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    OS01 - Better Care Outcomes through Data and Analytics (ID 8)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 3
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      OS01.01 - Enabling Public Health Surveillance Using IoT Data (ID 198)

      K. Sahu, School of Public Health and Health System, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: The purpose of this project is to explore individual behavioral patterns, trends, and facilitate remote patient monitoring using data from IoT sensors. The focus of this study is to understand individual- and population-level behaviors based on smart thermostat data extracted from the ecobee database. This data will be used for remote patient monitoring, population-level insights, and monitoring of the progression of chronic diseases.

      Methodology/Approach: ecobee, a Canadian smart home technology company, currently has the technology to collect temperature and motion data from thermostats and remote sensors. The motion data from the thermostat and remote room sensors have the capacity to capture the amount of indoor physical activity, sleep patterns, sedentary behavior, and ultimately inform on various health conditions (such as dementia and mental health). Presently, our research team has access to data collected by ecobee’s Smart WiFi Thermostats owners who consented to having their data shared in the ecobee’s Donate Your Data (DYD) program. Our sample data comes from 10,251 households with a ranging number of remote sensors, predominantly located in the US and Canada, over a two-year period. For the purpose of creating a computational environment to store, transform, and deliver the data, this study will follow a typical big data software architecture. In order to explore and analyze the data, we are going to use Python machine learning.

      Finding/Results: Currently, we are in the process of analyzing ecobee’s entire DYD dataset. In phase-1, using machine learning, we will apply pattern recognition on the dataset and expect to identify variations in user behavior. Our algorithms will identify unique patterns at different levels, as for example intra- and inter-day variations. They will also be able to predict the micro- and macro-level behavior patterns, such as the time of the day or sleeping vs. awake. Ultimately, we will leverage these algorithms to identify abnormal behavior within a household to be used as an early warning for deviations health status. In the following phases, our prototype will display the statistics and summary of activity in a dashboard that public health agencies will be able to access and visualize the data in near-real time. Aggregate data will be displayed in near real-time to enable public health agencies to monitor activity across Canada’s different regions. At a later stage, deep learning will be used to identify challenging areas and forewarnings will be provided via map visualizations.

      Conclusion/Implications/Recommendations: This project is pioneering improvements to public health surveillance: (1) a novel data source; (2) new indicators for physical activity, sleeping habits, and sedentary behaviour; (3) novel tools/solutions for capturing data; and (4) creating newly linked datasets combined from a variety of sources including IoT sensors. Data collection has never been achieved on such a granular level (5-minute intervals) and in virtually real-time. The Public Health Agency of Canada (PHAC) has yet to use in-home monitoring via sensors. This study will open opportunities for PHAC to go beyond traditional methods for public health surveillance.

      140 Character Summary: Remote monitoring of health indicators at the population level using motion data from ecobee’s smart thermostat (IoT) and machine learning.

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      • Abstract
      • Slides

      Purpose/Objectives: To support Fraser Health’s Integrated Plan of Care initiative at Abbottsford Regional Hospital, an electronic documentation tool has been selected. This tool enhances inter-professional care planning and collaboration. Ensuring the usability and safety of the tool has become critical.

      Methodology/Approach: A framework for applying usability engineering to ensuring system usability and safety of health information technology developed by Broycki et al. (Broycki et al., 2013) has been employed in designing and building the tool. A series of multilayered user tests of the electronic documentation tool have been performed beginning with basic usability inspection and cognitive walk-through, followed by usability testing and limited clinical simulations. A framework for applying usability engineering to ensuring system usability and safety of health information technology developed by Broycki et al. (Broycki et al., 2013) has been employed in designing and building the tool. A series of multilayered user tests of the electronic documentation tool have been performed beginning with basic usability inspection and cognitive walk-through, followed by usability testing and limited clinical simulations.

      Finding/Results: Usability Inspection: • Both positive and negative features of the tool were identified • Informed design and build / customization Usability Checklist: • Completed by the development team to check the compliance of the usability heuristics of the prototypes they built • Served as a guideline to form the discussion around design between the development team and stakeholders Usability Test: • 14 build packages, all of which were tested at least once (29 tests in total) • Created 5 formal Usability Test reports and 24 brief summaries Clinical Simulation Test: • 24 frontline clinical participants (Nursing: 17, Allied Health: 7) • Covered 95% of the identified workflow in Medicine, Surgery and Critical Care areas • 19 designed test cases Results informed training, highlighted anticipated questions, and mitigated issues that might occur during real patient encounters Usability Inspection: • Both positive and negative features of the tool were identified • Informed design and build / customization Usability Checklist: • Completed by the development team to check the compliance of the usability heuristics of the prototypes they built • Served as a guideline to form the discussion around design between the development team and stakeholders Usability Test: • 14 build packages, all of which were tested at least once (29 tests in total) • Created 5 formal Usability Test reports and 24 brief summaries Clinical Simulation Test: • 24 frontline clinical participants (Nursing: 17, Allied Health: 7) • Covered 95% of the identified workflow in Medicine, Surgery and Critical Care areas • 19 designed test cases • Results informed training, highlighted anticipated questions, and mitigated issues that might occur during real patient encounters

      Conclusion/Implications/Recommendations: Synergistic use of usability checklist, heuristic review, “think-aloud” protocol and “near-live” clinical simulations provide a robust assessment of how the clinical documentation tool would interact in live clinical environments and allows for early redesign to increase clinician utilization. Integration of the usability checklist and the framework in the design, development and test phases buttress efforts to achieve safe technology in healthcare.

      140 Character Summary: Integrating usability framework and user-centered design method in Health IT projects advances efforts to achieve safe technology in healthcare.

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      OS01.04 - Innovative Interoperability: Standardized Insurance Forms to Improve MD-Generated Data (ID 158)

      A. Ocana, NorthShore Mental Health and Addiction Clinic; North Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Primary Care Physicians (PCPs) manage of 80% of patients with mental health challenges. They have no systematic way to assess or monitor their patients. Currrently EMRs are not interoperable and there is no standardized digital format for insurance reports. Insurance and benefits providers pay physicians to generate medical reports. The data is handwritten, returned by fax, unsecurely, not digital, not entered in distinct fields, generally incomplete, nonspecific, replete with errors, uncodable and therefore impossible to analyze, according to a recent qualitative study: Tang KL, Lucyk K, Quan H. CMAJO August 21, 2017 vol. 5 no. 3 E617-E622. Without access to quality data, we can't answer the big questions in healthcare, like the Fentanyl crisis or teen suicide. According to the WHO, Mental Health and Addiction are the number one causes of disabiilty world-wide. The annual health cost in North America is staggering. Insurance forms are an easily accessible source of patient-level data. Consent to use patients' anonymized data for research is not implicit, but can be obtained. The objective of our project was to develop and implement a standardized, digital, mental health assessment and reporting tool that could be used interoperably in any EMR.

      Methodology/Approach: We reviewed a broad sample of current insurance reports, discerned the commonly asked questions and reverse-engineered our assessment to be able to answer and score those questions in text, drop down menus and other digital fields. Our assessment included: Symptoms and their severity Functional Impact of symptoms on: cognitive tasks, work, home, relationship, social, driving and physical health. A comprehensive Co-morbidity Screen for Mood Disorders, Chronic Pain, ADHD, Substance Use Disorders and Trauma. Patient-rated measures of Current Function including: cognitive, executive, social and emotional function, as well as measures on productivity, mood, social support, motivation, readiness for change, pain, stress tolerance, quality of life and emotional stability. For simplicity and interoperability, measures were rated on a 10-point scale. Prognosis using the balance of resources (such as social support, motivation) vs. risks (such as unemployment or emotional instability) We trialed our assessment on the 150 consecutive patients.

      Finding/Results: By asking the same question, the same way and putting the answer into the same field, our assessment tool simplified and standardized data capture and analysis compared to having multiple different paper-based forms. It uncovered a broad measure of relevant co-morbid psychopathology. It generated quantitative measures with face and construct validity, where previously there was unstructured, unsubstantiated opinion.

      Conclusion/Implications/Recommendations: If insurance and benefits providers could agree on a standardized digital format for medical reports, using industry-standard questions, then physician-generated forms would be much more valuable as a health analysis tool. In future, machine learning, using highly segmented, anonymized, data that is disease, symptom and treatment specific, would allow us to evaluate and optimize interventions across the full cycle of care, based on patient-rated outcomes. The millions of data points created would facilitate the generation of artificial intelligence-driven algorithms that could improve care, reduce adverse events and decrease health costs. That would allow us to answer the big questions.

      140 Character Summary: Mental Health is the primary cause of disability world-wide. Stakeholder collaboration on data collection would generate health benefits and cost savings.

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    OS07 - Outcomes-Based Delivery (ID 16)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
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      OS07.01 - Doing More with Less; Practical Strategies to Enable Provincial Change (ID 270)

      M. Cleghorn, IT, Alberta Health Services; Calgary/CA

      • Abstract
      • Slides

      Purpose/Objectives: Since 2009 the Alberta health care delivery system has no longer been organized into a regional structure but rather a single province-wide provider organization called Alberta Health Services (AHS). In balance of years since regional consolidation, the AHS-IT department has been focused on service alignment, coordination, and building a strong foundation from the historic and disparate IT pieces inherited by AHS. That foundation has enabled AHS-IT to actively work on IT service consistency, application consolidation, and infrastructure stability across an entire province through an IMIT strategy that sits alongside patient care and organizational strategies at a peer level of importance. AHS is preparing to deploy a provincial EHR/CIS in 5 years, so we have to do more. At a time of severe resource constraint, exceedingly high information sharing expectations, and public demand for transparency and accountability, we have to do more with less. That requires effective partnerships between clinical care delivery and IT services delivery, and across all areas of AHS. Everyone deserves and should expect robust, stable, and accessible IT services. Using practical deployment strategies, creative approaches to partner with internal and external teams, and diligently following a few creative ideas, we're really enabling provincial change. The purpose of this presentation is to share approaches, tools, and structures used by AHS-IT to do more with less at a provincial level.

      Methodology/Approach: This presentation will breakdown the People, Process, Technology, and Partner elements of each key area that revealed success, or early indications of success as well as "red herring" approaches that did not deliver intended outcomes. The approaches used will be shared to include the tools and structures used by AHS-IT (and across AHS) that is allowing us to do more with less. Each key topic will be reviewed with a focus on recommendations. What did we do to embrace a "Dev Ops" application enhancement delivery? How did we track operational resource capacity? What tools were necessary and what were extraneous where maybe simple communication and diligent focus on culture is what was needed? Demonstration of tools, sharing of findings and Check List will help deliver the message of large scale provincial level management.

      Finding/Results: AHS-IT has developed new approaches, governance models, management tools, and cultural strategies to do more with less. The results of years of effort appear with findings in 7 key areas: (1) Dev Ops application enhancement delivery; (2) Operational resource capacity management; (3) Capital and Operational Resource Roadmapping; (4) Triad Partnerships (IT, Physician, Clinical Ops); (5) Empowered and Team-based Decision Making; (6) Supportive Accepting Culture; (7) Provincial Exposure and Accountability.

      Conclusion/Implications/Recommendations: AHS has matured significantly since 2009, and the AHS-IT department has capitalized on a provincial structure. Consolidated application environment (still improving), infrastrucutre stability (still enhancing), diligent resource management (still refining), collaborative workforce (still collaborating), and accountable leadership (still accountable!) have allowed AHS-IT to do more with less. By sharing our learning we hope to demonstrate what people, processes, technology, and partner structures are in place to prepare AHS in delivering a successful provincial EHR/CIS in 5 years.

      140 Character Summary: AHS is going to a provincial EHR/CIS that will transform healthcare delivery. AHS-IT dept used a number of ops strategies to prepare; now ready to share. #AHSgotime

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      OS07.02 - ITAC Health: Leveraging Analytics to Develop Provincial Interoperability Scorecards (ID 323)

      E. Huesing, ITAC Health; Vernon /CA
      D. Ritz, ecGroup Inc.; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Evidence shows that interoperable health information exchange positively impacts care continuity, care quality, and patient safety. Interoperability is especially important in the primary care setting to support the management of chronic diseases, which represent Canada’s most significant disease burden. To date, jurisdictional health administrations have invested substantial funds and human resources in digital health solutions intended to improve such information exchange. Have these initiatives been successful? The ITAC Health Interoperabilty and Standards Committee (ISC) has partnered with the researchers from the School of Health Information Science at the University of Victoria to evaluate Canada’s current state of digital health interoperability, jurisdiction by jurisdiction.

      Methodology/Approach: The research will leverage existing data sets (and conduct interviews with experts) regarding primary care physicians’ use of EMR solutions to share data (i.e. between EMRs and regional health authority EHRs); EMR use specifically focused on managing NCDs; digital health adoption rates; etc. Based on the available data, an analytic model will be constructed and used to develop a comparative interoperability scorecard for Canada’s jurisdictions. Analyses will be developed to look for correlations between interoperability scores and health system outcomes. The scorecard results will be mapped to ITAC Health ISC’s 2016 Position on Canadian Healthcare Interoperability Standards.

      Finding/Results: With an initial focus on primary and ambulatory care, our research is working towards producing an Interoperability Scorecard that will allow for comparative evaluation of interoperability in Canadian health authorities and among physician primary care practices in a consistent, constructive and measurable way. ITAC Health ISC, in cooperation with the School of Health Information Science, University of Victoria, will present the methodology and preliminary Interoperability Scorecard at the upcoming eHealth Canada Annual Conference in May 2018. The presentation will also include discussion of a preliminary comparison of interoperability approaches taken internationally (based on publicly available sources).

      Conclusion/Implications/Recommendations: The intent behind this undertaking is to establish clinical and technical interoperability measures for delivering universal access to effective care for all Canadians, in a financially responsible fashion.

      140 Character Summary: Lots of eHealth investment, but how interoperable are we? ITAC Health ISC introduces the Canadian Interoperability Scorecard. See how the provinces compare!

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      OS07.03 - Trimming the Fat: Redesigning Telemonitoring Systems and Services for Scalability (ID 225)

      P. Ware, Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Although telemonitoring is an intervention with a demonstrated ability to ease the burden of managing chronic conditions, its diffusion as part of the standard of care across Canada is lagging. Our objective was to develop and implement changes to the system and services of an existing app-based heart failure telemonitoring program to improve its sustainability and scalability.

      Methodology/Approach: The path from idea generation to implementation took place over stages. First, discussions between high-level stakeholders and during bi-weekly operations meetings led to the identification of opportunities for cost reduction and optimization of existing resources. Second, semi-structured interviews were developed to probe the opinions of end users regarding these opportunities; the objective being to understand the acceptability of the proposed changes and to identify potential negative implications. Interview participants included HF clinicians (n=9) and patients (n=25) both with and without prior experience with the existing telemonitoring program. Third, based on interview results, requirements needed to operationalize these changes were developed; strategies were prioritized based on potential impact to scalability, feasibility, and risks to the effectiveness of the program. Finally, system and service changes were implemented and closely monitored and fine-tuned as needed.

      Finding/Results: Identified opportunities for reducing costs and support scaling included (1) moving toward a bring you own device (BYOD) model whereby patients would use their own smartphone, weight scale, and blood pressure cuff, and (2) reducing telehealth support time by enabling patient self-training and troubleshooting. Opportunities for optimizing existing resources included: (1) identifying the most suitable patient candidates for the system, and (2) identifying the optimal duration of patient enrollment. Informed by the interview results, BYOD and self-training/troubleshooting were prioritized for immediate deployment as these were identified as having a high potential for reducing costs and would have immediate benefit towards the sustainability of the existing program. Specifically, this involved developing and distributing the telemonitoring app on both iOS and Android. In addition, a redesign of the patient onboarding materials and procedures was done to minimize the role of a telehealth support staff member. This was supported by the creation of a product website with detailed instructions and FAQ sections for user support ranging from initial setup to common troubleshooting. While opportunities for optimizing existing resources were seen as important factors in sustaining and scaling the existing program by interview participants, stakeholders opted not to restrict accessibility to the program until more robust evidence justifying criteria for patient selection and duration of enrolment could be obtained.

      Conclusion/Implications/Recommendations: Theories of diffusion of innovation suggest that one of the keys to scaling lies in modifying elements of its delivery to better fit the implementation context. This however, is only true if the integrity of the intervention can be maintained and effectiveness is not compromised. Our efforts provide a patient and user-centred example of how necessary actions can be taken to ensure the sustainability and scalability of consumer health technologies.

      140 Character Summary: This presentation will discuss the redesign of an existing telemonitoring program’s system and services to improve sustainability and scalability.

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      OS07.04 - PHSA’s Office of Virtual Health: Connecting for Wellness (ID 335)

      K. Steegstra, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Provincial Health Services Authority (PHSA) is responsible for planning, coordinating and evaluating specialized health services across provincial clinical and academic programs and for collaborating with the BC health authorities to provide equitable and cost-effective health care for people throughout the province. One of the strategies outlined in PHSA’s mandate letter from the Ministry of Health is “to leverage and enhance virtual care as part of the care continuum for patients”. In order to effectively achieve this strategy, PHSA established the Office of Virtual Health (OVH) in 2017 to lead the development and implementation of an organizational, clinically-driven, virtual health strategy and plan.

      Methodology/Approach: Some of PHSA’s clinical and academic programs have been implementing various aspects of virtual health into their care delivery models since 1994 and excellent achievements have been made. With the creation of the Office of Virtual Health there is now an opportunity for all virtual health work to be more coordinated, efficient and clinically driven. OVH will establish forums to share lessons learned, build on others’ experiences, communicate results and requirements and build a PHSA Virtual Health Community of Practice. OVH has already engaged with Clinical leaders from across the organization to begin work on the PHSA Virtual Health strategy. A result of the engagement activities is the development of the functional model below, which identified the Clinical and Academic program areas as the leaders and owners of virtual health initiatives at PHSA.

      Finding/Results: The Office of Virtual Health will facilitate several demonstration projects between November 2017 and May 2018. Each project will include a thorough evaluation strategy with both standard measures that are reviewed for all PHSA virtual health initiatives as well as program-specific measures. The key measures will include focus on outcomes, patient and provider satisfaction, accessibility, program reach and wider system impacts.

      Conclusion/Implications/Recommendations: PHSA’s Office of Virtual Health will provide leadership and guidance to all Clinical and Academic programs to effectively implement virtual health initiatives. This includes providing strategic direction, planning and coordination, facilitating transformation and communication. This coordinated approach will facilitate organizational assessment and evaluation of the effectiveness of virtual health, information sharing and collaboration.

      140 Character Summary: PHSA has established an Office of Virtual Health to lead a coordinated, organizational strategy for implementing virtual health initiatives.

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    OS13 - Delivering the Benefits of Digital Healthcare (ID 50)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
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      OS13.01 - Improving Access, Navigation, and Communication About Health Services (ID 540)

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

      • Abstract
      • Slides

      Purpose/Objectives: Local Health Integration Networks (LHINs) provide strategic direction and fund health service providers (HSPs) in Ontario. To understand the current services available at the community level, the Toronto Central (TC) LHIN began collecting supplemental data from their HSPs in 2017. The analysis of this data set helps inform planning, and enables providers across the LHIN to collaboratively address common challenges to better serve Torontonians. Ultimately, the goal is to help improve access, navigation, and communication for patients. Some challenges faced by TC LHIN included manual and time-intensive data collection, analysis, and presentation through Excel. As HSP360 provides a centralized platform for HSPs and LHINs to access multiple data sets from various sources (for example, SRI, ALC, MLAA, Stocktake, etc.), incorporating this supplemental data set allows for greater insights through the following capabilities: - Web input form, allowing users to update their respective supplemental data at any time - Interactive dashboards, providing users with the most up-to-date information, as well as dynamic visualization, drill-throughs, and filtering capabilities (See figure 1) hsp supplemental dashboard.png Figure 1: Overview of LHIN Services

      Methodology/Approach: The web input form and interactive dashboards were built through close collaboration between TC LHIN and CAMH, with the scalability to expand these capabilities to other interested LHINs. First, the design and development were iterated upon through brainstorming sessions and mockup reviews. Secondly, user review and testing was incorporated to ensure that health service providers were involved in the process. Lastly, the release of the input form and dashboards were incorporated into existing SAA processes.

      Finding/Results: LHINs and HSPs have found great value in using HSP360 in data collection and analysis. With HSP360’s current automation of administrative and benchmarking processes, including HSP supplemental information on the same platform provides a new level of insight on community HSPs that was previously not available – further building the decision support capacity for LHINs and HSPs. The Toronto Central LHIN and their HSPs have found this information helpful as a starting point in planning for new services, and looking for efficiencies to improve overall system performance and the patient experience. LHIN and HSP users are now able to identify opportunities in: coverage of service area; priority populations and conditions; and availability of services: what, when and where.

      Conclusion/Implications/Recommendations: The progression of HSP360 has enabled LHINs and HSPs to set new standards in performance monitoring and a common view of performance metrics across LHIN boundaries. Including the HSP Supplemental data set on HSP360 enhances and supports the performance monitoring process, and improves access to comparable information for evidence-informed decision making.

      140 Character Summary: HSP360 supports service planning for HSPs and LHINs – most recently providing users with additional insights from data collected at the community level.

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      OS13.02 - Multilevel Interoperability:  Enabling Disciplinary Autonomy within Interdisciplinary Process and Technology (ID 624)

      A. Pigou, eHealth, Baycrest Health Sciences; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Illustrate how a diverse healthcare environment specializing in multiple disciplines was limited in ability to share and access information across entities due to limitations of “one-size-fits-all” technology, but can now globally access information across diverse yet relevant areas of professional practice.

      Methodology/Approach: All three levels of the HIMSS Interoperability Model are utilized to achieve the desired outcome, including: Functional – Level One (basic): This lowest level includes simple criteria for sharing information between health information systems. Structural – Level Two (intermediary): At the mid-level, data interpretation is possible. Semantic – Level Three (advanced): In the most advanced level, disparate solutions can interpret and exchange information. *Figure A: HIMSS Multilevel Interoperability Model interoperability.jpg Prior to implementation, Readiness Assessment methodology was developed to identify – at the core: current environmental status, overall level of impact on all stakeholders, and required actions for achieving the desired future state. Extended arms of the readiness assessment framework include: People & Culture, Process, Technology, Documentation Workflow, External Environment. The approach selected for implementation includes project management methodology with the following included: 1) Process improvement with workflow mapping 2) Change management 3) Agile software development 4) Post-implementation Evaluation Figure B*: Baycrest Readiness Assessment Framework: readiness.jpg

      Finding/Results: Findings, results and predicted outcomes include examples as follows: 1) Improved clinical documentation and interprofessional practice across the continuum of care. 2) Use of universal care protocols to enable regulatory compliance. 3) Quality improvement, enhanced risk mitigation and increased patient safety. 4) Business administration and financial management becomes more supportive to clinical services. 5) Integration of multi-dimensional data architecture with electronic health records, enables advanced health analitics and clinical decision making.

      Conclusion/Implications/Recommendations: In conclusion, all levels of interoperability within a health information technology framework are essential for integrating the multiple specialized areas across a health services environment. It enables services to meet their unique needs related to information, workflow, care, quality, research, revenue and regulatory compliance. Interoperability not only facilitates the needs of uniquely specialized services, but it is recommended in order to achieve effective communication and ubiquitous sharing of health information when appropriate. The result is patient centric interprofessional collaboration across disciplines and throughout the continuum of care.

      140 Character Summary: Disparate health services in a hospital, community, retirement or nursing home, achieve both individual and shared requirements via all interoperability levels.

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      OS13.03 - Evaluating an EMR Implementation in Home Health Care (ID 377)

      L. Turchet, MD+A Health Solutions; Toronto/CA
      D. Wesley, VHA Home Healthcare; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The introduction of electronic medical record (EMR) systems is expected to provide numerous benefits; however, literature reviews often provide inconsistent evidence for the promised or expected benefits -- particularly in the home and community care sector. The lack of strong evidence in the literature for the benefits of an EMR and how to realize them undermines the business case for prospective EMR purchasers and poorly advocates for further advancement of health IT within an organization. To better understand how nurses are currently using the EMR and to identify gaps or challenges that could be addressed our organization undertook an evaluation of our EMR.

      Methodology/Approach: The evaluation was conducted over a series of months and was based on an adapted version of the Canada Health Infoway Benefits Evaluation. Key domains included: System Use, System Quality, Information Quality, Training & Support as well as the Client Perspective. Information to support the evaluation was collected numerous ways including staff survey, focus groups, chart audits, client interviews, and review of system/support logs.

      Finding/Results: The majority of nurses report satisfaction with the performance and reliability of using the EMR. Barriers to use were largely related to issues with network performance and connectivity in the community. When the EMR was used as intended, it improved the overall efficiency and productivity of our nurses; however the opposite was reported when the system use was described as poor. The top benefits identified were the enhanced ability to protect the privacy and security of clients’ health information, improved collaboration and communication to and for service delivery, and the ability to adhere to best practice standards and promote evidence based clinical practices.

      Conclusion/Implications/Recommendations: The evaluation revealed several key areas of benefits allowing for a compelling business case for further investment in digital health and provided our organization with insights on areas for further enhancements. It was clear that the benefits of the EMR have had a strong, positive and measureable impact on the organization and nurses.

      140 Character Summary: VHA Home Healthcare evaluates their Home & Community Based EMR for nurses using an adapted version of the Canada Health Infoway Benefits Evaluation Framework.

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      OS13.04 - Measuring Individual and Organizational Transformation: An eHealth Adoption Maturity Model (ID 54)

      R. Wilson, Registered Nurses' Association of Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Individual and organizational transformation are important goals of large scale eHealth solution implementation projects. Yet, these goals are often not realized because these projects are inherently complex with failure rates as high as 70 percent internationally. Successful implementations require strong leadership and ongoing monitoring and evaluation of key indicators. The eHealth Adoption Maturity Model is a conceptual model developed by a panel of experts to guide this process. The Model identifies indicators for individuals with varying degrees of involvement in the implementation as well as indicators in the practice environment and the broader organizational context. This presentation provides an overview of the Model and the three levels of eHealth adoption that can be used to measure individual and organizational transformation.

      Methodology/Approach: The Model emerged as a by-product of the collaborative work of a panel of international experts which was convened in January 2016 to develop a best practice guideline intended to enhance the informatics capacity of individuals involved in the implementation of an eHealth solution. The Panel included patient partners, health care executives, nurses, and other health professionals from various settings. Several panel members played key roles in eHealth solution implementations that resulted in their organizations attaining Stage 6 or higher on the HIMSS Analytics Electronic Medical Record Adoption Model. The Guideline development process included a systematic review of the peer-reviewed literature from 2006–2016 to identify the best available evidence to formulate recommendations. The panel developed the eHealth Adoption Maturity Model as a conceptual model comprised of key elements (and corresponding measurement indicators), each of which was aligned with one or more of the Guideline recommendations.

      Finding/Results: The eHealth Adoption Maturity Model identifies several elements that are thought to impact the overall individual and organizational transformation process: management and leadership; focus on stakeholders; process and infrastructure; education; resources; and the context and environment. The Model demonstrates that as organizations and individuals progressively mature through their adoption of an eHealth solution, some elements may evolve faster than others. This lack of uniformity in the rate of maturity can persist to the end of the formalized transformation process. For each of the Model elements, generic eHealth adoption and maturity characteristics were identified and categorized along a continuum ranging from Level 0 (Beginning) to Level 2 (Advanced) to facilitate the measurement of individual and organizational transformation over time.

      Conclusion/Implications/Recommendations: The eHealth Adoption Maturity Model is generic in scope with broad and practical application across all sectors. Health care leaders, nurses, and other health professionals involved in the implementation of an eHealth solution can examine the level of transformation in themselves and their organizations in light of the Model elements and associated indicators. Users of the Model can focus on the strengths and barriers that each element identifies in their specific context. Those areas in need of further transformation should be noted and a plan developed to advance the process. In this sense, the Model may be used as a driving force for sustained change.

      140 Character Summary: This presentation provides an overview of an eHealth adoption maturity model, which can be used to measure individual and organizational transformation.

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    OS18 - Minding the Gap in Our Healthcare Policies (ID 34)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS18.01 - Developing a Data Quality Assessment Framework for Primary Care (ID 385)

      M. Cousins, The eHealth Centre of Excellence; Waterloo/CA
      M. Alarakhia, The 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 POC is being conducted across four Family Health Teams in southwest Ontario. A key objective is to improve data quality to enhance data sharing; ensuring the data being shared is accurate, complete and timely and can be used to inform clinical care. The purpose of this presentation is to explain the framework, including tools and templates that was developed by the project team to assess and monitor data quality improvements.

      Methodology/Approach: To create the framework, existing data quality frameworks were assessed and customized to meet project needs. The tools focused on three dimensions: a) completeness: how well the data in the EMR reflects the actual medical state of the patient; b) correctness: how up-to-date the data is in the EMR; and 3) comparability: how much of the data in the EMR is comparable (e.g. coded and easily analyzed). The framework enables the evaluation of these dimensions across several elements of EMR data including: problem list, past medical and surgical history, medications, immunizations, allergies, and risk factors. The framework consists of two data quality assessment tools (an objective and a subjective tool). An online survey to assess the clinician’s perception of their level of confidence of their EMR data and a checklist used to validate data quality by completing a mini chart review. For both tools, a percentage of completeness, correctness and comparability is calculated, and averaged to calculate an overall data quality score.

      Finding/Results: Our analysis resulted in a number of key findings. First, clinicians recognized the necessity of data standardization, but also recognized the need for resources (human and time) to achieve desired outcomes. In addition, continued reinforcement is needed to remind clinicians to motivate change including showing them what their data looks like. Some sites addressed their interest for reinforcement by creating a data quality scorecard that showed data quality status by physician and site. An additional consideration for future work included data capture inconsistencies across clinicians and vendor variation in terms of completion of data queries to support data quality plans. In terms of benefits, standardizing EMR data was shown to enable more accurate identification of patients with complex care needs; allowing clinicians to better focus on providing preventative care. This finding, of course, is vital to consider when the POC is put into the larger system goals of improving patient outcomes and ensuring appropriate use of health system resources.

      Conclusion/Implications/Recommendations: The PCDS POC has designed a framework to assess and monitor data quality improvements over time. The framework includes a number of tools that can be utilized by primary care sites. The tools and templates reveal important potential being developed during a POC centred on Primary Care Data Sharing and offer considerable potential for decision-makers considering scaling and spreading of such an initiative.

      140 Character Summary: Development and validation of a data quality assessment framework to support primary care sites in assessing and monitoring data quality improvement activities.

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      OS18.02 - Electronic Consultation Services Worldwide: An Environmental Scan (ID 458)

      J. Joschko, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many healthcare systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists via a secure platform to facilitate discussion of patients’ care. In this presentation, we examine the different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different healthcare contexts worldwide.

      Methodology/Approach: We conducted an environmental scan comprised of three stages: a literature review, a grey literature search, and targeted, semi-structured key informant interviews. A team member searched Medline and EMBASE (literature review) and Google (grey literature search) using an established keyword matrix. Upon completing the searches, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, care providers, and decision-makers. Maximum variation sampling was employed to ensure sufficient breadth of participant experience. We conducted semi-structured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach.

      Finding/Results: A total of 53 services emerged from the published and grey literature. Services spanned 16 countries, with the majority (53%) located in the United States. Hospitals/clinics comprised the most common provider type (34%), while the most common technology platforms utilized were web-based (38%) and electronic medical records (28%). Interviews have been conducted with respondents from various countries and represented a mix of service types (e.g. public versus private, electronic medical record versus web-based). Preliminary analysis has revealed a variety of service structures, payment models, and technologies. Recurring themes include need for physician engagement, importance of maintaining workflow, and value of improving access. Further analysis will be shared during the presentation.

      Conclusion/Implications/Recommendations: eConsult services have emerged in a variety of countries and health system contexts worldwide. Structure, platform, and delivery model varies, but the services consistently demonstrate improved access and high levels of satisfaction.

      140 Character Summary: We conducted an environmental scan of eConsult services available worldwide and compared the strategies, barriers, and successes of their implementation

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      OS18.03 - Psychometric Evaluation of the Canadian Nurse Informatics Competency Assessment Scale (ID 194)

      M. Kleib, Faculty of Nursing, University of Alberta; Edmonton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Purpose: While the Canadian Association of Schools of Nursing (CASN) has defined entry-to-practice informatics competencies for Registered Nurses, there has been no research-based tool developed to date for the assessment of these competencies. The purpose of this study was to integrate these competencies into a measurement scale and evaluate its psychometric properties. Such a tool would serve to evaluate nurses’ informatics readiness for practice, their learning and continuing education needs related to same, and assist in the planning of targeted informatics education in the workplace.

      Methodology/Approach: Methods: The researchers developed the Canadian Nurse Informatics Competency Assessment Scale (C-NICAS)—a 21-item comprehensive measure and applied it into a cross-sectional survey; 2844 nurses from practice settings in Alberta completed the survey. An exploratory principal component analysis with oblique promax rotation was applied to examine the factor structure and internal consistency reliability of the (C-NICAS).

      Finding/Results: Results: Results revealed a four-component/factor structure of the C-NICAS, explaining 61.04% of the variance. Items loading per each component reflected the original Canadian Association of Schools of Nursing’s grouping of nursing informatics competency indicators, as per three key domains of competency: information and knowledge management (? = 0.85); professional and regulatory accountability (? = 0.81); and ICT use in the delivery of patient care (? = 0.87) with the exception of one item (Indicator 3), which loaded into the category of foundational information and communication technology (ICT) skills (? = 0.81).

      Conclusion/Implications/Recommendations: Conclusion: This study provided a preliminary evidence for the construct validity of the entry-to-practice competency domains, and the factor structure and reliability of the C-NICAS among practising nurses. Further testing among nurses in other settings and among nursing students is recommended.

      140 Character Summary: A principal component analysis supported the validity and reliability of the new Canadian Nurse Informatics Competency Assessment Scale.

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      OS18.04 - Patient Privacy Perceptions in a Digital Mental Healthcare Environment (ID 388)

      N. Shen, Institution of Health Policy, Management and Evaluation, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The concepts of privacy and trust are critical for patients with mental health conditions or addictions as effective therapeutic relationships are grounded in the assurance that disclosed information will be held in confidence by the healthcare provider. Without this assurance, individuals may avoid seeking mental health care due to fears of stigmatization if their health records are inappropriately disclosed. Privacy concerns about the appropriate use of mental health records have often overshadowed the valuable characteristics of interoperable health information technology (HIT) — the potential to improve the integration and continuity of care, support clinical and health service research, and empower patients through consumer-based applications. The purpose of this study is to explore the privacy perspective of mental health patients and understand how they feel about the electronic sharing of their records.

      Methodology/Approach: Semi-structured interviews were conducted with outpatients receiving care for mood and anxiety disorders or substance addictions at an Ontario mental health hospital. Participants were recruited using a maximum variation sampling strategy on the following characteristics: perceived health status, disposition to trust, and tech savviness. The interview questions were developed based on the eHealth Trust Model (eHTM), a theory-grounded conceptual framework, to understand the patient views on privacy and trust, the factors that contribute to those views, and the impact of those views. Using Braun and Clarke’s framework for thematic analysis, qualitative themes were identified through iterative rounds of coding using a schema based on the eHTM.

      Finding/Results: Interviews were conducted with 14 patients. Privacy was defined by some as the self-controlled release of information while others equated it to confidentiality. Participants were concerned about their privacy for fears of stigmatization, particularly from employers, insurance companies, and healthcare providers. The term privacy was often used interchangeably with security and linked to a fatalistic belief that there is nothing that can be done about hackers. The concept of trust was grounded in the following themes: competency, credentials, familiarity, and past experiences. Key themes on building trust include: greater accountability, more transparency on how data is used, and more education on patient rights to their information. While patients were not always comfortable with the idea, they were willing to electronically share their records because they saw the individual benefits of providers having complete information and of having online access to their own health records. They were also supportive of sharing their records for clinical and health service research because of the societal benefits.

      Conclusion/Implications/Recommendations: The preliminary analysis of the interviews found that patients were unaware of their health privacy rights and the permitted uses of their health records; however, they supported interoperable HIT because the perceived benefits outweighed privacy risks. With a body of literature mainly comprised of commentary from academics and healthcare providers, this research makes a contribution by gathering first-hand accounts from a vulnerable patient population on how trust can be developed to support Canadian efforts in building interoperable HIT.

      140 Character Summary: This study found that patients with mental health conditions and addictions supported interoperable HIT because the potential benefits outweigh privacy risks.

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    OS26 - Expanding the Spread and Scope of Care (ID 48)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS26.01 - Accelerating the Provision of Comprehensive, Continuous Primary Care in Manitoba (ID 53)

      K. Morrison, Manitoba eHealth; Winnipeg/CA

      • Abstract
      • Slides

      Purpose/Objectives: To explain how Manitoba introduced a province-wide change to the primary care system in a short time enabled through digital health solutions. To demonstrate the impact of putting an appropriate policy and incentive framework in place to encourage technology adoption in support of transformational change leading to improved quality of care.

      Methodology/Approach: In 2015 Manitoba put in place a strategic framework of policies, financial incentives and digital health solutions which includes: My Health Team – virtual network of clinics (FFS and regional) and providers with the goal of addressing shared service standards such as improving access to primary care, improving quality and efficiency, increasing focus on patient-centered care, and providing seamless transitions in care. Home Clinic - a patient centered primary care clinic that serves as a patient’s home base within the health-care system and the MyHealthTeam. Provides patients with timely access to care, coordinates their health care within the health-care system, and supports comprehensive and continuous care. Comprehensive Care Management Tariffs – purpose is to support physicians in the provision of care to complex patients to promote continuity, comprehensiveness, coordination, access, and patient centered care. For care of patients 50 and over or with one or more of the following chronic diseases: diabetes, Asthma, COPD, Congestive Heart Failure, Hypertension, and Coronary Artery Disease. EMR Certification - ensures EMR products have the ability to support the strategic and operational objectives of Manitoba and end-users of Manitoba Certified EMRs. Provides a means for EMRs to reliably and securely integrate with Manitoba provincial services. Home Clinic Portal - Primary Care clinics can use this portal to register as a Home Clinic, update provider information, and upload enrolment information from the EMR. This provides a foundation for future client centric information sharing to support continuity of care.

      Finding/Results: Within only six months of implementing the CCM Tariff and going live with the Home Clinic Portal, over 70% of primary care clinics have registered as Home Clinics and over 50% of Manitoba’s population has been enrolled to a Home Clinic. . For the first time, Manitoba has a source of truth for primary care clinics and the physicians working there as well as an unambiguous record of a Manitoban’s Home Clinic and Most Responsible Provider (“family doctor”). By mid-2018 it is expected that the patient’s Home Clinic status will be available in Manitoba’s Electronic Health Record (eChart Manitoba). Home Clinic Enrolment will provide a foundation to make primary care information more widely available. It is expected that by the end of 2018, home clinics will be able to publish a patient summary to eChart, addressing key information gaps in the provincial electronic health record. Directed exchange of encounter notes between primary and secondary providers will also be facilitated, improving continuity of care.

      Conclusion/Implications/Recommendations: Rapid adoption of transformational technology would not have been possible without appropriate policies and financial incentives in place. Strong business sponsorship and vision, as well as a close working relationship between policy makers and digital health providers, are needed to introduce significant change.

      140 Character Summary: Manitoba is achieving rapid adoption of transformational change in primary care through strategic use of digital health solutions, policy, and incentives.

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      OS26.02 - IBD Dashboard: Providing Quality Care for ALL IBD Patients (ID 507)

      V. Huang, Mount Sinai Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Background: Individuals with inflammatory bowel diseases (IBD) often live remote to specialized tertiary care centers. In traditional practices, this impedes the close surveillance of symptoms, objective markers of disease (C-reactive protein (CRP), fecal calprotectin (FCP)), and optimization of therapies recommended to achieve the best health outcomes. Emerging self-management and e-Health strategies have improved medication adherence and reduced duration and severity of disease flares. Our center (University of Alberta IBD centre) developed an innovative eHealth platform, the “IBD Dashboard”, a secure, online, portal where patients can upload their self-collected data at regular intervals to provide a cross-sectional and longitudinal assessment of disease state. The IBD clinician can modify therapy accordingly in near real-time to prevent disease relapse. Objectives: To test the feasibility and impact of the IBD Dashboard for providing optimized care in a virtual environment to IBD patients based upon patient self-reported data.

      Methodology/Approach: Methods: The IBD dashboard incorporates patient reported clinical disease activity scores (Harvey Bradshaw Index, HBI, for Crohn's disease and partial Mayo (pMayo) for ulcerative colitis. Objective disease markers include C-reactive protein (CRP) and fecal calprotectin (FCP), and drug levels. Medication adherence questions are also asked. Since July 2017, physicians across Alberta invited their adult IBD patients to enroll into this study. Patients were instructed to submit clinical scores every month on the IBD dashboard, and complete a home FCP (Buhlmann IBDoc test) at baseline, 3 and 6 months. Those who had elevated FCP repeated FCP 1 and 2 months later. Feasibility questions included ease of use, impact on management decisions of the physician, patient medication adherence, and patient acceptance. Outcome measures include phone/clinic visits, ER visits, hospitalizations, clinical and objective flare events.

      Finding/Results: Results: A total of 29 patients have consented to the study thus far, including 12 (41.4%) females, and 14 (48.3%) with Crohn’s disease. The median age is 37.0 years (IQR: 32.0 to 50.0). Medication snapshot: 9 (31.0%) on 5-ASA, 2 (6.9%) on steroids, 6 (20.7%) on immunomodulators, 19 (65.5%) on biologics, and 4 (13.8%) taking no medications. A total of 21 (65.5%) have completed baseline FCP. The median FCP was 276.0 mcg/g (IQR: 64.0 to 956.0), with 11 (52.4%) having an FCP *>*250 mcg/g.. Of these patients with elevated FCP, only 5 (45.5%) reported clinical disease activity scores that were consistent with disease remission (<5 modified Harvey Bradshaw or <2 partial Mayo).

      Conclusion/Implications/Recommendations: Conclusion: Our feasibility pilot study on the use of IBD dashboard, an innovative eHealth platform, is showing near seamless integration in the routine clinical management of remote patients. It is accessible and easy to use for both physicians and patients. The high proportion of patients with elevated FCP, half of which were asymptomatic, suggests a need for close surveillance irrespective of disease activity. The study is currently ongoing recruitment of patients, and continued follow up of enrolled subjects to 6 months study end point.

      140 Character Summary: The online interactive IBD Dashboard program is a feasible, clinically useful tool that allows clinicians to optimize care for IBD patients.

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      OS26.03 - A Digital Health Roadmap for First Nations in Ontario (ID 243)

      K. Mallory, Mallory Consulting Ltd.; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: Years ago, the First Nations Panorama Deployment in Ontario (FNPDiO) project was started between Chiefs of Ontario, FNIHB Ontario Region and the Ontario Ministry of Health and Long-Term Care to support First Nations use of the Panorama Public Health Surveillance System. Time has passed and eHealth strategies and systems have changed. However, the need for effective on-reserve health information management tools and processes remains, including a strong requirement to interoperate with provincial providers, systems and data. The FNPDiO project has been renamed the First Nations Health Information Management in Ontario Project (FNHIMiO) and has had a tremendously successful year identifying, testing and validating practical digital health tools and processes with Initial Subscriber First Nations (Garden River First Nation, Oneida Nation of the Thames, KO Tribal Council, Constance Lake First Nation, Nipissing First Nation and Couchiching First Nation). At the request of Health Canada, a “Roadmap” has been developed to describe how the successful results of the project could be extended to other First Nations across the Ontario Region. This presentation describes that 3-year First Nations Digital Health Roadmap.

      Methodology/Approach: With guidance from the Initial Subscribers, FNHIMiO has developed tools and processes to support: On-reserve health centre health information management needs and priorities assessment Enhancements to privacy and security process and controls Implementation of local data systems (community EMR / EMR) Community member (patient) access to health records and electronic communication with health care providers Data exchange with Ontario’s Digital Health Immunization Repository (Panorama) Access to ConnectingOntario clinical EHR viewers These tools and processes have been tested, refined and successfully adopted by the project’s Initial Subscribers and a Roadmap has been developed to guide an extension of this digital health model to other First Nations in Ontario.

      Finding/Results: The FNHIMiO Initial Subscribers continue to refine and optimize the Roadmap tools and processes, and guide further implementation activities. Ongoing work is also underway with provincial agencies to improve integration with provincial digital health assets and strengthen patient-centric clinical workflows. Due to the success of the project’s work, other First Nations in Ontario are requesting information and/or support from the Initial Subscribers and the project team, and are being assisted to follow the Roadmap to the best of the project’s ability.

      Conclusion/Implications/Recommendations: The First Nations eHealth environment is complicated. However, experience has demonstrated that with patience, perseverance, partnerships and a focus on practical clinical requirements, progress can be made. The FNHIMiO Digital Health Roadmap represents a standardized, provincially-integrated solution that recognizes and support the specific needs of on-reserve health centres and the communities they serve. Our recommendation is for other regions to consider the Roadmap approach for supporting the digital health needs of First Nations communities.

      140 Character Summary: A practical path for advancing First Nation eHealth capacity can be found through the FNHIMiO Digital Health Roadmap.

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      OS26.04 - Mobile Maternity (MoM) a New Kind of Telehealth (ID 160)

      M. Mattei, Chronic Disease Management, Kootenay Boundary Division of Family Practice; Grand Forks/CA

      • Abstract
      • Slides

      Purpose/Objectives: Mobile Maternity (MoM), led by Dr. Shiraz Moola obstetrician and gynecologist and Jude Kornelsen of the Center for Rural Health Research, is a new type of telehealth program and a research project for which the objective is to document impacts of care provided closer to home for expecting mothers. Research documents social morbidities for women with high risk pregnancies, and their families that result from the challenges faced by rural and remote residents for who must travel to receive specialist care. (Kornelsen, J. & Grzybowski, S. 2008, Grzybowski et al 2015). MoM offers real-time telehealth obstetrical consults for elective and emergent conditions through secure mobile devices, and support for precipitous deliveries in remote sites to mitigate these challenges. The consults differ from traditional linear communication between patient and specialist, to tripartite (PCP, patient and specialist) patient care planning.

      Methodology/Approach: To bridge the gap for expecting mothers and their families, the MoM telehealth project provides mobile devices for OB/GYN specialists to connect remotely with family physicians, nurse practitioners, midwives and patients. Using mobile tablets is a key to providing the service particularly for emergent consults at any time from any site. Midwives often use the devices to connect with the specialist from the patient’s home directly making the access to speciality support instantaneous. Mobile Maternity is offered in two regions with very distinctly different patient populations – Kootenay Boundary in the interior of BC and North Vancouver Island. The service began in the Kootenay Boundary with Interior Health IT as partners and focused on piloting the use of iPads with the health authority preferred software for video conferencing Polycom Real Presence. Using the HA software also allows the specialists to connect with any site that has the common platform including emergency room carts and sites without iPads. On Vancouver Island the Telehealth team has supported the project using Microsoft Surface Pro tablets and their preferred video software Cisco Jabber. Similar to the Interior setting, physicians are able to link into any existing telehealth sites as well as those developed specifically for the MoM Project.

      Finding/Results: MoM is demonstrating that a collaborative model of care impacts patients’ outcomes not only by providing access to specialist care, but also in developing skills of the primary care providers while providing patient care closer to home. While patient volumes fluctuate across the seasons, their feedback is clear that the service is saving them cost and risk. The details of results from research data collection to be presented will demonstrate key contrasts in sites and systems, technical and clinical successes and challenges encountered.

      Conclusion/Implications/Recommendations: “The ability for women to stay in town to deliver is very important. When we have a consult conversation through telehealth, women feel like they can stay in their hometown and know that we have support,” Leah Barlow, midwife in Creston, B.C.

      140 Character Summary: Mobile Maternity offers obstetrical consults through secure mobile devices for elective, emergent, and precipitous deliveries for patients in remote locations.

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      OS26.05 - Breaking New Ground for Telehealth Programming (ID 161)

      M. Mattei, Chronic Disease Management, Kootenay Boundary Division of Family Practice; Grand Forks/CA

      • Abstract
      • Slides

      Purpose/Objectives: Telehealth is usually seen as a way to bridge the travel chasm for patients to see specialists from rural and remote communities. Interior Health and the Kootenay Boundary Division of Family Practice have collaborated in piloting telehealth in non-traditional settings involving not only patients, but also linking primary care teams with specialists.

      Methodology/Approach: These first of it’s kind in BC programs have integrated connections: - between physicians for clinical decision support from rural emergency departments to regional ICU teams and other specialists for emergent care; - providing pre-surgical screening access to anesthetists with the support of nursing or primary care teams at rural sites; - between primary care teams and specialists using in-clinic systems and mobile devices. These programs were piloted between Kootenay Boundary Regional Hospital in Trail and outlaying rural sites. Since inception, the PSS clinic service has spread to Vernon Jubilee Hospital to support patients in other parts of Interior Health. The ED/ICU concept is being considered for a provincial program as well.

      Finding/Results: Telehealth for rural areas is still a new practice for many physicians and they have at times struggled to adopt the new technology. While patients seem to be enthusiastic to have the telehealth option, they too are often reluctant to change they way they have traditionally met with their physician, especially for seniors. The core of the work completed has been to create options and ensure systems are in place for when they are needed. The systems are being adopted into practice slower than expected, but the importance of access is the emphasis of the development of the programs. Key successes are clearly linked to physician and nurse champions who enable patients to access care through the telehealth systems. Other key factors include ease of use of the technology, patient education, and relationship building between physicians themselves.

      Conclusion/Implications/Recommendations: This session will provide: - data collected through evaluation processes on the services; - sample workflows for setting up similar programming; - key lessons learned in developing unique telehealth programs; - ideal team and service supports required to implement programs.

      140 Character Summary: Interior Health and Kootenay Boundary Div. of Family Practice piloting telehealth in non-traditional ways linking patients and primary care teams to specialists.

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      OS26.06 - Virtual Emergency Support Service. Evaluation and Lessons Learned (ID 221)

      O. McKenzie, KO eHealth Telemedicine Services; Balmertown/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to “enhance support to nurses and [for] clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner.

      Methodology/Approach: The evaluation of Virtual Emergency Support services proceeds in two phases. The interim, or soft-launch evaluation, provides a snapshot of the three-month start up period beginning 16 March and ending 16 June 2017. A subsequent and final evaluation will provide a comprehensive assessment of VES process and impact measures using data gathered between 16 March and 31 December 2017. The information contained in the evaluation is drawn from four main sources. These are nursing feedback, physician feedback, service-level data, and direct engagement. A.Nursing Feedback -Nurses summarized VES encounters by filling out a record of event (NROE) -Each week, KOeHealth staff debrief with Nurses-in-Charge (NICs) at each community endpoint to capture VES event details & context -Face-to-face interviews were conducted with NICs B.Physician feedback -Seven community physicians were interviewed about the VES service model or provided written responses about their experiences/concerns -One air ambulance Transport Medicine Physician (TMP) -TMPs completed post-event surveys after VES encounters C.Service-level data -Nursing records of event (as above) -Event logging files (date, site(s), provider(s), duration) -Service Desk logs (incident type, date, duration) -Provincial air ambulance transport logs (transports per site during the soft launch period) -Federal Service Administration Logs (historical urgent/emergent events) D.Direct engagement and observation -Site visits to two First Nations -Participation at a Nurse-In-Charge (NIC) conference in Sioux Lookout, 31 May,2017 VES has been available in four Sioux Lookout Zone First Nations since 16 March 2017. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.

      Finding/Results: Clinician use of VES is increasing. Uptake in March & April was slow and has steadily increased since mid-May. After three months of service, VES was used 19 times to manage 16 urgent/emergent events. That represents about eight percent of the total medevac traffic in Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations between mid-March and mid-June. VES use by community physicians is at an early stage.

      Conclusion/Implications/Recommendations: Provider feedback and service-level data indicates that a First Nations, Federal, Provincial partnership and a relatively modest investment in information and communications technologies is transforming the delivery of essential health services. Federal nurses at four isolated points-of-care are now directly linked to provincial emergency medical management systems. VES makes multiple levels of medical expertise available on demand during urgent/emergent events. Clinicians report that VES supports nursing practice and patient care and contributes to the effective management of scarce medical evacuation and transport resources. Expansion of the service model appears to be scalable and would benefit other First Nations Nursing Stations in the region.

      140 Character Summary: VES provides information that increases the capacity to advise, triage, and support transport of community members living in northern FNs.

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