EP02 - From mHealth to Interoperability and Beyond! (ID 42)
- Event: e-Health 2017 Virtual Meeting
- Type: e-Poster
- Track: Clinical and Executive
- Presentations: 5
- Coordinates: 6/05/2017, 10:00 AM - 11:00 AM, Exhibit Hall B - Station 2
EP02.01 - Heading Ontario in the Direction of FHIR Without Getting Burned (ID 280)
Purpose/Objectives: HL7 Fast Healthcare Interoperability Resources (FHIR) is an emerging approach to integrating health care information systems using modern technology standards. The designers of FHIR have made ease of adoption a cornerstone of the standard for trial use. Desirable qualities include documentation that is freely accessible and easily consumable without the need for complex custom tooling, no licensing fees, and an emphasis on implementation examples for all artifacts and reference implementations for several platforms, including live test servers available over the Internet. This has contributed to FHIRs implementation by many projects before it has achieved normative standard status. As a result, rapid proliferation can lead to local interoperability but incompatible implementations between projects. This presentation will describe eHealth Ontarios environmental scan which sought to understand Ontario-based health care organizations readiness to adopt FHIR as well as the tactics that should be pursued to minimize incompatible implementations.
Methodology/Approach: The advantages of using FHIR and current adoption challenges were researched through an online literature review. Ontario stakeholder input was gathered by survey to understand perspectives on the direction of standards selection in the future, resource effort to learn new standards, and which stakeholders influence standards adoption. Over 70 stakeholders participated in a FHIR adoption readiness workshop aimed at learning perspectives on the state of FHIR adoption in Ontario, and the opportunities and cautions that should be considered in standards selection. Further input and stakeholder feedback was gathered on the subsequent FHIR Adoption Readiness - Ontario position paper. Finally, ongoing anecdotal reports indicated that organizations are implementing FHIR to solve local interoperability needs.
Finding/Results: FHIR appears to be in the early adopters phase in Ontario. Attributes from Rogers Diffusion of Innovations theory are applied to interpret the process of FHIR adoption within Ontario. What is less clear is whether all implementations of FHIR are using the same FHIR build and/or how significant these differences are in terms of achieving long-term interoperability.
Conclusion/Implication/Recommendations: FHIR, in some capacity, will likely continue to be adopted by the majority of Ontario health system organizations. The findings of this project indicate that Ontario should invest in efforts to influence standardization across FHIR implementations so that it is aligned with the broader North American health IT markets use of FHIR to minimize Ontario-specific customization.
140 Character Summary: Exploring Ontarios readiness to embrace HL7 Fast Healthcare Interoperability Resources (FHIR), as well as its benefits and pitfalls.
EP02.02 - Thought Spot: mHealth Intervention for Post-Secondary Students (ID 344)
Purpose/Objectives: Thought Spot (http://mythoughtspot.ca/ ) is an intervention that provides post-secondary students with an all-in-one online and mobile platform where they can geo-locate mental health and wellness services in the Greater Toronto Area (GTA). The CIHR eHealth Innovations Partnership Program Grant is aimed at optimizing the Thought Spot platform to effectively meet the needs of end users. Thought Spot makes access to information easy and interactive by mobilizing students to share knowledge about services, discover wellness options in their area and build support networks. The purpose of this e-poster is to provide an overview of the innovative participatory action research methods used during the engagement phase of this project. This project is split into two phases: engagement and intervention enhancement and intervention testing (RCT). Throughout the first phase, post-secondary students shared critical information related to accessibility of services, navigating university and maintaining mental wellness. Findings from our summer workshops with post-secondary students will be presented. Issues surrounding post-secondary students help-seeking behaviours, including barriers and facilitators and insights on how to optimize the Thought Spot intervention will be explored further.
Methodology/Approach: Through the use of participatory action research (PAR) principles, we recruited and engaged with students across the GTA to drive the optimization of the Thought Spot platform. The participatory action research strategy encompassed different levels of involvement from passive participation to self-mobilization. Consistent with co-design approaches and PAR, seven student-led workshops, attended by 59 students, were delivered to obtain student feedback regarding the apps usability, its potential value in a post-secondary setting, effective recruitment strategies for the evaluation and approaches to including health information in the app. The workshops were co-designed and co-facilitated by students to increase ownership and oversight by youth over the research process. A range of creative activities were delivered to provide opportunities for youth to share their views and experiences, including semi-structured focus groups, questionnaires, personas, journey mapping, user-shadowing, and a world café.
Finding/Results: Participants discussed the following issues related to help-seeking throughout the focus groups: feelings of confusion and vulnerability when accessing health services; concerns of stigma, taboo and labelling; and overall health care costs and time constraints. Innovative technological features and refinements to were also brainstormed throughout the workshops. Four key areas of improvement, within the app, were established: creating a hook that creates valuable and relevant interactions from the start; provide more social interaction within the users own trusted community; design more responsive discovery, search and navigation functions; and obtain better data and finesse organization within the app.
Conclusion/Implications/Recommendations: Preliminary feedback on engagement and optimization has been positive: challenges in maintaining individual engagement will be addressed by forming smaller student working groups and outlining clearer roles and responsibilities for all participants. Findings from phase two will significantly inform new technological features, within the app, that enable positive help-seeking behaviours amongst transition-aged youth. These behaviors will be further explored in the third phase: a randomized controlled trial.
140 Character Summary: Thought Spot is a mHealth/eHealth intervention providing post-secondary students with an all-in-one platform to locate mental health and wellness services.
EP02.03 - NutriMob: An e-Health System to Support Home Enteral Nutrition Programs (ID 123)
Purpose/Objectives: Enteral Nutrition is defined as the use of dietary foods for special medical purposes, independent of the route of application. It includes tube feeding via nasogastric, nasoenteral or percutaneous tubes. In Home Enteral Nutrition (HEN), many interventions involving dietitian expertise, are needed. The communication between health professionals and caregivers must be clear and direct. Furthermore, acceptance and training of family/caregivers are critical points for the successful of tube feeding treatment. The use of technologies to support professionals and patients, become essencial to reach effectiveness of tube feeding outcomes. This project takes an innovative health knowledge translation approach, to develop the NutriMob, an e-Health system that aims to support the assessment, prescription and monitoring of tube feeding in HEN programs.
Methodology/Approach: This research project was developed in partnership between the Faculty of Comuter Sciences and the Faculty of Nursing, Nutrition and Physiotherapy (PUCRS/Brazil). To develop the NutriMob system, we used the Open Unified Process, that applies an iterative and incremental approaches to a structured a life cycle, addressing an agile and pragmatic method that focuses on collaborative nature of software development. Also, we used an Unified Modeling Language, to provide a standard way to visualize the design of a system. The content of the computational solution has been obtained by requirements gathering, evaluation and validation of system through regular meetings of the working group and health professionals.
Finding/Results: The main results were: modeling of computational solution; definition and implementation of the decision-making algorithm; Website development; Android Mobile Application Development. To address the outreach issue, NutriMob is accessible to healthcare professionals and patients through the website and mobile application. To professionals, NutriMob provides evidence-based assessment and prescription of HEN, giving them a computerized clinical decision support. Our approach is to operationalize the paper-based international guidelines about HEN in terms of computerized decision support aids, so that health professionals can easily apply the guidelines to design patient-specific HEN programs. The main features of NutriMob Website are: nutrition assessment (anthropometric and subjective data) nutrition intervention (develops the nutrition prescription, choose of enteral formula, determines the caregivers/families orientation) and nutrition monitoring and evaluation (data from patients). To patients and patients families/caregivers, NutriMob is accessible via mobile phones (mobile application) to provide them instructions on how to administer the prescribed HEN and also to send them timely reminders and educational material (in the local language and soon in English), so that they adhere to the treatment. More information about NutriMob is available in: http://www.nutrimob.com.br/sobre.html .
Conclusion/Implications/Recommendations: In a year of activities, the NutriMob was consolidated as a research, focusing on multidisciplinary work and cooperation between professors, students and health professionals. The system has been developed and validated internally. The next steps will be external validation through the use of the system by healthcare professionals and patients.
140 Character Summary: NutriMob is an innovative e-Health system that aims to support the assessment, prescription and monitoring of tube feeding in Home Enteral Nutrition programs.
EP02.04 - MedChart: Empowering Patients and Improving Health Care in Canada (ID 283)
Purpose/Objectives: The objective of MedChart is to improve overall patient care by 1) empowering patients with easy access to their official health records; and 2) improving and streamlining the interoperability of medical records between health care providers.
Methodology/Approach: MedChart is a secure, cloud-based platform that transforms patient engagement by making access to official medical records convenient and reliable for patients. We digitize all records onto our secure Patient Portal and provide tools for health management and collaborative care. Using patient consent, MedChart provides online access to all clinical medical information (EHR data, imaging, written notes, etc.) from all of a patient’s providers, and gives the patient the ability to coordinate their care with physicians, family members, and other caregivers. MedChart also provides a comprehensive online platform for medical professionals to seamlessly request and receive medical records from any healthcare provider, clinic, or hospital in Canada.
Finding/Results: The current fragmented system of paper and electronic medical records makes the process of acquiring medical records extremely time-consuming and difficult. For patients, there can also be a financial burden associated with requesting medical records, and reading the records often relies on technology that the patient may not have access to (for example, faxes machines or medical image viewing software). Results from studies have indicated that access to patient medical records can enhance patients’ perceptions of control over their health (Giardina et al., 2013), increase feelings of trust and confidence in physicians (Archer et al., 2011), improve doctor-patient communication (Ross & Lin, 2005), and identify record errors. For example, in a recent report of an online patient portal system, it was found that almost 37% of users identified a medication error in their medical record, and 40% found errors in their allergy information (Epic EHR Program, 2015). For medical providers, the fragmented access of patient health information can result in less effective medical care, including adverse drug-events, delays in patient access to care, and unnecessary laboratory tests and medical imaging (Health Infoway, 2016). In addition, clinics with seamless access to patients’ medical records experience reduced time spent managing patient records, which also results in economic benefits (Health Infoway, 2016).
Conclusion/Implication/Recommendations: Patient access to personal health information is the keystone to proactive, patient-centred healthcare, and the current process for patients to access their health information is onerous and expensive. MedChart is an innovative online platform that allows patients to safely and conveniently access their official health records, resulting in more informed, empowered patients, and a better overall health care experience. Patients with access to their own medical records require fewer medical tests, experience fewer medical errors, and enjoy faster access to medical services. For medical clinics, the ability to make simple online requests for medical records, as well as having instant access to all of a patient’s health information, not only increases the quality of care, but also reduces administrative workload and therefore reduces costs.
140 Character Summary: MedChart is a secure cloud-based platform that is improving health care by providing simple access to patient medical records to patients and healthcare providers.
EP02.05 - Bridging the Gap Between Data and Standards (ID 219)
Purpose/Objectives: Across the health care system data are collected daily using multiple standards, often not well aligned. People working within the system are looking for opportunities to improve alignment between standards, hoping to reduce data collection burden and improve understanding and use of data to support evidence-based decisions. This project provides an example where two organizations have collaborated with the end goal of improving the experience for stakeholders by reducing burden and in this presentation, we will share the process, and lessons learned from a pilot implementation. The Canadian Institute for Health Information (CIHI) and Canada Health Infoway (CHI) collaborated to enhance the clinical nomenclature standard used in laboratories across the country to incorporate information required to create management information that complies with the MIS Standards as a byproduct of the clinical reporting process. As such, one standard can be used to support data collection for multiple purposes. Collect once, use many! CIHI maintains the MIS Standards, which underlies the financial and statistical data reported to the provincial/territorial ministries of health. This data is used to produce financial and operational indicators of efficiency, to support funding methodologies and for comparative analysis and benchmarking. Infoway maintains the clinical nomenclature standard for the clinical laboratory. This standard is used to populate clinical data within the eHR and the jurisdictional LIS.
Methodology/Approach: Flowing from the partnership between CHI and CIHI, a working group was established with joint membership. This working group of experts developed principles for the overall alignment between the two data standards. These principles were applied to over 30,000 codes and a new attribute added to the codes within the CHI clinical nomenclature standard. Since results are generally sent to a jurisdictional lab information system using the nomenclature standard code, the approach tested by a jurisdictional LIS was to a) identify those codes with the attribute of 'laboratory test' b) count the 'laboratory tests' performed by each lab c) categorize the tests by location of patient Pilot phase - will evaluate the feasibility of broader implementation, and will support the development of a more detailed implementation plan.
Finding/Results: A pilot is currently underway and we expect to share the results and impressions from the pilot site at the eHealth conference in the spring, along with next steps.
Conclusion/Implication/Recommendations: This project demonstrates the advantages of collaboration across standards organizations to reduce duplication, improve efficiency and support stakeholders when developing standards. Aligning standards so they can be used for multiple purposes helps the end user clarify and simplify data collection. This process can serve as a model for future work, as technology and more integrated systems demand that standards allow stakeholders to "collect once, use many".
140 Character Summary: Canadian Institute for Health Information and Canada Health Infoway collaborated to align a laboratory nomenclature standard to be used for multiple purposes.
EP06 - Adoption and Use Across the Care Continuum (ID 46)
- Event: e-Health 2017 Virtual Meeting
- Type: e-Poster
- Track: Clinical and Executive
- Presentations: 5
- Coordinates: 6/06/2017, 09:30 AM - 10:30 AM, Exhibit Hall B - Station 2
Purpose/Objectives: The Telemedicine Program at St. Michaels Hospital (SMH) functions on the mandate: To increase access to healthcare services and resources by supporting the adoption of telemedicine technologies. During initial years of its existence, telemedicine was somewhat of a novelty, appealing to early adopters who were open to use of technology in order to help increase access to their patients, who lived at a distance. In 2011, the Telemedicine Program at SMH employed specific adoption and integration strategies based on needs assessment and customization, with an ultimate aim to integrate and embed telemedicine in routine patient care practice. The Telemedicine Program at SMH is viewed as a strategic enabler that can support improved access to care while making delivery of health care efficient and cost effective. The telemedicine adoption and integration strategies, support our hospitals quality agenda in the areas of access, efficiency and patient experience as outlined in the Hospitals strategic plan.
Methodology/Approach: Recognizing the fact that introduction of telemedicine in a clinic environment means significant changes in otherwise well-established routines and processes, the adoption strategies focused mainly on clinicians readiness assessment, change management and ensuring simple and easy-to-follow new processes, to minimize disruption of routines. Detailed telemedicine clinical protocols are developed in collaboration with the providers to ensure an efficient and smooth telemedicine clinic, providing a seamless experience for clinical providers. Depending on need, new users are also given a trial run through a simulated clinic to address any concerns and to familiarize the users to technology. These initiatives were initially implemented in departments of General Surgery, Respirology, Mental Health, Geriatrics and Trauma. The increased clinical activity in these areas reinforced our standard approach to drive adoption in other clinical services. In a study conducted by a medical student at SMH, location of the telemedicine studios; disruption in the daily routine were identified as limiting factors for uptake of telemedicine. As a way of addressing the limiting factors, SMH Telemedicine Program implemented desktop videoconferencing solution PCVC (Personal Computer VideoConferencing) in physicians offices. Again, the introduction and integration of PCVC in clinicians offices followed the same philosophical approach for adoption.
Finding/Results: The impact is measured qualitatively by surveying users (clinicians & support staff), and quantitatively by number of providers using telemedicine to provide care for their patients and by telemedicine clinical activity numbers. The overall clinical activity numbers and number of clinical providers have doubled in years since the adoption and introduction strategies were introduced. Both qualitative and quantitative results will be shown on the poster for the conference.
Conclusion/Implications/Recommendations: These early results indicate that the SMH Telemedicine Programs adoption and integration strategies have enabled the program to demonstrate its potential as an enabler to address the issue of access, efficiency and sustainability. The adoption and integration strategies developed and implemented, with a focus on ease of use, by SMH Telemedicine Program, can help create a framework for approach to promote clinician acceptance and integration of telemedicine in delivery of healthcare.
140 Character Summary: This poster presentation will describe adoption and integration strategies implemented at a large academic health center.
EP06.02 - Workflow Analysis to Inform a Remote Patient Monitoring System Implementation (ID 104)
Purpose/Objectives: This summer student project created a workflow and implementation plan for a remote patient monitoring (RPM) system in a complex chronic disease management clinic. Baseline observations and analysis were performed in order to understand care pathways and identify how to introduce the technology and contextually train patients and providers involved in care. We avoided interruption of care while designing optimal methods for training and support. The goal was to improve patient outcomes through earlier detection and treatment modification to avoid complications and unnecessary hospital admissions. Based on favorable pilot study data the intent was to scale and offer RPM as standard care.
Methodology/Approach: Analysis of current workflow. The complete ambulatory process from patient check-in, waiting time, exam room, clinical care, and check out were carefully observed and documented. New workflow creation. UML diagrams modeled the training and deployment of the RPM technology in the clinic setting. This allowed clinic staff to easily and visually follow the steps on how to handle patients, reports, and notifications. The staff training was customized to roles and responsibilities and individualized on the basis of skills and requirements. Unique job creation. In order to provide ongoing support and sustainability, the analysis highlighted the need for unique roles and responsibilities to train and onboard patients and staff, advise them of system updates, gather ongoing feedback for quality improvement, and provide technical assistance. In addition, based on our observations and interviews we created print and online learning tools including videos tailored to the needs of patients and staff. Assembled kits were intuitive for a wide range of patients including the visually and physically impaired.
Finding/Results: Systematic and detailed workflow and process analysis was very effective in determining the implementation, training and support requirements for deployment of an RPM system in a large congestive heart failure clinic providing care to patients with advanced complex chronic illness. The UML diagram summarizes some of our key observations and proposed interventions.
Conclusion/Implications/Recommendations: Scaling an RPM system requires a clear understanding of the needs of both patients and the care team in order to implement, support and optimize the value of the deployed technology. There is sufficient data to support the use of RPM in order to improve patient outcomes in a variety of clinical conditions. The approach and learnings from this project will be applied to other patients in our organization and hopefully elsewhere in order to provide safer, more effective and affordable care.
140 Character Summary: Implementing a large scale RPM system requires the efforts of new workflows, electronic teaching materials, and unique staff.
EP06.03 - The Impact of Electronic Medical Records in Clinical Teaching Environments (ID 114)
Purpose/Objectives: Limited research has investigated the implication of Electronic Medical Records (EMRs) on physician education and training and what tools and functionality medical educators need to effectively supervise and teach residents.
Methodology/Approach: A quantitative survey was developed to assess respondents experience related to EMR use and their impact in clinical teaching environments. Participants across Canada were invited to complete the survey online with an email invitation. The themes and topics were identified in a previous qualitative study conducted by our research group.
Finding/Results: There were 147 surveys completed representing respondents using all of the most common EMR products in Canada. Most respondents were family physicians (67%) with a smaller proportion of interdisciplinary (24%) and specialist providers (12%). Responses demonstrated that 50% of learners received no formal EMR training. A majority of respondents (51%) felt that EMRs improved the learning environment compared to paper charts. For most of the specific features related to teaching and supervision between 15-30% felt that their EMR performed sub-optimally, poor or horribly. Seventy five percent felt that reviewing encounter notes was the most important feature, with 62% of users reporting their workflow to be good, very good, or excellent.
Conclusion/Implication/Recommendations: Our findings suggest that EMR use in Canadian teaching environments has had an overall positive impact. Several EMR features related to teaching had sub-optimal use and there is much room for improvement in workflows across Canada. Many areas requiring improvement were identified and could be used to advocate for improved functionality from EMR vendors. Clinician teachers who use EMRs, professional organizations that accredit training programs as well as provincial licensing authorities should be aware of the advantages and limitations of EMR functionality related to teaching and supervision of learners. Further research is needed to identify the impact of improvements in EMR design on training environments.
140 Character Summary: Study suggests clinicians felt EMRs improve their clinical teaching but more work still needs to be done to improve teaching functionality
EP06.04 - Scheduling/Registration Workload Assessment after Cerner Implementation: Lesson Learned (ID 165)
Purpose/Objectives: Orillia Soldiers Memorial Hospital (OSMH) is a community based hospital in North Simcoe Muskoka. The hospital recently implemented a Cerner Electronic Medical Record (EMR). The new system replaced paper charting as well as a home grown application used for Scheduling and Registration. In addition, some areas within the hospital had previously been using a manual booking procedure. The Project Management Office (PMO) and the Health Records Department developed a staff survey 4 months after implementation of the system, in order to assess the impact of the new EMR on clerks workload across various service areas in the hospital.
Methodology/Approach: The survey was circulated to 123 clerks with 75 (61.0%) responding Participants were from the following areas; ambulatory care 34 (45.3%), admission/preadmission clinic 11 (14.7%), cardiorespiratory service 9 (12.0%), diagnostic Imaging (DI) 7(9.3%), Day Surgery/OR 6 (8.0%), Emergency Department 5 (6.7%) and Dialysis 3(4.0%).
Finding/Results: Scheduling time was significantly higher in the new system compared to the previous one (7.9 ± 2.9) versus (3.3 ± 1.9) minutes P=0.001; respectively. A similar observation was found in registration (7.8 ± 3.7) versus (3.0 ± 1.8) minutes P=0.001; respectively. Ten users were using the new system for billing. The average workload duration of billing was significantly higher in the new system compared to the old one; (5.0 ± 4.3) versus (2.4 ± 1.8) minutes (P=0.017). 37 out of 75 (49.3%) users acquired new task(s). The average number of additional tasks was found to be 1.4 ± 0.64; range (1-3). Scanning documents was the most frequently added task at 15.0, with billing at 10.0 and the Wait Time Information System (WTIS) activity in OR and in Diagnostic Imaging at 5. Additional tasks were related to booking for more than one service areas or helping other end users. Time needed to scan documents varied considerably from 10 seconds to 15 minutes, based on the number of documents and the complexity of the task. No significant difference in the time needed to schedule or register cases between the different service areas had been observed (P>0.05).
Conclusion/Implication/Recommendations: The transformation resulted in an increase in OSMHs EMR Adoption Model (EMRAM) hospital score from 2.065 to 3.17 (OSMH). Increases in workload is believed to be related to: (1) complexity of the new system, the previous system was more streamlined in terms of data entry efficiency; (2) none of the service areas has implemented CPOE yet (HIMSS level 4); therefore, additional scanning of requisitions was now required; (3) additional tasks related to billing and WTIS could be contributing factor(s); (4) The time needed for users to master the new system (study was conducted 4 months post go live). It is anticipated that the numbers would be slightly reduced if this survey were repeated in 6 months. Senior executives and managers may use the information in this study to set up effective strategies prior to go live such as conducting time studies with their current health information system to determine if they need to adjust the resourcing during the interim/ongoing operation.
140 Character Summary: Workload impact on clerical staff is a significant issue following a hospital wide EMR adoption. Planning prior to go live is critical to ensure seamless transition.
EP06.06 - Launching Electronic Documentation for Community Nursing (ID 99)
Purpose/Objectives: It is well known and documented that electronic medical record systems offer substantial opportunities to organize clinical data in ways that can improve the coordination of care and services provided. As part of our organization's strategic direction to create more spectacular care, an initiative to introduce electronic documentation among nurses was undertaken. Objectives included streamlining documentation processes through collaboration in system design and improving client outcomes.
Methodology/Approach: The project methodology included a two-stage release, first to a small group of nurses and later to the community with planned roll-out across multiple regions in Ontario. Throughout the project cycle, an iterative approach to design was undertaken where nurses participated in development of new features.
Finding/Results: Several critical success factors were identified including early user engagement, strong technology vendor relationships, champion support and the ability to recognize the opportunity to redesign practices. Other success factors included ensuring frequent monitoring and feedback mechanisms during initial stages to ensure proper usage.
Conclusion/Implications/Recommendations: While much success has been obtained thus far, future work efforts will be focused on interface upgrades, specialized assessment tools to support specialty populations and the development of a client-facing interface which would further strengthen organizations commitment to client and family centered care.
140 Character Summary: Transforming the way community nurses provide care through the use of electronic documentation system.