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  • e-Health 2018 Virtual Meeting

    Celebrate, Grow & Inspire Bold Action in Digital Health - Vancouver, BC

    This product offers access to the e-Health 2018 Keynote / Plenary Presentation Live Webcasts, the recording of these 4 sessions and access to all PDF/Presentation Slides of each conference presentation.

    Group Discounts Available for 5+ Purchases. Contact us to request group pricing.

    PDF's of presentation PowerPoints are now online!

    Presentation Date(s):
    • May 27 - 30, 2018
    • Total Presentations: 240
    Non-Member Price: $120 CAD Digital Health Canada Member Price: $100 CAD
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    RF01 - Innovation Is No Longer an Option in Digital Health (ID 10)

    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 6
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      RF01.01 - Beyond Cranes and Concrete: Creating Smarter Hospitals (ID 230)

      Z. Szalay, EllisDon Corporation; Misissauga/CA

      • Abstract
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      Purpose/Objectives: To demonstrate the shifting roles and responsibilities within the construction process as it pertains to Hospital CIOs, IT Departments, Redevelopment Staff, Clinical Staff, Biomed and construction partners to determine integration and interoperability requirements. This partnership flushed out efficiencies in the Hospital’s overall operations for all stakeholders. Due to the complexity of this project, EllisDon developed a dedicated group, EllisDon Information, Communication, Automation and Technology (ED-ICAT), to assemble teams who understood Hospital workflows, clinical applications and IT requirements. The General Contractor selected healthcare integrator Orion Health to deliver the new integration solution at Joseph Brant Hospital.

      Methodology/Approach: The Joseph Brant Hospital Redevelopment project had a detailed integration requirement that included replacing the existing end-of-life Hospital Enterprise Service Bus (ESB)/Integration Engine, which was responsible for the data exchange of all administrative, clinical, and patient information systems. The construction team was tasked with delivering 164 integration and interoperability use cases to help facilitate clinical workflows. This included creating customized alarm workflows as part of an alarm management system deliverable. User group discussions with clinical, facility management, IT, and security personnel were held to determine the Hospital’s business requirements. Through this process, alarm workflow documents were created, including alarm collection, alarm filtration, and workflow design. EllisDon partnered with Orion Health to migrate existing HL7 interfaces from the existing integration engine and create new interfaces for the Hospital systems. ED-ICAT, Orion Health and the Hospital user workgroups reviewed existing message definitions and message specifications of all source and destination systems, and their interdependencies. Components of the integration were broken down to the thread level whereby each source, destination system, and interface type were identified. All parts of the integration were validated in a stringent commissioning process consisting of pre-functional testing, functional testing, stress testing, and integrated testing.

      Finding/Results: Successful delivery was contingent on: professional design consultants who understood clinical applications to provide clear direction, input from clinical staff who understood the Hospital's daily operations, defined use cases which equated to outcomes early so deliverables were clear, and oversight from the ED-ICAT group to ensure integration and interoperability requirements were met. The Hospital transition team, commissioning team, PDC team, and ED-ICAT group developed a comprehensive commissioning plan, testing all alarm points via a three-stage process that included functional testing, integrated testing, and stress testing.

      Conclusion/Implications/Recommendations: Defining the scope was important to identify objectives and to tailor system configurations and integrations to achieve the desired workflow. ED-ICAT had extensive understanding of networks, servers, system architectures, Hospital workflows and clinical applications, which was crucial to the project’s success. Testing all critical alarm points, as well as integration use cases for performance criteria and then trying to break the system, proved the systems were capable of handling increased traffic. Completing the technology prior to construction meant the project team could fine tune system configurations before the full roll-out of the remaining areas. Hospital staff performed individual testing in various early-access areas, and the ability to train other Hospital staff members in advance of project completion ensured they were ready for opening day.

      140 Character Summary: The project's collaborative effort brought together many groups to achieve a smart, effective, efficient Hospital meeting the needs of its day-to-day operations.

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      RF01.02 - Institutional Teledermatology: Impact of an Urban E-Health Initiative (ID 284)

      T. Champagne, Division of Dermatology c/o Laura Barwell, Women's College Hospital; Toronto/CA

      • Abstract
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      Purpose/Objectives: Teledermatology, the clinical practice of dermatology using e-health technologies, is a rapidly advancing field in telemedicine. Dermatology complaints comprise nearly 25% of primary care visits and can be impactful on quality of life, morbidity, and potentially mortality. The original purpose of teledermatology is to overcome geographical barriers to access specialty care. At Women’s College Hospital (WCH), in Toronto, Ontario, an institutional teledermatology initiative has been developed that uses existing, accessible technology to provide consultative dermatology services to the in-house family practice unit at WCH using store-and-forward teledermatology. The intent of this service was to more rapidly triage dangerous conditions, eliminate unnecessary consults, reduce the no-show rate to clinic, and offer continuing dermatology education to referring providers. This service went live in February 2017. The purpose of our presentation is to outline the current impact of the institutional teledermatology service, and to discuss the challenges, benefits, educational value, and economic value from the patient, provider, and systemic perspectives.

      Methodology/Approach: We are currently conducting a systematic appraisal of the service guided by the Canada Health Infoway Benefits Evaluation framework, using chart review of all patients managed with the teledermatology service, surveys to patients and providers, and semi-structured interviews with existing and potential consultant and referring providers.

      Finding/Results: Research and recruitment is ongoing and analysis is expected to be complete in April 2018. The frequency of consults has steadily increased over the lifetime of the service, particularly by a core group of dedicated users. Preliminary analysis indicates the service does require additional effort for the referring provider to implement the management plan, but that the service clearly offers an educational benefit to referring physicians. There are also suggestions of the potential effectiveness of new models of care such as ‘bounce-store-and-forward’, where the referring physician receives a question and photographs electronically and directly from the patient, and then engages the services of the teledermatologist to help manage the patient.

      Conclusion/Implications/Recommendations: The results will help direct further implementations of this model of teledermatology at other institutions and suggest which clinical scenarios benefit from primary management with institutional teledermatology.

      140 Character Summary: This presentation will discuss the impact of an institutional store-and-forward teledermatology service, guided by the CHI Benefits Evaluation framework.

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      RF01.03 - Addressing the Opioid Epidemic with Evidence (ID 376)

      V. Gupta, InfoClin Analytics; Toronto/CA

      • Abstract
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      Purpose/Objectives: Canada is facing a severe opioid overdose crisis. At least 2,458 Canadians died from opioid?related overdose in 2016. Many patients want to control their use of opioids, however physicians find tapering opioids time-consuming and fraught with error. We aimed to develop a web-based Opioid Manager tool for physicians that can dramatically reduce the time needed to develop a customized, safe opioid tapering schedule for patients, allowing physicians to spend more time counselling patients and to see more patients that need guidance with opioid use.

      Methodology/Approach: We developed a web-based Opioid Manager, based on the latest opioid management guidelines. We incorporated an expert system Opioid tapering algorithm based on the heuristics used by expert clinical pharmacists. The tapering algorithm is used by the Opioid Manager to generate a prescription that can be given to a patient to assist them in safely lowering their dose of opioids slowly over time. We validated the tapering algorithm through review with a clinical pharmacist.

      Finding/Results: Creating a customized opioid taper schedule takes a highly experienced physician or pharmacist 30?45 minutes per patient; longer for less experienced providers. Opioid tapering is emotionally and physically demanding on patients, requiring support from the extended care team to ensure that they follow through on the taper and that problems are solved quickly and efficiently, before the patient loses confidence and reverts to prior high doses. The tapering algorithm can automatically generate an opioid tapering prescription in less than 30 seconds. The algorithm automatically calculates the patient’s total current opioid dose and proposes a tapering regime that effectively utilizes real-world tablet formulations during the taper.

      Conclusion/Implications/Recommendations: The Opioid tapering calculator is reliable and can potentially save a physician or clinical pharmacist at least 30 minutes per patient, allowing them more time to explain the tapering process to the patient, to support the patient more effectively in tapering their dose and to assist more patients in managing their opioid medications. Payors and policy makers may also be interested in this tool, as it provides them a way to reduce the burden of addictions and reduce the overall cost to provide opioid management services.

      140 Character Summary: New Opioid Manager saves doctors 30 minutes per patient while decreasing opioid overdose risk.

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      RF01.04 - SMART on FHIR in Canada: Innovation Begins at the EHR (ID 600)

      P. Hollott, Health, Sierra Systems; Victoria/CA

      • Abstract
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      Purpose/Objectives: Working as a Java architect on several enterprise health registry and repository projects (BC PLIS, WHIC Provider Registry), and coming from a JavaScript and modern web application background – it’s challenging to straddle the line. On the one hand, I am designing foundational systems that barely have a user interface; on the other hand, I’m developing highly interactive client applications using cutting edge platforms and libraries… in other industries. There is a disconnect.

      Methodology/Approach: Using mobility profiles like SMART on FHIR and IHE MHD, enterprise software vendors can break away from tightly coupled client-server, server-server, and HIAL architectures, by updating their EHR systems to comply with these profiles, which in turn allows client application developers to work independently. This encourages innovation. For instance, as part of their commitment to Project Argonaut, U.S. EHR vendors like Epic, Cerner and AllScripts are creating developer programs and EHR sandboxes, allowing developers to work with cloud-based sample data in connect-a-thon settings and beyond.

      Finding/Results: With sufficient standards and profile based support on the back end, low code and rapid development platforms for mobile web apps are reaching a point where organizations can rapidly develop small portable apps to fill their immediate needs for secure access to high value information. Examples of these platforms include Ionic Framework, a drag-and-drop creator for forms-based mobile apps; Oracle APEX, a low code mobile web application development tool for the Oracle database; Altova Mobile Together, an enterprise app rapid development platform that integrates with XML Spy. With MRAD (Mobile Rapid Application Development) tools like these, rapidly developing and deploying professional enterprise applications is becoming more affordable, requiring less programming experience, while still providing secure, ubiquitous access. Even so, for these tools to gain traction in healthcare settings, profound changes still need to take place within the EHR and EMR systems themselves. This is where future innovation in health information technology will come from.

      Conclusion/Implications/Recommendations: I propose to provide a technical breakdown of SMART on FHIR, and how it can be applied to EHR products, as well as a comparative summary of the maturity levels of several enterprise mobility and rapid development platforms (MEAP and MRAD). This is drawn from my own experience as a solution architect, tied to specific examples, profiles and patterns. Several U.S. EHR vendors have committed to creating and supporting cloud-based EHR sandboxes, with more still committed to participation in Project Argonaut. Here in Canada, these same products are deployed in a multitude of healthcare settings. How can we benefit from these sandboxes and connect-a-thons? Do we need to invest in similar EHR sandbox initiatives locally? How does a Canadian profile for SMART on FHIR differ from a U.S. profile, and can SMART Apps cross borders seamlessly?

      140 Character Summary: American EHR vendors are creating cloud-based connectathon sandboxes based on the SMART on FHIR profile. Does Canada need to invest in similar initiatives locally?

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      RF01.05 - Time to Get SMART on FHIR (ID 152)

      G. Tong, ITS, Gevity; Toronto/CA

      • Abstract
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      Purpose/Objectives: To demonstrate that SMART on FHIR apps are changing the face and locus of healthcare delivery across all care settings and that healthcare executives need to determine how to incorporate this disruptive technology into their digital health strategies. Over 250,000 Canadian healthcare professionals use digital health solutions on a daily basis. However, it is impossible for health IT vendors to create systems that meet every users’ needs and preferences for features, workflow and information display when users are diversified by role (e.g., doctor, lab techncian, occupational therapist, etc.), specialty (e.g., mental health, paediatrics, cardiology, etc.) and care setting (e.g., community, home, hospital, etc.). SMART on FHIR enables the creation of apps that work within existing jurisdictional EHRs, clinical information systems, and EMRs to meet the needs of diversified users. Like the apps on your phone, SMART on FHIR apps can be designed to do a few things very well, such as perform complex calculations specialists need to perform daily (e.g., Cardiologists’ CHADS-65 cardiovascular risk scores) or present information in more consumable ways (e.g. Patient facing lab results that use icons and infographics).

      Methodology/Approach: The presentation will frame the challenge for health IT vendors to provide products that can “be all things to all users”. This will set the stage for discussion of the opportunity to meet the needs of diversified users across care settings and specialties by enabling SMART on FHIR apps. Using non-technical language, the presentation will answer the question “What is SMART on FHIR?”, and assess factors in the Canadian and US healthcare IT industries indicating that now is the time for Canadian healthcare executives to determine how SMART on FHIR fits into their digital health strategies. Examples include the prevalence of “SMART on FHIR” app markets established by CIS vendors, the growing number of SMART on FHIR apps available today, maturation of jurisdictional EHRs, and the collective need to find innovative ways to enable patients’ access to their data. Using case studies from Duke University Hospital and clinical information systems vendors such as EPIC and Cerner, the presentation will cover strategic considerations government organizations and vendors need to resolve to enable SMART on FHIR apps. Example strategic considerations include: credential provisioning for patient facing apps, controlling the user experience, branding, privacy and security, and impacts to service level agreements. The presentation will conclude with a framework for categorizing types of SMART on FHIR apps by use case and complexity to implement. This framework will be used to facilitate discussions with audience members on real world needs that can be solved with SMART on FHIR apps.

      Finding/Results: The timing is right. Jurisdictions like Ontario are making progress to enable consumer access to EHR data with SMART on FHIR apps. CIS vendors have launched their own SMART on FHIR ‘app’ stores. Governments across Canada are trying to figure out how to introduce innovation in primary care EMRs.

      Conclusion/Implications/Recommendations: Audience members will walk away understanding how SMART on FHIR apps can solve challenges and the actions required to enable this technology.

      140 Character Summary: It's time for Canadian governments and vendors to include SMART on FHIR in their digital health strategies to meet the diverse needs of patients and providers.

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      RF01.06 - My Migo: On-Demand, Mobile CBT (ID 213)

      B. Veder, Morneau Shepell; Toronto/CA

      • Abstract
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      Purpose/Objectives: As the technological and lifestyle needs and expectations of both consumers and behavioural health experts change, the use of digital applications in mental health continues likewise to evolve, and research shows that expert-developed digital tools, in combination with self-directed learning, can be very impactful in providing effective mental health support in easy, convenient, accessible, and intuitive ways. Launched in January 2017, My Migo is a blended iCBT counselling program that leverages smartphone capability to provide effective mental health and behavioural change support in a way that connects individuals to EAP experts and provides a platform for independent learning, practice, and integration of new skills and techniques. Through the examination of user demographics, best practice details, patterns of user engagement with the various program components, clinical outcomes, and direct client feedback, we will demonstrate the value added benefits of this latest service offering in supporting mental health and behaviour change for digitally savvy support seekers.

      Methodology/Approach: My Migo was developed using Design Thinking; a creative, empathy-driven, and client-informed problem-solving methodology that shapes the creative process and the ultimate design of an effective program. The initial version of My Migo was tested with early adopters and feedback was used to enhance, improve, and update the program prior to its full launch in January. Post-launch, ongoing feedback from clients collected in a variety of ways (including mechanisms built within the app, analytics, and counsellor/client interactions) further informed the progress and evolution of the program.

      Finding/Results: Client and user uptake since launch has been very enthusiastic, and the program now exceeds over seven thousand users. This presentation will report on early outcomes based on the first phase results of qualitative and quantitative program research that is currently under way.

      Conclusion/Implications/Recommendations: Morneau Shepell has committed to using technology in a new, innovative clinical EAP service that, from the initial design phase, to the ongoing enhancements to My Migo’s program features, puts the end user client in a central and formative role in the evolution of the program itself, ultimately providing clients with the care and support they need, when they need it, and in a way they can easily relate to.

      140 Character Summary: My Migo: An on-demand mobile iCBT program tailored to provide effective, easily accessible support for digitally-savvy EAP clients.

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    RF02 - Digital Health: The Canadian Way (ID 9)

    • Type: Rapid Fire Session
    • Track: Executive
    • Presentations: 6
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      RF02.01 - Modernizing Legacy eHealth Solutions: Provider Registry System (ID 493)

      K. Lewis, Sierra Systems; Halifax/CA

      • Abstract
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      Purpose/Objectives: This presentation will explore technology innovation from the perspective of a legacy eHealth solution.

      Methodology/Approach: We tend to think of new and novel uses of technology when we talk about technology innovation. Today we think apps, connected devices, analytics, consumer health, etc., but what about yesterday’s innovation? Canadian jurisdictions invested hundreds of millions of dollars on innovative solutions in the past 20 years, and those solutions are aging. The Provider Registry System used in multiple jurisdictions is a prime example of a foundational eHealth architecture service, that, despite its age, still fulfills its original intent – centralizing and standardizing access to the many pockets of provider data across jurisdictions. The Provider Registry System Collaborative has adopted a practical approach to modernize the solution, utilizing a relatively small sustainment fund.

      Finding/Results: Custom enterprise solutions are incredibly expensive to build, and we all understand that software has a lifecycle, beginning with an idea, and concluding with disposition. We seek to maximize the longevity (and value) of these solutions through regular sustainment, but we need to be practical about such investment. We monitor solutions throughout their lifecycle and direct investment based on current need and vision. We rationalize solutions and their context, and monitor the market of similar solutions. Are they still necessary, and are there better alternatives? In the case of the Provider Registry System, the governing collaborative continues to get good value from the PRS solution. - The core requirements of the solution still exist and the solution works well and meets those requirements. - The solution is integrated with EHR Architectures, and difficult to replace - The solution is economical to operate. Therefore the solution is good candidate for sustainment and modernization. In their approach to modernization, the PRSC has adopted the following strategy: - Maintain an application roadmap, including not only vision of new functionality, but lifecycle state and planned replacement of existing components. - Clear understanding that just maintaining compatibility with a deployment environments is not modernization - Include modernization of existing components as a key component of each release. - Balance extensions and enhancements with continuous improvement of the core solution. - Accept that some aspects of the solution are best maintained “as-developed” even if there are more modern alternatives. PRS modernization approach is realized by focusing on the following: - Ensuring an up-to-date user experience - Alignment with evolving interoperability standards - Streamlining development, configuration, testing, and operations This approach ensures the application remains viable while preserving the investment in core business logic that forms the largest, most expensive portion of the application.

      Conclusion/Implications/Recommendations: Key success factors: - Maintaining a roadmap that balances sustainment of existing components with addition of new functionality. - Focus modernization where it has most impact: User Experience, Operations Experience, Interoperabilty. - Recognizing the scope of what can be achieved with sustainment funds can’t include sweeping redevelopment of components for the sake of change. Sometimes modernization is not necessary or offers little value.

      140 Character Summary: Applying a sustainment and modernization strategy to ensure jurisdictions continue to get value out of their investment in the Provider Registry System.

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      RF02.02 - Assessment of Digital Health Companies' Value to the Health System (ID 520)

      B. Griffin, Institute for Health System Solutions and Virtual Care, Women's College Hospital; Toronto/CA

      • Abstract
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      Purpose/Objectives: Complicated funding structures and the absence of clear incentives create challenges for small-to-medium size enterprises (SMEs) in the digital health space. Many SMEs struggle to navigate the Canadian health system to gain insight into opportunities for purchase or procurement by public and private funders. The objectives of this work were to: (i) identify common challenges faced by SMEs in the digital health space; and (ii) explore effective methods of rapidly assessing and improving the performance of these SMEs within the Canadian health system.

      Methodology/Approach: To help promote innovation and entrepreneurial success in digital health in Ontario, the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), supported by the National Research Council of Canada Industrial Research Assistance Program (NRC IRAP), is developing a structured assessment to support SMEs in digital health. The process engages experts in key domains (clinical, technology design, health administration policy, venture capital, and business development), using a tailored evaluation framework to assess the Innovation and Business Model, the Innovators, the Health System Impact (including, patients, clinicians, and institutions), Policy and Economic alignment, and Regulatory compliance. This abstract presents content analysis of the final recommendation reports produced for ten companies assessed by WIHV in 2016-2017.

      Finding/Results: Two key challenges when developing and marketing digital health tools in the Ontario health care system emerged: (1) Understanding funding models and the role of incentives within the Canadian healthcare system (e.g. SMEs incorrectly assumed that improved patient outcomes, provider efficiency, or reduced patient visits to the clinic would result in a direct financial benefit to the physician). (2) Establishing clinical efficacy and safety owing to a lack of clear pathways into real-world clinical settings for testing. Our most common recommendations to SMEs were to: (1) Identify at what level of the health system your product is likely to be purchased: Difficulty understanding funding models created ambiguity around who to target as a potential payer (e.g. government, providers, institutions, clinics, insurers, or patients); (2) Demonstrate the value proposition to the primary payer: Without the ability to identify the appropriate payer, SMEs struggled to clearly articulate their value proposition or to devise the most appropriate outcomes to target in an evaluation; (3) More clearly understand the workflows of patients and clinicians: SMEs often focused on financial and administrative benefit of their tools, without explicitly evaluating the impact on patients and clinicians, whether positive or negative. When users were not considered viable payers, their needs (usability, patient reported outcomes) were often overlooked, creating a large risk to uptake and long-term success.

      Conclusion/Implications/Recommendations: Identification of common missteps and challenges facing SMEs in the digital health space will assist the entrepreneurial community in navigating the health system. Findings from this work will be developed into a checklist of considerations for digital health entrepreneurs to assist with strategic planning throughout digital tool development. In addition, this work aims to develop a standardized evaluation framework that can be used by other Canadian and international organizations to assess the investment potential of digital health SMEs.

      140 Character Summary: Common challenges and recommendations from a structured assessment of digital health companies’ potential entrepreneurial success in Ontario.

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      RF02.03 - Synoptic Reporting: Embracing Opportunities and New Possibilities (ID 166)

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

      • Abstract
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      Purpose/Objectives: Expansion of the NS synoptic reporting program to support electronic clinical documentation is discussed including the processes implemented, successes, challenges and opportunities. The presentation will use case examples to present how synoptic reporting has met diverse clinical needs in NS.

      Methodology/Approach: The system benefits of synoptic reporting established in 2012 in Nova Scotia include improved quality, timely, consistent, and comprehensive clinical documentation. Building on this foundation, the synoptic reporting program continues to expand for surgery and pathology as well as discharge summaries, follow up notes, mental health and addictions clinical reports, and children in foster care comprehensive reports. Although the development and implementation of new or expanded synoptic reporting initiatives follows a similar approach, each new initiative has unique requirements which requires flexibility, modifications to the foundational structures as well as realistic timelines and deliverables. These customizations and modifications provided new opportunities to enhance the overall application. The success of these new initiatives is credited by ensuring adequate development, modifications and testing of standards; developing new or revising existing technical requirements; completing necessary documentation; partner engagement; and clinical champions.

      Finding/Results: Clinicians and administrators continue to explore new opportunities to improve clinical documentation and clinician work flow through synoptic reporting. Uptake by end users varies depending on numerous factors including clinical champions, dependence on other projects, number of templates available for use, known benefits to practice, ease of use and level of commitment/ mandate by leadership for implementing a specific initiative. However, the biggest factors contributing to uptake for clinical users is engagement by clinician users and responsiveness to accommodate known work flow processes. For example the surgical spine template has a 100% uptake by users as a result of a comprehensive engagement strategy whereas in pathology the initial rollout of standards in April 2017 received resistance from pathologists not initially consulted. Meeting end user needs can lead to a significant benefit for all involved. This is seen for vascular surgery where surgical synoptic reporting was dependent on another initiative, and integrated together lead to a positive overall result. Finally, implementing synoptic reporting supports a change management approach that engages and readies clinicians for a true electronic EMR.

      Conclusion/Implications/Recommendations: As clinical users become increasing comfortable with standard templates/ clinician documentation new requests are being brought forward to explore how synoptic reporting can improve clinical workflow and needs. Understanding the overall organizational environment as well as unique clinician requirements, offers opportunities for synoptic reporting to be a leader in developing and implementing standards as well as providing a supportive role for data collection in a discrete electronic format to meet organizational and departmental needs. The success of the program rests with clinical engagement, responsiveness, flexibility to adapt and change focus as required, balancing user needs as well as playing not only a leading role in developing standards but a supporting role in using standards to meet organizational requirements.

      140 Character Summary: Using case studies, processes, lessons learned, benefits and challenges for the continued expansion of Nova Scotia’s synoptic reporting program is discussed.

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      RF02.04 - Clinician and Citizen Adoption of Digital Health Technologies: National Update (ID 249)

      S. Sepa, Canada Health Infoway; Toronto/CA

      • Abstract
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      Purpose/Objectives: Digital health information infrastructures and integrated virtual care technologies support quality outcomes of clinical practice, enable patient engagement, and drive system transformation and governance in high performing health systems. This session provides a national update on clinician and citizen adoption of digital health technologies and current perceptions of value and barriers to use-optimization. Results from the new 2018 Canadian Physician Survey - focused on adoption and use of digital health technologies in practice, will be showcased. Findings from the recent 2017 national Nurses’; and 2016 national Community-Pharmacist’s surveys will also be shared along with results from a 2018 national survey of citizen’s access to their health information and other digital health/virtual care technologies (e.g. e-visits: secure e-mail to providers; and virtual visits: real-time video consultation).

      Methodology/Approach: In the absence of the long running National Physician Survey, the 2018 Canadian Physician Survey: Adoption and Use of Digital Health Technologies in Practice was developed and launched in January 2018. The survey ensures continuation and evolution of national metrics to support Canada’s broad community of clinical, industry and digital health governance and innovation stakeholders. The detailed survey methodology will be provided in the session along with national-level results. The national survey of community pharmacists (2016) and Canadian Nurses’ survey (2017) were completed through an online recruitment and survey administration process in collaboration with the Canadian Pharmacists Association (CPhA); and the Canadian Nurses Association (CNA) and Canadian Nursing Informatics Association (CNIA) respectively. Canadians’ online access to their health information and utilization of virtual care services in 2018 was conducted online with a nationally representative sample of Canadians.

      Finding/Results: The 2018 Canadian physician survey captures a nationally representative sample of primary care and specialist physicians, by age, sex and region. Detailed national and regional specific adoption and value/ impact results will be shared. Nationally representative samples of Canadian nurses (2,058) and community-based pharmacists (N=535) were achieved in 2017 and 2016 respectively. Use of electronic records/clinical information systems varies substantially across nurses’ clinical practice settings. The majority of nurses providing direct patient care (55%) report that the main record keeping system for patients in their setting is a combination of paper and electronic systems – which emerges as the primary barrier to realizing value. Areas of value identified by nurses include: improved quality of patient care (56%); improved practice productivity (50%); and improved continuity of patient care (71%); and use of data to inform quality initiatives (42%). Results from the latest national survey of Canadians will summarize access, use and citizen perspectives on digital health services in Canada.

      Conclusion/Implications/Recommendations: The use of digital health information infrastructures across Canada have made substantial progress and represent the “technical backbone” of a high-performing health system - advancing integrated capability for performance measurement and accountability. Their use and optimal integration to clinical practice and patient access to their health information and virtual care services do, however, face relevant barriers to realizing citizen and system value and demonstrating impact on patient and system outcomes.

      140 Character Summary: Get the latest results from national citizen, physician, nursing, and pharmacist surveys – focused on use/value of digital health technologies.

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      RF02.05 - Canadian Nurses Use of Digital Health Technology and Quality Impacts (ID 494)

      S. Sepa, Canada Health Infoway; Toronto/CA

      • Abstract
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      Purpose/Objectives: This presentation will highlight the key findings of investigations into nurses use of digital health technologies, specifically electronic clinical information systems (CIS) and electronic health records (EHR). A national survey was conducted in early 2017 to understand the current use of these digital health technologies by Canadian nurses, across multiple clinical practice settings. The survey also explored attitudes and perceptions related to access, implementation and the impact of use on quality outcomes. The study compares progress to the first national survey (2014). Seondary analysis workshops convened with nursing leaders and researchers contribute to the findings.

      Methodology/Approach: An online survey in English and French was conducted between January and March of 2017. (n2,108). The majority of the results focus on Canadian nurses providing direct care (n=1,342). The survey was open to all Canadian nurses using digital health in various capacities within their main practice setting including community, hospital, academic and private industry. The data was statistically weighted to ensure a reliable representation of the nursing workforce in Canada. Secondary analysis of the findings was conducted by a group of nursing leaders and researchers to identify qualitative correlations, additional research questions emerging from the data, and to increase meaning of the results as well as recommendations.

      Finding/Results: Nurses who are solely using electronic systems are much more positive about the impact of digital health on productivity, improved quality of patient care, and confidence in their skills. However a number of challenges are identified. The majority of nurses are in work environments that use a combination of paper and electronic systems and use numberous log ins to access disparate and multiple systems. The satisfaction with continuous learning about the systems is low, and the level of consultation prior to implementation is also low. Additionally it was reported that nursing education does not incorporate training versions of CIS / EHR systems in the teaching of nursing skills in the majority of cases. New users report steep learning curves, especially in hybrid environments and high levels of dissatisfaction.

      Conclusion/Implications/Recommendations: Nurses who are not in a hybrid environment report higher levels of satisfaction and confidence to use digital health systems and are much more positive about the impact on productivity and quality of care. True benefits can be realized when full transition to electronic solutions occurs. The majority of nurses continue to work in hybrid paper and electronic environments which is reported as the most significant barrier to satisfaction and confidence. A key learning from this study is the need to ensure better engagement and participation of nursing in the selection, design and implementation of the electronic solutions they will use in their clinical workflow as a critical success factor. There is an opportunity to influence change and improvement in future projects through broader communication of these results to health care leaders, implementers, and solution designers.

      140 Character Summary: Recent investigations of Canadian nurses use of digital health technology (CIS and EMR) in multiple practice settings and the impact on quality of care.

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      RF02.06 - Towards CIHI’s Future iHospital System and One Patient-One Record (ID 201)

      I. Tsui, CAD, CIHI; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: CIHI provides comparable and actionable data and information to accelerate improvements in health care, health system performance and population health across Canada. The Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) are two of CIHI’s highest volume and most commonly used data sets for planning and management purposes in the health care system. As the health care data landscape evolves to become increasingly integrated and interoperable, CIHI’s pan-Canadian data holdings must evolve in tandem to ensure relevant and timely data can continue to be made available for planning and management purposes. This panel presentation will discuss how investments made in eHealth/digital technology can be leveraged to access near real-time data and the role data standards play in this work. Findings on a recent demonstration project that CIHI completed with the Vancouver Island Health Authority (VIHA) will be presented, including an overview how data directly from VIHA’s hospital information system can be used beyond clinical care. The panel will also discuss how learnings from this project will support the development of CIHI’s future Integrated Hospital (iHospital) system, which is being planned for launch in April 2021. This system will integrate CIHI’s hospital-based systems, starting with DAD and NACRS, and improve efficiencies while reducing data collection and submission burden. The integrated system will be the first step towards a ‘one patient, one record’ based secondary use system in acute care.

      Methodology/Approach: CIHI is currently in the planning phase of the iHospital project, which includes business transformation. The goal of this work is to streamline data requirements and gain efficiencies in business processes by leveraging technology and automation. A key part of this phase is incorporating learnings from demonstration projects. This presentation will describe how data representing 12 sites across VIHA has supported this work to date.

      Finding/Results: Initiating a major change project is generally met with numerous challenges, including resistance, requirement for clarity and the need to identify all impacted stakeholders and processes as early as possible. In order to ensure smooth change management, CIHI will complete a longer planning phase in the project. This presentation will provide insights into change management approaches from this large-scale business and IT project.

      Conclusion/Implications/Recommendations: As part of its 2016-2021 strategic plan, CIHI is committed to being a trusted source of standards and quality data, which includes making data collection easier and improving timeliness. CIHI is also committed to ensuring it brings value to its stakeholders and evolves to keep pace with the health care system. This and other demonstration projects are providing CIHI and hospitals with important information about the reliability and quality of data in point-of-care systems. CIHI will describe how these learnings will result in data flows that don’t require extensive manipulation to, or fragmentation of data by hospitals before it is submitted to CIHI. Additionally, VIHA will discuss the processes it is putting in place to change data collection practices at the point of collection, in an effort to put more seamless data flows from clinical care to secondary use in place.

      140 Character Summary: As the health care landscape becomes increasingly integrated and interoperable, CIHI’s pan-Canadian data is evolving in tandem to provide relevant and timely data

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    PL02 - Monday Afternoon Plenary (ID 59)

    • Type: Plenary Session
    • Track:
    • Presentations: 1
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    OS07 - Outcomes-Based Delivery (ID 16)

    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
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      OS07.01 - Doing More with Less; Practical Strategies to Enable Provincial Change (ID 270)

      M. Cleghorn, IT, Alberta Health Services; Calgary/CA

      • Abstract
      • PDF

      Purpose/Objectives: Since 2009 the Alberta health care delivery system has no longer been organized into a regional structure but rather a single province-wide provider organization called Alberta Health Services (AHS). In balance of years since regional consolidation, the AHS-IT department has been focused on service alignment, coordination, and building a strong foundation from the historic and disparate IT pieces inherited by AHS. That foundation has enabled AHS-IT to actively work on IT service consistency, application consolidation, and infrastructure stability across an entire province through an IMIT strategy that sits alongside patient care and organizational strategies at a peer level of importance. AHS is preparing to deploy a provincial EHR/CIS in 5 years, so we have to do more. At a time of severe resource constraint, exceedingly high information sharing expectations, and public demand for transparency and accountability, we have to do more with less. That requires effective partnerships between clinical care delivery and IT services delivery, and across all areas of AHS. Everyone deserves and should expect robust, stable, and accessible IT services. Using practical deployment strategies, creative approaches to partner with internal and external teams, and diligently following a few creative ideas, we're really enabling provincial change. The purpose of this presentation is to share approaches, tools, and structures used by AHS-IT to do more with less at a provincial level.

      Methodology/Approach: This presentation will breakdown the People, Process, Technology, and Partner elements of each key area that revealed success, or early indications of success as well as "red herring" approaches that did not deliver intended outcomes. The approaches used will be shared to include the tools and structures used by AHS-IT (and across AHS) that is allowing us to do more with less. Each key topic will be reviewed with a focus on recommendations. What did we do to embrace a "Dev Ops" application enhancement delivery? How did we track operational resource capacity? What tools were necessary and what were extraneous where maybe simple communication and diligent focus on culture is what was needed? Demonstration of tools, sharing of findings and Check List will help deliver the message of large scale provincial level management.

      Finding/Results: AHS-IT has developed new approaches, governance models, management tools, and cultural strategies to do more with less. The results of years of effort appear with findings in 7 key areas: (1) Dev Ops application enhancement delivery; (2) Operational resource capacity management; (3) Capital and Operational Resource Roadmapping; (4) Triad Partnerships (IT, Physician, Clinical Ops); (5) Empowered and Team-based Decision Making; (6) Supportive Accepting Culture; (7) Provincial Exposure and Accountability.

      Conclusion/Implications/Recommendations: AHS has matured significantly since 2009, and the AHS-IT department has capitalized on a provincial structure. Consolidated application environment (still improving), infrastrucutre stability (still enhancing), diligent resource management (still refining), collaborative workforce (still collaborating), and accountable leadership (still accountable!) have allowed AHS-IT to do more with less. By sharing our learning we hope to demonstrate what people, processes, technology, and partner structures are in place to prepare AHS in delivering a successful provincial EHR/CIS in 5 years.

      140 Character Summary: AHS is going to a provincial EHR/CIS that will transform healthcare delivery. AHS-IT dept used a number of ops strategies to prepare; now ready to share. #AHSgotime

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      OS07.02 - ITAC Health: Leveraging Analytics to Develop Provincial Interoperability Scorecards (ID 323)

      E. Huesing, ITAC Health; Vernon /CA
      D. Ritz, ecGroup Inc.; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Evidence shows that interoperable health information exchange positively impacts care continuity, care quality, and patient safety. Interoperability is especially important in the primary care setting to support the management of chronic diseases, which represent Canada’s most significant disease burden. To date, jurisdictional health administrations have invested substantial funds and human resources in digital health solutions intended to improve such information exchange. Have these initiatives been successful? The ITAC Health Interoperabilty and Standards Committee (ISC) has partnered with the researchers from the School of Health Information Science at the University of Victoria to evaluate Canada’s current state of digital health interoperability, jurisdiction by jurisdiction.

      Methodology/Approach: The research will leverage existing data sets (and conduct interviews with experts) regarding primary care physicians’ use of EMR solutions to share data (i.e. between EMRs and regional health authority EHRs); EMR use specifically focused on managing NCDs; digital health adoption rates; etc. Based on the available data, an analytic model will be constructed and used to develop a comparative interoperability scorecard for Canada’s jurisdictions. Analyses will be developed to look for correlations between interoperability scores and health system outcomes. The scorecard results will be mapped to ITAC Health ISC’s 2016 Position on Canadian Healthcare Interoperability Standards.

      Finding/Results: With an initial focus on primary and ambulatory care, our research is working towards producing an Interoperability Scorecard that will allow for comparative evaluation of interoperability in Canadian health authorities and among physician primary care practices in a consistent, constructive and measurable way. ITAC Health ISC, in cooperation with the School of Health Information Science, University of Victoria, will present the methodology and preliminary Interoperability Scorecard at the upcoming eHealth Canada Annual Conference in May 2018. The presentation will also include discussion of a preliminary comparison of interoperability approaches taken internationally (based on publicly available sources).

      Conclusion/Implications/Recommendations: The intent behind this undertaking is to establish clinical and technical interoperability measures for delivering universal access to effective care for all Canadians, in a financially responsible fashion.

      140 Character Summary: Lots of eHealth investment, but how interoperable are we? ITAC Health ISC introduces the Canadian Interoperability Scorecard. See how the provinces compare!

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      OS07.03 - Trimming the Fat: Redesigning Telemonitoring Systems and Services for Scalability (ID 225)

      P. Ware, Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Although telemonitoring is an intervention with a demonstrated ability to ease the burden of managing chronic conditions, its diffusion as part of the standard of care across Canada is lagging. Our objective was to develop and implement changes to the system and services of an existing app-based heart failure telemonitoring program to improve its sustainability and scalability.

      Methodology/Approach: The path from idea generation to implementation took place over stages. First, discussions between high-level stakeholders and during bi-weekly operations meetings led to the identification of opportunities for cost reduction and optimization of existing resources. Second, semi-structured interviews were developed to probe the opinions of end users regarding these opportunities; the objective being to understand the acceptability of the proposed changes and to identify potential negative implications. Interview participants included HF clinicians (n=9) and patients (n=25) both with and without prior experience with the existing telemonitoring program. Third, based on interview results, requirements needed to operationalize these changes were developed; strategies were prioritized based on potential impact to scalability, feasibility, and risks to the effectiveness of the program. Finally, system and service changes were implemented and closely monitored and fine-tuned as needed.

      Finding/Results: Identified opportunities for reducing costs and support scaling included (1) moving toward a bring you own device (BYOD) model whereby patients would use their own smartphone, weight scale, and blood pressure cuff, and (2) reducing telehealth support time by enabling patient self-training and troubleshooting. Opportunities for optimizing existing resources included: (1) identifying the most suitable patient candidates for the system, and (2) identifying the optimal duration of patient enrollment. Informed by the interview results, BYOD and self-training/troubleshooting were prioritized for immediate deployment as these were identified as having a high potential for reducing costs and would have immediate benefit towards the sustainability of the existing program. Specifically, this involved developing and distributing the telemonitoring app on both iOS and Android. In addition, a redesign of the patient onboarding materials and procedures was done to minimize the role of a telehealth support staff member. This was supported by the creation of a product website with detailed instructions and FAQ sections for user support ranging from initial setup to common troubleshooting. While opportunities for optimizing existing resources were seen as important factors in sustaining and scaling the existing program by interview participants, stakeholders opted not to restrict accessibility to the program until more robust evidence justifying criteria for patient selection and duration of enrolment could be obtained.

      Conclusion/Implications/Recommendations: Theories of diffusion of innovation suggest that one of the keys to scaling lies in modifying elements of its delivery to better fit the implementation context. This however, is only true if the integrity of the intervention can be maintained and effectiveness is not compromised. Our efforts provide a patient and user-centred example of how necessary actions can be taken to ensure the sustainability and scalability of consumer health technologies.

      140 Character Summary: This presentation will discuss the redesign of an existing telemonitoring program’s system and services to improve sustainability and scalability.

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      OS07.04 - PHSA’s Office of Virtual Health: Connecting for Wellness (ID 335)

      K. Steegstra, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives: The Provincial Health Services Authority (PHSA) is responsible for planning, coordinating and evaluating specialized health services across provincial clinical and academic programs and for collaborating with the BC health authorities to provide equitable and cost-effective health care for people throughout the province. One of the strategies outlined in PHSA’s mandate letter from the Ministry of Health is “to leverage and enhance virtual care as part of the care continuum for patients”. In order to effectively achieve this strategy, PHSA established the Office of Virtual Health (OVH) in 2017 to lead the development and implementation of an organizational, clinically-driven, virtual health strategy and plan.

      Methodology/Approach: Some of PHSA’s clinical and academic programs have been implementing various aspects of virtual health into their care delivery models since 1994 and excellent achievements have been made. With the creation of the Office of Virtual Health there is now an opportunity for all virtual health work to be more coordinated, efficient and clinically driven. OVH will establish forums to share lessons learned, build on others’ experiences, communicate results and requirements and build a PHSA Virtual Health Community of Practice. OVH has already engaged with Clinical leaders from across the organization to begin work on the PHSA Virtual Health strategy. A result of the engagement activities is the development of the functional model below, which identified the Clinical and Academic program areas as the leaders and owners of virtual health initiatives at PHSA.

      Finding/Results: The Office of Virtual Health will facilitate several demonstration projects between November 2017 and May 2018. Each project will include a thorough evaluation strategy with both standard measures that are reviewed for all PHSA virtual health initiatives as well as program-specific measures. The key measures will include focus on outcomes, patient and provider satisfaction, accessibility, program reach and wider system impacts.

      Conclusion/Implications/Recommendations: PHSA’s Office of Virtual Health will provide leadership and guidance to all Clinical and Academic programs to effectively implement virtual health initiatives. This includes providing strategic direction, planning and coordination, facilitating transformation and communication. This coordinated approach will facilitate organizational assessment and evaluation of the effectiveness of virtual health, information sharing and collaboration.

      140 Character Summary: PHSA has established an Office of Virtual Health to lead a coordinated, organizational strategy for implementing virtual health initiatives.

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    OS08 - Patients as True Partners in Care (ID 12)

    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
      • Abstract
      • PDF

      Purpose/Objectives: *Objectives*: The province’s objective is to use technology to provide anonymous access to naloxone and to improve prescribing/monitoring practices by establishing morphine-to-opioid equivalency.

      Methodology/Approach: *Approaches*: The provincial strategy calls for widespread access to naloxone to prevent overdoses. Free naloxone kits will be available through pharmacies and to support this distribution an electronic process is being implemented to submit claims to reimburse pharmacies. The electronic billing process requires dispenses of naloxone kits to be recorded in pharmacy software and submitted to the DIS, like other device dispenses. The challenge is that naloxone kits cannot be associated with an identifiable patient; to address this requirement, a patient profile only for free naloxone kit dispenses has been setup in the Client Registry. To ensure this profile is used exclusively for naloxone dispenses, a new business rule that will be sufficiently flexible to account for future changes will be implemented in the DIS to restrict dispenses on that patient profile to naloxone products only. Morphine equivalency addresses the lack of a standard potency measurement across all opioids making it difficult to identify high risk opioid doses leading to overdose. A tool that allows for comparison of opioid doses has been developed to equate the different opioids into one standard value based on morphine, referred to as morphine milligram equivalents (MME) or morphine equivalent doses (MED). MME is a value assigned to opioids representing their relative strength in terms of morphine. MME is determined by using an equivalency factor to calculate a morphine dose equivalent to the ordered opioid. Daily MED is the sum of the MME of all opioids a patient is likely to take within 24 hours; that total is used to determine if the patient is nearing a dangerous threshold. The province is working with its DIS vendor to determine if its product could support calculating and displaying daily MED for prescriptions and dispenses. This equivalency would provide clinicians with Morphine Equivalent information for opioids so they can make educated decisions on the appropriate therapy of opioid drugs for patients. The implementation of Morphine Equivalence will be a multi-phased approach based on the timing and availability of reliable ME data from FDB and determining messaging requirements. The implementation’s first phase will address two capabilities with respect to Morphine Equivalence (ME): capturing and storing ME using a simple file structure and communicating ME information for a specific drug to clinicians accessing the DIS. A second phase will include support for ME data once it is available from FDB and the third phase will build on the available FDB data and provide maintenance of ME thresholds, business rule development, and reporting on patient opioid use.

      Finding/Results: *Results*: At the time of writing, both these projects were in the initiation stage; however, it is expected that by May 2018, they will be sufficiently advanced to report on successes and obstacles.

      Conclusion/Implications/Recommendations: *Recommendations*: The province recommends seeking innovative ways of utilizing technology to further serve the public and, especially as in this case, to save lives.

      140 Character Summary: A province’s use of digital methods – enabling naloxone access and establishing morphine equivalency – to address opioid misuse.

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      OS08.02 - The Critical Yet "Not So Glamourous" Trusted Citizen Identity (ID 580)

      A. Carter-Langford, Canada Health Infoway; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Digital health solutions have the ability to improve the health of Canadians, transform the quality of care and reduce health system costs. This can be realized in large part by empowering Canadians to play a more active role in managing their own health. Canadians want to access their personal health information (PHI) and they expect more digital health services. While the private and public sectors are keen to help make this a reality, there are foundational enablers that are necessary to make this improved digital health services a possibility for all.

      Methodology/Approach: A foundational enabler to achieving citizen access to PHI is deploying identity and access management solutions. The availability and use of common trusted digital identities and credentials to enable access to PHI and digital health services and solutions is lacking. By contrast, credentials issued by certain financial institutions are being used today by the Federal government to enable some of its online services. This panel will consist of Government, not-for-profit organizations, and industry stakeholders who will share their perspectives and insights on the opportunity for private/public co-operation in the development and use of trusted digital identities. Panelists will engage in a provocative dialogue on the barriers to use federated, trusted digital identities for healthcare applications and share key learning for initiatives undertaken to date. An outcome of this panel discussion will be a greater shared understanding of the roles and contributions from these groups of stakeholders to achieve the future Canadian expect and deserve.

      Finding/Results: Trusted digital identities for the purpose of PHI access and its enabling of digital health services is complex because of the interdependence of stakeholders, lack of robust governance models, financial incentives, limited deployment and lack of demonstrable success in Canada. These complexities make this a “not so glamorous” undertaking that many groups simply do not want to “dabble” in. However, there is now strong growing awareness and consensus that trusted digital identities are critical to harness the full potential of PHI access and to enable digital health solutions. The time is now to develop trusted digital identities in healthcare.

      Conclusion/Implications/Recommendations: The trusted digital identity in healthcare is: - Acknowledged as foundational yet lacking presenting a challenge for PHI access and development of digital health services - An opportunity for governments, industry and not-for-profit groups to collaborate to empower citizens to take control of their own health and benefit from online services - Key to enable innovations in digital health

      140 Character Summary: Trusted digital identity; critical for citizen access to Personal Health Information and the gateway to improving digital health services.

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      OS08.03 - Mustimuhw Citizen Health Portal – National Expansion Project (ID 242)

      K. Mallory, Mallory Consulting Ltd.; Victoria/CA

      • Abstract
      • PDF

      Purpose/Objectives: The successful completion of an Infoway-supported consumer health demonstration project and strong benefits evaluation results have led to the expansion of the Mustimuhw Citizen Health Portal. Cowichan Tribes has engaged with First Nations in multiple regions across Canada to support the adoption and use of nationally consistent digital health tools. These tools, designed by First Nations for First Nations, support citizen access to health records and citizen integration into the holistic clinical and wellness workflows typically delivered in on-reserve health centres. Our presentation will describe how the successful Closing the Circle of Care Demonstration Project has inspired a targeted implementation and adoption model that is now being extended to others. The Mustimuhw Citizen Health Portal National Expansion Project is a significant opportunity for First Nations to advance their digital health capacity and enable their community members with electronic access to their health records. The National Expansion Project has the potential to support First Nations providers and citizens to benefit from consumer health technologies and take a leadership role in enabling health information continuity across the circle of care.

      Methodology/Approach: The Citizen Health Portal uses an Infoway-Certified PHR platform that enables patients to submit and access personal health information. Leveraging the successful implementation processes developed during the demonstration project, the project team is now engaging with other First Nations across Canada to extend the use of the Citizen Health Portal digital health solution and support the establishment of a practical and sustainable national model. The combined use of the proven Mustimuhw community EMR (cEMR) and the Citizen Health Portal establishes a digital health presence in on-reserve health centres, enables patient access and creates an interoperability platform to support information sharing and workflow integration with local, regional and provincial healthcare partners.

      Finding/Results: To date, response and willingness to adopt both the cEMR and the Citizen Health Portal is strong – by both providers and citizens. However, and not surprisingly, engagement and change management activities require both creativity and effort, particularly in light of the capacity challenges many on-reserve health centres deal with. As adoption proceeds, refinements are constantly being applied to the implementation model based on our many lessons learned. These lessons will be of interest to others seeking to enable consumer health models for their target patient and provider groups.

      Conclusion/Implications/Recommendations: Early results indicate that a PHR solution is a viable and beneficial consumer health tool within First Nations communities. Use of a PHR can address longstanding issues and challenges that previously have impeded patient access to health services and provider access to important patient data – particular challenges in First Nations communities. Given that there are many similar health care requirements across First Nations communities in Canada, and many similarities in the challenges posed to effective information sharing between First Nations and their health care partners, a recommendation can be made to continue to extend the cEMR and the Citizen Health Portal to other First Nations within Canada wishing to adopt and use these tools.

      140 Character Summary: The Mustimuhw Citizen Health Portal provides an opportunity for First Nations to benefit from digital health and consumer health tools.

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      OS08.04 - Innovation Through Predictive Analytics in the Non-Profit Sector (ID 55)

      D. McIntosh, Sierra Systems Group Ltd; Calgary/CA

      • Abstract
      • PDF

      Purpose/Objectives: The Calgary Drop-In and Rehab Centre (The DI) serves the homeless population in Calgary and much more: provides a ‘voice’ for the marginalized, provides access to affordable housing, counselling services and employment transition. The DI is undertaking a transformation of its information technology ecosystem. Fingerprint scanning serves as the current check-in function to identify active clients. This process is time consuming and can result in significant queues, particularly in cold weather. The DI may feed 300 – 400 clients over a lunch hour. Currently, it may take up to 30 seconds to check in a client, resulting in long line ups, potential bypassed check-in for those clients known to The DI staff and duplication of client profiles. Further, if The DI staff is unaware of the client’s presence, they cannot be helped. The DI was seeking a more efficient means of check-in and confirmation of clients on site. Integration of facial recognition technology with CRM allows many advantages – elimination of human error prone manual check-in, instant notification of client check-in triggering delivery of scheduled services such as counsellor appointments, health clinic appointments, medication review or employment services follow-up. In short, leveraging technology to support The DI as a resource hub for homelessness and poverty. This presentation will demonstrate aspects of emotional-IT bringing true value to the clients of The DI.

      Methodology/Approach: Validation and / testing of the following: - - Development of test algorithms to enhance accuracy of recognition - Ambient lighting, skin colour, presence of hats/baseball caps or sunglasses - System recognition of previously captured images with profile merging in CRM - Camera position - Wall colour in check in area - CRM configuration and image integration (e.g., impact of facial hair) - Lighting / hue of background objects - Still images vs video

      Finding/Results: - Facial recognition accuracy > 95% - Decrease in manual entries at Security - Integration with CRM facilitating services, tasking and staff workflow - Real time notification of client presence - Increased efficiency and effectiveness of the The DI’s intake and check in processes - Enhanced case management capability for counsellors and health resources

      Conclusion/Implications/Recommendations: - Reduced human error and manpower requirements at security check in - Elimination of duplicate client profiles - Ambient lighting and wall/environment colours impact resolution - Iterative test algorithms are required (video preferred) Office 365 helped The DI realize a modern IT workspace, increased security and staff collaboration and decreased manual workload centre staff. The use of state of the art biometrics using Azure to perform facial recognition linked to a Dynamics 365 client database was fundamental to achieving these outcomes. This translates in to not only significant cost savings, but also greatly enhances the level of service received by their clients primarily through speeding up the process to render assistance to individuals often in extremely stressful situations.

      140 Character Summary: Integrating facial recognition software at a community drop-in centre key in expediting security check-in and streamlining client processes

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    OS09 - Changing the Health Care Delivery Landscape (ID 15)

    • Type: Oral Session
    • Track: Executive
    • Presentations: 3
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      OS09.02 - Health Analytics Platform for Health System Transformation (ID 93)

      T. Lehtonen, Healthand Wellness, NS Government; Halifax/CA

      • Abstract
      • PDF

      Purpose/Objectives: In 2015, the Nova Scotia health system embarked on the significant transformational change that resulted in the consolidation of nine district health authorities to the Nova Scotia Health Authority (NSHA) and the IWK Health Center. In 2016, the Department of Health and Wellness (DHW) initiated its own transformation change with the redesign of the department. The new mandate of the DHW is providing leadership for the health system by setting the strategic policy direction, priorities and standards for the health system; ensuring appropriate access to quality care through the establishment of public funding for health services that are of high value to the population, and ensuring accountability for funding and the measuring and monitoring of health system performance. Foundational to each organization achieving their new mandate is the use of data and information to inform strategy, policy, performance, and services. Department's 2016/17 business plan reflects this change in direction and mandate by specifically calling out the focus on analytics and the use of data and evidence to plan for health services, to demonstrate progress throughout the system, and to establish future directions. The redesigned DHW established a new division as a center of excellence for data and analytics, called Investment and Decision Support (InvDS). While InvDS has invested in attracting new people with skills and competencies for analytics and advanced analytics it also recognized that the exsisting data storage and analytic technologies didn't meet the data and information needs of the health system. Currently, disparate data repositories house data from different health systems without providing a cosolidated view from the perspective of the patient or citizen; consequently, the current practice does not support comprehensive analysis at population level, either. The Department recognized that the data storage and analytic technologies in use did not meet new data and information requirements to deliver on the mandate and transformation commitments.

      Methodology/Approach: In collaboration with NS Government's ICT Services division, Health Data Analytics Platform (HAP) was designed as a comprehensive data analytics solution for meeting all the known and anticipated data management and analytics needs. Crafted according to industry leading practices and recommendations (Gartner, Canada Health Infoway) and conforming to government's Data & Analytics Blueprint and information technology strategy, HAP is a versatile platform that meets data and analytics needs of the Department and its stakeholders.

      Finding/Results: The implementation of HAP is a multi-year program, and several projects are carried out simultaneously. The approach has already proven its power to streamline, consolidate, and align fragmented workstreams and initiatives. At teachnical level, an architecture that is able to support various stakeholder groups, analytical uses, and applications while maintaining centralized governance, and role-based privacy and access control has already been demonstrated and received with enthusiasm.

      Conclusion/Implications/Recommendations: Our recommendation is taking a strategic approach to the portfolio of data & analytics initiatives, think about the big picture and strategic goals, consolidate disparate data holdings and stores, align relevant governance workstreams, standardize platforms and toolsets, and empower end users with data and information self-services.

      140 Character Summary: NS supports health system transformation by a center of excellence, empowered with a versatile data and analytics platform, self-serve analytics tools included.

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      OS09.03 - The Power and Potential of Data (ID 558)

      T. Murphy, Provincial Platforms and SPOR, Alberta Innovates; Edmonton/CA

      • Abstract
      • PDF

      Purpose/Objectives: The objectives of the Secondary Use Data Project (SUDP) were to: - Improve access to secondary use data and to make secondary use data available. - Inform and support health sector decision-making. - Support future research, development, and innovation.

      Methodology/Approach: A 3 year project was carried out to create a collaborative, province-wide solution to increase access to and use of aggregated, analyzed, and privacy-protected data for decision making, strategic planning, policy development, service delivery, care, research and innovation. Through sponsorship of 5 Demonstration Projects, the SUDP worked to decrease the time it takes to access health and social data in Alberta: - Demonstration Project 1 focused on releasing existing aggregate information about the health system in a privacy-protected format for use by researchers and the public. - Demonstration Projects 2 and 3 brought together information about the quality of care received by Albertans with chronic conditions creating balanced quality measurement sets for both Chronic Obstructive Pulmonary Disease and Diabetes. - Demonstration Project 4 examined how we use data to make decisions when we are planning for new health programs and services. - Demonstration Project 5 identified strategies and processes to support researchers and quality improvement experts to quickly gain access to social and health information required to answer important health system questions. The five demonstration projects had the following overarching objectives: - Liberate aggregate data currently unavailable to health system stakeholders and the public. - Identify, and where possible, address and/or leverage technical data integration and privacy impact assessment challenges and opportunities. - Demonstrate value of data integration producing outputs and outcomes of value to Albertans. - Contribute to the refinement of data governance roles and functions within the province of Alberta. In addition, a business case and requirements for a potential province-wide secondary use data solution were developed by the project team.

      Finding/Results: - While there is widespread support for solutions to integrate and link data, data integration and linkage efforts continue to be challenged by policy, organizational alignment, and process barriers as well as variability in how data sharing legislation is interpreted. - The cost to re-orient multiple infrastructure and analytics services to a provincially focused solution is prohibitive for many organizations, stalling collaborative planning efforts in this area. - Technologies exist to support data integration and linkage on a ‘big data’ scale e.g. privacy preserving software. - Analytics experts are difficult to recruit – this can be a barrier to creating analytics outputs even when data is available.

      Conclusion/Implications/Recommendations: - Develop a provincial roadmap for business and technical solutions that improve secondary use data access and use. - Identify and pursue data sharing opportunities that create actionable insights

      140 Character Summary: The project provides insight into the complexities of data sharing initiatives and illustrates the profound power that data has in our ever evolving health systems.

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      OS09.04 - Building Intelligence: Innovative Approaches to Product Alignment and Dashboard Delivery (ID 398)

      B. Shirazi, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: The Centre for Addiction and Mental Health (CAMH) provides client-centered care to a diverse population through a range of clinical, support and rehabilitation services. For reporting and accountability, this translates into a number of diverse process and outcomes measurements across the hospital, creating ambiguities in representation, prioritization, alignment and gaps in available data. The nature of this scattered reporting and nonintegrated information clutters user’s ability to develop a comprehensive understanding of available information and hinders their ability to apply it towards strategic and operational goals across CAMH. The abstract showcases how a product alignment model links clinical, operational and financial data for the purposes of actionable insights and comprehensive understanding of CAMH services and the patients.

      Methodology/Approach: The following approaches were leveraged for enhanced product alignment. Planning; The planning approach focused on targeting key audiences at different levels of the CAMH hierarchy, understanding what their data interests were and how refined reporting could support their initiatives around CAMH strategic priorities. By analyzing key questions, requirements for reporting organically appeared and there proved to be a strong desire to see a flow of data throughout the different levels of CAMH. Further engagement allowed for better understanding of multiple key drivers and performance indicators that could be grouped into reporting themes; operational, accountability and quality improvement. Dashboard Development; The dashboard development approach focused on how identified reporting themes could be used to improve the uptake and understanding of reporting. Accountability dashboards focus on balanced scorecard indicators that can help the organization stay accountable to key strategic priorities. Operations dashboards allow for leadership and management to have a view to all the data and indicators they need to support their day to day initiatives and can include clinical, human resources and financial data. Quality improvement dashboards are presented at a person or service-level and are targeted towards performance improvement projects, enabling stakeholders to monitor their progress on improvement initiatives.

      Finding/Results: As a result of product alignment, there has been greater clarity for stakeholders on where they can expect to find different kinds of information. This has led to a more active use of dashboards and reports, a more complete picture across financial, clinical and human resourcing goals and an overall enhanced user experience. Product Alignment Conceptual Framework

      Conclusion/Implications/Recommendations: Better planning and a more aligned approach will help decision makers anticipate and test the impact of their actions, estimate value of resulting outcomes, and monitor results to adjust decision making. This model has the ability to be transferable to other programs striving to improve the delivery of reporting services for the purposes of maximizing clinical outcome benefits.

      140 Character Summary: Thoughtful product alignment permits flexible autonomy in governing clinical and non-clinical reporting, allowing for maximum clinical outcome benefits.

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

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

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

      • Abstract
      • PDF

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

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

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

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

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

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

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

      • Abstract
      • PDF

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

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

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

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

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

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

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

      • Abstract
      • PDF

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

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

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

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

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

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

      A. Ytsma, CIHI; Toronto/CA

      • Abstract
      • PDF

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

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

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

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

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

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    OS11 - Connected Care: A Canadian Dream (ID 13)

    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 3
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      OS11.01 - Supporting Physicians and Clinicians’ Access to Prescribed Medications Through ClinicalConnect™ (ID 447)

      J. Haywood, HITS eHealth Office; Hamilton/CA

      • Abstract
      • PDF

      Purpose/Objectives: This presentation will explain how and why data from Ontario’s Digital Health Drug Repository (DHDR) was successfully integrated with ClinicalConnect, clinical viewer for south west Ontario.

      Methodology/Approach: Leaders from the Health Information Technology Services (HITS) eHealth Office at Hamilton Health Sciences, who worked with eHealth Ontario and Ministry of Health's (MOH) technical teams to integrate data from DHDR with ClinicalConnect, will describe the project’s scope and lifecycle; the first of its kind in Ontario. The presentation will overview work that began in 2016 when this repository was developed to enhance, but ultimately also replace, Ontario’s legacy Drug Profile Viewer as part of the MOH’s Comprehensive Drug Profile Strategy. We will explore how challenges, both technical and non-technical, were met during the project. Other aspects, such as how privacy training for end users would be delivered, or how temporary reinstatement of consent applied to data in the DHDR would be operationalized, will be discussed. The speakers will provide a variety of success stories about how having access to ClinicalConnect, and their patients’ data it aggregates has had a meaningful impact on their efficiency as providers and their abilities to put their patients first.

      Finding/Results: With Narcotics Monitoring System (NMS) and Ontario Drug Benefit (ODB) recipient medication data, and soon pharmacy services and OHIP+ children and youth pharmacare, having access to this data in a consolidated, one-stop-shop viewer, is invaluable in many ways. The presentation will examine usage statistics and how access to this repository, particularly in light of the current, nation-wide opioid crisis, is aiding clinicians to better manage their patients’ health care. We'll also explain enhancements underway to how data from DHDR presents and functions to better suit ClinicalConnect users, improving their ability to deliver care to patients with this, plus other personal health information integrated from hospitals, Local Health Integration Networks’ Home & Community Care Services and Regional Cancer Programs in south west Ontario, plus other Ontario data repositories. Deployment of this data set amongst existing ClinicalConnect Participant Organizations is ongoing; this graph provides a sense of number of accesses to data from the DHDR on an hourly basis. Undoubtedly, as more users are provisioned with access, these numbers will increase rapidly. dhdr.gif

      Conclusion/Implications/Recommendations: Making data from DHDR accessible to authorized ClinicalConnect users was a first in Ontario and we believe audiences will take great interest in the work completed to achieve this milestone. Furthermore, as this HITS eHealth Office continues its work to deploy the MyChart patient portal in south west Ontario, it 's hoped that future phases will see the integration of data from DHDR so patients too have ready access to their pharmacare data in an easy-to-use electronic format.

      140 Character Summary: A demonstration of collaboration to integrate data from Ontario’s DHDR with ClinicalConnect™, providing a walkthrough of work involved and success stories.

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      OS11.02 - Transforming Medication Management for Complex Acute Cancer Care (ID 326)

      S. Douglas, University Health Network (UHN); Toronto/CA
      C. Lutchman, University Health Network; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: As one of the top 5 academic cancer centres in the world, University Health Network’s (UHN) Princess Margaret Cancer Centre (PM) offers leading edge technical, surgical and medication based treatments available today. However, despite having an inpatient electronic medical record for 2 decades, medication management remained on paper. This presentation showcases a 3-prong approach that led to the successful design and implementation of a hybrid paper-electronic medication management solution leveraging best practices in clinically led implementations, Healthcare Human Factors (HHF) and computerized physician order entry (CPOE) system build design.

      Methodology/Approach: CPOE was implemented at 2 of the 3 UHN acute care sites in 2005. PM was not included due to complex date/time dependant protocols, and relative scheduling related to fluctuating patient conditions. These regimens could not be captured electronically in the existing CPOE solution and despite the fact that over 80% of medications were not related to chemotherapy regimens, clinicians were hesitant to support hybrid workflows. In addition, belief that CPOE would reduce time spent with patients and a high rate of infrequent physician users made clinical buy-in difficult to obtain. The following 3-prong approach led to successful implementation and adoption: 1. Integrated dedicated clinical leads on the project team were fundamental to project success. Multidisciplinary clinical stakeholders were seconded to the project team from planning to close-out, acting as advocates for patient safety and communication liaisons. They provided a front line understanding of the needs of the clinicians and patients. 2. A collaborative effort with HHF helped to refine and streamline clinical workflows, update order sets for paper-electronic medication management and pinpoint key processes that required focused training. Co-facilitated Failure, Mode and Effect Analysis (FMEA) workshops and clinical workflow simulations identified high risk practices that shaped future state workflows. 3. The project maximized system capability in build design. CPOE calculation tools for chemotherapy and anti-microbial prescribing, such as weight based dosing and weight banding allowed for customization of existing PM standards of practice to meet the needs of a complex oncology patient population. Build design not only impacted PM but also UHN’s other 2 acute sites as existing medication procedure builds and enterprise-wide policies were updated to align with current best practice standards and Accreditation Canada.

      Finding/Results: Adoption of a hybrid CPOE model at PM clearly demonstrated the powerful impact people and processes can have in designing sustainable solutions with existing technology. This approach resulted in a high adoption rate, development of fully customized, clinical co-facilitated training sessions, and increased adherence to organizational policy. With CPOE live at PM, the organization can plan future foundational initiatives to continuously enhance patient safety, patient experience and continuity of care within and outside the walls of UHN.

      Conclusion/Implications/Recommendations: This implementation was a major stepping stone in standardizing clinical practice across UHN. Securing clinical resources, working with outside teams and updating policy and practice was challenging but ultimately foundational in realizing CPOE benefits and aligning with UHN values and vision. This design model will be invaluable when planning CPOE implementation at UHN rehabilitation sites and emergency departments.

      140 Character Summary: Transforming medication management for complex acute cancer care: A 3-prong approach to designing a hybrid system

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      OS11.04 - A Physician's Time Is Precious: Bundling Digital Health Services (ID 40)

      M. Leduc, Product Strategy and Delivery, OntarioMD; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: We all recognize that doctors’ time is in short supply. Government and industry across Canada invest tremendous effort and resources to address this challenge, devising new and insightful ways to reduce the time it takes physicians to access and act on information for patient care. Why, then, do so many organizations collectively subject community-based clinicians to an endless barrage of engagements, readiness assessments, and introductions to “something that will make your life easier”? This presentation will examine one jurisdiction’s successful collaboration to engage community-based physicians through a bundled approach – incorporating several different products and services from multiple organizations, and relying on each organization’s strengths to deliver the best value for physicians.

      Methodology/Approach: Insurers, and telecommunications providers offer service bundles for home and auto insurance and phone/cable packages. Spas even offer service bundles for a variety of beauty and wellness services. For our customers, community-based physicians, we partnered with several publicly-funded organizations with digital health or practice efficiency products to offer physicians a package of services through a single engagement – and more value for their effort. (A physician’s time spent assessing a new solution is time not delivering care to patients, so a bundled service offering increases both time available to provide care and revenue associated with such care.) One organization has physician relationships and expertise in the EMR. Another organization delivers infrastructure such as identity services that provide a foundation for provincial digital health products. A third organization specializes in telehealth and virtual healthcare. By leveraging each organization’s strengths, this collaboration offers physicians eight distinct services and ongoing project management and change management support to implement them.

      Finding/Results: Not surprisingly, physicians loved the bundled engagement approach. One contact, one trusted advisor, and one time in their day to focus on digital health opportunities encouraged physicians to really invest the time to understand their options and maximize their benefits. To achieve this unified approach, the partnering organizations ensured that engagement processes were consistent and streamlined, and that information collected for one organization could be leveraged – with physician consent – for another service. An additional advantage of this bundled approach was that physicians were more open to learning about and trying services that would otherwise never have been considered. By funneling engagements through a single relationship, the physician was more apt to see the positives of other solutions (even from different organizations) and take a chance on a new service. This presentation will detail how deployment processes were aligned, and adoption and change management efforts were more productive as a result of the bundled service – benefitting all collaborating organizations as well as the physician practice.

      Conclusion/Implications/Recommendations: In addition to cataloguing our successes and learnings along the way, this presentation will include detailed instructions for other organizations interested in bundling services with partner organizations for a streamlined and organized deployment process that maximizes physician practice benefit and stakeholder reach, while reducing the overall cost of implementation. The proven approach used increased physician engagement, improved adoption and reduced system costs.

      140 Character Summary: Bundled service delivery among multiple organizations increases satisfaction and adoption among community-based providers while reducing system costs.

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    OS12 - eSafety, Quality and Usability (ID 11)

    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 4
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      OS12.01 - Thought Spot 2.0: Optimizing an mHealth Application Through Participatory Design (ID 257)

      D. Wiljer, University Health Network; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Thought Spot () provides post-secondary students with an all-in-one online and mobile platform where they can geo-locate and share knowledge about mental health and wellness services in the Greater Toronto Area (GTA). The CIHR eHealth Innovations Partnership Program grant is aimed at optimizing the Thought Spot platform to more effectively meet the needs of end users. This project is split into two phases: intervention optimization through participatory design (PD) and intervention testing (RCT). This e-poster provides an overview of the optimized platform (Thought Spot 2.0) after an innovative PD process

      Methodology/Approach: Through the use of PD principles, we recruited and engaged students across the GTA to drive the optimization of the Thought Spot platform. Using these findings, a collaborative and iterative design process was followed to optimize the platform with our technology partner, QoC Health, and students. Usability testing, both in a lab and field setting, was conducted to further refine the flow and processes of the platform. Lab testing participants used the think-aloud method when performing a series of representative tasks. Field testing required the completion of a separate set of tasks on their own time over a seven-day period. Qualitative and quantitate data was obtained through observation, semi-structured interviews, single ease questions (SEQ) and the post-study system usability questionnaire (PSSUQ).

      Finding/Results: Usability testing in lab and field settings identified various usability issues, most notably, in the features of searching and adding services. These features corresponded to the lowest SEQ scores across all lab testing tasks (average of 4.1 and 4 on a 7 point scale) and the highest number of errors. The overall app quality as determined by the total average PSSUQ score for lab and field testing was 4.6 and 4.4 on a 7 point scale. Qualitative data was used to inform solutions to the usability problems observed. Key features of the platform were developed and/or refined to improve the functionality and user experience. Main improvements included: data organization; search and navigation functionalities; adding and updating spots; data hygiene for existing spots; and graphics and design. New features were also added, including adding ‘thoughts’ with a journaling component; a timeline function; and migrating to a new mapping platform, MapBox. ts video screenshot 2.jpg

      Conclusion/Implications/Recommendations: This co-design approach with end users has resulted in an innovative mHealth intervention to improve students’ ability to seek out mental health and wellness resources within their community, while contributing to the knowledge base of services and resources available through crowdsourcing and commenting. A randomized control trial (RCT) is currently underway to evaluate Thought Spot and its impact on student’s help seeking behaviours.

      140 Character Summary: Thought Spot 2.0: using participatory design to optimize an mHealth platform that allows students to locate mental health and wellness services.

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      • Abstract
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      Purpose/Objectives: Discover how eHealth Ontario is designing, operating and governing solutions in a way that ensures the quality and integrity of digital health information. Hear practical suggestions that any organization can implement to accelerate eSafety maturity. The session will reveal how eHealth Ontario is building principles of eSafety into its existing operations by ensuring: • Governance controls are in place to proactively identify and mitigate safety risks • Consistent application of eSafety management practices through enhanced delivery frameworks and processes • Raised awareness of and consensus on the vital importance of an eSafety culture.

      Methodology/Approach: eHealth Ontario’s journey to launch an eSafety management program started with a self-assessment, using the eSafety Adoption Checklist and maturity model documented in COACH’s eSafety Guidelines. The self-assessment revealed opportunities to optimize how safety risks are identified, monitored and reported. A virtual eSafety team from across the organization was established to embed eSafety principles into existing processes and practices. Quarterly self-assessments allowed progress to be tracked and highlighted areas requiring focus and attention.

      Finding/Results: eHealth Ontario adheres to a robust governance and system development lifecycle framework which broadly addressed eSafety, but further work was required to address it more effectively. Quarterly self-assessments showed significant progress towards the target future state. eSafety use cases demonstrated the effectiveness of the processes and controls put in place and highlighted gaps and opportunities for further growth.

      Conclusion/Implications/Recommendations: As the health sector is increasingly reliant on the digital exchange of information, its vital eHealth Ontario’s policies continue to protect patient health information. eHealth Ontario is committed to ensuring a safe and reliable digital health system so that health care providers, including family doctors, nurses, emergency room clinicians and specialists, have real-time access to patient health records and are able to provide the best possible care. We have made significant progress towards our eSafety maturity targets. Critical to success was the concept of eSafety by design, whereby existing governance, risk, project delivery, and incident management processes were leveraged to ensure patient safety was considered throughout the entire lifecycle. An enterprise approach to eSafety required significant engagement from across the organization to ensure consistent application of new processes.

      140 Character Summary: Discover how eHealth Ontario designs solutions to ensure the integrity of digital health information. Session includes practical eSafety implementation tips.

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      OS12.03 - Implementing an Enterprise Approach to Data Quality Management at CCO (ID 251)

      S. Ingale, Enterprise Data & Analytics Governance Office, Cancer Care Ontario; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Cancer Care Ontario (CCO) is the principal advisor to the Ontario government on the cancer and kidney care systems, as well as access to care for key health services. Our mission is to work together with our partners to improve the performance of our health systems by driving quality, accountability, innovation and value. As such, CCO’s board and senior leadership embarked on the development of a Data and Analytics Strategy. Key to realizing this strategy is the Towards Actionable Insights (TAI) Initiative, which has the goal of strengthening CCO’s foundation in Data & Analytics and shift the organization towards one that is capable of realizing value from its assets. Having the highest quality data is key to delivering CCO’s mission and the data & analytics strategy. The TAI Initiative identified Enterprise Data Quality Management (EDQM) as a key organization-wide project. This project will establish practices to help improve the data quality (DQ) available at CCO thus leading to better information that can be trusted for decision-making.

      Methodology/Approach: The EDQM project was launched to help define, implement, and operationalize guidelines, dimensions, processes, roles, responsibilities and technology to consistently manage data quality across CCO’s datasets. An Enterprise Data Quality Management Guideline provides a DQ work cycle that describes high-level activities, such as DQ assessment and Issue remediation that needs to be performed to plan and build effective DQ practices that are sustainable. The guideline endorses 5-dimensions of data quality (illustrated in figure 1) that are used to monitor quality at dataset, data element and record-level. The guideline will be applied to ~20 datasets over a two-year timeframe. The guideline will be refined as it moves from theory to practice. Operational plans will be developed to ensure that data quality management is an ongoing capability of the organization. dq dimensions.jpg

      Finding/Results: The Enterprise Data Quality Management Guideline will promote a common understanding and consistent application of DQ practices and tools across CCO. The processes and procedures developed through the project will ensure an understanding of roles and responsibilities resulting in a consistent and efficient approach to data quality. Overall, this will promote collaboration, understanding and transparent communication among individuals accountable for data quality management. Lessons learned, quick wins and outcomes will be capitalized to ensure the project continues to meet its objectives.

      Conclusion/Implications/Recommendations: Data quality management at CCO will reinforce users’ trust in the data and allow for confident use of the data to drive decision-making. With a solid foundation in place, CCO will further its capability to realize value from its assets and enable transformation to respond and deliver on provincial strategies.

      140 Character Summary: The Implementation of Enterprise Data Quality Management is key to CCO’s success in delivering on actionable insights for decision-making.

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      OS12.04 - A Provincial Seniors Quality and Safety Program in BC (ID 626)

      V. Lukac, West Division, Gevity Consulting Inc; Vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives: BC Care Providers Association (BCCPA) members care for more than 16,000 seniors annually in residential care/assisted living and over 11,000 each year through home care and home support. With grant funding from the BC Health Ministry in 2017, BCCPA is developing and managing a new province-wide Seniors Quality and Safety Program. The objective of this presentation is to share lessons learned, applications deployed and key indicators of performance achieved by this program to improve seniors quality and safety in care settings.

      Methodology/Approach: The approach deployed to enable this new program will be deployed in 4 steps: The first step is to conduct a comprehensive province-wide needs assessment which serves as a baseline to feed into the prioritization of short and long-term fund allocation for all non-government publicly funded residential care homes operating within BC. The second step is to develop a provincial program process and organizational structure, analyze the needs assessment data, and develop program criteria and eligibility guidelines. (Table 1) The 3rd step is to enable the program with an app to track funding allocations for senior care homes to improve quality and safety of care for seniors. The 4th step is to measure the demonstrable benefits, improvements or impacts realized by funding and report upon them. Table 1: The five guiding principles of SSQIP ssqip.png

      Finding/Results: The results include an innovative approach in the design, delivery, implementation of a provincial program to improve Seniors Quality and Safety, with tangible demonstrated results and outcomes. This program also demonstrates innovation around people and processes to realize a province-wide needs assessment, allocate funding for senior care homes to improve quality and safety of care for seniors and measure program performance.

      Conclusion/Implications/Recommendations: B.C.’s population is aging, and a growing number of older British Columbians are living with illness, disability and/or frailty. About 853,000 seniors lived in B.C. in 2016. In March 2017, the Ministry of Health outlined an Action Plan to Strengthen Home and Community Care for Seniors. Lessons learned through this program implementation as well as the new tools used to monitor and improve the care for seniors in BC and recommendations will be shared during this presentation.

      140 Character Summary: Creating and deploying a Provincial Seniors Quality and Safety Program in BC: innovations in processes, people and performance measurement.

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    PS02 - Patient-Centric Solutions (ID 14)

    • Type: Panel Session
    • Track: Clinical Delivery
    • Presentations: 2
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      PS02.01 - Electronic Communications to Drive Connected, Collaborative Healthcare (ID 394)

      S. Wilson, Neurology and EMG; Calgary/CA
      K. Lemoyne, TELUS Health; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: The panel explores how accelerated electronic communication among a patient’s care team can support and sustain a truly integrated healthcare ecosystem that is more efficient for clinicians and more personalized for patients.

      Methodology/Approach: This moderated session brings together a panel of experts from across the healthcare ecosystem to provide a broad perspective on the challenges of communication among healthcare professionals and the solutions that exist on the market: - Dr. Scott Wilson, an Alberta-based neurologist, will present his use of a patient-centric solution for referrals, pre-appointment communication, consultation and results reporting. - Katie LeMoyne, TELUS Health will discuss the value of clinical communication across the primary care ecosystem to enable eReferrals, eConsults, ePrescriptions and other clinical messaging.

      Finding/Results: A recent survey of 150 Canadian physicians revealed that phone (85%) and fax (65%) are the top two means physicians use to share patient information and critical medical data with other healthcare professionals. This continued reliance on outdated tools makes for unnecessary inefficiencies and stress for clinicians who are already overwhelmed by demand. To begin addressing this challenge, an eReferral solution was embedded in a leading EMR solution and launched in BC in 2010. The solution quickly grew to over 214 participants by 2017, with an average of 2400 exchanges per month, and a total of more than 200K+ exchanges to date. The success of this solution is driving the development of a national, EMR-agnostic platform that aims to expand comprehensive communications among primary care physicians, specialists, and allied healthcare professionals. This includes access to health records, the ability to contribute to those records, and channels to communicate virtually with clinical providers, ensuring that patient data is available when and where it’s needed to support continuity of care. The solution chosen by Dr. Wilson is being used by 30,000 healthcare professionals in North America sending over 35,000 messages per month. The key learnings from a community family practice of 18 family physicians and 25,000 patients and a study of patient-centered communication for 150 headache referrals and the successful implementation in a specialist clinic will be presented.

      Conclusion/Implications/Recommendations: It is essential that more efficient and timely communications are enabled in the context of the patient’s record. Using electronic tools, significant efficiency is enabled through immediate communication among providers and patients. By opening up electronic communication opportunities, elements of a patient’s chart can be attached to a communication, achieving unprecedented record portability. And, structured messages could be used to enable highly complex clinical workflows between different clinical settings and, in some cases, with the patient themselves.

      140 Character Summary: Healthcare providers need the right tools to achieve a higher standard of care that is more accessible and better attuned to the need of their patients.

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      PS02.02 - Convenience in Health Care Delivery: Imagine the Possible (ID 476)

      M. Nenadovic, Canada Health Infoway; Toronto/CA

      • Abstract

      Purpose/Objectives: Imagine being empowered to book or change a medical appointment from your device rather than languishing “on hold” every time you call your health provider’s office to do the same. Imagine virtual visits and secure messaging in place of the time required to travel and wait for a few fleeting moments with your care provider. Imagine anytime, anywhere access to your complete digital health record rather than the current state where your record is likely distributed across providers, organizations and provincial repositories that are not, or only partially, accessible to you. Imagine health and wellness tracking devices and apps contributing data so that your personal health record is more comprehensive and representative of your wellbeing. Imagine artificial intelligence leveraging your health and activity data to personalize health and wellness coaching interventions for you. Imagine if all of these conveniences and many others are accessible to you from a secure, “one stop shop”. A future where the simple, routine health care interactions and processes – the ones that demand so much of your time -- are transformed by an ecosystem of innovation. A future where governments, the private sector, providers and patients convene to continuously create and sustain convenient consumer centric digital health solutions and services.

      Methodology/Approach: What will it take for this future state to be realized? Subject matter experts drawn from government, the innovation sector and the digital health vendor community will share their insights and frank assessments of the value proposition for patient engagement platforms and integrated services. Panelists will discuss their views on sustaining business models, the readiness state of technologies, governments and other market participants to disrupt the current state in order to improve the patient experience as envisioned in this future state.

      Finding/Results: Patient engagement technology platforms and integrated applications hold the power to drive convenience in an increasingly connected health system for both consumers and clinicians. They will support locally driven priority areas including chronic disease self-management, care in the home, mental health services and palliative care. Consumer platforms will anchor an expanding system of innovation where third party developers can create solutions that address patient and provider needs for improved convenience, efficiency, and patient outcomes.

      Conclusion/Implications/Recommendations: Integrated patient engagement technologies will: – Obtain further value from the foundational digital health investments – Harness the innovation creativity of the private sector to address Canada’s healthcare priorities and encourage the development of solutions that are consumer centric – Improve speed to market and scaling with lower cost and risk to developers and jurisdictional governments – Enable patients to access a consolidated and comprehensive health record in a privacy protective manner

      140 Character Summary: Integrated patient engagement technology to improve access, convenience and innovation in Canada’s health care systems; it’s time!