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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)

      Sarah Lee, 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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    OS18 - Increasing Digital Access for Patients (ID 30)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
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      OS18.01 - Patient-facing Health Information Technology for Decision-making: Evidence/Implications for Design (ID 536)

      Selena Davis, Faculty of Medicine, Department of Family Practice, University of Bristish Columbia; vancouver/CA

      • Abstract

      Purpose/Objectives:
      Today there is growing interest in patient-facing health information technologies (HIT) that engage self-management decision making. Shared decision making (SDM) is an optimal and collaborative approach to decision making between the patient and care provider. It is neither about convincing the patient to follow the provider’s recommendation nor about leaving a patient to decide on his/her own 1. SDM is fundamental to person-centered care, increases patients’- and providers’ satisfaction, improves quality of life and clinical outcomes, and fosters a better patient– provider relationship 2, yet it has been difficult to embed into clinical practice 3. Personal health record (PHR) technology is a promising approach for overcoming its implementation barriers 4. SDM has been conceptually framed to include four sequential elements - Acknowledge, Consider, Decide, Act – and mapped to patient-facing HIT functionality 5. The purpose of this research was to validate, from the perspective of the user, a functional model for an integrated patient-facing HIT that enables SDM.


      Methodology/Approach:
      Functional requirements analysis is widely accepted to be the most crucial part of system design and indeed implementation success can largely depend on how well this activity is carried out. In this research, the user-centered design approach allowed the patient and providers’ needs and interests to influence system design process. The mixed methods included an SDM task to PHR function mapping exercise followed by a semi-structured interview to collect the system functions that each user requires for the different tasks that they perform. User-centered design is argued to increase the likelihood that the system will fit with users’ expectations and preferences and ultimately promote usability, effective use, and sustained usage 6.


      Finding/Results:
      The research developed an enhanced SDM–PHR (e-PHR) functional model justified by patients and providers (n=22) with a moderate level of agreement (Cohen's kappa 0.60-0.74). Located within an interconnected EHR ecosystem and accessible across mobile computing platforms, e-PHR integrates 23 PHR functions for the SDM process, described as an action of the patient, and characterized as foundational, essential or optional. Many notable design implications were also identified and will be presented, such as notification functionality, tracking the decision-making process, intelligent decision support tools, integrated support networks, cultural safety, health literacy, structured vs. unstructured and manual vs automated data entry.


      Conclusion/Implications/Recommendations:
      It has become increasingly important to implement patient-facing HITs that are designed for self-management decision making, such that the patient and their care team stay better connected and informed, share in the decision-making process and improve care and outcomes. Together, the e-PHR functional model and other design aspects identified may be translated into detailed system design, implementation and operational requirements. The failure of EHR systems to provide patients access to their health information, incorporate patient self-reported data into interconnected systems, and enable the collaborative SDM process, may have undesired consequences for patient health. Just as PHR technology designed on an interconnected architecture with the required functionality has the potential to enable SDM, so too does the integration of the SDM process into the PHR have the potential to drive its value and adoption.


      140 Character Summary:
      User-centered design investigation of a functional model for an integrated patient-facing health information technology that enables shared decision making

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      OS18.02 - Patient Empowerment: A Review of Current and Emerging Approaches (ID 380)

      Brian Lefebvre, eHealth, PHSA IMITS; Burnaby/CA

      • Abstract

      Purpose/Objectives:
      Consumer health is a burgeoning field and many organizations and governments are seeking to empower patients and improve outcomes by providing electronic access to health information and health systems. This review examines both the academic and grey literatures for evidence regarding the use of personal health records (PHR) and patient portals. Key functionality and critical functions for these approaches were identified. The literature was further examined to understand what constitutes an optimal approach to provide a patient-centric solution for patient access and engagement.


      Methodology/Approach:
      A rigorous literature review was undertaken to identify and outline theories, narratives, ideas, and themes from a variety of studies. Additionally, an advisory panel consisting of senior healthcare leaders was established to review and validate findings of the literature review.


      Finding/Results:
      It is clear from the literature that the evidence that PHRs or portals will lead to better health outcomes for patients is not convincing. However, there is ample evidence suggesting the use of portals and PHRs will facilitate enhanced patient-provider communication, patient engagement, and a positive change in health behaviours. Much of this benefit is dependent on patient characteristics such as health and computer literacy, demographics, and current illnesses. There is a lack of research that fully considers the patient perspective. Much of the research available looks at solutions designed as extensions of electronic health record (EHR) or electronic medical record (EMR) solutions, with minimal patient input into design and functionality. Several portal and PHR solutions are provider- or product-centric and don’t fully appreciate the full spectrum of patient information needs. In addition, research shows there are several barriers to and facilitators of these solutions. The literature indicates that patients want access to a wide range of functions including scheduling appointments, renewing prescriptions, communicating securely with health care providers, viewing health records, and journaling about health status. Many of the functions desired by patients may be partially available in the current PHR and portal solutions, but there currently is no approach that takes into account the wider context of patient-centric solutions. A significant part of this review looked into potential solutions through a patient-centric lens. It was evident that neither portal nor PHR approach would provide the optimal solution for patient engagement. Limitations of these approaches include dependence on the availability of the host system in the case of the patient portals, and the effort required by the patient to input or acquire information in the case of the PHR.


      Conclusion/Implications/Recommendations:
      With this in mind, an emerging concept referred to as open digital solutions was seen as the optimal approach. Open digital solutions is an approach wherein the information needed by a patient is borderless and not tethered to one particular system. Open digital solutions are focused on providing information through the use of applications and standards that are not tied to any one product or provider. This is a product-agnostic solution and has the ability to provide for a patient-centric approach.


      140 Character Summary:
      A review of evidence regarding the use of personal health records and patient portals to identify an optimal and patient-centric approach for empowering patients.

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      OS18.03 - Engaged and Empowered: SK Citizen Health Portal (ID 318)

      Lillian Ly, eHealth Saskatchewan; Regina/CA

      • Abstract

      Purpose/Objectives:
      Citizens often do not have enough personalized health information to take an active and meaningful role in managing their own health care. In 2014, a Citizen Health Portal (CHP) was identified as a strategic breakthrough initiative aimed at providing individuals with access to their health system information and empowering them to participate in achieving better health outcomes. By providing individuals with access to their health information, it helps improve the health literacy of Saskatchewan citizens and allows for proactive conversations about their health with their care teams. Saskatchewan’s consumer health solution, CHP, is a web-based service designed for citizens to access their personal health information. It provides opportunity for input of self-generated information, as well as interactive tools that enhance lifelong health quality for individuals and their families. eHealth Saskatchewan (eHealth) went into the pilot with a focus on speed to deliver, cost and benefits evaluation of a citizen centric portal. The portal leveraged existing assets from the provincial repositories such as lab results, immunization history, prescription history and visits to acute care facilities, to provide citizens with valuable health information in CHP. Based on the results from the pilot, it is eHealth’s intent to proceed with a full implementation of CHP. A full production rollout of CHP could result in a transformative change within the health system. CHP could be leveraged by health and other partners to be the gateway for citizens to health information and services.


      Methodology/Approach:
      CHP Phase 2 will be looking to scale from a pilot group of about 1,100 citizens to the general Saskatchewan population. The estimated timeframe for the project is 24 months, which includes the: design and development phase, soft launch or technical go-live, and provincial go-live followed by benefits evaluation activities. Highlights include: Account and Access Management - Revamp the registration process to provide a seamless user experience, while integrating the provincial client registry to offer alignment with identity management in SK. A mobile interface will also be offered for those accessing their CHP accounts via tablets and smart phones. Personal Data Entry & Tracking - Optimize the workflow and work effort of data entry and personal tracking by offering direct integration to wearable devices and mobile health applications so that linked data seamlessly populates citizens’ CHP profiles. Integrated Data Sources - Design and architecture for provincial repository integration will be improved using FHIR which will allow for flexibility to scale to target adoptions and not negatively impact other integrated services. Provincial data sources will include lab results, medical imaging report, immunization history, hospital visit history, and prescription information. Citizen-Provider Interactions - Features and functionalities that offer services and tools that bring together shared care plans to improve health and wellness through collaboration with providers via secure messaging, provider directories, and interactive shared widgets.


      Finding/Results:
      CHP Phase 2 is anticipated to go live in 2019, and so findings and results are not available at this time.


      Conclusion/Implications/Recommendations:
      CHP Phase 2 is anticipated to go live in 2019, and so conclusion/recommendations are not available at this time.


      140 Character Summary:
      SK’s consumer health solution is an online service designed to help improve the health literacy of citizens and promote proactive conversations about their health.

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      OS18.04 - Selling a No-Brainer (ID 128)

      Stewart Cameron, Halifax/CA

      • Abstract

      Purpose/Objectives:
      In 2016 the government of Nova Scotia announced the intention to provide a personal health record (PHR) to all its citizens, the first province to do so. The “MyHealthNS” portal offered patients secure online access to their health summary, their test results, appointment booking and two-way secure communication with their provider (eMessaging). Providers could also send confidential communications to each other. There is evidence that such portals can improve patient safety, satisfaction with care and clinical outcomes.


      Methodology/Approach:
      The provincial rollout followed a very successful 2 year demonstration phase. Patients and physicians had expressed high levels of satisfaction with MyHealthNS. Physician participants advised that widespread adoption of this technology would require integration with practice EMRs and a physician funding model for the provision of virtual care. In response, the Department of Health and Wellness mandated that approved EMRs must integrate with MyHealthNS. However, the newly minted Master Agreement did not make provision for physician payment. Stakeholders agreed that a limited implementation would be presented. It would offer the eResults function but would leave eMessaging as optional. MyHealthNS was offered free to all. Providers choosing to use it received one-time compensation for their training and set up. As in the demonstration phase, patients were enrolled by the online practices.


      Finding/Results:
      After six months, family physician adoption plateaued at about 21%. Patient enrollment by physician offices was less effective than was seen in the demonstration phase. On average, each provider only sent 2-3 new invitations to patients to connect with their practice each month. Most providers were not using all features of the portal. Only a very small number of family doctors chose to activate the eMessage capability of MyHealthNS. A new pilot program was announced by government in March 2018 with improved funding for fuller use of the platform. To be eligible, physicians were required to offer an open invitation policy to their patients, share results and reports to the portal and to enable the eMessage function. After considerable delay in implementation, the pilot went live in August. Two months after the launch, only 135 of the province’s 900 family physicians had signed up. While this tripled the number of physicians using MyHealthNS for patient messaging, there has been feedback from non-participating doctors expressing concern about the potential for increased workload. Some felt patients might experience harm from accessing their reports. Some physicians regarded the recommended two business day response time for eMessages as unacceptable. Many physicians were migrating their EMRs and prioritized this over the portal adoption.


      Conclusion/Implications/Recommendations:
      The majority of citizens and their doctors still do not have access to the benefits of the PHR. For a number of reasons the program has not been fully embraced by the provider community. As well, the plan to have patents enroll through their providers has proven to be problematic. A permanent physician funding model will be needed. Only when these issues are addressed will the full benefits of the portal be available to the population.


      140 Character Summary:
      Lessons learned and barriers encountered in implementing a province-wide patient portal in Nova Scotia

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    OS24 - Co-design Clinician/Patient Interaction (ID 39)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
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      OS24.01 - Development of a Person-Centered Patient Portal Using Stakeholder Co-Design (ID 301)

      John Kildea, Medical Physics, McGill University Health Centre; 1001 Boul Decarie Montreal/CA

      • Abstract

      Purpose/Objectives:
      To share our experience in designing and developing Opal (opalmedapps.com) a person-centered patient portal for cancer patients at the McGill University Health Centre following a participatory stakeholder co-design approach.


      Methodology/Approach:
      Our stakeholder co-design approach comprised six core elements: (1) equal co-leadership including a patient, (2) patient preference determination, (3) security, governance and legal input, (4) user evaluation and feedback, (5) continuous staff input, and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of data access, all medical data should be contextualized with explanatory content, and educational material should be personalized and timely.


      Finding/Results:
      As a person-centered patient portal, Opal provides patients with access to their electronic medical records (appointment schedules, lab results, clinical notes, etc) and empowers them with automatically-personalized educational material tailored to their disease and phase of treatment. For example, it can automatically advise a patient on how to prepare for an upcoming appointment, provide a map of where to go and facilitate appointment check-in. Further, on check-in, Opal can automatically send the patient a symptom questionnaire before seeing the doctor, allowing both the patient and the doctor to focus on the patient’s needs and providing the doctor (and future researchers) with valuable patient-reported outcomes data. Opal is a unique patient portal in five important respects: (1) it was designed and developed from inside the Quebec healthcare system using a stakeholder co-design approach including patients, clinicians and other stakeholders at all levels including co-leading the project; (2) it was designed to encourage patients to submit their symptoms in real-time and/or by engaging them while they wait for appointments; (3) it has been developed with the participation of a large number of medical physics and computer science students at McGill University, thereby exposing the next-generation of researchers to real-world healthcare problems; (4) it facilitates patient self-management by personalizing and contextualizing the provision of information to patients according to diagnosis and stage of treatment; and (5) it was built in a modular way to allow expansion to include data from any EMR in any medical discipline. Presently, the Opal team, in collaboration with St-Mary’s Hospital in Montreal and the Direction générale de cancérologie de Québec, are expanding the app’s use to five other cancer centres in Montreal (St-Mary’s Hospital, CHUM, Cité de la Santé-Laval, HMR and Ste-Justine). Funding is being provided by the Canadian Partnership Against Cancer. The expansion will ultimately allow Opal to become multi-institutional such that patients who receive care at more than one of the participating centres will see all their medical data from each centre seamlessly integrated.


      Conclusion/Implications/Recommendations:
      Inclusion of all stakeholders in the design and development of patient-facing software can help ensure person-centeredness, clinician/patient acceptability, and informatics feasibility. That Opal was developed from the ground up inside a Quebec healthcare institution and is now used by patients in a pilot release is an initial measure of the success of the design and development approach followed. Further measures will be evaluated as the pilot project matures.


      140 Character Summary:
      This presentation is about Opal, a person-centered patient portal smartphone app developed in a Quebec hospital using a stakeholder co-design approach.

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      OS24.02 - A Complex Virtual Care Hub Supporting Perinatal Mental Health (ID 247)

      Ian Chalmers, Founder & Creative Director, Pivot Design Group; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Leveraging Design Research and Service Design to better understand the perinatal mental health system (service/delivery/treatment) and create a digital solution offering patients and stakeholders virtual assessment, resources, and treatment.


      Methodology/Approach:
      Our user-centered design approach is informed by primary and secondary research so designers can uncover and act on opportunities to improve experiences and ensure project decisions are based on real people, their real-life scenarios and lived experience. Discovery began with a project/stakeholder team of leading Perinatal Mental Health Psychiatrists in a kick-off work-session. We identified three main users—Patients, Providers, Partners—and developed personas detailing their usage scenarios and context of engagement; who is directly impacted by the challenge/problem we’re trying to solve for; and who is experiencing the most challenges. We conducted a thorough audit of the current marketplace - the mental health system, strategic action plans (federal, provincial), academic studies/research, and any other existing services, tools, and resources that users might be used to and/or allow us to identify areas of opportunity/innovation. User interviews were conducted to better understand lived experiences with mental health in pregnancy (before/during/after), the home support system, and gain key insights of the perinatal journey. Patients: women (range of racial/ethnic/socioeconomic backgrounds) Providers: specialists (obstetrics, gynecology, psychiatry), primary care, nursing Spouses: typically men


      Finding/Results:
      Research findings were translated into a journey map identifying key users, where they are in the continuum of self-awareness; level of care/service; and ranked to prioritize who’s directly impacted. It provided a vivid but structured visualization, telling a story based on experiences while conveying all influential factors, the accompanying emotions, and detailing current/potential service interactions and touch-points. Having identified key user issues/challenges, we developed an early concept for a comprehensive perinatal mental health Virtual Care Hub that supports the needs of end-users and the researchers whose primary goal is identifying, effectively supporting and treating people with mental health concerns at all stages of pregnancy and pre and postpartum. This complex virtual care hub is comprised of: > six main components - the building blocks to improving access to services/treatments > built-in AI and data collection > a virtual care team > end-to-end user feedback gathering for ongoing evaluation/testing.


      Conclusion/Implications/Recommendations:
      Together, these 4 design outputs were the proof-of-concept and core piece of the business case needed to validate the idea and secure future funding to fully design, test & build this Virtual Care Hub. Patient Personas & Journey Map of three patients with acute, chronic, atypical signs/symptoms of mental illness, constructed from their own perspectives. Strategic Design/Product Roadmap highlighting key communication elements that clearly articulate the vision of the network concept, a detailed requirements document, and how this will function on a design and operational level. Virtual Care Hub Concept visualization articulating key users of the health system, providers delivering care, family units, and the direction/flow for use of the hub. Preliminary Wireframes/Mock-ups demonstrating how integration of the various features/functionality address and support the severity stages/need states for perinatal mental illness.


      140 Character Summary:
      A Service Design approach to better understand perinatal mental health and improve access to assessment, resources and treatment for patients and stakeholders.

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      • Abstract

      Purpose/Objectives:
      People with multi-morbidity and complex care needs face some of the greatest challenges of any patient population. These individuals struggle to manage their many health conditions, which may be exacerbated by psychological and social challenges. Primary care providers working in integrated interdisciplinary integrated teams also find it difficult to manage these patients’ multiple discordant conditions and symptoms, and their often complex social challenges. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges through supporting goal-oriented primary care delivery. Using the tool patients and providers collaboratively develop health care goals on a portal which is linked to a mobile application to help patients and providers monitor and track progress. Multiple providers on the patients care team can view patient goals and work together to care for patients. This presentation describes the technology, development approach, and findings from the exploratory trial.


      Methodology/Approach:
      User-centered co-design principles were integrated with interpretive descriptive qualitative research methods to capture user priorities, experiences, feedback and expectations through 3 phases of development and usability testing. Development was informed by patient/family and provider focus groups, and interviews to develop an initial prototype which was then iteratively modified through user-working groups. Prior to full-scale evaluation (currently underway) we conducted a 4-month multi-method exploratory trial to uncover contexts, mechanisms and relevant outcomes prior to full-scale evaluation. The exploratory trial took place in two interdisciplinary primary care practices in Toronto, Ontario from 2015-2016.


      Finding/Results:
      The iterative user-centred design approach, informed by interpretive description qualitative methods resulted in several changes in direction for the technology. Critically was the need to ensure both usability and meaningfulness of the technology which was achieved through the multi-phased approach which engaged over a dozen patients, caregivers, and providers. Eight providers and 16 patients (7-control, 9-intervention) participated in the exploratory trial, and while little changes was seen in primary quantitative outcomes of quality of life (captured using the AQoL-4D) and patient activations (captured using the PAM), qualitative data revealed important impacts at the patient and provider levels. Patients reported meeting and exceeding their goals of care (which included physical, social and mental health related goals), and providers reported an improved understanding and goal-oriented care processes. Perhaps most notably, usability concerns around efficiency (particularly around fit to provider workflows) were overshadowed by tool effectiveness. Despite the challenges of adopting the technology into primary care practice, patients desire to use the tool and their positive outcomes meant providers were more willing to modify behavior to adopt the technology.


      Conclusion/Implications/Recommendations:
      : While mobile health technologies are not yet pervasive in the primary care space, the experiences in developing, implementing and testing the ePRO tool are instructive. Developing tools that resonate with what is important to end users, in this case patients and primary care providers, can mean a greater willingness to change processes and behaviours to adopt innovative technologies. Overcoming that first hurdle can lead to greater adoption and subsequent improved outcomes at the patient, provider and system level.


      140 Character Summary:
      Exploring the development, implementation of testing of ePRO: a mobile health tool to enable goal-oriented care in primary care settings.

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      OS24.04 - Application of Virtual Care Models into Palliative Care (ID 470)

      Megan Nguyen, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      An aging population, rising chronic disease prevalence, and desire for a quality end-of-life are increasing demand for hospice and palliative care services throughout Ontario. Virtual care solutions have the potential to reduce unnecessary travel for both patients and healthcare providers and decrease the use of costly acute health services and hospital admissions while simultaneously fulfilling the growing desire to die in-home. The purpose of this project was to identify major gaps in palliative care in Ontario that potentially could be addressed using digital health technologies. The overarching goal was to inform how a virtual care model could be implemented and sustainably scaled and spread to maximize its value at the health systems-, patient- and provider-levels. Our investigation was embedded within the context of two virtual palliative demonstration projects in two Ontario regions. The technology consisted of remote symptom monitoring, videoconferencing, and electronic medical management for patients receiving in-home palliative care.


      Methodology/Approach:
      Eighteen qualitative, semi-structured interviews were conducted with administrative stakeholders, policymakers, healthcare providers, and patients involved in the demonstration projects. Participants were identified using a purposive and snowball sampling technique whereby the demonstration project leads provided eligible contacts for interviewing. Interview questions were open-ended and exploratory to gain insight into participants’ experiences with the technology with respect to its features, aspects of implementation into existing models of care, and suggestions for improvement. A qualitative content analysis was conducted to analyze participants’ feedback and identify major themes.


      Finding/Results:
      Our interviews confirmed major gaps in palliative care including inadequate access to services, particularly among rural areas and non-malignant patients, lack of early identification of patients, and lack of communication and integration within patients’ entire circle of care. Based on the interviews, two technology features were identified as high-value: videoconferencing and remote-monitoring. Videoconferencing supports access to and efficiency of palliative care by enabling providers to interact with patients remotely. Remote monitoring (e.g. self-monitoring tools to virtually track pain and symptoms) was found to promote patient engagement in self-management of their care while also enabling the care team to remotely track and respond to important changes in patients’ health status. The evaluation highlighted critical factors for the implementation, scale, and spread of virtual palliative care including: the identification of target users that can benefit more; engagement of end-users in the design of technology; establishing a clinical model that fits into existing workflows; supporting the integration of care; determining a clear value proposition for end-users; incorporating champion leaders to drive adoption of technology onsite; and ensuring the ease-of-use and feasibility of the technology.


      Conclusion/Implications/Recommendations:
      Though the pilot project surfaced many challenges regarding implementation, virtual care models in palliative care could address scarce resources, improve access to services, and support the efficiency and quality of palliative care delivery. Our study provides a list of technological features with high potential and recommendations on implementation strategies that can increase adoption.


      140 Character Summary:
      The project aimed to inform how virtual care can support palliative care in Ontario in the context of two demonstration initiatives.