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Karim Keshavjee



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    EP06 - Data and System Governance (ID 28)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Executive
    • Presentations: 1
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 9
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      EP06.04 - A Canadian Digital Health Policy & Practices Observatory (ID 327)

      Karim Keshavjee, InfoClin Analytics; Toronto/CA

      • Abstract

      Purpose/Objectives:
      The healthcare system in Canada continues to evolve rapidly. Investments made over the last 30-40 years have paid off: Canadians are living longer and with fewer disabilities. However, Canadians are now living with more chronic diseases than ever before, putting greater pressure on the system and placing more responsibility on them for the management of their own health. As Canada moves into a brave new world, it requires new policies, perspectives and practices that will enable it to embrace change and thrive in a rapidly changing healthcare world. The new policies and practices need to consider the complex interactions that are necessitated by a more complex stakeholder environment. The new policies and practices need to be coordinated to ensure synergies between players and ensure that all benefit from the investments and efforts put into the system. We propose to institute an academic-led policy observatory to provide an independent and objective assessment of how well Canada and its political processes are moving toward achieving important pillars and practices for the digitization of the healthcare system.


      Methodology/Approach:
      We conducted a stakeholder analysis to identify key stakeholders in the health information technology arena. We identified the key needs of each stakeholder using business analysis methods. We obtained feedback through key informant interviews and email review of a first draft of the proposal for a digital health policy and practices observatory (N=7). Ongoing feedback and discussion allowed for iterative improvements and progress with this initiative.


      Finding/Results:
      As Canada moves forward, it faces the following issues: 1) difficulty in coordinating the efforts and incentives for multiple stakeholders to move in tandem, 2) patients who lack the ability and resources to participate meaningfully in system change, 3) innovation policies that generate world-class innovations that do not reach the market, 4) an inability to kick-start interoperability projects that can catalyze system transformation, 5) an inability to procure early-stage innovative technologies at scale and 6) an inability to share data seamlessly across organizational silos for improved patient coordination and care, health system management and research. Canada needs the following practices and policies to enable system transformation: ? Multi-stakeholder governance structures
      ? Patient engagement and empowerment policies
      ? Federal and Provincial innovation policies that support dissemination of invented-in-Canada technologies
      ? An interoperability research agenda
      ? Technology and innovation procurement policies
      ? Policies for the governance of shared health information


      Conclusion/Implications/Recommendations:
      The Digital Health Policy and Practices Observatory will: ? Establish an observatory of digital health policy and practices in Canada;
      ? Develop credible, respected, transparent and easy to understand policy assessment tools;
      ? Conduct and report on assessments of policies and practices that can help us move the digital health agenda forward;
      ? Provide a credible, independent and unbiased source of high quality information about digital health progress in Canada;
      ? Influence the development of digital health policies and practices in Canada in a manner that is consistent with the best interests of society and the stakeholders who work to make healthcare a valuable cultural asset in Canada.


      140 Character Summary:
      Digital health policy observatory provides report cards on Canada's policies for use of technology to improve patient care and outcomes.

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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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      OS25.02 - Rearchitecting Interoperabiiity (ID 226)

      Karim Keshavjee, InfoClin Analytics; Toronto/CA

      • Abstract
      • Slides

      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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    OS28 - Not Without the Patient (ID 49)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
    • Coordinates: 5/29/2019, 10:30 AM - 12:00 PM, Room 200 A
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      OS28.03 - Electronic Medical Records- The Next Generation (ID 102)

      Karim Keshavjee, InfoClin Analytics; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Purpose: More people are living with chronic health conditions and multiple comorbidities into an older age leading to increasing medical complexity and continually rising health care costs. Electronic Medical Record (EMR) systems have great potential to improve public health, increase quality, efficiency and safety of care as well as health equity. However, current EMR systems are all text-based and require physicians to parse large amounts of text. We are designing a next generation EMR that provides high quality visualizations to assist health care providers to gain deeper insights about patients faster and easier.


      Methodology/Approach:
      Methodology: We used the British Design Council?s Double Diamond method to design interactive visualization of patients' clinical and medication utilization data. These visualizations have been tested with a variety of physicians to get their feedback.


      Finding/Results:
      Findings/Results: A visualization of past history with timeline was well-accepted by clinicians. The timeline enables physicians to quickly gain a sense of how often a patient has come to visit the doctor ?replacing a familiar ?thick chart is a sick patient? concept to the electronic chart. The 2-dimensional body image views provide clinicians with a quick history of patient diseases, their severity and recency. The visualization of ?future? medical history (i.e., predictive analytics) was also well-received, although there are many questions about how genomics will fit into the picture. The medication visualization allows clinicians to see current medications and reasons for prescribing, prior medications that were stopped and medication allergies. If given a new diagnosis, the medication visualization provides recommendations for new medications that will not interact with existing medications.


      Conclusion/Implications/Recommendations:
      Conclusions/Recommendations: We have developed several new visualizations of data in the EMR. The new visualizations support rapid review of past history, medication history, ?future? history (predictive analytics), patient engagement and team-functioning. Furthermore, it addresses emerging requirements including genomics, artificial intelligence and personalized medicine.


      140 Character Summary:
      140 Character Summary: New visualization designs point to features that will be in the Next Generation of Electronic Medical Records.

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