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Chris Hobson



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    OS25 - You've Got Mail, But No Paper! (ID 40)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
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      OS25.04 - HIE Adoption Lessons from International Healthcare Systems (ID 46)

      Chris Hobson, Orion Health; Toronto/CA

      • Abstract
      • Slides

      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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    PS04 - Breaking the Silos: It's Not All About Technology! (ID 23)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical Delivery
    • Presentations: 1
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 4
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      PS04.02 - Implementing an e-Safety Program (ID 440)

      Chris Hobson, Orion Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2013, Digital Health Canada conducted extensive research across Canada and around the world, in collaboration with a host of subject matter experts, to develop the e-Safety Guidelines. Input from eight leading healthcare organizations? trial use of the resource was used to document and maximize its relevancy and usefulness in real-life situations. e-Safety, in the guidelines, is classified into 8 principles 1. Accountability 2. Safety and Culture 3. Quality Management 4. Human Factors 5. Security Safeguards 6. Risk Management 7. Effectiveness Response 8. Reporting This panel will discuss the application of these guidelines and risk management techniques to reduce the probability and severity of key risks materializing in clinical practice. Additionally we will review insights from a survey and interviews of key stakeholders from across Canada


      Methodology/Approach:
      To identify gaps in the implementation and success of the e-Safety Guidelines, an initial survey of health care practitioners across Canada was conducted. Every effort was made to reach Digital Health Canada members from all jurisdictions, however the responses were relatively limited in number. In order to further explore the results, and provide additional understanding of the gaps, individual interviews with key stakeholders occurred. Key stakeholders include Canadian Patient Safety Institute, Canadian Medical Protection Association, Several major jurisdictional and hospital e- safety representatives


      Finding/Results:
      From the initial survey, it was identified that: 40% of the responders stated that their organization had no e safety program at all and no obvious plans to introduce one Of those who did have a program almost all were at an early stage of the COACH Maturity model (2013.) Only one facility had a structured program The major barrier to advancing e safety was listed as inadequate resources 1. 40% said they did not have a person in their organization who was accountable for e safety 2. 40% said they did not have a formal mechanism for staff to report any adverse events or near misses During the interview cycle, the following key risks were identified: 1. Technology does not eliminate and, in fact, can increase existing process and communication issues. 2. Identifying critical information, such as planned procedures, allergies and medications can be difficult. 3. Technology can create alert fatigue for clinicians


      Conclusion/Implications/Recommendations:
      It was identified in the interviews that implementing an e-Safety system and working to follow the e-Safety guidelines can significantly reduce the risk associated with technology implementations. The panel will discuss best practice for the implementation of an e-Safety Program. This will include discussion around: 1. Implementation and process improvement 2. Identification and remediation of technology risk 3. Incident and near miss reporting standards and management systems 4. Clinical and data governance best practices


      140 Character Summary:
      This session will discuss the benefits, implementation and risk management associated with implementing an e-Safety Program drawn from pan Canadian observations

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    RF05 - Technology Empowerment; Near and Far! (ID 48)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Technical/Interoperability
    • Presentations: 1
    • Coordinates: 5/29/2019, 08:30 AM - 10:00 AM, Room 201 B
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      RF05.06 - Supporting Clinical Interfaces Using Natural Language Processing and Machine Learning (ID 189)

      Chris Hobson, Orion Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      This research involved development of software tools, prototypes and user interfaces for improving access and understanding of unstructured healthcare data that today does not support effective information seeking by clinicians. At least 60% of the content in most clinical records consists of free text, and is either unstructured or very lightly structured, typically in non?standard templates. In most electronic clinical records, documents are manually filtered and displayed using basic document metadata such as date, category, service author, encounter, to categorize the data in the user interface. While this is helpful, metadata does not reveal much about the actual content and therefore clinical value of the document. Long documents such as initial clinical assessments and discharge letters are good targets for searching manually yet can be the hardest to properly evaluate in acute clinical settings with tight time frames. From a clinician perspective, one of the biggest challenges is knowing whether reading through a long document will reveal the information being sort, or will be a waste of precious clinician time. Natural Language Processing (NLP) techniques have been shown to support automated analysis of clinical documentation and data retrieved can be used for instance in clinical quality measure reporting. However little is known regarding techniques for using NLP derived data to assist clinicians in the process of clinical care delivery.


      Methodology/Approach:
      In 2016, the New Zealand government seeded a collaborative research based effort to advance precision health with more than $30m in initial funding. A wide range of projects were undertaken by a collaborative of organizations from healthcare, technology and academia. As one of several projects within the precision medicine initiative, Clinical Document Semantic Search was established to use NLP techniques to retrieve relevant information in a user friendly format from an EHR. Our approach utilized two streams of work in parallel: 1. Design sprints which adopted design thinking methodologies and co-design workshops with Clinicians, Product Management, Developers, User Experience and Data scientists. This ongoing iterative design process steadily refined the prototype in support of clinical time savings which will be demonstrated. 2. Evaluation of NLP and SNOMED CT tagging tools by clinical subject matter experts to compare the precision, accuracy and specificity with the ML derived outputs. Software tools for machine learning included a mix of open source software, self-built software and commercial products.


      Finding/Results:
      This project provided clinicians with tools to search for information and navigate effectively across clinical documents that include structured and unstructured text about a patient, using the latest machine learning techniques and Snomed terminologies. The prototype was able to sit easily within the existing overarching electronic patient record, and enabled clinicians with a summary of the patient?s overall clinical status as well as a timeline view of events and diagnoses.


      Conclusion/Implications/Recommendations:
      Enhanced information retrieval will produce tangible advancements in health outcomes through improvements in workflow and efficiency. This project sets foundations for other beneficial applications including machine learning techniques for precision medicine and enhanced decision support tools.


      140 Character Summary:
      The presentation explores the journey, approach, lessons learned and a discussion of the prototype solution to support clinical users navigating patient records.

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