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Rita Wilson



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    OS01 - Implementation: Futuristic Thinking (ID 3)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 2
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 201CD
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      OS01.02 - Successful Digital Health Systems: Guidelines for Healthcare Leaders and Clinicians (ID 215)

      Rita Wilson, RNAO, RNAO; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Health Canada describes eHealth as the utilization of information and communications technologies to support a variety of functions ranging from administration to health services delivery. There is general consensus that, when properly deployed and adopted, eHealth can increase efficiency, enhance patient safety and optimize health outcomes. However, the implementation of a digital health system is a large and complex undertaking with failure rates as high as seventy percent. Factors at the macro, meso and micro levels have been identified as contributors to these failed implementations. For these reasons, successful implementations require strong leadership at all levels as well as individuals (i.e. management and staff) with the appropriate informatics knowledge, skills and abilities to lead and support the initiative. There is a scarcity of evidence-based resources to adequately prepare individuals involved in the implementation of digital health systems to realize the intended benefits for patients, staff, healthcare organizations and the broader healthcare system. The recent development and publication of an evidence-based Guideline intended to enhance the informatics capacity of healthcare executives and clinicians is therefore timely. This presentation highlights the Guideline development process and provides an overview of the recommendations it contains.

      Methodology/Approach: An international panel of experts was convened in January 2016 to collaboratively develop the Guideline. The panel members included healthcare executives, nurses and other healthcare providers from a range of settings including practice, education, research and policy. There were also two patient partners on the panel. All panel members with the exception of the patient partners had previous experience with digital health system implementations. A systematic review of the grey and peer-reviewed literature from 2006 to 2016 was conducted to identify relevant articles and other resources that met the search criteria. A total of 178 peer-reviewed articles and 56 grey literature resources were deemed relevant. Draft recommendations were formulated from these sources of evidence. A Modified Delphi technique was used to achieve panel consensus on the final 26 recommendations published in the Guideline.

      Finding/Results: The expert panel identified individual, organization, education and system recommendations that address known micro, meso and macro level barriers to successful digital health system implementations. The individual and organizational recommendations focus on micro and meso level factors that contribute to the implementation, adoption and optimal utilization of high quality digital health systems that realize the intended return on the investment. The education recommendations focus on the eHealth education infrastructure required to facilitate the acquisition of micro, meso and macro levels informatics competencies by healthcare executives and clinicians. And, the system recommendations address the structure, process and policy requirements at the macro level to realize the long-term goals of nation-wide electronic health information exchange and health systems transformation.

      Conclusion/Implication/Recommendations: This Guideline will be an invaluable resource for healthcare executive and clinical leaders, nurses and other healthcare professionals, health information technology personnel, patients and families as well as policy makers at the organization and system levels. By adopting the recommendations provided in this Guideline, individuals, organizations and health system administrators will pave the way for successful health system transformation.

      140 Character Summary: This presentation highlights a recently published evidence-based Guideline that enhances the informatics capacity of healthcare executives and clinicians.

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      OS01.06 - Multi-Sector Implementation of Evidence-Based Wound Care Order Sets: Lessons Learned (ID 218)

      Rita Wilson, RNAO, RNAO; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: With a price tag of approximately four billion dollars annually, wound care is a significant financial burden to the Canadian healthcare system. This panel presentation will showcase a multi-sector wound care management strategy that targeted individuals with pressure injuries (PI) and diabetes-related foot ulcers (DFU) to optimize wound healing using evidence-based order sets. Panel members will each describe their implementation approach and lessons learned during the process. They will also discuss the net benefits derived from the project as these relate to patient safety, provider and patient/caregiver adoption, health outcomes and efficiency.

      Methodology/Approach: Six nurse peer leaders (NPLs) were established in four healthcare organizations across the care continuum (i.e. ambulatory care, acute care, home care and long-term care). The NPLs received training that enabled them to provide technical expertise, leadership and mentorship to support the integration of evidence-based wound care order sets within their organization’s health information system. Two healthcare organizations in the acute care and long-term care sectors implemented interprofessional order sets that were used to guide the care of patients/clients/residents with PI and to reduce their risk of developing additional PIs. Healthcare providers in the remaining two organizations used wound care order sets in ambulatory and home care settings for the assessment and management of DFUs. Each organization also implemented a self-management order set to actively engage patients/clients/residents or families in their care. A comprehensive benefits evaluation framework was used to design the evaluation strategy. Clinical analytics enabled each organization to monitor specific structural, process and outcome indicators.

      Finding/Results: Approximately 1,000 healthcare providers integrated the evidence-based order sets into their practice. The order sets facilitated knowledge translation and evidence-based decision-making at the point-of-care resulting in reduced variation in wound care management at each site. There was increased patient safety resulting from patients and residents with PI or their families conducting an initial assessment of their risk for additional PIs using a web-based tool developed for the project and keeping a PI prevention diary in which they recorded their self-management activities on a daily basis. Patients with DFUs assessed their knowledge of diabetes and foot care and used a wound care App or web-based resource and electronic goal calendar to identify SMART goals that they wished to achieve, in collaboration with their healthcare provider. Overall, the order sets improved efficiency in wound care management and patient engagement.

      Conclusion/Implications/Recommendations: This multi-sector nurse peer leader project has demonstrated the value of implementing evidence-based wound care order sets across the continuum of care. These order sets support the interprofessional care team model used in this project but they may also be integrated into other service delivery models such as the nurse-led models in the primary care sector. They facilitate knowledge translation and evidence-based decision-making at the point-of-care, resulting in safe, high quality wound care and optimal health outcomes.

      140 Character Summary: This presentation describes the implementation of evidence-based wound care order sets in multiple sectors: acute care, home care, ambulatory care and LTC.

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    OS30 - Novel Education Models (ID 35)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical
    • Presentations: 1
    • Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 205B
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      OS30.05 - Peer Network Collaborative Learning Enhances Health Information System Quality (ID 217)

      Rita Wilson, RNAO, RNAO; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Many healthcare organizations struggle to implement health information systems (HIS) with limited informatics knowledge and skills. Considering that approximately seventy percent of these implementations fail, it is important to explore innovative models that can be used to build organizational informatics capacity and increase the likelihood of success. Collaborative learning is one such model that is increasingly being recognized as an important contributing factor to successful HIS implementations. This presentation describes a collaborative peer network that was established to build organizational informatics capacity to facilitate the integration of advanced clinical e-Functions within four different HIS: Meditech, Procura, EPIC and PointClickCare.

      Methodology/Approach: Four organizations participated in the initiative. The collaborative peer network, which was part of a broader pan-Canadian peer-to-peer program, consisted of six nurse peer leaders (NPLs) employed within the organizations. They each received formal in-person education and training to lead and support the initiative within their organizations. The education was provided by the project sponsor and two health informatics consultants contracted for the project. The in-person sessions were supplemented by a virtual community of practice and weekly virtual meetings that afforded the NPLs multiple opportunities to acquire new knowledge, share best practices and additional resources to meet the project deliverables. At various points of the project the peer network brought together healthcare leaders, nurses, other healthcare providers, health information technology personnel and decision support staff from the four organizations to enhance their informatics knowledge, skills and abilities to effectively lead and support the integration of the advanced clinical e-Functions within their respective HIS. Three components comprised the advanced clinical e-Functions: (1) evidence-based order sets built as decision support resources; (2) standardized terminology language used to capture and retrieve clinical data for technology-enabled outcome evaluation; and (3) e-Clinical analytics to monitor structure, process and outcome indicators and evaluate the impact of using the order sets on health outcomes.

      Finding/Results: The NPLs participated collaboratively as a learning community throughout the project enabling them to share resources, knowledge and experiences with each other and with their peers within their own organizations. The NPLs also obtained help and guidance from each other to develop their project plans and the methodology used to integrate the order sets and the standardized terminology language within their HIS. Using this approach also helped them to identify solutions to potential barriers; thereby, mitigating possible risks to their implementation. All participating healthcare organizations met their implementation deadlines and achieved successful end-user adoption.

      Conclusion/Implication/Recommendations: The peer network highlighted the benefits of collaborative learning within the context of eHealth and demonstrated its potential to increase the success rate of HIS implementations. It provided opportunities to enhance the informatics knowledge, skills and abilities of clinicians and healthcare leaders and facilitated the sharing of best practices among participating organizations to optimize their adoption of advanced clinical e-Functions. Collaborative learning may be an ideal approach for organizations participating in a multi-site HIS implementation. It may also prove to be an invaluable strategy for smaller health care facilities in primary care settings and rural areas with limited resources.

      140 Character Summary: This presentation will report on a collaborative approach used by four healthcare organizations to optimize their health information system.

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