A national person-centred digital health strategy provides a framework to connect Canadians with their health and information and empower them to become active partners in their care team. In this presentation, Infoway will share evidence from existing projects on the impact digital health is making for Canadians. Insights about the benefits a national strategy can deliver and the opportunities for moving forward to enable connected care for all Canadians will also be discussed.

Speaker:
Cassandra (Cassie) Frazer, Program Director, Consumer Health & Innovation, Canada Health Infoway

Canada’s health system is under significant pressures that increasingly threaten its ability to provide high-quality, universal care for all Canadians. Learn about the progress to date on Canada Health Infoway’s financially self-sustaining e-prescribing service, known as PrescribeIT™. By reducing the use of paper prescriptions, PrescribeIT™ will strengthen medication management, enhance patient safety, optimize existing drug information system investments and facilitate better health outcomes.

Speaker:
Roberta (Bobbi) Reinholdt, Division Executive, e-Prescribing, Canada Health Infoway, CA

Purpose/Objectives: Your Health System: Insight is the beginning of CIHI’s analytical centre where information is integrated together with sophisticated, yet user friendly, business intelligence software. Its main purpose is to provide health system stakeholders a user friendly analytical tool where they can access timely, relevant and actionable information to answer key questions that matter to them. They can track their progress monthly and compare to their peers, identify factors that might contribute to their performance, and investigate potential savings.

Methodology/Approach: YHS: Insight brings together indicator results, clinical and administrative data, and cost estimates of the acute and ambulatory care sector. In this session, we will use various user stories to demonstrate how data is transformed into meaningful information to support health system planning and quality improvement. Users of Insight can delve into emergency department and acute inpatient data to answer questions such as: what are characteristics of patients who wait the longest to see a doctor in emergency? What are the top three reasons patients are being readmitted to a hospital? Are there efficiency opportunities to discover in our operation and utilization data?

Finding/Results: The number of users for Insight is continuing to grow, and they’re logging in to use it more-and-more. To date, feedback from Insight users has been tremendously positive and an evaluation of usability is planned. Through the demonstrations and testimonies, the audience will see how Your Health System: Insight will support the needs of facility and regional health system managers and their efforts to measure, monitor and improve performance, by offering timely, relevant, and actionable data.

Conclusion/Implication/Recommendations: As the health system moves to more integrated care across the continuum, CIHI is working towards providing integrated reporting that supports improvement of performance and outcomes. CIHI will actively engage stakeholders to ensure that Insight is evolving in meaningful ways for the acute care sector, as well as for other health sectors as the tool is expanded into long-term care, home care, and beyond.

140 Character Summary: Your Health System: Insight helps clients better understands their performance indicators and explores potential savings in operation and utilization.

Purpose/Objectives: Asthma management for children in primary careis suboptimal despite guidelines. Management can be improved by point of care prompting. The Asthma Working Group (AWG) purpose was to provide and test a template for asthma management for primary care physicians (PCPs) to structure their management according to guidelines.

Methodology/Approach: An asthma management algorithm was developed by a panel of experts in one Canadian province. Several iterations were developed of algorithms for (1) approach to first diagnostic visit (2) management of follow up visits of viral induced and (3) allergy induced phenotypes of asthma and(4) management of acute exacerbations. These paper-based algorithms were reviewed by groups of PCPs for content and presentation. Consensus was that even brief paper based formats would not be used regularly. 85% of PCPs have Electronic Medical Records (EMRs) for charting; therefore templates were developed that could be inserted into the EMR for point of care patient management. One EMR vendor provides the software for 80% of primary care practices in the province using one of three programs. The AWG consulted them to upgrade the first templates. It was soon apparent that much more was possible than the AWG had envisioned and a working partnership was developed with the EMR vendor. Through this partnership the AWG improved the template design and added a population management dashboard to enable proactive management processes and usability. To test the templates, 23 primary care practices were recruited and randomised to receive the asthma management education and the EMR tools. Clinical and process indicators for childhood asthma are captured within the dashboard for the PCP to review, analyse or act upon. Dashboard statistics can be shared by the PCP with the AWG support team, which then returns the peer average in the PCP's dashboard trends. The dashboard indicators provide insight to the AWG team to validate the asthma templates adoption, identify areas for coaching to reinforce best practices and assist with future program planning. Additional resources are accessible for template use via an integrated educational package.

Finding/Results: Four templates have been produced and approved by clinician members of the AWG incorporating free flow algorithms and are supported by a quality improvement dashboard. These have been inserted into 11 practices that use one of two EMR systems.

Conclusion/Implication/Recommendations: If the randomised trial outcomes show that the templates improve the management of asthma in children, the templates will be offered to all PCPs in the province who use any of the three systems (over 3000 PCPs covering over 70% of paediatric patients with asthma). Feedback from participating PCPs will enble modification of the templates before going province wide. The fact that the EMR vendor covers so many of the practices through the three systems will be a major facilitator of this roll out. Provincial working groups for Chronic Obstructive Pulmonary Disease (COPD) and for diabetes have expressed an intention to use the same approach for improving management of those conditions in primary care.

140 Character Summary: Pediatric asthma management templates and tools were developed and inserted in primary care EMRs by a clinician/vendor partnership. Other conditions will follow.

Purpose/Objectives: Studies estimate that diabetes affects 8% of the U.S. population, but confirming this in patients who are undiagnosed, and identifying those at highest risk, remains challenging. There are suboptimal levels of health literacy and a lack of engagement among asymptomatic diabetics, who go on to develop complications of the complex and costly chronic disease. This necessitates development of an innovative approach to identify and manage this population.

Methodology/Approach: We identified pre-diabetics in the USA from more than 3000 Allscripts client sites and included de-identified longitudinal records on 40 million patients nationally using the AMA-CDC retrospective algorithm. 3.48 million patients met inclusion criteria by the algorithm.

Finding/Results: Of the approximately 40 million patients analyzed, 3.48 million were pre-diabetic patients. Patients who met inclusion criteria demonstrated significant conversion of pre-diabetes to diabetes mellitus (near 80%) in tracked by time-series analysis of HbA1c’s over the three year period. The burden of pre-diabetes was demonstrated geographically at the national, state and county level with real-time analysis. Given the complexity of the disease, provision of tailored insights (emphasis on diet, exercise, medications, optimize geography) to empower and incentivize individual patients to assume responsibility for preventative care in the real world is needed.

Conclusion/Implication/Recommendations: Once we have defined at-risk patients, we can begin to look at specific complex social and environmental risk factors that impact diabetes – that aren’t necessarily in the health data. For example, counseling a patient on diet modification is unlikely to help if your patient only has access to fast-food delivery because they can’t walk, or resides in a ‘food desert’ where fresh fruits and vegetables are unavailable. With targeted, informed interventions, patients can get treatment tailored to and relevant to their environments, which may include dietary advice, exercise programs or medication availability. This information must not only be delivered to the point of care for health providers, but also directly to the patient in a relevant format. We are using historical insight from 40 million records in real populations to better understand pathogenesis of disease among different groups of people. If we can show positive patient results from thousands of other diabetic patients with similar BMI, or race or age, and other sociobehavioral drivers of health, we can empower people with understanding and responsibility for their own health. Future goals are to create and refine predictive models to understand progression to DM, successfully identify at-risk populations for enrollment into DPP’s (Diabetes Prevention Programs) and other personalized treatment plans, quantify cost savings, and identify additional areas for potential intervention.

140 Character Summary: Provision of tailored insights is needed to empower and incentivize diabetes patients to assume responsibility for preventive care in the real world.

Purpose/Objectives: Investments in digital health have led to the generation of a vast amount of health data. Traditional approaches to knowledge generation through data and analytics can be resource-intensive and not always well-positioned to support decision-makers’ needs for timely, action-oriented evidence. This has triggered interest in innovative alternatives, such as open challenges or crowd-sourcing. This presentation will share a case study of an organization using open innovation challenges to answer health-related policy questions with existing data and analytics. The effectiveness of this approach, and potential for future use, will be discussed.

Methodology/Approach: Canada Health Infoway conducted two Data Impact Challenges in 2015 and 2016. It invited authorized users of health data from across the country to answer 20 research questions related to the health system and patient care, such as rates of duplicate testing, screening, or inappropriate prescription use. The questions were sourced from a variety of supporting health care organizations, as well as an open call to Canadians. Teams had 64 and 76 days, respectively, to submit their answers to the two challenges. A total of $167,500 in awards was made available. Submissions were judged on timeliness and quality (data quality, representativeness, and innovation). The judging panel consisted of 51 experts selected with expertise in health policy, research, data and analytics. A mixed-methods approach was used to understand the effectiveness of the Data Impact Challenges. Quantitative data were collected in the course of the registration, submission, and judging processes, and analysed. Qualitative analysis of content from semi-structured key informant interviews with participants, non-participants, and judges was also conducted.

Finding/Results: Thirty-three individuals or teams made 51 submissions to the challenge. Nineteen of 20 research questions were answered through the challenge using data from 8 of Canada’s 13 provinces and territories. Submissions came from researchers, clinicians, and analysts based in health care organizations, government, academia and the private sector. Qualitative findings suggest that participation was driven more by non-monetary factors than by the awards. Almost all, including non-participants, indicated that they would take part in similar challenges in the future. An analysis using administrative data from British Columbia earned the highest score for the first challenge and identified opportunities for more appropriate use of screening blood tests. In the second challenge, a research organization from Ontario earned the highest score and found that 55% of patients were re-dispensed the culprit medication after an adverse drug event.

Conclusion/Implication/Recommendations: Open innovation challenges can generate timely information in a cost-effective way that responds to novel questions that support evidence-informed decision-making while also demonstrating the value and potential of existing health data sets. Characteristics of challenge design and implementation affect both participation and the quality of submissions received.

140 Character Summary: Open innnovation challenges are an effective way to find solutions to important health care questions.

Purpose/Objectives: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials.

Methodology/Approach: We conducted a review of the ClinicalTrials.gov registry to identify and examine current clinical trials involving mHealth apps and retrieved relevant trials registered between November 2014 and November 2015. Descriptive statistics were conducted on all variables to identify methodological data trends and parameters. Independent t tests, one-way ANOVAs and Pearson correlation analyses were conducted to determine whether there were differences in study duration for all methodological variables. A multiple linear regression analysis was performed with study duration as the dependent variable and all significant predictor variables from the preliminary analyses as independent variables.

Finding/Results: Of the 137 trials identified, 71 met inclusion criteria. The majority used a randomized controlled trial design (80%, 57/71). Study designs included 36 two-group pretest-posttest control group comparisons (51%, 36/71), 16 posttest-only control group comparisons (23%, 16/71), 7 one-group pretest-posttest designs (10%, 7/71), 2 one-shot case study designs (3%, 2/71), and 2 static-group comparisons (3%, 2/71). 17 trials included a qualitative component to their methodology (24%, 17/71). Complete trial data collection required 20 months on average to complete (mean 21, SD 12). For trials with a total duration of 2 years or more (31%, 22/71), the average time from recruitment to complete data collection (mean 35 months, SD 10) was 2 years longer than the average time required to collect primary data (mean 11, SD 8). Trials had a moderate sample size of 112 participants. Two trials were conducted online (3%, 2/71) and 7 trials collected data continuously (10%, 7/68). Onsite study implementation was heavily favored (97%, 69/71). Trials with four data collection points had a longer study duration than trials with two data collection points: F4,56=3.2, P=.021, ?2=0.18. Single-blinded trials had a longer data collection period compared to open trials: F2,58=3.8, P=.028, ?2=0.12. Academic sponsorship was the most common form of trial funding (73%, 52/71). Trials with academic sponsorship had a longer study duration compared to industry sponsorship: F2,61=3.7, P=.030, ?2=0.11. Combined, data collection frequency, study masking, sample size, and study sponsorship accounted for 32.6% of the variance in study duration: F4,55=6.6, P<.01, adjusted r2=.33. Only 7 trials had been completed at the time this retrospective review was conducted (10%, 7/71).

Conclusion/Implication/Recommendations: mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations. There is a need for clinical evaluation to keep pace with the level of innovation of mHealth if it is to have meaningful impact in informing payers, providers, policy makers, and patients.

140 Character Summary: Our research has revealed that mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations.

Purpose/Objectives: This panel discussion will examine and debate the use a Maturity Model for Health Analytics. The purpose of the panel will be to test and inform the audience on some of the potential uses and benefits of a maturity model and the merits of different approaches.

Methodology/Approach: As part of developing a paper on the Considerations and Approaches to Deployment Health Analytics in Canadian Health Care, Infoway is developing a discussion paper on a proposed Health Analytics Maturity Model. The rationale for the maturity model will be presented, along with assertions about its potential use, and the panel will debate the model and relative benefits.

Finding/Results: The Health Analytics Maturity Model is a discussion document that will be introduced in the months before the conference and the panel will discuss the merits of having such a model and of the specific approach taken.

Conclusion/Implications/Recommendations: Implications and recommendations will be surfaced during the course of the panel discussion.

140 Character Summary: A panel discussion on the merits and approach to establishing a maturity model for health analytics in Canada.

Purpose/Objectives: This session will describe the current challenges with the lack of a common terminology in Canada to meet the e-prescribing business needs and identify how Infoway and Health Canada have partnered to begin to solve these challenges. Currently all systems do not speak the same language as demonstrated in the diagram below. <img alt="erx.png" annotation="" id="image://43" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=e190fc98c647450f198e43f9644c333104fd158c&id=43&width=350&height=350&download=0" title="erx.png" />

Methodology/Approach: In the session I will provide the details of the approach which included: Exploration of options to find a pragmatic solution that would work in Canada within tight timelines. An expert panel was convened to develop editorial guidelines The development and testing of the Non-Proprietary Therapeutic Product Data set (NTP-CA Data set) co-led by Health Canada and Canada Health Infoway The NTP-CA Data set will be “machine generated” then subject to a curation review prior to being published Public comment and review periods to allow broader input and feedback

Finding/Results: Infoway has initiated a work plan with Health Canada to develop and publish the NTP-CA Data set This will include new codes and descriptions with a mapping to the associated DINs This work is necessary to move forward with safe electronic prescribing and other medication e-services Early findings/results are only available at abstract time however we anticipate completion of the first publication of the NTP-CA Data set by April 2017.

Conclusion/Implication/Recommendations: While socializing this work we learn that stakeholder interest is very high. This work contributes to the benefits for e-prescribing by: Allowing prescribers to unambiguously identify the drug they wish to prescribe in an e-prescription Making it easier for dispensing systems to provide safe product selection Other benefits include Medication Profile / Medication Reconciliation Hospitals using multiple systems that need to exchange drug information (e.g. supporting Medication Reconciliation modules) Medication Surveillance / Healthcare Analytics

140 Character Summary: Canadians will finally have easy access to drug terminology that solves their e-prescribing needs and beyond, and all published by one authoritative source.

Purpose/Objectives: Care providers need pertinent patient information, at the point of care and not locked into ‘silos of collection’. There’s a need for rapid, secure healthcare interoperability. In response, there is a new standard from HL7 called FHIR or Fast Healthcare Interoperability Resources, which is now at a level of maturity where clinicians and healthcare executives can begin to fully benefit from. The presentation will cover: -What is FHIR? -Evolution of this new healthcare standard -How profiling can customize FHIR for your organization -Security and how SMART will ensure this -How FHIR will benefit clinicians, executives, implementers and patients -How FHIR APIs will future-proof your organization

Methodology/Approach: FHIR represents a major standards upgrade that will boost access to health information in Canada. FHIR aims to speed application development and interoperability, plus boost information sharing in healthcare, especially on mobile platforms. FHIR is both a model and an API and promises to make health information easily and securely accessed from any device, anywhere – helping to break down information silos existing in healthcare. For example, a lack of readily available patient health history often forces doctors in emergency departments to make guesses about appropriate medication, when there is no one to speak for the patient. It will support the creation of an “app store” of independently developed mobile applications, because it supports the collection of data via APIs. To secure these applications, the standard ‘SMART’ has been developed to assist with this. SMART defines the use of the widely used OAuth2 authentication standard along with FHIR as the model and API layer to encourage the development of a secure ‘ecosystem’ of data sources, services and applications. It also defines the ‘app launch’ mechanism to allow an EHR to securely launch an external application.

Finding/Results: FHIR aims to support the following groups: -Clinicians: FHIR provides access to a more complete, higher quality electronic health care record, by being able to include data from traditional sources like laboratory results, as well as evolving sources like genomic information. -Patients: With more applications being targeted at patient engagement, FHIR removes the technical barriers for data from patient engagement apps to be included in clinical systems. -Developers: Familiar tooling and technologies are used. Predefined resources, and APIs allow implementers to focus on the core application functionality. -Healthcare providers: Vendors are committed to FHIR, which increases the range of applications able to be deployed. This should lead to faster deployments, and lower cost interoperability. It supports the ability to develop applications specific to their needs, yet integrate with the clinical information already available.

Conclusion/Implication/Recommendations: FHIR has captured interest around the world and promises to revolutionize sharing of healthcare information. David has been involved with the formulation of the new FHIR standard from the beginning and is active in the international standards community as the chair of HL7 New Zealand and co-chair of the FHIR Management Group. FHIR represents a major standards upgrade that will boost access to health information and healthcare delivery in Canada.

140 Character Summary: Learn how the new standard HL7 FHIR will future-proof your organization and enable improved healthcare interoperability with Dr. David Hay.

Purpose/Objectives: Better Outcomes Registry and Network (BORN) Ontario is developing a common Digital Health Exchange Service (DHEX) in partnership with the Digital Health Solutions and Innovation (DHSI) Branch and the eHealth Strategy and Investment Branch (HSIB) of the Ministry of Health and Long-Term Care (MOHLTC). DHEX has three primary objectives: 1. Design, plan and implement a proof of concept with Electronic Medical Record (EMR) vendors to allow submission and retrieval of immunization records with Public Health Units (PHUs) via the Ontario Digital Health Immunization Repository (DHIR). 2. Implement a general exchange mechanism, based on HL7-FHIR, between the BORN Information System (BIS) and the DHIR to synchronize immunization and demographic data. 3. Support current EMR integration initiatives at BORN.

Methodology/Approach: Provide Ontario PHUs more complete immunization records by delivering immunization information from EMRs for children up to 18 years of age. Develop an updated and simple EMR submission (DHEX) approach using HL7-FHIR to enable providers to easily and securely submit and retrieve immunization administrations to PHUs via the DHIR. Develop a working proof of approach/technology to finalize the HL7-FHIR specifications and reference implementations that will allow EMRs to submit and query the DHIR, providing EMR primary care providers with a mechanism to both submit and view an immunization record (at the record level), encouraging the adoption of the DHIR immunization dataset by EMR vendors. Develop a proof of concept for an enhanced HL7-FHIR based mechanism for BIS integration with EMRs and upgrade the security integration with the current eHealth Ontario ONE ID Single Sign On project. Equip health care providers with enhanced information, tools and support

Finding/Results: The project will provide the MOHLTC with: • Timely access to the largest EMR vendors in the province in support of Immunization 2020 goals • Further refinement and endorsement of the IHR (Immunization Health Record) specification • A single EMR transmission solution in support of provincial expansion for initiatives supported by BORN This project will provide EMR Vendors with: • A simplified and unified approach to interoperability HL7-FHIR • Simplified development and technology tools, lowering barrier to entry • Input to the specifications and development of the proposed solution • Input to create broader auxiliary data services that can be leveraged for other initiatives This project will provide health care providers with: • EMR access to patient level immunization records, including forecaster data, which will alert to upcoming or improperly administered vaccinations • Ability to provide PHUs with up to date immunization records, seamlessly embedded within the EMR, in support of proposed immunization reporting legislation and improved clinic workflow

Conclusion/Implication/Recommendations: This project supports the goals and objectives of Immunize 2020, the MOHLTC’s strategic framework to modernize Ontario’s publicly funded immunization program (MOHLTC, 2015). It also supports the development of a common provider solution that allows for immunization data from EMRs to be transmitted to PHUs via the DHIR. This would occur seamlessly, in near real-time, avoiding the need for clinicians to implement new clinic workflows or processes to support proposed legislative requirements.

140 Character Summary: Development of a common provider solution that allows for immunization data from EMRs to be transmitted to PHUs via the Digital Health Immunization Repository.

Purpose/Objectives: The purpose of the Long Term Care (LTC) eConnect Project is to enable clinical interoperability between LTC clinical information systems and Ontario’s Electronic Health Record (EHR). 20,000 clinical users will have seamless access to EHR data so they can improve the quality and timeliness of care for some of the province’s most vulnerable residents. Ontario’s Long Term Care sector includes 630 Long Term Care homes providing care for approximately 100,000 residents with approximately 60,000 clinical and non-clinical staff at a cost of almost $4B per year. Specific objectives include: · Connecting up to 520 of the 630 LTC Homes to at least one of the two provincial EHR clinical viewers (ClinicalConnect in the Southwest Region, ConnectingOntario ClinicalViewer in the Northern and Eastern Region (NER) and Greater Toronto Area (GTA)); · Enabling at least 20,000 clinical users in these homes to have seamless (i.e., single sign on and patient context), privacy-enhanced access to resident EHR information: laboratory results, diagnostic imaging reports, discharge summaries, and hospital and community care reports; · Ensuring appropriate legal agreements, including privacy and security due diligence are completed, support integration and user authorization; and · Undertaking a detailed Benefits Evaluation to support the sector-wide expansion and on-going sustainability for the solution.

Methodology/Approach: The project sponsor is the Ontario Long Term Care Association (OLTCA) working in collaboration with the Ontario Association of Homes and Services for Seniors (OANHSS), Ontario Long Term Care Clinicians (OLTCC), eHealth Ontario, and many delivery partners. The project integrates long term care homes with EHR assets managed by eHealth Ontario, using PointClickCare’s Electronic Medical Record (EMR) using ThoughtWire’s Ambient integration technology. There are two main phases: 1) View Integration within PointClickCare to ClinicalConnect 2) View Integration within PointClickCare to ConnectingOntario Clinical Viewer Both phases follow an agile development process over five, two-week sprint cycles, guided by a Clinical Advisory Committee of front-line users who ensure that the solution is easy to use and meets their clinical requirements as well as legislative and business requirements. Clinical users require a ONE ID credential – the provincial standard for accessing provincial EHR Services. The project team works closely with eHealth Ontario and other partners to streamline and manage the legal agreement processes and implementation activities needed to authorize, train, and support clinical users. Following each development phase, a rolling wave deployment process used to on-board LTC homes to ensure staff are trained to effectively use the EHR services.

Finding/Results: At time of submission the project is in the Phase 1 development stage. Rollout in February 2017 and by June 2017 preliminary results: design, development and deployment results for the first group of Long Term Care homes and clinical users in the Southwest Region.

Conclusion/Implication/Recommendations: The project presents an innovative approach to integrating clinical users with provincial EHR services using middleware integration technology to streamline the integration approach, enhance privacy and security controls, improve quality and timeliness of care, and provide an efficient user experience. This is an approach that others can leverage to accelerate EHR interoperability and deployment efforts elsewhere.

140 Character Summary: An innovative LTC sector based approach using single sign on and context management to support advanced clinical workflows and future value-added capabilities.

Purpose/Objectives: eHealth Ontario helps health care stakeholders integrate the province’s electronic health record (EHR). This session introduces our Innovation Lab (www.innovation-lab.ca) and explores how it promotes innovation in Ontario. Health care is an information-intensive industry. The lab helps innovators garner support for solutions that make optimal use of health information for improved patient care. It is a free and open sandbox where participants can experiment to verify the usability of new products using the structure and composition of the EHR.

Methodology/Approach: Initially, the lab was built to help eHealth Ontario drive risk out of its own technology projects. Along the journey, we recognized the opportunity to enable innovation on a broader scale. Approaches used for developing the Innovation Lab include: Casting a wide net. Enticing talent that is potentially interested in health care, but is unfamiliar with health care-specific standards and protocols. Developing different levels of services: Lite Services are for innovators to access and illustrate proofs of concept for garnering initial clinical and financial support. These services are for ‘getting started’ and are freely accessible. Secure Services are identical to our production systems, and include authentication and other privacy and security controls. Implementing a website with all relevant information, and a test harness to help familiarize newcomers to health IT messaging. Starting small and growing (as opposed to big bang).

Finding/Results: Through feedback from users, workshops with stakeholders and building on the services of our partner and host, Mohawk College’s Mohawk eHealth Development and Innovation Centre (MEDIC), we discovered: Hamilton Health Sciences and their vendor, Influence Health, used the lab to build and validate a proof of concept integration between ClinicalConnect and the Provincial Client Registry (PCR) Lite Service (the PCR uniquely identifies individuals based on demographic information). They said: “Using the Innovation Lab simplified the logistics and communication requirements associated with this very complex integration project.” That other organizations want to contribute their assets to the lab. The benefits for them are: It encourages innovation with their assets They can explore further integration with other provincial assets That many organizations wish to provide support for innovation. We learned they should base their contributions on the value that their organization is uniquely positioned to provide. For eHealth Ontario, this is the provincial EHR assets; no one else can contribute this to innovation

Conclusion/Implication/Recommendations: Our ‘start small and grow’ approach has allowed us to fund the lab with a modest budget. The initial services have already proven the effectiveness of the lab, and will continue to be leveraged by innovators as we add new services. Through our engagement with stakeholders from across the province, we are developing a consortium atmosphere in the lab, where all parties become part of the solution. Partnerships with other EHR service providers are key. Nobody owns innovation; it should be open, transparent and collaborative.

140 Character Summary: Ontario’s Innovation Lab, our open EHR platform, fosters ehealth solution testing in a virtual EHR environment and gives innovators a space to prototype new ideas.

Purpose/Objectives: This presentation will explain how ClinicalConnect, a provider portal that is now known as one of North America’s largest health information exchanges, was built from the ground up, starting at Hamilton Health Sciences in 2005. We will review a series of key milestone events, beginning in 2005 with data first being aggregated in real-time from Hamilton area hospitals, through to 2016 and beyond, where there are now more than 42,000 registered users from across south west Ontario accessing their patients’ data, aggregated from multiple regional and provincial data sources, consolidated into a one-stop-shop viewer.

Methodology/Approach: We will explore how innovative features and functionality, such as context-aware, evidence-based clinical information, has been integrated into this scalable digital health solution that is transforming patient care and augmenting decision-making abilities. The discussion will highlight not only what data has been successfully integrated into the portal, but how the data has been integrated. In addition, the development and deployment of ClinicalConnect on desktop computers, smartphones and tablets will be examined. Taking into account the scope of the integrations, working with diverse stakeholders, the intricacies of varying agreement frameworks, required education and communication tactics – we will share success stories as well as lessons learned, and touch on the growing number of privacy considerations impacting technical integration work.

Finding/Results: To wrap up the presentation, the speaker will provide current statistics about how the portal is used, by which health information custodian types most often, and will include short testimonials from regular users about how being able to access ClinicalConnect has changed the way they can deliver healthcare. Time will be dedicated to discussing two ancillary online tools that have been developed and deployed as a result of the enormous growth ClinicalConnect has experienced in the last five years to automate the account management function and manage passwords. We believe the audience will take great interest in the complexity of the varied integration projects that have been undertaken; from connecting with local hospital information systems, to the Ontario Association Community Care Access Centre’s Client Health & Related Information System (CHRIS), to oncology information systems and provincial data repositories including eHealth Ontario’s Ontario laboratories information system (OLIS), the Southwestern Ontario Diagnostic Imaging Network (SWODIN), and most recently, the Ontario Ministry of Health’s Digital Health Drug Repository. Audiences will learn about new directions and emerging opportunities and ideas being explored to further engage both providers and patients in unique ways.

Conclusion/Implication/Recommendations: ClinicalConnect facilitates the efficient and effective sharing of patient data across the continuum, and is a catalyst for change as the eHealth landscape evolves and adapts to accommodate new data sources and privacy and security legislation. It’s an excellent example of a homegrown solution that has attracted attention from regional and provincial healthcare industry professionals and grown to become a strategic asset as identified by the Province of Ontario.

140 Character Summary: How an EHR has been built, aggregating data from regional and provincial data sources, to improve patient care and provider efficiency.

Purpose/Objectives: To share the successful outcome and implementation experience of BC’s first deployment of the Provincial eHealth Viewer (CareConnect) to non-Health Authority users. A key aspect of the project was integrating with the new BC Service Card as the authentication mechanism to identify Canadian Blood Services staff.

Methodology/Approach: CareConnect is actively used by all six of BC’s Health Authorities (HA). User requests identified a significant interest in providing access to CareConnect to non-Health Authority users. As such, the Provincial Health Services Authority (PHSA) project team created a non-HA Access Model Framework, initially focused on organizations with establish IT infrastructures, privacy and user support departments. The Framework included approaches to address: Technical Deployment Agreements User Access Privacy Security Operational Engagement and Governance process A key issue was how to identify individuals that the Health Authorities have no direct relationship with. The solution was to integrate with the BC Services Card. The BC Services Card replaces BC’s Health Card. It includes a contactless encrypted chip that is linked to identity services and supports online authentication with passcode functionality. In effect, two factor authentication. PHSA and the Ministry of Technology and Citizen Services (MTICS) completed a technical proof of concept which confirmed the technology principles. With governance approval, the project team implemented the solution which included: Integration between the HA's Active Directory Federation Services (ADFS) and the BC Service Card infrastructure Creation of a CareConnect logon process for non-HA users, which seamlessly directs the users to the BC Service Card logon service. BC Service Card confirms the correct card and passcode combination, and informs the HA ADFS of a successful authentication, which in turn grants access to CareConnect. Once authentication is complete, users are matched with the role they registered with in CareConnect, and provided with the appropriate access

Finding/Results: The partnership with the BC Service Card leverages the key strengths of both organizations: BC Services Card’s role is to identify specific individuals and authenticate their online presence to a very high security standard CareConnect enforces a role-based user access model to provide the appropriate content to authenticated user With this implementation, PHSA now has an established process to provide access to Provincial eHealth data to non-HA users who work in established organizations. Canadian Blood Services' staff benefit by having faster access to the information they require to support their clinical activities. While the user experience is very streamlined, there are concerns about employees having to use their personal BC Services Card in a work environment and the initial manual process to obtain passcodes. There were two significant Lessons Learned from the project: The technical infrastructure and network connectivity was extremely complex Multiple legal, privacy and security agreements were required amongst the numerous organizations involved

Conclusion/Implication/Recommendations: In designing provincial solutions, it is important to look outside the Health sector and create partnerships across Ministries in order to create an ideal solution. While it does add complexity, the first implementation sets the foundation for future growth.

140 Character Summary: Sharing the successful integration of the new BC Services Card with the Provincial eHealth Viewer in support of providing access to Canadian Blood Services' staff.

Purpose/Objectives: While it can be said that many other professions design: an architect designs a house or an engineer designs an electrical circuit; it sadly cannot be said that health care providers design their patients’ care plans. The chief tools for creating and implementing patient care planning are classical medical documentation and order entry. There are two main problems with this prior art. Medical documentation is semi-structured and not rigorous enough for non-ambiguous analysis Medical documentation contains the reasoning for orders, but there is no rigorous path to align and validate these important relationships. An evolving research software prototype was constructed and is in active alpha testing in a busy inpatient environment to explore the feasibility and advantages of fusing documentation and orders while keeping their relationships explicit.

Methodology/Approach: Over the last 5 years, we have used a software modeling approach to create a formal language to represent medical documentation and orders and fuse them into singular model (PCM). Formal languages are a family of languages that are in common use in the engineering industry in the form of programming languages. The strength of these languages is that they eliminate ambiguity and allow the creation of responsive and intelligent editors that can be created to analyze and manage this code. We saw an opportunity to create a sophisticated design tool that is conceptually familiar to other technical professions (especially software engineers). We also saw an opportunity to create a programmable language that can both facilitate and constrain PCMs such that they are in compliance with best practice, local and regional policies. The result is an early generation Patient Care Design Tool (PCDT) which has been undergoing alpha testing over the last 4 years in a very busy medical inpatient environment at TBRHSC (Thunder Bay Regional Health Science Center). We have been gathering feedback in order to advance the PCDT prototype.

Finding/Results: From the live clinical field, a trained user can construct PCMs using our early generation PCDT under very high clinical workloads and gain significant advantages in speed, accuracy, automation and clarity. Large arrays of automation can be implemented during PCM design and thereafter. These include decision support, error detection, e-learning, background commentary, asynchronous communications, and metrics gathering. Isolated order entry workflows in most cases can be entirely eliminated. This allows care providers to focus entirely on the construction of optimal design of their PCMs for their patients and eliminate the recapitulation and afterthought of CPOE. Additionally, such a system can permit collaborative asynchronous drafting of PCMs to reduce the amount of overhead associated with team collaboration while still allowing maximum participation (Collaborative Patient Care Design: CPCD).

Conclusion/Implication/Recommendations: Our group is seeking to broaden the discussion and resources in order to advance PCMs as the new platform for patient care planning. We are a research group in search of likeminded academic and industry partners to advance, test and publish to trigger the rise of PCDTs to tame cost, complexity, efficiency and measurability in health care.

140 Character Summary: The rationale and demonstration of the enormous advantages of fusing medical documentation and order entry into a single model called a Patient Care Model (PCM)

Purpose/Objectives: This oral presentation will provide a synopsis of the most recent work of Canada Health Infoway in assessing the approaches taken to the use of Cloud Computing in Healthcare across Canada.

Methodology/Approach: In 2016-17 Canada Health Infoway has embarked on a significant update to its original white paper on Cloud Computing in Healthcare. The new white-paper looks at illustrative uses of Cloud that have been deployed across the country through interviews and informal surveys. It examines the public sector business drivers for use of Cloud and the approaches taken. It also explores vendor perspectives on working with the health sector in Canada. Early benefits from Cloud implementations are identified and evaluated for applicability, extensibility, and scalability across Canada.

Finding/Results: The white paper is still in development and is expected to be published in March of 2017. Findings and results will be available at that time.

Conclusion/Implication/Recommendations: The white-paper and oral presentation will provide insights into the challenges faced by implementers and users of Cloud-based solutions as well as the benefits and positive impacts and outcomes that have been achieved.

140 Character Summary: A presentation on the findings of an Infoway white paper on the application of Cloud Computing in the Health sector in Canada.

Purpose/Objectives: An IT assessment conducted by Deloitte that highlighted areas for improvement is eliciting a multi-year organization wide IT transformation aimed at building a framework for UHN to become a digitally enabled hospital and changing the way we deliver IT. Productivity tools, such as email, instant messaging, and file sharing are currently under examination for the IT transformation because... they serve as the backbone for connecting our researchers, clinicians, and administrators with each other and to their peers as promote collaboration. This presentation will focus on UHN’s transformation journey through the implementation of Microsoft Office 365 and how we’re disrupting status quo to enhance the way we work on a day-to-day basis.

Methodology/Approach: UHN is in the process of delivering Office 365 through a phased approach starting with Microsoft’s cloud platform Azure, Exchange Online, Skype-for-Business, and OneDrive-for-Business. This enterprise-wide initiative will be implemented across all four UHN campuses, affecting approximately 20,000 users including clinicians, researchers, and IT administrators. To redefine status quo, we’ve selected individuals from all facets of business to form working groups to challenge our way of thinking and act as project champions. To actively engage users, departmental roadshows will be held to demo the system, lunch-and-learn sessions will be offered directly on units, and e-newsletters detailing new functionality will be distributed. As this initiative has high visibility and high impact, an easy to access repository will be set up for users to access training material and project updates. As proof of concept, various end user groups will be engaged as part of a pilot to serve as checkpoints to ensure that all Office 365 features are functioning as intended prior to full rollout across the organization.

Finding/Results: At the outset of UHN’s IT transformation, an organization-wide survey was conducted to assess customer satisfaction of IT services. Results from the survey highlighted certain pain points within the organization including small mailbox sizes, the need for real time collaboration tools across teams, and frustration relating to downtimes of critical communication services. Ongoing monitoring and measurements will be conducted to continuously understand the organizations receptiveness to this change, however, anticipated results are solutions to these reported pain points, fewer downtimes, increased productivity and collaboration, and ultimately a new foundation for using cloud technology.

Conclusion/Implication/Recommendations: Cloud technology is widely adopted by cross-functional industries to reduce capital expenditures of hosting equipment on premise and to allow for server scalability on demand. UHN will be one of the first early adopters of cloud technology within Ontario’s healthcare sector where leveraging cloud will not only boost internal connections, but boost external connections across multiple organizations that adopt similar technology. To stimulate further adoption within healthcare, provincial incentives and encouragement are recommended. It’s also recommended that provincial measures towards creating a private cloud specifically for healthcare be developed to increase security and privacy controls to encourage more healthcare organizations to join.

140 Character Summary: Through UHN’s Office 365 cloud implementation, we are building the runway to becoming a digitally enabled research hospital.

Purpose/Objectives: It has been frequently commented upon that Canada’s health care system is in need of a change. Within the burgeoning pressures it faces, the patient voice has become stronger; and expectations of an active partnership in a team-based model that includes the patient as a partner, have become paramount. The purpose of this presentation is to bring the patient voice to the Conference; to hear about their experience with digital health and to get their advice about how we continue to evolve to best meet their needs.

Methodology/Approach: With a commitment to understanding and meeting the needs of Canadians is a national approach for patient/citizen engagement, centered on four pillars: listen, amplify, invest and influence. National public opinion research, education, engagement and storytelling strategies, are part of the approach used to gather the patient, caregiver and family member experience and perspective to help shape the digital health agenda directly from the voice of the citizens we serve.

Finding/Results: International research suggests that “empowered patients make informed choices, have better relationships with their healthcare providers, are committed to adhering to treatment, take responsibility for their care and seek preventative measures to better manage their health” (European Union’s Patient Forum). Furthermore, national public opinion research suggests that over three-quarters of surveyed Canadians (77%) feel that digital health tools assist them in having improved knowledge of their health. Almost one in seven (69%) feel they have improved confidence in self-management of their health through the use of digital solutions; and nearly three in four (74%) feel more informed in their discussions with their doctor. Additionally, national survey data indicates that the use of consumer health solutions has nearly doubled in the past two years, making the impact of these emerging practices even more meaningful. At the same time, benefits studies from implementations underway corroborate this growing evidence base and also demonstrate that Canadians who use digital tools are as satisfied with their care as with traditional face-to-face models. Other studies suggest that the use of digital tools and access to information would have avoided a significant amount of in-person visits and time off work. All of these things improve outcomes for the patient; streamline processes for clinicians; and save the health system money.

Conclusion/Implications/Recommendations: With the rise of the patient engagement movement in health care, more and more patients are influencing the health care agenda in Canada and are moving from patients to partners. But the question remains: are we meeting the health care needs of Canadians? Within this panel we will hear the personal experiences of a panel of patients who will share their health care expectations and the role digital health has played. National public opinion research and evidence from existing digital health projects will also be reviewed.

140 Character Summary: A panel of patients will share their digital health experiences and perspectives on how these tools can support Canadians in partnering in their care

Purpose/Objectives: Clinicians are increasingly recognized as essential to health information systems projects, bringing their healthcare knowledge and expertise, as well as industry credibility to the project. Rarely, however, is their role well understood or maximized on projects. This presentation will address some of the underlying issues and provide effective strategies for team success while optimizing utilization of distinctive resource skills and contributions. Teams are a partnership of shared and unique skills and knowledge but are not always equipped or experienced to maximize each member’s contribution potential. The most effective project teams in all sectors of healthcare are both interprofessional and collaborative, which is defined by Health Canada (2010) as teams “working together with one or more members of the … team who each make a unique contribution to achieving a common goal, enhancing the benefit for [clients and] patients. Each individual contributes from within the limits of their scope of practice…all the while emphasizing [client/] patient- centred goals and values” (para 3). Success starts with understanding each team member’s professional knowledge and practice experience and their project related skill sets. However, the integration of clinicians into project teams is the least understood and most challenging for team dynamics. Models of clinical practice utilize process (e.g. the nursing process) in the planning, delivery and evaluation of patient care that parallel the project lifecycle. Leveraging the shared approaches supports the team maximizing each member’s unique abilities to advance the project goals, processes, and outcomes. This panel presentation will demonstrate the overlapping competencies between the project manager (PM), business analyst (BA), clinical informatician (CI), frame the approach to successful interprofessional team assembly and building, and share strategies for maximizing their unique contributions to the benefit of the team and client/project outcomes.

Methodology/Approach: A role and competency matrix for an interprofessional team was developed, and incorporates specific role-based competencies and responsibilities, including the roles of the PM, BA, and CI. The focus was to illustrate how the competencies both overlap and remain distinctive, and to reflect the respective contributions to the team so all roles are used effectively with recognition. It also highlights when specific skills are required and when a specific skills-based resource may need to be added to the team.

Finding/Results: The roles of team members can overlap in a significant number of areas. Working from this shared baseline, understanding team member ‘s level of ability with each project skill, and naming their unique qualities will allow appropriate assignment and best partnerships to leverage the unique contributions through a collaborative approach.

Conclusion/Implications/Recommendations: A successful interprofessional project team can deliver and maintain a healthcare solution in a clinically relevant and responsive way with the assembly of the right professionals equipped to acknowledge the training, expertise, experience, unique abilities of each team member to collaborate on achieving the initiative’s/client’s goals.

140 Character Summary: Use of interprofessional teams in healthcare projects can be optimized using roles matrix paradigm, to ensuring best use of existing knowledge and skills.