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    Closing Keynote Address (ID 58)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
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    Opening Keynote (ID 55)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
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    OS17 - Engaging Me, the Client (ID 29)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
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      OS17.01 - Clinically Enabled Provincial Electronic Medical Record with Patient Engagement (ID 224)

      Blair White, Newfoundland and Labrador Centre for Health Information; St. John's/CA

      • Abstract

      Purpose/Objectives:
      Our Electronic Medical Record(EMR) journey in Newfoundland and Labrador has been clinic and clinician focused to date, Patient engagement has been a vision of our provincial EMR implementation within Newfoundland and Labrador. Our journey has matured to the point where we have begun this engagement. Our presentation will outlined our clinic and now patient engagement journey, what we offer, clinical adoption progression, what has worked and what has not worked for lessons learned. The clinically enabled Electronic Medical Record within Newfoundland offers the following standardized clinical functionality to clinicians; • Demographic dashboard including roster and panel information • Diabetes, COPD, screening care-plans and dashboard reports • Integrated billing functionality • Integrated patient order results distribution into the EMR • Electronic Prescribing pilot sites • Patient in context launch to the provincial EHR viewer for electronic ordering, electronic consult, viewing provincial medication & Immunization profiles • Secure electronic communications across EMR instances throughout the province • General office functions - patient and clinician scheduling • Vendor provided clinical templates The above requires constant education with the existing clinics on our program. Patient engagement functionality includes; • digital appointment reminders • Online appointment booking • sending of tasks to a patient in advance of the appointment to be completed, for example Laboratory order We will outline our journey to date and where we are heading.


      Methodology/Approach:
      Our approach has been enabled via a multi-stakeholder governance structure. The governance is a tri-party model consisting of the provincial Ministry of Health, provincial Medical Association, along with the Newfoundland and Labrador Center for Health Information (ehealth provincial organization). Under this governance model we have been able to implement working groups to manage the various stakeholders and topics around our EMR program called eDOCSNL. We have representation from the tri party governance organizations along with each Health Authority within NL on our three working committees; • Clinical advisory committee • Data governance advisory committee • Regional Health Authority primary care committee The other key to our success has been constant educaiton to clinicians in multiple facets. Face to face in clinics, conferences.


      Finding/Results:
      Our results have been increasing demand for adoption as well as enhancing the mature use model of our provincial EMR. Our findings have shown us increased education to the clinicians is requied and it is not a one time thing. Education is a constant process required by the program. We presently still have a demand for more clinics to come onto the EMR program as well as our existing clinics are looking for us to enhance the clinical functionality within the software and move up the EMR maturity model.


      Conclusion/Implications/Recommendations:
      Our conclusion is the central multi-party governance model including the working groups are the key to our advancement. Implications are this progress has created a resource constraint as meeting the demand requires an increase in resources such as capital money and people with the appropriate knowledge on staff. Recommendations include working towards governance models, as well as continuous clinical engagement in any forum available within your province.


      140 Character Summary:
      Our EMR journey within NL has been a great learning environment for EMR implementations. We would like to share our experiences along with time for QA.

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      OS17.02 - Patient and Provider Experiences with Mobile Technology and Health Apps (ID 187)

      Sarah Harvey, Toronto/CA

      • Abstract

      Purpose/Objectives:
      This study focused on the use of mobile health and wellness applications (apps) in chronic disease management in a cardiac rehabilitation patient population. There are over a hundred thousand health apps available that patients can download from public app stores and an increasing number of patients are choosing to use these apps. These include apps in key areas of focus for chronic disease management such as exercise and diet. However, there is little evidence on patient use (or desired use) of these health apps to support self-management of chronic conditions. The study objective was to describe patient and provider experiences with publicly available health apps and perceived impact on self-management, the patient-provider relationship and care processes.


      Methodology/Approach:
      An exploratory mixed methods design was used to gain an understanding of patient and provider perspectives and experiences. The study was conducted in a cardiac rehabilitation program in Ontario, Canada. A quantitative survey (n=242) focused on patient demographics and technology use profiles. Patient interviews (n=30) and a provider focus group (n=8) were conducted to explore perspectives on mobile technology and health app use as a part of self-management and the patient-provider relationship.


      Finding/Results:
      Results from this study describe an aging patient population with a range of cardiac diagnoses and co-morbidities. Ninety-two percent of patients in this study used mobile technology and 50% of those with mobile technology were using health apps. Most patients and providers felt that health apps can support chronic disease management, particularly with respect to tracking progress against exercise and diet goals. Patients and providers also felt that they needed more support in using health apps and integrating them into care processes. This included the need for education on how to use apps as well as access to information on app accuracy and how to choose or recommend health apps given the large number available. Participants also emphasized the desire for health apps to connect patients and providers during and after the rehabilitation program. Health apps were mostly used by patients in the study in the absence of provider recommendations and without connectivity between patients and providers. Findings highlighted the need for health care practices to leverage and support health apps as a part of care during and after rehabilitation for patients self-managing in the community. While this study supports the use of health apps in practice, future care that includes the use of apps should ensure equitable options of care for those that choose not to use them as there was a portion of study participants that did not want to, or, could not use health apps.


      Conclusion/Implications/Recommendations:
      Approximately half of all patients in cardiac rehabilitation are choosing to use publicly available health apps, however, these apps are not supported by practice standards and are not connected with providers. Health policies are needed to support the use of health apps as they pertain to key areas of chronic disease management such as diet and exercise. This would set the stage for development of health app standards and connected virtual care in the community.


      140 Character Summary:
      This study describes patient and provider experiences with publicly available health apps. Results support use of health apps if integrated with care practices.

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      OS17.03 - Patient Engagement in Home Health Monitoring Research (ID 155)

      Helen Novak Lauscher, Emergency Medicine, University of British Columbia; Vancouver/CA

      • Abstract

      Purpose/Objectives:
      Patient engagement in health research has gained traction in recent years in Canada as evidenced by the movement toward patient oriented research. Research has shown that patient engagement improves the quality and relevance of health research. TEC4Home, a four-year project studying home health monitoring to support the safe transition of heart failure patients from hospital to home is implementing a provincial randomized controlled trial (RCT) in 19 hospitals across four BC health authorities. This presentation will describe patient engagement in TEC4Home, along with reflections of both researchers and patient partners on learnings to date, including practical approaches for meaningful engagement.


      Methodology/Approach:
      Patient and family caregiver partners participated in the grant proposal process. During the feasibility trial phase patient partners were members of governance and implementation committees, contributing to decisions in clinical, evaluation, and technology streams. Patient partners helped develop and review all patient-facing materials such as information brochures and surveys, and participated as actors during recruitment dress rehearsals. TEC4Home’s committee structure was expanded for the RCT. Working with the BC Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit, Heart Life Canada, and Patient Voices Network, a provincial Patient Advisory Committee (PAC) was formed. A full-day workshop was held in Vancouver to form relationships, provide orientation on all aspects of TEC4Home, and build understanding about health research in general amongst patient members. The PAC, co-chaired by patient partner and TEC4Home’s principal investigator, has eight members with patients and family caregivers living with heart failure from three geographical regions of BC. The terms of reference stipulate PAC is responsible for advising on decisions concerning TEC4Home including reviewing, informing, and ratifying patient materials. PAC members also sit on other TEC4Home committees. The participatory approach includes an ongoing focus group for PAC and project team to reflect on quality of engagement and help adjust as needed.


      Finding/Results:
      The PAC has been instrumental in ensuring readability of research materials, and in quality improvement during implementation. The PAC supported the analysis of patient care pathways in receiving HF management, identifying where key opportunities and challenges lie. Patients and family caregivers with lived experiences shared their personal stories of the importance of autonomy and not losing their own identities during recovery, and how they would like to see health services improve. These insights helped shape TEC4Home; PAC continues to make significant contributions to knowledge dissemination activities, for example producing a patient- and family-centred summary of feasibility trial findings. The PAC will participate in ongoing evaluation of their engagement in TEC4Home. This will include documentation of patient partners’ goals, and collaborative efforts to ensure their experiences are rewarding and productive.


      Conclusion/Implications/Recommendations:
      From grant proposal through to the ongoing RCT, patient engagement has been key. Patient partners contribute to foundational and practical aspects of research alike. It is important to adopt a patient-oriented stance from the outset, and grow the project with patient and family input. Patient partners must be supported through ongoing collaborative reflection to address issues such as power, and to determine tangible ways to value patient partners for their contributions.


      140 Character Summary:
      Patient engagement in all phases of a multi-sectoral research initiative contributes to effective and robust processes and outcomes.

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      OS17.04 - Patient Engagement and Access to Digital Health Services Amongst Canadians (ID 94)

      Simon Hagens, Canada Health Infoway; TOronto/CA

      • Abstract

      Purpose/Objectives:
      Patient engagement is a crucial component of high-quality healthcare services (Forbat, Cayless, Knighting, Cornwell, & Kearney, 2009). Yet despite its primacy, there remain substantive variation in the level of patient engagement with healthcare providers. The purpose of this study is twofold. First is to differentiate demographically characteristics of patients within each of the levels of engagement patients have with their healthcare providers. Second is to conduct correlational analysis on the relationship between patient’s perception of engagement with healthcare provider and access, utilization and interest in e-services in Canada. Reference: Forbat, L., Cayless, S., Knighting, K., Cornwell, J., & Kearney, N. (2009). Engaging patients in health care: An empirical study of the role of engagement on attitudes and action. Patient Education and Counseling, 74(1), 84–90. https://doi.org/10.1016/j.pec.2008.07.055


      Methodology/Approach:
      This study uses self-reported data from Canada Health Infoway’s 2018 Annual Tracking survey: Access Digital Health 2018. Access Digital Health surveyed 2,406 Canadians on their attitudes, utilization, perceptions and expectations regarding digital health services in Canada. The sample was recruited from Harris Poll Online (HPOL)—Nielsen’s proprietary panel—supplemented with sample from other Nielsen-vetted partner panels. The survey instrument was available in both English and French, administered online. Weighting has been applied to reflect the natural incidence of Canadians 16+ by age, sex and province. Perception of engagement with health care provider was determined by a combination of patient’s involvement with their health care providers and confidence to participate with their health care providers for health care management and decision-making. The relationship between patient engagement and patient access, utilization, and interest in various e-services were investigated controlling for demographic variables.


      Finding/Results:
      Four-in-ten Canadians (42%) report that they are engaged with their health care provider in the management of their health. Approximately one-third (33%) report being non-engaged and one-quarter (25%) report having partial engagement. Engagement with health care providers increases with age, and is particularly high among 54+ (52%). Engaged patients are also more likely to have a regular health care provider (93%), take more prescription medications, and have a chronic health condition (65%). Preliminary results indicate that engaged patients are more likely to have access, use and show interest in certain types of e-services such as electronic prescription renewal and visit health care provider virtually online by video.


      Conclusion/Implications/Recommendations:
      Preliminary analysis of this self-reported patient survey suggests that patients who perceive themselves to be more engaged patients are more likely to access, use and show interest in various types of electronic health services. The positive correlation between patient perception of engagement and digital health service utilization indicate that patient engagement may be a promising factor in improving the uptake of electronic health services and improving health service delivery and quality. Continual efforts in patient-centered care and efforts to improve patient engagement are vital steps toward changing the landscape around digital health utilization and lays the foundation for improved health quality and system performance.


      140 Character Summary:
      Results suggest that engaged patients are more likely to have access, use and shows interest in certain types of e-services.

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    OS23 - Looking Through the Data Lens (ID 38)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
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      OS23.01 - Using the EMR to Rapidly Respond to Product Recalls (ID 394)

      Jim King, Paediatric, Children's Hospital of eastern Ontario; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      Drug and consumer product recalls are fortunately rare in healthcare. When a recall occurs timely response to identify, remove and provide an alternative are crucial. A voluntary recall was issued in September 2018 by Abbott (for certain liquid nutrition products due to possible bacterial contamination) and in October 2015 by Sanofi-aventis (for Allerject®, epinephrine injection, for potentially inaccurate dosage delivery). The purpose of this presentation is to highlight how CHEO used the analytic capability of an integrated EMR to rapidly respond to these product recalls.


      Methodology/Approach:
      Following the announcement of each recall a product based report was generated for all the potential order ids (ERX) for both the inpatient and outpatient departments identifying both the patient and provider. The report was generated for the current order (day of) for the inpatient department and the order within the last year (time - 1 year) for the outpatient department. Relevant information for these orders including ordering provider, ordering date, and the patient address, name, phone number were extracted. An alert was then developed within the EMR and presented to the provider when ordering the recalled product. The alert provided information about the recall with hyperlinks to the Health Canada or the Canada Food Inspection Agency websites along with prescription information and a recommended alternative when attempting to order the recalled product.


      Finding/Results:
      The following table outlines the number of unique patients that were identified as having an order for the recalled product. The report was generated the same day as notification of the reporting team of the product recall. Orders Sanofi-aventis (Allerject®) Abbott Formula Inpatient N/A 94 Outpatient 21 18 Total 21 112 An alert for the recall and an alternative for the recalled product were built within the order entry system.


      Conclusion/Implications/Recommendations:
      Managing product recalls may be challenging. While it is a responsibility of the dispensing pharmacy to notify patients when there is a recall it is equally important for the ordering physician to identify and notify patients and prescribe an alternative course of therapy. In the hospital setting we have used the analytic capability of our EMR to rapidly respond to two product recalls. This allowed a quick and reliable means to identify patients and their providers and communicate quickly with our families. Also, we were able to notify prescribers with the EMR of the recall in the context of their ordering and to offer an alternative to the recalled product.


      140 Character Summary:
      Using our EMR we rapidly responded to two product recalls, identified affected patients and providers and offered alternatives to the recalled product.

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      OS23.02 - Using Blockchain To Capture Patient Consent for Genomics Research (ID 337)

      Daipayan Mukherjee, Deloitte Inc; Toronto/CA

      • Abstract

      Purpose/Objectives:
      The process of enrolling a new study participant in a research study is time and paper intensive. Further, the process requires researchers and hospitals to validate patient consent before sharing data for research, causing significant delays to overall research timelines (on average, it takes 60 days to onboard, enroll and receive data from study participants). Further, the enrolled study participants have little visibility into their data after providing consent. The project's objective is to use blockchain to solve these issues.


      Methodology/Approach:
      Below is f the conceptual model of the platform proof architecture.png


      Finding/Results:
      Expanding on the PoC, the Informed Patient Consent project focuses on bringing the PoC developed by PROOF from a beta version state to a market ready, commercially viable product. Key outcomes for this project are: Develop product roadmap and framework that defines the path to bring the application from a PoC state to a market ready product Complete development to move the product to a market ready product, including successful integration with clinical data from multiple parties including research organization and hospitals Determine application governance and operating model, including IP ownership, licensing model, operations / sustainment management plan, sales strategy, and revenue forecast


      Conclusion/Implications/Recommendations:
      Expected Benefits Informed patient consent and health data auditability is foundational for a secure health and genomics platform. The informed patient consent application establishes ‘trust’ and enables transparent sharing of clinical and genomic data across parties in a timely, easy, secure manner. A blockchain-based solution will remove the need for centralized consent management, such as by the researcher or hospital, facilitating decentralized record access and storage. Smart contracts, autonomous programs that run on the blockchain, will ensure that only authorized parties have access to that patient’s data. The following are key outcomes that will be derived directly as a result of this project: Blockchain is a distributed technology that brings a built-in layer of transparency and traceability, therefore removing the need for third parties such as researchers or hospitals (e.g. paper consent forms) Use of smart contracts can automatically execute transactions based on the implemented rules from all regulators which establishes trust and automated compliance amongst various stakeholders in the ecosystem Enhances visibility, transparency and control over patient consent and ensures the security and consistency of the data Creates an unfalsifiable and verifiable fingerprint on the blockchain, with timestamps corresponding to consent statuses to provide an audit trail for reporting purposes Enables long term outcomes for the participating stakeholders such as, moving discovery into innovation in action, establishing a platform for a health data commons to unleash scientific research and discovery


      140 Character Summary:
      Going beyond proof of concepts. Pilot Project: Using Blockchain To Capture and Track Patient Consent for Genomics Research

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      OS23.03 - Lessons from the Field: Nova Scotia’s EMR Migration Deadline (ID 412)

      Michael Kelly, Mara Consulting; halifax/CA

      • Abstract

      Purpose/Objectives:
      In this presentation, Christine Grimm, Senior Executive Director, Investment and Decision Support with Nova Scotia’s Department of Health and Wellness (DHW), and Michael Kelly, EMR Migration Senior Project Manager (Mara Consulting) will provide the audience with successful strategies used to implement a large-scale change in Nova Scotia’s approach to community-based electronic medical record (EMR) systems. Christine and Michael will describe how Nova Scotia responded to a vendor-initiated sundown of the provincially hosted solution. While there were several other EMRs in use across the province, approximately 70% of primary care physicians and 29% of community-based specialists in the province had adopted the provincial system. Over a two- year period, they will have moved from a provincially hosted and supported EMR – Nightingale on Demand (NOD), to a model where providers will work with and be supported by one of two existing EMR vendors certified to operate in the province. Topics will include how to: · Develop a governance structure to support a large-scale migration in a unique, complex environment · Successfully migrate over 3000 health care providers and clinical staff from a provincially-hosted EMR to one of two private sector EMR products in a two-year period · Build positive relationships with stakeholders in a multifaceted dynamic landscape


      Methodology/Approach:
      Methodology/Approach: Nova Scotia’s approach to the migration includes the following: · Building a new governance structure within an evolving digital health landscape · Completing a pilot phase to ensure EMR vendors have the capacity to comply with provincial migration and data standards · Assembling a dedicated project team of existing NOD support resources and external consultants to streamline processes and implement a comprehensive change management strategy to encourage adoption · Providing financial incentives to compensate physicians and their staff for the time spent validating patient records and training on their new EMR


      Finding/Results:
      Findings/Results: · As of October 2018, over 50% of providers had committed to migrating to a new EMR.


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations: · Stakeholder engagement is key – understanding your stakeholders’ perspectives and what else is happening in the bigger context is important to understand when building project and engagement plans · Ensure the governance structure for the project and its ongoing success within broader digital landscape includes all of the key stakeholders – representation from health care providers, government, health authorities, vendors and the medical association


      140 Character Summary:
      Nova Scotia’s key success factors in a large-scale change to EMR solutions and governance in a unique and complex digital health landscape.

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      OS23.04 - Managed Service Model: Accessing Healthcare Through a Different Lens (ID 459)

      Orpah McKenzie, KO eHealth Telemedicine Services, Keewaytinook Okimakanak "Northern Chiefs"; Balmertown/CA

      • Abstract

      Purpose/Objectives:
      The Managed Service Model (MSM) project provides access to timely and culturally safe health care services to First Nations communities throughout Ontario. Keewaytinook Okimakanak eHealth Telemedicine Services (KOeTS) and Ontario Telemedicine Network (OTN) invited remote First Nations communities across Ontario to participate in the MSM project. The project is facilitated using OTNinvite, a videoconferencing feature that allows individuals external to OTN’s network, to participate in real-time video visits.


      Methodology/Approach:
      OTN and KOeTS piloted a new model for First Nations communities with a simpler and more convenient alternative to purchasing a room-based videoconferencing system. First Nations on-reserve communities with adequate internet connectivity applied to receive a secure desktop computer with videoconferencing devices (high definition web camera and an echo cancelling speakerphone) so that they could participate in video consults. Consults are enabled through a private and secure web link. In March 2017, the participating First Nations communities attended an engagement session in Kenora where they received equipment and process training. In all, 40 OTNinvite systems were distributed to the participating communities. Community engagement is continuously provided by a Regional Telemedicine Navigator (RTN), located in Balmertown. The RTN identifies and schedules healthcare providers and services to meet the needs of the community members. Funding for this project is provided through Ontario’s First Nations Health Action Plan. While the project was designed to facilitate the connection between patients and providers using OTNinvite, the feature was also leveraged as a teaching device to familiarize providers with the project. This ensured that providers and communities were comfortable with the technology and processes prior to patient engagement.


      Finding/Results:
      Communities within the project identified a demand for healthcare in areas such as mental health, oncology, and diabetes. Mental health presents the area of most potential to expand utilization within the community health centres. Awareness and partnership development with mental health partners is ongoing. Based on the identified needs, engagement sessions were held with Misaway (diabetes management centre), Waypoint Centre, SickKids Telepsychiatry program, as well as St. Michael’s Hospital and Thunder Bay Regional oncology departments. To date, the project has discovered: -There exists a knowledge gap among providers who are unfamiliar with OTNinvite and accustomed to traditional room-based telemedicine services. -Despite the connectivity available throughout the province, First Nations communities are still challenged with bandwidth issues. -The communities selected for the MSM project had no prior experience with telemedicine and so require a higher level of support.


      Conclusion/Implications/Recommendations:
      -The RTN continues to mitigate the provider knowledge gap through ongoing outreach and working with Telemedicine Coordinators (TMC). To keep their skills sharp, TMCs are encouraged to participate in OTNinvite test calls. -Where bandwidth issues are not resolvable, systems will be re-allocated to other communities. -The frequency of contact and engagement with these communities will be increased to better support their participation in the project. By encouraging health care providers and patients to use MSM, First Nations communities have access to a low-cost alternative to purchasing a video clinical system which requires OTN membership, management, and staffing resources.


      140 Character Summary:
      The KOeTS and OTN lead MSM project provides timely access to culturally safe health care for harder-to-reach Ontario First Nations communities using OTNinvite.