Purpose/Objectives: The purpose of the session is to provide an update St. Joseph’s Healthcare Hamilton’s (SJHH) Clinical Transformation project and their use of guiding principles in the rollout of our benefits driven implementation approach including lessons learned since our early design phase. Building on the poster presented last year, this is an opportunity to discuss where things have gone right and where we have had to course correct.

Methodology/Approach: Our poster last year described how SJHH used the Advisory Board Company presentation Best Practices for Realizing EMR Business Value from March of 2013, to embark on the development of a benefit driven implementation approach for use in the design and planning of the Clinical Transformation project. Through the use of this framework and others, SJHH has implemented the decision making process and has used the benefit realization plan and approach to focus decision making to achieve the desired clinical and business outcomes as they relate to specific target areas of improvement. A cross functional, inter-disciplinary benefits realization committee was created and is leading this work and to ensure the project maintains alignment to the principles established under the mandate of this committee.

Finding/Results: The benefits driven implementation approach to project planning has provided focus to the project ensuring that each decision made aligns with our project guiding principles and has a direct impact on a desired outcome. This link is empowering decision makers and provides a framework for making tough decisions.

Conclusion/Implications/Recommendations: We have completed design and are working through our build phase of the project towards an implementation in late 2017 and at this time have new lessons learned from using this process and how it has influenced how we use this approach in a complex, multi-year project. We recommend the exploration of this approach for use in other healthcare projects as it lends itself to ensuring continued focus on desired outcomes.

140 Character Summary: SJHH is using a benefits framework providing guiding principles to ensure project decisions align with desired outcomes for our Clinical Transformation Project.

Purpose/Objectives: Electronic medical records have the potential to transform community healthcare by improving care coordination, quality of care, patient safety and reducing inefficiencies. Despite the known benefits, the implementation of these systems has faced numerous challenges including poor workflow integration and end user adoption which suggests inadequate investment into interface design and build of the software. A study was conducted to evaluate the ease of use of a clinical documentation system as part of an iterative development cycle and acts as a case study demonstrating the value of early end-user engagement in designing quality-based systems.

Methodology/Approach: A low-fidelity testing environment mimicking a community environment was setup, where clinicians used the system by going through a series of tasks that were identified as critical elements of their current workflow. Observational techniques, retrospective audio analysis and participant surveys were used to qualitatively evaluate the system according to predetermined usability criteria and best practices.

Finding/Results: Through the usability testing process key deficiencies pertaining to ease of use, safety and quality were identified which resulted in numerous system requirements. The usability study also provided valuable information on the utilization patterns of Clinicians in the community, the process of documenting as well as identified unique nuances of the point of care environment all of which would have been undiscovered had end users not been given the opportunity to participate.

Conclusion/Implications/Recommendations: Usability represents an important yet very often overlooked factor that directly impacts the adoption and meaningful use of EMR systems across all healthcare sectors. Without usable systems, end users (eg. any member of the interprofessional team and/or client) cannot realize any of the potential benefits of features and functions of health IT systems.In conclusion, it is essential that clinicians play an active role in the selection, design, deployment and evaluation of health IT solutions and advocate for solutions that integrate with their current workflow, practices and needs at the point of care. It is vital for health leaders and adminisrators to recognize and acknowledge the unique community landscape by providing encouragement and incentives for clinican involvement in Health IT by ensuring there are opportunities for participation.

140 Character Summary: Evaluating usability of a EMR as part of an iterative design cycle while highlighting the value of early end-user engagement in developing quality systems.

Purpose/Objectives: The aim is to assess the readiness of Orillia Soldiers' Memorial Hospital (OSMH) to adopt the Electronic Medical Record (EMR) and to develop a change management plan prior to full implementation of the new system.

Methodology/Approach: The EMR Project Management team developed a survey which was sent electronically to OSMH staff and covered the following domains: Participant's characteristics, current use of paper / electronic chart, participant's expectations, engagement, and participant's computer literacy.

Finding/Results: The survey targeted 1200 participants with 304 (25.0 %) responding, of which, 214 (70.0%) reported regularly working with patients. The percentage aged 45.0 years or older was 57.0 % whereas 43.0% were below the age of 45. Participants working regularly with patients were significantly more interested in attending EMR seminars 132/194 (68.0%) as compared to remaining participants 35/74 (47.3%), P=0.003. Although 143/220 (68.0%) of Healthcare Professionals (HCPs) were interested in attending EMR seminars, only 18/32 (47.4%) of non-HCPs were interested (P=0.058). Seventy percent of physicians (12/17) and (66/100) 66.0 % of registered nurses were interested in attending seminars (P=0.811). When asked if an EMR will enhance best practice, 129/174 (74.1%) of HCPs, and 66/85 (77.6%) of non-HCPs agreed (P=0.644). Participants with previous experience in an acute EMR were much more interested in attending seminars and believed that the new system will enhance best practice as compared to those with no past experience, 102/167 (61.1%) vs. 48/102 (47.1%) P=0.031 and 127/151 (84.1%) vs. 76/116 (65.5%) P=0.0001; respectively. Sixty six out of 147 (45.0%) of participants ?45 years old believe that they need 10 hours or more of training to completely learn the new system and 23/110 (21.0%) of those younger than 45 think that they need that amount of time to learn the system (P=0.0001). Interestingly, the perception that the new system implementation was worth the time and effort, enhances work performance, makes the tasks easier and improves the quality of data did not differ between the two groups. The average of general computer and information literacy skills scores were significantly higher in the below 45 age group compared to above ?45 age group (3.5±0.62 Vs. 2.7±0.88, 3.3±0.74 Vs. 2.47±1.1, 3.4±0.6 Vs. 2.7±0.9 and 3.0±0.77 Vs. 2.2±0.97, respectively P=0.0001). The same observation was apparent in participants with previous experience in an EMR as they scored higher than those with no EMR experience in the first 3 domains and average information literacy skills score was nevertheless the

Conclusion/Implications/Recommendations: Staff without previous experience in EMR or without regular patient contact are less engaged and probably need additional, focused training. Interest among HCPs and non-HCPs is virtually the same. Regarding value of an EMR system, staff nearing retirement share the same attitude as their younger peers, but, feel a significant need for more training. The perception of the overall value of an advanced acute care EMR among HCPs and non-HCPs is similar.

140 Character Summary: Assessment of the organization readiness in the planning phase is necessary for successful implementation of the EMR projects

Purpose/Objectives: The patient perspective is a missing dimension in the reporting of health outcomes, which historically has been based on clinical and administrative data. Canada does not currently have a standardized program for the routine collection and use of patient-reported outcome measures (PROMs) data. Working collaboratively with a wide variety of stakeholders, the Canadian Institute for Health Information (CIHI) is developing a pan-Canadian PROMs program focusing on standards, data collection and reporting for different audiences in the health care system, including patients.

Methodology/Approach: In 2013-2014, CIHI performed an environmental scan of the PROMs landscape in Canada and internationally. In 2015, CIHI held a pan-Canadian PROMs Forum to advance the development of PROMs information across Canada. A series of recommendations arose from the Forum, including the identification of three clinical areas (hip arthroplasty, knee arthroplasty and renal care) for PROMs work. Demonstration projects have been launched in these areas with support by the clinical community and to illustrate the value of PROMs. Through working groups facilitated by CIHI, consensus was gained on condition-specific PROMs tools for the selected clinical areas and further work will include the development of standards for survey administration (covering timing, frequency, and survey modes) based on best practices and pragmatic considerations. An additional working group is focusing on the selection of a common generic PROMs tool that could be applied across sectors and clinical groups. In parallel, CIHI is investigating the applications of PROMs in terms of reporting for clinicians, administrators, health system policy makers, and patients.

Finding/Results: CIHI’s clinical area working groups have reached consensus on condition-specific PROMs tools: Oxford Hip Score (hip replacements), Oxford Knee Score (knee replacements) and Edmonton Symptom Assessment Scale (renal care). Working groups are focusing on survey administration standards, taking into account the varying implementation abilities across different jurisdictions and centres. CIHI is also developing a minimum data set standard for the collection of PROMs data in each of these areas. Work is underway to identify a generic PROMs tool as the national standard, with the Veterans RANDS 12-item Health Survey (VR-12) and the EuroQol Group EQ-5D as candidates. The recommended generic tool would be administered in conjunction with the condition-specific tool or on its own for broad health care sector or population surveys. Working in collaboration with stakeholders, CIHI will develop key PROMs measures that will support use of the data for varying audiences within health care systems. CIHI plans to make facility-level comparative data available to health system users in a manner that enriches current administrative and clinical outcomes reporting. PROMs data can also be used to support provider-patient discussions regarding expectations of outcomes related to care and specific patient characteristics. Development of Canadian population norms would support comparisons of individual patient results against these aggregate norms.

Conclusion/Implication/Recommendations: CIHI will continue to work with stakeholders to develop standards in PROMs tools and data collection for use in improving outcomes and the effectiveness of the health care systems.

140 Character Summary: CIHI is developing a pan-Canadian PROMs program, focusing on standards, data collection and reporting for a range of health system users, including patients

Purpose/Objectives: The purpose is to describe how the high touch high tech approach can be implemented into a mHealth app to improve quality and quantity of data collection.

Methodology/Approach: We worked closely with Carcinoid Cancer Foundation (CCF) to initiate this approach named Project Zebra. We recruited for both new users and existing registered user of the Carcinoid NETs app. We employed a “High Touch” component as a key feature to drive both acquisition and app usage (engagement). New and returning users were encouraged to fill out an online form to enroll in Project Zebra. Once complete, they were contacted by a coach. This coach helped them complete the demographic data and provided a detailed description of how to use specific health tools within the app. Peoples’ app activity was monitored and the coach followed up with them on a regular basis. On top of the high touch approach, we offered an additional incentive labelled health currency to this process. This incentive was designed to allow people to see that there is financial value to the data that they recorded.

Finding/Results: Through the recruiting efforts of both the CCF and Self Care Catalysts we report an increased number of new registrations by 150% over a 2-month period. During this time, those that were enrolled in Project Zebra had a 519% increase in the number of in app responses, whereas those that were not enrolled had a -4% change in responses. With respect to the financial incentive, despite its availability, only 35% of individuals met the requirement to receive the financial incentive.

Conclusion/Implication/Recommendations: The results described herein demonstrate that the use of high touch high tech approach compared to a standard approach yields substantially increased rate of user acquisition, and rate of engagement. The increased use was not solely dependent on the financial aspect as many users who had access to this chose not to complete the required components to receive compensation. This suggests that financial compensation alone does not account for the increase in app engagement, and that it is the human contact that is more important at driving user engagement.

140 Character Summary: High touch high tech approach for patient engament with mHealth

Purpose/Objectives: Healthcare literature is inundated with publications promoting the promise of e-health tools and interventions in delivering improved patient outcomes. Frequently, these reports feature discussion of patient engagement, empowerment, activation, or some combination therein. The issue that appears to be arising however, is the indistinct use of these terms in the science of e-health, particularly regarding how the influence of technological solutions are measured and reported. The purpose of this research was to reexamine these critical concepts and unite both academic and software development perspectives to more effectively operationalize these measures for future research and practice.

Methodology/Approach: A scoping review on patient empowerment with a particular focus on the measurement of this concept in relation to e-health intervention was conducted. During the course of this review the overlapping, and in certain instances, interchangeable use of empowerment and engagement emerged. Literature featuring patient activation, and more specifically the use of the PAM or Patient Activation Measure, completed the concept trifecta. Using the review as a foundation, an interdisciplinary team was formed with both academic research and ICT practice representation. Through this collaboration, an in-depth analysis of the concepts of patient engagement, empowerment, and activation was undertaken with the express purpose of harmonizing terminology between the domains and providing a means of distinct application and measurement of these concepts for future use.

Finding/Results: We have concluded that while empowerment, engagement, and activation are closely interrelated they describe very different aspects of patient participation in the process of healthcare self-management. Ongoing confusion of these concepts, especially in their operationalization and measurement, risks a dilution of e-health science and potentially the advancement of patient-focused intervention. The integration of academic rigour and software development best practice has resulted in a new conceptualization of these key aspects of performance measurement and a more precise framework on which to move forward.

Conclusion/Implication/Recommendations: The ongoing evolution of e-health technology will increasingly require joint undertakings between healthcare, and computer science/software development professionals. This should include the critical work of efficacy assessment and detailed performance measurement that serves the needs of both domains. By recognizing crucial differences in the concepts of patient engagement, empowerment, and activation and delivering a collaborative view on the mechanisms underlying each, we have proposed a framework for clear and concise future measure. This work can support researchers and health informatics professionals in more consistent and exact evaluation of the degrees to which patients are involved in healthcare self-management and decision making, and ultimately, the quality and success of that involvement.

140 Character Summary: ICT meets academia in a collaborative analysis and reconceptualization of patient engagement, empowerment, and activation including future use and measure.

Purpose/Objectives: Utilization of the continuously-generated data from physiological monitoring medical devices has been predicted to advance medical research and lead to improvements in patient care [1-3]; however, there is a lack of information documenting the acquisition of high-resolution physiological data in live clinical settings. Medical Device Integration (MDI) solutions and Clinical Information Systems (CIS) typically implemented into healthcare facilities are designed for integration into Electronic Health Records (EHRs) and provide limited numeric snapshots of complex physiological data [1, 2]. Tools claiming the ability to support high resolution data stream access often provide little or no information on in practice use; data quality, frequency limits, parameter profile, scalability, and system impact are unknown. This presentation demonstrates the acquisition of high-resolution physiological data in a live clinical setting and provides in practice information on data encountered. REFERENCES: [1] Belle, A. et al. “Big Data Analytics in Healthcare,” BioMed Research International,” vol. 2015, Article ID 370194, 16 pages, 2015. doi:10.1155/2015/370194 [2] De Georgia, M.A. et al. “Information Technology in Critical Care: Review of Monitoring and Data Acquisition Systems for Patient Care and Research,” The Scientific World Journal, vol. 2015, Article ID 727694, 9 pages, 2015. doi:10.1155/2015/727694 [3] Rumsfeld, J. et al. “Big data analytics to improve cardiovascular care: promise and challenges,” Nat Rev Cardiol. 2016 Jun; 13(6):350-9. doi: 10.1038/nrcardio.2016.42

Methodology/Approach: We simultaneously captured high-resolution physiological data streams from 44 Phillips IntelliVue patient monitors in a Critical Care Unit (CCU) using a software-based Biomedical Device Integration tool. Patient parameters, waveform and numeric, were captured including: arterial blood pressure, respiratory impedance, plethysmography, electrocardiogram (ECG), heartrate, and peripheral oxygen saturation (Sp02). Data and parameter information was captured from high-resolution data streams encountered in a live CCU, from 44 patients monitors simultaneously, and averaged over a 24hr period.

Finding/Results: 1) 62 distinct numeric and waveform parameters encountered; 2) 1,400 average data points per second per patient; and 3) 3.7 gigabytes of data generation per patient per 24 hour day.

Conclusion/Implications/Recommendations: High-resolution physiological data is being captured in a live clinical environment and is providing biomedical researchers additional visibility into subjects’ physiological status. This demonstration shows the feasibility of capturing high-resolution physiological data in intensive care units using a biomedical device integration tool. High-resolution physiological data acquisition is a viable option to support biomedical investigation in live clinical environments.

140 Character Summary: This presentation demonstrates the acquisition of high-resolution physiological data from biomedical devices in a live Clinical Care Unit.

Purpose/Objectives: A web-based form could potentially solve several issues that currently plague electronic medical record forms: 1) Forms cannot be updated each time a new discovery is published in the literature; 2) Version control is almost impossible with current forms; 3) Every physician has to update their own forms each time an update is required; 4) Data is not easily captured for analysis and reporting; 5) Clinical decision support cannot be provided within the form, decreasing the impact of decision support; 6) A/B testing, the most powerful tool available to web designers, is not available to EMR vendors, researchers and clinicians. We sought to design an architecture that will allow web-based forms to integrate into multiple EMRs, be used seamlessly by health care providers and that will allow data captured on the web to be returned to the EMR for medico-legal purposes.

Methodology/Approach: We used a user-centered design process to identify user needs. We then engaged in joint design sessions where mockups of the form were modified iteratively and in real-time to address user feedback. Once the mock-up was finalized, we developed a prototype of the form for further evaluation. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, a well-accepted and validated questionnaire, to assess user acceptance of the form and behavioral intent to use the form.

Finding/Results: Users (N=12) responded to questions on a 5-point scale. We aggregated the scores by calculating the % of respondents who Strongly Agreed, Agreed or Somewhat Agreed. If the % was greater than 66%, it was colored green. If greater than 33% and less than 66%, it was colored orange. If the % was less than 33, it was colored red. See Table 1. Overall, the form was considered easy to use (Effort Expectancy) and useful for completing clinical work (Performance Expectancy). More marketing and supports could enhance Social Influence and Facilitating Conditions for use of the form.

Conclusion/Implication/Recommendations: Creating and integrating a web-based form into multiple EMRs is feasible and can be created in a way that clinicians find interesting and useful. This new tool could support capture of standardized data across multiple EMRs, allow for the return of clinical decision support to the point of care and be easily updated when new knowledge is published in the literature. The form could also be used for advanced A/B testing for forms improvement and for improving the quality of clinical decision support.

140 Character Summary: New web-based form revolutionizes application of evidence-based medicine to electronic medical records. Time to re-evaluate our current approach to EMRs.

Purpose/Objectives: Attendees will learn about: 1. A program that has the potential to involve a large part of Ontario and is leading strategic system improvements to support faster access to the majority of health services 2. The unique innovative design approach to develop a secure, system-wide, open electronic referral (eReferral) technology platform. 3. A patient portal and notifications system that supports patient and caregiver access to referral information and patient self-booking of appointments.

Methodology/Approach: The eHealth Centre of Excellence (eCE) is leading the innovative System Coordinated Access Program (SCA) to: 1) improve knowledge of and access to the majority of health care services for providers and patients, 2) support organizations to coordinate access to services and, 3) support the development of an eReferral solution and patient portal. To realize these goals, SCA collaborated with the Waterloo Wellington’s Community Care Access Centre and Local Health Integration Network to secure a vendor consortium to build an open and flexible system that will evolve as both technology and healthcare systems change. This eReferral solution is starting by supporting specialist referrals, referrals to a Central Intake Program, and patient self-referrals, and will support other work-streams as time goes on. A unique benefits realization model will be utilized for the SCA evaluation, to understand the realized workflow efficiencies, clinical value for provider and patient, organizational value, and economic impact.

Finding/Results: The Ontario-based consortium of Think Research, CognisantMD, and the Centre for Effective Practice was selected to lead the design and deployment of the ground-breaking eReferral platform. Three Proof of Concept (POC) pathways will be deployed using a rapid prototyping approach and involve input from patients, clinicians and administrators. The results from these POCs will determine if SCA will proceed with the current vendor consortium to support the future state vision of SCA. Results from the POCs and the go/no-go decision for the vendor consortium will be available for the eHealth 2017 Conference. A review of the growing body of literature on referral systems has demonstrated that access to services and patient and provider satisfaction can be improved by the implementation of an eReferral system. Parts of the benefits evaluation including some of the economic analysis will be available for the eHealth 2017 conference.

Conclusion/Implication/Recommendations: Digital healthcare solutions should be designed as an ecosystem, where functionality can be added by many different partners and information can be integrated from different systems. Such solutions are needed to support complex processes like referral to multiple parts of the health care system. Patients and caregivers should receive faster access to services close to home and be able to find their own services. Primary care clinicians should have access to up to date information on the availability of services, referral status and their patients’ outcomes. Specialists and service providers should receive complete and appropriate referrals and have fewer patients miss appointments. SCA offers a unique approach and a critical combination of project, clinical, change management, health system, and technical expertise that will ensure the successful creation and use of an eReferral platform.

140 Character Summary: @eHealthCE is leading the innovative @SCAprogram to design an integrated and adaptable eReferral system

Purpose/Objectives: Discuss the future of mHealth and eHealth support for patients going through Home-Hemodialysis (HHD) treatments, leveraging the experience of the world-renowned UHN Explore Home Dialysis Program. Data extracted from a global assessment of the barriers to HHD and Peritoneal Dialysis (PD) will be used to show the landscape of home dialysis programs and how mHealth and eHealth tools should be designed to support HD patients.

Methodology/Approach: Dialysis is an artificial process used to eliminate harmful metabolic waste, salts, and excess water from the blood of patients with kidney failure. There are two types of dialysis, peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the inside lining of the patient’s abdominal cavity to filter the patient’s blood; while hemodialysis utilizes an artificial filter (dialyzer) that cleans the patient’s blood on an external machine (dialysis machine) outside the body, before returning the filtered blood back into the patient’s bloodstream. Unlike traditional hemodialysis that is performed by nurses in hospital settings, home dialysis treatments (HHD and PD) allow patients to perform their own dialysis independently in their homes, promoting better quality of life as it allows greater flexibility and convenience in the treatment and daily living.

Finding/Results: Barriers – Despite the benefits of home hemodialysis, several barriers still limit the successful implementation of this type of treatment for large patient populations. The most important barriers to self-care from a patient’s standpoint include patient education, remote patient support, and access to information about their treatment and equipment. Although systemic barriers also impact the deployment of HD, patient-perceived barriers are one of the main constraints to the wider deployment of HD. Needs – To successfully self-manage their care, patients need tools that will allow them to understand and take control over their treatment on a daily basis, as access to nurses and clinicians is limited. The utilization of eHealth and informatics can help by providing patients with easy access to information that will give them the ability to manage the common issues and maintenance of the machines on their own. Most of the patient-perceived barriers could be addressed if a combination of telehealth and educational platform was available to them. Potential tools – mHealth platform delivering access to training and FAQ about their treatment, remote technical support and training for their equipment, the ability to communicate with and seek medical advice from healthcare professionals remotely, and gaining access to their health information to monitor the changes and effectiveness of their treatment overtime. Examples of how these tools have been used to support patients with other chronic diseases will be explored.

Conclusion/Implication/Recommendations: Home dialysis has a strong positive effect on patients’ quality of life, but the perception that HD is risky and that patients and caregivers may not have the direct support of nurses can be a barrier to the wide deployment of the technology. mHealth and eHealth systems with the features outlined in this proposal could be used to support patients at home and ensure that they have the right level of oversight while getting accustomed to the technology.

140 Character Summary: Discuss some of the user-perceived barriers towards the deployment of home dialysis technology and how mHealth tools can be designed to support these patients.

Purpose/Objectives: To meet accountability demands, health-care organizations are expected to invest in quality improvement initiatives and demonstrate their performance through various health-related indicators, which are predominately based on outcome indicator measurement. Such measures include minimal focus on the human resource (HR) related structures and evidence-based nursing practice interventions that greatly impact health outcomes. Therefore, this presentation will describe how the web-based innovative Nursing Quality Indicators for Reporting and Evaluation® (NQuIRE®) data system facilitates the evaluation of HR structure indicators, and best practice guideline-based process and outcome indicators, and how this interrelationship effects quality health care. The main learning objective of this session is to facilitate the understanding of leaders across the health-care continuum related to leveraging technology applications to generate and utilize evaluation indicator data to optimize evidence-based, safe, quality health care.

Methodology/Approach: RNAO's Best Practice Spotlight Organization® (BPSO®) designation is a globally recognized knowledge translation strategy that engages health-care organizations in a formal partnership to implement and evaluate the use of RNAO’s Best Practice Guidelines (BPG). The program promotes the spread of evidence-based nursing practice and quality patient care and to date encompasses over 500 health care organizations world-wide. To evaluate the guideline implementation efforts of BPSOs, RNAO has developed NQuIRE, a unique international data system of quality web-based indicators that collects, compares, and reports data on HR structure and guideline-based nursing-sensitive process and outcome indicators. Because of the inclusion of structure, process and outcome indicators, BPSOs can meet their targets on quality improvement initiatives, and demonstrate their performance on various health-related indicators focusing not only on outcome indicators, but also on the evidence-based process indicators and the human resources context. This unique and innovative international data system to *advance the evaluation* of the effects of human resources structures within health-care organizations, and evidence-based nursing care on patient outcomes and organizational and health system performance, provides sound information about the impact of evidence-based guidelines on practice and outcomes and the necessary human resources required. The growth and expansion of the NQuIRE data system participation globally in health-care sectors in Canada, Spain, Chile, Columbia, Australia, Italy, South Africa, and China will lead to cross country comparisons of: client outcomes, use of evidence-based practices and nursing's contribution.

Finding/Results: NQuIRE is a unique approach to quality improvement in that it includes performance measurement and helps to foster a culture of evidence-based practice within BPSOs. Its technology enabled features such as the auto-generated single and overlay indicator run charts with annotations, as well as the dashboards enable BPSOs to conduct within-BPSO comparisons of units/wards/programs. These features have greatly enhanced monitoring of performance indicators that are aligned with BPG implementation in local, national and international BPSOs across the care continuum and have shown to improve health outcomes

Conclusion/Implication/Recommendations: Health-care leaders in BPSOS globally are able to utilize their NQuIRE data to: a) determine the extent of evidence-based intervention uptake (b) identify how process indicators (nursing interventions) impact clinical outcomes and (c) demonstrate the impact of human resources on quality evidence-based practice and client outcomes.

140 Character Summary: This presentation describes how the innovative NQuIRE data system facilitates the evaluation of structure, process and outcomes indicators on health outcomes.

Purpose/Objectives: Smart cities is an endevour to assimilate technologies and and IoT (Internet of Things), securely and efficiently to manage assets in a city, including hospitals, care centres, waste management, community services, schools - to name a few. In the past decade, density of urban population has risen, so has the longevity due to healthy ageing population in the cities. Subsequently, there is growing demand to enhance the quality of life, such that the ageing population can live longer independantly in their homes rather than care facilities. The objective of this research is to explore IoT solutions that faciitate the above mentioned evolving needs of citizens, while engaging them in the process, leading to the development and growth of smart cities.

Methodology/Approach: This research has taken an exploratory approach, leading from empirical findings relating to an RFID implementation project within hospitals. Specifically, the use of wearable devices has been explored in the hospital context, extending to home care, seamlessly, in the Australian context. Furthermore, using the theories of participation and engagement, an investigation is presented on extending hospital care to homes, engaging citizens and using IoT devices. Recommendations are presented through Living Labs approach used by the Space and Global Health Expert Group (Committee on Peaceful Uses of Outerspace Affairs - COUPOUS) within the umbrella of the United Nations initiative of building sustainable communities.

Finding/Results: The findings elaborate on real-time potential of IoT in the context of bringing long term sustainable care, within homes, enabling the ageing population in cities to live independant lives for a longer term. By engaging citizens in the process of assimilating IoT devices assist in the diffusion into communities, thereby leading to smart communities and smart cities.

Conclusion/Implication/Recommendations: IoT devices present a sustainable, smart future for communities around the globe, as illustrated in the findings. Assimilation of IoT devices into the assets of a city (such as hospitals, care centres, schools, rehabilitation centres etc) facilitates improvement of quality of life in a sustained manner, leading to smart cities. Citizen engagement through the Living Labs approach is recommended for increased participation of citizens in the translation of IoTs into smart cities, at a faster pace.

140 Character Summary: IoT solutions that faciitate seamless healthcare for smart cities, considering the needs of ageing populations, through Living Labs approach of UN Expert group.