mixed, filtered, processed and presented to the end user. That benefit comes in the form of reducing patient waits, de-stressing caregivers on the front lines and optimizing the use of limited resources such as staff, beds, equipment, etc. The panelists will share numerous real-world instances of applying real-time and predictive analytics strategically to solve specific challenges and drive outcomes that were otherwise not attainable.

      Conclusion/Implications/Recommendations: Hospital and health system command centres are challenging the status quo such that functions across the enterprise no longer need to work in silos, decision-makers no longer need to act without good information and caregivers can spend more time delivering care instead of coordinating care. All of this translates into better health service delivery and better quality of care which all patients deserve.

      140 Character Summary: Like NASA mission control, large-scale hospital command centres enable real time situational awareness and prompt action in the moment for direct patient benefit.