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Lynn Nagle

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    OS10 - Four Implementation Vignettes (ID 17)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 6
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      OS10.01 - e-Mental Health Demonstration Project: Implementing and evaluating Stepped Care 2.0© (ID 429)

      Danielle Impey, Knowledge Exchange Centre, Mental Health Commission of Canada; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2017, the Mental Health Commission of Canada (MHCC) launched an e-mental health (e-MH) demonstration project to improve access to mental health services in publicly funded health systems. The MHCC, the Government of Newfoundland and Labrador, and the core team at Memorial University of Newfoundland lead by Dr. Peter Cornish, are working closely together to implement and evaluate Stepped Care and e-mental health programming in 15 clinical sites across Newfoundland and Labrador. Stepped Care 2.0? is an evidence-based, rapid access system of delivering programs, including same day, flexible access to mental health resources, including face-to-face and e-MH components, while promoting client autonomy & resilience. Patients receive the least intensive treatment with the greatest likelihood of improvement. Care is stepped up or down depending on client need/preference and is continuously monitored. e-Mental Health refers to the use of the internet and other electronic communication technologies to deliver mental health information & care, and these services have been found to be an effective and complementary option. This rapid access approach aims to reduce wait times and to improve access. The objectives of the project are to: 1. Introduce innovative approaches and new technologies to mental health and addictions service delivery in the province (i.e. stepped care and e-mental health programming). 2. Reduce wait times for services. 3. Improve mental health outcomes.


      Methodology/Approach:
      Data for the evaluation component is collected from healthcare providers and site managers through training workshop and feedback surveys, usage data from pilot sites, outcome scales and interviews. Data is collected from clients via anonymous patient surveys developed by the evaluation team. A report will be produced amalgamating the feedback received during a quality improvement workshop on the project.


      Finding/Results:
      Preliminary results have shown a decrease or elimination of wait lists at some implementation sites. Feedback on the change management and training process by health care providers has been positive. We expect to show improved mental health outcomes through the introduction of stepped care and the e-mental health services offered. The final report will be released in spring 2019.


      Conclusion/Implications/Recommendations:
      The rapid access approach of the e-mental health demonstration project aims to reduce wait times and to improve access. Results from the project evaluation will inform opportunities to improve and scale-up Stepped Care 2.0? and similar mental health care approaches.


      140 Character Summary:
      The MHCC's e-mental health demonstration project seeks to improve access by implementing and evaluating Stepped Care and e-mental health rapid access approaches.

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      OS10.02 - Improving Care Transitions from Hospital to Home with Electronic Tool (ID 519)

      Terence Tang, Institute for Better Health and Program of Medicine, Trillium Health Partners; Mississauga/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Care transitions from hospital to home are vulnerable times for patients and caregivers as they sometimes cope with changing physical, cognitive, and functional status, assume increasing self-care responsibilities, and experience change in care plans. As a result, adverse events and unplanned Emergency Department (ED) visits and hospital re-admissions sometimes occur. Effective communication (both among the interprofessional team, and with patients/caregivers) is essential to ensure adequate discharge planning and support safe transitions. Our objective is to evaluate the impacts of an electronic communication tool used by clinicians and patients/caregivers on patient experience, ED visits/re-admissions, and care transitions.


      Methodology/Approach:
      We augment a previously built electronic interprofessional communication and collaboration platform used by hospital clinicians to coordinate care of complex hospitalized patients with new discharge planning and patient-facing components. We facilitate care transitions by adapting the Patient-Oriented Discharge Summary (PODS, developed at University Health Network Open Lab) into the discharge planning component, incorporating its electronic completion in clinical workflow via co-design with hospital clinicians, and making PODS electronically available to patients/caregivers after discharge. To evaluate the impact, we are conducting a mixed methods study on 4 general medicine wards. The quantitative component uses an intervention-control design where the intervention will be deployed on 2 wards (intervention arm) with the remaining 2 wards providing usual care (control arm). Outcomes will be measured on both intervention and control wards at 2 time points (baseline and 3 months after the intervention has been deployed in the intervention wards). The qualitative component consists of semi-structured interviews with clinicians and patients/caregivers exposed to the electronic tool to understand the perceived impacts, reasons for success and failure, and contextual factors affecting implementation.


      Finding/Results:
      Quantitative outcome measures include patient experience using 4 selected questions about communication from the Canadian Patient Experience Survey ? Inpatient Care (CPES-IC) and 1 question related to overall hospital experience, and care transition using the 3-item Care Transitions Measure (CTM-3). These outcomes will be obtained with post-discharge telephone surveys of patients. Outcome data of ED visit and re-admission within 30 days will be obtained using routinely collected administrative data. A chart review will be used to determine process measures relating to the completion of discharge documentation including PODS. A pre-defined subgroup analysis will be performed for patients with dementia to understand the effect on this complex high-need population. Semi-structured interviews with clinicians and patients/caregivers will explore the experiences more deeply and contextualize quantitative findings. We have so far completed baseline data collection and anticipate that preliminary analysis of full results will be available for the eHealth conference.


      Conclusion/Implications/Recommendations:
      As communication technology continues to advance and its adoption are increasing in the general population, the result of this study will inform if and how such technology may be leveraged to engage patients/caregivers to impact patient experience, care transitions, and outcomes.


      140 Character Summary:
      A mixed methods study assessing the impact of an electronic tool used by clinicians and patients/caregivers on patient experience, care transitions, and outcomes.

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      OS10.03 - Streamlining Electronic Emergency Department Order Sets Between CHEO and SickKids (ID 113)

      Daniel Rosenfield, Paediatric Emergency Medicine, SickKids Hospital; M5G1X8/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Tertiary paediatric care is delivered in only a few large centers in Ontario, and these centers often share patients. It is imperative that they maintain the most up to date and share similar standards when treating children, especially as they act as regional centers of excellence that often determine local practice patterns. One way to standardize care is to align order sets for commonly seen paediatric conditions. Order sets represent evidence-based treatment algorithms to promote standardization of practice amongst frontline providers. We describe the process used at Children?s Hospital of Eastern Ontario (CHEO) in Ottawa and the Hospital for Sick Children (SickKids) in Toronto capitalizing on a shared instance of our Electronic Health Record (EHR) to align Emergency Department (ED) order sets during implementation. This alignment has helped standardize care in the two largest paediatric EDs in the province. Additionally, through future expansion of the Kids Health Alliance (KHA), best implementation practices were shared between CHEO and SickKids for respective EHR rollouts.


      Methodology/Approach:
      As part of the larger KHA initiative, CHEO and SickKids are sharing one instance of Epic, the enterprise-wide EHR. As a result, there is a joint KHA Governance; however, each department is still responsible for building/maintaining its own content/order sets. Local ED subject matter experts (SMEs) reached out to one another to compare order sets, using the Epic go-live as a catalyst for collaboration. Order sets were compared in an iterative fashion, presented to local committees and integrated and modified accordingly to local preferences. The net result was an overall alignment of various order sets, as well as expansion of order sets at both institutions. This initial collaboration led to further understanding between institutions, resulting in further utility at go-live, when individuals from CHEO came to the SickKids ED to help local users navigate the system on go-live weekend.


      Finding/Results:
      Prior to collaboration, SickKids had 18 unique ED order set documents while CHEO had 37. Following review and internal consolidation of existing order sets, SickKids finalized 25 EHR-version ED order sets, including 8 order sets derived from CHEO original order sets. Similarly, CHEO developed 28 unique order sets and derived one of these from a SickKids order set. Many order sets were similar between institutions with only minor amendments introduced due to the collaboration.


      Conclusion/Implications/Recommendations:
      As large-scale EHRs and hospital alliances become more commonplace, collaboration between local divisions/department allow providers to implement local best practices and standardize care across multiple institutions. This can be achieved via the standardization of order sets, and further collaboration can be facilitated by having ?boots on the ground? from individuals from each institution help out at others during EMR implementation.


      140 Character Summary:
      Through the Kids Health Alliance and one shared EMR, several disparate ED order sets were aggregated and shared across CHEO and SickKids to promote best practices

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      OS10.04 - An Implementation Story: Public Health Digitization in Nova Scotia (ID 518)

      Latifa Mnyusiwalla, Gevity Consulting Inc. ; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Public health digitization is a silent stream in the eHealth landscape where acute care and primary care implementations dominate the conversation. Immunization registries and communicable disease management systems are key to modernizing public health practice, reporting and surveillance, and protecting and enabling a healthy population. This presentation aims to shed some light on public health system implementations in Canada, through telling the story of Nova Scotia?s journey in becoming one of the only provinces in Canada, and globally, to have a single, seamless system for the management of immunization, vaccine inventory, and communicable disease data.


      Methodology/Approach:
      In January 2017, Nova Scotia embarked on an ambitious project to configure and deploy the Inventory, Immunization and Communicable Disease/Outbreak modules of a comprehensive public health information system over a 23-month period. Each module is a distinct business area with different requirements, configuration, integration points, and users. A consulting firm partnered with the vendor of the system to serve as the implementation team. The large multi-disciplinary team to ensure that subject matter expertise for all components of the deployment was available. This included a team of business analysts, a public health subject matter expert, configuration experts, data migration and integration experts, report developers, a testing team, a change management lead, and a senior project manager. At time of abstract submission, the Inventory and Immunizations modules have been deployed, with the Communicable Disease module to follow at the end of 2018.


      Finding/Results:
      Some lessons learned that may be beneficial to other provinces/jurisdictions embarking on public health digitization projects: - Leveraging existing configuration from other provinces was not as beneficial initially thought. Though the goals of public health bodies across Canada are universal (e.g. health promotion, disease prevention etc.), how programs and services are delivered differs from province to province. - The intensity of the project scope, scale and timelines warranted a large multi-disciplinary project team to ensure that subject matter expertise for all components of the deployment was available. The cohesiveness and effective communication within the team, and between the team and the client was integral to successful deployments. - Engaging end users early in the implementation through the establishment of Working Groups that met weekly throughout the duration of the deployment, fostered ownership of the project and the configuration. Working Groups were key to driving decisions about business processes and configuration. Decision-fatigue, time-pressures to make decisions, and not being able to fully understand the implications of a decision surfaced as issues with this approach.


      Conclusion/Implications/Recommendations:
      Public health system implementation projects historically in Canada have been long and complex. Other jurisdictions have rolled out much less functionality over a longer period of time, so the Nova Scotia implementation was determined to be very aggressive with many potential points of failure. To date, this project is the fastest deployment of a provincial public health system in Canada. The project is on track within the original schedule. The project team and the province have risen to the challenge of delivering and experiencing three go-lives within an 18-month period.


      140 Character Summary:
      Nova Scotia?s journey in implementing a seamless information system for the management of immunization, vaccine inventory, and communicable disease data.

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    EP01 - Technology Innovation, Telehealth (ID 8)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Technical/Interoperability
    • Presentations: 1
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 9
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      EP01.04 - Digital Health in Nursing Curricula: Findings of a National Study (ID 12)

      Lynn Nagle, Saint John/CA

      • Abstract

      Purpose/Objectives:
      Canada?s health sector is increasingly relying on the adoption and successful use of information and communication technologies (ICT) in all care settings. Therefore, care providers, such as registered nurses, must possess the required knowledge and skills to effectively utilize digital health tools in the provision of safe, quality patient care in today?s technology intensive clinical settings. As the largest group of care providers in Canada, the development of core digital health competencies among practicing and future registered nurses is of the utmost priority. The purposes of this study were to: (1) describe the current state of Canadian nurse educator integration of digital health in nursing education and the current state of digital health content integration into nursing curricula, (2) to understand needs of nurse educators in promoting their capacity and future development of digital health integration, (3) to identify teaching and learning exemplars of digital health integration in nursing curricula, and (4) to identify recommendations for advancing the development of informatics and digital health in nursing education.


      Methodology/Approach:
      Research questions were addressed using multiple methods including surveys, telephone interviews, and a focus group; target participants included nursing educators and administrators within Canadian schools of nursing.


      Finding/Results:
      The results depict the current state of digital health content integration in nursing curricula in Canada and identify nurse educators? capacity to integrate and utilize this content, and the impact of efforts to increase nurse educators? capacity in informatics to date. The qualitative and quantitative findings from this study indicate that a number of schools of nursing have incorporated informatics content within their basic curricula, while others offer elective courses at the graduate and undergraduate level, and the remainder provide little to no content in any of their nursing programs. These discrepancies exist even though Canadian core nursing informatics competencies for new graduates have been available since 2012.


      Conclusion/Implications/Recommendations:
      Recommendations for next steps in faculty and pedagogical development needed to further advance the curricular integration of digital health will be discussed. This study was made possible through the support of Canada Health Infoway and the Canadian Association of Schools of Nursing.


      140 Character Summary:
      Findings from a national study of digital health curricular content and faculty capacity in Canadian schools of nursing will be discussed.