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    EP04 - The Tango: Standards & Innovative Health Outcomes (ID 44)

    • Event: e-Health 2017 Virtual Meeting
    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 6
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      EP04.01 - Embracing Innovation in Healthcare: Dis-Organize for Disruption (ID 72)

      Paul Flach, GEF CONSULTING INC.; TORONTO/CA

      • Abstract
      • Slides

      Purpose/Objectives: How to "Walk the Talk" on Innovation To provide *practical and demonstrable* designs for implementing "innovative" organizations Innovation does not result from following a linear process - there are organization strategies and methods available to catalyze innovation An explanation on how these strategies and methods can be adopted by Healthcare organizations

      Methodology/Approach: We will look at radically new leadership strategies based on the phenomena of “emergence and complexity behaviour” and how they are employed to enable self-organizing and innovative organizations. Emergence and complexity theory identifies the stimuli for self-organizing behaviour and and the methods for managing this phenomena. We will also look at organizational strategies that deliberately implement a healthy tension between result-oriented analytics and sustainable product development to drastically increase productivity. Opportunity Management is another key method for ensuring that viable innovations are rapidly progressed from ideation, through approvals and delivery while ensuring a focus on optimal value realization.

      Finding/Results: Today’s most innovative analytical organizations are to be found in start-up companies unencumbered by traditional IT and project management paradigms. We will explain why large corporate organizations are grossly outmatched by the emerging data science community who were once looking for a level playing field and now have the upper hand as disrupters in the marketplace. This talk will demonstrate how large private and public corporations are radically changing their organization strategies and development methods to get back into the game as innovators and market disrupters.

      Conclusion/Implication/Recommendations: Organizations in both the public and private health sectors have realized that they need to re-organize and take a deliberate approach to foster and enable innovation especially in the area of data analytics. We will look at the strategies they have implemented. Then based on our extensive knowledge of the Canadian healthcare marketplace, we will then illustrate appropriate tactics and tools Canadian Healthcare organizations can implement.

      140 Character Summary: Innovation is one of the hot topics in Healthcare in recent years. This presentation introduces the concept of the Innovation Based Organization.

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      EP04.02 - Innovative Approach to Improve Healthcare Outcomes of a Bleeding Disorder (ID 175)

      Maha Othman, Queen's University; Kingston/CA

      • Abstract
      • Slides

      Purpose/Objectives: Rare inherited bleeding disorders such as platelet type von Willebrand disease (PT-VWD) exhibit considerable diagnostic challenges; however, standard guidelines for their management are as yet unavailable. Lengthy periods of misdiagnoses and subsequently inappropriate treatments resulting in significant morbidity can have serious implications on both patients and health care systems. Mysteries around the disease exist and research funding is scarce, leaving scientists with limited resources to support underprivileged patients. The purpose of this study is to propose a new interdisciplinary approach involving the primary care physician, the hematologist, and the laboratory, to improve diagnosis and management of PT-VWD.

      Methodology/Approach: Extensive international work www.pt-vwd.org on this rare disease with over 10 years of experience (Othman etal., J Thromb Haemost. 2016;14(2):411-4) and established International Society of Thrombosis and Haemostasis guidelines for diagnosis of inherited platelet disorders (Gresele etal., J Thromb Haemost 2015; 13: 314–22) together with a recent case series report (Sánchez-Luceros etal., Platelets 2016; in press) have provided the foundation for this proposal. The required resources including physician awareness/education, appropriate laboratory tests and personnel training were examined. Models from other systems/countries have also been evaluated. The proposal is based on: integration of a specific education module into physicians’ (primary care and hematologists) CME program, improved recognition and referrals of abnormal bleeding conditions (thrombocytopenia and VWD) in the primary care setting and the implementation of a simple diagnostic algorithm, where essentially all patients with provisional diagnosis of type 2B VWD and undiagnosed adult or neonatal thrombocytopenia, would undergo a simpli?ed RIPA mixing assay (Favaloro Semin Thromb Hemost 2008; 34: 113–27) followed by genetic analysis for confirmation.

      Finding/Results: A flow chart representing the diagnostic problem, implications of delayed diagnoses and the suggested interdisciplinary approach involving all stakeholders together with the proposed diagnostic algorithm will be presented.

      Conclusion/Implications/Recommendations: It is anticipated that incorporating this approach directly into the clinical setting will enable timely and improved diagnosis of the disease, reduce health care costs resulting from unnecessary and misdirected lab testing, inappropriate treatments and most importantly minimize patients’ serious bleeding complications.

      140 Character Summary: New interdisciplinary approach to improve diagnosis of PT-VWD and reduce healthcare costs resulting from misdirected lab testing and inappropriate treatments

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      EP04.03 - eNotifications: Timely Improvement of Patient Care and Health Outcomes (ID 284)

      Eric Labadie, Architecture and Standards, eHealth Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: eNotifications are events triggered by patient encounters within a health care setting, such as a hospital department (emergency department or in-patient) or a health care program (e.g. a Continuing Care Access Centre (CCAC)) or a patient status change in a clinical repository. Typically these brief messages are delivered to recipients (e.g. primary care physicians’ electronic medical record, hospital information system (HIS) or a CCAC) in near real-time. eNotifications aim to support better patient care and health outcomes through the timely availability of patient information (e.g. CCAC patient status, Health Link status, presenting condition) following trigger events such as hospital admit, transfer, discharge. What is the best approach for delivering eNotifications to recipients within the EHR eco-system?

      Methodology/Approach: Ontario’s current eNotifications landscape: Hospitals currently send multiple HIS admission/discharge/transfer (ADT) feeds to various recipients, including the provincial client registry (PCR), the Ontario Association of CCACs (OACCAC)/CCAC’s client health and related information system (CHRIS) and clinical data repository (CDR). Each of these ADT feeds differs slightly with respect to the type and format of the information it carries. The CHRIS system transforms the ADT message to a hospital report Manager (HRM) document targeted to the specified EMR recipient. An eNotification HRM document notifies the primary care physician that their patient has been admitted or discharged from hospital. The CHRIS system also sends an eNotification message to the OACCAC patient’s care team (e.g. registered nurse, meals on wheels) to let them know that the patient is in hospital. Finally, the CHRIS system sends an eNotification message to the sending HIS system about the community care status of the patient. Other circle of care partners have also asked to be notified when patient health status is changing.

      Finding/Results: Current electronic eNotification options exist as point-to-point interfaces to several solutions, creating multiple connections for health service providers to manage. This forces hospitals and clinics to maintain high IT resource levels, which is neither cost efficient nor effective. As Ontario builds centralized repositories and registries, we also need to provide eNotification capabilities for these EHR assets.

      Conclusion/Implication/Recommendations: A provincial approach to eNotifications presents an opportunity to coordinate and streamline Ontario’s investments in this type of communication, and to avoid implementing multiple point-to-point solutions to deliver eNotifications. eNotifications should be sent from health providers through a central solution to regulated or unregulated practitioners (recipients) who have a time sensitive need to know about the patient’s disposition, in order to facilitate delivery of patient care. eHealth Ontario is currently building a prototype eNotification solution in its Innovation Lab to validate design, feasibility and clinical value .

      140 Character Summary: eNotifications is a centralized solution to support better patient care and health outcomes through timely availability of patient information.

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      EP04.04 - Improving Surveillance of Communicable Disease in Canada (ID 295)

      Beverly Knight, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The capture and management of unsolicited Lab Test Results is needed to manage Public Health Surveillance of Communicable Diseases. Automated exchange between labs and public health agencies is not yet in place in all jurisdictions. This session will demonstrate how Public health resources led by Infoway have developed the data needed to automate management of communicable diseases.

      Methodology/Approach: Identify a jurisdiction who would lead the work Establish an open, group based community platform available for clinicians, ehealth representatives, vendors, developers, and others interested in working collaboratively. Develop a model to identify the required data elements and drive the values required. Leverage previous work Adapt the approach as knowledge evolves and as resources and participants are available. Publish the content so other jurisdictions could leverage the work.

      Finding/Results: Manitoba agreed to lead the development of 3 data sets based on the previously developed Communicable Disease data set. These data sets were intended to be used by those working in public health information systems to capture required data consistently and correctly to enable the management of communicable disease cases and outbreak management from both a jurisdictional perspective and a national perspective. Interested stakeholders were solicited to participate in the development including Public Health Agency of Canada, IBM, the Canadian National Microbiology Lab, and other jurisdictional lab and public health stakeholders interested in this work. Infoway established a space on InfoCentral for the stakeholders to come together to connect with experts, host meetings, and collaborate in the development of the data sets. The following data sets were developed: Causative/Etiologic agent Disease Presentation Disease Staging

      Conclusion/Implication/Recommendations: During the development of the data sets it was clear that a lack of clinical practice standards made it challenging to agree on the model and the data. Public health is an area where jurisdictions have different regulations making it also challenging for Public Health Agency of Canada and others who need to use the point of care data in communicable disease surveillance do use the data for national surveillance. It was challenging to “harmonize” the data to suit most stakeholder needs. And in the end there was a very valuable outcome agreed to by all who participated. Manitoba recognized and appreciated the other stakeholder input to make the data sets as “future proofed” as possible as Panorama evolves. The data sets are being used regularly to assist surveillance clerks in interpreting complex lab results to consistently and correctly input the data in the Manitoba Panorama system. This has resulted in better management of communicable disease in Manitoba.

      140 Character Summary: This session will provide an approach and lessons learned that public health and other stakeholders can leverage in their ehealth projects.

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      EP04.05 - Cancer Data Journey Through Activity Level Reporting in Ontario (ID 231)

      Michael Waligora, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: In Ontario, the Activity level Reporting (ALR) data is a major source of information about different aspects of cancer patient management such as consultation with medical oncologist, treatment regimen and treatment intent. The ALR data has been playing an important role in cancer patient management by providing support to funding allocation, system level performance measurement, and cancer related research. As ALR data is a unique source of information about cancer patient management, Cancer Care Ontario (CCO) has being working on improving its quality and coverage in order to promote meaningful secondary use.

      Methodology/Approach: Activity level reporting data is routinely submitted to CCO by 80+ hospitals including Regional Cancer Centres (RCCs) in Ontario. Following receipt of data by CCO, data quality assessment is conducted and if data is found to be of acceptable quality its added to the repository. Formatted and aggregated data is shared with different internal and external stakeholders to facilitate various secondary uses such as funding allocation, cancer care research, clinical and regional program reporting. In order to facilitate the cancer data journey i.e. to promote its secondary use, CCO conducted multi-level review of the program to identify and address the data quality issues. Through this process, healthcare providers, policy makers and researchers were engaged to validate their information needs and to identify any information gaps.

      Finding/Results: In order to facilitate the cancer data journey, identification and addressing of the existing information gap in ALR was done through engagement with internal and external stakeholders. To further promote the use of the cancer data, improvement in data quality has been implemented through development of data dictionary and data quality framework. These initiatives are expected to improve availability, usability and integrity of the data.

      Conclusion/Implications/Recommendations: Addressing of information gaps and implementation of a data quality framework leads to better cancer data to support improvements in system level performance reporting, equitable funding allocation and promoting an evidence based environment for better management of cancer patients.

      140 Character Summary: Improvement in ALR data quality and fulfilment of information gap will promote meaningful secondary use of data and facilitate the cancer data journey.

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      • Abstract
      • Slides

      Purpose/Objectives: Prior to the internet, the usual and often only method of getting information on credible consumer health services was probably during an appointment with your doctor. Today, both the public and health care professionals can easily access numerous health resource directories on the internet, but are they truly reliable? The presentation will describe the Standardized Inclusion/Exclusion Criteria that were developed to provide a rigorous and reliable framework ensuring the publicly funded online directory (thehealthline.ca) remains a trustworthy site.

      Methodology/Approach: Background In Ontario, each Community Care Access Centre (CCAC) is responsible for maintaining a regional directory of health and community services within its respective Local Health Integration Network (LHIN). The 14 regional directories are integrated into a provincial online directory (thehealthline.ca) with over 40,000 records, to support the delivery of information across Ontario. Providing people with high quality information is a critical component to help bridge the gap between patients and health resources in a health system that strives to deliver the best care possible. The information must be comprehensive, accurate, and up-to-date. The public and health care professionals rely on CCACs’ Information and Referral services and their respective regional online directories as a trusted source providing valuable information. In order to develop relations of trust, these regional online directories need to be hubs of certainty for those looking for accurate and reliable information. Standardized Inclusion/Exclusion Criteria were developed to provide a rigorous and reliable framework to ensure the information remains trustworthy for the health information seeker, knowing that the service profiles provided by the CCAC or viewed in the online directory may imply a “seal of approval.” The framework ensures that CCAC staff and public are aware of the scope and limitations of the CCAC online directory. Methodology/Approach Implementation of the online provincial directory allowed sharing of records between regions across the province. A service profile was identified that did not meet a particular CCAC’s inclusion/exclusion criteria, and a gap analysis was conducted to reveal inconsistent inclusion processes existed. A provincial working group was formed to explore the development of a provincial inclusion and exclusion criteria standard.

      Finding/Results: An inclusion/exclusion criteria document was developed, and to ensure validity, internal and external stakeholders were surveyed to provide broader feedback. The CCAC Information and Referral Service Profile Inclusion/Exclusion Criteria received final approval in September 2016. The criteria outlined three (3) main inclusion conditions that must be passed for an agency or service to include a service profile in the I&R database; Agency eligibility, Data requirements, and Service profile category eligibility Exclusion criteria are applicable throughout the onboarding process and thereafter in each review.

      Conclusion/Implication/Recommendations: The inclusion/exclusion criteria framework guides evaluation of health and community service categories and appropriate inclusion of service profiles. In addition, it provides a publically transparent criteria to support awareness of the scope and limitations of the CCAC online directory.

      140 Character Summary: Using a rigorous & reliable data governance approach, CCACs’ online directory of health & community services remains trustworthy to the health information seeker

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    EP08 - Novel Canadian Delivery Projects (ID 48)

    • Event: e-Health 2017 Virtual Meeting
    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 6
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      EP08.01 - The Value of Patient Generated Data (PGD) (ID 47)

      Reshma Prashad, Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The objective of this presentation is to discuss the value of patient-generated data. A summary of the dialogue in the industry and academia on the potential benefits of capturing, analyzing and utilizing patient-generated data will be covered. The forecasted benefits and the current progress towards achieving these benefits will be discussed.

      Methodology/Approach: An environmental scan of gray literature and an academic literature review were utilized to gather the facts for this presentation. This information was synthesized to derive the findings and arrive at the conclusions that will be presented.

      Finding/Results: The findings from the environmental scan and academic literature review revealed that both clinical and financial benefits can be gained (results of both international and national projects will be discussed) from capturing, analyzing and utilizing patient-generated data. However, despite the many benefits, the progress has been slow in the collection and utilization of patient-generated data in Canada. Currently, care is provided based on data collected from episodic interactions with care providers; this data does not accurately represent the patients’ health status. In many cases, it was shown that several interactions with care providers were required before a patient received the appropriate care. This is both costly to the healthcare system and results in unnecessary complications that affect a patient’s quality of life.

      Conclusion/Implication/Recommendations: Implications The implications of not utilizing patient-generated data have a significant impact on both clinical and financial outcomes. In terms of clinical outcomes, patients are not benefitting from the proactive collection of data that provides clinicians a better picture of their health status. The collection of patient’s data over a longer period is shown to help providers gain a better understanding of the patients’ health status and facilitates proactive care which results in a better quality of life for patients. In terms of financial outcomes, healthcare organizations are not benefitting from the collection and utilization of patient-generated data. Proactive data collection can facilitate care in the community versus costly care in acute care organizations that results when patients’ health status deteriorate significantly (due to a lack of proactive care) and cannot be handled in the community. There is potential for significant cost savings as a result of proactive management of patients; this is particularly the case for patients with multiple chronic conditions. In 2005-2008 the cost of caring for patients with multiple chronic diseases was $192.8 billion, many of these patients can benefit significantly from proactive management of their conditions which can result in reductions in acute care readmissions. Chronic diseases have a profound impact on society, both in terms of health outcomes and economic burden. Conclusions/Recommendations By discussing the results of the environmental scan and academic literature review, the goal is to create awareness and a call to action for healthcare organizations to leverage patients’ increased use of technology to enable a better quality of care and create a sustainable healthcare system through significant cost savings.

      140 Character Summary: The results of an environmental scan and an academic literature review on the value of patient-generated data will be shared with attendees.

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      EP08.02 - Students Mental Health Virtual Community: Results of a Focus Group (ID 222)

      Christo El Morr, York University; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Anxiety, stress and depression are on the rise among post-secondary student. Yet, support for mental health concerns available on campuses are limited and may not address the vast needs for students on campus. A recent survey of 25,000 students by the Ontario University and College Health Association reported a rise in anxiety, depression and suicide attempts rates in Ontario: 65% reported experiencing anxiety; 46% reported feeling depressed, 13% had suicidal thoughts. Further, campus based counsellors report that they are overwhelmed with the mental health needs. Indeed, innovation is needed to address growing mental health needs on campuses. Given that mindfulness is a proven technique that decreases levels of stress, anxiety and depression when delivered online, our team aimed to develop a student centered, Mindfulness Virtual Community (MVC) that could be scalable at a reasonable cost once found effective. Our research team has received a Canadian Institutes of Health Research (CIHR), eHealth Innovation Partnership Program grant to develop the MVC and conduct a randomized control trial to test its effectiveness (lower depression, anxiety and Stress) and efficiency (cost reduction).

      Methodology/Approach: In order to achieve this goal, we have conducted eight focus groups with students at York University, between April to May 2016, in order to elicit their mental health challenges, their online a behavior, and their perspectives about the development of an online MVC to address stress, anxiety and depression. In total, 72 students participated in the focus groups. The discussions were audio recorded and later on transcribed. All qualitative data was analyzed thematically using technique of constant comparison.

      Finding/Results: Participating students' mean age was 23.38 (SD 5.82) years, 55.6% identified as females,58.3% were working for varying hours. The focus group qualitative data analyses uncovered two themes related to the design of the Mindfulness Virtual Community: (1) the need for a dedicated mental health Virtual Community (VC), and (2) its desired content and features. Students perceived that the campus mental health resources were either limited and not known to students. They perceived value in having a student VC for mental health. The main advantages that the student found in an MVC were anonymity, flexibility and sense of connectedness. Student have seen anonymity as a way to overcome stigma associated with mental health and cultural barriers. Besides, they have expressed that online access to mental health resources allow flexibility in terms of commute and comfort (e.g. anytime, anywhere) and to be connected with peers having similar experiences. The main potential challenge of an MVC was cyber bullying, and thus students have seen the presence of a moderator as an essential requirement.

      Conclusion/Implication/Recommendations: A Mindfulness Virtual Community presents definitive advantages from the point of view of students, such as, anonymity, flexibility and connectedness. A moderation of the online forums is a must to guarantee a safe environment.

      140 Character Summary: Mental health challenges among students can be addressed by a moderated Mindfulness Virtual Community providing Anonymity, Flexibility, Connectedness.

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      EP08.03 - Critical Success Factors and Engagement Methodology for Successful Project Delivery (ID 313)

      Kathy Steegstra, Telemedicine, Trauma Services BC, Mobile Medical Unit (MMU), PHSA; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: The BC Patient Transfer Network (BCPTN) initiated the Patient Transfer Management System (PTMS) project to replace its existing application. PTMS will set the foundation for a standardized, integrated system with enhanced reporting functionality to drive improved outcomes. BCPTN engaged with TELUS Health to provide project management consulting services to bring the project to completion. The presenters will provide insight into how TELUS Health partnered with BCPTN to successfully deliver the project.

      Methodology/Approach: The TELUS Health delivery methodology contained four key phases. Planning and Analysis The TELUS Health team conducted a current state assessment of the PTMS project, to understand challenges being faced and strategies for addressing them. Stabilization TELUS Health reviewed the project structure and governance and provided recommendations. The TELUS Health project manager established a detailed project plan with defined resources and deliverables, and core project management processes. Transformation Working collaboratively with the project team, TELUS Health adapted an agile methodology to design the software to meet end-user requirements. A product owner from the business was empowered to make decisions about system functionality. Issue management and testing processes were put in place to bring the software to go-live readiness. Sustainment TELUS Health developed and executed a go-live plan, supported go-live, and managed the transition to operational support for the project.

      Finding/Results: A number of key lessons and critical success factors were identified during the delivery. Establishing Governance For TELUS Health, the first priority when engaging on a project is to validate and establish clear governance, with engaged sponsors and a steering committee. This enables the project manager to raise and resolve risks and issues, gain support on high priority asks and enable key decisions to be made. Delivering a Team-based Approach TELUS Health established a multidisciplinary consulting team, and leveraged each individual’s strengths to focus on driving process improvements in areas of the project with the highest business value. Maintaining Objectivity As an objective third party, TELUS Health conducted a fact-based current state analysis of the project. They created an action plan to appropriately address any challenges or barriers being faced. Driving Engagement The project team promoted transparent, regular communication between teams, and through governance to executive leadership to foster the trust required to move the project forward. Developing a Transparent Plan with Clear Deadlines The project team created a credible deployment schedule with a high likelihood of delivery. The scheduled was designed to be flexible and adaptable to meet business needs while maintaining the overall scheduling objectives. Managing Scope The project team collaboratively set about de-scoping items that were not critical for the project’s success in order to keep the schedule on track.

      Conclusion/Implication/Recommendations: By applying an adaptable methodology, TELUS Health was able to bring together a diverse project team with a strong focus on delivery, successfully meeting the client’s needs. The outcome was a successful deployment, allowing the PTMS project to realize its business objectives and ensuring that the patients of British Columbia will continue to receive the best possible care from BCPTN.

      140 Character Summary: TELUS Health will share its critical success factors and engagement methodology to successfully deliver a project on time, while meeting the client’s vision.

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      EP08.04 - Telegerontology: A Novel Approach to Rural Dementia Care (ID 183)

      Elizabeth Wallack, Medicine, Memorial University of Newfoundland; St. John's/CA

      • Abstract
      • Slides

      Purpose/Objectives: Telegerontology is a type of home Gerontology support that takes advantage of Information and Communications Technologies to facilitate remote medical care. The goal of this project is to test Telegerontology as a way to assist people with dementia and their caregivers to stay safe and age in place in rural and remote regions of eastern Newfoundland. We intend to enhance the caregiver/patient/physician triad using the remotely delivered expertise of a dementia care team and specialized remote assessment tools, thereby improving care for people with dementia in rural and remote areas.

      Methodology/Approach: Participants (n=19) were recruited through primary care physicians in four geographical regions within the Eastern Health Authority of Newfoundland. Primary care physicians identified potential participants from their practices and participated in interviews prior to the intervention phase of the study. Blocks of patients, grouped by primary care physician practice were randomized into intervention and control groups. All participants receive an initial home visit, an iPad with study-designed remote assessment apps, a case report with recommendations sent to family physician (implementation at the discretion of Dr.), occupational therapy recommendations, and post, 6 month and 12 month follow up. The intervention group received weekly Skype™ or telephone calls from a representative of the dementia care team.

      Finding/Results: Ten participants were assigned to the intervention group and 9 were assigned to the control group. The average age in the intervention group was 76 (SD±8.0), who had on average 8 comorbid conditions (SD±4) and who were prescribed an average of 8 (SD±5) medications. The control group (n=9) had a mean age of 77 (SD±7), with 9 (SD±4) comorbid conditions and were prescribed on average 8 (SD±4) medications. Caregivers in both groups reported similar levels of stress (Caregiver Hassle Scale) at baseline with 19.89 (SD±14.98) in the intervention and 19.44 (SD±19.99) in the control group. There were no significant differences found between the groups with respect to level of disability (Barthel Index) t(17)=2.076, p=0.053 or stage of dementia (Reisberg Scale) t(17)=0.992, p=0.580. At this time there have been an equal number of falls in the treatment and control groups (1:1); and fewer reported emergency room visits (2:4), hospital stays (1:2), primary care physician visits (18:22) and admissions to long term care (1:3) in the intervention group versus the control. Primary care physicians (n=11) noted the importance of anticipatory care, system navigation and caregiver validation in successfully managing dementia patients at home. With respect rural practice a lack of resources (dementia specific supports), unclear circles of care, and lack of communication between physicians and families were seen as barriers to effect service delivery. Twelve month follow up is complete for the first group (n=9). At this time we are completing 6 month follow up on group 2 (n=10). 12 month assessment will be complete in April 2017. Full results will follow.

      Conclusion/Implications/Recommendations: Preliminary findings provide evidence of the benefits of Telegerontology for the remote management of people with dementia living at home.

      140 Character Summary: The utility of Telegerontology was assessed as a way to assist people with dementia and their caregivers to stay safe and age in place in rural/remote Newfoundland.

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      EP08.05 - Innovative Model of Ambulatory Care Within an Academic Hospital Center (ID 240)

      Jacqueline Barrett, Women's & Infants, St. Joseph's Healthcare; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: St. Joseph’s Healthcare Hamilton is the busiest birthing centre in the region, delivering 3,600 babies per year, which accounts for 51% of all the babies born in Hamilton. The Obstetrics and Gynecology Clinic provides care for obstetrics (pre and post-natal), as well as gynecology patients. While the 2013 goal was a volume cap at 12,000 patients, the clinic received 13,747 ambulatory patient visits in 2014-15 and 14,013 ambulatory patient visits in 2015-16. Continued increasing patient volume in 2016 and cost containment pressures prompted an optimization review of services and an innovative model to emerge. Increasing access to care and efficiencies as well as acting upon pressures to reduce per patient care costs led to restructuring the ambulatory care model for Obstetrics and Gynecology.

      Methodology/Approach: This will be a phased implementation, both from a care delivery perspective as well as a physical location within the hospital buildings. The expected outcome will be to establish a new 11-physician group practice model situated on site with physical space including several in-kind hospital support services, but funded and managed independently by the physician group. The redesign includes recommendations for staffing, physical space and an operating business model. The methodology included a review of background information, an environmental scan to identify hospital-based clinics with a physician-funded and managed model, analysis of reports and clinic data, a review of all EMRs currently certified in Ontario as considerations to increase efficiencies for the new model.

      Finding/Results: For medical groups with 3 or more physicians, hiring a professional practice administrator may bring additional value and efficiency. The new structure ensures minimum overhead costs to the practitioners (?10%) including staffing and supplies and shows various options for revenue sharing between the practitioners depending on previous year revenues of patient volumes or equal revenue sharing distribution. Job descriptions were developed for the various positions at the Ambulatory OB-GYN clinic and use as appropriate in recruiting staff for this new clinic. Taking into account physician roles in teaching and research as well, the respective Women’s & Infant Program at St Joseph HealthCare Hamilton and the Ambulatory OB-GYN Clinic Physician group have endorsed a plan for physicians practicing within the hospital setting to integrate their independent offices and processes at an operational level, while ensuring the independence and autonomy of each medical staff at a strategic level.

      Conclusion/Implication/Recommendations: Recommendations included measurement metrics to know and track how the practice is performing clinically, financially, and in delivering services. Financial and operational considerations included tracking indicators of operational efficiency such as deliveries, diagnostic tests, surgeries by type, and outpatient visits. Tracking relative value units and revenue per doctor is also useful as indicator of practice performance. Managing change proactively was key to maintaining excellence in working relationship between physicians. Finally, looking at budgeted versus actual expenses and evaluating the service mix each month will ensure continued sustainability of the practice.

      140 Character Summary: St Joseph Healthcare Hamilton Hospital developed an innovative operating business model to restructure its ambulatory care model for OB/Gyn Ambulatory care.

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      EP08.06 - Stop Complaining About Healthcare Procurement: The Fix Is In (ID 373)

      Graeme Foster, GEF CONSULTING INC.; TORONTO/CA

      • Abstract
      • Slides

      Purpose/Objectives: Identity the pain points, common solutions and roadmap for change for traditional procurement organizations looking to adapt to the changing marketplace and Government policy agenda Introduce innovation procurement and provide real-world evidence of adoption

      Methodology/Approach: Provide a level set on traditional procurement models, functions and organizations Itemize the systematic issues with the tradititional procurement function Identity the pain points, common solutions and roadmap for change Introduce innovation procurement Provide real-world evidence of adoption of innovation procurement methods

      Finding/Results: Solutions to issues are rooted in process Strategic Sourcing / Strategic Procurement is an oxymoron in Healthcare - it doesn't have to be this way however Organizations have not evolved with the times - procurement of complex IT solutions or Solution-as-a-Service offerings require a higher level of sophisication and alternate engagement model from the procurement organization Fairness monitoring is analagous to a referee in a hockey game. The procurement officers are the players. So why is there often no coach?

      Conclusion/Implication/Recommendations: Innovation procurement is not the only solution to procurement challenges, nor is it the solution for all - we must crawl before we walk before we run However for those further along the maturity cycle, innovation procurement offers some truly powerful tools

      140 Character Summary: Healthcare Procurement has gotten a bad rap. And not entirely undeservedly. However there are solutions for Healthcare organizations of all shapes and sizes.

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