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    HS02 - A Conversation with CIHI about Modernizing Canada’s Data Supply and Access (CIHI Session) (ID 39)

    • Event: e-Health 2018 Virtual Meeting
    • Type: HOST Session
    • Track:
    • Presentations: 3
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    OS04 - Communication Redefined for Better Care Outcomes (ID 7)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS04.01 - How Unified Communication Improves Patient Care and Safety (ID 628)

      A. Masood, Vocera Communications, Inc.; San Jose/US

      • Abstract
      • Slides

      Purpose/Objectives: Hospital communication has become exceedingly complex with multiple and disparate systems. Too often, physiological monitors, beds, IV pumps, ventilators, and other systems sound alarms or send messages to clinical staff that are not actionable. As a result, care team members often suffer from alarm fatigue and become immune sounds and alerts from these systems, which can have serious consequences. In addition, hospitalized patients are also fatigued by the incessant sound of alarms, which often disrupt their sleep and makes them and their family members feel anxious. The impact this noise has on patient, family and staff well-being has accelerated the need to understand alarms, how often they occur, how they are responded to, and how to manage them safely and efficiently. Being able to connect the right people with the right information quickly is critical to delivering safe patient care in a quiet, healing environment.

      Methodology/Approach: William Osler Health System implemented an intelligent alarm management solution to improve patient care, safety and experience across three sites. With the solution, alerts and alarms are automatically sent to the right care team member(s) based on workflow and escalation rules defined in the system. Clinicians can easily distinguish between alarms from multiple sources and different criticalities based on the audio and visual information sent directly to their device of choice – whether it’s a smartphone, laptop or workstation. The solution enables them to quickly prioritize alarms and respond appropriately. All alarm events and responses are date and time stamped and logged in real time, providing robust data and an audit trail to identify potential gaps in communication and processes. Analytics from the solution helps hospital leaders understand alarm trends per bed, unit, staff, alarm type, alarm density, distribution and response times. This data allows refinement of alarm filtering and escalation to reduce alarm fatigue, improve patient safety and enhance care team efficiency.

      Finding/Results: Integration of the alarm management solution with clinical systems such as the EHR, nurse call system, and physiological monitors has streamlined workflows and minimized the complexity of managing multiple systems and vendors. One of the most impactful alerts set up connects the communication system to a point-of-care decision-support application. The software monitors patient data gathered from the EHR system, looking for early signs of a developing infection. When the system detects early warning signs of sepsis, it automatically sends an alarm to the appropriate nurse on his or her device of choice. With early warning, hospital staff can act immediately to accelerate treatment and improve patient outcomes. These workflow integrations and intelligent codes have helped decrease code blue events and ICU transfers. Clinicians have also noted a decrease in mortality rates.

      Conclusion/Implications/Recommendations: In integrated approach to communication and alarm management is key to reducing alarm or interruption fatigue, increase staff response times, and improve the healthcare experience. Mobile healthcare technology that is fully integrated to workflows and with clinically relevant patient data can also lead to better patient outcomes.

      140 Character Summary: Intelligent alarm management can reduce alarm fatigue, create a quiet, healing environment, and improve patient care, safety and experience.

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      OS04.02 - Texting for Communication and Engagement at Provincial Tuberculosis Services (ID 46)

      R. Lester, Medicine, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Despite being preventable and curable, tuberculosis (TB) is one of the world’s deadliest communicable diseases. Timely and effective communication among clinicians and patients can be challenging since care is often provided “in the field”. The British Columbia Centre for Disease Control (BCCDC) TB Services provides case management and Directly Observed Therapy (DOT) within a defined geographic setting. Due to the ubiquity of mobile phone ownership and demonstrated uptake by vulnerable and isolated groups, text-messaging via WelTel, is being used to promote and enhance communication among our team of nurses, outreach workers, and active TB patients.

      Methodology/Approach: WelTel is a secure, browser-based application that allows clinicians and patients to text-message with a weekly text asking “how are you?” to start the conversation. The focus of this study is to determine the acceptability of the WelTel digital platform by the nurses and outreach workers working at the BCCDC TB Clinics. Acceptability includes ease of use, usefulness, and improved communication among the team. Feasibility will be measured systematically through assessing costs, guidelines, privacy and security requirements for the Provincial Health Services Authority. Finally, aiming to align with the World Health Organization’s recommendations for universal DOT, transferability will be evaluated to expand reach and options for care through video DOT. Using qualitative research methods, baseline, midpoint, and end-of-study focus groups were conducted with the nurses and outreach workers and thematically analyzed.

      Finding/Results: This project provided lessons on the convergence of health care and technology. Twenty clinicians were using the platform and there was a patient recruitment rate of 70%. Addressing concerns such as language barriers and technical issues early on encouraged confidence and interest among the clinicians. An identified challenge includes integrating digital technologies into routine clinical workflow, which was mitigated with clinical guidelines for the nursing staff. Factors contributing to success included frequent training and feedback sessions, ongoing support, local champions, and buy-in.

      Conclusion/Implications/Recommendations: We are currently in the knowledge translation stage to operationalize the study within TB Services. Rapid identification of patients who require more or fewer resources aligns with practicing precision public health. Future opportunities include eventually expanding video DOT. Novel digital technology allows for undiscovered avenues to enhance patient-centered care and subsequently improve the quality of care in the BCCDC TB Services. Our team envisions the eventual use of digital technology to support routine clinical practices across the spectrum of care – from treatment delivery, to diagnostic testing, to patient appointment reminders, and beyond.

      140 Character Summary: We started the conversation using text messaging at the BC Tuberculosis Services with patients and providers to promote communication and engagement

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      OS04.03 - The Impact of Smartphone Communication Technology in Clinical Practice (ID 276)

      S. Spina, Clinical Pharmacy, Royal Jubilee Hospital; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: While almost every other industry has abandoned pagers in favor of smartphones, healthcare remains largely dependent on them as the main communication device. We completed a clinical trial designed to determine how the use of an integrated smartphone solution affects communication (and the efficiency of communication) between hospital pharmacists, physicians, switchboard operators, and ICU nurses/unit clerks compared with current state.

      Methodology/Approach: The study measured how the use of the new integrated smartphone solution, which combines texts, and alerts into one secure smartphone app, affected communication. It enabled clinicians to use their personal devices or corporate devices to text and share secure, encrypted patient digital information. To quantitatively test the hypothesis that smartphones would improve efficiency of communications at Island Health, over 12 dozen clinicians participated in a first-in-Canada prospective, observational study. This project was aimed at improving clinician communication efficiency and improving patient care. The primary outcome was "page turnaround time", other outcomes were usage data and survey responses. The surveys focused on the efficiency, accuracy, satisfaction, and drawbacks of new integrated smartphone communication app.

      Finding/Results: The primary outcome showed a reduction in turnaround time of pages sent from physicians to pharmacists form 5.5 minutes to 3 minutes. High priority page turnaround times from 18 minutes to 4 minutes with the new system. Physicians and switchboard operators were most receptive of the communication app, with 81% and 71.4% wishing to continue using the system. The convenience of only needing to carry one device was the most commonly reported positive aspect for physicians at 88.6%. 77% of Physicians reported that sending or receiving pages interrupts patient care “often” or “very often” before implementation, whereas only 23% responded this way after the communication application was implemented. spina smartphone primary.jpg spina chart.jpg

      Conclusion/Implications/Recommendations: Formally, evaluating objective outcomes when implementing technology is essential to appreciate the impact and value of technology on clinical practice. The results of this project provides sufficient evidence to continue the implementation of the secure communication solution. The implications of this project has been the design and implementation of a large communcation project to minimize the communcation gap between acute and community care clinicians during patient transfers.

      140 Character Summary: Award-winning research conducted by Island Health proved that a secure and integrated smartphone applications can improve clinical communication and workflow

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      OS04.04 - Clinical Communication & Collaboration at Fraser Health: SMS or Not? (ID 118)

      A. Sahota, Fraser Health Authority; Surrey/CA

      • Abstract
      • Slides

      Purpose/Objectives: There is an emerging need for Secure Messaging (SM) from clinicians. Unfortunately, with the prevalence and consumerization of mobile apps, finding an effective enterprise-level solution within the HA has its challenges due to prolonged timelines and rigid privacy/security requirements. Currently, clinicians are using unsecure methods of text messaging to support clinical care by sending PHI through text messaging on their personal device. At Fraser Health, an EMM platform has been implemented to enable secure access to FH data from personal or corporate smartphones. We introduced SM to enable our clinicians to communicate effectively while supporting their mobile workflows.

      Methodology/Approach: The approach to implement SM was to leverage EMM to support mobile device management of personal and corporate smartphones. SM platform was identified to support the mobile workflows of the various multidisciplinary teams and more effectively communicate in support of patient care. The objective was to enable Clinical Communication and Collaboration (CC&C) and layer clinical systems integration capabilities such as, On-Call, alert notifications, MEDITECH modules and pager replacement. Without progress in this space, physicians will continue to insecurely text message colleagues to risk security of sensitive data, patient safety and fall behind in communication efficiency/effectiveness. The project focused on delivery of procurement, design, build and integration for SM in a PoC prior to expanded rollout. A clear BYOD strategy and app roadmap was created with the enterprise in mind for the acute and community sites. The complexity including smartphones and expectations around new access to clinical data impacted our security, privacy, legal and professional practice policies. A change management strategy to support a transformational app was required to support the wide range of use cases. Finally, a communication and roll-out strategy to support the pent-up demand was created to ensure effective rollout across the health authority. The challenge was managing expectations for those keenly interested while supporting those concerned with change.

      Finding/Results: Secure Messaging requirements included identification of a Clinical Communication & Collaboration solution. PoC go-live included acute and community area across emergency, hospitalists, surgery, primary and mental health. The solution design supported effective communication for patient care. The implementation was successful because of ongoing support from clinical leadership to accurately identify use cases that would maximize SM utility. The implementation introduced timely communication between care providers, optimal decision making between care providers, enhanced clinical workflow to reduce unncessaary phone calls/faxing/chasing providers, and minimized user technology overload to simplify process for clinical users.

      Conclusion/Implications/Recommendations: Delivering a successful mobile app at an enterprise level requires effective design, delivery, implementation and engagement, adoption and use. Many apps have the capability to create innovation and transformational change if implemented correctly. SM is a basic functionality but could be a disruptive technology if it mobilizes users, access to information and effective communication workflows. At FH, it has optimized, simplified and integrated communication for our clinicians because they have the data to support clinical decision making when required urgently. The greatest opportunity will come as we integrate systems, interoperability between other HA's and create policies to ensure professional practice are supported.

      140 Character Summary: Introducing Clinical Communication & Collaboration solutions to mobilize clinicians in the Health Authority, while effectively securing PHI on personal devices

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    OS10 - Patient-Centric Data - Driving Tangible Outcomes (ID 19)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS10.01 - Surgical Synoptic Reporting: Comparing Variation in Surgical Care Across Jurisdictions (ID 167)

      A. Hilchie-Pye, Nova Scotia Health Authority; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: Synoptic reporting provides an opportunity to collect comprehensive data sets which can be used for outcomes reporting. Synoptic data sets provides an opportunity to compare selected indicators at the clinician, provincial and national levels. These comparisons allow assessment and reporting on variation in clinical practice at point of care. This presentation uses breast, colon and rectal cancer surgery as case examples of how this can be achieved.

      Methodology/Approach: A national standard was developed by the Canadian Partnership Against Cancer (CPAC) to report on required data elements for breast, colon and rectal cancer surgery. Alberta, Manitoba and Nova Scotia all implemented an electronic synoptic system to collect surgical findings discretely. Using the data collected across the three provinces, national indicators developed by CPAC were adopted and addressed diagnosis, treatment planning and peri-operative events. The three provinces worked together and created a common report card that allowed the provinces to compare individual clinical practice to the aggregate of that province as well as against the other participating provinces. The data for each quality indicator was compiled on a quarterly bases, report cards were generated and distributed to participating individual clinicians. Meetings were held with clinicians to present findings, discuss results and solicit feedback.

      Finding/Results: Participating surgeons received disease site specific summary report cards at 3 month intervals comparing their practice to provincial and national aggregate data. Comparing across jurisdictions provides opportunities to examine where there is clinical significant variation as well as clinical similarities. Findings include significant variation across the three provinces over a six month period in 2016 for breast reconstruction (P<0.001) and rectal cancer patient receiving neoadjuvant treatment (P<0.0001). Comparing against the aggregate data of a province as well as against other jurisdictions provides information for the clinician to assess his/ her own practice patterns against set standards.

      Conclusion/Implications/Recommendations: Synoptic reporting data provides an opportunity to use real time comprehensive data to make informed decisions and monitor clinical variances. Data that is comparable across jurisdictions as well as over time allows for clinical practice review at the local, regional and national levels. This case study demonstrates that processes of care can vary between provinces and that timely prospective feedback from point of care data is feasible. Having the capability for standardized synoptic reporting supports a point of care process improvement tool that can be applied to and inform multiple clinical areas and jurisdictional levels.

      140 Character Summary: Data utilized synoptically provides a point of care process improvement tool at the clinician, provincial and national levels.

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      OS10.02 - Spine Surgery Synoptic Reporting Data for Informing Quality Improvment (ID 468)

      A. Hilchie-Pye, Nova Scotia Health Authority; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: Capturing data discretely through synoptic reporting provides opportunities for monitoring and quality improvement at the organization, department and individual clinician level. Using data collected from the spine operative report a selected number of indicators were identified and a process established to report findings to the group on regular intervals. Benefits, opportunities and lessons learned will also be discussed that can be applied to other groups using synoptic reporting.

      Methodology/Approach: Nova Scotia Synoptic reporting program captures clinical documentation through a templated approach using drop downs menus to select information. This data is captured in a discrete format and is maintained in a database allowing it to be searchable and analyzed. Five surgeons have been recording their operative findings for spine surgeries synoptically since early 2016. Over 1000 cases have been recorded over the two years making this an ideal case study for using the data to improve departmental outcomes and processes as well as provide individual clinician feedback. The surgical group discussed, identified and through consensus agreed on indicators that could be useful for monitoring individual performance as well as overall departmental performance from the data set of the operative report. Case mix differences between orthopedic and neuro spine surgery were explored. Other areas examined included percentage of trauma vs non trauma cases and indications. Quarterly reports were compiled using the date from operative report and sent to individual surgeons. Follow-up meetings were held with the department to discuss these report findings and the findings could inform quality, clinical and system improvements.

      Finding/Results: The data captured synoptically provides a breadth of information that can inform department decisions and clinical practice patterns. Neurosurgeons complete 67% of spine surgeries compared to orthopedic surgeons (33%). Understanding the cohort of surgical patients can assist in effective planning and management of the department. For example 91% of all cases are non-trauma related compared to 9% for trauma cases and of those trauma cases 39% are a spinal cord injury. Although in the early stages it is anticipated that providing surgeons with regular reporting on individual practice patterns compared with the aggregate of their peers will help improve clinical practice. In addition it is also anticipated that this data will contribute towards evaluating patient outcomes as well as evaluating departmental benchmarks and outcomes.

      Conclusion/Implications/Recommendations: The synoptic data provides comprehensive and complete information that can be searchable and can offer insight to both individual surgeons on his/her own practice patterns as well as provide information to help departments in making informed decisions for planning and quality improvement. Identifying the measures that can provide the most value is an important step and requires engagement by clinical users as well as leaders. Providing regular reports back to clinician users and department leaders is useful but there needs to be a commitment to discuss the findings so that there is opportunity for continuous quality and patient improvement.

      140 Character Summary: Spine synoptic reporting data was used to demonstrate how discrete data is able to inform decisions at the clinician, and departmental level.

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      OS10.03 - Data Linkage for an Evidence-Based Cancer Survivor Model of Care (ID 196)

      M. McBride, Cancer Control Research, BC Cancer; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Most young cancer survivors have increased risks of late or long-term morbidity, which vary depending on original diagnosis, treatments, age at diagnosis, and length of survival. The purpose of our research program, linking electronic data from provincial registries, clinical records, death registrations, and health administrative databases for young cancer survivors tracked for up to 40 years, was to generate population evidence of patient and care outcomes, and drivers of these outcomes, that could be used to inform development of a risk-based model of ongoing care for this survivor population in BC.

      Methodology/Approach: We identified all young cancer cases diagnosed in BC from 1970 from the BC Cancer Registry, and linked registry records, using the provincial health insurance Personal Health Number, to clinical, death, and administrative datasets (from 1986) representing multiple government-funded health care settings (cancer, outpatient physician-ordered services, inpatient care, hospitalizations, mental health, long term care) and (from 1991) the provincial outpatient prescription drugs program dataset PharmaNet. Late mortality, morbidity, and healthcare utilization were determined, as well as sociodemographic, clinical, temporal, and health system factors affecting these outcomes, and quality (timeliness, efficiency, effectiveness, access, equity, patient-centredness) of care. In 2014, these results were used in a needs assessment, evaluation of ongoing healthcare demand and costs, identification of gaps in care, determination of the size and characteristics of subgroups requiring different levels of care, and development of a tiered, evidence-based, model of care.

      Finding/Results: To end 2010, there were 8735 survivors identified, with the oldest in their early 60s at end of the study; 28% had died. Approximately 83% of survivor registrations successfully linked to clinical records; 85-86% linked to health administrative data; only 6.4% of person-years of observation were missing. The number of child survivors transitioning to adult-age care increased each year by 3%; overall care needs decreased with time since diagnosis due to late mortality, but relative risks of health problems and excess multimorbidity did not decrease. Over 40% lived more than 70 km from the main pediatric hospital; 28% lived in small communities or rural areas. The proportion of at-risk survivors receiving at least one recommended follow-up surveillance test ranged from 0.8% (thyroid-stimulating hormone) to 87% (complete blood count). By 20 years post-diagnosis, survivors had two to three times the health care utilization of similar BC residents without a cancer diagnosis. Characteristics of high users of later outpatient services (51% of the cohort) were identified. These results contributed to the development of risk-stratified models of care and a business case for implementation. In January, 2015, the BC Ministry of Health announced five years of funding for a risk-based Adult-age Childhood Cancer Follow-up Program, based on the recommended model, which is now being implemented.

      Conclusion/Implications/Recommendations: This innovative approach can provide population evidence to characterize the ongoing health care of specific patient populations, and inform healthcare delivery change in order to improve patient outcomes, and cost and quality of healthcare. This approach can also be used to assess additional risks and outcomes, and evaluate uptake and effectiveness of new programs.

      140 Character Summary: Linkage of clinical and healthcare administrative data for young cancer survivors generates evidence to support risk-based models of quality ongoing care.

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      OS10.04 - OECD Interactive eTool: Learning from our Peers (ID 272)

      A. Ytsma, CIHI; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: There is increasing interest in comparing health system performance internationally to identify potential areas for improvement and cross-national learning. The OECD interactive etool created by CIHI allows researchers and public to compare their health system with 35 other OECD countries on over 50 indicators, as well as identify peer countries based on demographic and health system metrics. This comparison tool shows insight into what area of care Canada, and individual provinces excel at, and where there is room for improvement.

      Methodology/Approach: To compare 50 indicators over 6 dimensions of care (health status, non-medical determinants of health, access to care, quality of care, patient safety and prescribing in primary care), data from many sources were used. Country-level data were collected from OECD Health Data 2017. Provincial-level results were either calculated by Statistics Canada or the Canadian Institute for Health Information using OECD methodologies. Data from the 2016 Commonwealth Fund International Health Policy survey was also used for both levels. Indicator results were normalized to present multiple indicators on the same scale and compared to the international average, 25th and 75th percentiles. The data is displayed in an interactive format allowing the user to compare provincial data to all international values, or Canada’s peer countries.

      Finding/Results: In general, Canada’s results were similar to the international average or to peer countries for most indicators; however, in every dimension of care, there were indicators where Canada’s results were higher or lower than the international average. In general Canada performs better when it comes to lifestyle factors and health status and has some room for improvement in access to care and patient safety. When compared to specific countries, no countries were found to be consistently higher than Canada across all indicators. When comparing provinces to other countries, each province’s profile was unique: in some areas the results were higher than the average, in others they were lower. But similar to national-level results, no province was consistently higher or lower than the international average across all indicators. Compared to previous versions of the tool results were relatively stable with no overall trend in results.

      Conclusion/Implications/Recommendations: International comparisons can help provinces identify areas where they can learn from other countries, particularly where similar peer countries are performing well above average. The interactive format allows a large collection of data to be readily accessible and be viewed cohesively by both the general public and researchers. This allows patients, health professionals, researchers and policy makers to be part of the discussion. Moving forward we will continue to identify additional indicators that could potentially be compared internationally to give more well rounded picture on how Canada compares.

      140 Character Summary: The OECD interactive etool created by CIHI allows researchers and public to compare their health system with 35 other OECD countries on over 50 indicators.

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    OS16 - Innovation in Capacity Building (ID 25)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS16.01 - Digital Health FACTS: Celebrating Innovation & Collaboration in Education (ID 57)

      A. Fazzalari, Clinical & Change Leadership, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Canada has focused on building digital health infrastructure over the last 15 years and benefits are now being realized from these foundational investments. However, there was a gap in the training and education of students in the Faculties of Medicine, Nursing and Pharmacy to meet the ever-changing digital landscape. To address this need, a national Canadian clinical informatics competency program was created. Commonly known as the Digital Health “Faculty Associations Content & Training Solutions” (FACTS) program, this unique program has national organizations participating in a collaborative focused on advancing clinical informatics in medical, nursing and pharmacy education. Discipline specific resources such as medical, nursing and pharmacy informatics competencies will be shared, along with interprofessional lessons learned that will be relevant to policy, research & practicing clinicians.

      Methodology/Approach: The Digital Health FACTS took a national program approach, yet enabled a discipline specific and regional implementation. The program leveraged a national Change Management (CM) Framework and leveraged Peer-to-Peer Networks across Canada to facilitate educators in supporting their colleagues and preparing students to practice in a digitally enabled environment. These educators, known as “Faculty Peer Leaders” act as change agents in medicine, nursing and pharmacy faculties, providing hands on support and guidance to their peers as well as students via face-to-face meetings, workshops and webinars. Engaging clinical faculty led to the development of pharmacy, nursing and medical clinical informatics competencies along with real life case studies for teaching and learning.

      Finding/Results: The program impacts all educators and students in the Faculties of Medicine, Nursing and Pharmacy in Canada. To date, there have been nine successful projects whereby approximately 40 Faculty Peer Leaders have engaged over 9,700 of their colleagues/educators. Each discipline-specific project within the interprofessional program conducted evaluation activities such as focus groups and in-person/online surveys were utilized when engaging Faculty Peer Leaders, their colleagues/peers and students. Interprofessional evaluation results, emerging themes and lessons learned will be shared with the audience.

      Conclusion/Implications/Recommendations: A “people project” is unfolding across Canada to engage educators and students in digital health dialogue, learning and teaching. Faculty Peer Leaders in this national program are unique as they engage faculty and students in an interprofessional, collaborative patient-centred care approach. Momentum has been built and due to the demand for digital health content by educators and students, the recommendation to continue the program has been accepted and funding as been allocated for additional project activities. Future initiatives will focus on national priorities such as e-Prescribing and telehomecare. Planning is underway for a national program evaluation to better understand the intersection of program/project management, clinical and academic expertise contributing to the advancement of digital health in the Faculties of Medicine, Nursing and Pharmacy.

      140 Character Summary: Come hear about the Canadian Digital Health FACTS program: recipient of the 2017 Ted Freedman Award for Innovation in Education!

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      OS16.02 - Community Paramedicine Implementation: Build the Program Then the Technology (ID 587)

      C. Calderone, TELUS Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Community Paramedicine is a community-based model in which paramedics provide primary care services, such as patient home visits and community engagement services, within their paramedicine scope of practice. The target population served is seniors living in rural and remote British Columbia who are at risk for falls and/or living with chronic conditions such as congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and hypertension. Community Paramedicine is a new initiative for this provincial emergency health service provider, and they knew that a successful deployment would depend on an innovative approach. Based on lessons learned from similar initiatives, it was obvious the requirements for an electronic system could not be fully defined without at least prototyping the program. The team decided to pursue a simple program design that would allow them to modify quickly and at a lower cost so they could build in continuous feedback from real-world program experience. This approach created an environment that allowed for constant feedback and communication between prototype users and the project team.

      Methodology/Approach: When searching for an electronic solution for the group’s referral, scheduling, service delivery, and program management business processes, the nature of the program posed some challenges. Community-based paramedics serve communities dispersed over a large geographical area. In addition, there was a need to accommodate multiple technologies in the various health authorities and primary care physician offices. These factors made program design a challenge. As a result, the team decided to take a step back and focus on program design first; only then did they look to the technology. The requirements for the electronic solution were expected to change as the program matured and settled, so interim technologies, and in some case paper, were used as temporary solutions. This allowed for requirements to settle before procuring permanent, and more expensive, solutions.

      Finding/Results: This approach has proven beneficial for the development of the Community Paramedicine program. As the program matured, we were able to adapt to changing needs, new discoveries, and end user feedback, working towards building definitive requirements for long-term solutions. Paper referral forms, a SharePoint scheduling application, and paper charts have all evolved and undergone several revisions through the beginning phases of the project, and the project team is now working toward transitioning these into electronic applications. This approach can also be attributed to significant cost saving as the interim solutions are far less expensive to change than large scale solutions, and we can be confident in the requirements we now have as we develop permanent solutions.

      Conclusion/Implications/Recommendations: Patient-centric care is the driving force in almost every modern healthcare initiative. Sometimes, however, programs can be driven to a particular technology solution that may not be the best fit. By first building trust with patients, health authorities, and the community, the Community Paramedicine program has seen tremendous success. Focusing on the technology as one component of the overall solution has allowed for the service to flourish and provided a path forward where technology solutions can later improve established business processes.

      140 Character Summary: The Community Paramedicine implementation in BC highlights a successful strategy where relationship building and program maturity come before technology.

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      OS16.03 - Evaluating the Effects of Post-Implementation EMR Training on EMR Use (ID 356)

      G. Randhawa, Clinical Improvements & Informatics, Island Health; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: To address the need for continuity, comprehensiveness, and coordination of care, primary care plays a key role in the management of chronic diseases, especially diabetes care. The electronic medical record (EMR) facilitates proactive diabetes care management through advanced features such as reminders/alerts. Although the majority of primary care physicians (PCP) in Canada have adopted an EMR, their use is generally limited to basic features, such as scheduling and billing. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features. However, training is an important type of EUS that the majority of PCPs currently lack, especially post-implementation EMR training. A recent Canadian study by Infoway also highlights the need to invest in training and education initiatives for current PCPs to improve their use of the EMR. The purpose of this research study is to evaluate the effects of an EMR training intervention for diabetes care management in primary care. Specifically, the study examines the extent to which the training affects the process measures for type 1 and type 2 diabetes care management, including: (a) use of a diabetes registry, (b) use of diabetes recalls/reminders, (c) ordering/viewing a patient's Hemoglobin A1C, and (d) recording a patient's blood pressure.

      Methodology/Approach: The study is set in British Columbia (BC) and includes all PCPs who use OSCAR EMR, one of the top three EMRs used in BC. This study employs a mixed methods approach and a quasi-experimental design. The study intervention is based on the internationally-recognized and evidence-based Chronic Care Model (CCM). The study intervention is a series of four online video tutorials for diabetes care management that provide training on Level 4 (Proactive Care/Data Driven Practice) of BC's Meaningful Use Model for EMRs. From June-August 2017, the video tutorials were co-designed and developed with an OSCAR EMR Physician Super-User based on best practices in the literature. Human Research Ethics Board Approval was sought from the University of Victoria in June 2017. The study was initiated in July 2017 and study recruitment was done through BC's Divisions of Family Practice until October 2017. Data collection is currently underway and includes: (1) PCP Demographic Survey, (2) Diabetes Care Management Survey (Pre-Baseline, Baseline, 3 Months, and 6 Months), and (3) Follow-Up Interviews (3 and 6 months).

      Finding/Results: In total, 23 PCPs from across BC have completed the baseline Demographic and Diabetes Care Management Surveys. Of these, 18 PCPs have received the study intervention thus far. Data collection and analysis to evaluate the effects of the EMR training are ongoing until May 2017.

      Conclusion/Implications/Recommendations: Video tutorials are a cost-effective, accessible, and convenient medium for delivering post-implementation EMR training to PCPs. It is anticipated that the video tutorial series will help to significantly increase PCPs' process measures for type 1 and type 2 diabetes care management using the EMR. The study findings can be applied to the design, delivery, and evaluation of EMR video tutorials for other EMRs and chronic diseases in Canada and internationally.

      140 Character Summary: Post-implementation EMR training delivered through video tutorials can significantly increase physicians' advanced use of EMRs for diabetes care management.

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      OS16.04 - A Novel Provincial Approach to Implementing Advanced Hospital Information Systems (ID 212)

      J. Theal, North York General Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: It is well known that advanced hospital information systems (HIS) are difficult to implement successfully. Benefits to quality, safety, value and evidence-based care are possible, but not guaranteed. Risks include poor clinician adoption, inefficient workflows, unclear quality benefits, and changes to practice that introduce new types of error. Furthermore, these systems are costly. In Ontario, approximately 80% of hospitals have yet to implement advanced HIS. In the next 5 years, there will be a large investment in advanced HIS province-wide. The Ministry of Health and Long-Term Care (MOHLTC) has recognized there is a very real risk that not all hospitals will achieve the desired clinical and financial benefits from advanced HIS. However, some hospitals in the province have already been successful, with substantially improved clinical outcomes and demonstrable return on investment from advanced HIS. In a publicly-funded healthcare system, it appeared sensible to share these successes with other hospitals just beginning on their HIS journey. To meet this need, the HISBAT (HIS Benefits and Adoption Team) was created in January, 2017. The objectives of this presentation are to: a) outline the rationale, purpose, and methodology of HISBAT; b) to illustrate the outcomes achieved to date; c) to discuss future goals and directions for the Team in the provincial HIS landscape, and d) propose how a similar team could be implemented to benefit other Canadian provinces

      Methodology/Approach: To comprise HISBAT, a team of HIS experts was procured from two Ontario hospitals that have demonstrated improved clinical and financial outcomes with advanced HIS: North York General Hospital (HIMSS Stage 6), and Ontario Shores Centre for Mental Health Sciences (HIMSS Stage 7). The HISBAT employs an innovative approach where a series of tactical on-site visits are provided to client organizations depending on individual identified needs. Peer-to-peer mentorship is provided on HIS implementation-related topics such as project governance and management, clinician engagement, change management, clinical content development and standardization, outcome measurement, and iterative quality improvement.

      Finding/Results: In its first 10 months, the HISBAT has assisted more than 50 Ontario hospitals on a wide variety of HIS-related topics. Feedback from client organizations has been extremely positive. Survey responses indicate that clients especially appreciate the credibility and trust that a peer-to-peer hospital relationship fosters. Several organizations made note that key information points were brought forward that resulted in avoidance of potentially costly early project decisions. Having a single team that provides continutity in HIS renewal province-wide has also enabled the adoption of standards that will provide the foundation for HIS instance consolidation into more efficient clusters and provincial hubs. While exact provincial financial savings from HISBAT have yet to be quantified, the MOHLTC has already indicated that creation of this team has been a very effective use of capital.

      Conclusion/Implications/Recommendations: The HISBAT is a novel approach to leveraging existing knowledge within a publicly-funded healthcare system to assist in reducing time and cost for HIS implementation, while increasing standardization and HIS-related quality outcomes across Ontario. Such an approach could be leveraged to benefit other provincial jurisdictions in Canada.

      140 Character Summary: A peer-to-peer mentorship approach has been successfully undertaken in Ontario to assist hospitals in implementing advanced hospital information systems.

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    OS21 - Advancing Telehealth: The Next Wave of Opportunities (ID 33)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 3
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      OS21.02 - Mixed Method Exploration of Telehealth for Autism Intervention Services (ID 299)

      P. Hancock, Western Regional School of Nursing; Corner Brook/CA
      K. Tulk, Long Term Care and Rural Health, Western Health; Corner Brook/CA

      • Abstract
      • Slides

      Purpose/Objectives: Western Health serves a catchment area of approximately 70,000 residents across a large geographic area of Newfoundland and Labrador (NL). Children who are diagnosed with autism spectrum disorder (ASD) within the jurisdiction of Western Health are eligible to receive early intervention services in the form of Applied Behavioral Analysis (ABA) therapy. Traditionally, orientation and ongoing follow-up for these services have been provided in face-to-face format, requiring travel by family members and healthcare providers (HCP). This modality has many limitations for families as well as for involved HCPs, primarily due to the rural nature of the area as well as needs of families who care for vulnerable children. Telehealth has been implemented to ensure adequate access for families as well as maximal efficiency for all involved at three distinct phases of the Western Health ABA delivery process, including the three-day ABA training, mentorship and support for healthcare providers, and to facilitate ongoing evaluation/communication with the family and home therapist in the child’s home. The research team leading this mixed methods study have followed a patient-engagement framework perspective. Quantitative data provided insight into registration information and family/healthcare provider participant satisfaction with using telehealth. Qualitative data from focus groups and interviews provided more extensive exploration of the processes and experiences of families and HCPs involved in the program. The program and evaluation framework are based on the Patient Provider Expectations Model. The final evaluation of the various phases of the project have informed changes required to transform the program to one that is truly “home based.” Based on study results, the researchers conclude that telehealth is a viable method of delivery for the three phases of the ABA program delivery, with the results having implications for improving efficiency of additional programs. The aim of this study is to build upon the existing use of telehealth for the ABA program’s three-day training and then expand into a telehomecare component for the mentoring phase. The objectives of the study include: 1. Implementation of telehomecare in the delivery of ABA parent/caregiver training 2. Explore the experiences of healthcare professionals and clients in the implementation of telehomecare 3. Summative and formative evaluation of health professional and client satisfaction with use of telehomecare for delivery of ABA orientation and ongoing mentoring 4. Review of cost and clinical effectiveness of telehomecare implementation to determine clinical efficacy of this mode of program delivery 5. Provide recommendations for further implementation of telehomecare initiatives

      Methodology/Approach: Mixed method methodology

      Finding/Results: Surverys received from over 60 participants of the three day ABA training. Results include: 87% satisfaction rate among participants; significant cost savings of participants (up to $2000 per participant); emotional benefits (avoidance of travel and separation from children for training). Individual interviews and focus groups provide insight into the challenges and solutions to identified issues.

      Conclusion/Implications/Recommendations: The first phase of this project included a one year pilot of telehealth use for the three day ABA sessions. Based on the results and feedback received from this review, the program has been adapted by the facilitators to be “telehealth-friendly”. Based on the successful results and subsequent change to the program, Telehealth is now used to assist in the delivery of all sessions of the three-day ABA training. Recommendations have been made based on the surveys and other feedback from participants and facilitators, including the recommendation that all staff who will be involved in facilitating the sessions via Telehealth participate in comprehensive telehealth orientation.

      140 Character Summary: Celebrating successes in telehealth -- bridging the gap for families of children with ASD and healthcare providers involved in ABA program delivery!

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      OS21.03 - Rural-Urban Comparison of Telehomecare for Patients with Heart Failure (ID 529)

      M. Jaana, Telfer School of Management, University of Ottawa; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: To assess the differential benefits of telehomecare for patients living in rural versus urban environments and suffering from chronic heart failure.

      Methodology/Approach: A cross-sectional design was used to examine the differences in process and outcomes care measures between rural and urban patients enrolled at a major specialized hospital. Chart review of all patients enrolled in the program in 2014 was conducted to extract data on relevant indicators. Rural status indicated a patient’s home residence in a geographic area with < 30,000 habitants. Descriptive analysis provided an overview of the sample; bivariate analyses examined the relationship between rural/urban status (R/U) and patient characteristics, and process/outcomes measures. Multivariate analysis was conducted with the variables that demonstrated significant relationships at the bivariate level.

      Finding/Results: Table 1 presents an overview of the sample that included 240 patients (137 urban and 103 rural). Analysis of differences in their characteristics revealed a significantly higher proportion of rural patients living with someone and diagnosed with diastolic heart failure. In addition, a significantly higher number of emergency room visits was observed for male patients and when living alone. Patients who were seen by a specialist and a regular GP had the longest telehomecare duration, and the highest number of diuretic adjustments, nurse calls and emergency visits. A preliminary examination of the relationship between R/U and process/outcomes measures did not reveal any significant association, although more rural patients had undocumented reason for emergency visits compared to urban patients (Table 2a). The multivariate analysis controlling for significant patients’ characteristics further confirmed the absence of any significant differences between rural and urban patients on process/outcomes measures related to telehomecare. Interestingly, a posthoc analysis of correlation between process of care (e.g., frequency of changes of diuretic doses, calls) and outcomes measures (e.g., emergency visits, admissions) demonstrated significant positive relationships (Table 2b). table 1.jpg table 2a and 2b.jpg

      Conclusion/Implications/Recommendations: Telehomecare is equally beneficial for urban and rural patients with chronic heart failure. The improved process of care attributed to this patient management approach was associated with more emergency visits and hospital admissions. This is an indication that timely interventions are done, when needed, especially that the emergency visits appear to be correlated with hospital admissions.

      140 Character Summary: There are no differential benefits associated with the use of telehomecare for rural versus urban patients with chronic heart failure.

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      OS21.04 - Supporting COPD Patients with Home Telemonitoring: Insights from TEC4Home (ID 479)

      J. Cordeiro, Digital Emergency Medicine, Uninversity of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality that decreases patient quality-of-life and increases health system utilization due to frequent emergency department (ED) visits and hospitalizations. Supporting patients either before or after an exacerbation can optimize health outcomes. TEC4Home COPD is an evaluation to determine how home health monitoring (HHM) technology can better support patients with COPD at home, after leaving the hospital or clinic. The aim of TEC4Home COPD is to improve patient outcomes and quality-of-life, while also reducing ED readmissions and hospitalizations.

      Methodology/Approach: In TEC4Home COPD patients, either in acute exacerbation or in stable condition, are provided with home telemonitoring. Participants are recruited from emergency departments, in-patient units, and out-patient clinics. Once enrolled, the HHM equipment – a tablet, BP monitor, pulse oximeter, weight scale, and pedometer – is delivered to the participant’s home. Participants are asked to submit their measurements every weekday, for 60 days. A monitoring nurse reviews the data and follows up with the patient and/or primary care provider when necessary. After 60 days, the patient is discharged from the service, and equipment is retrieved. To assess impact and outcomes, participants are asked to complete an enrollment (pre-) and completion (post-) survey. The surveys are comprised of various validated scales including the Veterans Rand 12 Item Health Survey; the Clinical COPD Questionnaire; the COPD Self-Efficacy Scale; a healthcare utilization survey; and the System and Use Survey. Surveys assess overall health and disease-specific quality of life, self-efficacy, healthcare utilization, and comfort with technology. Patient biometric data from the 60-day monitoring period is also analyzed to assess changes to the patient’s health outcomes (e.g., change in symptom severity). Follow-up surveys with the monitoring nurses are conducted to assess provider experience and feedback on the monitoring process, communication with patients and other healthcare providers, and to collect recommendations for improvements to the technology and service. Other providers a part of a patient participant’s circle of care (e.g., family doctor, respirologist, etc.) are invited to provide insight into the impact of home telemonitoring on their patient care. Hospital administrative data is used to assess utilization and cost outcomes.

      Finding/Results: Enrollment is open until February 2018. Results and recommendations from the benefits evaluation will be shared at the eHealth conference. This study will contribute unique insights into home telemonitoring by: 1. Determining the efficacy of monitoring to help patients in exacerbations recover and to help stable patients avoid deterioration; 2. Comparing those in stable condition versus those recovering from exacerbations to identify similarities and differences in the use of home telemonitoring for COPD management; 3. Applying the triple aim framework to understand how home telemonitoring impacts patient experience, health outcomes, and costs in both groups of COPD patients.

      Conclusion/Implications/Recommendations: This evaluation of home telemonitoring for the care of both COPD patients recovering from exacerbations and those in stable condition will generate insights into how best to deploy home telemonitoring in accordance with patients’ specific needs. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

      140 Character Summary: Better COPD outcomes: The benefits of home monitoring for enhanced patient quality-of-life, self-management & reduced healthcare utilization.

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    OS29 - e-Health Solutions for Patient Self Management (ID 47)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS29.01 - Change Before You Have to…Emerging Models of Care (ID 48)

      M. Wilson, Providence Health Care; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Healthcare is in a perpetual state of change with new treatments, models of care and technologies being implemented daily. What used to be the traditional “doctor’s bag” now includes handheld devices facilitating the care connection with patients and other care providers outside of the hospital and doctor’s office. At the same time, patients are demanding not only prompt service, but also convenience of access for their health care. This workshop will explore emerging models of care enabled by virtual technology. This includes the growing expectation that a patient’s primary care provider has immediate access to the information they need to provide a continuum of care no matter where the patient is – in a rural setting or an urban location.

      Methodology/Approach: The panel will review new evolving models of care enabled by technology at Providence Health Care in Vancouver and the BC Interior led by the Kootenay Boundary Division of Family Practice from the provider and patient experience. Rapid Access to Consultative Expertise is a telephone advice line where family physicians (FPs) can call one number, choose from a selection of specialty services and be routed directly to the specialist’s cell phone for advice usually within a few minutes. eCASE, electronic consultation to specialists expertise is a non-urgent model of e consultation where FPs can access specialists advice through email. Other models of virtual health including secure messaging, enotification and video conferencing in traditional and not-so-traditional settings (ICU, Mobile Maternity, PreSurgical) will be discussed.

      Finding/Results: Evaluation metrics, based on the Triple Aim Framework show promising results in relation to - Experience of Care, Population Health, and Per Capita Cost. Provider and user satisfaction is high at 95%, 60% of interactions avoid a face-to-face consultation, 32% of interactions avoid an emergency department visit and patients have improved access to speciality care.

      Conclusion/Implications/Recommendations: These models are revolutionizing communications between specialists and family physicians - building relationships, providing clinical decision support, and opening access to different modalities of care - so patients have a continuum of care in their own community. By exploring future models of care through technology we will: • Present information from the patient and provider perspective on remote consultation services • Delve into new models of care – eCase, RACE, secure messaging, Mobile Maternity, non-traditional telehealth • Investigate the shifting value base related to virtual care – do our values match those of our patients?

      140 Character Summary: This workshop will explore emerging models of care enabled by virtual technology from the provider, user and patient perspective.

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      OS29.02 - Feasibility of Remote Patient Monitoring for COPD and Heart Failure  (ID 294)

      K. Ghaney, Remote Patient Monitoring Program - HTDM, Eastern Health; St. John's/CA

      • Abstract
      • Slides

      Purpose/Objectives: 1. Describe strategies used for initiation and modification of remote patient monitoring/telehomecare. 2. Describe lessons learned from feasibility period to sustainability and scalabilty. 3. Promote patient success stories and outcomes. The Remote Patient Monitoring Program focused initially on Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) patient populations, whose chronic conditions lead them to frequent emergency departments and multiple hospital admissions. Management of Diabetes Type II was included in recent months. Technology is used as a platform to deliver healthcare outside the conventional setting in the patient's own home. Patient data is electronically transmitted (e.g., symptoms, vital signs, outcomes) from the home to the clinical team with a goal to identify evidence-based care interventions, provide education, support, and health and wellness coaching that improves patient self-management. Early evidence shows that expected benefits of: reduced length of stay, emergency department visit and acute admission reductions will be realized. High satisfaction rates with the patient care experience with this healthcare delivery model have been demonstrated. Over 700 patients have been enrolled in the program to date with numbers expected to double in the next 12 months - improving access. Patient success stories and outcomes will be shared to demonstrate the impact remote patient monitoring/telehomecare can have - especially in remote locations.

      Methodology/Approach: Patient identification was competed using electronic data examination and direct patient referral. Health session kit (iPad and peripheral devices) were delivered using in-home assisted installation and through a self-install (direct ship to patient) model. These methods were analyzed for efficiency and cost. Referrals received via fax, email or by telephone Eligible patients are contacted either by phone and/or letter Patients who accept are consented and enrolled for a 4 - 6 month period iPad mini, BP cuff, pulse oximeter, and weigh scale delivered to the home Biometric data and symptom question responses are delivered remotely to the RPM dashboard daily to be monitored by RN. RNs contact the patient when pre-established individualized thresholds are surpassed. Advice, coaching and intervention is provided as required. Pre-scheduled coaching calls are completed for goal setting, action planning, self-management support and behaviour modification

      Finding/Results: Direct patient referral is more efficient but requires increased focus on clinician engagement. Self-install model (direct ship) is more cost efficient but requires more technical support via phone and clinician. Technology is the enabler. Clinical self-management support, education, and intervention are considered most valuable to patients. ER visits and acute admissions will be examined in the 12 month period before enrollment in the RPM program and 12 months after enrollment Patient surveys are administered on enrollment, completion of the program and 4 months after disenrollment A benefits analysis report will be completed by December 2017

      Conclusion/Implications/Recommendations: Audience will hear results of the program: - enrollment and equipment feasibility anlysis - findings in efficiencies and cost reductions - learnings for scalability and expansion - outcomes for patients and efficiencies for organizations - patients related stories of success

      140 Character Summary: RPM empowers and engages patients to be experts in their own care. Self-management support and education using technology is key to success in achieving outcomes.

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      OS29.03 - Personalized Chronic Disease Management: Balancing Apps and Health Coaching (ID 369)

      S. Goyal, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Medically complex patients with co-existing conditions often receive conflicting clinical advice, hindering their abilities to appropriately self-manage multiple chronic conditions (MCC), resulting in frequent hospitalizations, premature admissions to long-term care, and a decreased quality of life. The aim of this demonstration project was to iteratively evaluate the impact of a patient-centered mobile remote patient monitoring (RPM) system, coupled with health coaching, on the experience of care, health outcomes, frequency of hospitalizations, and overall well-being of patients with MCC. The RPM system specifically enabled patients with MCCs (i.e., heart failure, chronic obtrusive pulmonary disease, chronic kidney disease, and/or diabetes) to track and monitor their own biometric data and patient reported outcomes, triggering appropriate self-care instructions and social supports. The alerts generated were also remotely monitored by a nurse and health coach; the nurse monitored intervened when appropriate, and the health coach promoted self-management and healthy behaviour change through the empowerment approach. Together, the nurse and health coach collaborated and facilitated social support for the patients. The three key priorities of this project were to 1) improve the patient experience, 2) improve health outcomes, and 3) reduce avoidable hospitalizations and emergency room visits.

      Methodology/Approach: The demonstration project had a rolling recruitment of patients who were diagnosed with heart failure, chronic obtrusive pulmonary disease, and/or diabetes. Once enrolled, patients visited the health coach at the clinical site to be on-boarded into the study, receive training on the RPM platform, and complete the study activities, such as study questionnaires and blood tests. The patients were enrolled in the program for a duration of 6 months. The project team developed a health coaching protocol that was adapted based on the needs expressed by the patient, moving towards a highly personalized health coaching protocol.

      Finding/Results: Over the 6-month period, we recruited 40 patients who had one or more of the following: heart failure, chronic obtrusive pulmonary disease, and/or diabetes. In addition to clinical outcomes, we collected analytics around both the usage of the mobile apps and the individualized health coaching delivered to each patient, and conducted 31 semi-structured interviews with patients. Preliminary analysis suggests that the preferred ratio of technology to health coaching was highly variable among participants, however technology assisted delivery of health coaching had high acceptability and perceived effectiveness among patients.

      Conclusion/Implications/Recommendations: While the benefits of remote patient monitoring for complex patients in specialty clinics have been demonstrated, there remains a gap in the support these patients receive prior to the escalation of their condition. This project demonstrated that these patients valued the ongoing support of a health coach in conjunction with remote patient monitoring, and that the ratio of the technology and coaching vary greatly on the individual’s needs and their unique psychosocial complexities. The next generation of mobile platforms need to consider that chronic disease management requires a blended approach, that moves away from “one-size-fits-all” concept, and towards a model that is able to titrate the ratio of technology and customized support based on individual needs.

      140 Character Summary: Complex patients in primary care valued the combination of digital remote patient monitoring and highly individualized health coaching for the management of MCCs.

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      OS29.04 - End-User Engagement: Electronic Self-Care Application for Patients with Heart Failure (ID 206)

      S. Wali, Medicine, McMaster University; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Heart failure (HF) is a chronic disease that affects over 1% of Canadians and is associated with a significant economic burden (2.8 billion/year). Self-care is key to the management of HF and can potentially lead to better clinical outcomes. Proper HF self-care includes tasks such as daily weight and symptom monitoring, as well as adjusting diuretics based on weight. Nevertheless, patients find HF self-care challenging, with less than 50% of patients regularly weighing themselves. Mobile applications can support self-care but barriers such as literacy, numeracy and mild cognitive impairment can lead to challenges in adopting technology. Our previous work supports the use of a paper-based standardized diuretic decision support tool (SDDST) promoting self-care in older individuals with HF to manage their daily weight and adjust their diuretic dose accordingly. The primary objective of this study was to use participant (HF patients, informal care-providers [CPs]) input to convert our paper-based SDDST into a user-centered electronic mobile application.

      Methodology/Approach: We recruited patients (male and female, age > 60) with a confirmed diagnosis of HF, and their CPs from the Heart Function Clinic at the Hamilton Health Sciences General site. HF patients were categorized into three groups, 1) adequate self-care patients, 2) inadequate self-care patients without a CP or 3) inadequate self-care patients with a CP, based on their self-care abilities measured with the Self-Care Heart Failure Index (SCHFI) where a score of > 70 is considered self-care adequate. We are conducting semi-structured interviews with HF patients and CPs using Persona-Scenarios. Interviews are transcribed verbatim and analyzed using NVivo, version 10, for emerging themes regarding self-care. This study has received ethics approval from the Hamilton Integrated Research Ethics Board.

      Finding/Results: Thus far, we have interviewed 6 patients (4 male, 2 female, mean age: 74) and 3 CPs. We have identified 3 major themes which include 1) Challenges with technology, 2) Communication and assistance with circle of care, and 3) App customization. Many of the challenges patients and CPs mentioned involved their unfamiliarity with technology. However, participants were supportive and more likely to actively use the HFApp when informed of the intervention’s inclusion of volunteer and nurse assistance. Data collection and analysis is still in-progress and will be completed by the end of December.

      Conclusion/Implications/Recommendations: Many mHealth apps fail to maximize their potential due to the lack of end-user engagement. To our knowledge, this is the first the study that includes patient and CP feedback throughout the design process. Our solution focuses on the patient’s needs, where the app must be easy to operate, robust and effective. Today, value-based outcomes and patient engagement are key to managing costs, which self-care can help achieve. We expect that simpler more user-friendly apps will result from our study supported by a patient-centric model of feedback.

      140 Character Summary: Self-care is key for HF management. We have designed a simple, patient-centered mHealth app to improve HF-self-care in the home setting.

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      OS29.05 - A Business Case for Artificial Intelligence in Remote Patient Monitoring (ID 470)

      R. Whittaker, Wellington Waterloo CFDC; Elora/CA

      • Abstract
      • Slides

      Purpose/Objectives: The use of Remote Patient Monitoring (RPM) technology to manage chronic disease patients is gaining popularity. Dealing with chronic conditions only at the acute state in an episodic manner has led to high demand and inefficiencies in most health care delivery systems (Thorpe et al. 2004). It has been suggested that early diagnosis, continuous care, and coordinated health care would reduce system burden and make chronic disease management more effective (Rajan et al. 2013). However inefficient use of technology can in fact lead to less efficiency itself. In our recent CPRPM study paramedics using RPM technology observed that close to 50% of the patient interactions were non-coachable moments. The introduction of Artificial Intelligence (AI) in the RPM system not only increases the efficiency of the system but also increases the engagement of patients for coaching purposes and to keep patients engaged. Preliminary research has differentiated between three roles: 1) patient monitoring provides patients with access to their daily readings, 2) provider feedback helps patients understand and learn how to self-manage their condition, and 3) digital leverages artificial intelligence to predict health risks and exacerbations. The objective of this study is to examines RPM technologies used by patients not in isolation, but rather within an ecosystem that includes learning technology, providers, patients, and feedback that supports and gently pushes or “nudges” positive health behaviors and outcomes.

      Methodology/Approach: Observational study that utilizes a prospective longitudinal cohort design to compare the role of RPM across two use cases. The first use case is human-centric as its design is highly dependent on the active role of the provider to respond to systematic alerts and provide feedback. The second use case is technology-centric as its design incorporates data analytics and artificial intelligence to generate more customized alerts and predict risks and exacerbations. The outcomes evaluated are the impact of both use cases on healthcare system utilization (i.e., reduction in 911 calls, reduction in ED visits). EMS Service Rurality Target # Patients Use Case 1 Target # Patients Use Case 2 Total Sample EMS 1 Rural 10 10 20 EMS 2 Rural 15 15 30 EMS 3 Urban 10 10 20 EMS 4 Urban 15 15 30 Total 50 50 100

      Finding/Results: A previous study of 212 participants involved in the first use case resulted in a 42% reduction in 911 calls and 40% reduction in ED visits. Although results were extremely promising, it is difficult to scale results to a larger population due to high demand on provider influence. By comparing the original use case with the technology-centric alternative, benefits and challenges for both use cases will be identified.

      Conclusion/Implications/Recommendations: The implications of our study are relevant to organizations and government bodies involved in connecting the business of health and technology to transform health care into a more sustainable delivery model.

      140 Character Summary: The introduction of smart home AI in the remote monitoring system not only increases the efficiency of the system but also increases the engagement of patients.

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      OS29.06 - Scaling up Home Telemonitoring: Insights and Lessons from TEC4Home    (ID 532)

      H. Harps, Telus Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: TEC4Home Heart Failure (HF) examines using home tele-monitoring to support the safe transition of care from hospital to home. Home monitoring equipment is used to collect biometric measurements (weight, blood pressure, pulse, and oxygen saturation) from patients daily to detect deterioration and implement early interventions, thereby avoiding unnecessary ED readmissions and hospitalizations. This project is led by a Canadian university in partnership with the provincial health ministry, regional health authorities, and a health technology partner. The four year initiative is designed to evaluate the efficacy of home tele-monitoring and to scale up and spread the practice provincially. The Phase 1 feasibility study at 3 sites demonstrated a reduction in re-hospitalizations and improvement in quality of life, resulting in the expansion to the Phase 2 randomized controlled trial with 22 community sites across the province, starting in 2018. This abstract explores insights and lessons learned while scaling up across health authorities in a “real-world” research trial implementation.

      Methodology/Approach: In Phase 1, the feasibility study tested and refined procedures in three domains: model of care (i.e. how monitoring nurses work with patients and health professionals); model of technology (i.e. how the equipment and data will be used); and model of research (i.e. what metrics to use to track outcomes). This approach proved effective. When scaling up from three sites to multiple sites across health authorities in Phase 2, a fourth domain, model of management, was added as another stream. Topics requiring consideration within each domain are listed: Model of Care: How to account for and accommodate variations in standards of care and resourcing between sites, and identify areas of harmonization? How can monitoring nurses develop and share best practices provincially, while also retaining practices relevant to community-specific needs? Model of Technology: How will the monitoring equipment be delivered to patients’ homes in various communities, including ones with limited connectivity and those in remote areas? How will data be captured and shared across jurisdictions using different electronic health systems? Model of Research How to develop capacity for research on sites and across health authorities to set up support for future trials? How to develop a common evaluation framework, identifying key provincial metrics with health authority and site specificity? How to pool data to facilitate analysis and prospective tracking for future quality improvement? Model of Management How to create new job descriptions for monitoring nurses in keeping with health system and professional standards? How to establish policies and practices across health authorities to enable sharing of monitoring nursing capacity and data? How to transition from project to sustainable program with appropriate governance?

      Finding/Results: We will discuss how the above framework guided the project to scale up and roll out the trial.

      Conclusion/Implications/Recommendations: TEC4Home aspires to generate high quality evidence to define future standards of care in home tele-monitoring. This will contribute to the evidence-based policy translation needed to guide the implementation and sustainability of home tele-monitoring in the province. This empirical approach can help harmonize administrative practices and create new channels of collaboration to introduce innovations into routine health practices, establish sustainability, and increase research capacity for an enduring legacy in digital health research. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

      140 Character Summary: Scaling up TEC4Home Heart Failure: Insights for collaborative "real-world" large scale trials and implementations.

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