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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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    RF08 - Ideas for Leveraging Approaches and Technology Solutions (ID 35)

    • Type: Rapid Fire Session
    • Track: Executive
    • Presentations: 4
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      RF08.01 - Creating Shorter, Lower-Literacy Patient Experience CAHPS on Digital Platform, Tickit® (ID 586)

      S. Whitehouse, Tickit Health; Vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives: Healthcare policy supports inclusion of patient experience ratings in healthcare quality measurement & reporting. • Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is gold standard for collecting patient perceptions and experiences with care. • Traditional mailed CAHPS surveys have low response rates (~30%) • Racial/ethnic minorities and older adults are less likely to respond. • Mobile technology can be used to capture perceptions of patient experience at the point of care.

      Methodology/Approach: Survey Adaptation & Design • Partnered with start-up company Shift Health to create tablet-based survey interface that was visually attractive, icon-based, and simple. • Adapted Clinician and Group CAHPS (CG-CAHPS) survey to lower literacy levels of questions and shorten survey length. Patient Feedback & Validation • Elicited feedback from 3 existing patient advisory councils to refine survey questions, interface, and workflow for administration. • Conducted 25 in-depth interviews with patients to: • Elicit perspectives about care experiences and preferences for reporting feedback to providers/clinics. • Validate a tablet-based survey compared to the standard paper-based CG-CAHPS (patients received both surveys in randomized order). • Collect feedback about the interface and content of a tablet-based survey to inform future iterations.

      Finding/Results: Preferences for Survey Administration • Timing of data collection – Value of collecting feedback at the point of care to avoid mail delay, occupy time in waiting room. • Prefer tablet-based survey administration – Novelty, color, interactivity, “fun” factor, familiarity with mobile platforms. • Prefer paper-based survey administration – Tradition, lack of technology skills or interest, privacy. Usability of Tablet-Based Survey • High ease of use – Tablet quick, easy, and convenient to use. • Few technical barriers – Difficulty with key-in answers, lack of flexibility in answering questions. Importance of Reporting Patient Experience • Survey not capturing positive feedback/experiences – Value of reporting good experiences to recognize staff and providers. • Survey capturing the need for clinic improvement, but not personal negative experiences – Value of reporting bad experiences to get resolution or drive changes in quality of care. Perceptions of Survey Capture of True Experience • Quality of provider communication, staff respect, and access to care were prioritized concepts. • Need for open-ended reporting format.

      Conclusion/Implications/Recommendations: A majority of patients served in safety net healthcare settings are interested in using tablets to provide timely feedback to their clinic. • Engaging patients in the design process produced a tablet-based survey with high usability and appropriate content. Clinics can integrate quality improvement & patient experience efforts with enhanced data collection . • Current CAHPS questionnaires capture some core concepts of diverse patient care experience, but not the full range of responses. Federal policy should support improved content and format for collecting patient experience data from diverse populations.

      140 Character Summary: Using the Tickit platform improved the completion rate and cultural inclusivity of San Francisco Department of Public Health's CAHPS survey.

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      RF08.02 - Has Canada Really Caught the FHIR Train? (ID 175)

      A. Farkas, Clinical Systems Integration, Canada Health Infoway; Toronto/CA

      • Abstract
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      Purpose/Objectives: HL7’s FHIR (Fast Healthcare Interoperability Resources) has quickly become a cross between the Holy Grail and a household name for health IT implementers. The past year has seen much in the way of leadership activity that has taken hold across the country. Although a number of countries have embraced FHIR as the interoperability solution of choice for in health IT, Canada is just getting started. Early implementations have been initiated with some learning on what to avoid. How we ensure this new technology becomes embraced and used by all includes a number of factors including the use of the early adopter experience to build best practices for Canada.

      Methodology/Approach: A community has united and convened to identify priorities, discuss opportunities and collaborate on the building blocks of a national strategy. Various tools and resources have been identified and secured to support the advances in health IT in order to improve access to health information and care.

      Finding/Results: FHIR is truly an international standard with early adopters in Canada amassing a wealth of knowledge and experience. FHIR is not without its operational challenges that must be recognized. It is these experiences in development and delivery that could lay a strong foundation for a united national strategy.

      Conclusion/Implications/Recommendations: A panel of experts and early adopters will demonstrate the level of due diligence required to form a national FHIR strategy facilitating scalable implementations.

      140 Character Summary: Early adopter experience may be the secret sauce to inform all future successful FHIR adoption in Canada.

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      RF08.04 - Adoption Drivers of Personal Mobile Health Management and Pharmacist Monitoring (ID 193)

      M. Arcand, Marketing, Université du Québec à Montréal; Montréal/CA

      • Abstract
      • PDF

      Purpose/Objectives: In Québec, the rapid adoption of mobile devices by consumers (Cefrio, 2015), an aging population, and increasing incidence of chronic disease (Émond, 2011) have encouraged the development of "mobile health”, notably facilitated by the proliferation of mobile applications and the marketing of health-related connected objects (WHO, 2011). Nevertheless little is known about the factors influencing consumer adoption of these applications or mobile health platforms. The objective of this study is to measure the influence of several determinants on the intention of consumers/patients (aged 40+ in Quebec) to adopt a free mobile health management platform and their interest in personalized follow-up by the pharmacist via the platform. More precisely, the study examines the influence of mobile technology characteristics (ease of use and perceived utility) (Davis 1989), personal variables (social influences and innovativeness with technology), health behavioral factors (Rogers, 1975) (perceived health-related vulnerability and severity), as well as relational variables such as trust in, and commitment to, their pharmacists. As such, it uses variables and models from the marketing, information technology and health.disciplines in a single theoretical framework.

      Methodology/Approach: An online survey was conducted on 356 representative Québec respondents owning a mobile device and having visited their pharmacist at least once over the past year. The results were analyzed using structural equation modeling software (EQS 6.0).

      Finding/Results: The results revealed that 50% of respondents would be willing to adopt the mobile health management platform. The main determinant of adoption intention is perceived usefulness of the technology, followed by innovativeness with technology and the perceived vulnerability of one's state of health. However, interest in personalized follow-up by the pharmacist depends on the quality of the relationship with the pharmacist and the perceived severity of threats to the respondent’s health. Interest in personalized tracking by the pharmacist does not influence intention to adopt the mobile application.

      Conclusion/Implications/Recommendations: We suggest that providers of this type of technology target consumers that are open to new technologies, and for whom perceived utility is an important factor in adopting the platform, for example, patients with a chronic disease. It would also be advisable to target consumers who have already developed a certain relationship with their pharmacist. This research is original by taking a multidisciplinary approach in focusing on consumer/patient intentions to adopt a mobile health management platform. It is also original in its interest in the concept of the patient-pharmacist relationship. Its social contribution is important given current economic and public health issues and improvement of the health system. Indeed, while (1) the health system is in a funding / resource crisis, (2) the role of pharmacists has recently been expanded in Quebec, and (3) patients are increasingly exposed to this type of service technology focusing on health, exploring the potential of new technologies in the context of the individual /pharmacist relationship is part of a process of reflection relevant to the Canadian, society.

      140 Character Summary: This study tests the effect of various factors driving the intention of patients to adopt a mobile health management platform and personalized monitoring by their pharmacist.

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      RF08.05 - An Operational Excellence (OpEx) Approach to Value-Based Healthcare (ID 264)

      S. Wark, CGI; Edmonton/CA

      • Abstract
      • PDF

      Purpose/Objectives: Healthcare providers are facing challenging times as they look to find a balance between decreasing inpatient volumes, continued aging of the Canadian population, the diffusion of new healthcare technologies, increased pressure for other public spending and as the trend moves towards value-based care accelerates. Clinical and data analytics leverage big data with clinical evidence to manage health and drive decisions. However, analytics alone will not lead to value-based outcomes. How does Operational Excellence leverage data analytics and Continuous Quality Improvement (CQI) methods to drive value?

      Methodology/Approach: A 3 step examination of how Continuous Quality Improvement methodologies have been utilize in healthcare, a look at Operational Excellence as a systematic alternative and examples of how it has been successfully applied in the Alberta health system. 1. A high level review of popular quality and analytics methods that have been utilized in the Canadian healthcare sector and their progression, strengths and weaknesses. Including: - Lean - Six Sigma - Agile 2. Exploration of Operational Excellence as a holistic approach to drive improvement in operational, clinical and financial results throughout a health organization. 3. Review of the application of Operational Excellence to Alberta Health Netcare Support Services and how selected OpEx techniques were applied to translate data into valuable quality outcomes.

      Finding/Results: The majority of Canadian Healthcare organizations are lagging behind in implementing an improvement system, or they are still early on in their journey. The application of improvement methods in the healthcare sector vary in the level of sophistication. Evidence indicates adoption in most health authorities however they are rarely managed holistically. The next step to increase maturity is the systematic coordinated planning and execution of value-based performance management and improvement. Operational Excellence case studies (including Alberta Health) have demonstrated: - OpEx has improved financial efficiency as significant operating dollars were tied up in unintended variability - Drive decision making and continuous improvement through the initiation of 11 improvement projects - Process control and effective planning - True transparency throughout organization and accurate reporting

      Conclusion/Implications/Recommendations: Achieving Operational Excellence is one of the most important contributors to an organization’s sustainable performance and growth. Many approaches to quality improvement have been tested in healthcare with varying levels of complexity, adoption and success. However, it is proven that organizations that reach for a higher level of Operational Excellence reap numerous benefits – a systematic, evolving and effective approach to business operations; a continually productive and innovative workforce; and an organization that consistently realizes sustainable and continuous improvement. In a big data era, an approach to leverage clinical, financial and operational data is required to understand the integrated outcomes.This requires moving away from traditional “silo” based measurement and improvement to a structured approach that takes into account the entire organization.

      140 Character Summary: OpEx is "doing the right things right, consistently." OpEx leverages big data, analytics and Continuous Quality Improvement methods to drive value.

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    EP05 - e-Poster Session 5 (ID 56)

    • Type: e-Poster Session
    • Track: Clinical Delivery
    • Presentations: 8
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      EP05.02 - Devops is Coming (ID 496)

      L. Sutton, CGI Group Inc.; Victoria/CA

      • Abstract
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      Purpose/Objectives: This discussion will provide you with a common understanding of DevOps, its approach, methodology, and tools, as well as the benefits and implications for the management of your IT systems. But implementing DevOps will also extend into how you hire and motivate your staff, how you structure your organization’s roles, how you approach governance and decision making, how you deliver your services, how you layout your facilities and choose to co-locate your staff.

      Methodology/Approach: We will speak briefly to this image to explain DevOps: devops.jpg

      Finding/Results: The practical benefits of DevOps and what it means for eHealth 1. Shorter development cycles, faster delivery of features and fixes a. Means that new or enhanced capabilities are available more frequently for your clients. 2. Reduced deployment failures, rollbacks, and time to recover a. Means less interruption to dependent internal processes and shorter downstream system outages. 3. Increased efficiency through automation of tasks from code development through to deployment a. Means you achieve consistency, reliability, and auditability of IT processes and more time for your teams to spend on higher level tasks. 4. Increased collaboration and reduction of team and business silos a. Means a reinvigoration of your software engineering teams as they find new ways to innovate to meet business needs.

      Conclusion/Implications/Recommendations: DevOps is coming. If you want to implement DevOps successfully and reap the benefits, then you must think about changing the culture of your organization to allow it to flourish. 1. Encourage experimentation and innovation so teams can “Fail Fast, Fail Small, Recover Fast”. 2. Shift the traditional concepts of accountability and responsibility so people feel empowered to embrace the idea of expanding the boundaries of their work and the definition of “done”. 3. Redefine recruiting, professional development and traditional career paths to account for a wider range of skills and experience. 4. Break down the boundaries between teams, even to shifting how you design the workspace to promote collaboration. 5. Communicate with your clients to include them in the changes and get them excited about the benefits they will get from the faster release of features.

      140 Character Summary: DevOps is inevitable in the way IT systems are developed and operated in the future; the implications extend beyond IT to an organization's culture and operations.

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      EP05.03 - Streamlining a Multi-Facility Electronic Health Record (EHR) Change Request Process (ID 365)

      E. Edosa, Clinical Informatics, Ontario Shores; Whitby/CA

      • Abstract
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      Purpose/Objectives: Establishing a joint EHR change request process in a HIS cluster was integral to ensuring clinical standardization and adherence to system change control processes. In the past, change requests were managed using Microsoft Word documents that were stored on a joint SharePoint site. Challenges arose: understanding the process; version control; determining approval status, auditing changes; reporting common characteristics. These challenges presented an opportunity to develop an electronic solution to create, track, and store EHR change requests.

      Methodology/Approach: Software was utilized to create an EHR Application Change Request form and portal as shown below: change request.png This software enables EHR change requests to be created and tracked electronically. It allows for business intelligence rules to be built in, facilitating adherence to the change request workflow, such as clinical committee approvals at the applicable time in the review process. The solution allows for each change request to flow through the approval process in the correct manner before being flagged as ready for adoption into the live EHR system. The solution also enables discrete data collection and reporting, and includes an audit trail that is useful for reviewing the changes to the change request form. The system also allows for keyword searching and filtering which is valuable to view historical changes. The solution use eliminates the need to have copies of Word documents and hyperlinks on agendas as the one electronic copy that everyone can view and contribute to is used. The use of business intelligence rules facilitates the automation of the change request process, automatically adding the change request to the required committee agendas.

      Finding/Results: Using an electronic solution for change requests has resulted in increased compliance of change requests. Efficiencies in time savings were found as Clinical Informatics staff no longer need to submit change requests to be added to agendas and administrative support was no longer require to compile committee agendas or for the storing of completed change requests. Staff also reported gains in being able to understand where each of their submitted change requests were in the change request process and were better able to report on workload and timelines. Staff reported increased satisfaction in using the new software.

      Conclusion/Implications/Recommendations: Introducing an electronic solution for EHR change requests in a multi-hospital HIS cluster environment is a robust solution compared to the manual creation, tracking, agenda creation, and storing of change requests using Microsoft Word. The ability to use business intelligence rules allowed for the change request process to be built into the software producing increased compliance to the process and significant efficiencies. The adoption of an electronic solution for EHR change requests is recommended.

      140 Character Summary: A multi-facility EHR collaboration required a new EHR change request process. A new electronic system was successfully implemented and is receommended.

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      EP05.04 - Alberta EHealth Support Services: Evolutive Adoption and Support (ID 421)

      S. Wark, CGI; Edmonton/CA

      • Abstract
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      Purpose/Objectives: Alberta is on an exciting journey, with Alberta Health’s mission to set policy and direction to lead, achieve and sustain a responsive, integrated and accountable health system. Providing the right information in order to for the right caregivers to provide the right services to citizens in the right setting and the right time is a hallmark of an advanced and proficient eHealth program. This is achieved through Alberta eHealth. What is the eHealth Delivery Model and why are eHealth Support Services important?

      Methodology/Approach: The eHealth Delivery Model was introduced in 2015. It is a new comprehensive and flexible model, methodology and approach, designed to meet the client goals and objectives by focusing on continuous improvement, innovation, automation, mobility, self-support and sustainability. The CGI eHealth Support Services (eHSS) Team supports the Alberta Health Digital Health initiatives and eHealth technologies to enable improvements in the delivery of health services in Alberta. Additionally the team support the enhanced functionality of Alberta Netcare to healthcare providers, clinical students, and the Personal Health Portal to Albertans.

      Finding/Results: The graphics depict the evolutive nature of the model and a high level overview of where the benefits were realized. ehealth delivery model.pngehealth delivery model benefits.png

      Conclusion/Implications/Recommendations: Benefits were quickly realized. Five months into the contract CGI implemented the eHealth Avaya Contact Centre, receiving over 6,000 inquiries from healthcare providers. Over the first 4 months, it did not take long for physicians, nurses and other healthcare providers to gain a high confidence in the eHSS professional team of eHealth Consultants. The next benefit was at the 18 month mark when cost savings of $675K, in travel and training expenses were realized as a result of the new eHSS Delivery Model. Alberta Health quickly turned those savings back into eHealth, as new revenue to provide additional effort to the support new eHealth initiatives.

      140 Character Summary: The new eHealth Delivery Model supports entire value stream of eHealth initiatives to deliver quality support to healthcare providers.

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      EP05.05 - Efficiency and Clinical Effectiveness of Telehomecare in Insulino-Treated Diabetic Patients (ID 156)

      R. De Patureaux, Endocrinology, CHUM- University of Montreal; Montreal/CA

      • Abstract
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      Purpose/Objectives: Prevalence of diabetes has drastically increased in the last decade. Clear correlation between elevated A1c and diabetes associated morbidity and mortality has been established. Unfortunately, over 50% of North American patients with diabetes have difficulty to control their sugar levels and consequently have an A1c above target. In this context, use of hospital resources for education and management of diabetic patients increased markedly. Given its chronic nature, the patient's involvement in the management of its diabetes on a daily basis is essential. The Telehomecare (THC) project was initiated at the ambulatory clinic of the Centre hospitalier de l'Université de Montreal (CHUM) in order to improve the follow-up of diabetic patients treated with insulin while maintaining the same quality of care and patient's satisfaction. The objectives are to evaluate the impact of THC on organizational efficiency, clinical efficacy and patients' satisfaction compared to the standard care in diabetic patients treated with insulin. Main outcome is to analyse impact of THC on diabetes management during the first 3 months of use of the teaching platform and 3 months after THC was stopped.

      Methodology/Approach: A prospective non inferiority and controlled clinical trial was designed. A total of 105 patients was assigned to either an intervention group provided with a THC system during 3 months for transmission and online analysis of capillary glucose (n=55) or to a control group receiving standard care (n=50). Patients in the THC group either use a dedicated tablet provided by healthcare provider, or access services through a web browser via their personal computer/tablet/phone. Patients use THC to register their daily health activities personalized by their care provider and receive real-time feedback. Clinical data are securely transmitted, stored and accessible to caregivers allowing a prompt therapeutic adjustment if needed.

      Finding/Results: Preliminary results: 49 patients in THC group and 22 patients in the control group have, to date, completed the study. THC group had an average of 0.6 medical visit compared to 1.0 in control group. However, an increase in nursing interventions (mainly emails or phone calls) was noted in THC group (n=14.8) compared to control group (n=1). A significant decrease in A1c levels was observed at 3 months with a reduction of -0.66% in THC group compared to -0.12% in control group. The program targeted diabetes type 1 and 2 patients with no discrimination on duration since diagnosis. One surprising result from the program is that even expert patients, with long-term experience managing their condition, seemed to have obtain improved results and knowledge from undergoing the program. Satisfaction in care was similar in both groups.

      Conclusion/Implications/Recommendations: These preliminary results suggest an improvement in glycemic control in patients followed by THC, compared to usual care, which can be explained by an intensive glycemic monitoring and a rapid therapeutic adjustment. Also, it suggests a decrease in the number of medical visits needed for patients followed by THC. The final analysis of the data is currently pending to determine the impact on glycemic control at 6 months and the cost-effectiveness of THC compared to usual care.

      140 Character Summary: E-Health Medicine to Improve Diabetes Management (Care and Cost Effectiveness): Evaluation of Telehomecare Management in Diabetic Patients on Insulin Therapy

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      EP05.06 - Evaluation of a Telehomecare Initiative Used in Gestational Diabetes Women (ID 157)

      R. De Patureaux, Endocrinology, CHUM- University of Montreal; Montreal/CA

      • Abstract
      • PDF

      Purpose/Objectives: The prevalence of gestational diabetes mellitus (GDM) increases steadily in recent years. Pregnant women with GDM are at risk for obstetrical and neonatal complications. These patients therefore require close multidisciplinary follow-up to ensure proper management of GDM, which implies many appointments for patients and a significant use of hospital resources. The telehomecare (THC) initiative is a clinical Remote Patient Management project led by the Endocrinology division at the Centre Hospitalier de l’Université de Montréal (CHUM). Primary objective is to evaluate the ability of THC to decrease medical visits in clinics or at the emergency room. Secondary outcomes are: 1) to improve diabetes control and possibly limit GDM related complications, 2) to increase access to care and dedicated team, 3) to evaluate patient's satisfaction and empowerment, and 4) to evaluate cost effectiveness of THC by assessment of direct and indirect costs.

      Methodology/Approach: A prospective noninferiority and controlled clinical trial was designed. A total of 161 women was assigned to either an intervention group provided with a THC system for transmission and online analysis of capillary glucose data (n=80) or to a control group receiving usual care in clinic (n=81). Patients in the THC group were either given a tablet to use or an access to a web patient portal via their personal computer/tablet/phone. They register their daily health activities as outlined by their care plan. Automated and adjusted feedback is provided directly to the patient by the platform to promote better health behaviours. Clinicians will receive alerts based on predetermined algorithms and can adjust therapy quicker upon the symptoms and results registered by the patient. An innovative aspect of this project is that THC is integrated within traditional care as the responsibility for the remote care of patients is assigned to nurses working on the unit. Another innovative aspect is the delivery of personalize and interactive coaching through the technology. This automated and individualized process upon patients’ results generates motivation by promoting better health condition thus, facilitating patients’ empowerment.

      Finding/Results: The results are the outcome of a large collaboration, led by clinicians (doctors, nurse, nutritionist, etc.) and patient partners, supported by a group of technologists and implemented in a platform that supports clinical processes. Preliminary result (n=80 THC and n= 81 Controls) indicate that patients in the THC group had an average of 1.45 compared to 3.32 medical visits, a decrease of 56%. However a 80% increase in nursing interventions (mainly by emails or phone calls) was noted. Maternal and fetal outcomes were similar between groups demonstrating that by using THC, there is no loss in the quality of care. Satisfaction in care was similar in both groups (9/10) however women in the THC group felt that access to their clinical team was easier.

      Conclusion/Implications/Recommendations: THC monitoring appears to significantly reduce medical visits as well as improving access to care without compromising pregnancy outcomes and patients’ satisfaction. However, the impact on maternal and fetal complications rates and cost-effectiveness remains to be analyzed. The final analysis to establish statistical and clinical significance is currently pending.

      140 Character Summary: Telehomecare Initiative to Ease Gestational Diabetes Mellitus Management in Pregnant Women Significantly Reduce Medical Visits and Improve Access to Care.

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      EP05.07 - Network Effects in Telemedicine (ID 609)

      S. Daya, Strategy and Planning, Ontario Telemedicine Network; Toronto/CA

      • Abstract
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      Purpose/Objectives: Over the past decade, a regional telemedicine provider in Canada has developed one of the largest telemedicine networks in the world. Last year, over 750,000 clinical events took place across the network. Over the past few years, the organization has gradually shifted its core business model from managing a telemedicine utility to developing a virtual healthcare platform. The platform business model leverages network effects to drive value and growth.

      Methodology/Approach: With the shift to a platform business model, the organization has broadened its focus beyond simply providing telemedicine services over its network to catalyzing clinical program development with partner organizations, driving the spread of successful telemedicine business models across the province, disseminating information about new innovations and best practices, enabling and supporting new communities of practice, and creating business intelligence for its users.

      Finding/Results: The repositioning of the organization from a service provider to a platform manager and redefinition of the network from technical to social in nature, has allowed it to leverage the innovation of its partners; drive the spread of best-in-class solutions and align the evolution of telemedicine services to health system priorities and transformational initiatives.

      Conclusion/Implications/Recommendations: By removing itself from the centre of business processes such as product development, adoption and change management, and customer care, the value proposition of telemedicine in the province is rapidly increasing.

      140 Character Summary: The adoption of a platform business model and leveraging of network effects has dramatically increased the value proposition of a provincial telemedicine system

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      EP05.08 - User Receptivity of BoosterBuddy: An App for Mental Health Disorder (ID 598)

      A. Smith, Psychology; School of Health and Exercise Sciences, The University of British Columbia Okanagan; Kelowna/CA

      • Abstract
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      Purpose/Objectives: BoosterBuddy is an app designed for youth between the ages of 15 and 24 years of age, and is intended to support and increase their self-management skills for mental health. BoosterBuddy uses “gamification” (e.g., quests, coins, levels) to improve motivation and to engage in behavioural activation focused activities. The study had the following two objectives: 1) To describe users feedback about the app (e.g., do users like it) and frequency of use, and 2) To examine whether users recommend the app to others via social media platforms. Each objective included different methodology, as outlined below.

      Methodology/Approach: Objective 1: 1,047 unsolicited user feedbacks were coded using two complementary coding methods: first, using the Mobile App Rating Scale (MARS; Stoyanov et al., 2015), which is a framework used to evaluate the quality of apps; second, using predetermined categories that were created using a small subset of the data, where similar feedback was grouped to create coding categories that are specific to the BoosterBuddy app. The app was also evaluated using online questionnaires, where 118 app users responded to an online questionnaire that assessed demographics, app usage (e.g., frequency), and users’ satisfaction with BoosterBuddy. Objective 2: Examined social media posts from Twitter, Instagram, Tumblr, and a variety of vlogs and blogs between September 2014 and April 2017 for mention of recommending the app.

      Finding/Results: Objective 1: Coding the unsolicited feedback indicated that 67% of app users reported that BoosterBuddy was helpful, and 49% found features of the app to be well-targeted to their demographic. The 188 users who completed the online questionnaire were 28 years old on average (SD = 10: min-max: 19-62) and mostly women (70%), gender fluid (7.7%), transgender man (6.8%), and don’t know (5.1%), other (4.3%), and man (3.4%). A total of 33% were of British descent or selected other as their ethnicity (31.4%). Majority of users (75%) reported using the app for 1-10 minutes per day and 64% reported that the app was ‘extremely/very useful’. Table 1 outlines the features of the app and the percentage of users who rated each feature as useful. Critically for behavioral activation, ~60% reported ‘agree/somewhat agree’ that BoosterBuddy helped them start their daily tasks. Objective 2: Trends emerged when observing the unsolicited feedback provided through social media platforms, with an overwhelming number of users recommending the app. Table 1. BoosterBuddy features and the percentage of users who reported the feature to be useful 'extremely useful' or 'very useful' (N=118) BoosterBuddy Feature Percentage of users who reported the feature to be useful Coping Library 62.7% Crisis Plan 39.8% The Quests 52.6% The inspirational quotes and encouragements 61.9% The check-ins about how I am feeling 64.4%

      Conclusion/Implications/Recommendations: Users of BoosterBuddy report that the app is helpful and indicated some recommendations for improvement. A limitation is that the data is self-report and conclusions cannot be made about the impact of the app on changes in users’ mood and personal well-being.

      140 Character Summary: Users of BoosterBuddy report high frequency of using the app and that it is useful for managing their mental health. The users had some suggestions for improvements.

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      EP05.09 - Exploring CIHI's Long-Term Care Quality Indicators Using Big Data Analytics (ID 324)

      C. Willemse, Data Quality, Canadian Institute for Health Information; Ottawa/CA

      • Abstract
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      Purpose/Objectives: CIHI’s Information Quality Framework includes quality monitoring and control activities that focus on quality at every stage of the information life cycle. Traditional activities employ simple data validation (e.g. checking for missing or invalid values) during data capture, submission and processing. Data surveillance is a newer quality approach that monitors information outputs (e.g. performance indicators) through a cyclical process of analysis, reporting, review, investigation and response and aims to mitigate the impact of data use on data quality. CIHI is using big data analytics and surveillance techniques to examine changes in health system performance indicators reported in its Your Health System (YHS) web tool. In collaboration with Health Quality Ontario (HQO), we are beginning with the Potentially Inappropriate Use of Antipsychotics in Long-Term Care indicator, which is based on information in CIHI’s Continuing Care Reporting System.

      Methodology/Approach: Regression modeling, trending analysis and facility-level comparisons determine whether indicator changes reflect changes in clinical practice or changes in data quality. A report summarizing the analysis highlights provincial-level findings and LTC homes with pronounced changes in data related to the indicator. Homes are engaged in a collaborative report review process that enables discussion and identification of the reasons for change, which will ultimately influence quality improvement across the sector.

      Finding/Results: Indicator results show that, in Ontario and across Canada, there has been a decrease in potentially inappropriate use of antipsychotics over the last 5 years. Regression analysis confirmed there has been real system-level change in clinical practice and reduction of antipsychotic use among residents, particularly those with dementia. However, there also appear to be some changes in coding and data quality. There was a decrease in denominator cases due to an increase in the coding of exclusion criteria (mostly delusions, hallucinations, end-stage disease and hospice care). Some of this change may be due to improved data quality (e.g., more comprehensive assessment of risk factors that exclude residents from the indicator), but some variation may also be due to differences in understanding of the data (e.g., lack of clarity in assessing delusions and hallucinations). This is evident in the variation seen across homes in the prevalence of exclusions, with some homes having larger increases over time than others. Some of these homes also exhibited unusual changes in data related to the indicator.

      Conclusion/Implications/Recommendations: Following up with LTC homes is essential to understanding the underlying factors associated with the observed data changes, and both CIHI and HQO have a role to play in this. The information gathered will influence and shape next steps, which could include the development of clear coding guidelines and education related to the exclusion criteria, and ongoing data monitoring. The information will also provide insights to surveillance analytics by strengthening statistical models and enabling identification of areas requiring further data quality improvement. It is important that all homes benefit from the data quality efforts undertaken by individual homes. Collaboration, openness and transparency are key to the success of data surveillance and ensuring continued trust in using the data for performance improvement.

      140 Character Summary: CIHI is exploring using big data analytics to monitor changes in the quality of data behind it's Your Health System performance indicators.

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    EP06 - e-Poster Session 6 (ID 57)

    • Type: e-Poster Session
    • Track: Executive
    • Presentations: 9
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      EP06.01 - Re-Architecting Interoperability: A Creative Use of Constraints (ID 360)

      V. Gupta, InfoClin Analytics; Toronto/CA

      • Abstract
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      Purpose/Objectives: To propose a new approach to interoperability in healthcare. Current technological approaches to interoperability generate increased effort for end-users, are costly to implement and do not provide sufficient value to stakeholders that they would pay for it out of their own pockets or contribute to its sustainability. We suggest that by introducing an economic value-based approach to data exchange, we can create a more compelling opportunity for adoption across multiple stakeholders. Using diabetes as a use case; we determined the economic value that accrues to the healthcare system that is associated with exchanging a single data element.

      Methodology/Approach: We used the British Design Council’s Double Diamond design method to identify and define key high value use cases. We identified screening for diabetic retinopathy as a use case due to the increasing burden of diabetes on the Canadian healthcare system. We developed and used an economic framework that assesses the Net Present Value of a stream of current costs (and savings by not screening 30% of patients) and compared them to the savings generated by increased screening (and associated costs).

      Finding/Results: Approximately 59% of the 3.4 million patients with diabetes in Canada have some form of diabetic retinopathy (DR), and 1.5% of those patients have vision loss due to DR (30,000/year). We identified that exchanging information on whether a diabetic patient completed their annual eye exam allowed for prevention, early detection of DR and timely treatment. Using our economic framework, we calculated the value of exchanging a single data element. (By definition, constraining exchenge to a single data element minimizes costs and minimizes effort.) This allowed us to find that the overall cost savings associated with exchanging one data element between optometrists (who provide eye exams) and family doctors (who provide care to patients with diabetes) would equal approximately $140-210 million per year. re-architecting interoperability -dr.png

      Conclusion/Implications/Recommendations: The implication of this method is to highlight that current interoperability approaches do not sufficiently incentivize stakeholders to exchange information. Interoperability is perceived as an end in itself; but our value-based approach suggests that it should be used only as a means to an end, in order to better support care planning, program design, and clinical decision support. As we have found, it is not necessary to exchange hundreds of data elements amongst stakeholders. Rather, sharing just one high-value data element for diabetes can benefit thousands of patients and provide cost-savings to government, with minimal data collection efforts from vendors and physicians. We believe we have found an alternative approach to solving the interoperability challenge.

      140 Character Summary: We undertook to find out why interoperability in healthcare is so elusive. We believe we have found an alternative approach to solving the interoperability problem.

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      EP06.02 - Evaluating Remote Consultation Services Using the Quadruple Aim Framework (ID 395)

      E. Keely, The Ottawa Hospital; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives: Health technology solutions are too often implemented without a true understanding of the system-level problem they seek to address, resulting in excessive costs, poor adoption, ineffectiveness, and ultimately failure. Prior to implementing or adopting health care innovations, stakeholders should complete a thorough assessment to ensure effectiveness and value. Our panel will describe how to evaluate the impact of health technology innovations through the four dimensions of care outlined by the Quadruple Aim Framework, using established remote consultation services as case examples.

      Methodology/Approach: The panel will draw on the implementation experiences of different remote consultation services who are at different stages of implementation. Remote consultation refers to a service that allows primary care providers (PCP) to connect with specialists via an electronic medium in order to receive advice regarding a patient’s care. Services may be synchronous (i.e. occurring in real time) or asynchronous (i.e. through text messages stored on a server and accessed by the other party at a later time). Through the presentation, panel members will demonstrate the evaluation of remote consultation services, provide an overview of their current data, and highlight challenges in capturing metrics for all four dimensions of care outlined by the Quadruple Aim framework: patient experience, provider experience, costs, and population health.

      Finding/Results: Panel members will highlight key data as guided by the Quadruple Aim framework. Examples of metrics from the four dimensions are as follows: Patient experience: specialist response times, rate of referral avoidance, patient satisfaction, wait times. Provider experience: PCP satisfaction, PCP description of service benefits, type of questions asked, specialist satisfaction. Costs: total system costs, per capita cost, direct and indirect savings. Population health: health outcomes (e.g. mortality, morbidity, health status), population served, patient safety, equity of access.

      Conclusion/Implications/Recommendations: Panel members will conclude with a discussion of the importance of evaluating new innovations in order to ensure long-term sustainability and growth. Members will provide advice on how to evaluate healthcare innovations, reflect on challenges faced, and offer their assessment of Quadruple Aim as a lens through which to view healthcare innovations. Differences in experiences between services will be explored.

      140 Character Summary: Our panel will describe how to evaluate the impact of health technology innovations using the Quadruple Aim framework's four dimensions of care.

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      EP06.03 - Key Issues for IT Executives in Ontario Hospitals: Emerging Challenges (ID 487)

      M. Syoufi, University of Ottawa; Ottawa/CA
      H. Tamim, Algonquin College; Ottawa/CA

      • Abstract
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      Purpose/Objectives: To develop an authoritative list of IT management issues facing executives in Ontario hospitals and examine their evolution since 2010.

      Methodology/Approach: The ranking-type Delphi survey, which involves a set of linked questionnaires, was used to elicit the opinion of three panels of experts (IT executives) through an iterative process: brainstorming, narrowing down, and ranking (Figure 1). Out of 39 participants who agreed to participate in the study, 33 completed phase 1 representing around 85% response rate (Figure 2). figures 1 and 2.png

      Finding/Results: The responses in Phase 1 were consolidated by two researchers (inter-coder reliability of 88%), resulting in a list of 26 key issues. The issues with a mean rating of importance above 4.5 ([1-7] scale) were retained in Phase 2 yielding 21 issues in the academic panel, 19 in the community panel, and 19 in the rural panel. Two rounds of ranking were conducted due to low consensus, but the final agreement level remained low: W (academic) = 0.235; W (community) = 0.254; W (rural) = 0.381. 5 out of 9 common issues to all hospitals identified in 2010, persisted until 2017. The reported issues in 2017 may be categorized as external/provincial, technological, and organizational (Table 1). Limited funding remains the no.1 issue for hospitals, paralleled by an increasing cost of technology investment, maintenance and support mostly for community and rural hospitals. Importantly, the need for provincial leadership in relation to standardizing policies and agreements, and outlining a provincial IT investment strategy, was reported as necessary to enable collaboration and information sharing across providers. Technology-related issues (e.g., evergreening, external security threats, privacy of information exchanged between providers) emerged, compared to 2010, given the increased connectivity and information sharing over wireless networks/platforms. Organizational issues (e.g., recruiting IT staff, time/cost of training, meeting end-users expectations) persisted to a variable extent in the three panels. table 1 - final ranking of key it issues.png

      Conclusion/Implications/Recommendations: Low consensus consistently observed in the three panels is an indication of the diversity and varying complexity of issues faced by hospitals in Ontario. Provincial leadership and funding support are needed to support hospitals and guide their efforts to implement sustainable IT solutions and develop partnerships for shared IT resources and services.

      140 Character Summary: Financial constraints, provincial leadership and technological issues with enhanced connectivity/wireless platforms are leading issues in Ontario hospitals.

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      EP06.04 - Manitoba's Home Clinics: Leveraging EMR Data to Support Quality Improvement (ID 560)

      M. O'Keefe, Sierra Systems; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives: Following-up on the 2017 eHealth Conference presentation, Manitoba’s Home Clinics: Aligning Continuity of Care, ICT, and Remuneration, the results of Manitoba’s implementation of the Comprehensive Care Management Tariffs will be shared.

      Methodology/Approach: The development and implementation of the Home Clinic model in Manitoba has been a collaborative effort including Manitoba Health, Seniors and Active Living, The College of Family Physicians of Manitoba, Doctors Manitoba, Manitoba eHealth, fee for service clinics, and Manitoba’s Regional Health Authorities. In 2015, a new Comprehensive Care Management Tariff, designed to support the adoption of the Home Clinic model, was negotiated that focused on the provision of comprehensive care to “Enrolled” patients with complex needs. The Tariff came into effect as of April 1, 2017. The annual management tariff encourages a team-based approach to care and requires that fee-for-service physicians use an EMR that can submit Manitoba’s Primary Care Data Extract. This extract leverages the Primary Care Quality Indicators and includes prevention, screening and management of chronic diseases, based on CIHI’s primary care indicators. In return for submitting data on the Primary Care Quality Indicators, Home Clinics will receive value-add analytic reports that combine information submitted from the Home Clinic’s EMR with other administrative data sets, including hospital and emergency department information, and provide comparative analytic data from other Home Clinics to support continuous quality improvement efforts. The intent of these efforts is to empower Home Clinics to leverage data to make better informed decisions about the provision of healthcare services to the populations they serve. In addition, Manitoba has established the Manitoba Primary Care Indicator Advisory Committee, led by clinicians, to elicit feedback and recommendations on existing and new indicators, and to ensure that the indicators are aligned with the latest clinical evidence and care guidelines.

      Finding/Results: The launch of the Comprehensive Care Management Tariff was successful, and resulted in more than 60% of eligible physicians registering with a home clinic and enrolling more than half of the Manitoba population within the first six months. The focus of this presentation will be on the initial findings regarding data quality, adoption of the value-add reports, and feedback from Home Clinics regarding their utility.

      Conclusion/Implications/Recommendations: Manitoba continues to promote Home Clinics, Enrolment, and the Comprehensive Care Management Tariffs areas part of the evolution towards more comprehensive, continuous, and coordinated care for Manitobans. This next phase focuses on leveraging the information from EMRs to support clinical information sharing, and evidence-informed continuous quality improvement activities to promote access to continuous, comprehensive quality primary care for Manitobans.

      140 Character Summary: Manitoba’s Home Clinics: aligning continuity of care, ICT, and remuneration to support continuous quality improvement through health analytics

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      EP06.05 - A Model of Best Practice to Support Vendor Procurement (ID 98)

      L. Huebner, eHealth Centre of Excellence; Waterloo/CA

      • Abstract
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      Purpose/Objectives: The eHealth Centre of Excellence (eCE) in Waterloo, Ontario, recently led an innovative procurement process for securing a vendor to facilitate the development and deployment of an electronic referral platform for the Waterloo Wellington Local Health Integrated Network (LHIN). Part of the innovative procurement process was an agreement that included a Proof of Concept (POC) and a decision point based on the outcomes of the POC to proceed with the selected vendor in a long-term contract, or to go back to market to consider alternative options (Go/No Go decision). With little to no existing frameworks to draw on related to a POC Go/No Go vendor decision, the Benefits Realization (BR) team at the eCE developed a model to ensure that the decision-making process was fair, transparent and evidence based. Attendees will hear about the process that was developed to support the innovative procurement POC evaluation.

      Methodology/Approach: ehealth 2018 1.png This evaluation process included partnering with a third-party consultant firm to develop a vendor evaluation framework that focused on six domains: 1) Solution Quality; 2) Implementation; 3) Service; 4) Engagement, Training and Knowledge Transfer; 5) Vendor Team; and 6) Project Experience. This evaluation was conducted in the Spring of 2017, and the results were combined with the results of other evaluation activities that were conducted simultaneously, all of which provided a rich source of evidence for the program governance to base their decision on.

      Finding/Results: ehealth 2018 2.png In this presentation, the data sources that were gathered as part of the evidence base development, the step by step process for making the decision, and who to involve in each step will be explored as well as on overview of the key lessons learned.

      Conclusion/Implications/Recommendations: This model for evaluating vendors as part of an innovative procurement process should be considered as a best practice for other health care organizations to leverage.

      140 Character Summary: An evaluation process to support a decision to proceed with a vendor in a long-term contract following a Proof of Concept or to explore other market place options.

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      EP06.06 - Unite and Conquer - a National Strategy! (ID 151)

      V. Ashworth, Vancouver Island Health Authority; Campbell River/CA

      • Abstract
      • PDF

      Purpose/Objectives: Health organizations are often at a disadvantage when procuring niche telemedicine peripherals available only from a limited number of vendors. Jurisdictions typically go to market alone for solutions, setting the stage for inconsistent agreements and service contracts between provinces. However, using collaborative technologies establishing a united front is quite literally just a click away. Collaborating with a pan-Canadian RFP team is efficient and worthwhile; allowing members to deepen the knowledge base in a specialized field.

      Methodology/Approach: Telehealth in Canada has benefited from an established network of specialist colleagues across the country that maintains strong relationships and shares insights into common problems. In the spring of 2015 it became clear that a number of jurisdictions were each pursuing the same goal: Find a new application to support remote auscultation. The complexities of coordinating a national procurement process seemed daunting but the opportunity to share the workload and gain economies of scale toward a common goal were attractive benefits deemed worthy of the effort. The team embarked on a mission to draft a national RFP to acquire competitive pricing and increased functionality for a telemedicine auscultation solution. A lead procurement jurisdiction and a separate lead project management jurisdiction were selected. Splitting the workload across the two jurisdictions proved to be a great strategy to manage effort and ensure an efficient process. The team agreed to a re-occurring meeting schedule using a feature rich web-conferencing tool allowing team members to regularly collaborate face-to-face. The visual connection proved key in enhancing the collaborative atmosphere for team members scattered across 6 time zones. Complex technical and clinical requirements were gathered, discussed and agreed upon. RFP terms were reviewed, signed off and shared. Evaluation tools were jointly created, locally deployed and comparatively assessed. And all of this achieved without direction or guidance from an external party or project manager. And… without any cost to the organizations involved apart from the participants’ time.

      Finding/Results: Over the 18 month journey our dedicated team learned a few things, including: - Joint RFPs at a national level take time. Coordinating 7-8 provinces requires patience and a minimum 12-18 month runway. - Regularly scheduled checkpoints using a rich media collaboration tool helps a team feel like a team. - Industry changes quickly – there were many changes in market during the RFP process. - Senior leadership buy-in is important to have resources available. - Success doesn't mean getting what you asked for…. . - As different as we think we are we are more alike than we think.

      Conclusion/Implications/Recommendations: Strength in numbers is expressed not only in economies of scale but also in knowledge and experience. The complexities of a dispersed team were diminished with the use of visual collaboration technologies and the value of a deep specialist knowledge pool outweighs burden of facilitating an endeavor like this. The team realized that having regular touch points with colleagues across the country allowed for sharing of information well beyond the scope of the RFP.

      140 Character Summary: Unite and conquer! Leveraging strength in numbers across Canada to drive down costs and improve features in a niche market space. A national telemedicine approach.

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      EP06.07 - Self-Perceptions and Factors Associated with Informatics Competency Among Registered Nurses (ID 195)

      M. Kleib, Faculty of Nursing, University of Alberta; Edmonton/CA

      • Abstract
      • PDF

      Purpose/Objectives: Purpose: As digital innovations continue to transform health systems in Canada, it is important to examine registered nurses’ readiness in informatics. The purpose of this study was to determine self-perceived informatics competencies, and factors associated with competency amongst practising nurses in Alberta.

      Methodology/Approach: Methods: An exploratory, descriptive, cross-sectional survey using the Canadian Nurse Informatics Competency Assessment Scale (C-NICAS)—a 21-item comprehensive measure of nurses’ informatics competencies based on the Canadian Association of Schools of Nursing’s entry-to-practice informatics competency requirements—was employed.

      Finding/Results: Results: 2844 nurses completed the C-NICAS. Nurses’ self-perceived informatics competency was slightly above the mark of competent. Perceptions of competency were highest on foundational computer literacy skills and lowest on information and knowledge management competencies. However, overall informatics competency mean scores varied significantly in relation to age, educational qualification, years of experience, and work setting. Regression analysis showed the quality of informatics training and support, offered by employers, contributed the most to variance in mean scores of total and sub-domains of informatics competency. Other factors—age; educational qualification; work setting; previous informatics education; access to internet; use of health technology; access to supporting resources; informatics training; an informatics role; and continuing education in informatics—also contributed to variance in mean scores of total and sub-domains of informatics competency; in varying degrees.

      Conclusion/Implications/Recommendations: Conclusion: Findings provide a basis for actionable policies to address informatics educational needs and support requirements for nurses practising now and in the future.

      140 Character Summary: A survey of 2844 nurses revealed a number of factors impact perceptions of informatics competency. Actionable strategies are proposed.

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      EP06.08 - Understanding Challenges and Opportunities to Encouraging System-Level Digital Health Integration (ID 519)

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

      • Abstract
      • PDF

      Purpose/Objectives: The Canadian health care system presents a challenging environment for innovation in digital health. Tool development and research promotion often occur in parallel, but rarely intersect in an efficient way. This lack of an integrated infrastructure to foster success in the Canadian marketplace leads to an unfortunate result: the acquisition of promising Canadian technology by other countries. The purpose of this study was to identify (1) current challenges and barriers to digital health innovation, and (2) identify existing resources that should be leveraged to promote digital integration.

      Methodology/Approach: A purposive sample of participants (n=60) were invited to participate in a symposium representing a broad range of players within digital technology and health sectors. The entirety of the symposium was audio-recorded and transcribed, and detailed field notes were taken throughout. Thematic analysis of resulting qualitative data allowed for identification of themes to be shaped into priorities for a digital health innovation strategy.

      Finding/Results: Themes highlighted ongoing challenges faced by innovators and health system gaps that present opportunities to encourage digital health innovation. Challenges Misaligned incentives: The Canadian fee-for-service funding model has no mechanism to incentivize individual clinicians to reduce in-person visits and hospital readmissions. There is a resulting tension between financial gain (realized at the organization/system level) and the critical role clinicians play in operationalizing digital solutions. Fragmentation of digital health initiatives: Numerous organizations in Toronto are working to promote digital health innovation including incubators, governmental departments, research organizations, and industry. This fragmentation creates unintended competition, resulting in an inability for any one organization to achieve their objective. Organizational barriers: De-centralization of system oversight has created layers of complex bureaucracy, with differing requirements between institutions. This precludes both a clear entry point into the system and an ability to efficiently scale solutions system-wide. No access to big data: Health data is often retained solely within the health institution that collects it, with no degree of interoperability between organizations. This decentralization is a barrier to comprehensive access, which would inform areas of system need where digital health technology could provide a solution. Opportunities Improved collaboration: Cross-sector relationships between organizations in the digital health space can optimize the likelihood of successfully integrating digital technology in the healthcare system. Training and education: The overarching need for a culture shift among clinicians presents an opportunity for Universities to develop innovative approaches to education that train professionals in health, computer science, engineering, and design. Need for innovative evaluation methods: Digital health tools interact with contextual factors to produce their effect and are constantly updated in response to user feedback; therefore, traditional evaluation methods utilized for pharmaceuticals and clinical trials are not feasible.

      Conclusion/Implications/Recommendations: There is need to build partnerships to link ongoing initiatives and align the limited resources invested in digital health innovation. The overarching consensus called for collaboration between developers, researchers, academic institutions, and health system partners to align priorities and streamline innovation infrastructure. Participants suggested that net new initiatives in the healthcare sector involve the explicit integration of digital health to ensure progression with respect to innovation.

      140 Character Summary: Identification of system challenges and opportunities to improve digital health innovation and integration in Ontario using qualitative methods.

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      EP06.09 - The Business Case for Digital Health Investments in Low-Resource Settings (ID 544)

      D. Ritz, ecGroup Inc.; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: This presentation reports on an business case tool designed to generate cost-effectiveness profiles for national-scale digital health infrastructure investments. The work was initially undertaken in collaboration with the Asia eHealth Information Network (AeHIN) and with support from the Asian Development Bank and UNICEF. The spreadsheet-based business case tool that was originally presented and workshopped at the AeHIN General Meeting in Naypyidaw, Myanmar in February, 2017.

      Methodology/Approach: The digital health investment case tool leverages health enterprise architectural models and implementation approaches informed by current best practice in low-resource settings. The overall cost profile for a national-scale digital health infrastructure investment is developed by generating 3 linked sub-profiles: 1. sociotechnical costs associated with digital health strategy, enterprise architecture, norms and standards, governance and programme management 2. shared infrastructure costs associated with implementing and operating a national-scale health information exchange service 3. point-of-service solution costs associated with rolling out digital health solutions at facilities (e.g. hospitals, clinics, labs, pharmacies, health outposts) and within community care workers that provide public health and curative care services across the breadth of the care delivery network. Specific cost profiles may be developed that operationalize underlying care workflows that are particularly "high value" (in terms of their health impact). To establish the health impact of a candidate care intervention, the model leverages the Lives Saved Tool (LiST) that has been developed by Johns Hopkins University with WHO and Gates Foundation support. Using LiST, the health impact of a particular care intervention can be determined and, leveraging published literature, the industrial engineering impact of digital health on improving the effectiveness of the particular health intervention can be modeled. For a particular health intervention, the digital health investment case tool associates the a national-scale, 10-year "total cost" profile with the health impact (and, potentially, the cost-efficiency impact) that would accrue from implementing digital health. What-if scenarios and sensitivity analyses can be applied to the resulting CUA and CBA outputs. In this way, MOH leaders can make construct the "business case" that supports their digital health investments.

      Finding/Results: The tool was employed to develop an example investment case for an electronic immunization registry. This use case was explored at the 2017 Myanmar workshop. The presentation will step through this use case to illustrate the business case regarding digital support of childhood immunization. In conclusion, updates from country uptake of the tool will be reported.

      Conclusion/Implications/Recommendations: The tool enables ministries of health in low and middle income countries (LMIC) to develop a cost profile for a national-scale digital health implementation and to associate this cost profile with a benefits profile (expressed in economic terms and in terms of health impact). A cost-utility analysis may be generated that expresses the "value" of the digital health investments in terms of disabilty-adjusted life years (DALYs) per dollar. By developing a second benefits profile expressed in economic terms, a cost-benefit analysis can also be generated and used to determine the relative opportunity cost of the proposed investments. In this way, evidence-informed digital health investments can be advocated for.

      140 Character Summary: DALYs per Dollar: what is the steely-eyed business case for making digital health investments in low-resource settings? As Jerry McGuire says: "show me the money!"

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    HS01 - Artificial Intelligence in Healthcare: Application, Research, and Leadership in Canada (Digital Health Canada Session) (ID 37)

    • Type: HOST Session
    • Track:
    • Presentations: 1
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    HS02 - A Conversation with CIHI about Modernizing Canada’s Data Supply and Access (CIHI Session) (ID 39)

    • Type: HOST Session
    • Track:
    • Presentations: 3
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    HS03 - Driving Access to Care (Infoway Session) (ID 40)

    • Type: HOST Session
    • Track:
    • Presentations: 2
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    OS23 - Labs, Drugs and Rock & Roll (ID 42)

    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS23.01 - Medication Safety Post Electronic Closed Loop Medication Implementation, Island Health (ID 433)

      B. Wagar, Clinical Analytics, Island Health; Victoria/CA

      • Abstract
      • PDF

      Purpose/Objectives: In March, 2016 Island Health implemented a closed loop medication system in a tertiary hospital, where all stages of the medication cycle are supported electronically (ordering, verifying, dispensing and administering) with decision support where relevant. Research has shown that roughly three of every four medication errors occur at either the ordering or administration stages of the medication order and delivery cycle (JAMA 1995 Vol 274, No. 1, pp. 35-43). This presentation focuses on the provider ordering and nurse administration stages, and evaluates the influence of decision support alerts on preventing medication errors during these stages

      Methodology/Approach: Clinical decision supports implemented at the physician ordering stage included drug allergy and drug interaction alerts (major contraindicated interactions only), duplicate anticoagulants and range dose checking. The influence of these alerts on provider ordering was measured as the proportion of instances where an alert fired and the provider heeded the warning; either didn’t place the order, or discontinued the active interacting medication and continued to place the order. In both of these cases the alert served the intended purpose. Several medication administration alerts were implemented at the nurse administration stage, including: Wrong drug: A medication scanned with no corresponding active order in the system, in any form, due at any time. Wrong dosage form: A medication scanned that matched the generic drug formulation of the order, but dosage form didn’t match (e.g. regular vs extended release). Wrong dosage time: The correct medication scanned, but the task to administer is not within the timeframe.

      Finding/Results: Island Health implemented a closed loop medication system and the influence of relevant clinical decision support alerts on ordering and administration of medication is presented. Specifically: - Provider ordering: roughly a quarter of clinical decision support alerts lead to a change in ordering. - Medication administration alerts: in an average month, nurses receive 377 alerts signalling that they are about to administer the wrong drug to a patient. Alerts for wrong dosage form and wrong time are much more frequent.

      Conclusion/Implications/Recommendations: Interpreting the influence of clinical decision support alerts on provider ordering is difficult. When interpreting changes in provider ordering following interaction alerts, it is important to note that there are few ‘hard and fast’ contraindications (when on Drug A never give Drug B). Most are open to context (patient age, comorbidities, etc.) or subject to the clinical judgement of the physician. On the other hand, we need to be mindful that providers are only getting major contraindicated interactions. The influence of medication administration alerts on nurse administration is much clearer. Near misses, preventing the administration of wrong medications to patients, are frequent enough that they can be counted per day. Other administration alerts, wrong dosage form and wrong time, are more frequent, but their potential for patient harm is less severe. Collectively, these results show that the electronic closed loop medication system implemented by Island Health has prevented a significant number of medication errors – errors which are known to cause or lead to inappropriate medication use or patient harm.

      140 Character Summary: Island Health examined the prevention of medication errors at ordering and administration, following the introduction of a closed loop medication system.

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      OS23.02 - Ontario's Digital Health Drug Repository (ID 350)

      K. Hay, Ministry of Health and Long Term Care; Toronto/CA

      • Abstract
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      Purpose/Objectives: Ontario’s Comprehensive Drug Profile Strategy (CDPS) aims to improve the health and wellness of Ontarians and the quality of care received from health care providers through integrated secure access to a patient drug profile for all Ontarians. The CDPS will enable the Best Possible Medication History for a patient, and supports Ontario’s response to the opioid crisis. The CDPS leverages existing assets where possible to build a comprehensive drug profile that captures information on dispensed drug events (and potentially prescribed events in the future) for all Ontario residents. The Digital Health Drug Repository (DHDR), the foundational first project of CDPS, provides a clinical data repository and corresponding secure web services that enable provincial Electronic Health Record (EHR) integration and facilitate expanded access to ministry drug data holdings (i.e., Ontario Drug Benefit (ODB) claims data and Narcotics Monitoring System (NMS) data). This data store provides the capacity and security necessary to share clinical data appropriately and meet user access demands expected of the system, as well as support the long-term CDPS vision of a repository containing ‘All Drugs, All People’ and contribute to the broader goal of a fully integrated EHR in the province.

      Methodology/Approach: Using a HL7 FHIR® enabled repository, the DHDR provides access to patients’ medication information, including ODB claims and NMS data. The DHDR is currently available to Ontario clinicians through regional clinical viewers (Clinical Connect and Connecting Ontario). Clinical access will be expanded to include integration with hospital information systems and electronic medical records. Public access to their drug data will be enabled by DHDR integration with consumer portals and applications. In the future, DHDR will be expanded to include additional clinically relevant data (e.g., dosage information) as well as additional data sets (e.g., electronic prescriptions and privately-paid and other medication event data).

      Finding/Results: The DHDR provides clinicians in Ontario access to more complete information on patients’ medication history to improve the health and wellness of Ontarians and the quality of care received from health care providers through integrated, secure access to a patient drug profile, enabling the Best Possible Medication History and supporting the Ontario Opioid Strategy.

      Conclusion/Implications/Recommendations: The DHDR advances the goals and objectives of the CDPS vision of ‘All Drugs, All People’ and contributes to the broader goal of a fully integrated EHR in the province by providing clinicians and consumers access to a patient’s medication information.

      140 Character Summary: Development of a HL7 FHIR® based repository that supports clinician and consumer access to patient medication information in Ontario.

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      • Abstract
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      Purpose/Objectives: Since 2013, Quebec is operating a centralized e-prescribing network allowing for the electronic transmission of prescriptions between prescribers and pharmacies in primary care. The objective of this study is to describe the system, its utilization and the experience of users.

      Methodology/Approach: Longitudinal analysis of usage data between Jan 2016 and April 2017 was performed. Interviews and observation sessions were conducted with frequent users on the prescriber side and the pharmacy - the receiver - side to compare usage patterns and experience of users with different commercial systems (2 EMR systems and 4 PMS). E-prescribing strings were analyzed from the receiver side to determine the quality of data being transmitted electronically.

      Finding/Results: The e-prescribing network is a centralized pull model providing for a paperless process. So far, only the patients are outside the loop. They are still receiving a paper copy of the prescription when it is electronically sent to the central warehouse. Pharmacists have to wait for the paper copy of the prescription to retrieve it from the warehouse. No alert is sent to their system when a new prescription is available for one of their patient. In April 2017, more than 2 800 prescribers were using the system (while at least 5 000 could technically do it with their EMR). Of all the e-prescriptions sent, only 16% were retrieved electronically in pharmacies (Table 1, Figure 1). The experience of users was heterogeneous depending on the commercial system they were using. In pharmacies, the most problematic feature was the absence of a view of the original e-prescription to be able to compare with what the local PMS was generating. All e-prescribing strings needed to be manually corrected in the PMS to be dispensed. The main factor influencing the completeness of the e-prescribing string was the pharmaceutical form of the medication (solid oral forms, creams, inhalers, drops, etc.). The fields with the most frequent corrections were the “instruction” field, followed by the quantity, the duration, and the prescriber ID. Table 1. Number of prescribers, prescriptions and retrieved up to April 2017 Details n(%) Number of prescribers (in the month) 2 851 Number of e-prescriptions sent (cumulative) 10 703 194 Number of prescriptions retrieved (cumulative) 1 767 138 (16%) Figure 1. Cumulative number of electronic prescriptions sent and retrieved through the e-prescribing network by month

      Conclusion/Implications/Recommendations: For the promises of e-prescribing to be realized, additional work is needed to improve the standardization of interoperable data exchanged between EMR and PMS.

      140 Character Summary: This study analyzed utilization and experience of users with the e-prescribing network implemented in Quebec since 2013.

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      OS23.04 - Use and Benefits of an iEHR System for Laboratory Medicine (ID 343)

      E. Maillet, Faculté des sciences infirmières, Université de Sherbrooke; Sherbrooke/CA

      • Abstract
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      Purpose/Objectives: Missed or missing laboratory test results may hinder physicians’ diagnostic process, cause important delays and jeopardize patient safety. Many efforts have been made to significantly reduce laboratory turnaround time and to improve the quality and continuity of care. However, there are still persistent errors both before the specimens reach the laboratory and after the results are produced. To overcome those challenges, many IT systems, such as laboratory information systems, electronic medical record systems, clinical information systems and interoperable electronic health records (iEHR) have been implemented in various settings. The present study focuses on iEHR use for laboratory medicine. More precisely, it aims to measure physicians’ use and perceived benefits of the iEHR deployed in Quebec (called DSQ for Dossier Santé Québec).

      Methodology/Approach: A cross-sectional survey of 9,005 Quebec physicians having authorized access to the provincial iEHR was conducted. A web-based survey platform (Qualtrics) was used to collect data. Descriptive and bivariate statistics were performed using the IBM SPSS statistical package. A total of 1,917 questionnaires were returned (21% response rate). Of these, 405 were removed due to incomplete data leaving us with a final sample of 1,512 valid responses. In terms of profile, 48% of our respondents are primary care physicians (PCPs), 41% are hospital care physicians (HCPs) and 11% are emergency care physicians (ECPs). 56% are women and 44% are men.

      Finding/Results: A large majority (80%) of respondents use the Quebec iEHR system for laboratory medicine purposes; although this percentage is somewhat lower in the ECPs’ case (73%). Physicians who use the iEHR make a relatively extensive use of the system. On average, they use 65% of the system functionalities and they use the iEHR in 78% of the cases for which it may be used for laboratory medicine. The latter ratio even reaches 84% for ECPs. Interestingly, less experienced physicians consult the iEHR system more frequently than more experienced ones. The perceived benefits associated with the use of the iEHR for laboratory medicine can be broken down into two categories, namely, efficiency and quality of care. With regard to efficiency, physicians (especially PCPs) said the iEHR saves them lots of time (i.e. due to the quick access to lab results anywhere and anytime) and it reduces the duplication of tests. With regard to quality of care, a majority of physicians perceive the iEHR system improves the continuity of care, allows them to make better, more informed clinical decisions, and increases the safety of their patients. Importantly, the system improves the way ECPs evaluate patients in the emergency room.

      Conclusion/Implications/Recommendations: While the vast majority of physicians who participated in this study use the iEHR deployed in Quebec and perceived numerous benefits associated with its use, 20% of them still refuse to use it. About half of our respondents made numerous and constructive suggestions for improvement (e.g., biometric access to the system, greater interoperability with EMRs and LISs, more rapidity when downloading data, especially in the ER). Quebec authorities need to pay attention to these suggestions so to increase adoption rate and physicians’ satisfaction.

      140 Character Summary: Physicians’ use and perceived benefits of the iEHR system deployed in Quebec (called DSQ for Dossier Santé Québec) to support laboratory medicine.

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      OS23.05 - Development and Adoption of an Electronic Medication Reconciliation Tool: RightRx (ID 56)

      A. Motulsky, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, University of Montreal; Montreal/CA

      • Abstract

      Purpose/Objectives: To improve patient safety, medication reconciliation is required at admission, transfer, and discharge for hospital accreditation in several countries. Medication reconciliation is expected to improve patient safety by preventing inadvertent discrepancies between community and hospital medications that lead to medication errors, and avoidable morbidity. However, the process is resource-intensive, resulting in poor adherence. We developed an e-medication reconciliation application (RightRx), and report on the impact of using population- and hospital-based drug information systems to pre-populate and align community and hospital drug lists and thus reduce workloads and enhance adoption and completion of medication reconciliation.

      Methodology/Approach: We developed a web-based e-medical-reconciliation software and are evaluating it in a cluster-randomized trial at an academic hospital network. We used agile development processes and user-centered design to develop features aimed at enhancing adoption, safety, and efficiency. We implemented RightRx in medical and surgical wards, where field staff and unit champions provided training and support. Using data retrieved from provincial health administrative databases, RightRx pre-populates the patient’s community drug list with all drugs dispensed in the 3 months preceding admission as well as all drugs dispensed, stopped, or placed on hold during hospitalization. The two lists are aligned, sorted by pharmacologic class, and displayed to physicians to enable reconciliation at admission, transfer, and discharge. Physicians reconcile and review the lists to generate the discharge prescription, which displays all changes, additions, and discontinuations, along with the reasons for those changes. Rates of medication reconciliation completion rates were measured using chart review and data retrieved from the RightRx application in the intervention and control units. In the intervention unit we also measured the time professionals spent using the application. figure.gif

      Finding/Results: User feedback identified required adjustments to RightRx, including addition of dose-based prescribing, clarification of discharging physicians’ roles in prescribing community-based medication, and providing access to the clinical reasoning behind medication decisions made during hospitalization. In intervention units, pharmacists and physicians were involved in reconciliation at discharge for 71.9% and 96.1% of patients, respectively. Pharmacists spent a mean time of 10.9 min (SD 10.9 min) per RightRx session, compared to 5.8 min (SD 7.8 min) spent by physicians. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in intervention units, and 0.7% (surgery) to 82.7% (medicine) of patients in control units. After adjusting for differences in patient characteristics, the odds of medication reconciliation completion were 9 times higher in intervention versus control units (OR 9.0, 95% CI 7.4-10.9).

      Conclusion/Implications/Recommendations: Automated prepopulation and alignment of community and hospital medication lists helped achieve high medication reconciliation completion rates.

      140 Character Summary: Right-Rx increased the efficiency and completion rate of medication reconciliation by automating the retrieval and alignment of community and hospital drug data.

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      OS23.06 - Clinical Workflow Improvement Through Barcode Medication Administration Implementation (ID 279)

      S. Farmer, Clinical Informatics, Island Health; Victoria/CA

      • Abstract
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      Purpose/Objectives: Invariably, all health organizations experience an unacceptably high incidence of medication errors and adverse drug events (ADEs). The Institute of Medicine said it well nearly 20 years ago – To Err is Human (1999). But if to err is human, what happens when the human is technologically enabled to help reduce ADEs? Island Health (IH) asked this question while planning the functionality of the electronic health record, which ultimately resulted in the launch of a closed-loop medication administration system, including barcoded medication administration (BCMA). Endorsed by the Institute of Safe Medication Practices, well-adopted barcode medication administration systems reduce the incidence of bedside medication errors by 50%.

      Methodology/Approach: Using BCMA as an adjunct to existing Island Health medication administration procedures and workflows, nurses are now better able to assure verification of the patient and medications to be administered. Nevertheless, implementation of BCMA represents a significant practice change that is not without its challenges; although BCMA promises 100% accuracy to match the right patient with the right medication, route and time, the benefits are only realised when the technology is applied. From unit-dose packaging to individual physical limitations, IH has acknowledged, accepted and overcome significant barriers to BCMA adoption.

      Finding/Results: Since BCMA’s inception in March 2016, IH has observed high rates (74%) of BCMA use in adult medical inpatient settings. Care areas that have not fully adopted other components of the closed-loop medication administration system, like computerized provider order entry, experience significantly lower rates (36%) of BCMA. Over 2,500 BCMA warnings have been issued at the point of care to alert nursing that there was a mismatch between the patient, the medication product being scanned and what was ordered. Notoriously, we cannot measure what did not happen; however, 2,500 fewer medication administration errors to date is a benefit any health authority cannot afford to pass up.

      Conclusion/Implications/Recommendations: Despite early successes, future BCMA implementations can benefit from the lessons learned following the initial deployment. The transformation to BCMA was concurrent with the release of advanced EHR functionality; this resulted in significant workflow changes to nursing beyond BCMA. There was less focus on BCMA than might have been if the change had occurred independently. IH recognizes that changes often need to be concurrent; nevertheless, expressing the benefits of the change with express focus on the benefit to nursing, such as having a second line of defense for catching errors at the point of care, may have positive benefits on adoption rates of BCMA. Further, where halls are narrow and rooms are small, nurses have a challenging time maneuvering computerized workstations to meet their patients. This is further compounded when a patient is on isolation precautions or has greater-than-average equipment needs. BCMA continues to be an effective means to decrease medication administration errors at the point of care. Greater attention to the information needs of nursing and nursing’s capacity for change, in combination with thorough infrastructure analysis, may help increase adoption for future BCMA implementations.

      140 Character Summary: BCMA can reduce medication administration errors but only when used appropriately. A robust change management strategy may improve adoption of the technology.

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    PS05 - Making EMR’s Work for Physicians and Patients (ID 38)

    • Type: Panel Session
    • Track: Health Business Process
    • Presentations: 3
      • Abstract
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      Purpose/Objectives: Playing a critical role in the health system, the TC-LHIN (one of the 14 regions that manage local funding and healthcare initiatives in Ontario) identified primary care as a strategic focus area. Putting the clinician experience front and centre, the LHIN engaged PCPs to understand key pain points and gaps in needed tools. Feedback from PCPs indicated that many of required tools were available, however, highlighted the need to invest more efforts to drive adoption. This presentation outlines how UHN, delivery lead, worked in collaboration with key partners OntarioMD and eHealth Ontario to develop an innovative approach to increase PCP adoption of digital technologies. After initial success, this approach is now being replicated by other regions across Ontario.

      Methodology/Approach: With a clear understanding of the most pressing tool and information needs for PCPs, the project partners recognized an opportunity to bundle a set of digital tools as one service offering and to then focus on developing one onboarding experience to reduce the administrative workload and registration period. Presenters will share insights garnered in a three-phase process, including how the project was able to secure the necessary clinician input that is so critical to project success: 1) Consolidate and streamline the onboarding process This step required the project team to consolidate and streamline processes for four services from two delivery partners. 2) Engagement and adoption planning Drawing on clinician experiences and expertise, the project gathered input from the five sub-regions within TC-LHIN to guide local engagement planning and delivery. While a standardized approach was developed, the ability to customize support to address sub-region nuances was critical to success. 3) Onboarding Success of this step required significant coordination from all project partners. While partners were supportive of the overall objectives, extensive effort and commitment was required to take into consideration different organizational priorities, structures and resources.

      Finding/Results: As the start of a multi-phase program, the project was able to onboard hundreds of PCPs within a few months. Lessons learned will be used to refine the process and key success factors maintained as the approach is rolled out more broadly. The success of the project included: 1) Maintaining a focus on clinical needs first and foremost – ensured that all work actually brought clinical value. 2) Ability to customize implementation approaches – maximized the effectiveness of engagement efforts since each sub-region had different nuances and priorities. 3) Investing in a team to conduct registration activities for clinicians – helped address concerns of clinicians by supplementing with resources and decreasing administrative time.

      Conclusion/Implications/Recommendations: In conclusion, this approach has proved to be effective in addressing pressing needs for primary care. When working with different service offerings from different organizations the project has been able to improve the onboarding process in the first phase and will move into a second phase with a more ideal state. With its initial learning and experience other regions in the province are now leveraging the approach and processes to better support the thousands of primary care providers across Ontario.

      140 Character Summary: University Health Network (UHN) successfully streamlined the onboarding process for 4 healthcare services and piloted it for 300 Primary Care Providers (PCPs).

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      PS05.02 - Effective Supports for EMR Optimization Enhance Use and Patient Outcomes (ID 581)

      J. Littlejohn, OntarioMD; Toronto/CA
      D. Larsen, OntarioMD Inc.; /CA
      D. Daien, Primary Care, Trillium Health Partners; Toronto/CA

      • Abstract
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      Purpose/Objectives: Most primary care practices have adopted electronic medical records (EMRs), but while physicians are aware of the benefits EMRs hold for their practice and patient outcomes, many have not tapped into the technology’s full potential. While this is due to a number of factors – including financial, technical understanding and time – in many cases, clinicians simply “don’t know what they don’t know” about optimizing their EMR. This presentation will demonstrate the success of an EMR practice enhancement program in providing on-site support from a team of EMR experts to improve data quality, workflow and EMR-led patient outcomes.

      Methodology/Approach: The EMR practice enhancement program uses advisors who are experts in diagnosing barriers to efficient EMR use. In a typical engagement, practice advisors work with clinicians to conduct a gap analysis, workflow analysis and mapping, review the quality of a practice’s EMR data, and recommend an action plan for improved EMR use. Practice Advisors also help clinicians understand and reconcile discrepancies in their patient rosters, which can affect the ability to accurately monitor patient adherence to prevention and screening routines, and to help patients co-manage their chronic conditions. In the action plan stage, clinics are given achievable, concrete tasks to improve the quality of data in their roster and meet their EMR use goals. This presentation will showcase six case studies to illustrate how the program has helped improve practice efficiency and patient outcomes through EMR optimization.

      Finding/Results: Approximately 500 clinicians in community-based practices have ‘graduated’ from the EMR practice enhancement program with marked improvements in roster variance and EMR data quality. Before these engagements, roster variance for participating practices were as high as 26% compared to Ministry reports; in most cases, after the engagements, variance was reduced to 1% or less. The case studies will demonstrate the program’s clinical value through dramatic improvements in roster data for cancer screening, immunizations, smoking status, and diabetes monitoring. The following post-engagement improvements will be highlighted: • Up to 22% increase in cervical cancer screenings • As much as 90% decrease in problem list errors for suspected diabetes • Up to 34% improvement in childhood immunization capture • Up to 39% increase in smoking status capture

      Conclusion/Implications/Recommendations: Working together, clinicians and the program’s advisors can realize significant improvements in roster data quality, which provides clinicians with the information needed to improve patient support and outcomes. Practices profiled in these case studies have capitalized on the improvements made through the program to begin such initiatives as offering a nutritional consultation program for diabetic patients, and using a diabetic toolbar in the EMR to display up-to-date information (lab results, graphs) during patient visits for more thorough care. The program has been in effect for two years. Clinicians who have had positive experiences with the program have recommended it to others, creating new opportunities for the program to demonstrate value to community-based primary care and improve patient outcomes.

      140 Character Summary: Case studies show that an extensive EMR practice enhancement program can lead to dramatic improvements in data quality and patient outcomes.

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      PS05.03 - Regional Integration: Physician Perspectives on EMR Use and Impact (ID 435)

      S. Raji, Western University ; London/CA

      • Abstract
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      Purpose/Objectives: Regional initiatives in the Canadian health care context typically involve governance models used by provincial governments to administer and deliver health care services, organized along geographic boundaries or operational units (e.g., regional health authorities, local health integration networks). Similarly integration of Electronic Medical Records (EMR) and health information flow in these health regions has been continuing across Canada, yet the use and impact of regionally integrated EMRs are not routinely assessed. Are the stated goals of simplifying connection of electronic health data managed by multiple service providers being met? What are physicians’ perspectives on the use and impact of a regionally integrated EMR? This presentation will describe key factors influencing the integration of EMRs and accessibility and use of health data within the region of southwest Ontario and the perceptions of physicians in family medicine and general practice who use them.

      Methodology/Approach: This research project was designed to discover key factors that influence the use and impact of regional integration of eHealth resources. It involved a detailed scan and review of literature on EMR integration initiatives and experiences; observation and shadowing of physicians using a regionally integrated EMR; and analysis of survey data from a large sample of doctors in the region. The research project applied qualitative and quantitative research methodologies, using both grounded theory and principal components analysis to observe, discover, describe and analyze the use and impact of EMR regional integration. Data were acquired from two sources; semi-structured interviews and self-administered questionnaires. Respondents were drawn from a random sample of primary health care physicians within four Local Health Integration Networks (LHINs) in southwestern Ontario who had various levels of involvement and experience with integration of electronic health information in the region.

      Finding/Results: There are clear and present challenges to regional integration of electronic records. Although integration initiatives such as the implementation of ClinicalConnect, a clinical viewer in South West Ontario, continue to expand, physicians still face challenges related to adoption, implementation, support, and more meaningful or enhanced use of the EMR. Additionally not every patient has access to their data and patient portals are often not integrated with physician and/or health facilities. Based on our data analysis, we propose a six-stage maturity model to apply to and routinely map the stages or levels at which primary health care practices within a region integrate their EMR with associated health information resources.

      Conclusion/Implications/Recommendations: This study describes and explains the current status of EMR use in a regional setting, which is critical to understanding both the benefits and drawbacks of EMRs and a better understanding of the problems and challenges of evaluation of regional integration of electronic health information. It can assist those who are working in the field of primary health care to understand more fully the use and impact of EMRs over time and space. This new model of eHealth evaluation incorporates a maturity process specific to primary health care and provides a better understanding of the effective use of electronic health information in primary health care.

      140 Character Summary: Regional integration is a fundamental requisite to promote use and improve impact of EMR in an interconnected primary health care system.

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    OS25 - Understanding Patient-Centred Care Amidst Digital Health Era (ID 49)

    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS25.01 - Digital Health Assistants (ID 143)

      B. Billings, IntelligentCare, Saint Elizabeth Health Care; Markham/CA

      • Abstract
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      Purpose/Objectives: The need for digital personal assistants and chatbots in healthcare is obvious. This presentation explores the various use cases for digital health assistants for health promotion, counselling, behavioral change and supporting seniors living.

      Methodology/Approach: SE Health has reviewed many new and innovative digital assistants driven by knowledge bases, predictive analytics, machine learning and AI engines. We share our early experience using digital assistants for access to health information, care automation and Chatbots. Health Information According to Stats Can, seventy percent of Canadians go online to search for medical or health-related information, making the Internet the first source of health information for many people. With the appearance of intelligent personal assistants (IPA) such as Siri, Google home and Alexa, accessing health information online has never been easier. We look at the providers of content and how natural language is improving access to health information. Health Symptom Triage and Advice Chatbots, intelligent personal assistants and messaging apps supported by artificial intelligence have the potential to respond to asily diagnosable health concerns and take the burden off off of medical professionals regarding. We review some of more interesting implementations of Chat Bots in healthcare, including our own implementation of Tess™, an AI chatbot that provides real-time and personalized mental health care for everyone. Defining Normal with Predictive Analytics Seniors want to live and age in the place they call home. However, physical and mental decline eventually limits our ability to care for ourselves, placing burden and worry on family caregivers. Enter the smart digital assistant that uses IoT sensors throughout the home to build a profile of “normal” behavior. Using predictive analytics, the assistant identifies activities that are cause for concern, providing guidance to the resident and alerting their caregivers as necessary.

      Finding/Results: The number of digtal health applications, devices and algorithms are growing exponentially. Concerns remain about the trustworthiness of information. Will Alexa keep your secrets, secret? Do AI engines propagate biases? How can intensely proud seniors retain privacy, dignity and security while big brother is watching.

      Conclusion/Implications/Recommendations: Digital health assistants in our homes and on our phones, are becoming trusted sources of health information and medical questioning. They can make our lives more comfortable and provide health guidance through curated content, coaching and advice. In a consumer- driven healthcare world, Digital Assistants can take the burden off medical professionals by responding to easily diagnosable health concerns or quickly solvable health management issues.

      140 Character Summary: Digital health assistants can make our lives more comfortable, respond to medical questioning and repond to easily diagnosable health concerns.

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      OS25.02 - Delivering Results as Patients Access Their Online Medical Records (ID 176)

      S. Brudnicki, UHN Digital, University Health Network; Toronto/CA
      L. Bishop, University Health Network; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Patients told us they want real-time access to their health information so they can be informed partners in care! Our enterprise patient portal was designed and built in collaboration with patients and their caregivers. This session will provide insight into the value and benefits of patient access to their online medical records. Successes, challenges and key learnings will be discussed.

      Methodology/Approach: Patients prioritized their need for timely access to their online medical records. Our Patient Portal enables them to see their appointments and receive appointment reminders; see lab results with links to patient education; see clinical documentation, such as assessments, discharge summaries, clinic notes, and reports (including sensitive information such as mental health notes and pathology reports); share their health information with others; and find programs, clinic information and patient education resources. Medical records are released to patients at the same time information is made available to their care providers. Our Patient Portal was first made available to early adopter clinics in May 2015, and expanded to the rest of the organization in January 2017. Successes, challenges and key learnings will be presented and discussed.

      Finding/Results: Real-time patient access to their online medical records was shown to improve the patient experience and reduce preventable harm. 94% of patients report being more prepared for their appointments; 94% report better communication with their care team; and 91% said that online access helps them make decisions about their care. 10% of patients report that their information was out of date or incorrect (n=9827), which could have implications to their patient experience or patient safety. 94% of patients prefer to look at results as soon as they are ready, even if they could be worrisome. 92% prefer to see results even if they have to wait until their next appointment to understand what they mean. Prior to roll-out, 86% of staff supported the idea of patient access; however, access to information in real-time was challenged. Staff concerns include real-time release of sensitive reports (e.g. mental health notes and pathology), potential impacts to clinic call volumes, and fear of increased patient anxiety.

      Conclusion/Implications/Recommendations: Patients prefer timely release of information. Engaging patients in all stages of planning, design and delivery of patient portals is key to delivering value for patients. Although 86% of staff support the idea of patient access to their online medical records, real-time access and access to sensitive reports were challenged. Management of large-scale organizational culture change through staff engagement and education, supported by senior-level leadership are critical to success.

      140 Character Summary: This session will provide insight into the value of real-time patient access to online medical records. Successes, challenges and learnings will be discussed.

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      OS25.03 - Patient Access - Anytime, Anywhere (ID 262)

      S. Cheng, Sunnybrook Health Sciences Centre; Toronto/CA

      • Abstract

      Purpose/Objectives: MyChart is a personal health management and continuity of care record solution that enables patients-consumers to directly access their medical records and personal health information from anywhere at any time with strong sharing capabilities. Patients can share their medical health record information with family members, multiple hospitals, physicians, care teams, caregivers and individuals who participate in their care and health decisions. Offers strong sharing capabilities, e-services, self-monitoring tools, resources to support users at home and in between visits. MyChart’s focus: Improve the patient and family health care experience Enhance the patient and care team relationship Empower patients with electronic access to their medical record information Improve information sharing across the continuum of care Support patient self-monitoring and management of personal health and information Support health care services and communication

      Methodology/Approach: The MyChart Program is developing strategic alliances with health organizations and industry partners. MyChart is positioned well to support continued growth and recognized as a great success story in Canada with out of country interest. The expansion of the MyChart can provide a national and global forum and platform where member organizations can work collaboratively to empower the consumer with timely access to own health information and self-monitor for improved outcomes no matter where they are. Acting as a service provider, MyChart optimizes the broad network by continuously adding services that benefit consumers and providers. MyChart data provides insight to the health consumer’s healthcare requirements and supports the consumer in their own health management.

      Finding/Results: 1. MyChart’s alignment to Provincial Digital Health Strategy improves engagement and transparency, enables patients to access their information, improves sharing of patient records and information across the circle of care and improves the patient experience. 2. Enhanced patient experience: e-View access to personal health records, convenient e-Booking services, self-monitoring and entering of data, ease of access through device integration, automated alerts and e-Notifications, medication tracking and refills 3. MyChart is positioned well to support Primary care and Community Services with e-services such as automated reminders for important screenings and appointments, online bookings, educational information, self-monitoring tools, pre/post care questionnaires device integration and announcements. 4. Good chance of addressing/mitigating the acute health issue without impact on other resources. MyChart is data rich. We can realize and trend shifts in health care utilization, patient and family role, reduced no shows, identify complex patients, access provider services, reduced visits to the ER, reduce drug errors , increased mobile access/opportunities.

      Conclusion/Implications/Recommendations: MyChart is flexible and customizable, allows for easy expansion of added features and functionality; MyChart is open technology, flexible with other technology systems and platforms. 1. Industry: Enable consumer access to their medical and personal records with sharing capabilities. 2. Practitioners: Better informed patients, earlier follow ups, and improved patient self-monitoring for healthier outcomes. 3. Patients: Increased patient and family experience and satisfaction, increased self-monitoring, decreased travel and wait time, increased access to medical records from multiple care providers, increased access to information and transparency

      140 Character Summary: MyChart is a personal health management and continuity of care record solution that enables patients-consumers to directly access their medical records

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      OS25.04 - Effects of a Patient Portal on Satisfaction and Clinic Use (ID 338)

      T. Graham, Alberta Health Services; Edmonton/CA

      • Abstract
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      Purpose/Objectives: The purpose of this study was to describe the use and utility of a Patient Portal (PP) tethered to a shared Electronic Medical Record (EMR). In Canada there is ample evidence that citizens want electronic access to their health information, and a growing trend for access through web-based PPs. Proven benefits of PPs include enhanced satisfaction, decreased postage, decreased no-show rates to clinic appointments and time answering phone calls, fewer inpatient visits, more efficient medication refills, improved understanding of health information, better relationships with doctors, better quality adherence and compliance, and improved self-care and empowerment. Organizations with electronic medical records in the United States report online access rates of 22-75%, but despite this PPs are relatively rare in Canada – in 2013 only about 10% had online access to their own information, or the ability to email their care providers. We report early experience with over 2200 patients using a PP called eCLINICIAN MyChart (“MyChart”) tethered to an EMR call eCLINICIAN (Epic systems corporation) being used in the Edmonton Zone of Alberta Health Services.

      Methodology/Approach: The MyChart PP was deployed as a pilot project accross five clinics - one family practice clinic and four specialty clinics: rheumatology, inflammatory bowel disease, multiple sclerosis, and diabetes. Enabling patient access to MyChart required extensive policy work and multi-disciplinary engagement. After Health Ethics Board Approval, we built in informed consent to be contacted for online surveys via email into the MyChart signup process. We also examined system audit logs, kept as part of rountine delivery of the system, matched to other EMR scheduling data.

      Finding/Results: Since February 2016, over 2200 patients have accessed MyChart. There was a high degree of usability and general satisfaction: 96% of respondents said MyChart was easy to use, 83% answered it made communication more convenient, and 75% answered it saved time when scheduling an appointment (38.7% responnse rate). Among respondents, 50.3% stated MyChart had helped them avoid a clinic visit, and 13.8% stated it helped them avoid an emergency department or urgent care visit. Users of MyChart had fewer missed or “no-show” appointments. The baseline no show rate in clinics not using MyChart was 12.7% (range: 12.0%-13.7%). Amongst MyChart users there were 12,436 visits and a no show rate of 7.4% (range: 5.7%-8.7%), a 42% relative reduction.

      Conclusion/Implications/Recommendations: PPs are rapidly gaining popularity in Canada - patients expect increased access to their health information, and better ability to interact with the health system as consumer. Clearly, health systems will be forced to shift towards offering self-service options, and secure messaging channels, and away from physician offices arbitrating how and when such communications occur. While many local EMRs have portals for their patients, provincial efforts to provide meaningful interaction (beyond just access to results of tests) are in their infancy, and it is unclear what effect they will have on patient health, or system efficiency. As MyChart is rolled out more widely in Alberta, we anticipate that reductions in no-show rates, clinic and ED visits will contribute to increasing health system efficiency.

      140 Character Summary: We describe early postive feedback and decreased missed appointments resulting from a new patient portal tethered to an enterprise electronic medical record.

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      OS25.05 - Self-Tracking and Adoption of Connected Health Technologies in Canada (ID 32)

      G. Paré, Research Chair in Digital Health, HEC Montreal; Montreal/CA

      • Abstract
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      Purpose/Objectives: The present study examines Canadians’ use of mobile apps and smart devices to monitor aspects of their health and well-being. It is the first national survey of its kind in Canada, and the largest ever, world-wide.

      Methodology/Approach: We conducted an online survey with a sample of 4,109 Canadian adults. The questionnaire was developed based on a review of the scientific literature on the subject and pre-tested on 50 respondents. The survey was available from January 11 to February 2, 2017. To ensure a representative sample, the quota method was used (sex, age) following stratification by province. The maximum margin of error associated with our sample size is estimated at 1.6%, 19 times out of 20. The results were weighted based on the following variables: province, age and gender.

      Finding/Results: Our findings reveal that a majority of Canadian adults (66%) regularly track one or more aspects of their health or well-being. We defined two specific groups, namely, traditional trackers (39%) and e-trackers (61%). While traditional trackers monitor their health using mostly paper-based tools such as a notebook or a journal, e-trackers do so with the help of mobile apps and/or smart connected devices. About one third (32%) of Canadian adults use one or more mobile apps while 24% owns at least one smart connected device to monitor aspects of their health. Canadian e-trackers are typically younger adults (41%), employed (59%), university educated (55%) with an annual family income of over $80,000 (46%); and generally healthy - only a small segment (28%) of those who use mobile apps or smart devices reported living with a specific chronic illness or condition or self-rate their health status as ‘fair/poor’. The most popular smart device is by far the bracelet or watch, which is owned by 88% of respondents with at least one smart connected device. Mobile apps and smart devices are mainly used to monitor aspects of well-being such as physical activity, nutrition, weight, sleep, sports performance and, to a much lesser extent, medical or clinical data such as chronic disease condition indicators. The level of satisfaction with digital devices is reflected in respondents’ intentions to continue using such tools (88% for smart connected devices and 72% for mobile apps). About half of Canadian adults who do not currently own a smart connected device for health do not see the interest in owning one. Comparisons with other international survey findings will be presented.

      Conclusion/Implications/Recommendations: The present study shows an opportunity to advance the health of Canadians through mobile apps and smart devices; and highlight important nuances to better understand key market segments and opportunities. Our results can also be used to set the national baseline for future studies on the diffusion of connected health technologies. Importantly, findings are useful for IT developers as well as clinicians and administrators across all health settings to better understand the current digital market, the profiles of e-trackers, traditional trackers and non-trackers, the value proposition these tools provide to users, and health system transformation.

      140 Character Summary: A survey of 4,109 Canadian adults allowed us to study the current use of mobile apps and smart connected devices to monitor aspects of their health and well-being.

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      OS25.06 - Digital Mergence of Patient and Provider-Generated Health Information (ID 227)

      D. Anderson, eHealth, Hamilton Health Sciences; Hamklton/CA

      • Abstract
      • PDF

      Purpose/Objectives: This presentation will bring together patients, clinician, technology providers and change implementers to share the experience of deploying, and adopting, a regional patient portal. With a shift to patient-centred care, it is critical that providers have a single source of access to their patient’s aggregated health information. This has been made a reality through ClinicalConnect, a regional clinical viewer utilized by 40,000+ authorized provider users practicing in South West Ontario. Just as important in the paradigm of consumer-driven care, it is critical that patients have a single point of access to their health information. Currently, many standalone and tethered patient portals exist, forcing patients to log into multiple solutions to interact with various healthcare verticals. The South West Ontario Patient Portal Project, led by Hamilton Health Sciences, leveraging Sunnybrook Health Sciences Centre’s MyChart, brings patients one step closer to a solution in which they can access health information from any of the 67 acute care sites within SWO they have visited, and homecare data from 4 LHINs (previously CCACs). We will share the experience of bringing together the provider’s digital experience with the patient’s digital experience to facilitate more efficient collaboration in the delivery of care, truly putting patients first.

      Methodology/Approach: ClinicalConnect currently integrates data from provincial assets DHDR, DI Common Service, OLIS and aCDR, and in South West Ontario, 67 acute care sites, regional cancer programs and four LHINs (previously CCACs) for providers to have a consolidated view of their patient’s health history. Sunnybrook’s MyChart is integrating with ClinicalConnect to leverage a single data broker to populate patient health information from multiple clinical sources and move towards the vision of a truly integrated patient portal. Targeted to begin deployment in April 2018, patients will be provided access to clinical information from multiple sources and a personal health record (PHR) component to manage and contribute to a holistic record of their health information. The presentation will explain the governance, communications, stakeholder (patient and clinical) engagement and change management structure established for a project of this scale.

      Finding/Results: patient meets provider visual.png Patient & provider consultations were instrumental in developing models of data release. SMEs from health records, privacy, patient registration, patient education, and experience were consulted to support change management activities.

      Conclusion/Implications/Recommendations: The project has started to bring together information for patients from acute sites and will work to integrate more data sources to give patients a fulsome view of their health information as it phases in information from provincial assets and primary care. As additional data sources are being added, it is important to consider privacy and workflow implications for non-acute care institutions.

      140 Character Summary: Hamilton Health Sciences, through the HITS eHealth Office, is integrating Sunnybrook's MyChart with ClinicalConnect and deploying it across South West Ontario.

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    OS26 - Expanding the Spread and Scope of Care (ID 48)

    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 6
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      OS26.01 - Accelerating the Provision of Comprehensive, Continuous Primary Care in Manitoba (ID 53)

      K. Morrison, Manitoba eHealth; Winnipeg/CA

      • Abstract
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      Purpose/Objectives: To explain how Manitoba introduced a province-wide change to the primary care system in a short time enabled through digital health solutions. To demonstrate the impact of putting an appropriate policy and incentive framework in place to encourage technology adoption in support of transformational change leading to improved quality of care.

      Methodology/Approach: In 2015 Manitoba put in place a strategic framework of policies, financial incentives and digital health solutions which includes: My Health Team – virtual network of clinics (FFS and regional) and providers with the goal of addressing shared service standards such as improving access to primary care, improving quality and efficiency, increasing focus on patient-centered care, and providing seamless transitions in care. Home Clinic - a patient centered primary care clinic that serves as a patient’s home base within the health-care system and the MyHealthTeam. Provides patients with timely access to care, coordinates their health care within the health-care system, and supports comprehensive and continuous care. Comprehensive Care Management Tariffs – purpose is to support physicians in the provision of care to complex patients to promote continuity, comprehensiveness, coordination, access, and patient centered care. For care of patients 50 and over or with one or more of the following chronic diseases: diabetes, Asthma, COPD, Congestive Heart Failure, Hypertension, and Coronary Artery Disease. EMR Certification - ensures EMR products have the ability to support the strategic and operational objectives of Manitoba and end-users of Manitoba Certified EMRs. Provides a means for EMRs to reliably and securely integrate with Manitoba provincial services. Home Clinic Portal - Primary Care clinics can use this portal to register as a Home Clinic, update provider information, and upload enrolment information from the EMR. This provides a foundation for future client centric information sharing to support continuity of care.

      Finding/Results: Within only six months of implementing the CCM Tariff and going live with the Home Clinic Portal, over 70% of primary care clinics have registered as Home Clinics and over 50% of Manitoba’s population has been enrolled to a Home Clinic. . For the first time, Manitoba has a source of truth for primary care clinics and the physicians working there as well as an unambiguous record of a Manitoban’s Home Clinic and Most Responsible Provider (“family doctor”). By mid-2018 it is expected that the patient’s Home Clinic status will be available in Manitoba’s Electronic Health Record (eChart Manitoba). Home Clinic Enrolment will provide a foundation to make primary care information more widely available. It is expected that by the end of 2018, home clinics will be able to publish a patient summary to eChart, addressing key information gaps in the provincial electronic health record. Directed exchange of encounter notes between primary and secondary providers will also be facilitated, improving continuity of care.

      Conclusion/Implications/Recommendations: Rapid adoption of transformational technology would not have been possible without appropriate policies and financial incentives in place. Strong business sponsorship and vision, as well as a close working relationship between policy makers and digital health providers, are needed to introduce significant change.

      140 Character Summary: Manitoba is achieving rapid adoption of transformational change in primary care through strategic use of digital health solutions, policy, and incentives.

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      OS26.02 - IBD Dashboard: Providing Quality Care for ALL IBD Patients (ID 507)

      V. Huang, Mount Sinai Hospital; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Background: Individuals with inflammatory bowel diseases (IBD) often live remote to specialized tertiary care centers. In traditional practices, this impedes the close surveillance of symptoms, objective markers of disease (C-reactive protein (CRP), fecal calprotectin (FCP)), and optimization of therapies recommended to achieve the best health outcomes. Emerging self-management and e-Health strategies have improved medication adherence and reduced duration and severity of disease flares. Our center (University of Alberta IBD centre) developed an innovative eHealth platform, the “IBD Dashboard”, a secure, online, portal where patients can upload their self-collected data at regular intervals to provide a cross-sectional and longitudinal assessment of disease state. The IBD clinician can modify therapy accordingly in near real-time to prevent disease relapse. Objectives: To test the feasibility and impact of the IBD Dashboard for providing optimized care in a virtual environment to IBD patients based upon patient self-reported data.

      Methodology/Approach: Methods: The IBD dashboard incorporates patient reported clinical disease activity scores (Harvey Bradshaw Index, HBI, for Crohn's disease and partial Mayo (pMayo) for ulcerative colitis. Objective disease markers include C-reactive protein (CRP) and fecal calprotectin (FCP), and drug levels. Medication adherence questions are also asked. Since July 2017, physicians across Alberta invited their adult IBD patients to enroll into this study. Patients were instructed to submit clinical scores every month on the IBD dashboard, and complete a home FCP (Buhlmann IBDoc test) at baseline, 3 and 6 months. Those who had elevated FCP repeated FCP 1 and 2 months later. Feasibility questions included ease of use, impact on management decisions of the physician, patient medication adherence, and patient acceptance. Outcome measures include phone/clinic visits, ER visits, hospitalizations, clinical and objective flare events.

      Finding/Results: Results: A total of 29 patients have consented to the study thus far, including 12 (41.4%) females, and 14 (48.3%) with Crohn’s disease. The median age is 37.0 years (IQR: 32.0 to 50.0). Medication snapshot: 9 (31.0%) on 5-ASA, 2 (6.9%) on steroids, 6 (20.7%) on immunomodulators, 19 (65.5%) on biologics, and 4 (13.8%) taking no medications. A total of 21 (65.5%) have completed baseline FCP. The median FCP was 276.0 mcg/g (IQR: 64.0 to 956.0), with 11 (52.4%) having an FCP *>*250 mcg/g.. Of these patients with elevated FCP, only 5 (45.5%) reported clinical disease activity scores that were consistent with disease remission (<5 modified Harvey Bradshaw or <2 partial Mayo).

      Conclusion/Implications/Recommendations: Conclusion: Our feasibility pilot study on the use of IBD dashboard, an innovative eHealth platform, is showing near seamless integration in the routine clinical management of remote patients. It is accessible and easy to use for both physicians and patients. The high proportion of patients with elevated FCP, half of which were asymptomatic, suggests a need for close surveillance irrespective of disease activity. The study is currently ongoing recruitment of patients, and continued follow up of enrolled subjects to 6 months study end point.

      140 Character Summary: The online interactive IBD Dashboard program is a feasible, clinically useful tool that allows clinicians to optimize care for IBD patients.

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      OS26.03 - A Digital Health Roadmap for First Nations in Ontario (ID 243)

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

      • Abstract
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      Purpose/Objectives: Years ago, the First Nations Panorama Deployment in Ontario (FNPDiO) project was started between Chiefs of Ontario, FNIHB Ontario Region and the Ontario Ministry of Health and Long-Term Care to support First Nations use of the Panorama Public Health Surveillance System. Time has passed and eHealth strategies and systems have changed. However, the need for effective on-reserve health information management tools and processes remains, including a strong requirement to interoperate with provincial providers, systems and data. The FNPDiO project has been renamed the First Nations Health Information Management in Ontario Project (FNHIMiO) and has had a tremendously successful year identifying, testing and validating practical digital health tools and processes with Initial Subscriber First Nations (Garden River First Nation, Oneida Nation of the Thames, KO Tribal Council, Constance Lake First Nation, Nipissing First Nation and Couchiching First Nation). At the request of Health Canada, a “Roadmap” has been developed to describe how the successful results of the project could be extended to other First Nations across the Ontario Region. This presentation describes that 3-year First Nations Digital Health Roadmap.

      Methodology/Approach: With guidance from the Initial Subscribers, FNHIMiO has developed tools and processes to support: On-reserve health centre health information management needs and priorities assessment Enhancements to privacy and security process and controls Implementation of local data systems (community EMR / EMR) Community member (patient) access to health records and electronic communication with health care providers Data exchange with Ontario’s Digital Health Immunization Repository (Panorama) Access to ConnectingOntario clinical EHR viewers These tools and processes have been tested, refined and successfully adopted by the project’s Initial Subscribers and a Roadmap has been developed to guide an extension of this digital health model to other First Nations in Ontario.

      Finding/Results: The FNHIMiO Initial Subscribers continue to refine and optimize the Roadmap tools and processes, and guide further implementation activities. Ongoing work is also underway with provincial agencies to improve integration with provincial digital health assets and strengthen patient-centric clinical workflows. Due to the success of the project’s work, other First Nations in Ontario are requesting information and/or support from the Initial Subscribers and the project team, and are being assisted to follow the Roadmap to the best of the project’s ability.

      Conclusion/Implications/Recommendations: The First Nations eHealth environment is complicated. However, experience has demonstrated that with patience, perseverance, partnerships and a focus on practical clinical requirements, progress can be made. The FNHIMiO Digital Health Roadmap represents a standardized, provincially-integrated solution that recognizes and support the specific needs of on-reserve health centres and the communities they serve. Our recommendation is for other regions to consider the Roadmap approach for supporting the digital health needs of First Nations communities.

      140 Character Summary: A practical path for advancing First Nation eHealth capacity can be found through the FNHIMiO Digital Health Roadmap.

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      OS26.04 - Mobile Maternity (MoM) a New Kind of Telehealth (ID 160)

      M. Mattei, Chronic Disease Management, Kootenay Boundary Division of Family Practice; Grand Forks/CA

      • Abstract
      • PDF

      Purpose/Objectives: Mobile Maternity (MoM), led by Dr. Shiraz Moola obstetrician and gynecologist and Jude Kornelsen of the Center for Rural Health Research, is a new type of telehealth program and a research project for which the objective is to document impacts of care provided closer to home for expecting mothers. Research documents social morbidities for women with high risk pregnancies, and their families that result from the challenges faced by rural and remote residents for who must travel to receive specialist care. (Kornelsen, J. & Grzybowski, S. 2008, Grzybowski et al 2015). MoM offers real-time telehealth obstetrical consults for elective and emergent conditions through secure mobile devices, and support for precipitous deliveries in remote sites to mitigate these challenges. The consults differ from traditional linear communication between patient and specialist, to tripartite (PCP, patient and specialist) patient care planning.

      Methodology/Approach: To bridge the gap for expecting mothers and their families, the MoM telehealth project provides mobile devices for OB/GYN specialists to connect remotely with family physicians, nurse practitioners, midwives and patients. Using mobile tablets is a key to providing the service particularly for emergent consults at any time from any site. Midwives often use the devices to connect with the specialist from the patient’s home directly making the access to speciality support instantaneous. Mobile Maternity is offered in two regions with very distinctly different patient populations – Kootenay Boundary in the interior of BC and North Vancouver Island. The service began in the Kootenay Boundary with Interior Health IT as partners and focused on piloting the use of iPads with the health authority preferred software for video conferencing Polycom Real Presence. Using the HA software also allows the specialists to connect with any site that has the common platform including emergency room carts and sites without iPads. On Vancouver Island the Telehealth team has supported the project using Microsoft Surface Pro tablets and their preferred video software Cisco Jabber. Similar to the Interior setting, physicians are able to link into any existing telehealth sites as well as those developed specifically for the MoM Project.

      Finding/Results: MoM is demonstrating that a collaborative model of care impacts patients’ outcomes not only by providing access to specialist care, but also in developing skills of the primary care providers while providing patient care closer to home. While patient volumes fluctuate across the seasons, their feedback is clear that the service is saving them cost and risk. The details of results from research data collection to be presented will demonstrate key contrasts in sites and systems, technical and clinical successes and challenges encountered.

      Conclusion/Implications/Recommendations: “The ability for women to stay in town to deliver is very important. When we have a consult conversation through telehealth, women feel like they can stay in their hometown and know that we have support,” Leah Barlow, midwife in Creston, B.C.

      140 Character Summary: Mobile Maternity offers obstetrical consults through secure mobile devices for elective, emergent, and precipitous deliveries for patients in remote locations.

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      OS26.05 - Breaking New Ground for Telehealth Programming (ID 161)

      M. Mattei, Chronic Disease Management, Kootenay Boundary Division of Family Practice; Grand Forks/CA

      • Abstract
      • PDF

      Purpose/Objectives: Telehealth is usually seen as a way to bridge the travel chasm for patients to see specialists from rural and remote communities. Interior Health and the Kootenay Boundary Division of Family Practice have collaborated in piloting telehealth in non-traditional settings involving not only patients, but also linking primary care teams with specialists.

      Methodology/Approach: These first of it’s kind in BC programs have integrated connections: - between physicians for clinical decision support from rural emergency departments to regional ICU teams and other specialists for emergent care; - providing pre-surgical screening access to anesthetists with the support of nursing or primary care teams at rural sites; - between primary care teams and specialists using in-clinic systems and mobile devices. These programs were piloted between Kootenay Boundary Regional Hospital in Trail and outlaying rural sites. Since inception, the PSS clinic service has spread to Vernon Jubilee Hospital to support patients in other parts of Interior Health. The ED/ICU concept is being considered for a provincial program as well.

      Finding/Results: Telehealth for rural areas is still a new practice for many physicians and they have at times struggled to adopt the new technology. While patients seem to be enthusiastic to have the telehealth option, they too are often reluctant to change they way they have traditionally met with their physician, especially for seniors. The core of the work completed has been to create options and ensure systems are in place for when they are needed. The systems are being adopted into practice slower than expected, but the importance of access is the emphasis of the development of the programs. Key successes are clearly linked to physician and nurse champions who enable patients to access care through the telehealth systems. Other key factors include ease of use of the technology, patient education, and relationship building between physicians themselves.

      Conclusion/Implications/Recommendations: This session will provide: - data collected through evaluation processes on the services; - sample workflows for setting up similar programming; - key lessons learned in developing unique telehealth programs; - ideal team and service supports required to implement programs.

      140 Character Summary: Interior Health and Kootenay Boundary Div. of Family Practice piloting telehealth in non-traditional ways linking patients and primary care teams to specialists.

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      OS26.06 - Virtual Emergency Support Service. Evaluation and Lessons Learned (ID 221)

      O. McKenzie, KO eHealth Telemedicine Services; Balmertown/CA

      • Abstract
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      Purpose/Objectives: The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to “enhance support to nurses and [for] clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner.

      Methodology/Approach: The evaluation of Virtual Emergency Support services proceeds in two phases. The interim, or soft-launch evaluation, provides a snapshot of the three-month start up period beginning 16 March and ending 16 June 2017. A subsequent and final evaluation will provide a comprehensive assessment of VES process and impact measures using data gathered between 16 March and 31 December 2017. The information contained in the evaluation is drawn from four main sources. These are nursing feedback, physician feedback, service-level data, and direct engagement. A.Nursing Feedback -Nurses summarized VES encounters by filling out a record of event (NROE) -Each week, KOeHealth staff debrief with Nurses-in-Charge (NICs) at each community endpoint to capture VES event details & context -Face-to-face interviews were conducted with NICs B.Physician feedback -Seven community physicians were interviewed about the VES service model or provided written responses about their experiences/concerns -One air ambulance Transport Medicine Physician (TMP) -TMPs completed post-event surveys after VES encounters C.Service-level data -Nursing records of event (as above) -Event logging files (date, site(s), provider(s), duration) -Service Desk logs (incident type, date, duration) -Provincial air ambulance transport logs (transports per site during the soft launch period) -Federal Service Administration Logs (historical urgent/emergent events) D.Direct engagement and observation -Site visits to two First Nations -Participation at a Nurse-In-Charge (NIC) conference in Sioux Lookout, 31 May,2017 VES has been available in four Sioux Lookout Zone First Nations since 16 March 2017. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.

      Finding/Results: Clinician use of VES is increasing. Uptake in March & April was slow and has steadily increased since mid-May. After three months of service, VES was used 19 times to manage 16 urgent/emergent events. That represents about eight percent of the total medevac traffic in Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations between mid-March and mid-June. VES use by community physicians is at an early stage.

      Conclusion/Implications/Recommendations: Provider feedback and service-level data indicates that a First Nations, Federal, Provincial partnership and a relatively modest investment in information and communications technologies is transforming the delivery of essential health services. Federal nurses at four isolated points-of-care are now directly linked to provincial emergency medical management systems. VES makes multiple levels of medical expertise available on demand during urgent/emergent events. Clinicians report that VES supports nursing practice and patient care and contributes to the effective management of scarce medical evacuation and transport resources. Expansion of the service model appears to be scalable and would benefit other First Nations Nursing Stations in the region.

      140 Character Summary: VES provides information that increases the capacity to advise, triage, and support transport of community members living in northern FNs.

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