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    OS01 - It's All About the Patient Outcomes! (ID 1)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
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      OS01.01 - Implementing a Patient Portal in a Paediatric World (ID 124)

      Narissa Dharamshi, Information Services, SickKids; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Provide an overview of the people and processes involved in the implementation of a patient portal in a paediatric setting. Outline the benefits and challenges of sharing the same portal across two paediatric organizations who went live on the same system at different times. Detail the strategies necessary to achieve engagement and adoption from both patient populations. Inform audience of lessons learned and provide a glimpse at the future-state roadmap planned for both hospitals.


      Methodology/Approach:
      Each organization had unique implementation approaches given they went live with varying project scope and in different years (2015 and 2018). Extensive collaboration was required between the two hospitals to review shared system settings including those impacting consent requirements, release of information (e.g., results) to portal and communication between patients and providers. Both organizations chose to implement outpatient areas in a pilot phase with a subset of clinics and form official working groups to facilitate decision making. There was heavy engagement from representative stakeholders including communications and privacy. Each organization engaged patient and family representatives or existing family advisory councils to obtain valuable feedback prior to, during and post-implementation.


      Finding/Results:
      The sequential implementation of patient portals in two organizations allowed for enhanced planning and decision making for the latter organization and facilitated re-analysis of important issues for the former organization. The pilot areas informed broader rollout strategies, both with patients/families and clinic staff. Adoption of portal differed in varying specialties (and by organization) due to patient populations and provider/clinic engagement and likely perceived portal utility. Patient portal implementation in a paediatric setting sparked interesting discussions surrounding policies around adolescent vs. parental/guardian access to personal health information. As clinic activation spread, new questions arose given the unique specialty-specific patient populations impacted. The working group membership - clinicians, patients/families, communications and privacy staff - proved to be a great resource for decision-making and facilitation of larger discussions required at an organizational level. The working group was an ideal venue to vet communication and training materials for the portal to establish consistent messaging across the organizations. Once live, the project teams had to balance resolving go-live issues with appetite from clinical and patient/family communities for advanced portal features and functionality. The working groups for both organizations continue to play an important role in defining priorities and establishing expectations beyond the initial implementation.


      Conclusion/Implications/Recommendations:
      Involving key stakeholders early on in the process was a success factor for each organization. Having working group members weigh in from the planning stage through implementation and beyond was critical to drive communication, implementation and post-live strategies. Strongly encouraging clinic champions or ‘hype’ staff proved to contribute to a clinic’s success in increased patient/family activations and engagement. Creating and providing ample communication and training material from the onset helped to facilitate each clinic activation and reduce the burden on the project team. There are benefits and challenges with sharing the same portal across two organizations. Building a solid relationship between the organizations to reach consensus on shared system settings and share lessons learned proved valuable for each hospital.


      140 Character Summary:
      Two organizations effectively implemented a shared paediatric patient portal. Keys to success were engaged, representative working groups at each organization.

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      OS01.02 - Virtual Emergency Support Service. "I've Got Eyes on the Patient" (ID 272)

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

      • Abstract

      Purpose/Objectives:
      The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to enhance support to nurses and clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner. VES has been implemented in eight First Nations Nursing Stations in Sioux Lookout Zone. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.The objective of the final evaluation is to determine if the VES service model is an effective means for enhancing urgent and emergent care in isolated nursing stations.


      Methodology/Approach:
      The evaluation is based on a limited production roll-out in the Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations and reflects service-level data and provider feedback collected between 16 March and 31 December 2017. VES Data Sources and Collection Approach: A. Nursing Feedback · Nurses summarized VES encounters by filling out a record of event · KOeHealth staff conducted short interviews with Nurses-in-Charge (NICs) on a weekly basis. · Face-to-face interviews with NICs B. Physician feedback · Eight physicians were interviewed or provided written responses about their experiences with the VES. · Three ORNGE Transport Medicine Physicians (TMPs) provided feedback about their experiences. · ORNGE shared results of post-VES surveys C. Service-level data · Nursing records of event · Logging files from OTN’s videoconferencing application for Emergency Medicine · Provincial air ambulance transport logs · Monthly VES Implementation Team meetings · Promising Practices Workshop – 4 October 2017, Thunder Bay. D. Direct engagement and observation: · Site visits to four First Nations communities.


      Finding/Results:
      Between mid-March and end of December 2017, VES resources were mobilized to manage 10.4% of the 666 medical evacuations that originated from one of the four VES First Nations. Feedback by nurses, ORNGE TMPs and Regional Critical Response Program (RCCR) confirm that VES is an effective means for enhancing urgent and emergent care in isolated nursing stations. With VES, patients living in Ontario’s most remote communities have access to the same level of clinical expertise as any other resident in the North West LHIN


      Conclusion/Implications/Recommendations:
      VES is an advanced, integrated and scalable urgent/emergent service model that is effectively supporting nurses and patient care in isolated First Nations nursing stations. Provider feedback and service-level data show promising results. Nearly three-quarters of the ORNGE TMP workforce (17 of 23) have used VES one or more times to support nurses and MDs in isolated nursing stations. Regional Critical Care Response teams have used VES multiple times to stabilize critically ill patients prior to transport, coach nurses in the optimal use of life-saving equipment, and counsel family members about the imminent death of a loved one. Service-level data and provider feedback signal successful completion of the VES pilot project and anticipate its expansion to additional isolated First Nations in the Sioux Lookout Zone.


      140 Character Summary:
      VES is urgent/emergent service model that support nurses and patient care in remote and isolated First Nations nursing stations in Sioux Lookout Zone.

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      OS01.03 - Patient-Reported Outcomes for Hip and Knee Replacements in Ontario (ID 430)

      Nicole De Guia, Patient-Reported Outcome Measures, Canadian Institute for Health Information; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Patient-reported outcome measures (PROMs) are essential to patient-centred health care delivery. Hip and knee replacements are procedures aimed at improving patients’ pain, functioning and overall quality of life. To support the delivery of patient-centred, evidence-based care, the Ontario Ministry of Health and Long-Term Care (MOHLTC) approached the Canadian Institute for Health Information (CIHI) and CCO to help execute a new PROMs project for hip and knee replacement patients. The PROMs project is being implemented in alignment with the bundled hip and knee replacement surgery Quality Based Procedure (QBP) program. Goals of the project included: • Piloting collection of PROMs, with intent to scale-up to province-wide. • Leveraging technology to support implementation and real-time reporting back to providers. • Developing initial comparative reports for health system monitoring. • Improving communications between providers and patients, informing treatment decisions and patient expectations. • Complementing traditional, clinical outcomes, cost, and patient experience data for a more comprehensive understanding of their relationships. • Supporting the evaluation of performance and effectiveness of care.


      Methodology/Approach:
      The MOHLTC oversees the governance structure for the project and provides leadership to ensure project alignment with the bundled hip and knee QBP project. The MOHLTC, CIHI and CCO have complementary roles in the execution of the PROMs project. CIHI is responsible for confirming data collection standards including instruments, minimum data set, and collection time points. After receiving PROMs data collected by CCO, CIHI will provide a range of comparative reports to support Ontario health system performance monitoring and evaluation (e.g., comparative reports to facilities and others, and data files to the MOHLTC). CCO has over a decade of experience overseeing the systematic collection of oncology PROMs in Ontario. Electronic PROMs collection is currently available at more than 80 oncology centres across the province and more than 30,000 oncology patient screens are completed via CCO’s e-PROMs platform each month. CCO has been commissioned to leverage and apply this expertise to the collection of hip and knee PROMs. CCO is responsible for implementing electronic PROMs collection across the province and for hospital-level data collection. CCO will regularly submit datasets to CIHI for use in comparative reporting. Based on the needs of the MOHLTC, the planned approach is a three-year pilot project which started September 1, 2017, with data collection commencing April 2018.


      Finding/Results:
      The objectives of the project are to demonstrate the value of collecting PROMs data, test the platform/mechanism for collecting PROMs data in Ontario, and initiate technological and business processes for a cost-effective scale-up to provincial implementation. Other benefits include measures of access and appropriateness, and the potential to support patient and surgeon decision-making prior to surgery. The goal of the pilot is to determine the most effective, user-friendly, and cost-effective method for collecting PROMs over the long-term.


      Conclusion/Implications/Recommendations:
      Ontario is the first province in Canada to implement the national PROMs hip and knee arthroplasty standards and electronic collection. Early learnings from an implementation, data and reporting perspective will be presented at the conference.


      140 Character Summary:
      To support patient-centred, evidence based care, a new patient-reported outcome measures project for hip and knee replacements has launched in Ontario.

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      OS01.04 - Sex Workers’ Preferences for ICT Tools for Health and Safety (ID 188)

      Th, IHPME, University of Toronto; Toronto/CA

      • Abstract

      Purpose/Objectives:
      While sex work itself is not illegal, the criminalization of certain aspects of sex work in Canada increases Occupational Health and Safety (OHS) risks, including violence, stigma and discrimination. The use of Information and Communication Technology (ICT) such as web pages, Twitter, and WhatsApp as a tool for the sex worker communities to access OHS strategies is largely unexplored. The objective of this qualitative study is to explore the question: What are the needs and preferences of Toronto-based sex workers (SWs) regarding ICTs as a strategy to communicate knowledge and education about OHS risks in the workplace?


      Methodology/Approach:
      This qualitative study consists of two components, both using a community-based research approach. The first is a thematic analysis of three focus groups and three individual interviews (unpublished data from a previous research project) to provide preliminary insights into how sex workers might like to utilize ICTs for OHS. The second component will delve deeply into the needs and barriers of sex workers in terms of OHS, and their preferences in ICT use through focus groups. The findings from the first component will be used to inform the categories of inquiry for the focus groups. The second component will be conducted with Maggie's: The Toronto Sex Workers Action Project (Maggie's). Focus groups of 6 to 8 participants will be convened until data saturation is reached. Leaders from the sex worker community will facilitate the discussions. After each interview, the researcher will practice reflexivity by documenting her own observations on what took place during the interviews. Using thematic content analysis, the focus group transcripts will be analyzed by three people; this group will be composed of the researcher, a research assistant and a member of the sex worker community trained in qualitative analysis.


      Finding/Results:
      The first component revealed that sex workers would like the following OHS strategies to be available via an ICT tool: condom negotiation techniques; anonymous reporting of assault; reducing a sense of isolation; reduction in HIV vulnerability; job satisfaction; client does not attempt removal of condom; prevention of stalking, exploitation, being outed. The interviews did not provide insights into the privacy and security concerns when using ICTs and will be explored in the focus groups in the second component. The research will be completed by March 2019; results from the completed study will be presented at the conference.


      Conclusion/Implications/Recommendations:
      The research into ICT tools will support sex workers in their access to OHS strategies. As most SWs in Toronto, Canada, own a smartphone, the provision of an ICT tool for SWs to exchange OHS strategies endeavours to reduce their OHS risks, strengthen their social network, enhance their social cohesion and social capital. The findings from this research will inform a future study “What are the core components of potential ICT intervention strategies to exchange OHS information in the workplace?” Once the chosen ICT intervention has been established, another phase of research, exploring the feasibility of SWs using an ICT intervention to exchange OHS strategies in the workplace, is proposed as the next step.


      140 Character Summary:
      Community-based research with Toronto sex workers in exploring the potential of exchanging occupational health and safety strategies via an ICT tool

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    OS12 - Smart Consumers (ID 21)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
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      OS12.01 - Froogie - Healthy Eating Goes Global (ID 434)

      Ashwin Kutty, WeUsThem INc.; Halifax/CA

      • Abstract

      Purpose/Objectives:
      Increasing fruit and vegetable consumption is an important target for cancer prevention. Public health goals recommend that we consume at least 600g of fruit and vegetables each day, which is the equivalent of at least five or more servings daily, but many people fail to achieve this target. In Canada, only 1 in 10 children consume the recommended intake of fruits and vegetables. Innovative ways to engage children in increasing fruit and vegetable intake for positive health benefits are therefore needed. One way to do this is through interactive smartphone apps that offer real potential for delivery and evaluation of health interventions in an innovative and engaging way. Given the ubiquity of smart phones among Canadians, apps offer the potential for enhanced accessibility, portability and interactivity to support health behaviours, like increasing fruit and vegetable intake.


      Methodology/Approach:
      As part of a broader research project, we developed a smartphone application designed to promote fruit and vegetable consumption among families with young children. The app, called Froogie (a named derived from the words fruit and veggie), was developed to engage families with young children in recognizing the importance of eating more fruits and vegetables for health. The app featured cartoon characters, called Froogies, and messaging around ways to increase fruit and vegetable intake. We undertook pilot-testing with a sample of families, prior to launch on the app store and google play. The app was designed to be self-contained and included elements of gamification to encourage engagement over a nine-week period.


      Finding/Results:
      Froogie was launched in March 2017, garnering 1000 downloads in its first week after launch, and featured on the Apple App Store as a New and Notable app in its second week. Apple also Recommended the App while also hitting over 2 Million impressions within the first month. Feedback from users highlighted the engaging nature of the app for children, as well as the opportunity to use the app characters to introduce children to different types of fruits and vegetables. Users also highlighted further opportunities for refinement of the app, for example through incorporating rewards for achieving recommendations and additional health messaging. The App garnered the attention of the Daveys and was the winner of a Gold Davey internationally placing it amongst the top 20% of all applications designed & developed for a smart device.


      Conclusion/Implications/Recommendations:
      Smartphone apps, designed to be interactive and engaging, offer one way of promoting positive health behaviours among diverse groups. Froogie therefore has great potential as a behavior change intervention. However, more work is needed to field test the app using a theoretically-driven framework and to refine the components to address user feedback.


      140 Character Summary:
      Froogie is a gamified approach to improve healthy eating by shifting the statistic of only 1 in 10 children consuming the recommended fruits and vegetables.

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      OS12.02 - Digital Service for Youth: Learnings from a National Texting Service (ID 225)

      Alisa Simon, Kids Help Phone; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Accessing traditional mental health services can be challenging with stigma, lack of services, long waiting lists and other barriers preventing youth from connecting to needed supports. In addition, youth of all ages, are increasingly looking for e-services to support their mental health and well-being. More data is needed on the efficacy of these e-services and the impacts of implementing new digital health solutions for youth. This session will provide results for a new national texting service for youth, including how AI has been used to improve user experience, evaluation results on the impact of the service and movement towards development of Canada’s largest database on youth mental health challenges. Learning Objectives Understand the efficacy of a fully implemented e-mental health solution for youth Determine the challenges, merits and limitations of implementing e-health services for youth populations Review usage data to understand the audiences digital health solutions are attracting and where more work is needed to serve all Canadians. Discuss how e-mental health services can and need to work together to develop an integrated solution for youth in Canada


      Methodology/Approach:
      Young people across Canada are suffering from challenges to their mental health and wellbeing, including mental illness. And yet, an estimated 75% of children with mental disorders do not access specialized treatment services. And, young people are increasingly relying on emergency departments, which, between 2007-2017, had a 66% increase in visits. This is in large part to long waiting times for counselling and therapy, a confusing and fragmented system, stigma, the lack of local services and transportation and dearth of culturally appropriate services. Digital health solutions, like Kids Help Phone’s services, can play a critical role in providing accessible services to youth who, otherwise would not reach out for mental health support. The objective of this session is to present the Kids Help Phone experience as they launched and scaled Canada’s first 24/7 texting line as well as to share evaluation data around the efficacy of e-mental health solutions for youth.


      Finding/Results:
      Top 4 reasons young people reached out through texting was: Anxiety, Depression, Relationships and Isolation. · 24% - of texters spoke about suicidal thoughts Outcomes · 88% of respondents found their texting conversation helpful · 87% reported feeling less alone, less distressed, less upset, more hopeful, more confident and more-in control of their issue. · 60% said they had not shared their experience or feelings about the issue they were texting about with anyone else before. · 79% percent said had they not texted for help, they would have tried to manage the issue on their own, not spoken to anyone, or ignored the issue, hoping it got better or went away. · 7% said they would have gone to an emergency room. Crisis Text Line powered by Kids Help Phone is there for young people of diverse backgrounds, age-levels, and sexual orientation. · 11% - Indigenous · 9% - visible minority


      Conclusion/Implications/Recommendations:
      Digital e-mental health services for young people work and can provide important access points to needed mental health services.


      140 Character Summary:
      This session will provide results for a new national texting service, including how AI has been used to improve user experience and evaluation results

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      OS12.03 - Outcomes of a Heart Failure Telemonitoring Program after Two Years (ID 183)

      Emily Seto, Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto/CA

      • Abstract

      Purpose/Objectives:
      There is growing evidence from clinical trials on the potential of telemonitoring to improve heart failure outcomes, but still very few sustained programs exist as standard of care. A smartphone-based heart failure telemonitoring program, named Medly, was established at the Ted Rogers and Family Centre of Excellence in Heart Function, University Health Network (UHN) in August 2016. The objective of this evaluation was to determine the impact of the Medly Program on patient health outcomes, patient self-care, and healthcare utilization, two years after the initiation of the Program.


      Methodology/Approach:
      This pragmatic pre- and post-test evaluation included questionnaires administered to patients at baseline and 6 months. The questionnaires included the Self-Care of Heart Failure Index (SCHFI) to determine the impact of the Program on patient self-care, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to determine its impact on quality of life, and questions to determine patient satisfaction. Other outcome measures included blood test values, such as brain natriuretic peptide (BNP) which is a prognostic marker for heart function. Healthcare utilization measures included comparing the number of hospitalizations, length of hospital stay, number of visits to the emergency department, and number of visits to the heart function clinic six months before enrolling into the program and six months during the Program. Data analyses included comparing baseline and 6-month values with paired t-tests for data with normal distributions and Wilcoxon signed rank tests for not normally distributed data.


      Finding/Results:
      Approximately two years after initiation of the Medly Program, there were 232 patients who had been in the Medly Program for at least 6 months (mean age 58+/-16; 79% male). Statistically significant findings included improved self-care maintenance (4.9-point SCHFI maintenance increase; p<0.001), improved quality of life (3.8-point MLHFQ decrease; p=0.04), and improved BNP (from 626 pg/mL to 499 pg/mL; p=0.04). No differences in healthcare utilization measures were found, except an increase in the number of heart function clinic visits (from 1.9 visits to 3.8 visits over the 6-month period; p<0.001). Patients generally rated the Medly Program with high satisfaction, such as 90% of patients strongly agreeing (63%) or agreeing (27%) the Medly Program was important for managing their heart failure.


      Conclusion/Implications/Recommendations:
      Over the first two years of the Medly Program, it has been found to improve patients’ self-care management, quality of life, and heart function (i.e., improvement in BNP). The evaluation was underpowered to detect changes in hospitalization and emergency department visits, but an increase in the number of clinic visits was found. However, the cost of additional beneficial scheduled clinic visits may be a positive outcome if it results in improved health outcomes and reductions in hospitalizations. Future evaluations with a larger sample size as the Medly Program continues to expand at UHN and other sites will help determine the impact of the Program on healthcare utilization. Our current evaluation provides preliminary support for the effectiveness of heart failure telemonitoring as standard of care, particularly with the use of a smartphone-based telemonitoring system.


      140 Character Summary:
      A smartphone-based telemonitoring program improved self-care, quality of life, and heart function during its first two years.

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      OS12.04 - Closing the Circle of Care in First Nations Communities (ID 53)

      Karl Mallory, Mallory Consulting Ltd.; Victoria/CA

      • Abstract

      Purpose/Objectives:
      Over the past year, the Closing the Circle of Care Project has made excellent progress. A partnership between Cowichan Tribes and Canada Health Infoway supports First Nations across Canada to adopt purpose-built digital health tools. 100+ First Nations are working with us to improve digital health capacity and enable patients with access to their health records. We are collaborating with First Nations and their healthcare partners to advance interoperability, clinical workflow coordination and patient access – all with the objective of closing the circle of care for First Nations community members.


      Methodology/Approach:
      Cowichan Tribes is a leader in digital health solutions and understands the challenges of implementing digital health tools in First Nations health centres. Canada Health Infoway has a long, successful record of digital health tools implementation. Combining our knowledge, we have developed a comprehensive implementation methodology that addresses the many challenges on-reserve health centres encounter when they transition from siloed, paper-based health systems towards transformative digital health tools. Our National Expansion Project works with interested First Nations across the country to enhance privacy and security capacity, address technical infrastructure gaps, migrate data, manage change, and support adoption and use of new digital health tools for both health centre providers and community members. This comprehensive approach resonates with the First Nations we’re working with and up to 137 First Nations organizations across Canada are implementing the Mustimuhw community EMR (cEMR) and Mustimuhw Citizen Health Portal (an interoperable Personal Health Record). Many First Nations have gone live and are beginning to benefit from their new digital health foundation. Many are now seeking to leverage the interoperability within their new digital health tools to create more tightly coordinated care models with their healthcare partners while increasing the scope and value of patient-accessible health records in the Citizen Health Portal.


      Finding/Results:
      Since our presentation at this conference last year, the number of First Nations participating in our project has increased significantly. As workflows transition from paper-based to electronic, many opportunities for standardization are being identified and advanced. We are working with funding and support agencies to bring efficiencies to screening activities, reporting functions, transitions of care and other areas of day-to-day operations. We are working with regional groups to explore how the growing use of these tools can support surveillance, epidemiology, program evaluation, health transformation, Nation-based capacity development and First Nations Health Data Sovereignty. But perhaps most importantly, hundreds of health care providers in First Nations health centres are now benefiting from practical digital health tools, and their patients are able to access their own health records, communicate electronically with their care providers and participate meaningfully in their circle of care.


      Conclusion/Implications/Recommendations:
      Our results continue to indicate that the implementation of a foundational cEMR and an interoperable PHR solution is a viable, practical and efficient digital health strategy for First Nations. Provincial health care partners should continue their work with First Nations communities, leverage this new digital health capacity and advance opportunities to improve circle of care coordination for First Nation community members.


      140 Character Summary:
      The Mustimuhw cEMR and Citizen Health Portal are advancing capacity and circle of care coordination for First Nations health teams and community members

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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)

      Jennifer Cordeiro, Digital 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)

      Ellie Yu, 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
      Amrit Singh, UBC; Vancouver/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.

      • 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.