• +

    OS02 - Venues of Virtual Care (ID 2)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
    • +

      OS02.01 - How Unified Communication Improves Patient Care and Safety (ID 496)

      Asim Masood, Chief Medical Information Officer, William Osler Health System; Etobicoke/CA

      • Abstract

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


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


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


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


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

    • +

      OS02.02 - Service Design for The Chronic Pain System of Care (ID 351)

      Torey Taferner, Management, Pivot Design Group; Toronto/CA

      • Abstract

      Purpose/Objectives:
      TAPMI is an innovative program that brings together 5 unique Toronto-based pain management services under one umbrella. The multi-institutional partnership needed help rethinking the design of the existing processes in order to provide improved access for both chronic pain patients and their PCP’s. The goal was to take a service design approach to understand chronic pain patients, their PCP’s, the existing chronic pain specialty clinics and their unique processes, and the current patient experience across all touch-points. With these learnings, we created a virtual hub where their services could be virtually accessed, intake and triage procedures could be standardized, and ensure a more efficient and accurate referral process for patients and their providers.


      Methodology/Approach:
      As part of our user-centered design process, user/stakeholder interviews were conducted to better understand how key users navigate the health system and current model of care for chronic pain patients, as well as the mental, emotional, and physical impact along the way. We researched international programs innovating in the treatment and triage of chronic pain, and identified areas of opportunity for improvement. Our findings were compiled into a document/presentation with the star finding being a Patient Experience Map. The research and Experience Map further informed the content strategy and design of the website, which we rolled out in phases as the program continued to develop.


      Finding/Results:
      The Experience Map clarified where the team should focus their efforts: seeing the patient journey mapped out visually and sequentially revealed that during the patient’s longest wait times, the system was doing nothing for them. This informed strategic planning of the website and the program itself to develop pain education and self-management tools for patients, as well as resources and educational tools for primary care providers to build capacity and provider chronic pain patients with better, easier access to care. The website provides TAPMI with a virtual home, establishing who they are and the services they provide, as well as accomplishing their primary objectives. They are now able to provide a centralized referral process with one referral form into all of the 5 pain services, and both patients and primary care providers can easily access information about chronic pain, treatment options, and how to access the TAPMI program.


      Conclusion/Implications/Recommendations:
      TAPMI is providing an accessible space where patients can create their own self-management pathway. Space where they can educate themselves on chronic pain and holistic treatment methods, experiment with different techniques, set and work towards their goals — both small and large — and access support services at their own pace and from the comfort of their home. This allows for TAPMI to extend these services to chronic pain patients who live far away or may not have time to attend regular sessions in person. The efforts put forth in this project are placing patients on a successful path to begin their journey to a better quality of life. TAPMI is not only a catalyst for better self-care, but care at the primary, specialist, and system level.


      140 Character Summary:
      A Service Design approach to understanding the chronic pain patient and provider experience and inform the design of an innovative, accessible hub for virtual care.

    • +

      OS02.03 - Breaking Down Barriers:The Perinatal Mental Health Telemedicine Program (ID 273)

      Alisha Ramlogan, Sinai Health System; Toronto/CA

      • Abstract

      Purpose/Objectives:
      The literature indicates that during pregnancy and the postpartum period, women have a very high incidence of new onset mood and anxiety disorders and high relapse rates for pre-existing psychiatric disorders. However, only 33-50% of women receive services provided by existing community groups, which do not always identify, monitor or treat the mental illness. These women often end up going to emergency departments or do not access services at all. The objectives of the program are the following: 1) Increase accessibility to specialized perinatal mental health services in the community 2) Develop and promote an appropriate interdisciplinary care pathway to serve women with perinatal mental health concerns 3) Promote perinatal mental health knowledge and skills translation to community care providers through various educational activities including telemedicine 4) Strengthen collaboration of hospital and community service providers in providing community-based services 5) Improve patient and family and provider satisfaction with the delivery of an improved consultative experience using telemedicine technology


      Methodology/Approach:
      With the use of Ontario Telemedicine Network (OTN) technology, the Perinatal Mental Health Telemedicine Program has been able to provide ongoing follow-up and support for patients in their own homes. Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. It is an efficient and cost effective way for patients to access specialized perinatal mental health care without the associated costs of travel from their home environment.


      Finding/Results:
      Performance indicators include the number of unique patients who engage in the program as well the total number of telemedicine events. By the end of fiscal year 2017-2018, the total number of telemedicine events was 1326. This exceeded the telemedicine numbers during the previous year, which were 1245 events. In terms of new unique patients who were seen via telemedicine, the final count was 198. In addition to this, the program has also obtained other metrics including patient satisfaction with telemedicine. For fiscal year 2016-2017, 399 surveys have been sent out with a total of 133 responses (33.3% response rate). Based on the responses, there is a high level of satisfaction. Some of the positive feedback from telemedicine patients include: “It's very simple to use. I really like it and feel very grateful for this service. It has allowed me to receive a closer psychiatric monitoring of my health condition without adding additional stress and without spending time and money on transportation." and “An absolutely fantastic program that enables people like me who live in smaller cities to access the resources traditionally afforded to only those in large cities (without the hassle of travel)."


      Conclusion/Implications/Recommendations:
      Through the implementation of telemedicine, the Perinatal Mental Health program has been able to reach deeper into the community to evaluate, diagnose and treat patients both within the TC-LHIN and in remote locations across the province. In terms of spread, the central focus of the telemedicine program include further outreach to various community partners, including family health teams and community health centers in order to provide consultations, education and case conferences leveraging telemedicine technology.


      140 Character Summary:
      The Perinatal Mental Health Program aims to improve access to perinatal mental health services and promote capacity building by leveraging the use of telemedicine.

    • +

      OS02.04 - Practical Apps: Evidence-Based Physician Reviewed mhealth Care Apps for Patients (ID 99)

      Payal Agarwal, Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      There has been great excitement and growth in the mobile health field; however, due to a lack of oversight, it is likely that many of these apps are of poor quality posing potential risks to patients. Previous attempts, including efforts at the National Health Service, had significant limitations or were not sufficiently rigorous to inform health system decision makers. The objective of the Practical Apps project is to leverage a comprehensive framework to develop set of credible reviews that identify high quality, patient-facing health apps that have the potential to impact chronic disease outcomes across the health system.


      Methodology/Approach:
      The first phase of this project involved the development of a methodology to review mobile health apps for chronic disease management. The research team reviewed relevant academic literature and regulatory guidelines. No current evaluation criteria were comprehensively addressed all factors relevant to real-world clinical use. Therefore, a new framework was created incorporating previously identified quality criteria from multiple resources, listed and grouped into six common themes. A group of primary care physicians were trained in using the resulting framework to review 4-5 apps related to a single common chronic condition. Reviews were posted on the site practicalapps.ca with the ability for clinicians to subscribe to receive alerts of new reviews.


      Finding/Results:
      The resulting framework integrates quality heuristics related to both clinical and regulatory needs to support the rapid evaluation of app quality, thus enabling further decisions around clinical use and scale (see Table 1). Table 1: Mobile Health App Quality Framework Dimension Details Features overall purpose, user engagement, clinical integration, data integration Clinical Effectiveness creator credibility, evidence-based information, empirical evidence, clinically comprehensive Usability learnability, memorability, efficiency, satisfaction, visual appeal, clarity Privacy/Security privacy policy, secure data storage, data sharing, permission management, password use Safety/Reliability technical performance, technical support, ongoing updates, error handling, company profile Accessibility cost, available languages, health literacy level, compatible devices, accommodates disabilities Overall 1/5=no clinical use, 3/5=potential for clinical use with limitations, 5/5= appropriate for widespread clinical use and scale The framework was utilized to review 70 apps relating to 17 different health topics. Of the apps that were evaluated, the average overall rating was 3/5 with 39% receiving a rating of 3.5 or higher. However, there was significant variation on key indicators and between topics, especially with regards to clinical effectiveness and privacy/security. Overall, the apps rated well for accessibility and usability but poorly for privacy/security and clinical effectiveness. Over one year, over 3000 people, mostly clinicians, have registered for an online subscription to the site.


      Conclusion/Implications/Recommendations:
      The Practical Apps project and framework provides an effective tool to rapidly identify and inform use and scale of high quality mobile health apps for chronic disease management. The Practical Apps website has received significant amount of unique visitors and subscribers who read the reviews. Currently, our research team is working on a scoping review to inform a more comprehensive updated version of this framework. The results of the Practical Apps can support both clinicians and health systems decisions makers in identifying and supporting high quality apps for patient use.


      140 Character Summary:
      Practical Apps is a project aimed to assess the quality of patient-facing mobile health applications for chronic disease management.

  • +

    OS13 - My Information, My Access! (ID 22)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
    • +

      OS13.01 - Implementation and Impacts of a Pediatric Patient Portal Launch (ID 423)

      Ellen Goldbloom, Pediatrics, Endocrinology, CHEO; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      A pediatric patient portal was piloted in Fall 2014 and launched November 2016 in attempt to increase patient/family engagement in their care and provide a secure means of communication with the health care team. We aim to continuously evaluate key process indicators (KPI) and end-user feedback both quantitatively and qualitatively.


      Methodology/Approach:
      Evaluation of the pilot guided expansion of portal functionality to include messaging to the health team and patient entered information (e.g., new allergies, medications, questionnaires). Annual evaluation, KPI data and a partnership with a second pediatric hospital enhanced the value-added features for families.


      Finding/Results:
      The portal is available to all patients/families and 2-way messaging is live in 30% of teams (~800 messages exchanged each month) and expanding to all clinics. Number of accounts is increasing steadily with highest uptake in clinics with complex patients populations (e.g., 47% of complex care clinic patients). Portal-user feedback has been positive: • 94% viewed health information • 94% agreed that registration was easy and that the portal was easy to use • 92 % agreed that portal health information was accurate and 93% understood it • 91% agreed that they received test results in a timely way and 91% agreed that they were easy to understand • Of those sending secure messages, 91% felt the response was timely and 94% found it helpful • Due to the portal, 54% avoided a call to a clinic and 31% avoided a clinic visit. • 76% agreed that the portal helped them feel more prepared for next clinic visit We underestimated the profound impact on families who have described the portal as their lifeline. since it relieves their burden of compiling and cataloguing information. Integrating the use of a patient portal also required shifting the culture of how the chart is regarded – moving from a communication tool for the clinical team to a shared resource of information. Youth access needed to be contemplated ensuring that youth consent and control access to their information. Providers’ worry about the increased workload related to questions about information seen in the portal and messages received was not realized. Nurses report streamlined documentation and efficiency with messaging. Providers note that their clinical visits have been reshaped. With less time spent reviewing information, more time can be spent to address important issues and solidify care plans. Errors in the chart noted by families was a worry of providers, but have been found to build trust and ultimately increases EMR accuracy and potentially patient safety.


      Conclusion/Implications/Recommendations:
      Patient portals are becoming more common place and require a shift in culture to embrace the benefits. We expected positive patient/family feedback and clinician apprehension. We did not predict the impact that families describe or the change in the exam room. Early adopters sharing their stories can assist with change management. Pediatric patient portals provide an impetus ensure that activation strategies consider the need for appropriate proxy and youth access. Functionality that allows for communication and updates from families facilitates a truly shared communication tool that leads to empowerment.


      140 Character Summary:
      We describe launch and evaluation of a pediatric patient portal with functionality to review and add information as well communicate with the health care team.

    • +

      OS13.02 - e-Health Portal Improves Pregnancy-Related Concerns of Inflammatory Bowel Disease Patients  (ID 389)

      Reed Sutton, Edmonton/CA

      • Abstract

      Purpose/Objectives:
      The impact of a mother’s chronic disease on fetal development makes dealing with inflammatory bowel disease (IBD) during pregnancy complicated. Almost 50% of women with IBD have poor reproductive knowledge; this has been associated with unsubstantiated concerns toward pregnancy, and towards IBD medications. We developed an educational e-health portal for pregnancy in IBD patients. We have previously shown it can improve knowledge acutely and in follow up. We now aim to evaluate its effectiveness for addressing IBD patients’ reproductive and medication concerns.


      Methodology/Approach:
      IBD patients aged 18-45 years accessed an e-health portal covering the topics of heritability, fertility, surgery, pregnancy outcomes, delivery, postpartum, and breastfeeding in the context of IBD and IBD medications. They completed pre-, post-, and 6+ month post-intervention questionnaires covering IBD-specific reproductive concerns, beliefs about medicines (BMQ), medication adherence (MARS), and knowledge (CCPKnow). The non-parametric McNemar’s test was used to determine if the proportion of patients who had each pregnancy concern decreased post-intervention. For medication concerns, the Wilcoxon signed-rank test was used to compare median differences between Likert scores. 95% confidence intervals and SPSS Version 23 were used for all analysis.


      Finding/Results:
      Seventy-eight of 111 patients (70.3%) completed pre and post-intervention questionnaires. Demographics for the 78 are as follows: median age 29.3 (IQR 25.6 - 32.9) years; 54 (69.2%) Crohn’s disease; 21 (26.9%) ulcerative colitis; 63 (80.3%) females, 5 (7.9%) currently pregnant and 19 (30.2%) previously pregnant. Medication history: 10 (12.8%) sulfasalazine, 67 (85.9%) mesalamine/5-ASAs, 17 (21.8%) budesonide, 63 (80.8%) steroids, 12 (15.4%) methotrexate, 55 (70.5%) azathioprine/mercaptopurine, 42 (53.8%) biologics, and 38 (48.7%) antibiotics. Post-intervention, the median number of reproductive concerns decreased from 3 to 1, and remained, 6+ months later (p<0.001*). Individual concerns are visualized in Figure 1 for all time points. The median BMQ score decreased from 28 to 25, and remained 6+ months later (p=0.032*). The median BMQ scores significantly decreased post-intervention for concerns about having to take IBD medication (p=0.006*), becoming too dependent on IBD medication (p=0.041*), and the long-term effects of IBD medication (p=0.036*). The percentage of participants adherent to medications also increased from 82.4% to 87.8% post-intervention (p=0.099). figure 1.png


      Conclusion/Implications/Recommendations:
      Using an e-health portal reduced IBD-specific reproductive and medication concerns for IBD patients. Medication adherence was high and correlated with beliefs of necessity (BMQ). Pregnancy in IBD patients should be referred to high quality (readable, interactive, up-to-date) educational resources, particularly when they are unable to attend specialized clinics / consultation. Our study suggests these may have beneficial and longstanding implications for knowledge, concern, and medication adherence.


      140 Character Summary:
      After accessing an innovative e-health portal, women with inflammatory bowel disease had lowered concerns regarding reproduction and medications.

    • +

      OS13.03 - Online Patient Health Portals: A Survey of Public Perceptions (ID 315)

      Alicia Polachek, W21C Research and Innovation Centre, University of Calgary; Calgary/CA

      • Abstract

      Purpose/Objectives:
      Secure, comprehensive health information exchange among the care team—including patients—is foundational to high quality, continuous health care. Despite this, many Canadian jurisdictions do not have an integrated system that communicates health information to all care providers or allows patients to access or contribute to their health records. The use of online patient health portals is therefore being considered or implemented in various jurisdictions to enhance access to health information. Given increasing interest in online patient health portals, this study examined public perceptions regarding the use of online patient health portals to access, manage, and share health information.


      Methodology/Approach:
      Public perceptions were examined using an electronic questionnaire that was accessible from October 23 to December 8, 2017. The questionnaire included both closed- and open-ended questions regarding who should have access to their health information, what information and functions should be available in online patient health portals, how people would like to interact with their care team, and perceived benefits and concerns of using online patient health portals. The study was advertised through various electronic, radio, and print media to recruit a voluntary sample of English-speaking Albertans over the age of 18 with valid Alberta Health Care numbers. Responses were received from 1530 respondents. Quantitative data was analyzed using descriptive statistics and plots, while qualitative data from open-ended responses was analyzed using inductive thematic analysis.


      Finding/Results:
      Respondents supported the use of online patient health portals to access, manage, and share health information. Most respondents (92%) agreed that people should have access to their health information through online patient health portals, including information such as medication and medical history, specialist reports, and test results. Furthermore, respondents agreed that parents (71%) should have access to their child’s portal, as should alternate decision makers (81%) when adults are unable to understand or manage health information. Respondents also agreed that they would like online patient health portals to be used to communicate with providers (79%) and share (90%) information within the care team for the purposes of care. Respondents noted many potential benefits related to the use of online patient health portals, including improved care coordination, opportunities for patients to be informed about their health and health care, and access to one’s health information from any location, at any time. Despite overall support, respondents also identified several important concerns. In particular, many respondents (52%) were very concerned about information security and the possibility of health information being accessed by those outside the direct care team. Nevertheless, most respondents (84%) agreed that the benefits outweighed the concerns.


      Conclusion/Implications/Recommendations:
      These results suggest that the public holds positive views regarding the use of online patient health portals. Despite some concerns, the public is keen for such portals to be implemented, emphasizing that any concerns could be mitigated through careful attention to how the portals are implemented, governed, and monitored. Given this strong support, Canadian jurisdictions should continue to consider the greater use of online patient health portals that allow for improved health information exchange among the entire care team, including patients.


      140 Character Summary:
      Despite some important concerns, most Albertans support the use of online patient health portals for accessing, managing, and sharing their health information.

    • +

      OS13.04 - Implementing a Patient Portal in Fraser Health (ID 133)

      Brianne Bourdon, Fraser Health; Surrey/CA

      • Abstract

      Purpose/Objectives:
      Fraser Health partnered with Sunnybrook Health Sciences Centre to implement the MyChart patient portal. MyChart recognizes that patients are the central stakeholders in their health care and streamlines how a patient's health record is accessed and shared. In fall of 2018, Fraser Health implemented the MyChart patient portal to the renal patient population as a targeted initial launch. The objectives of implementing a patient portal to the Fraser Health patient population were threefold: to provide patients with access to their health record, to enable patients to access to their health information from anywhere at any time, and to improve the process for release of information.


      Methodology/Approach:
      Fraser Health used a proof of concept methodology for the initial launch of the MyChart patient portal. The renal program was chosen as the targeted patient population and clinician group for the proof of concept. Renal patients are invested and knowledgeable in their health care and regularly access the renal program and Fraser Health facilities. The Fraser Health instance of MyChart used an iterative approach in which eHealth, professional practice, the renal program, and patients were partnered to design and build the system and incorporate change management at project onset. A logic model was used to design the evaluation of the proof of concept.


      Finding/Results:
      There are several findings and learnings from the project phase of the Fraser Health MyChart patient portal. Although it is a patient portal, it is important to engage clinicians early. Clinicians are advocates for the patient and improvements to patient care. The renal clinician team is excited for the patient portal and have been strong change agents supporting communications and change management activities. As well, it is important to engage clinicians early along with health records and professional practice to bring awareness to patients’ ability to view their records. This has implications to release of information and clinician documentation practices.


      Conclusion/Implications/Recommendations:
      This proof of concept will be used to inform the next phases for Fraser Health’s patient portal. Future phases will include new patient populations onboarding and enabling more features via integrations to MyChart. Two such features include integrations to the provincial lab information system and provincial diagnostic imaging viewer. This will be pioneering to provide to patients as these provincial systems are presently intended for clinician viewing. The evaluation of the proof of concept will also help inform how Fraser Health approaches subsequent rollouts of MyChart: big bang or by patient population.


      140 Character Summary:
      Fraser Health implemented a patient portal and used the renal program for the proof of concept initial launch that will inform next phases for the patient portal.

  • +

    OS19 - Using Analytics/AI to Improve Care (ID 31)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
    • +

      OS19.01 - A Learning Health System for Breast Cancer: Pilot Project Experience (ID 531)

      mark Levine, Oncology, Hamilton Health Sciences; Hamilton/CA

      • Abstract

      Purpose/Objectives:
      *Background: In oncology, frontline clinicians need reliable and timely information on treatments administered to patients and associated impact on patient outcomes e.g. tumor shrinkage, side effects and quality of life (QOL). Currently, timely information is not easily accessible. In 2007, the Institute of Medicine described a Learning Healthcare System (LHS). This was a new paradigm on the critical role information played in the delivery of health care services to meet the health needs of populations. The LHS creates a continuous cycle or feedback loop in which scientific evidence informs clinical practice, while data gathered from clinical practice and administrative sources inform care and scientific investigation. Stage III breast cancer presents with large bulky breast tumors breast and was chosen as the clinical model for our pilot study. There is variation in the treatment of this cancer because physicians differ in their interpretations of research evidence. Objective:* To develop and validate a prototype LHS platform based on IBM Watson technology that can describe the clinical course of patients with Stage III breast cancer over a 24-month time period. In doing so the pilot project had two-dimensional proof-points: to characterize the patient related outcomes while at the same time validating Watson Natural Language Processing (NLP) technology.


      Methodology/Approach:
      A sample of 50 patients with Stage III breast cancer who presented to the Hamilton Health Sciences (HHS) Juravinski Cancer Centre (JCC) between 2013 and 2015 was identi?ed. Clinical information from these patients e.g. tumor stage and characteristics; treatments received; side effects; and disease status (cancer recurred or not) were extracted from several clinical data systems: MEDITECH (in-hospital notes, imaging, lab results); MOSAIQ (JCC notes, radiation); OPIS (chemotherapy); and ESAS (QOL) and used to create the LHS. De-identi?ed electronic health record data extracts were provided by HHS and imported into IBM Cloud-based AI systems. IBM developed specialized NLP annotators in support of this pilot project to extract medical concepts from unstructured clinical text and transform them to structured attributes. The algorithms developed during the first phase were then applied to 18 additional Stage III breast cancer patients from the same years in a validation phase. The data extracted by the NLP annotators from theses patients was compared against the data in the medical chart (gold standard) for 9 indicators.


      Finding/Results:
      The project demonstrated that HHS has the necessary data to build a view of the patient journey and that it is possible to extract, read and combine this data in a way that helps unlock the potential value and derive insights for clinical decision support. The natural language process had a high degree of accuracy and agreement with the gold standard data: there was disagreement for 6 of 171 pieces of information, 3.5% (95% confidence interval=1.3% to 7.5%).


      Conclusion/Implications/Recommendations:
      Our Breast Cancer LHS pilot study has shown the ability to take HER data from a number of sources, harness it in real time and make it accessible to clinicians. This approach could also be applied directly to other cancers and diseases as well.


      140 Character Summary:
      Pilot research experience on the application of analytic and cognitive capabilities in support of creating a Breast Cancer LHS.

    • +

      OS19.02 - Using AI to Improve Access to Mental Health Services (ID 414)

      Colleen McDowell, IBM ; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Even with access to effective services, many people struggling with mental and life challenges do not seek timely support. This talk will share lessons learned as we applied AI technologies to the mental wellness space. I will discuss how AI can help with early detection of cognitive changes by providing access to safe, stigma free, and non-judgmental space to help people lead better lives and connect them with assistance sooner. This talk will explore how we are using AI technologies in an innovative way to help people lead better lives and connect them with assistance sooner. I will share the story of how we are leveraging IBM's Watson APIs and custom machine learning to work alongside counseling staff to provide assistance and make a deep impact in this global issue.


      Methodology/Approach:
      Citizens and employees no longer accept lengthy paperwork, complicated processes, and organizations centered on procedures and tradition as the norm, especially when it comes to personal health and wellness. I will speak about how IBM has created a Cognitive Assistant tool, harnessing IBM Watson to connect Canadian IBM employees to internal and external mental health and wellness resources and how this is not only being rolled out across IBM Canada, but is being developed for public, military and higher education facilities.


      Finding/Results:
      IBM used the most cutting edge cognitive technology, powered by Natural Language Processing capabilities, to build a Virtual Assistant (VA), trained to guide IBMers to existing services and resources to help with work, health, family, and life challenges. Working closely with counsellors and subject matter experts to ensure that the responses were optimized to provide a supportive and informative response, the anonymous and confidential VA allows IBMers to ask questions in a safe and private space, away from shame, fear, and societal or associative stigma. Today we have all IBM Canada employees connected with services to help them live better lives. Additionally, our solution has enabled those who would usually suffer silently and never call a help line, get anonymous and immediate access.


      Conclusion/Implications/Recommendations:
      Cognitive solutions, services and innovations are enabling the future for healthcare and life sciences. With healthcare data growing exponentially, much of it unstructured, IBM has developed a new class of cognitive systems to augment the human capacity to understand — and constructively intervene into — our complex, emergent health systems, while building a cloud ecosystem for discovery, innovation and advancement to tap into new data sources to make the healthcare system more integrated and effective.


      140 Character Summary:
      Demand for counselling is outpacing capacity. Hear how AI can provide self-service capabilities and guide those who need it to human care

    • +

      OS19.03 - Impact of a Redirection Program on Emergency Department LWBS Patients (ID 303)

      Alexandre Messier, Logibec Inc.; Montreal/CA

      • Abstract

      Purpose/Objectives:
      Emergency department patients who leave without a medical examination, or leave without being seen (LWBS), account for about 10% of the 14,000,000 annual ED visits in Canada, and few solutions to this problem have been identified. The redirection of patients from the emergency department to nearby clinics has been proposed to reduce the proportion of LWBS patients. The purpose of this study is to document the impact of the redirection program on LWBS patients.


      Methodology/Approach:
      This prospective cohort study was conducted using a convenience sample of patients recruited in an academic center. No interventions performed by clinicians or through the program have been modified by this research. Patients gave verbal consent for the research, previously accepted by the ethics committee, and then completed a questionnaire adapted to the context of the redirection program. Feasibility was assessed based on the proportion of potentially eligible patients with a contraindication preventing participation, and acceptability based on the proportion of patients who accepted redirection. The results are presented as the proportion of patients with a confidence interval (CI) of 95%. The Hôpital du Sacré-Coeur de Montréal (HSCM) project is unique in that it requires simple technology and is not based on patient selection using the triage levels 4 and 5 of the Canadian Emergency Department Triage and Acuity Scale (CTAS). *Patients are selected using a medical algorithm created for this purpose only and integrated in the application. The algorithm has proven to be safe following the redirection of 30,000 patients in three Montreal hospitals. The triage staff have direct access to the availabilities of front-line clinics and can book appointments for ED patients* directly through the application. The entire process takes an average of 30 seconds.


      Finding/Results:
      During the period studied, 554,474 visits were analyzed and 49,239 (8.9%) patients left without being seen. The regression curves before and after implementation of the program were in the order of 6 with a pre-program R2 of 0.49 and post-program R2 of 0.43. An LWBS rate of 11.6% was observed just before the program was implemented and 7.5% immediately after (absolute difference of 4.1% [CI95% 3.4-4.8], p<0.001; relative difference of 35%).


      Conclusion/Implications/Recommendations:
      An ED patient redirection program has resulted in a significant decrease of more than a third of the proportion of LWBS patients. The number of patients who leave without being seen, as well as the wait time for ambulatory patients, decreased significantly from day one; the 48-hour return rate is low (less than 4%) and there are no adverse health consequences for patients. With regard to costs, most experts believe that it costs 3 to 4 times more to treat the same patient in the emergency department than in a front-line clinic. All research on the solution was carried out by the Hôpital du Sacré-Coeur de Montréal's Emergency Medicine Research Centre before any involvement of a private company.


      140 Character Summary:
      The medical algorithm integrated to the technology allowed to safely redirect 30,000 patients in 3 Montreal hospitals by not using the triage levels 4 and 5 of the CTAS

    • +

      OS19.04 - Activate Your Content with Enterprise Search (ID 305)

      Laura Hall, Quanum Enterprise Content Solutions, Quest Diagnostics ; Mason/US

      • Abstract

      Purpose/Objectives:
      Alberta Health Services is deploying an enterprise-wide, medical records search capability that unlocks the value of historical patient records with the potential to save lives and improve patient outcomes by radically reducing the time needed to retrieve critical patient information. The search capability also reduces the cost of retrospective cohort studies used by physicians to improve the standard of care. This presentation will showcase the hospital’s journey to drive operational excellence for the CancerControl program. Digitizing paper records to enable contextual, key word searches drives process improvement and organizational efficiencies. The objective of this session is to share this journey such that other organizations can apply the same technologies, methodologies, and lessons learned.


      Methodology/Approach:
      While keyword search capability has become ubiquitous on the web and in many other industries, stringent privacy regulations regarding patient information access have hindered the development and implementation of similar search capabilities in hospitals. AHS found technology tailored to medical records that preserves patient privacy and maintains medical records integrity while providing the search paradigm we have learned to expect from tools like Google. AHS was experiencing particular problems in Alberta Health Services CancerControl where an advanced search search capability on static scanned documents was deemed a potential for clinical improvement. A pilot project was developed focusing first on these problems.


      Finding/Results:
      The CancerControl program realized multiple operational efficiencies, improvements to staff satisfaction, and overall improvement to the patient experience. This presentation will detail the before and after state of key performance indicators.


      Conclusion/Implications/Recommendations:
      AHS will share implementation challenges and lessons learned along with their next steps to rollout the enterprise search tool to other areas of the organization. The benefits to AHS will be demonstrated through Oncology use case and a brief video.


      140 Character Summary:
      AHS's enterprise search system will unlock the value of historical patient records with the potential to save lives and improve outcomes.

  • +

    OS25 - You've Got Mail, But No Paper! (ID 40)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 4
    • +

      OS25.01 - Adoption and Perceived Usefulness of Health Information Exchange (ID 290)

      Aude Motulsky, École de santé publique de l'Université de Montréal; Montreal/CA

      • Abstract

      Purpose/Objectives:
      Health information exchanges (HIE) are seen as an essential technology for improving healthcare quality and efficiency by allowing patient-centered data exchange over time and across organizations. The objective of this study was to describe the adoption and the perceived usefulness of an HIE in the province of Quebec, four years after its full implementation.


      Methodology/Approach:
      A mixed method study was conducted, including longitudinal descriptive analysis of usage data obtained from the Quebec Ministry of Health from Jan 1st 2017 until Dec 31st 2017, combined with in-depth case studies from 5 primary health care organizations using different commercial electronic medical record (EMR) systems. Data collected in each case included interviews with users (n=66). The number of users by role and by tool were described, as well as a detailed analysis of the weekly accesses by physicians.


      Finding/Results:
      Up to October 2017, a total number of 47 928 individuals had received a security certificate to access the HIE, including 14 127 physicians and 17 932 nurses. However, only 68% of these physicians and 48% of these nurses actually accessed the HIE in October 2017, while 86% of these pharmacists accessed it. For physician users, two types of tools were available to access the HIE, depending on their availability in their work place: an EMR integrated with the HIE, or a Web Viewer. While 50% of general practitioners and 49% of nurse practitioners have accessed the HIE using an integrated EMR, only 11 % of specialists have used an integrated EMR to access the HIE. The number of weekly accesses by physicians to the medication domain (Fig 1A) was higher when using an EMR in the outpatient setting (O-EMR). This was confirmed with the case study indicating that the advanced feature of importing granular medication data into the EMR was only possible using an O-EMR. For the lab domain (Fig 1B), the level of use was similar for O-EMR and Viewer, and lower for EMR in acute care. For images (Fig 1C), the level of use was higher using the Viewer application. This might be related to the fact that the image was only accessible using the Viewer application. Perceived benefits were reported by users across all dimensions of care performance, including accessibility, efficiency, quality and safety, as well as patient experience. capture d’e?cran 2018-10-16 a? 20.57.20.png


      Conclusion/Implications/Recommendations:
      This HIE was used by a diverse group of healthcare professionals and was able to offer concrete perceived benefits in primary care. Our results suggest that the availability of the advanced features of HIE/EMR integration was essential to stimulate adoption and perceived benefits.


      140 Character Summary:
      The adoption and perceived usefulness of Health information exchange in Quebec was evaluated four year after the full implementation of the system.

    • +

      OS25.02 - Rearchitecting Interoperabiiity (ID 226)

      Karim Keshavjee, InfoClin Analytics; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Around the world, countries have struggled with true interoperability: standardized digitized data flowing easily from organization to organization and seamlessly being used at the point of care for improving patient care. Over the last 3 years, we have identified several barriers to the smooth flow of standardized data across organizational boundaries and its use at the point of care. Our research aims to find acceptable, feasible and easy to implement solutions to our current interoperability woes. This presentation integrates the findings from several different research projects.


      Methodology/Approach:
      Integration of several research projects which have used barrier analysis, stakeholder analysis, economic analyses, critiques of existing interoperability projects, key informant interviews with national and international leaders in health IT and information governance (N=70) and prototype testing as the methods to better understand how we can overcome the barriers to interoperability.


      Finding/Results:
      The barriers to interoperability are multi-faceted: 1) Privacy and confidentiality, 2) Program Governance, 3) Information Governance, 4) Cost and effort of standardization, 5) Cost and effort of developing new methods of understanding and using data obtained from another setting, 6) Incomplete coverage of use cases, 7) Lack of appropriate leadership, 8) Lack of compelling business cases and returns on investment, 9) Lack of aligned incentives and 10) Lack of easy to use methods to standardize data.


      Conclusion/Implications/Recommendations:
      Solutions for several of these barriers have been developed in partnership with academia, industry and clinicians. This presentation will cover: Principles of governance for data sharing, economic models for developing compelling business cases, findings from an international survey of what works and doesn’t work in other countries and methods and mechanism to align incentives. Barriers that require additional research will be highlighted.


      140 Character Summary:
      Barriers to interoperability are many, but can be overcome. Stakeholders must work together to overcome for the benefit of Canadians.

    • +

      OS25.03 - Health Information Standards and Results Distribution in BC – Paper Reduction (ID 126)

      Francois Chevallier, Excelleris, Lifelabs; Burnaby/CA

      • Abstract

      Purpose/Objectives:
      The Health Information Standards and Results Distribution Executive Steering Committee in BC has taken steps to phase out the delivery of paper based (Canada Post/Courier) clinical reports. This change reflects the Ministry of Health’s strategic priority of delivering a system of responsive and effective health care services for patients across British Columbia. Excelleris supported this important initiative as the purveyor of varied types of clinical health information for partner health authorities. In this panel presentation, Excelleris and members from two Health Authorities in BC will share their perspective and the results of this initiative.


      Methodology/Approach:
      A project based approach was used for this initiative. At its core was a formal communication & engagement strategy undertaken to support transition of providers to an electronic distribution channel. The joint team developed: 1) Detailed process flows, 2) Tracking systems for provider transitions, 3) Detailed procedures document for the joint project team, 4) Monthly status reports, 5) Weekly dashboard reports and 6) Technology enhancements. The team has continually applied lessons learned and focused on high-volume paper recipients to reduce operational costs as quickly as possible


      Finding/Results:
      In 2017, over 150,000 paper reports were being distributed to health care providers every month in the Lower Mainland of BC. By 2019, we expect that just over 6,000 paper reports per month will be distributed (as this initiative is still under way, exact number will be provided during the conference) Achieving a 95% reduction in paper reduction: * Brings more reliable, timely, and secure access to clinical reports (enabled through electronic distribution) * Enhances quality of patient care; * Is improving patient confidence that reports are protected, viewed and actioned in a timely manner * Leverages investments in technology and effective processes to maximize the use of health care dollars * Contributes to environmental objectives by protecting our forests and reducing carbon emissions.


      Conclusion/Implications/Recommendations:
      Moving from paper to electronic distribution required the cooperation of several stakeholders, as well as the coordination several work streams that had to be brought together and managed simultaneously. Although this was a technology driven project, the largest challenges faced by the working group were related to change management, process review and communication. A multi-disciplinary approach was necessary to achieve the goals. We will examine regional differences with technology adoption, discuss the main objections received by the working group, and review how those were addressed, and provide general recommendations for other provinces, health authority or hospitals who wish to engage in a similar initiative.


      140 Character Summary:
      Healthcare providers in BC switched to electronic reports distribution. This presentation highlights the results, challenges and learning

    • +

      OS25.04 - HIE Adoption Lessons from International Healthcare Systems (ID 46)

      Chris Hobson, Orion Health; Toronto/CA

      • Abstract

      Purpose/Objectives:
      The topic presented here is adoption in relation to the next phase of Health Information Exchange use. This discussion looks at two successful HIE initiatives, Northern Ireland’s Electronic Care Record (NIECR) and Alberta’s Netcare Portal, and discusses why these initiatives continue to be used heavily by clinicians. Both Northern Ireland and Alberta used disparate clinical systems and recognized the increasing amount of clinical time devoted to locating patient information, which prevented effective and timely decision-making. The solution was to include clinically relevant information, assembled from electronic systems located anywhere in the service and presented in real-time via a single, web-based, easy-to-use solution, accessible from anywhere.


      Methodology/Approach:
      Both jurisdictions took a pilot-to-production approach to rolling out their portal. In Alberta, once the initial pilots with selected physicians and clinical providers were completed, data sharing was opened up to any authorized professional interested in using it. Initial data sharing was focused on drug, laboratory, and diagnostic imaging results. With each successful integration, new components and functionality have been added to Netcare. In Northern Ireland, the initial pilot went live in 2010, joining information from two hospitals in separate trusts and GP information from two separate practices. Following the successful pilot, more information was added, with full regional rollout taking place in 2013. These examples emphasized clinical engagement and participation in the design of their solutions, to ensure that clinically relevant and useful data was presented in the portal. Both solutions were also designed to sit on top of current information systems, providing health and social care professionals with a single view of patient information, wherever the patient is.


      Finding/Results:
      In Northern Ireland, the NIECR is producing wide-ranging benefits across quality, efficiency, safety and experience: - Over 740,000 user log-ins in March 2018 - In use by >98% of medical workforce - >95% of users say NIECR saves them time It has also surpassed original project objectives to: - Reliably and correctly pull together information needed in a near-instant, easy to read patient record view - Reduce time wasted trying to access or confirm information, and increase the effectiveness of clinical encounters - Reduce unnecessary delays caused by lack of access to information, and reduce avoidable duplicate testing In Alberta, the results of Netcare Portal included: - 64,000 health professionals have active access to Netcare, with over 10,000 concurrent users at peak usage and 3,470 community healthcare provider sites accessing Netcare provincially - User access is being expanded to Optometrists, Dentists and Chiropractors - Since launch, 366.5 million screens of information in 133.6 million patient records were accessed by Alberta health professionals - Approximately 7.2 million screens of information in 2.5 million patient records accessed monthly


      Conclusion/Implications/Recommendations:
      It is essential to include clinical oversight at the beginning of an HIE engagement. This clinical oversight must be sustained throughout production use. Additionally, the pilot-to-production approach can be used as additional functionality is introduced into the solution. Finally, Medicine Reconciliation is an essential component of the pipeline and provides a single, standard interface to support medicines optimization processes.


      140 Character Summary:
      This presentation looks at two Health Information Exchange initiatives in Northern Ireland and Alberta and assesses their adoptions, uses and key learnings.