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Karim Keshavjee



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  • EP05 - Innovative Technologies Today! (ID 45)

    • Event: e-Health 2017 Virtual Meeting
    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 1
    • EP05.02 - Re-Architecting Interoperability (ID 239)

      Karim Keshavjee, InfoClin; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: A web-based form could potentially solve several issues that currently plague electronic medical record forms: 1) Forms cannot be updated each time a new discovery is published in the literature; 2) Version control is almost impossible with current forms; 3) Every physician has to update their own forms each time an update is required; 4) Data is not easily captured for analysis and reporting; 5) Clinical decision support cannot be provided within the form, decreasing the impact of decision support; 6) A/B testing, the most powerful tool available to web designers, is not available to EMR vendors, researchers and clinicians. We sought to design an architecture that will allow web-based forms to integrate into multiple EMRs, be used seamlessly by health care providers and that will allow data captured on the web to be returned to the EMR for medico-legal purposes.

      Methodology/Approach: We used a user-centered design process to identify user needs. We then engaged in joint design sessions where mockups of the form were modified iteratively and in real-time to address user feedback. Once the mock-up was finalized, we developed a prototype of the form for further evaluation. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, a well-accepted and validated questionnaire, to assess user acceptance of the form and behavioral intent to use the form.

      Finding/Results: Users (N=12) responded to questions on a 5-point scale. We aggregated the scores by calculating the % of respondents who Strongly Agreed, Agreed or Somewhat Agreed. If the % was greater than 66%, it was colored green. If greater than 33% and less than 66%, it was colored orange. If the % was less than 33, it was colored red. See Table 1. table for utaut evaluation.png Overall, the form was considered easy to use (Effort Expectancy) and useful for completing clinical work (Performance Expectancy). More marketing and supports could enhance Social Influence and Facilitating Conditions for use of the form.

      Conclusion/Implication/Recommendations: Creating and integrating a web-based form into multiple EMRs is feasible and can be created in a way that clinicians find interesting and useful. This new tool could support capture of standardized data across multiple EMRs, allow for the return of clinical decision support to the point of care and be easily updated when new knowledge is published in the literature. The form could also be used for advanced A/B testing for forms improvement and for improving the quality of clinical decision support.

      140 Character Summary: New web-based form revolutionizes application of evidence-based medicine to electronic medical records. Time to re-evaluate our current approach to EMRs.

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  • OS26 - Creating Effective Health Care Platforms for the Future (ID 31)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 202AB
    • OS26.02 - Evaluating Canada's Innovation Agenda: Will It Meet Expectations? (ID 149)

      Karim Keshavjee, InfoClin; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Canada’s health landscape is undergoing far-reaching and fundamental changes: an increasingly engaged and aging population with more complex and chronic health needs is demanding ever-greater choice, access, and integration in the provision of healthcare and related services. Innovation policies developed in the past 2-3 years to advance value-based procurement, consumer-driven innovation and enhanced use of technology do not lack vision and ambition. The question is ‘can they deliver’? We developed and used a comprehensive policy evaluation framework to assess the strength of recent healthcare innovation agendas in Canada. We assess and report on the Federal, Ontario and Alberta health innovation programs.

      Methodology/Approach: We developed a policy evaluation framework that assesses the ability to execute on a sophisticated and nuanced program of innovation across different settings, disease areas, patient types and funding mechanisms. We identified the following categories of best practices in program design and execution: (1) governance, (2) health system coalitions, (3) implementation approach, (4) fostering innovation, and (5) independent program evaluation. For each category, we identified 4-6 best practices that are likely to lead to excellence in execution of health innovation programs. <img alt="health innovation analysis framework.png" annotation="" id="image://27" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=0352e3d94c02fff4ad1034734a0c6f5f7ba6dbb0&id=27&width=350&height=350&download=0" title="health innovation analysis framework.png" /> The four authors assessed each program independently. One point was given if the program exhibited the best practice; half a point was given if the best practice was implemented partially. If the program did not exhibit a particular best practice, it was given a score of zero. A final overall score for each policy was achieved through consensus across all four evaluators. A program could achieve a maximum of 22 points.

      Finding/Results: All Innovation Programs received poor overall scores (Federal = 8; Ontario = 7.5; Alberta = 11.5). Significant gaps in best practices in encouragement of innovation, innovation implementation and rigorous and independent evaluation were seen across all three policies. The Federal and Ontario programs also exhibited weakness in the area of encouraging multi-organizational and multi-jurisdictional coalitions to solve problems of fragmentation and cost-optimization.

      Conclusion/Implication/Recommendations: This preliminary analysis shows significant room for improvement across all three Innovation programs in elements of implementation planning, fostering innovation and program evaluation. In particular, greater emphasis must be placed on stakeholder engagement, providing R&D incentives, budgetary analysis, commercialization potential and transparency to promote successful healthcare delivery transformation through disruption and innovation.

      140 Character Summary: Feds and Provinces get failing mark for #HealthInnovation Agenda. Lack of Best Practices creates lost opportunities. More could be done.

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