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    HS01 - Artificial Intelligence in Healthcare: Application, Research, and Leadership in Canada (Digital Health Canada Session) (ID 37)

    • Event: e-Health 2018 Virtual Meeting
    • Type: HOST Session
    • Track:
    • Presentations: 1
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    OS03 - Geography and Telehealth: It's Not Always Distance (ID 6)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS03.01 - IH Telehealth Patient Experience Project (ID 86)

      C. Von Dohren, Telehealth, Interior Health; Kelowna/CA

      • Abstract
      • Slides

      Purpose/Objectives: The purpose of this project is to evaluate the telehealth patients’ experience, to assess the quality of care we provide, and to ensure alignment with both accreditation standards and Interior Health’s five key strategies. The data gathered and analyzed from this audit is part of a strategy to support quality, safety, and standardization. The findings from this project will help to establish recommendations to improve the quality of the patient care experience, and allow for continued growth and sustainability of our Telehealth program.

      Methodology/Approach: We developed a standards based auditing tool to obtain both qualitative and quantitative data to measure the current telehealth patient experience state. The auditing tool encompasses a multitude of criteria to assess current state; the criteria is categorized into themes such as quality & safety, accessibility, privacy & security, resources, efficiency, and overall workflow. The audit will encompass a review of current documentation, staff interviews, and observations of current practices. A representative from the telehealth team will audit pre-selected acute care sites to obtain data. This data will be analyzed for each site and then compared against other sites assessed. A qualitative measure of the patient’s experience will be attributed by a global score ascertained from a five-point Likert scale. A quantitative measure will be determined from observations and open-ended questions to staff members

      Finding/Results: The results of the data collected from each site will be analyzed for compliance with Accreditation standards. The results from each site will act as a baseline of current practices and allow for comparison between sites and future audits. Discussion and evaluation of these results to identify deficiencies and an acceptable action plan to improve services to be implemented before the 2019 Telehealth Accreditation Survey. These results will further act as a catalyst to define IH Telehealth standards.

      Conclusion/Implications/Recommendations: The analysis will be disseminated to our quality control advisory committee to implement recommendations. Once change has been implemented, a subsequent audit will be performed at the same site to confirm compliance and identify problems or issues. The auditing tool developed will be utilized as part of an ongoing audit process to measure compliance and to meet the evolving Accreditation Telehealth Standards.

      140 Character Summary: Evaluate current practices against Telehealth Accreditation Standards by creating an auditing tool to identify gaps and plan for improvements.

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      OS03.02 - Enhancing Homecare in Remote and Rural Areas Through Virtual Visits (ID 63)

      S. Maley, Care and Community, Government of Yukon; Whitehorse/CA

      • Abstract
      • Slides

      Purpose/Objectives: Yukon government’s Home Care program supports individuals across the territory to live independently in their communities. Approximately one quarter of Yukon’s population live in rural or remote communities spread out over a large geographic area, and service delivery to these communities is an ongoing challenge. Whitehorse-based Community Liaison Coordinators (CLCs) coordinate care and provide direct service to clients via home visits to rural communities every 4 to 6 weeks. Home Care CLCs, with support from the Territorial Health Investment Fund (THIF) team, have initiated a trial where clients or Home Support Workers (HSWs) in rural and remote communities can meet with them via video. ‘Virtual visits’ are not intended to replace home visits, but evidence suggests that a combination of virtual visits with in-person visits can result in improved health outcomes. The objectives of the trial are to promote social inclusion and reduce feelings of social isolation for clients, and to explore how more regular contact with clients may support symptom management and avoid acute care interventions.

      Methodology/Approach: Clients or HSWs were provided with a tablet enabled with a video conferencing app connected via the cellular network. Client selection was completed by the CLCs, from an existing caseload. Enrolment was based on client need, established functional goals, and perceived ability to benefit from increased contact. Virtual visits are available during regular working hours, and scheduled weekly. Ad hoc virtual visits are also available during regular working hours if needs arise. Clients participating in the program are asked about their comfort with technology, and are assessed using the interRAI Home Care Assessment System (RAI-HC).

      Finding/Results: While the trial is still in its early stages, there have been multiple instances where client needs have been effectively addressed via virtual visits with CLCs. The technology has, in some cases, allowed rapid assessment of a client in their home, preventing a short-notice and costly face-to-face visit by a CLC. An unexpected outcome of the trial has been increased support for and involvement of HSWs in rural communities, who in some cases operate the tablets with the clients and liaise with the CLCs. Preliminary impressions of the CLCs include improved connection with their rural clients, increased support for client social interaction, and overall, a positive client experience in the use of technology. Quality of video and audio continue to be challenges for a network such as Yukon’s, where connectivity can be limited in some rural and remote areas. More positive outcomes and lessons are expected as the program continues over the following months.

      Conclusion/Implications/Recommendations: Yukon Home Care and the THIF team have demonstrated how innovative use of technology can empower clients to stay at home, and improve access to health care services for rural and remote communities, while still working within existing resources. Evaluation of the virtual visits trial will continue and is expected to inform decision-makers on possible applications, outcomes, and areas for improvement.

      140 Character Summary: Despite Yukon's remote landscape, virtual visits are improving access and care to rural clients who depend on the vital support of home care for health improvement.

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      OS03.03 - Telehealth Integration for Residents of Long Term Care (ID 298)

      K. Tulk, Long Term Care and Rural Health, Western Health; Corner Brook/CA

      • Abstract
      • Slides

      Purpose/Objectives: The primary purpose of the presentation is to demonstrate how two Regional Health Authorities in Newfoundland and Labrador utilized an evidence-based approach to Telehealth integration for residents of Long Term Care who require healthcare access to urgent and non-urgent care and services. Objectives of this presentation are to: 1. Identify current evidence to support telehealth use in Long Term Care. 2. Identify the process and benefits realized in Eastern Health RHA for telehealth integration for non-urgent care. 3. Identify the process and benefits realized in the Western Health RHA for telehealth integration for residents requiring urgent or emergency care.

      Methodology/Approach: Presentation of highlights of projects that have been developed, implemented and evaluated in the RHA associated with the integration of telehelath in the Long Term Care area for non-urgent and urgent issues that traditionally would have been provided face to face.

      Finding/Results: Use of Telehealth for non-urgent appointments: Telehealth has been integrated into the Long Term Care homes in the Eastern Health region. The process included extensive collaboration with the homes involved in the integration, with associated departments (e.g. Information Managerment) and with residents who reside in the homes and their famiy members . Residents are seen by their consultants/specialists via video, from the comfort of their long term care home with the support of their regular attendantsThis has resulted in a lowered risk to residents, and with cost savings to the health care system. Use of Telehealth for urgent/emergency care: The integration of telehealth for emergency care has been completed using the eHealth Change Management Framework. Challenges and successes have been identified. The results will be tabulated within the pilot period of 6 months. The project will result in the development of criteria and algorithm for appropriate use of telehealth for residents of long term care who require urgent/emergency care.

      Conclusion/Implications/Recommendations: The work completed in both RHAs supports the expansion of telehealth into other programs and sites throughout the regions. In Eastern Health, it supports preplanned appointments to improve access to services required for residents. Recommendations have been identified to improve further expansion: education/training program for future sites based on lessons learned, integration of appropriate technology. In Western Health, lessons learned will support expansion into other sites in the region and to other RHAs who are interested in expanding services in long term care for urgent and emergency care for residents.

      140 Character Summary: Reducing risks and increasing access to urgent and non-urgent healthcare services for older adults residing in Long Term Care homes in Newfoundland and Labrador!

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      OS03.04 - Development of a Provincial EConsult Program: The Ontario Experience (ID 492)

      R. Williams, OTN; Timmins/CA

      • Abstract
      • Slides

      Purpose/Objectives: eConsult services in Ontario have been provided by OTN and Champlain BASE (Building Access to Specialists through eConsultation) for several years. eConsult is a service that connects referring physicians and nurse practitioners to specialists, providing the opportunity to inform clinical decision making without sending the patient to see the specialist in person. Through a private and secure web page, referring providers can get an answer to a clinical question from a specialist in less than three days on average. eConsult provides access to over 10,000 referring providers and 700 specialists, including dermatology, hematology, endocrinology, and mental health.

      Methodology/Approach: In partnership, OntarioMD, OTN and Champlain BASE successfully grew eConsult from pilots to a scaled Provincial program that enables faster and improved access to specialist care. eConsult is now available in all health jurisdictions in Ontario. A comprehensive, multi-faceted project, eConsult is built on clinical modeling, business process design, technology implementation and a governance framework. This panel presentation will profile the methodologies leveraged for the provincial initiative, as well as learnings and research from clinical champions, user experiences, and details about the service model. OntarioMD has also developed a successful EMR integration with OTN eConsult which will be further enhanced to include the managed service model so that clinicians can access eConsult through both web and EMR channels.

      Finding/Results: Collaboratively, a single, blended provincial service was established to accommodate multiple models of care. As of July 31, 2017, over 55,000 eConsults were submitted using OTN’s eConsult Program, Champlain Base and OTN’s Telederm program. General practitioners indicated that, with eConsult, they continued to be able to manage 72 per cent of their cases without needing to refer patients in-person or virtually to a specialist. The average response time was 2.5 days, and often as little as a few hours.

      Conclusion/Implications/Recommendations: Elements critical to establishing a provincial eConsult program include effective collaboration of partners. With the support of the provincial government, Ontario continues to extend the reach of eConsult. Its commitment to accessibility is being driven by the proven benefits and patient and clinician acceptance of the approach. The goal is to deliver 40,000 eConsults in 2018 and 140,000 eConsults in 2021. The audience will: Learn how the different models of eConsult services will be combined into a provincial platform and service Gain insight into how to plan and deliver a comprehensive, multifaceted jurisdictional eConsult program Learn from research from clinical champions and users on performance metrics and evaluation of eConsult services and how they can be used to inform policy and funding decisions.

      140 Character Summary: Elements critical to establishing a provincial eConsult program include effective collaboration of partners. With the support of the provincial government, Ontario continues to extend the reach of eConsult. Its commitment to accessibility is being driven by the proven benefits and patient and clinician acceptance of the approach. The goal is to deliver 40,000 eConsults in 2018 and 140,000 eConsults in 2021.

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    OS09 - Changing the Health Care Delivery Landscape (ID 15)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 3
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      OS09.02 - Health Analytics Platform for Health System Transformation (ID 93)

      T. Lehtonen, Healthand Wellness, NS Government; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: In 2015, the Nova Scotia health system embarked on the significant transformational change that resulted in the consolidation of nine district health authorities to the Nova Scotia Health Authority (NSHA) and the IWK Health Center. In 2016, the Department of Health and Wellness (DHW) initiated its own transformation change with the redesign of the department. The new mandate of the DHW is providing leadership for the health system by setting the strategic policy direction, priorities and standards for the health system; ensuring appropriate access to quality care through the establishment of public funding for health services that are of high value to the population, and ensuring accountability for funding and the measuring and monitoring of health system performance. Foundational to each organization achieving their new mandate is the use of data and information to inform strategy, policy, performance, and services. Department's 2016/17 business plan reflects this change in direction and mandate by specifically calling out the focus on analytics and the use of data and evidence to plan for health services, to demonstrate progress throughout the system, and to establish future directions. The redesigned DHW established a new division as a center of excellence for data and analytics, called Investment and Decision Support (InvDS). While InvDS has invested in attracting new people with skills and competencies for analytics and advanced analytics it also recognized that the exsisting data storage and analytic technologies didn't meet the data and information needs of the health system. Currently, disparate data repositories house data from different health systems without providing a cosolidated view from the perspective of the patient or citizen; consequently, the current practice does not support comprehensive analysis at population level, either. The Department recognized that the data storage and analytic technologies in use did not meet new data and information requirements to deliver on the mandate and transformation commitments.

      Methodology/Approach: In collaboration with NS Government's ICT Services division, Health Data Analytics Platform (HAP) was designed as a comprehensive data analytics solution for meeting all the known and anticipated data management and analytics needs. Crafted according to industry leading practices and recommendations (Gartner, Canada Health Infoway) and conforming to government's Data & Analytics Blueprint and information technology strategy, HAP is a versatile platform that meets data and analytics needs of the Department and its stakeholders.

      Finding/Results: The implementation of HAP is a multi-year program, and several projects are carried out simultaneously. The approach has already proven its power to streamline, consolidate, and align fragmented workstreams and initiatives. At teachnical level, an architecture that is able to support various stakeholder groups, analytical uses, and applications while maintaining centralized governance, and role-based privacy and access control has already been demonstrated and received with enthusiasm.

      Conclusion/Implications/Recommendations: Our recommendation is taking a strategic approach to the portfolio of data & analytics initiatives, think about the big picture and strategic goals, consolidate disparate data holdings and stores, align relevant governance workstreams, standardize platforms and toolsets, and empower end users with data and information self-services.

      140 Character Summary: NS supports health system transformation by a center of excellence, empowered with a versatile data and analytics platform, self-serve analytics tools included.

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      OS09.03 - The Power and Potential of Data (ID 558)

      T. Murphy, Provincial Platforms and SPOR, Alberta Innovates; Edmonton/CA

      • Abstract
      • Slides

      Purpose/Objectives: The objectives of the Secondary Use Data Project (SUDP) were to: - Improve access to secondary use data and to make secondary use data available. - Inform and support health sector decision-making. - Support future research, development, and innovation.

      Methodology/Approach: A 3 year project was carried out to create a collaborative, province-wide solution to increase access to and use of aggregated, analyzed, and privacy-protected data for decision making, strategic planning, policy development, service delivery, care, research and innovation. Through sponsorship of 5 Demonstration Projects, the SUDP worked to decrease the time it takes to access health and social data in Alberta: - Demonstration Project 1 focused on releasing existing aggregate information about the health system in a privacy-protected format for use by researchers and the public. - Demonstration Projects 2 and 3 brought together information about the quality of care received by Albertans with chronic conditions creating balanced quality measurement sets for both Chronic Obstructive Pulmonary Disease and Diabetes. - Demonstration Project 4 examined how we use data to make decisions when we are planning for new health programs and services. - Demonstration Project 5 identified strategies and processes to support researchers and quality improvement experts to quickly gain access to social and health information required to answer important health system questions. The five demonstration projects had the following overarching objectives: - Liberate aggregate data currently unavailable to health system stakeholders and the public. - Identify, and where possible, address and/or leverage technical data integration and privacy impact assessment challenges and opportunities. - Demonstrate value of data integration producing outputs and outcomes of value to Albertans. - Contribute to the refinement of data governance roles and functions within the province of Alberta. In addition, a business case and requirements for a potential province-wide secondary use data solution were developed by the project team.

      Finding/Results: - While there is widespread support for solutions to integrate and link data, data integration and linkage efforts continue to be challenged by policy, organizational alignment, and process barriers as well as variability in how data sharing legislation is interpreted. - The cost to re-orient multiple infrastructure and analytics services to a provincially focused solution is prohibitive for many organizations, stalling collaborative planning efforts in this area. - Technologies exist to support data integration and linkage on a ‘big data’ scale e.g. privacy preserving software. - Analytics experts are difficult to recruit – this can be a barrier to creating analytics outputs even when data is available.

      Conclusion/Implications/Recommendations: - Develop a provincial roadmap for business and technical solutions that improve secondary use data access and use. - Identify and pursue data sharing opportunities that create actionable insights

      140 Character Summary: The project provides insight into the complexities of data sharing initiatives and illustrates the profound power that data has in our ever evolving health systems.

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      OS09.04 - Building Intelligence: Innovative Approaches to Product Alignment and Dashboard Delivery (ID 398)

      B. Shirazi, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Centre for Addiction and Mental Health (CAMH) provides client-centered care to a diverse population through a range of clinical, support and rehabilitation services. For reporting and accountability, this translates into a number of diverse process and outcomes measurements across the hospital, creating ambiguities in representation, prioritization, alignment and gaps in available data. The nature of this scattered reporting and nonintegrated information clutters user’s ability to develop a comprehensive understanding of available information and hinders their ability to apply it towards strategic and operational goals across CAMH. The abstract showcases how a product alignment model links clinical, operational and financial data for the purposes of actionable insights and comprehensive understanding of CAMH services and the patients.

      Methodology/Approach: The following approaches were leveraged for enhanced product alignment. Planning; The planning approach focused on targeting key audiences at different levels of the CAMH hierarchy, understanding what their data interests were and how refined reporting could support their initiatives around CAMH strategic priorities. By analyzing key questions, requirements for reporting organically appeared and there proved to be a strong desire to see a flow of data throughout the different levels of CAMH. Further engagement allowed for better understanding of multiple key drivers and performance indicators that could be grouped into reporting themes; operational, accountability and quality improvement. Dashboard Development; The dashboard development approach focused on how identified reporting themes could be used to improve the uptake and understanding of reporting. Accountability dashboards focus on balanced scorecard indicators that can help the organization stay accountable to key strategic priorities. Operations dashboards allow for leadership and management to have a view to all the data and indicators they need to support their day to day initiatives and can include clinical, human resources and financial data. Quality improvement dashboards are presented at a person or service-level and are targeted towards performance improvement projects, enabling stakeholders to monitor their progress on improvement initiatives.

      Finding/Results: As a result of product alignment, there has been greater clarity for stakeholders on where they can expect to find different kinds of information. This has led to a more active use of dashboards and reports, a more complete picture across financial, clinical and human resourcing goals and an overall enhanced user experience. Product Alignment Conceptual Framework

      Conclusion/Implications/Recommendations: Better planning and a more aligned approach will help decision makers anticipate and test the impact of their actions, estimate value of resulting outcomes, and monitor results to adjust decision making. This model has the ability to be transferable to other programs striving to improve the delivery of reporting services for the purposes of maximizing clinical outcome benefits.

      140 Character Summary: Thoughtful product alignment permits flexible autonomy in governing clinical and non-clinical reporting, allowing for maximum clinical outcome benefits.

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    OS15 - Propelling Clinical Care via Standardization (ID 24)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS15.01 - Achieving Clinical Standardization in a Regional Clinical Information System (ID 374)

      E. Nemeth, Healthtech Consultants; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Many hospitals in Ontario have been moving rather slowly in adopting clinical standards into their organizations. There seems to be a gap in the adoption of standards and best practices that can ultimately have great positive impact on the patient and on the financial stability of healthcare organizations. Since eHealth 2.0, a paradigm shift has emerged in Ontario where many organizations are collaborating and partnering in the investment of a regionalized Health Information Systems (HIS) including advanced clinical systems to support physician documentation, electronic medication administration with bedside medication verification and computerized provider order entry (CPOE). Partnerships leverages opportunities for human resource sharing, financial incentives and may even reduce costs for hardware, software and ongoing sustainability. When investing in a regionalized HIS, there is a greater necessity to support clinical standardization. Clinical standardization and the interchange of information can help facilitate early diagnosis, reduce readmissions, better manage population health, and improve the operational efficiency of patient care. Ultimately, clinical standardization will drive seamless, high-quality, and cost-effective care through cutting out extraneous costs, reducing unneeded treatment variation, and leveraging data. By using best practice guidelines and evidence in the development of standards and protocols for caregivers to follow when treating patients, it will reduce variation in treatment, improve patient care, caregiver accountability, and will increase interoperability and sharing of standardized patient information. At the end of this presentation, participants will be able to: Articulate best practices related to effective clinical engagement in a regional clinical standardization project Evaluate strategies to develop and review evidence based standardized clinical content Understand the governance model, guiding principles and decision making framework that supported the process for achieving high levels of clinical standardization in Region with 24 hospitals moving to shared clinical information system

      Methodology/Approach: Our team led a large 24 hospital regional group through a six month clinical standardization project. The project began with a two day clinical standardization workshop with clinical leadership representation from the participating organizations to determine the guiding principles, decision making framework, governance model and project deliverables. With a focus on face to face engagement of clinical subject matter experts, six clinically focused Regional Working Groups were created with an emphasis on development of standards for: Medication Management, Medical Imaging, Laboratory, CPOE, Clinical and Physician Documentation and Health Information Management. The working groups meet face to face for two full days each month for six months and remotely by teleconference to complete follow up between face to face meetings.

      Finding/Results: Over the six month timeframe the Regional Working Groups leveraged evidence based clinical standards to support the development of core clinical content standards that will be built into the shared regional HIS. Specifically the team developed and approved standards for: 118 Standardized Clinical Documentation Tools for Nursing and Allied Health 14 Medication Management Standards 13 Health Information Management Standards 5 Core Physician Documentation standard templates for admission, discharge, consultation, progress notes and floor procedures 2000 Medical Imaging Orders 1350 Laboratory Orders A comprehensive regional centralized process for the development of up to 400 standardized order sets

      Conclusion/Implications/Recommendations: The achievement of regional clinical standardization is possible with the appropriate structure and frameworks in place to support adequate clinical engagement and consensus building. Using evidence based content as a starting point can effectively streamline and speed up the process for agreeing upon clinical content standards.

      140 Character Summary: With appropriate structure and frameworks in place to support adequate clinical engagement - achieving multi-organizational clinical standards is possible.

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      OS15.02 - Emergency Physician Use of a Provinical Interoperable Electronic Health Record (ID 278)

      T. Graham, Alberta Health Services; Edmonton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Canada’s hospitals are still primarily paper-based, with only 5.2% of hospitals progressing to stage five or higher on the on the seven point Electronic Medical Record Adoption Scale. Although most hospital-based care is still documented on paper, there has been systematic investment and adoption of digital ancillary systems such as laboratory, pharmacy, and diagnostic imaging, sponsored by Canada Health Infoway. One of the Canadian strategies for digitizing healthcare has been the promotion of the interoperable EHR (iEHR), which is equivalent to the concept of a Health Information Exchange (HIE) used in other jurisdictions. iEHRs are being developed by each province as part of the wider Canadian initiative to connect healthcare nationally. In 2017, over 51,000 physicians, nurses, pharmacists and other Alberta healthcare providers have role-based access to the Alberta Netcare Portal (ANP), with more than 1.9 million patient records accessed monthly. Objective: Many Canadian provinces use interoperable Electronic Health Records (iEHRs) to facilitate Health Information Exchange (HIE). Our study describes the use and utility of a provincial iEHR called the Alberta Netcare Portal (ANP) in four urban Alberta emergency departments (EDs).

      Methodology/Approach: Four EDs were included in the study, two in Edmonton Zone (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and two in the Calgary Zone (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]) between October 2014 and March 2016. The UAH and FMC are comparable large, academic tertiary care facilities and the GNCH and PLC are comparable community hospitals. The average annual number of ED visits between 2012-2016 for each of these hospitals was 66,003 (UAH), 67,3007 (GNCH), 80,466 (FMC) and 79,172 (PLC). A mix of direct clinical observations, examination of system audit logs and inteviews were carried out over the study period.

      Finding/Results: Over 566 hours of observation, the median percentage of observed time spent using ANP for UAH was 9.1%. This was substantially higher than the median percentage of time spent using ANP at GNCH (4.8%), FLC (5.0%), and PLC (5.3%). Audit logs were compared to the structured observations to check for correlation. Audit log access data showed that laboratory and imaging data were accessed most often. Physicians were observed spending relatively more time reviewing textual reports (4.6%, CI 4.1-5.1) than lab results (2.6%, CI 2.1-3.1) or diagnostic imaging (1.9%, CI 1.6-2.1). These patterns of access were consistent across the four sites (p = n.s.). The main themes that emerged from the analysis were: participant perceptions that ANP improved quality and continuity of care and patient safety; that there were notable barriers to use, particularly in the Edmonton Zone; and ANP’s unrealized potential.

      Conclusion/Implications/Recommendations: To our knowledge, there have been no prior Canadian studies describing the use and utility of an iEHR in the ED or any other clinical setting. Physicians described high utility and usability of ANP. The ANP was utilized less frequently in Calgary EDs, where they were able to access much of the ANP information in their regional CIS, and as CIS implementations increase across the country the role of separate provincial iEHR’s needs further evaluation.

      140 Character Summary: Using mixed methods, we describe the high use and utility of the Alberta's provincial interoperatble Electronic Health Record in four urban Emergency Departments.

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      OS15.03 - Policies, Guidelines, and Standards for Ambient Assisted Living Data Exchange (ID 273)

      L. Fadrique, School of Public Health and Health Systems, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: The primary objective of this study was to understand what Ambient Assisted Living (AAL) technology companies are using as policy guidelines and standards in the creation of their products and services. Ultimately, this study will highlight the gap between what is currently available for innovators in terms of data security, privacy and encryption, and what should be developed to ensure that AAL technology is designed ensuring benefits to patients and the healthcare system through safe technologies. The long-term goal of this project is the development of requirements for an infrastructure to enable IoT, mHealth, and wearable data integration, focusing on describing the design, data exchange requirements, policy and governance guidelines, and general standards for implementing this infrastructure.

      Methodology/Approach: This study will explore human factors methods (user-centered design) to guide the development of standards and the data sharing infrastructure. The project is divided into the following phases: 1. Review the existing ALL technology literature and technology market in Canada. 2. Interview key policymakers, innovators, researchers, stakeholders, and leaders in the AAL landscape to support the development of policy governance guidelines, standards, and identifying the requirements of a data integration infrastructure for AAL technology. 3. Use ethnographic and UCD methods focusing on gathering key stakeholders' perspective on the issue.

      Finding/Results: In this study, we will identify existing standards and guidelines that are currently used to guide the development of AAL and IoT technologies by the current technology industry. This study will lead to recommendations for standards to be created to support innovators in the development of AAL in Canada. The guidelines and standards will focus on security, privacy, and encryption around data sharing from wearable, IoT, and AAL technology. In parallel, we will initiate the development of an AAL data exchange infrastructure modelling that will identify: (1) the data sharing requirements for such platform, (2) how we could develop this platform in the upcoming years, and (3) the necessary infrastructure needed to collect and aggregate this data from IoT and wearable technology. Ultimately, we would establish a platform to centralize AAL, IoT, mHealth, and wearable data for population-level and remote patient monitoring.

      Conclusion/Implications/Recommendations: IoT and AAL technologies are here to help and support the aging population in Canada. These technologies enable continuous and unobtrusive data collection at home, empowering the healthcare system to monitor patients remotely. Sharing this data will be relevant for the development of precision medicine models and aging related health research. In this project, we aim at developing a better understanding of how we can make Canada a leader in the IoT+ mHealth data integration by creating a roadmap for the development of this data-sharing infrastructure and the affiliated standards to guide the process while ensuring data encryption, security and privacy are kept in mind.

      140 Character Summary: Explore how Ambient Assisted Living technologies share data generated by sensors, suggesting future policies, guidelines, and standards to support innovators.

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      OS15.04 - Clinical Standardization: Advancing Mental Health Care in a HIS Cluster (ID 366)

      J. Borg, Waypoint Centre for Mental Health Care; Penetanguishene/CA
      S. Riahi, Ontario Shores; Whitby/CA

      • Abstract
      • Slides

      Purpose/Objectives: Building on the demonstrated significant clinical and financial benefit realization following the adoption of an advanced HIS, Hospital X has partnered with Hospital Y and Z, to implement an advanced integrated HIS, putting the infrastructure in place that will support creating a strategy towards clinical adoption and standardization, the streamlining and centralization of data, enable advanced decision support, data analytics capabilities, and inform quality improvement in the mental health and addictions sector. Objectives: -Drive quality improvement by reducing unnecessary variability in care across the three hospitals through the implementation of standardized clinical practices -Contribute to the provincial HIS body of knowledge through the development of a repository of standardized clinical documentation including standardized order sets; an implementation toolkit for mental health quality standards; shared governance models; and change management tools -Enable improved use of data for clinical decision-making, care coordination and monitoring patient outcomes.

      Methodology/Approach: Aligned with the Ontario HIS renewal strategy, the creation of a shared vision for the partnership was established. A shared governance agreement between the three mental health hospitals was developed to drive clinical standardization and improve HIS service delivery. Standardization principles were established to help guide the clinical working groups through the standardization of clinical practice and documentation. An intense review of services and related documentation was completed in order to establish a mutually agreed upon standardized repository of assessments, order sets and other clinical documentation and evidence based best practices. This included leveraging on the work completed by Health Quality Ontario around the development of quality standards for mental health care for the behavioural symptoms of dementia, major depression, and schizophrenia. Where an agreement could not be reached, decision documents were utilized to capture non-standardized practices with a future plan to re-visit the standardization discussion.

      Finding/Results: In alignment with the Auditor General’s recent report and recommendations and the Ontario HIS renewal strategy, the collaboration is standardizing the following key clinical processes: -admission process to ensure comprehensive intake assessments are completed that include the identification of risk factors through the implementation of standardized, auditable admission processes and documentation -transitions in care and discharge planning through the review and standardization of discharge related processes -care planning including the integration of quality standards and mental health clinical assessment protocols. -falls -choking -restraint and seclusion practices The aim is that the resultant work will contribute to a standardized repository of evidence based assessments and practices that can be adopted across the mental healthcare spectrum and thus contribute to a more comprehensive, integrated patient experience. This will also help to inform benchmarking across the mental health hospitals. The governance model, measuring clinical standardization process and results, and lessons learned will be shared.-

      Conclusion/Implications/Recommendations: The formation of a mental health HIS cluster provides the opportunity to build capacity and capability to support an improved, integrated mental health system. Through collaboration, an evidence-based approach to standardized mental health practices that enables clinical decision support, data analytics and measureable health outcomes can be delivered. Moreover, the HIS collaboration will ensure the delivery of consistent, integrated quality mental health services that optimizes the patient experience and improves patient outcomes.

      140 Character Summary: The MOHLTC has identified building a foundation to support a system transformation of mental health and addiction services and the HIS renewal strategy in Ontario as a key priority. With this objective in mind, three mental health hospitals have formed a HIS cluster to implement clinical standardization through a shared HIS. This collaboration puts the infrastructure in place to support the creation of a repository of standardized, evidence based clinical assessments, the streamlining and centralization of data to support advanced data analytics and clinical decision support capabilities, and meet data reporting requirements while informing quality improvement in the mental health sector.

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    OS20 - Patient Connectivity Goes Mainstream (ID 32)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 4
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      OS20.01 - The Secret is Out: Achieving High Patient Portal Adoption (ID 177)

      S. Brudnicki, UHN Digital, University Health Network; Toronto/CA
      D. Wiljer, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: New patient portal implementations aimed to give patients access to their own electronic health record, along with added functions, achieve average adoption rates of 5-10%. This session will reveal secrets of our success in achieving and sustaining high adoption rates of 49%.

      Methodology/Approach: Our Patient Portal is a Web-based solution that enables patients with real-time access to their personal health record so they can be informed partners in their care. Patients are able to see their appointments and receive appointment reminders; see lab results with links to patient education; see clinical documentation, such as assessments, discharge summaries, clinic notes, and reports (including sensitive information such as mental health notes and pathology reports); share their health information with others; and find programs, clinic information and patient education resources. Our Patient Portal was first made available to early adopter clinics in May 2015, and expanded to the rest of the organization in January 2017. Approaches to achieving and sustaining high adoption rates will be discussed. This includes meeting the needs and priorities of patients and their caregivers; strategic alignment; organizational change management; patient and staff engagement; and gaining public support.

      Finding/Results: Patients told us that they want and need access to their online medical records and health data to become informed partners in care. Patient sign-ups soared from 3,100 to 30,000+ within nine months of portal expansion. Adoption rates of 49% have been sustained for over two years. 84% of monthly log-ins are returning visitors. 53% of unique visitors log in 2-10 times per month.

      Conclusion/Implications/Recommendations: Despite initial clinician reluctance to give patients real-time access to their personal health record, our organization put needs and priorities of patients and their caregivers first! A solid patient and staff engagement framework are necessary when planning, designing and delivering an enterprise Patient Portal in order to achieve and sustain high adoption rates. This includes meeting patient, caregiver and staff needs; and addressing challenges and concerns. As part of large-scale organizational culture change, processes need to be well-integrated into clinical care and at point-of-care. This includes administrative staff engagement with patients as part of patient check-in, admitting and registration; along with education and support for the multi-disciplinary team of physicians and health professions.

      140 Character Summary: This session will reveal secrets of our success in achieving and sustaining high adoption rates of 49% for a new patient portal implementation.

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      OS20.02 - BC Cancer Agency: Online Art Therapy Groups (ID 329)

      S. Prins, BC Cancer Agency, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Art therapy allows patients the opportunity to express themselves in a new way. It is also an intervention that patients find relaxing and empowering, and it may even alleviate symptoms that cancer patients experience. Working in a busy cancer centre, finding space to host art therapy sessions is a challenge. Cancer patients may not be able to attend support groups as they may live in rural areas, lack energy, or not want to access support from a cancer centre. CancerChatCanada.ca provides an online platform for hosting art therapy groups. These groups bring participants from across the country together to receive emotional support.

      Methodology/Approach: In 2012, BC Cancer Agency (BCCA) began collaborating with art therapists with expertise in digital art therapy across Canada. Together they began experimenting with different methods for creating art and meeting online. BCCA created an online platform for online groups called CancerChatCanada, which provided a forum for groups to meet online in a secure chat room, where participants would discuss the art that they had created. In 2013, a pilot group of international art therapists and health care professionals piloted BCCA’s first online art therapy group for young adults with cancer. From there, BCCA began hosting art therapy groups on CancerChatCanada (now CancerChatCanada at de Souza Institute.) Each group consists of 10 weekly sessions with an art assignment given each week. Participants create their art work with whatever tools they have available (including online art-making programs), then submit photographs of their work. Photos are compiled and sent in a document to the group members and the art therapist facilitates a discussion of the art while in the chat room.

      Finding/Results: From 2015-2017, five art therapy groups took place on CancerChatCanada, and plans are to continue running two 10-week groups per year. The presentation at e-health will also review findings of patient satisfaction surveys and program evaluation data. Participants in the online art therapy group bond quickly. Many have shared how grateful they are for the opportunity to participate in an art therapy group (since they live in a rural area) and meet others who share this experience. One participant stated, “While art therapy was outside of the box for me, it was successful in creating an important connection to other people with cancer. The discussions generated by the projects helped to address real fears, frustrations and questions that were common to all of us. The resulting moral support was invaluable.”

      Conclusion/Implications/Recommendations: Art therapy is an effective form of support for people with cancer. However, art therapists are challenged to find spaces to work in health care centres, and many cancer patients have difficulty accessing face-to-face support services. CancerChatCanada is an innovative and effective way to provide art therapy services to cancer patients across the country.

      140 Character Summary: Art therapy groups for cancer patients hosted in chatrooms

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      • Abstract
      • Slides

      Purpose/Objectives: When Ontario’s largest Children’s Treatment Centre was faced with the unprecedented opportunity to create three new purpose build facilities, they were enfranchised simultaneously with a new horizon of both possibilities and challenges. The ambit of technology in these buildings far exceeded anything the organization previously had access to, and the opportunities for transforming service delivery were staggering. However, equally humbling was the requisite level of change for staff, and workflow re-engineering, in order to harness the full potential of these advancements.

      Methodology/Approach: Of the design and implementation approaches that were familiar to the organization, many were simply impossible given the interdependence between the new technology and the design of the physical spaces. The seamless integration of technology within the yet-to-be built facilities, meant that small scale experiments were often impossible to recreate in existing spaces for the purpose of running small tests of change or pilot studies that could inform broad scale process change. For the same reasons, it was not feasible to introduce the changes to a select group of staff who could act as early adopters, providing support to their colleagues when organization-wide change was later implemented. Additionally, a phased approach to the implementation of technology was also unworkable given the move to the new facilities had a remarkably short transition time for staff. Operational requirements for client service necessitated that the existing 10 sites would remain fully functional until they simultaneously closed on the same day, and the 3 new buildings were all fully occupied by staff 3 days later. This condensed transition period did not allow for an approach where both old and new processes could run in parallel, with groups of staff gradually transitioning over to the new way of functioning; each group benefitting from the experiences of the previously transitioned group. Forced to consider new and different approaches, the organization undertook a journey within the constraints of the physical move to successfully transition to the new technologies and accompanying workflows.

      Finding/Results: The approaches employed were rooted in LEAN principles, with a particular emphasis on leveraging the knowledge and expertise of front line staff. Collaboration between the staff who had experience with our client population and the vendors introducing the technology were able to collectively design systems that would meet the needs of both our staff, and their clients and families. Testing and validation of these systems was of course a challenge for the reasons described above, so once again innovative approaches, based on LEAN methodology were relied upon to develop ‘low-tech’ simulations to help prepare staff in the existing environments. Underpinning the focus on clients, staff, and workflow was a leadership approach that fully engaged the entire executive team for the 4 year venture of operational readiness planning.

      Conclusion/Implications/Recommendations: This presentation describes the learnings that were acquired throughout this project and the synergistic elements that supported this success.

      140 Character Summary: The move into fully accessible, technologically advanced facilities has brought a new horizon of possibilities to Ontario's largest Children's Treatment Centre.

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      OS20.04 - Engaged Patients Are Driving Healthcare Innovation and Efficiency (ID 453)

      A. Arsenault, TELUS Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Almost 50 percent of provincial budgets are now consumed by healthcare, with 30 percent of health system resources going to 12 percent of the population. How can healthcare respond to spiraling costs, especially high for a small number of chronically ill patients? The answer lies in patients themselves and their demand for the digital health technologies that will deliver dramatically more efficient care for all Canadians. Global leaders believe empowered patients create better value care. In fact, research tells us that patients who are less engaged cost the health system between 8 and 21 percent more than those who are engaged. Fortunately, patients today are playing a more active role in their own healthcare than ever before. Access to personal health management tools and information are motivating people to be more proactive about their health and wellness goals. In a world where the ubiquity of the Internet and powerful smart phones are transforming business models and entire industries, personal health technologies can empower people to access and manage their health information anywhere, anytime. This presentation will illustrate how the demand for personal health technologies is driving better health management – and better health.

      Methodology/Approach: Citizens are looking at ways to be part of the healthcare decision-making process, communicate electronically with their care provider and access their results anytime from any location. As a result, personal health technologies such as patient portals, Personal Health Records, virtual care tools and health monitoring solutions are now widely available. Patient self-management and engagement are having remarkable effects on health outcomes and costs. This presentation will present stories and results from personal health technology implementations across Canada.

      Finding/Results: Better access to patient health information, particularly for patients with chronic diseases or those located in remote areas, is proving to reduce healthcare system costs, increase patient satisfaction and improve overall population health. In addition to significantly reducing medical travel for patients and providers, we’ve seen that personal health technologies are reducing hospital admissions by 71 percent and ER visits by 43 percent, resulting in a significant cost savings per patient. We will provide results from a range of patient engagement implementations across Canada.

      Conclusion/Implications/Recommendations: Providing digital health tools that engage patients to play a central role in their own health ultimately drives better health outcomes at lower cost for all Canadians.

      140 Character Summary: Patient demand for personal health technologies is driving better health management – and better health.

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    OS28 - Bringing Mental Health to the Forefront (ID 46)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS28.05 - A Smart Homes Concept for an Inpatient Psychiatric Population (ID 254)

      C. Forchuk, Parkwood Institute; London/CA

      • Abstract
      • Slides

      Purpose/Objectives: The objective of this exploratory pilot study is to gain insight into the use of smart technologies for individuals with mental illness living in transitional hospital apartments. This pilot study, planned after a successful previous trial by Corring, Campbell and Rudnick (2012), is currently examining the feasibility of implementing a smart homes intervention for participants with mental illness and to determine if further modifications are needed prior to wide-scale community deployment in the homes of discharged participants. The innovative use of technology may be one such strategy in increasing the communication between clients and health care providers. In addition, it was hypothesized that the intervention will assist participants nearing discharge into the community with greater support for successful integration by facilitating independence and improving self-reported health outcomes.

      Methodology/Approach: Up to 20 participants (aged 18-85) who are inpatients at either Parkwood Institute or Southwest Centre for Forensic Mental Health Care and meet inclusion criteria will be recruited. Participants will be provided with screen devices such as smartphones, tablets and smart mirrors that can provide video-conferencing capabilities and send questionnaires to their health care providers through the Collaborative Health Record program. These smart technologies will be linked with the Lawson Integrated DataBase which is programmed to transmit prompts and reminders to coincide with the participants’ care plans. Health adjunct Bluetooth-enabled monitors such as blood pressure monitors, heart rate monitors, weigh scales, glucometers, medication dispensers, and sensor floor mats will also be available. Participants are allowed to select their preferred screen devices and health adjunct monitors based on their health needs. The research team will use a mixed-methods (quantitative & qualitative) design to assess the feasibility of the technology, as well as the perceptions and health of the participants. Upon a one week minimum stay in the apartment, participants will complete a semi-structured interview with research staff. This will be followed up with a 6-month interview post-discharge. Furthermore, focus groups will be conducted with hospital staff to further evaluate the feasibility of the smart technologies.

      Finding/Results: The quantitative results from the participant interviews and the qualitative findings from staff focus groups will be discussed. Quantitative findings will include an analysis of the Perception of Smart Technology tool, the Housing History Survey Form, the Community Integration Questionnaire, the EQ-5D Health Utilities Index, Short Form-36, and the Health, Social, Justice Service Use Questionnaire. Thematic analysis will be used for open-ended questions and focus group discussions.

      Conclusion/Implications/Recommendations: This pilot study is being conducted to assess the feasibility of using smart technology within an inpatient hospital setting for individuals with mental illness. It is envisaged that this pilot study will provide information to enhance the intervention before wider-scale adoption of the technology in the community. The implications of this study could inform health policy and decision makers to adopt more smart technologies into mental health care and/or treatment plans. Long term implications could include being able to effectively serve more individuals with mental illness, and prevent homelessness and criminalization of the population under study.

      140 Character Summary: A pilot study investigating the use of smart technologies in providing support to individuals with mental illness living in transitional hospital apartments.

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      OS28.02 - Physician Adoption of Standardized Order Sets and Electronic Order Entry (ID 106)

      I. Gladding, Quality, Trillium Health Partners; Mississauga/CA

      • Abstract
      • Slides

      Purpose/Objectives: Prescription errors and unexplained prescriber variation within hospital practice greatly contributes to adverse drug events that lead to potential safety incidents. Patient safety initiatives at other institutions prioritized reducing these occurrences and out of these initiatives, electronic-order entry has demonstrated a significantly decrease adverse drug events. The multi-site structure of Trillium Health Partners (THP) fosters different physician cultures, practices and protocols between sites. Standardization of physician order sets across the three locations will decrease prescriber variation and provide a standardized patient experience. The Clinical Order Sets, Technology and Standardization (COTS) project aims to harmonize order sets and embed these in an electronic-order application while promoting physician adoption of the new electronic system.

      Methodology/Approach: Standardized order sets were developed from best-practice literature/guidelines and follow Quality Based Procedures (QBPs) and Quality Standards where applicable. Approval was obtained from a multidisciplinary team of physicians, clinical educators, pharmacists, and nurses to ensure applicability. All order sets were approved at an organized Order Set Committee. The Mental Health Program was identified as an early adopter group to implement the use of the order set technology platform on their units. Forty-six physician pre- and post-implementation surveys were completed to identify demographics and any barriers related to technology uptake. Parameters such as user demographics, attitudes towards harmonized orders and towards electronic entry were assessed. Technology uptake and application usage data were also analyzed. Findings were used to identify barriers and enablers in adopting standardized electronic order entry.

      Finding/Results: Gender, awareness of QBPs, and computer proficiency impacted the uptake of standardized electronic order entry, while a physician’s duration within their current position had little effect. Clinicians recognized that harmonized orders improved decision-making whereas their attitudes regarding harmonized orders improving patient safety were unclear. EntryPoint uptake and patient safety incidents may be monitored long term.

      Conclusion/Implications/Recommendations: Findings offered insight into perspectives around change management and standardized electronic order entry. A robust change management plan has been developed to promote clinician utilization of only order entry thought user-acceptance testing, hands-on demonstration, in-time training, and peer-to-peer education. Process mapping sessions are being completed to embed newly acquired hardware into clinician practice. Attitudes from physicians in different programs will be aggregated over the next seven months as the system becomes available throughout THP.

      140 Character Summary: Physician usage of standardized electronic-orders and attitudes towards their implementation was analyzed to promote uptake across multiple sites.

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      OS28.03 - Global Experiences in Building Cognitive Digital Health Systems (ID 317)

      D. Gordon, GBS, IBM Canada; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Digital and cognitive care has the potential to contribute to better and safer care of patients, more effective health providers as well as to the sustainability of health systems world-wide. With increasing digitization of the healthcare world, cognitive systems help organizations unlock new opportunities. In a recent Institute of Business Value study, 4 out of 5 healthcare executives believe that cognitive computing will have a critical impact on the future of their healthcare business and even more intend to invest in cognitive capabilities (IBM IBV, 2016). But what is a Cognitive Digital Health System and how are organizations getting started on these journeys? We will define Cognitive digital healthcare with an example of how cognitive care got started in the mental health domain and provide guidance for organizations wanting to begin their own cognitive journey.

      Methodology/Approach: Cognitive platforms are designed to ingest vast quantities of structured and unstructured information — from numbers and text to audio, video, images and other data. With an increasing volume and velocity of data, cognitive solutions focus on assembling new kinds of data in machine readable forms and on curating information identifying new patterns and insights to accelerate discoveries, treatments and insight. Various cognitive tools and methodologies are proving useful in digital healthcare, including virtual agents, natural language understanding, advanced analytics for risk scoring and predictive modelling and Internet of Things functionality. For example, the IBM #Here4U team with mental health as focus area developed the #Here4U virtual agent for youth in need of support, aiming to reduce bullying, anxiety and addiction with preventative analysis and intervention through digital personal connection that’s available anytime, anywhere. The virtual agent is a set of cognitive technologies, including a conversation agent that responds to text-chats, natural language processing, machine learning and training by identifing presenting issues such as stress, anxiety and depression. After this successful experiment, the team applied the same foundation to build virtual agents for PTSD and for employee mental health support.

      Finding/Results: The team successfully built a mental health virtual agent proof of concept utilizing a cognitively trained chatbot to detect presenting issues. The team then reused the underlying cognitive components and data structures to build other mental health virtual agent solutions An effective approach to understanding cognitive in digital health systems is to create a cognitive program and then fund a series of use cases in a learning environment.

      Conclusion/Implications/Recommendations: Cognitive technologies are so new that cognitive strategies are journeys into the unknown. Unlike traditional technologies, cognitive programs must be designed to explore different linked use cases, iterate, experiment with sets of technologies and pivot in different directions as circumstances, benefits and adoption becomes clearer. Digital Hospitals are complex ecosystems with hundreds of clinical and business processes containing thousands of sub-processes. Cognitive solutions will not be standalone, identifiable applications, but will be capabilities that are embedded through the digital hospital fabric to seamlessly unite patients, clinicians, staff, assets and information throughout the hospital, delivering the right information and resources at point of care at the right time.

      140 Character Summary: An effective approach to Cognitive digital health systems is to create a cognitive learning program and then experiment with use cases built on a common foundation.

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      OS28.04 - Telemedicine and Its Growing Usage (ID 137)

      S. Gulati, Forensic, Secure Treatment Unit; Brockville/CA

      • Abstract
      • Slides

      Purpose/Objectives: To demonstate the adoption, applicability and benefits of using telemedicine.The intended outcomes were to prove an improvement in the accessibility and timelines of specialized mental health services for patients at the receiving institution, improving clinical outcomes for the recepients of the service and to reduce costs associated with the provision of mental health service.

      Methodology/Approach: We piloted the use of telemedine in a correctional setting over a 12 month period. The clinic was held once weekly with a mean of four clinics or sixteen hours per month. Pre and post case discussions were facilitated with staff in addition to seeing the patient. Inclusion and exclusion criteria were applied. Patients were seen following screening done by in reach staff at the correctional institute. Patients referred included, male or female, adult or Youth offenders with documented or suspected serious mental disorders in need of assessment and/or treatment. Treatment was provided in the form of Pharmacological and Psychological interventions.

      Finding/Results: We found that there was an increased level of understanding of the criminal justice system and the inmate population. Appropriate and efficient use of the inpatient hospital beds with some referrals being initiated, some being averted and others being expedited for clinical reasons. From the receiving institution point of view, patients expressed satisfaction and comfort using Telemdicine. Enhanced access to specialist service was reported through decreased wait time, timely follow up, reduction in wait time for urgent assessments for those on suicide watch.

      Conclusion/Implications/Recommendations: The improvement in the services and mutual satsfaction between the service provider and the receiving institution in addition to improved outcomes have resulted in more contracts being awarded. We are now a dedicated service in the province of Ontario who are providing service to at least six correctional institutions many of which are remote. Some of these institutions have had very little Mental Health Support over the years. The team has a team of Physicians who are supported by excellent staff from the Learning and Development team who coordinate and ensure the smooth running of the clinics.

      140 Character Summary: The rise of the machines: Telemedicine allows timely access to care with reduction in costs and inconvenience associated in providing in person care.

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      OS28.01 - Development of Mental Health Reporting Framework (ID 530)

      R. Comrie, Reporting and Analytics, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: This presentation will focus on the development of a robust enterprise wide reporting framework to support organizations strategic, operational and quality improvement plan.

      Methodology/Approach: A meaningful reporting project was launched with a goal of streamlining reporting; establish measurement standards and definitions; reducing number of and variation in reports and facilitating single source of truth for enterprise data. This multi-phased project included conducting an in-depth current state analysis exercise to understand the measurement, reporting and analytics needs and activities of CAMH. Following the current state analysis, a gap analysis exercise was conducted to identify reporting efficiencies, opportunities for product alignment and unmet reporting needs. Recommendations from the gap analysis exercise resulted in formation of an enterprise reporting framework comprising of report mapping by audience, frequency and business intelligence product alignment.

      Finding/Results: First year of reporting framework implementation resulted in the following: Governance structure: A Data and Reporting Governance Committee was established to provide CAMH-wide leadership and oversight for data quality assurance, measurement and reporting priorities, and alignment of reporting across CAMH. Two sub-committees were also created to specifically focus on internal measurement and reporting; enterprise data quality. Centralized Intake process: A centralized intake process was established to ensure a standardized method is followed for anyone requesting reports from the Reporting and Analytics department ehealth pho.png Figure1. Centralized Intake Process of Reports Annual measurement plan: Annual measurement & reporting plans are being developed for priority areas as per the operational and quality improvement plan Reporting products to aid in data driven decision making: The Corporate Balance Scorecard, Clinical Programs and Key Priorities Dashboard were developed to measure organization wide performance against mission, vision and quality improvement priorities. Noticeable improvements post balanced scorecard implementation included: Significant increase in medication reconciliation completion rate at discharge. In 17-18-Q1 the rate was 4% above target at 77%. 17% increase from16-17-Q4. ehealth photo 2.png Figure 2. Medication reconciliation discharge rate over time

      Conclusion/Implications/Recommendations: Development of the centralized intake process for reporting, enterprise reporting framework has improved customer service by increasing quality, efficiency and efficacy of reports generated at CAMH. It has enables the organization to move towards data driven decision making and quality improvement initiatives.

      140 Character Summary: This abstract outlines the development and implementation of a Mental Health Reporting Framework that supports the organizations strategic goals.

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      OS28.06 - Insights to Impact: Helping Organizations Use Data for Business Improvements (ID 472)

      J. Au, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Centre for Addiction and Mental Health (CAMH) provides high quality and client-centered care to meet the needs of people facing addiction and mental health challenges. To support these diverse clinical services, CAMH established a Reporting Framework to create a single source of truth for clinical, finance and workforce reporting. iManage is the self-serve management reporting tool that informs and enhances planning, decision making and performance improvement. The purpose of this abstract is to showcase how the development of Key Performance Indicators (KPIs), through stakeholder engagement, led to the active use of iManage and the ability to transform lives through data.

      Methodology/Approach: The CAMH Business Intelligence (BI) team leveraged iManage, an enterprise reporing portal, in order to develop a “Suicide Risk Assessment (SRA) Dashboard” that includes a series of KPIs to provide managers and clinical teams with important information related to suicide risk assessment and clinical best practices. There were two critical steps used to implement KPIs: stakeholder mapping and business requirements gathering. The first step to building effective KPIs is to understand the targeted audience. The BI team, employing the knowledge of data usage in CAMH by clinical staff, mapped all potential users of an SRA dashboard. All users were later refined into a single user group. The second step in this approach was to understand which KPIs would provide the most value and benefit to the user group. With the support of the applications and clinical teams, the BI team was able to map out key suicide risk pathways and responsibilities. For example, patients who are assessed as high risk should be monitored more closely than those identified as moderate risk. The user group was leveraged to identify the step by step patient journey and the areas along the pathway that should be measured and monitored. These focus points were then prioritized and appropriately developed into KPIs.

      Finding/Results: Significant stakeholder engagement allowed the SRA dashboard to be developed with a number of distinct views, each representing a different focus area from the business focus group. The dashboard series contained an overarching performance summary dashboard, as well as requirement specific dashboards focusing on; assessment compliance, care plan compliance, continuous observation orders and incidents. The SRA dashboards are actively used by CAMH stakeholders to provide a weekly lens to monitor improvements and observe care planning on current clients, as well as noticing any trends from previous week’s data. The development of the SRA Dashboard and the availability of rich data drove SRA Completion rates up from 82% in August 2015 to 95% by August 2016.

      Conclusion/Implications/Recommendations: Through effective stakeholder mapping and business requirement gathering, the BI team was able to build the correct KPIs for an enterprise SRA dashboard. This in turn led to the use of KPIs in iManage to create business improvement initiatives. The principles applied in this model should be considered for future data projects, in order to enhance engagement and improve clinical outcomes.

      140 Character Summary: Effective development and evaluation of key performance indicators allows for optimal data adoption and application for the benefit of improved patient outcomes.

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