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Amelia Hoyt

Moderator of

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    OS06 - Innovations to Process Non Digital Data (ID 24)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 5
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      OS06.01 - Using Natural Language Processing for Improving Coded Data (ID 269)

      Majid Sharafi, Scarborough and Rouge Hospitals; Scarborough/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Inpatient coding is a complex and tedious process that has not changed in the past thirty years. Health records departments are under constant pressure to meet tight timelines and compete for a shrinking pool of expert coders. Furthermore, the introduction of quality-based funding models increased the pressure on hospitals to improve quality of their data. Missed diagnoses are costly to hospitals. A possible solution is to leverage digital data: computational coding employs tools to ?read? clinical documents to recognize evidence and make recommendations on coding of diagnoses and procedures at a higher level of specificity. Scarborough and Rouge Hospital (SRH) embarked on a journey with 3M in 2017 to introduce Computer-Assisted Coding (CAC) to improve coding productivity and data quality. A prerequisite for CAC is availability and access to clinical documentation and other data feeds in electronic and computer readable form. Coders are trained to use the evidence and recommendations made by the computational tools to select appropriate codes. A year later, we conducted a study to understand the impact of this tool on data quality. The study?s objective was to measure the accuracy of the codes captured and whether using this tool influenced weighted cases.


      Methodology/Approach:
      The study was conducted jointly by SRH and 3M, as a before and after intervention comparison of the number of diagnoses and procedures coded by coder and their impact on weighted cases. Multi-variable regression analysis used to measure differences in weighted cases based on variables: diagnosis/procedure count and coder. Charts were randomly assigned to coders pre- and post-implementation; length of stay and weighted cases of charts coded were similar across coders, before and after CAC implementation.


      Finding/Results:
      Number of diagnoses coded post-CAC implementation was significantly higher, as was both, the Comorbidity Levels and Resource Intensity Levels of charts coded. More importantly, there was a statistically significant increase in Resource Intensity Weights (RIW) and Health Based Allocation Model Inpatient Grouper (HIG) weighted cases. Impact on inpatient data (excl. Newborns, Pediatrics and Obstetrics) 6 months post-CAC implementation within 2017/18 FY # of Diagnoses Coded 7% Increase Comorbidity Level 3% shift from Level 0 to Level 2 Resource Intensity Level 4% shift from Level 1 to Level 2 Average RIW 2% Increase (up to 9% for one coder) Average HIG Weighted Case 5% Increase (up to 13% for one coder)


      Conclusion/Implications/Recommendations:
      Results showed clear increase in weighted cases through use of CAC; increase was significant from hospital funding perspective. We anticipate further improvements in coding efficiency; the limiting factor is quality of underlying documentation. The next phase of our journey is to embark on a clinical documentation improvement (CDI) initiative to bring these tools closer to physicians and provide evidence based and data driven tools to improve accuracy and completeness of documentation. Another exciting opportunity in our CAC roadmap is the benefit from advances in natural language processing (NLP) and artificial intelligence (AI) that are incorporated in CAC.


      140 Character Summary:
      Scarborough and Rouge Hospital implemented 3M?s Computer-Assisted Coding tool using NLP engine. Results shows increase in coding quality and weighted cases.

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      OS06.02 - Realizing Patient Movement through an application adapted to your EMR (ID 352)

      Jennifer Backler, Clinical Informatics, St. Joseph's Healthcare; Hamilton/CA
      Andriana Lukich, St. Joseph's Healthcare Hamilton; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The purpose of this presentation will be to share our journey with patient movement within an academic health care setting located in Hamilton, ON during an EMR implementation and share creative strategies that enabled providers and front line staff to navigate the transfer within a complex environment through the developmen of an "app" that could be navigated to within the EMR. The opportunity for attendees to see the application and also understand the complexities of patient movement from the provider and front-line staff perspective. The opportunitity for developers, to consider the neeeds working wtih acute care and between multiple facilities to achieve the necessary patient movement in order to ensure that the right care provisions are available at the point of care.


      Methodology/Approach:
      The SJHH had an implementation of "Big Bang" EMR with leading practices December 2, 2017. We were aware of the complexity of patient movement having detailed patient flow with a hanbook to assist staff and providers with successfully navigating through the EMR tool. We benefited from the work of another organization who went live before us. We mapped out every patient journey with the 80:20 principle to ensure that we did not get caught up on examples which occured infrequently. It was the learnings in the post-live environment that helped us to develop an application that would ease and support the transitions of the patient through a tool that was supportive to front line users and would give them the results needed to successfully move a patient. It was born though the collaborative work on interdisciplinary team including IT professionals, clinical managers and staff and Clinical Informatics.


      Finding/Results:
      The result of this methodology was an "app" that was accessible within the journey of the patient at the time the individual provider needed to complete a discharge or transfer for the patient. This could be during a very acute episode of care and needed to be timely and accurate. The tip sheets that had been developed at go-live were extremely beneficial but were lengthy for staff to acccess. This "app" was the direct result of staff listening to provider and staff feedback about what was required to make them successful. A demo of this application will be reviewed as part of the presentation.


      Conclusion/Implications/Recommendations:
      This application development has enabled us to consider how we merge our own abiliites and developers skills with the well developed documentation and the powerful application of EMR that we have adopted. We have had the opportunity to consider this type of app for many of our clinical parameters used within the EMR.


      140 Character Summary:
      This presentation is an opportunity for industry and health care practitioners to come together to see evidence of the importance of integration.

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      OS06.03 - Automated Patient Location Identification in Pediatric Emergency Departments (ID 307)

      Raza Abidi, Faculty of Computer Science, Dalhousie University; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Pain, dehydration and anxiety in children are common paediatric Emergency Department (ED) diagnoses but are not well managed. In particular, long ED wait times are well known to increase the anxiety of the patients. We aim to mitigate the anxiety of patients, as well as their families, by providing personalized and location-specific therapeutic and educational interventions while visiting a pediatric ED. Our focus lies on customizing the content with respect to the child?s current location in the ED as well as the current healthcare task, as they move through the stages of examination, investigation and treatment. Using interactive adventure-based scenarios, we aim to proactively collect data about the child?s condition, reduce the child?s anxiety, and lead them to give more meaningful responses about their condition.


      Methodology/Approach:
      In partnership with a Canadian children?s hospital, we extended a mobile, game-based, e-therapeutic and patient education app with personalized and location-aware features. This app leads children and parents through a series of screens asking questions about the individual, their condition and other related information. Based on their responses, the app invokes a variety of therapeutic protocols (e.g., self-administration of Pedialyte for vomiting) and educational videos. The platform is made accessible to children and their parents using an iPad, to mitigate their anxiety, fear and discomfort while waiting in the hospital ED. By leveraging the child?s current location, as well as detected wait and dwell times, the platform is able to dynamically customize the educational content. We designed an intelligent indoor localization method based on (Bluetooth Low Energy) beacon signals, which detect the relative proximity between the iPad and detected beacons as (immediate, near, far, unknown). Based on these proximities, we applied machine learning methods to create an indoor localization model, which can accurately classify the child?s location by correlating multiple beacon signals.


      Finding/Results:
      Our intelligent indoor localization methods have been implemented and validated in a children hospital ED, where 14 beacons where deployed. Data from 29 locations were collected to build indoor localization models (classifiers). Using a hierarchical clustering approach, our approach supports merging multiple locations into cohesive regions to balance localization accuracy with the fine-graininess of indoor localization. Our indoor localization approach was able to recognize the current location of a child with 79% accuracy on average.


      Conclusion/Implications/Recommendations:
      With the proliferation of smart sensors and devices, this innovative project provides numerous opportunities to deliver personalized and timely location-sensitive services to patients.


      140 Character Summary:
      Indoor localization to personalize a mobile e-therapeutic platform for mitigating anxiety, fear and discomfort in children while waiting in the ED waiting room.

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      OS06.04 - Dementia Talk App - Empowering Dementia Caregivers through Technology  (ID 264)

      Einat Danieli, 60 Murray St L1-012, Sinai Health System ; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Dementia Talk App: An award winning smartphone App designed to support dementia caregivers in tracking and managing challenging behaviours and in enhancing their communication with other care providers in the circle of care. Nearly 12% of Canadians are caregivers for a person with dementia. Up to 90% of people with dementia (PWD) experience significant behavioural and psychological symptoms (BPSD) that challenge and upset caregivers. Currently, there is no easy way for caregivers to manage and track behaviour-related symptoms in the care recipient, making it difficult to improve care and share information across the circle of care. OBJECTIVES: This presentation will discuss the development of a mobile application called the Dementia Talk App, designed to empower dementia caregivers to manage and track behaviours in the person with dementia as well as enhance communication among care providers. The presentation will showcase key features of the App and share highlights from beta testing results to demonstrate the importance of caregiver driven development process in creating meaningful and accessible digital solutions for clients and their caregivers.


      Methodology/Approach:
      This qualitative study involved 16 caregivers for PWD, recruited through the Reitman Centre Sinai Health System. Participants were asked to use the application for a period of 3 weeks, starting from the date that they received the link. Once the 3-week trial period is completed, a semi-structured phone interview was conducted to seek feedback from users in three main areas: 1. technology and usability 2. clarity of the content 3. The level of relevance of the App to caregivers? concerns in dealing with behaviour-related challenges. Their responses were summarized in written notes and analyzed and organized in main themes using the ?framework analysis? approach. Inclusion criteria: Age 18+; caregiver to a PWD; PWD presenting behavioural symptoms; Grade 3 literacy level; English speaking; ability to use one of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad. Exclusion criteria: Under 18 years of age; Not actively involved in caring for someone with dementia; PWD not demonstrating any behavioural symptoms; Less than Grade 3 literacy level; not English speaking; Unable to use any of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad


      Finding/Results:
      16 eligible caregivers were recruited to participate in the study, 1 participant dropped out for personal reasons. Complete data was obtained from 10/15 participants. All participants that were interviewed agreed that the content of the App was relevant to their concerns as caregivers, and most found the triggers and coping strategies to be very useful. This is a validation of the contents, as one of the most important aspects of the application for its success. Limitations: The 3-week trial period may not have been enough time to completely evaluate the usability of the app. Small sample size.


      Conclusion/Implications/Recommendations:
      Conclusions: Overall, the feedback received was overwhelmingly positive and there is great potential for the app as a meaningful tool for caregivers and other stakeholders in dementia care. Further evaluation needed to validate benefits of the application and long term impact with a larger sample size for a longer period of time.


      140 Character Summary:
      Dementia Talk App: An App designed to support dementia caregivers in tracking and managing care and enhancing communication with members of the circle of care.

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Author of

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    OS11 - The Value of Moving to Digital...Realizing the Benefits (ID 18)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 7
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      OS11.01 - Enterprise Management of Clinical Media and Images at Sick Kids (ID 473)

      Amelia Hoyt, Enterprise Applications, The Hospital for Sick Children; Toronto, ON/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The hospital was experiencing an explosive volume of digital images and other digital media generated in various clinics on multiple platforms, such as microscopes and specialized cameras. This resulted in workflow inefficiencies for clinicians within the departments that needed to view images from more than one system and made sharing images with other departments nearly impossible. Moreover, the hospital administration could not guarantee the legal integrity and security of patient data captured during clinical encounters, and stored on many stand-alone, unmanaged platforms. The potential proliferation of ad hoc use of Smartphone cameras to capture patient images further added to the legal risks.


      Methodology/Approach:
      The hospital had already achieved efficiencies by centralizing images for radiology in a Picture Archive and Communications System (PACS). Initially, the hospital assessed the possibility of extending the PACS technology to include digital media other than radiology images. Radiology, such as x-rays, MRI?s, and CT-scans, use a mature set of standards for Digital Imaging and Communications (DICOM). Further consideration revealed serious limitations with the PACS/DICOM approach. SK found that PACS systems are oriented towards an ?order based? workflow, whereas much of the new digital media is created in ?encounter based? work flow where the care-giver creates the image during an examination or procedure. The DICOM standard could not encapsulate new digital media in their native format resulting in loss of fidelity. The DICOM annotation standards were not easily extensible to other types of media. And, the PACS system were not easily integrated with either the digital media capture systems, or able to link historical and current images to patient electronic records. The pathology department was already part of the Multi-jurisdictional Telepathology Project that enabled sharing images not only inside the hospital, but between hospitals in multiple provinces. The information systems group contacted the technology provider to see if the same technology could be applied to other specialities. As a proof of concept, the hospital and vendor jointly developed a pilot project in dermatology. Dermatology served as an excellent test-bed, as the department acquires and compares images that are taken over time ? resulting in many pictures that must be managed and coordinated.


      Finding/Results:
      Based on the success in dermatology, the system was expanded to include over 40 clinical departments. Workflow considerations were found to be essential in delivering value to clinicians. Besides providing easy capture and access to images, processes were added included patient consent and physician review.


      Conclusion/Implications/Recommendations:
      The SK architecture has enabled rapid deployment of new services and functionality. For example, a secure web site was developed that enables police, physicians and social workers to upload photos in cases of suspected child abuse and share legal evidence securely. These and other future projects will be presented.


      140 Character Summary:
      A new image management solution at The Hospital for Sick Children is computerizing all types of clinical images and making them easily accessible to care-givers.

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