OS12 - Expanding Digital Competencies Through Education (ID 18)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 206B
OS12.01 - Adoption of an e-Health e-Resource via Peer Leader Educator Network (ID 232)
Purpose/Objectives: The Association of Faculties of Pharmacy of Canada (AFPC) and Canada Health Infoway partnered to develop a national, online, competency based, educational resource to prepare undergraduate pharmacy students in the use of Information and Communication Technologies (ICT). Drivers for development of the educational resource included an expanding scope of pharmacist practice, increased availability and reliance on information and technology for practice, and paucity of teaching resources and faculty members with expertise in informatics. The resource was intended to be flexible and modular, for use by faculty members either within their respective courses, or in its entirety.
Methodology/Approach: The first version of the Informatics for Pharmacy Students e-Resource was launched for general use December 15, 2013 (http://afpc-education.info/moodle/index.php). <img alt="logo small.png" annotation="" id="image://26" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=216d165fb1a3ecbf8a344ebe7ed3314fcd51b1e8&id=26&width=350&height=350&download=0" title="logo small.png" /> A Peer Leader Network of pharmacy educators was created to foster adoption of the e-Resource at 10 faculties of pharmacy across Canada.
Finding/Results: A formal evaluation was conducted to determine the effectiveness of the network model and drive changes for Version 2 of the e-Resource (open access, launched May 2016). Peer leaders were supportive of the network model and were enthusiastic about engagement with colleagues toward a common goal. Students were very positive about the interactive learning activities, notably Virtual Patients, Polls, Videos, Quizzes and Gamification elements. Over 4,000 students and educators have accessed the platform (October, 2016). The e-Resource has been cited as a "best practice" in informatics and e-learning by American colleagues. A Peer Review process is being undertaken for the development of Version 3, and another group of Peer Leaders has been convened (Aug 2016) to deepen the network, conduct curriculum mapping, and continue local adoption and integration projects.
Conclusion/Implication/Recommendations: This project has resulted in a viable and scalable approach for developing an accessible and valid educational e-Resource using open source educational technology and a collaborative approach to instructional design. Thousands of Canadian pharmacy students have been exposed to the emerging area of Information and Communication technologies, achieving the goal of the original funding. The integration of the e-Resource across faculties of pharmacy in Canada was largely due to a Peer Leader Educator Network, which is proving viable and sustainable through a central, coordinated approach.
140 Character Summary: The combination of a Peer Educator Network, project managment, and access to a valid e-Resource resulted in e-Health education in 10 Canadian faculties of pharmacy.
OS12.02 - Striking a Balance: Theory vs Applied Practice in HI Education (ID 71)
Purpose/Objectives: Theory and applied practice are polarities in health informatics education a balance of both elements is needed to prepare students for emerging health informatics job opportunities. How do students, educators and employers align on how much concept vs. practice is optimal for future professionals? Health Informatics programs seek to build foundations of sustainable theories and models for students to apply in highly-variable live settings that are replicated by practicum placements, internships and co-op work. Mixing academic and applied efforts within a graduate program, however, doesnt automatically produce cohesive health informatics professional thinking. This materializes when the learnings from both mesh effectively. The question emerges as to how to best adapt, synthesize and contextualize learnings from both polarities to suit upcoming HI professional needs. The presentation will be based on insights collected from an online survey of actual employers, students and educators related to a particular HI program. It will consider the degree to which balance can be productively reached by focusing both academic and applied opportunities on achieving competencies and skills set by organizations as COACH and AMIA. It will also note current North American dialogues on standards of professionalism. The presentation will propose a framework for consideration of opportunities and challenges in balancing educational polarities.
Methodology/Approach: The presentation will explore approaches and methods for applied placements within graduate and post-secondary settings. The placements will be compared, and differences will be highlighted to point to needs in the system. Evidence will be used from targeted employer, student and educator interviews and surveys. Specifically, practicum learning experiences of students attending a professional HI program and employers hosting these placements will be assessed. This will be done via an online questionnaire. An evaluation of career paths, practicum experiences and obtained job positions from graduates of these programs is currently underway and be drawn from, as possible. The presentation will review what elements are foundational to both academic and applied modes of study, how these areas differ and to what effect. Observations will be presented in a framework for balancing theory vs applied practice.
Finding/Results: Findings will be focused on areas of similarities and differences between academic and applied learning settings. With major evaluation efforts currently underway, the presentation will contribute, if and where possible, findings from health informatics alumni assessment at University of Toronto. An online questionnaire of stakeholders will be used as the basis of a framework to convey findings and results.
Conclusion/Implication/Recommendations: A framework for balancing polarities will be proposed based on findings and results of anylysis. The framework will serve as a tool with a recommned approach to striking a balance of theory and applied practice that will be useful for students and educators, as well as employers. . An interpretation of how this fits into the changing HI job environment will be made.
140 Character Summary: Theory vs. applied practice are polarities at the centre of graduate education in health informatics. How do we frame a balance to best enable HI careers?
OS12.03 - Using Peer Networks to Integrate Digital Health in Nursing Education (ID 321)
Purpose/Objectives: Information technologies are being harnessed to deliver efficient and accessible high quality healthcare, and this trend is expected to continue. Increasingly, nurses are at the intersection of these technologies and patient care. Given the growing impact of informatics on nursing practice, it is critical that nurses enter the workforce having developed entry level competence in this area. The purpose of this project is to leverage previous CASN-Infoway work to support and enable nursing faculty to integrate digital health content into undergraduate curricula with the ultimate goal of graduating nurses who are well-prepared to practice in technology enabled environments.
Methodology/Approach: The Canadian Association of Schools of Nursing (CASN) and Canada Health Infoway have partnered on a series of initiatives to prepare new nurses for technology-enabled environments; the first phase was the development and publication of entry-level nursing informatics competencies, followed by the creation of a faculty peer network to mentor nursing colleagues across Canada. This third phase of the partnership has involved reengaging the Digital Health Nursing Faculty Peer Network to further support the integration of entry-to-practice digital competencies into curricula. Over the course of a year, 12 Peer leaders from across Canada with expertise in nursing informatics were engaged to provide knowledge, educational tools and mentorship to fellow faculty through three regional workshops and three online webinars. Each webinar focused on one of CASN-Infoways previously developed entry-to-practice competencies. The purpose was to continue to build foundational knowledge of digital health among nursing faculty to increase their baseline capacity. The regional workshops provided an opportunity to go deeper and build a greater depth and breadth of understanding of digital health and included topics such as consumer health solutions and virtual care. By using a train-the-trainer approach, this project has been able to leverage efforts to support and educate faculty through strategies developed by faculty who are champions of digital health, thus increasing their perceived value and uptake.
Finding/Results: Pre and post workshop and webinar evaluations surveys are being conducted to assess the self-identified change in knowledge of, and capacity to, integrate digital health content. The results of these surveys will be presented and their implications will be discussed.
Conclusion/Implication/Recommendations: The reengaged Digital Health Faculty Peer Network has been an innovative and effective mechanism for supporting the integration of digital health content into undergraduate nursing curricula. By enlisting faculty to help disseminate the content and the support tools, this project has been able to reach a cross-country audience who respected the experience and qualifications of their peers.
140 Character Summary: Leveraging previous CASN-Infoway work to support nursing faculty to integrate digital content into curricula through a faculty peer network.
OS12.04 - Graduating in Health Informatics: Where Do We Go From Here? (ID 224)
Purpose/Objectives: Health informatics (HI) job prospects are expanding for candidates with graduate education credentials. This presentation will explore the value of professional and research programs in terms of achieving desired career pathways. Top of mind for HI students is securing relevant post-graduation positions that meet their HI interests and aspirations. The presentation will look at qualifying and quantifying the risk and rewards of both professional and research tracks of study to meet career goals. In so doing, the differences between research and professional pathways will be discussed. An assessment of positions acquired post-graduation from students at a particular graduate HI Professional and HI Research program will be central to the presentation. Based on responses to an online survey about what types of jobs are desired and attained, this presentation will analyze whether students are being well prepared for HI careers. There will be an assessment of whether graduate professional and research options are currently translating into achievement of immediate and near-term career goals. Consideration will be made of implications from student, academic and employer perspectives, with reference to what seems reasonable in our current Canadian job environment.
Methodology/Approach: The presentation will explore evaluation approaches and methods for tracking career success and HI pathways by using evidence from the job-market, social media data, interviews and targeted surveys. Specifically, career aspirations of students attending a professional HI program and students attending a HI research program will be determined through an online questionnaire. An evaluation of career paths and obtained job positions from graduates of these programs is currently underway. A comparison of the aspirations and realistic career opportunities will be discussed. The presentation will review what elements are foundational to both professional and research areas of study, and how these areas differ. The methods will be focused on defining the needs of students in both streams. The perspective of educators will also be captured and presented.
Finding/Results: Findings will be focused on areas of similarities and differences between research and professional stream needs. In addition to targeted survey findings, there is a larger-scale evaluation effort around career aspirations and acquired jobs currently underway. The presentation will contribute, if and where possible, findings from health informatics alumni assessment at University of Toronto.
Conclusion/Implication/Recommendations: A summary evaluation model will be proposed. Methods for for annual tracking will be also be proposed. An interpretation of the level of need to re-assess programs given the changing HI environment will be made.
140 Character Summary: Job opportunities are expanding for prospects with graduate health informatics credentials. See how professional and research programs lead to career results.
OS12.05 - Accelerating eHealth Integration in Medical Education (ID 252)
Purpose/Objectives: Medicine has entered the digital era. In Canada, this change is clearly reflected by 77% electronic medical record (EMR) adoption in physicians' practices, and continued growth of hospital information systems. The proliferation of patient portals, use of the Internet (and particularly social media) to search for and exchange health information by clinicians and patients alike, and the growing number of health and wellness mobile apps open new possibilities to engage patients in their own care but also introduce new challenges for professionalism. Current and future clinicians need information skills and knowledge in order to be effective in a digital technology-enabled environment. To address the challenges facing medical practice and education, the Association of Faculties of Medicine of Canada (AFMC), with support from Canada Health Infoway (Infoway), has built a peer-leader educator network across Canada that identified and published Canadas first eHealth competencies for undergraduate medical education in 2014. AFMC and Infoway also created a series of national eHealth faculty development (eHealth FD) workshops delivered in Spring 2016 targeted to medical educators and residents to raise awareness of informatics and eHealth competencies. Webinar participants asked for more resources in French as well as English, particularly in the form of teaching tools, tips, case studies and clinical examples that can bridge knowledge learned in the classroom setting with the realities of the clinical setting.
Methodology/Approach: Education is essential to better prepare our medical learners (students and residents) to practice in modern, technology-enabled, clinical environments. Yet, educational interventions that address the challenges are limited. In this phase of the project the eHealth team focused on developing the requested teaching tools (resources, case studies, and clinical examples) to address the goals and challenges of designing and introducing eHealth topics into the undergraduate medical curriculum.
Finding/Results: Members of the panel will present the learning materials developed for the eHealth resource toolkit and housed in the AFMC's Canadian Healthcare Education Commons (CHEC). We will describe the process of case development and show with an example (use of emails between clinician and patient) how this case can be introduced at the beginner level, intermediate, and advanced levels with more complex learning outcomes and competencies for advanced learners and practicing clinicians. In the panel presentation we will give an overview of the available resources and how best to search and find relevant materials, demonstrate the completed case example, describe steps taken to work with the Medical Council of Canada to include eHealth competencies in medical school examinations, and during discussion ask participants for examples from their own institutions and ideas for further incorporation and integration into the medical curriculum.
Conclusion/Implications/Recommendations: eHealth is not just another component to add into the medical curricula; rather it is the way in which medicine will be practiced in the future. The AFMC-Infoway eHealth project is an example of a national-level initiative with collaboration across medical organizations and faculties to address these issues as well as to develop learning and educational resources and promote competency and accreditation standards.
140 Character Summary: This eHealth Resources Toolkit (AFMC-Infoway) provides essential tools to prepare medical learners for practice in technology-enabled clinical environments.
OS12.06 - Strategic Integration of an Educational EHR into Health Informatics Curriculum (ID 127)
Purpose/Objectives: To support the effective design, development, implementation, use and optimization of electronic health records (EHR), there is a considerable need for Health Informatics (HI) students to have hands-on experience and training with using EHRs. However, many HI students in Canada have very limited exposure to EHRs in the classroom/laboratory setting. This lack of exposure results in student challenges with developing HI competencies that are pre-requisites for other courses, co-op work terms, and eventually the workplace. Consequently, HI students may feel inadequately prepared to design, develop, implement, and support EHRs as graduates. The integration of an educational EHR into HI curriculum is central to develop fully students' HI core competencies related to the health sciences. To meet this need, McMaster University procured an educational EHR for its Health Informatics and Health Information Management (HIM) diploma programs.
Methodology/Approach: To introduce the educational EHR to its HI and HIM Course Developers and Instructors, McMaster University organized a vendor-led training session with hands-on homework. The teaching team was provided the opportunity and option to use the educational EHR in their respective courses. As a part of the course redesign efforts for HTH 105: Information Systems and Technology, the educational EHR was adopted by the course developer and instructor for integration into the course curriculum. A three-hour scavenger hunt activity using the education EHR was included as a pre-requisite for the course. Relevant hands-on activities were included as weekly learning activities, providing 1-3 hours of weekly hands-on exposure to the educational EHR. Students were also provided supplementary activities to gain additional practice with using the EHR.
Finding/Results: Nearly all HTH 105 students (n=21/22, 95%) have adopted the educational EHR, completed the course pre-requisite EHR activities, and are completing the weekly hands-on EHR activities for the course. However, students have encountered a number of technical challenges with initial installation of the EHR and co-signing EHR notes (the instructor was not listed as a co-signer by the EHR vendor). The American-centric build of the EHR is also one limitation of the system. Nevertheless, the implementation challenges were presented as a learning opportunity for students to gain an understanding of the common issues faced during EHR implementation. Many students expressed the value they realized in "applying theory in practice" through use of the EHR. Evaluation and monitoring of the benefits and limitations of the educational EHR is ongoing until the end of the course (December 2016).
Conclusion/Implication/Recommendations: With the introduction of hands-on exposure to the educational EHR, HTH 105 students at McMaster University have experienced an EHR's features, learned how clinical and administrative data is inputted and retrieved, observed its workflows, evaluated its usability, and made recommendations for system improvements. These skills are foundational to the development of health sciences core competencies for HI students. Educational EHRs should be integrated strategically into other HI courses and programs across Canada to support the applied learning of HI students. Further, there is a need to develop a Canadian educational EHR to achieve this vision.
140 Character Summary: McMaster University's lessons learned will help inform the strategic integration of educational EHRs into HI curriculum across Canada.
OS21 - Adoption & Engagement (ID 27)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical
- Presentations: 4
- Coordinates: 6/06/2017, 01:00 PM - 02:00 PM, Room 206B
OS21.01 - Engaging Mental Health Clients/Patients in Closed Loop Medication Administration (ID 139)
Purpose/Objectives: Closed Loop Medication Administration (CLMA) supports client/patient safety by ensuring that they receive the right medication at the right time by scanning client/patient identification, as well as the medication to be given, prior to administration. In order to achieve a 95% scanning compliance rate as a mental health organization, feedback from all stakeholders involved in this process must be elicited. The purpose of this initiative was to implement an engagement strategy to solicit feedback from mental health clients/patients on their perceptions of the medication administration process using technology intended to promote safety.
Methodology/Approach: Engaging clients/patients provides invaluable information and insights into their experience of the use of technology for safe medication administration. To gain a genuine perspective from client/patients, a survey of 50 inpatient clients/patients was conducted by a mental health peer support worker.
Finding/Results: Quantitative and qualitative data was analyzed and then summarized by an Advanced Practice Clinician and a masters student. Themes were used to identify recommendations for improvements and innovative solutions to support the medication administration process. Preliminary findings indicate that mental health clients/patients value the nurse-client relationship, being engaged as an active participant in the process, and having choice in the client/patient identification methods. In addition, concerns about the intention of personal identification, physical comfort of wristbands, and having photos taken were raised.
Conclusion/Implication/Recommendations: Feedback was incorporated into educational initiatives for inter-professional inpatient staff, and considerations for organizational practices, policies and procedures were identified. Client/patient education material, including brochures and posters, were also developed as a means for communicating medication administration process and expectations.
140 Character Summary: An innovative client/patient engagement strategy regarding the use of technology for safe medication administration in a mental health inpatient setting.
OS21.02 - Telehealth and Medical Assistance in Dying - Enabling Equitable Access (ID 102)
Purpose/Objectives: In June 2016, federal legislation governing Medical Assistance in Dying (MAiD) was passed by Parliament. Patients experiencing intolerable suffering due to a grievous and irremediable medical condition may now end their life with the assistance of a qualified medical professional. However, MAiD is not immediately available in every community and not all doctors/nurse practitioners are willing or able to provide the service. The Island Health Authority has turned to Telehealth to help bridge this gap by connecting patients to appropriately qualified clinicians in other communities.
Methodology/Approach: Patients requesting MAiD need to have access to the highest standard of compassionate and respectful care, and healthcare professionals must be fully informed and supported. Every person requesting MAiD must be assessed to see if they are eligible for this service. A written and signed request must be witnessed by two independent individuals. In addition to the primary physician, a second independent physician or NP must also provide an assessment and written second opinion. Access to a secondary physician/nurse practitioner to complete the necessary documentation and assessment can be difficult in smaller communities. It may be easier for clinicians in larger urban facilities to access resources related to MAiD requests and develop proficiency in the associated processes. Given this reality, Telehealth was identified as a way to connect these providers to patients requesting MAiD in smaller centres such as Campbell River. Regardless of location, regulated Island Health healthcare professionals can act as a witness for a telehealth assessment to comply with the requirements of the process. Telehealth staff members have connected community hospital in-patients by video both at the bedside and in standard telemedicine rooms to clinicians in Victoria, across Vancouver Island, and to surrounding islands to complete MAiD assessments.
Finding/Results: Telehealth removes a significant barrier to MAiD for individuals facing end of life in rural and remote locations, or where no providers are available to support their application. Although Telehealth is accepted as part of an integrated approach to care, using it in this new, time sensitive and emotionally delicate service demonstrates the degree to which that integration has occurred. Challenges remain in terms of reliable quality video over wireless hospital networks; however, through the combined efforts of the clinical teams and the telehealth staff, those hurdles can be overcome and patients provided the same level of access to MAiD regardless of their location.
Conclusion/Implication/Recommendations: Telehealth, through the use of live video conferencing, can be used effectively to enable access for patients to MAiD where the necessary qualified health care providers may not be available in person.
140 Character Summary: Telehealth enables equitable access for Island Health patients to MAiD when qualified health care providers are not locally available.
OS21.03 - Innovative Change Management Approach to Implementing an Electronic Health Record (ID 302)
Purpose/Objectives: Purpose: The purpose of this proposed oral presentation is to share an innovative change management approach used to successfully support the implementation of an electronic health record in a 300 bed mental health care centre. The model is unique, based on formal stakeholder feedback and recommendations from an organizational EHR change readiness survey conducted in January 2015. The following actions were recommended to ensure effective transition to EHR Develop a robust change management strategy Creating a climate of influence and championship with leaders with particular emphasis on frontline clinical management Ongoing and innovative communication and clinical staff engagement initiatives with multiple opportunities for input from a wide variety of hospital staff Utilizing strategies to manage resistance and engage dissenters Ongoing stakeholder analysis regarding change and responding with customized interventions to build awareness and support staff Strong project structure and work plan(s) specific to the EHR change project Standardization leveraging the EHR change project as an opportunity to embed standardized change management practice in the organization The presentation will address the development and success of the change management strategies implemented by the organization in response to these recommendations.
Methodology/Approach: This innovates change support project successfully employed a unique methodology which integrated a diverse range of approaches and tools. It is intended as a pilot program which will serve as the organizational model for future change projects. This integrated approach included: Targeted application of the ADKAR model for successful change implementation Application of William Bridges model for transition as a theoretical foundation Sustained engagement with frontline clinical managers to develop their roles as transition leaders Collaborating with clinical mangers to develop and implement program specific change plans using customized tools and templates Establishing a long term change support committee, structured in sub groups to address the key components of the change project including: communication, clinical informatics, clinical manager engagement, advisory group liaison, organizational development, professional practice Establishing a large multi-disciplinary change advisory group to disseminate key information hospital-wide and support committee initiatives Integrating structured project management methodologies as a foundational element of the initiative. Integrating organizational leadership competency model adoption and training and with the change initiative Note: Because of its complexity, training coordination was considered as a separate function; independent of the change initiative.
Finding/Results: Currently, in house evaluation methods reveal a high degree of success in the EHR change process, including: 100% percent of milestones complete in the overarching committee change plan, a 100% compliance rate for program change plan development, and 25% (to date) of clinical staff being engaged in a structured change planning workshop. The formal post-survey results are expected in November, 2016. Positive indicators and opportunities for improvement will be explored more extensively in the final presentation.
Conclusion/Implications/Recommendations: The change survey recommendations provided an effective framework for an innovative EHR change plan which engaged the organization, supported staff, and project implementation. The plan will act as an effective vehicle to embed a standardized change management approach to support future initiatives.
140 Character Summary: Embedding an innovative change management approach in a health care setting using best practices developed from implementing an electronical health record.
OS21.04 - Speech Recognition Versus Traditional Transcription Model for Documentation in EMR (ID 166)
Purpose/Objectives: Speech recognition (SR) is a valid new technology that provides an alternative to back-end transcription services. SR facilitates dictation and editing of clinical notes in real time. Front-end dictation using SR was proposed as a quality initiative in our organization in which physician documentation is done mostly through back-end dictation. Manual transcription not only is expensive but also results in delays of hours and days that substantially affect the continuity and quality of care provided. Our objectives were to evaluate the quality of documentation and the cost effectiveness of speech recognition versus back-end dictation. In using speech recognition, we aim to align with our digital vision for better integration and interoperability of care via: Ensuring accurate, timely completion of reports by utilizing a dictation tool that has speech to text capability and integrates with our EHR. Reducing annual dictation costs. Optimizing physician productivity and satisfaction through providing physicians with a tool that easily integrates with their workflow.
Methodology/Approach: We proceeded with a 1-year pilot project which involved 115 physicians, implementing a cloud-based SR for documentation in EMR. Analysis of the quality of documentation was performed on a sample of physicians (n=38); in which 2 files per physician were reviewed pre, mid and post implementation of front-end SR using a physician documentation quality instrument (PDQI) tool to evaluate the quality of clinical notes. Physician education and one-on-one training was followed by post-live support throughout implementation. We addressed change management and adoption delivery challenges, and monitored the KPI of the software system by soliciting physician feedback and undergoing post live surveys of project success from the physician perspective. Furthermore, we addressed, documented and analyzed troubleshooting issues.
Finding/Results: Based on our initial findings there is an overall benefit in relation to documentation speed when using SR which resulted in elimination of time lag to report availability. The accuracy and completion of clinical notes improved. With the use of SR, the quality and timeliness of documentation were evident, however, the main drawback reported by physicians was the time spent on editing documents. The software performance in regard to accuracy, response time and author accent or speech impediment were favorable. Preliminary findings show a reduction in cost as a result of adoption of front-end dictation versus back-end dictation. Barriers to adoption included; prior experience with other dictation software version that had slower response time and higher error rate; fear of increase in the workload and lack of familiarity with the new process.
Conclusion/Implication/Recommendations: We conclude that SR is a potentially valuable and effective tool that improved the quality of clinical documentation and reduced the cost incurred through manual transcription. The implementation of SR in clinical practice significantly changed the clinical processes undertaken by our organization and these changes along with their follow-on effects may need to be further analyzed. The advantage to adoption of this technology must be weighted in regard to the efficiency, timeliness and the impact it has on patient safety as well as the added value it gives to the quality and continuity of care.
140 Character Summary: Speech recognition software versus back-end dictation improves quality, timeliness and the utilization of resources.