• e-Health 2019 Conference Program

    Celebrate, Grow & Inspire Bold Action in Digital Health - Toronto, ON

    This product offers access to the e-Health 2019 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 26 - 29, 2019
    • Total Presentations: 240
Filter Results:

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    FN01 - Advancing Indigenous Access to High Quality Virtual Care Solutions

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Pod 7
    • Type: First Nation Session
    • Track:
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      FN01.01 - Highlighting First Nation Patient Experiences Using Virtual Care in Northwestern Ontario

      02:30 - 03:00  |  Author(s): Orpah McKenzie

      • Abstract

      Abstract not provided

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      FN01.02 - Digital Health of the Future

      03:00 - 03:30  |  Author(s): Jonathan Fleury

      • Abstract

      Abstract not provided

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    OS23 - Looking Through the Data Lens

    • Type: Oral Session
    • Track: Executive
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      OS23.01 - Using the EMR to Rapidly Respond to Product Recalls

      02:30 - 02:45  |  Author(s): Jim King

      • Abstract

      Purpose/Objectives:
      Drug and consumer product recalls are fortunately rare in healthcare. When a recall occurs timely response to identify, remove and provide an alternative are crucial. A voluntary recall was issued in September 2018 by Abbott (for certain liquid nutrition products due to possible bacterial contamination) and in October 2015 by Sanofi-aventis (for Allerject?, epinephrine injection, for potentially inaccurate dosage delivery). The purpose of this presentation is to highlight how CHEO used the analytic capability of an integrated EMR to rapidly respond to these product recalls.


      Methodology/Approach:
      Following the announcement of each recall a product based report was generated for all the potential order ids (ERX) for both the inpatient and outpatient departments identifying both the patient and provider. The report was generated for the current order (day of) for the inpatient department and the order within the last year (time - 1 year) for the outpatient department. Relevant information for these orders including ordering provider, ordering date, and the patient address, name, phone number were extracted. An alert was then developed within the EMR and presented to the provider when ordering the recalled product. The alert provided information about the recall with hyperlinks to the Health Canada or the Canada Food Inspection Agency websites along with prescription information and a recommended alternative when attempting to order the recalled product.


      Finding/Results:
      The following table outlines the number of unique patients that were identified as having an order for the recalled product. The report was generated the same day as notification of the reporting team of the product recall. Orders Sanofi-aventis (Allerject?) Abbott Formula Inpatient N/A 94 Outpatient 21 18 Total 21 112 An alert for the recall and an alternative for the recalled product were built within the order entry system.


      Conclusion/Implications/Recommendations:
      Managing product recalls may be challenging. While it is a responsibility of the dispensing pharmacy to notify patients when there is a recall it is equally important for the ordering physician to identify and notify patients and prescribe an alternative course of therapy. In the hospital setting we have used the analytic capability of our EMR to rapidly respond to two product recalls. This allowed a quick and reliable means to identify patients and their providers and communicate quickly with our families. Also, we were able to notify prescribers with the EMR of the recall in the context of their ordering and to offer an alternative to the recalled product.


      140 Character Summary:
      Using our EMR we rapidly responded to two product recalls, identified affected patients and providers and offered alternatives to the recalled product.

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      OS23.02 - Using Blockchain To Capture Patient Consent for Genomics Research

      02:45 - 03:00  |  Author(s): Daipayan Mukherjee, Amrit Singh

      • Abstract

      Purpose/Objectives:
      The process of enrolling a new study participant in a research study is time and paper intensive. Further, the process requires researchers and hospitals to validate patient consent before sharing data for research, causing significant delays to overall research timelines (on average, it takes 60 days to onboard, enroll and receive data from study participants). Further, the enrolled study participants have little visibility into their data after providing consent. The project's objective is to use blockchain to solve these issues.


      Methodology/Approach:
      Below is f the conceptual model of the platform proof architecture.png


      Finding/Results:
      Expanding on the PoC, the Informed Patient Consent project focuses on bringing the PoC developed by PROOF from a beta version state to a market ready, commercially viable product. Key outcomes for this project are: Develop product roadmap and framework that defines the path to bring the application from a PoC state to a market ready product Complete development to move the product to a market ready product, including successful integration with clinical data from multiple parties including research organization and hospitals Determine application governance and operating model, including IP ownership, licensing model, operations / sustainment management plan, sales strategy, and revenue forecast


      Conclusion/Implications/Recommendations:
      Expected Benefits Informed patient consent and health data auditability is foundational for a secure health and genomics platform. The informed patient consent application establishes ?trust? and enables transparent sharing of clinical and genomic data across parties in a timely, easy, secure manner. A blockchain-based solution will remove the need for centralized consent management, such as by the researcher or hospital, facilitating decentralized record access and storage. Smart contracts, autonomous programs that run on the blockchain, will ensure that only authorized parties have access to that patient?s data. The following are key outcomes that will be derived directly as a result of this project: Blockchain is a distributed technology that brings a built-in layer of transparency and traceability, therefore removing the need for third parties such as researchers or hospitals (e.g. paper consent forms) Use of smart contracts can automatically execute transactions based on the implemented rules from all regulators which establishes trust and automated compliance amongst various stakeholders in the ecosystem Enhances visibility, transparency and control over patient consent and ensures the security and consistency of the data Creates an unfalsifiable and verifiable fingerprint on the blockchain, with timestamps corresponding to consent statuses to provide an audit trail for reporting purposes Enables long term outcomes for the participating stakeholders such as, moving discovery into innovation in action, establishing a platform for a health data commons to unleash scientific research and discovery


      140 Character Summary:
      Going beyond proof of concepts. Pilot Project: Using Blockchain To Capture and Track Patient Consent for Genomics Research

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      OS23.03 - Lessons from the Field: Nova Scotia’s EMR Migration Deadline

      03:00 - 03:15  |  Author(s): Michael Kelly

      • Abstract

      Purpose/Objectives:
      In this presentation, Christine Grimm, Senior Executive Director, Investment and Decision Support with Nova Scotia?s Department of Health and Wellness (DHW), and Michael Kelly, EMR Migration Senior Project Manager (Mara Consulting) will provide the audience with successful strategies used to implement a large-scale change in Nova Scotia?s approach to community-based electronic medical record (EMR) systems. Christine and Michael will describe how Nova Scotia responded to a vendor-initiated sundown of the provincially hosted solution. While there were several other EMRs in use across the province, approximately 70% of primary care physicians and 29% of community-based specialists in the province had adopted the provincial system. Over a two- year period, they will have moved from a provincially hosted and supported EMR ? Nightingale on Demand (NOD), to a model where providers will work with and be supported by one of two existing EMR vendors certified to operate in the province. Topics will include how to: ú Develop a governance structure to support a large-scale migration in a unique, complex environment ú Successfully migrate over 3000 health care providers and clinical staff from a provincially-hosted EMR to one of two private sector EMR products in a two-year period ú Build positive relationships with stakeholders in a multifaceted dynamic landscape


      Methodology/Approach:
      Methodology/Approach: Nova Scotia?s approach to the migration includes the following: ú Building a new governance structure within an evolving digital health landscape ú Completing a pilot phase to ensure EMR vendors have the capacity to comply with provincial migration and data standards ú Assembling a dedicated project team of existing NOD support resources and external consultants to streamline processes and implement a comprehensive change management strategy to encourage adoption ú Providing financial incentives to compensate physicians and their staff for the time spent validating patient records and training on their new EMR


      Finding/Results:
      Findings/Results: ú As of October 2018, over 50% of providers had committed to migrating to a new EMR.


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations: ú Stakeholder engagement is key ? understanding your stakeholders? perspectives and what else is happening in the bigger context is important to understand when building project and engagement plans ú Ensure the governance structure for the project and its ongoing success within broader digital landscape includes all of the key stakeholders ? representation from health care providers, government, health authorities, vendors and the medical association


      140 Character Summary:
      Nova Scotia?s key success factors in a large-scale change to EMR solutions and governance in a unique and complex digital health landscape.

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      OS23.04 - Managed Service Model: Accessing Healthcare Through a Different Lens

      03:15 - 03:30  |  Author(s): Mohamed Elmokadem, Joanna Hickey

      • Abstract

      Purpose/Objectives:
      The Managed Service Model (MSM) project provides access to timely and culturally safe health care services to First Nations communities throughout Ontario. Keewaytinook Okimakanak eHealth Telemedicine Services (KOeTS) and Ontario Telemedicine Network (OTN) invited remote First Nations communities across Ontario to participate in the MSM project. The project is facilitated using OTNinvite, a videoconferencing feature that allows individuals external to OTN?s network, to participate in real-time video visits.


      Methodology/Approach:
      OTN and KOeTS piloted a new model for First Nations communities with a simpler and more convenient alternative to purchasing a room-based videoconferencing system. First Nations on-reserve communities with adequate internet connectivity applied to receive a secure desktop computer with videoconferencing devices (high definition web camera and an echo cancelling speakerphone) so that they could participate in video consults. Consults are enabled through a private and secure web link. In March 2017, the participating First Nations communities attended an engagement session in Kenora where they received equipment and process training. In all, 40 OTNinvite systems were distributed to the participating communities. Community engagement is continuously provided by a Regional Telemedicine Navigator (RTN), located in Balmertown. The RTN identifies and schedules healthcare providers and services to meet the needs of the community members. Funding for this project is provided through Ontario?s First Nations Health Action Plan. While the project was designed to facilitate the connection between patients and providers using OTNinvite, the feature was also leveraged as a teaching device to familiarize providers with the project. This ensured that providers and communities were comfortable with the technology and processes prior to patient engagement.


      Finding/Results:
      Communities within the project identified a demand for healthcare in areas such as mental health, oncology, and diabetes. Mental health presents the area of most potential to expand utilization within the community health centres. Awareness and partnership development with mental health partners is ongoing. Based on the identified needs, engagement sessions were held with Misaway (diabetes management centre), Waypoint Centre, SickKids Telepsychiatry program, as well as St. Michael?s Hospital and Thunder Bay Regional oncology departments. To date, the project has discovered: -There exists a knowledge gap among providers who are unfamiliar with OTNinvite and accustomed to traditional room-based telemedicine services. -Despite the connectivity available throughout the province, First Nations communities are still challenged with bandwidth issues. -The communities selected for the MSM project had no prior experience with telemedicine and so require a higher level of support.


      Conclusion/Implications/Recommendations:
      -The RTN continues to mitigate the provider knowledge gap through ongoing outreach and working with Telemedicine Coordinators (TMC). To keep their skills sharp, TMCs are encouraged to participate in OTNinvite test calls. -Where bandwidth issues are not resolvable, systems will be re-allocated to other communities. -The frequency of contact and engagement with these communities will be increased to better support their participation in the project. By encouraging health care providers and patients to use MSM, First Nations communities have access to a low-cost alternative to purchasing a video clinical system which requires OTN membership, management, and staffing resources.


      140 Character Summary:
      The KOeTS and OTN lead MSM project provides timely access to culturally safe health care for harder-to-reach Ontario First Nations communities using OTNinvite.

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    OS24 - Co-design Clinician/Patient Interaction

    • Type: Oral Session
    • Track: Technical/Interoperability
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      OS24.01 - Development of a Person-Centered Patient Portal Using Stakeholder Co-Design

      02:30 - 02:45  |  Author(s): John Kildea

      • Abstract

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


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


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


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


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

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      OS24.02 - A Complex Virtual Care Hub Supporting Perinatal Mental Health

      02:45 - 03:00  |  Author(s): Ian Chalmers

      • Abstract

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


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


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


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


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

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      OS24.03 - Implementing Mobile Technology in Primary Care: The Epro Tool

      03:00 - 03:15  |  Author(s): Carolyn Steele Gray

      • Abstract

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


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


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


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


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

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      OS24.04 - Application of Virtual Care Models into Palliative Care

      03:15 - 03:30  |  Author(s): Megan Nguyen

      • Abstract

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


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


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


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


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

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    OS25 - You've Got Mail, But No Paper!

    • Type: Oral Session
    • Track: Technical/Interoperability
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      OS25.01 - Adoption and Perceived Usefulness of Health Information Exchange

      02:30 - 02:45  |  Author(s): Aude Motulsky

      • Abstract

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


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


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


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


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

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      OS25.02 - Rearchitecting Interoperabiiity

      02:45 - 03:00  |  Author(s): Karim Keshavjee

      • Abstract

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


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


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


      Conclusion/Implications/Recommendations:
      Solutions for several of these barriers have been developed in partnership with academia, industry and clinicians. This presentation will cover: Principles of governance for data sharing, economic models for developing compelling business cases, findings from an international survey of what works and doesn?t work in other countries and methods and mechanism to align incentives. Barriers that require additional research will be highlighted.


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

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      OS25.03 - Health Information Standards and Results Distribution in BC – Paper Reduction

      03:00 - 03:15  |  Author(s): Francois Chevallier

      • Abstract

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


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


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


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


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

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      OS25.04 - HIE Adoption Lessons from International Healthcare Systems

      03:15 - 03:30  |  Author(s): Chris Hobson

      • Abstract

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


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


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


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


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

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    OS26 - Telehealth in Action

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Pod 5
    • Type: Oral Session
    • Track: Clinical and Executive
    • +

      OS26.01 - Digital Health Enhances the Continuum of care for Oncology Patients

      02:30 - 02:45  |  Author(s): Krisan Palmer

      • Abstract

      Purpose/Objectives:
      The overall driving factor for provision of Teleoncology in New Brunswick is the concentration of clinical oncology specialists in the southeastern and southwestern regions of the province. Patients not in these locales, with their families or caregivers, must travel in order to interact with their clinicians. The goal of Teleoncology is to provide safe, evidence based practice in the nearest community to where the patient resides.Thus eliminating exhaustive travel for those patients already in a weakened physical and emotinal state.


      Methodology/Approach:
      Oncology referral patterns were analysed and in conjunction with the established satelitte chemotherapy clinic locations, Oncologists were approached to explore the potential use of Telehealth for patient follow-up appointments. Inclusion and exclusion criteria were established based on the clinical presentation of patients. The was determined during this exercise that Teleoncology provides the ability to deploy a wide range of services including clinical consultation, diagnostic services, knowledge exchange in the form of clinician and patient education, peer support and professional development. Exploration of access to required information electronically, such as electronic health records,was also explored to ensure that all of the required information was available, irrespective of geography. Technology plays a supportive role in that clinical needs are what drive the selection. Innovative clinical processes are the key to success in any sustainable Telehealth initiative and will be outlined specific to this application during the presentation. For example, the engagement of primary care physicians in performing the physical assessment for the specialist prior to each visit has definitely been a positive force in enhancing the patient care continuum, and physician knowledge transfer.


      Finding/Results:
      Teleoncology has facilitated the national clinical standard of patients being seen by an oncologist or a general practitioner in oncology (GPO) prior to each cycle of chemotherapy. This method of care delivery has greatly diminished the need for oncologists to visit outlying areas on a rotating basis, giving oncologists the opportunity to follow up on their own patients. As well, it now provides the opportunity for many patients to become engaged in clinical trials whereas prior to Telehealth, distance and access eliminated them as recruitment candidates. One very real challenge for the remote hospital sites is that of nursing resources. This is net new activity and must be taken into consideration. Other care delivery impacts, challenges and lessons learned will also be discussed.


      Conclusion/Implications/Recommendations:
      Teleoncology offers the potential for improved access to a wide variety of cancer support services, leading to benefits for patients and their families closer to home. It can provide wider scale access to cancer related educational programs. The provision of opportunities for patients to receive clinical and support services much closer to their home community will reduce the cost to them and their families in terms of time and finances, as well as reduce the costs to our provincial healthcare system. Currently one group of Oncologists within one urban center in New Brunswick visit over 30 sites virtually on a regular basis to facilitate their patient care delivery.


      140 Character Summary:
      Engagement of primary care physicians in teleoncology delivery.

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      OS26.02 - A Comprehensive Telestroke Solution for New Brunswick

      02:45 - 03:00  |  Author(s): Jennifer Sheils

      • Abstract

      Purpose/Objectives:
      The goal of the provincial Telestroke program is to provide a solution that allows every New Brunswick (NB) citizen experiencing an acute stroke the potential to receive leading edge stroke care for this emergency event as well as thrombolysis therapy; specifically a medication known as TPA. The real issues arise with correctly identifying candidates who would benefit from TPA, as well as having a system that is equipped to respond in the rapid manner required and with the additional opportunity to provide this treatment at remote or rural locations and centers that do not ready access to stroke specialists.


      Methodology/Approach:
      Telestroke NB is built upon NB's existing Telehealth capacities, for which we have been previously recognized as a leader in using innovative technologies to provide high-quality intervention, prevention, follow-up, and educational resources to patients throughout our province. Telestroke NB links every 24 hour emergency room, which has computed tomography (CT) access, in the province to an on-demand stroke specialist in real time, regardless of the location of the patient or specialist. Neurologists connect to the hospital network using a virtual private network (VPN) from their home or office to review the CT image within seconds of the scan being completed. This system also allows them capacity to view older CT scans performed on that patient from additional NB sites. They document the necessary clinical assessment performed while connected in real time via interactive audio and video to the emergency room where the patient has presented. In this manner, benefits and risks are communicated to the patient, family and staff at the referring site who also receive advice and support for thrombolysis decisions.


      Finding/Results:
      Telestroke NB is a system that was developed cooperatively between two provincial health authorities (Horizon and Vitalit‚), Ambulance NB, and Heart and Stroke Foundation of NB with the support of the government of NB. This sustainable system was built to align within existing programs and all partners worked collaboratively. It is an innovative, province-wide system for delivering evidence-based acute stroke care and thrombolytic therapy. Each health authority supported the development of consistent guidelines and processes to ensure patients receive care in both official languages as mandated in a bilingual province. Emergency room staffs were integral to the program success as they developed ways to support the remote specialist with performing needed clinical assessments and dialogue with patients and their families.


      Conclusion/Implications/Recommendations:
      Telestroke NB is a sustainable program; improving health by increasing access to quality, evidence-based stroke care in the hyperacute setting. This results in better health outcomes by directly reducing disability caused by stroke. It results in cost-savings by reducing the burden of care for patients who might otherwise require longer hospital stays and long-term nursing care. It also reduces unnecessary transfers and demonstrates the power of cross regional program collaboration. Telestroke NB is one step of a truly comprehensive stroke system; moving towards using Telehealth for primary and secondary stroke prevention. It was launched in collaboration with every facet of the New Brunswick health care system.


      140 Character Summary:
      A province wide innovative technological solution to provision of hyperacute healthcare services.

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      OS26.03 - Explaining Longitudinal Patient Adherence in a Heart Failure Telemonitoring Program

      03:00 - 03:15  |  Author(s): Patrick Ware

      • Abstract

      Purpose/Objectives:
      Telemonitoring can improve heart failure outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients adhere to taking the expected physiological readings. While the literature is rich with studies exploring barriers and facilitators to patient uptake, few have studied longitudinal patient adherence to telemonitoring programs existing outside the context of clinical trials. The objective of this study was to quantify and explain longitudinal patient adherence in a heart failure telemonitoring program offered as part of the standard of care in a Toronto-based specialty heart function clinic.


      Methodology/Approach:
      A mixed-method explanatory sequential design was used to first quantify patient adherence rates over a 12-month(m) period and subsequently explain adherence using semi-structured interviews. As patients are instructed to take readings daily before noon, monthly adherence rates were defined as the percentage of completed morning readings (weight, blood pressure, and symptoms) over each 30-day period. Generalized linear models were performed to predict adherence rates using independent variables related to demographics, disease severity, and time since program start. Semi-structured interviews containing probes based on the constructs in the Theory of Acceptance and Use of Technology 2 (UTAUT2) were conducted with a subsample of patients.


      Finding/Results:
      Two years after program launch, longitudinal adherence data for 12m was available for 179 patients (mean age 58 +/-16; 80% male). Overall mean adherence over the 12m period was 70% +/-25 with average adherence rates declining from 80% +/-24 at 1m to 65%+/-35 at 12m. Time since starting the program was the only significant predictor of adherence accounting for 81% of variation in adherence over time (R2=0.81). Characteristics of interviewed patients included a range of ages (22-83), sex (70% male), time since onboarding (0-12m), and overall adherence rates (30-96%). Key themes explaining patients? motivation to adhere include: (1) perceived benefits of the program (self-management support, peace of mind, and improvement in clinical care); (2) ease of use; (3) a positive opinion of the program from family and friends; and (4) supporting services (training and technical support). Themes explaining low and imperfect adherence include: (1) technical issues that periodically prevented the transfer of readings and/or which led to patient frustration; (2) life events or circumstances that interfered with the ability to take readings; and (3) the perception that the benefits of the program were suboptimal due to the system?s inability to adequately capture additional context related to the readings.


      Conclusion/Implications/Recommendations:
      Despite a 15% drop in adherence after one year, an overall mean adherence of 70% is considered high given our strict definition of adherence and because the pragmatic nature of this study meant that we could not account for periods when patients were unable to take readings (e.g., travelling, inpatient stay, etc.). This limitation meant that true adherence was likely underestimated. Consistent with the UTAUT2, this study found that longitudinal adherence is not so much predicted by patients? demographic or health characteristics but rather their perception of a telemonitoring program?s benefits, its ease of use, and the presence of supportive individuals and supporting program components.


      140 Character Summary:
      Although declining over time, patient adherence to a telemonitoring program remained high and was primarily explained by patients? perceptions of the program.

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      OS26.04 - Intra-institutional Teledermatology: Results of a mixed methods case study

      03:15 - 03:30  |  Author(s): Trevor Champagne

      • Abstract

      Purpose/Objectives:
      Historically, teledermatology?s benefits have been mostly realized through improved access to rural or underserviced areas. This study examines the benefits and the overall impact of teledermatology in an urban, intra-institutional environment.


      Methodology/Approach:
      A store-and-forward teledermatology service was created between family medicine practitioners and a consultant dermatologist in the same urban ambulatory ?intra-institutional? hospital. Mixed methods analysis was then applied to chart reviews, electronic surveys to clinicians and patients, and semi-structured interviews with referring providers and dermatologists within a framework developed from the Canada Health Infoway Benefits Evaluation. Survey questions were designed to assess benefit quantitatively and interviews were subjected to qualitative thematic analysis. The final results were tabulated, triangulated, and compared against existing literature.


      Finding/Results:
      84.2% of the 76 consultations reviewed over 18 months of service were manageable solely with teledermatology. Subgroup analysis revealed that skin ?lesions? had a much lower success rate ? with 40.9% requiring transition to an in-person consult, as opposed to skin ?rashes,? of which 94.3% were manageable through teledermatology. All patients agreed they would use the service again. Cited benefits included savings in time, money, and missed work. Referring providers were satisfied with service reliability, timeliness and quality of responses, and the educational value of the consult opinions, but it did increase their administrative time.


      Conclusion/Implications/Recommendations:
      Patients were satisfied with intra-institutional teledermatology and felt it saved them time, money, and prevented them from missing work. Providers were similarly satisfied despite the increased administrative burden. This study demonstrates strong benefits of teledermatology even when used in populations that are not underserviced or geographically restricted. Future research should include assessments of cost-effectiveness and the impact of teledermatology services targeted exclusively at subgroups such as rashes.


      140 Character Summary:
      Intra-institutional teledermatology helped patients save time and money and providers were highly satisfied with the service.

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    OS27 - Integrating the Community Sectors

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Pod 6
    • Type: Oral Session
    • Track: Clinical and Executive
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      OS27.01 - Understanding the Technology Needs of Clinical End-Users for Care Coordination

      02:30 - 02:45  |  Author(s): Daniel Cornejo Palma

      • Abstract

      Purpose/Objectives:
      Rural communities are a difficult place to try internet-based technology to improve health outcomes. Part of the difficulty stems from not incorporating the concerns of clinical end-users when implementing new technology. Traditional approaches to evaluating technology implementation focus on measuring patient outcomes. The importance of understanding clinical end-user interests is traditionally downplayed. Ignoring the concerns of users has lead to technology disuse and lacklustre patient outcome improvements in the literature. To improve the understanding of clinical end-user concerns, we created the Tool+Team+Routine (TTR) heuristic. TTR is based on principles from value proposition design, in which empathy for the user underlies the first step in implementing engaging solutions. TTR aims to improve the engagement in technology implementation by defining success metrics in terms that matter to clinical end-users.


      Methodology/Approach:
      We used TTR to define success metrics for a digital platform set up to improve care coordination efficiency in a population of rural complex care patients. During protocol development, the evaluation team discussed or observed each TTR element with coordinators. We learned from coordinators that to understand meaningful platform use (i.e. ?tool? use), we would have to track usage. Coordinators also taught us that meaningful collaboration amongst 'team' members meant having case conferences, which prompted the inclusion of case conferences as a secondary outcome. Finally, we also learned that improvement to practice (i.e. ?routines?) meant reducing communication delays between health professionals. Thus, we developed a primary outcome, time to maintenance (TTM), based on elapsed time to highlight communication delays among providers.


      Finding/Results:
      *Tool: Usage of the platform was low. Half of the cohort barely used the platform. Overall, 30% of all communication on the platform occurred between care coordinators and clients ?70% was between clients and family. The tool was designed to centralize patient-related conversations among health professionals but did not do so, due to lacking engagement from other providers. Team: We observed that case conferences occurred in only 15% of patients. Care coordinators noted that a minority of clients with health teams that adopted the communication platform seemed to experience an efficiency gain in reaching their goals. Routine:* Care coordinators? claim of an efficiency gain with app engagement was supported by observed data. Video call usage, a measure of engagement, significantly reduced the coordination delay per co-morbidity. The delay observed per comorbidity was 28.7 days without platform use (i.e.< 2 calls made in six months of follow-up). If patients made at least ten calls in six months, the coordination delay per comorbidity decreased from 28.7 to 19.9 days (p=0.035).


      Conclusion/Implications/Recommendations:
      TTR is a simple heuristic that identified metrics that were relevant to clinical end-users. The primary outcome reflected communication delays because coordinators identified delays as a vital concern to the efficiency of daily routines. Coordinator worries about the engagement of other care team members meant we measured clinician involvement closely. TTR-based evaluation results challenged decision-makers to consider clinical end-user concerns as vital next steps to address in this technology implementation.


      140 Character Summary:
      Traditional technology implementation approaches overlook end-user concerns. We present a practical framework to understand end-users: 'Tool+Team+Routine'.

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      OS27.02 - Clinical Value of Standardized Primary Care Data: Learnings from POC

      02:45 - 03:00  |  Author(s): Michelle Cousins

      • Abstract

      Purpose/Objectives:
      The connecting South West Ontario Program?s Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, enabled a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontario?s integrated electronic health record (EHR). A key objective of the POC was to support clinicians to improve data quality to enhance data sharing. This presentation demonstrates how structured EMR data can be used to enable clinical and organizational value for primary care providers and their patients


      Methodology/Approach:
      Data quality assessments were completed before and after investments to improve data quality that included chart reviews, surveys and EMR searches. Data quality investments included historical coding of EMR data to ensure coded patient data was current. The eCE consulted with program managers and clinicians to explore how improved data quality could generate value for each organization and developed case studies to demonstrate this value to clinicians.


      Finding/Results:
      During the POC the eCE PCDS project team learned that data quality initiatives, when positioned together with tools developed in line with clinical best practices, generate internal value for contributing organizations and clinicians. Improved EMR data quality allows primary care organizations to: identify patients with specific conditions (including patients who did not have a documented diagnosis); identify complex patients (high-users of the healthcare system); identify and understand patient population (i.e. prevalence of chronic conditions). Overall, findings demonstrated that primary care data quality improvement initiatives promote improved documentation and a more accurate depiction of the patient roster in the EMR, which has allowed primary care providers to be more proactive in the way they manage care internally to their practices as well as through better communication to community and specialist supports.


      Conclusion/Implications/Recommendations:
      The PCDS POC has demonstrated not only that data can be extracted from EMRs and viewed by clinicians across communities and the continuum of care, but generated improved value for clinicians and patients within primary care practices by improving data quality. When EMR data is up-to-date and standardized using codes, practices can identify and mobilize to care for specific patient populations. Moving forward, it is important to invest in a scalable model that can structure and improve primary care data quality and to learn more about the opportunity a high-quality dataset from primary care offers to achieve the quadruple aim (improved patient experience, patient outcomes, system cost, physician experience). For example, EMR tools that incorporate best practice guidelines could be developed in ways that enable clinicians to document specific elements in structured ways that can lead to easier more effective management of patient populations. In addition, those structured fields can be shared with specialists and community supports to support stronger continuity of care.


      140 Character Summary:
      This presentation will demonstrate how quality primary care data can enable clinical and organizational value for primary care providers and their patients.

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      OS27.03 - LTC eConnect: Supporting LTC Access to the Electronic Health Record

      03:00 - 03:15  |  Author(s): Angela Lianos

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: The LTC eConnect solution leverages the provincial EHR clinical viewers, ConnectingOntario and ClinicalConnect, to provide clinicians working in Long Term Care (LTC) homes with simple, direct access to the provincial EHR from the existing secure resident record in the PointClickCare clinical information system, which is currently in use by LTCHs. This panel presentation will showcase the LTC eConnect solution that connects clinical users? patient information in a manner which supports their clinical workflow (i.e., with Single Sign-On (SSO) and Context Management (CM)). The project, went live with its first LTC site in March 2017, and is being delivered through a successful partnership between Canada Health Infoway, eHealth Ontario, PointClickCare and ThoughtWire with support from stakeholders across the sector, including the Ontario Long-Term Care Association (OLTCA), AdvantAge Ontario and LTC clinicians. This session will provide a demonstration of the solution, narrated by panel members, as well as an overview of project successes and lessons learned. LTC clinicians will explain how the LTC eConnect solution has benefited patient care and provided clinical efficiencies.


      Methodology/Approach:
      Methodology/Approach: Designed specifically for the LTC sector, the LTC eConnect solution provides clinicians access to the ConnectingOntario ClinicalViewer or ClinicalConnect directly from their PointClickCare EMR, while maintaining patient context. The solution was developed using Agile Methodology guided by two clinical advisory panels; one for each regional viewer. The solution was rolled out to a pilot site in each of the three regions before it was available generally.


      Finding/Results:
      Findings/Results: LTC eConnect has been rolled out to 73 Long-Term Care Homes in Ontario, and over 1,400 authorized users are now able to access residents? health information to support care delivery. An additional 200 homes across the province are scheduled to be using LTC eConnect by March 2019, which represents nearly half of the LTC homes in Ontario. The response from clinicians who have adopted the LTC eConnect solution has been overwhelmingly positive. Clinicians have reported: Greater access to residents? health information in real-time ? especially upon resident admission or transfer Easier access to labs, diagnostics and drug data Ease of use during medication reconciliation and access to a fulsome health profile during the patient assessment period Expanded use of information among registered staff supported by the controls put in place to access personal health information directly within the PointClickCare application Easier auditing controls for monitoring staff usage and access of the electronic health record


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations Implementation of the LTC eConnect initiative required stakeholder engagement from the LTC sector to ensure the digital health solution was appropriately integrated into clinician workflow. Both the complexity of the patients the LTC sector serves, as well as the diversity of the LTC clinicians themselves required unique considerations to ensure the success of the service. The development and implementation of the LTC eConnect solution was successful because it was designed around the people it serves. By putting LTC clinicians at the forefront of the project the solution could be tailored to prioritized needs of the sector.


      140 Character Summary:
      LTC eConnect: A sector specific solution created to support long-term care access to the electronic health record

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      OS27.04 - Discharge Optimization in the Emergency Department at CAMH 

      03:15 - 03:30  |  Author(s): Gillian Saracino

      • Abstract

      Purpose/Objectives:
      The CAMH Emergency Department (ED) Discharge Optimization project will improve transitions and experiences of individuals discharged from the ED through: -Implementation of an electronic ?PODS? (Patient Oriented Discharge Summary) that is built within the EMR (Electronic Medical Record) and provided to patients on discharge. -More efficient completion and distribution of discharge summaries to community physicians to promote smooth transitions and continuity of care for patients. These discharge improvements have been successfully rolled out to all inpatient units at CAMH. As a result, this initiative will align with organization-wide standards and initiatives. Further, initial consultation with families as part of the ED Optimization project has acknowledged that a PODS-type discharge summary will fill a reported gap in regards to transition, safety and care planning in the emergency department.


      Methodology/Approach:
      The implementation of PODS will use Project Management tools and approaches within a Quality Improvement Science frame to plan, implement, study and improve: -The use of PODS for patient education and self-management post-ED visit -Efficiencies in completion and distribution of discharge summaries to community Physicians The project team consists of representation and expertise in Project Management, Quality Improvement, and Reporting and Analytics, wherein a measurement plan is being developed to identify current process measures as well as outcome measures. Achievements to date include: -Current state analysis, including process mapping, analysis of variation in current state process, and identification of technical challenges -Current state analysis to inform implementation of PODS in the ED discharge process -Inclusion of patients and families in the planning of PODS for the CAMH ED. -Collaboration with CAMH?s Clinical Informatics team to develop and implement solutions within the CAMH Electronic Medical Record (EMR)


      Finding/Results:
      Currently, this project is underway, with a goal of implementation by the end of the fiscal year. Baseline data collection indicates opportunities for improvement in dissemination of discharge notes from the CAMH ED. Specific areas of opportunity include usability of the EMR function for sending clinical documentation. CAMH-wide implementation of PODS on inpatient units has involved continuous monitoring through initial implementation and PDSA cycles. Currently, there is monitoring for sustainability to ensure continued success of PODS implementation. The same approach will be used for implementation of PODS in the ED.


      Conclusion/Implications/Recommendations:
      The combined implementation of PODS in the ED, and more efficient completion and distribution of ED discharge summaries, will support and maintain a patient-centred approach to promote vital transitions in care.


      140 Character Summary:
      The CAMH Emergency Department is implementing a patient-centred initiative to improve discharge processes and promote more effective transitions in care.

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    PS06 - Digital Health Innovation Across Canada

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Pod 4
    • Type: Panel Session
    • Track: Executive
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      PS06.01 - Digital Health Transformation through an Economic Development Lens

      02:30 - 03:00  |  Author(s): Dale Vandenborre, Joel Dewolfe

      • Abstract

      Purpose/Objectives:
      Digital Health brings the promise of transfromation to a sector traditionally challenged to embrace change. For many jurisdictions, health spending trends, increased chronic disease prevalence and aging populations are driving the need to embrace healthcare transformation and digital solutions. An economic development strategy for digital health can allow a juristions to rally around change and spur both positive economic outcomes and new health outcomes for a region. Hear how investment in innovation, specifically in digital health technologies such as Biofabrication & Medical 3D Printing, artificial intelligence and consumer apps are changing the narrative in one of Canada's poorest regions.


      Methodology/Approach:
      By - bringing healthcare subject matter expertise into the agency focused on economic development - placing increased emphasis on long term financial stability of the region - bringing all healthcare stakeholders together under a common vision, - embracing realities, both strengths and weaknesses, that define us - understading roadmaps, challenges, performance indicators and inhibotors of various stakeholders - understanding what is possible at the edge of digital disruption internationally - picking winners - partnering strategically ... we changed the narrarative.


      Finding/Results:
      We are at the early stages of our journey ... and will have findings/results to report at the e-Health conference. Early noteworthy successes/results include establishing a pan-Canadian partnership with the Health & Technology District in Surrey, BC.


      Conclusion/Implications/Recommendations:
      Economic Development agencies are not commonly considered to be such a key role player in Healthcare transformation, but ... ... (1) looking at Health through an ecoomic development lens first was a missing ingredient to acheiving digital healtcare transformation in our region. (2) it takes a community.


      140 Character Summary:
      Economic development agencies must work in lock step with healthcare agencies and vice versa, and there is no better time to do so - inside a digital health revolution.

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      PS06.02 - Digital Health Roadmap: A First Nations-Led Strategy in Ontario

      03:00 - 03:30  |  Author(s): Karl Mallory, Kimberly Lalonde

      • Abstract

      Purpose/Objectives:
      A foundational level of digital health capacity is a necessity for First Nations health centres to manage their service delivery responsibilities. Not only is this true simply for efficiency, client-safety and privacy, but interacting electronically is the de-facto standard for coordinating care with provincial partners ? essential given the limited scope of health services available on-reserve. Recognizing the importance and urgency for digital health capacity in First Nations health centres, the First Nations Health Information Management in Ontario Initiative (FNHIMiO) developed a Digital Health Roadmap to support transition from paper-based processes and position First Nations in Ontario to access and use digital health tools best suited to their needs. Guided by a group of experienced First Nations Health Directors and clinical champions, FNHIMiO has systematically assessed requirements, identified corresponding tools, developed implementation processes and successfully supported several First Nations to build a foundation to effectively work in a 21st Century healthcare environment.


      Methodology/Approach:
      The FNHIMiO Roadmap approach follows a simple, pragmatic sequence: First Nation Health Centre Health Information Needs Review and Initial Change Management Privacy and Security Enhancement and Change Management Assist with Local System Adoption, Use and Change Management Support Access To/Use of Provincial eHealth Systems Develop and Implement Sustainment Model Key to this is the willingness of an initial group of First Nations to experiment with, refine and validate the Roadmap approach. Once validated, the approach is extended to other interested First Nations. In this way, FNHIMiO is now extending foundational P&S support to many First Nations, establishing information sharing agreements with provincial agencies, enabling immunization program coordination with provincial systems, and enabling access to provincial digital health assets.


      Finding/Results:
      The Roadmap approach is currently being followed by several First Nations across Ontario. The number of First Nations health centres who are benefiting from enhanced P&S capacity, digitally-enabled communications with provincial partners, and local digital health tools that improve efficiency, ease reporting burdens and improve client safety is steadily growing. Requests from other First Nations for assistance is similarly growing, as is support from First Nations leadership to leverage the work of FNHIMiO, and digital health capacity in general, to address inequities in health care for First Nations community members and support First Nations Health Transformation objectives.


      Conclusion/Implications/Recommendations:
      The FNHIMiO Roadmap approach is working. It is helping First Nations take a needs-based approach to build digital health capacity. By taking a methodological and pragmatic approach to integrate care processes with provincial partners, FNHIMiO is reducing overhead and enabling the adoption of standard models that can be extended and sustained. It is recommended that provincial partners explore opportunities to coordinate around the Roadmap approach and that First Nations in other regions explore its adaptability for their own benefit.


      140 Character Summary:
      A digital health Roadmap is bringing benefits to First Nations clients, providers and partners and supporting Health Transformation.

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    RF03 - Patient Empowerment: It's about Time!

    • 14:30 - 15:30
    • 5/28/2019
    • Location: Pod 8
    • Type: Rapid Fire Session
    • Track: Clinical and Executive
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      RF03.01 - Advanced use of EMRs yields greater benefits: 2018 Canadian Physician Survey

      02:30 - 02:40  |  Author(s): Chad Leaver

      • Abstract

      Purpose/Objectives:
      Clinicians, governments and the digital health sector have all made significant investments supporting adoption, use, and interoperability of Electronic Medical Records (EMRs) and associated digitally-enabled health services. We sought to update the current use and value of digital health technologies in practice by specialist and primary care and specialist physicians in Canada. The objective of this presentation is to highlight key insights from the 2018 Canadian Physician Survey while focusing on three main themes: advanced use of electronic medical records (EMR); use of functions related to medication management; and advanced use of consumer-facing e-services such as patient access to their own health information, e-visits, and e-booking of appointments.


      Methodology/Approach:
      A total of 1,393 physicians completed the survey: primary care physicians (PCPs) N=799; and specialists N=594. The survey was conducted in French and English using a multi-method promotion and recruitment strategy. A weighting methodology, developed by the Canadian Institute for Health Information (CIHI), was applied to all responses representing the (estimated total) 78,839 of eligible physicians in Canada. Weighted and unweighted results of the survey were compared; and comparison of the unweighted demographics to the 2018 Canadian Medical Association Masterfile physician profiles demonstrated no statistically significant differences between the 2018 CPS and the CMA Master file via Chi-Square test.


      Finding/Results:
      Use of EMRs is demonstrating significant efficiency benefits for physicians and the health system as evidenced by 82% of PCPs and 77% of specialists who stated that they provide more efficient care with electronic records. However, not all physicians are using EMRs in the same way or have access to the same functionality. While PCPs frequently access lab results (80%) and diagnostic images (74%), other functions such as ?generate lists of patients who are due or overdue for tests or preventive care? or ?electronically exchange patient clinical notes with any doctors outside your practice? are more rarely used. Use of more advanced clinical functions such as these is correlated with higher perceived efficiency and higher satisfaction with physician EMR systems than basic use (use of just 1 or 2 functionalities). A key finding is that 84% of highly optimized PCP EMR users (using 6 to 9 functionalities) are satisfied with their EMR, compared to only 49% of PCPs using 1-2 functionalities. Similar findings were observed when correlating use of medication management functions such as generating an electronic prescription with an EMR and use of electronic warnings for drug interactions and perceived efficiencies. Additional findings related to physicians? use of virtual care and consumer-facing e-services were also captured in the survey.


      Conclusion/Implications/Recommendations:
      A majority of primary care and specialist physicians use EMRs and have access to connected patient information from care settings outside their main practice. The methods of electronic access to clinical data from connected health information systems differs across jurisdictions and community-based and hospital care settings. Furthermore, there are various levels of integration with point-of-care EMRs such as viewers, in-context single sign-on, and direct data feeds. Altogether, these findings show growing adoption of digital health across physician practices.


      140 Character Summary:
      The 2018 Canadian Physician Survey maps use of EMRs in primary care and specialist practices. Advanced use is correlated with higher efficiency and satisfaction.

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      RF03.02 - Deploying Ontario’s Largest Regional Patient Portal: Keys to Success

      02:40 - 02:50  |  Author(s): Mark Berry

      • Abstract

      Purpose/Objectives:
      This presentation offers an update to what was presented last year about the massive, first-of-its-kind patient portal deployment in south west Ontario ? an initiative led by the HITS eHealth Office at Hamilton Health Sciences, leveraging Sunnybrook Health Science Centre?s MyChart solution. MyChart was officially introduced to patients at select Hamilton Health Sciences and London Health Sciences clinics in the fall of 2018. A significant collaborative effort from project stakeholders preceded MyChart?s deployment, including the intricate data integration into MyChart from ClinicalConnect, a regional clinical viewer utilized by 40,000+ authorized providers practicing in south west Ontario. Panelists will each bring their own unique perspective on managing a complex, multi-stakeholder technology transformation project ? the largest regional deployment of a patient portal platform in Ontario ? sharing lessons learned, challenges, and opportunities.


      Methodology/Approach:
      Part 1 of this project was to complete technical work to allow reports from hospitals and regional cancer programs, and LHINs? Home & Community Care Services, to flow through ClinicalConnect to MyChart. Part 2, actively underway at the time of abstract writing, is to deploy MyChart to patients registered at the hospitals whose data now also viewable in MyChart. mychart graphic.png


      Finding/Results:
      A deployment of this magnitude presented challenges that could be categorized as cultural, technical, clinical and legal. Some key findings from each: Cultural - Gain regional-buy in through a shared vision and inclusion of stakeholders from LHINS, hospitals, and MOH in project decision making - Educate organizations and health professionals regarding the evidence of benefits noted from Canadian and international patient portal deployments Technical - Determine limitations of systems to understand confines of what was possible - Educate stakeholders about limitations to ensure expectations managed - Co-design technical architecture with solution vendors (Aptean and Sunnybrook) - Usability review and testing Clinical - Comprehensive stakeholder consultation, including: - Patients and families - Clinicians - Pan-Canadian industry review - Health records policies and procedures - Legislative reviews (PHIPA) Legal - Develop a collaborative agreement framework, outlining roles and responsibilities Note: An overview of number of registered MyChart users/usage stats to date will be presented and will be current up to the conference.


      Conclusion/Implications/Recommendations:
      This project compiled patient information from acute sites and worked 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. The result has been an effective integration of a vast amount of personal health information from hospitals across south west Ontario, in addition to giving patients data access they may have at other existing partner sites (i.e. MyChart?s non-SWO data contributors).


      140 Character Summary:
      Integration of south west Ontario hospitals? personal health information, via ClinicalConnect, with Sunnybrook?s MyChart for patients and their caregivers.

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      RF03.03 - In Pursuit of Patient Empowerment: Collaborative Advances in Measurement Design

      02:50 - 03:00  |  Author(s): Tracie Risling

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: Patient empowerment has emerged as a crucial element in the ongoing evolution of healthcare delivery. Connections have been established between patient empowerment and improved engagement in care, commitment to healthy behaviours, and more active participation in shared decision-making. Research supports patient empowerment as a means to improve outcomes and lower healthcare costs. The challenge in advancing empowerment interventions however, is a lack of clarity regarding how best to capture the concept in a comprehensive and scientifically sound measure. The purpose of this research is to collaborate with patients to address this urgent measurement need in empowerment research. This presentation includes results from the first year and phase of this research where Q methodology was employed to engage participants in identifying priority aspects of patient empowerment for inclusion in a newly designed measure.


      Methodology/Approach:
      Methodology: This study is being conducted in three phases, each with a distinct methodological focus. In the first phase, Q methodology was used to support patients in sharing their views of empowerment as well as prioritizing key characteristics of the concept for operationalization. Q methodology unites the strengths of qualitative and quantitative research to capture personally held subjective views often expressed by attitudes, appraisals, or through reflections on life experiences. In this approach, participants form a P set, and rank order statements contained in a Q set that is then subjected to factor analysis. The Q set for this project was drawn from past pilot work on patient empowerment, led by members of this study team, with patients who had been given access to their electronic health record (EHR,) and through an extensive review of the literature on empowerment, engagement, and activation.


      Finding/Results:
      Results: More than 100 patients completed the Q-sort exercise representing a broad range of ages, reported health status, and a self-identified technology adoption using Rogers? Diffusion of Innovation Theory. In addition to completing the Q-sort exercise, participants provided a 5-minute digital download interview where they spoke to choices made during the sort. This interview data was coded and themed using a qualitative approach. The Q-sort data was processed with software specifically designed for the method, producing factor analysis results which were then used to identify essential elements for a new patient empowerment measure.


      Conclusion/Implications/Recommendations:
      Recommendations and Conclusions: Patient empowerment is a key aspect of the trifecta of patient empowerment, engagement, and activation, and yet there are significant deficiencies in existing measurement for this concept in particular. This first phase of this research has revealed patient selected essentials for measuring patient empowerment within the digital health context. These elements and the emerging measurement tool will be detailed in this presentation, along with qualitative commentary from patients themselves on the important role of empowerment and digital health in their daily lives.


      140 Character Summary:
      Patient voice was needed to correct deficiencies in empowerment measure and this presentation includes patient identified essentials in developing a new approach

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      RF03.04 - Uncovering the Mysteries of Electronic Medication Reconciliation

      03:00 - 03:10  |  Author(s): Kristie McDonald

      • Abstract

      Purpose/Objectives:
      Electronic medication reconciliation (eMedRec) is a complex process. For some, medication reconciliation is a new concept; for many, the first implementation of eMedRec within Island Health Authority?s Nanaimo Regional Hospital may have had unintended consequences on ordering practices, end user experiences, and the delivery of patient care.


      Methodology/Approach:
      An Island Health Authority interdisciplinary Think Tank was formed to closely examine eMedRec. Think Tank participants consisted of clinical informaticists, providers, pharmacists, pharmacy informaticists, medication safety and professional practice consultants, and educators. Workflow analysis and detailed testing were conducted over a series of four workshops. Simulating clinical and provider BPMH and reconciliation workflows, participants observed the flow of data and how it ?behaved? differently when using different synonym orders. As participants shared stories and knowledge, risks were tracked and analyzed, education and practice gaps were uncovered, and mitigation strategies unfolded. Through didactic conversation, open dialogue, and interprofessional discourse, knowledge from multiple perspectives was shared. This supported a deeper understanding of why the data behaved differently; some of the mystery and unknowns were uncovered.


      Finding/Results:
      Throughout the workshops, the Think Tank experienced data behaving in a seemingly mysterious or unpredictable fashion. Through a lens of curiosity and focused effort, members of the Think Tank identified three of the most challenging components to navigate: 1. Search struggles with result returns when searching for medication orders: 2. Conversion confusion regarding auto conversion and failure resolution: 3. Prescription paralysis related to difficulty with prescribing:


      Conclusion/Implications/Recommendations:
      Prior to the Think Tank sessions, understanding of synonyms and conversion logic was only understood by Pharmacy Informatics. It was through the common and vested interest of the Think Tank that several recommendations are underway. These include but are not limited to: -Conduct a third party vendor analysis of system parameters that might impact on auto conversion rates and ordering practices -Review Think Tank recommendations with Executive Steering to determine which will be actioned -Develop a plan for implementation of Think Tank recommendations -Host change management events -Provide education to fill current state gaps -Establish a governance structure that will clearly outline roles, responsibility, monitoring, and accountability -Implement and support front line users with changes -Create a permanent Working Group to continue to enhance eMedRec process -Build provincial networks to share ideas related to eMedRec While eMedRec continues to be a complex process within the CIS, it is vital to remain curious and unrelenting in uncovering remaining challenges. A Think Tank or small working group can provide further insight through interprofessional discussion and discourse, testing of system enhancements, and providing end users with the ability to provide ongoing feedback. Patients? care remains at the heart of why healthcare exists; unsolved challenges of eMedRec should not result in a discharge medication list that is a ?mystery? to providers or patients. Patients deserve to have a clear understanding of which medications they should be taking following discharge in order to stay safe.


      140 Character Summary:
      A Think Tank seeks to understand why end users experience challenges documenting home medications, managing conversion failures, and writing prescriptions.

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      RF03.05 - SmartMom: Delivering Prenatal Education Through Text Messages in British Columbia

      03:10 - 03:20  |  Author(s): Pooja Patel

      • Abstract

      Purpose/Objectives:
      Only one third of women attend childbirth education classes in Canada. Women living in rural and remote areas of British Columbia (BC) cannot always access in-person education in their community. Pregnant women increasingly use the Internet and mobile apps for pregnancy and childbirth information, and we are cognizant that these are often developed by lay groups or for-profit organizations, which can be unreliable. SmartMom is Canada?s first evidence-based prenatal education program delivered by text messaging. SmartMom provides women with accurate, timely and relevant information based on their stage of pregnancy and directs them to local resources, all reacted by a group of researchers, clinicians, and allied health professionals. The program is endorsed by the Society of Obstetricians and Gynaecologists of Canada, BC Ministry of Health, and Optimal Birth BC. The main goal of SmartMom is to improve health literacy and motivate health behaviour change among pregnant women. Currently, it is implemented in the Northern (NHA) and Fraser (FHA) Health Authorities in British Columbia.


      Methodology/Approach:
      Women who are pregnant, have access to Short Message Service (SMS) communication, and understand English can enrol in SmartMom. Pregnant women can enrol in SmartMom at any time during the pregnancy and can opt out at any point as well. They are invited, and asked for consent, to provide demographic information, complete a knowledge quiz and standard surveys about fear of childbirth and depression. An interim descriptive statistics analysis was conducted.


      Finding/Results:
      As of August 9, 2018, 48 women living in the FHA and 210 women living in the NHA were enrolled in SmartMom, totalling to 258 women completing the enrollment surveys. In both groups, most women owned smartphones (FHA=100%; NHA=97.6%) and the average age of participants was twenty. Knowledge gaps were demonstrated through questions most often answered incorrectly, which included healthy weight gain during pregnancy (% incorrect: FHA=71.1; NHA=80.7) and the safety of caesarean section vs. vaginal birth for both mothers and babies (% incorrect: FHA=55.6%; NHA=54.4%). Participants? fear of childbirth, on a scale with a maximum of 66, averaged 34. Valuable information has been obtained highlighting knowledge gaps about childbirth and pregnancy and general confidence in labour and childbirth.


      Conclusion/Implications/Recommendations:
      Using innovative and patient-tailored approaches, the SmartMom program can address the knowledge gaps and childbirth fear identified in our analyses. SmartMom delivers reliable prenatal education in a format that meets the needs of pregnant women in British Columbia and beyond, especially for those living in rural and remote communities. Equitable prenatal education access remains an issue in Canada, and creative technology facilitates greater access and increased knowledge. Expansion and scaling-up of SmartMom is currently ongoing to other British Columbia health authorities and the Northwest Territories and is met with positive feedback from patients. Supported by clinicians with evidence-based roots, pragmatic and simple harnessing of technology can fill gaps and meet patient needs for prenatal education for pregnant women using SmartMom.


      140 Character Summary:
      British Columbian women are using SmartMom, Canada?s first evidence-based prenatal education program delivered by text messaging.

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    Plenary Panel

    • Type: Keynote Session
    • Track:
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      Artificial Intelligence in Today’s Health System

      04:00 - 05:30  |  Author(s): Trevor Jamieson, Marc Lamoureux, Alexandra Greenhill

      • Abstract

      Purpose/Objectives:
      Artificial intelligence (AI) has become the buzzword bingo term in healthcare today. Everywhere from health care conferences to organizational strategic plans tout the benefits of AI for addressing health outcomes, efficiencies, and cost barriers we face today in health systems. Exciting as it may be, how do we square this with the current state of health care in Canada? Do we have the quality and quantity of data required to optimize clinical care? Can we implement these tools into existing systems? What are some instances of AI being used today in Canada and what impact is it having? And importantly, where do our policy and regulatory frameworks stand in terms of readiness for AI tools in medical practice. Today?s panel hopes to spark a conversation about what?s required to make the most of AI, and be realistic about the practical approaches we need to take to implement these tools.

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    HS01 - Digital Health Canada Host Session

    • Type: Panel Session
    • Track:
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      HS01.01 - Patient Empowerment in eHealth

      08:30 - 10:00  |  Author(s): Shannon Malovec, Anne O'Riordan, Justin Noble

      • Abstract

      Purpose/Objectives:
      A Panel Discussion on Patients, Families, and Caregivers as Authentic Partners in eHealth Care, Delivery, and Design