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    RF01 - Innovation Is No Longer an Option in Digital Health (ID 10)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 6
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      RF01.01 - Beyond Cranes and Concrete: Creating Smarter Hospitals (ID 230)

      Z. Szalay, EllisDon Corporation; Misissauga/CA

      • Abstract
      • Slides

      Purpose/Objectives: To demonstrate the shifting roles and responsibilities within the construction process as it pertains to Hospital CIOs, IT Departments, Redevelopment Staff, Clinical Staff, Biomed and construction partners to determine integration and interoperability requirements. This partnership flushed out efficiencies in the Hospital’s overall operations for all stakeholders. Due to the complexity of this project, EllisDon developed a dedicated group, EllisDon Information, Communication, Automation and Technology (ED-ICAT), to assemble teams who understood Hospital workflows, clinical applications and IT requirements. The General Contractor selected healthcare integrator Orion Health to deliver the new integration solution at Joseph Brant Hospital.

      Methodology/Approach: The Joseph Brant Hospital Redevelopment project had a detailed integration requirement that included replacing the existing end-of-life Hospital Enterprise Service Bus (ESB)/Integration Engine, which was responsible for the data exchange of all administrative, clinical, and patient information systems. The construction team was tasked with delivering 164 integration and interoperability use cases to help facilitate clinical workflows. This included creating customized alarm workflows as part of an alarm management system deliverable. User group discussions with clinical, facility management, IT, and security personnel were held to determine the Hospital’s business requirements. Through this process, alarm workflow documents were created, including alarm collection, alarm filtration, and workflow design. EllisDon partnered with Orion Health to migrate existing HL7 interfaces from the existing integration engine and create new interfaces for the Hospital systems. ED-ICAT, Orion Health and the Hospital user workgroups reviewed existing message definitions and message specifications of all source and destination systems, and their interdependencies. Components of the integration were broken down to the thread level whereby each source, destination system, and interface type were identified. All parts of the integration were validated in a stringent commissioning process consisting of pre-functional testing, functional testing, stress testing, and integrated testing.

      Finding/Results: Successful delivery was contingent on: professional design consultants who understood clinical applications to provide clear direction, input from clinical staff who understood the Hospital's daily operations, defined use cases which equated to outcomes early so deliverables were clear, and oversight from the ED-ICAT group to ensure integration and interoperability requirements were met. The Hospital transition team, commissioning team, PDC team, and ED-ICAT group developed a comprehensive commissioning plan, testing all alarm points via a three-stage process that included functional testing, integrated testing, and stress testing.

      Conclusion/Implications/Recommendations: Defining the scope was important to identify objectives and to tailor system configurations and integrations to achieve the desired workflow. ED-ICAT had extensive understanding of networks, servers, system architectures, Hospital workflows and clinical applications, which was crucial to the project’s success. Testing all critical alarm points, as well as integration use cases for performance criteria and then trying to break the system, proved the systems were capable of handling increased traffic. Completing the technology prior to construction meant the project team could fine tune system configurations before the full roll-out of the remaining areas. Hospital staff performed individual testing in various early-access areas, and the ability to train other Hospital staff members in advance of project completion ensured they were ready for opening day.

      140 Character Summary: The project's collaborative effort brought together many groups to achieve a smart, effective, efficient Hospital meeting the needs of its day-to-day operations.

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      RF01.02 - Institutional Teledermatology: Impact of an Urban E-Health Initiative (ID 284)

      T. Champagne, Division of Dermatology c/o Laura Barwell, Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Teledermatology, the clinical practice of dermatology using e-health technologies, is a rapidly advancing field in telemedicine. Dermatology complaints comprise nearly 25% of primary care visits and can be impactful on quality of life, morbidity, and potentially mortality. The original purpose of teledermatology is to overcome geographical barriers to access specialty care. At Women’s College Hospital (WCH), in Toronto, Ontario, an institutional teledermatology initiative has been developed that uses existing, accessible technology to provide consultative dermatology services to the in-house family practice unit at WCH using store-and-forward teledermatology. The intent of this service was to more rapidly triage dangerous conditions, eliminate unnecessary consults, reduce the no-show rate to clinic, and offer continuing dermatology education to referring providers. This service went live in February 2017. The purpose of our presentation is to outline the current impact of the institutional teledermatology service, and to discuss the challenges, benefits, educational value, and economic value from the patient, provider, and systemic perspectives.

      Methodology/Approach: We are currently conducting a systematic appraisal of the service guided by the Canada Health Infoway Benefits Evaluation framework, using chart review of all patients managed with the teledermatology service, surveys to patients and providers, and semi-structured interviews with existing and potential consultant and referring providers.

      Finding/Results: Research and recruitment is ongoing and analysis is expected to be complete in April 2018. The frequency of consults has steadily increased over the lifetime of the service, particularly by a core group of dedicated users. Preliminary analysis indicates the service does require additional effort for the referring provider to implement the management plan, but that the service clearly offers an educational benefit to referring physicians. There are also suggestions of the potential effectiveness of new models of care such as ‘bounce-store-and-forward’, where the referring physician receives a question and photographs electronically and directly from the patient, and then engages the services of the teledermatologist to help manage the patient.

      Conclusion/Implications/Recommendations: The results will help direct further implementations of this model of teledermatology at other institutions and suggest which clinical scenarios benefit from primary management with institutional teledermatology.

      140 Character Summary: This presentation will discuss the impact of an institutional store-and-forward teledermatology service, guided by the CHI Benefits Evaluation framework.

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      RF01.03 - Addressing the Opioid Epidemic with Evidence (ID 376)

      V. Gupta, InfoClin Analytics; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Canada is facing a severe opioid overdose crisis. At least 2,458 Canadians died from opioid?related overdose in 2016. Many patients want to control their use of opioids, however physicians find tapering opioids time-consuming and fraught with error. We aimed to develop a web-based Opioid Manager tool for physicians that can dramatically reduce the time needed to develop a customized, safe opioid tapering schedule for patients, allowing physicians to spend more time counselling patients and to see more patients that need guidance with opioid use.

      Methodology/Approach: We developed a web-based Opioid Manager, based on the latest opioid management guidelines. We incorporated an expert system Opioid tapering algorithm based on the heuristics used by expert clinical pharmacists. The tapering algorithm is used by the Opioid Manager to generate a prescription that can be given to a patient to assist them in safely lowering their dose of opioids slowly over time. We validated the tapering algorithm through review with a clinical pharmacist.

      Finding/Results: Creating a customized opioid taper schedule takes a highly experienced physician or pharmacist 30?45 minutes per patient; longer for less experienced providers. Opioid tapering is emotionally and physically demanding on patients, requiring support from the extended care team to ensure that they follow through on the taper and that problems are solved quickly and efficiently, before the patient loses confidence and reverts to prior high doses. The tapering algorithm can automatically generate an opioid tapering prescription in less than 30 seconds. The algorithm automatically calculates the patient’s total current opioid dose and proposes a tapering regime that effectively utilizes real-world tablet formulations during the taper.

      Conclusion/Implications/Recommendations: The Opioid tapering calculator is reliable and can potentially save a physician or clinical pharmacist at least 30 minutes per patient, allowing them more time to explain the tapering process to the patient, to support the patient more effectively in tapering their dose and to assist more patients in managing their opioid medications. Payors and policy makers may also be interested in this tool, as it provides them a way to reduce the burden of addictions and reduce the overall cost to provide opioid management services.

      140 Character Summary: New Opioid Manager saves doctors 30 minutes per patient while decreasing opioid overdose risk.

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      RF01.04 - SMART on FHIR in Canada: Innovation Begins at the EHR (ID 600)

      P. Hollott, Health, Sierra Systems; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: Working as a Java architect on several enterprise health registry and repository projects (BC PLIS, WHIC Provider Registry), and coming from a JavaScript and modern web application background – it’s challenging to straddle the line. On the one hand, I am designing foundational systems that barely have a user interface; on the other hand, I’m developing highly interactive client applications using cutting edge platforms and libraries… in other industries. There is a disconnect.

      Methodology/Approach: Using mobility profiles like SMART on FHIR and IHE MHD, enterprise software vendors can break away from tightly coupled client-server, server-server, and HIAL architectures, by updating their EHR systems to comply with these profiles, which in turn allows client application developers to work independently. This encourages innovation. For instance, as part of their commitment to Project Argonaut, U.S. EHR vendors like Epic, Cerner and AllScripts are creating developer programs and EHR sandboxes, allowing developers to work with cloud-based sample data in connect-a-thon settings and beyond.

      Finding/Results: With sufficient standards and profile based support on the back end, low code and rapid development platforms for mobile web apps are reaching a point where organizations can rapidly develop small portable apps to fill their immediate needs for secure access to high value information. Examples of these platforms include Ionic Framework, a drag-and-drop creator for forms-based mobile apps; Oracle APEX, a low code mobile web application development tool for the Oracle database; Altova Mobile Together, an enterprise app rapid development platform that integrates with XML Spy. With MRAD (Mobile Rapid Application Development) tools like these, rapidly developing and deploying professional enterprise applications is becoming more affordable, requiring less programming experience, while still providing secure, ubiquitous access. Even so, for these tools to gain traction in healthcare settings, profound changes still need to take place within the EHR and EMR systems themselves. This is where future innovation in health information technology will come from.

      Conclusion/Implications/Recommendations: I propose to provide a technical breakdown of SMART on FHIR, and how it can be applied to EHR products, as well as a comparative summary of the maturity levels of several enterprise mobility and rapid development platforms (MEAP and MRAD). This is drawn from my own experience as a solution architect, tied to specific examples, profiles and patterns. Several U.S. EHR vendors have committed to creating and supporting cloud-based EHR sandboxes, with more still committed to participation in Project Argonaut. Here in Canada, these same products are deployed in a multitude of healthcare settings. How can we benefit from these sandboxes and connect-a-thons? Do we need to invest in similar EHR sandbox initiatives locally? How does a Canadian profile for SMART on FHIR differ from a U.S. profile, and can SMART Apps cross borders seamlessly?

      140 Character Summary: American EHR vendors are creating cloud-based connectathon sandboxes based on the SMART on FHIR profile. Does Canada need to invest in similar initiatives locally?

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      RF01.05 - Time to Get SMART on FHIR (ID 152)

      G. Tong, ITS, Gevity; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: To demonstrate that SMART on FHIR apps are changing the face and locus of healthcare delivery across all care settings and that healthcare executives need to determine how to incorporate this disruptive technology into their digital health strategies. Over 250,000 Canadian healthcare professionals use digital health solutions on a daily basis. However, it is impossible for health IT vendors to create systems that meet every users’ needs and preferences for features, workflow and information display when users are diversified by role (e.g., doctor, lab techncian, occupational therapist, etc.), specialty (e.g., mental health, paediatrics, cardiology, etc.) and care setting (e.g., community, home, hospital, etc.). SMART on FHIR enables the creation of apps that work within existing jurisdictional EHRs, clinical information systems, and EMRs to meet the needs of diversified users. Like the apps on your phone, SMART on FHIR apps can be designed to do a few things very well, such as perform complex calculations specialists need to perform daily (e.g., Cardiologists’ CHADS-65 cardiovascular risk scores) or present information in more consumable ways (e.g. Patient facing lab results that use icons and infographics).

      Methodology/Approach: The presentation will frame the challenge for health IT vendors to provide products that can “be all things to all users”. This will set the stage for discussion of the opportunity to meet the needs of diversified users across care settings and specialties by enabling SMART on FHIR apps. Using non-technical language, the presentation will answer the question “What is SMART on FHIR?”, and assess factors in the Canadian and US healthcare IT industries indicating that now is the time for Canadian healthcare executives to determine how SMART on FHIR fits into their digital health strategies. Examples include the prevalence of “SMART on FHIR” app markets established by CIS vendors, the growing number of SMART on FHIR apps available today, maturation of jurisdictional EHRs, and the collective need to find innovative ways to enable patients’ access to their data. Using case studies from Duke University Hospital and clinical information systems vendors such as EPIC and Cerner, the presentation will cover strategic considerations government organizations and vendors need to resolve to enable SMART on FHIR apps. Example strategic considerations include: credential provisioning for patient facing apps, controlling the user experience, branding, privacy and security, and impacts to service level agreements. The presentation will conclude with a framework for categorizing types of SMART on FHIR apps by use case and complexity to implement. This framework will be used to facilitate discussions with audience members on real world needs that can be solved with SMART on FHIR apps.

      Finding/Results: The timing is right. Jurisdictions like Ontario are making progress to enable consumer access to EHR data with SMART on FHIR apps. CIS vendors have launched their own SMART on FHIR ‘app’ stores. Governments across Canada are trying to figure out how to introduce innovation in primary care EMRs.

      Conclusion/Implications/Recommendations: Audience members will walk away understanding how SMART on FHIR apps can solve challenges and the actions required to enable this technology.

      140 Character Summary: It's time for Canadian governments and vendors to include SMART on FHIR in their digital health strategies to meet the diverse needs of patients and providers.

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      RF01.06 - My Migo: On-Demand, Mobile CBT (ID 213)

      B. Veder, Morneau Shepell; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: As the technological and lifestyle needs and expectations of both consumers and behavioural health experts change, the use of digital applications in mental health continues likewise to evolve, and research shows that expert-developed digital tools, in combination with self-directed learning, can be very impactful in providing effective mental health support in easy, convenient, accessible, and intuitive ways. Launched in January 2017, My Migo is a blended iCBT counselling program that leverages smartphone capability to provide effective mental health and behavioural change support in a way that connects individuals to EAP experts and provides a platform for independent learning, practice, and integration of new skills and techniques. Through the examination of user demographics, best practice details, patterns of user engagement with the various program components, clinical outcomes, and direct client feedback, we will demonstrate the value added benefits of this latest service offering in supporting mental health and behaviour change for digitally savvy support seekers.

      Methodology/Approach: My Migo was developed using Design Thinking; a creative, empathy-driven, and client-informed problem-solving methodology that shapes the creative process and the ultimate design of an effective program. The initial version of My Migo was tested with early adopters and feedback was used to enhance, improve, and update the program prior to its full launch in January. Post-launch, ongoing feedback from clients collected in a variety of ways (including mechanisms built within the app, analytics, and counsellor/client interactions) further informed the progress and evolution of the program.

      Finding/Results: Client and user uptake since launch has been very enthusiastic, and the program now exceeds over seven thousand users. This presentation will report on early outcomes based on the first phase results of qualitative and quantitative program research that is currently under way.

      Conclusion/Implications/Recommendations: Morneau Shepell has committed to using technology in a new, innovative clinical EAP service that, from the initial design phase, to the ongoing enhancements to My Migo’s program features, puts the end user client in a central and formative role in the evolution of the program itself, ultimately providing clients with the care and support they need, when they need it, and in a way they can easily relate to.

      140 Character Summary: My Migo: An on-demand mobile iCBT program tailored to provide effective, easily accessible support for digitally-savvy EAP clients.

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    RF03 - Meaningful Data Use and Benefits (ID 17)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 5
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      RF03.01 - Exploring Clinical and Organizational Value of the DHDR (ID 253)

      J. Bickford, eHealth Centre of Excellence; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: Background/Context - Canada and the USA have the highest prescription opioid consumption in the world. Increased opioid prescribing is associated with increased opioid-related mortality; thus, better informed physician prescribing decisions are key to avoiding adverse drug events and improving patient safety. Although Canada has recently developed guidelines that recommend restricting the prescribed daily dose to less than 90mg morphine equivalents for patients with chronic noncancer pain, data from 2014 suggests that 40% of people receiving long-acting opioids are taking more than 200mg morphine equivalents. During the Fall of 2016, Ontario’s Ministry of Health and Long-Term Care (MOHLTC) implemented an initiative to integrate the Digital Health Drug Repository (DHDR) through the connecting South West Ontario (cSWO) Regional Clinical Viewer, ClinicalConnectTM, to further enhance the data and information (including narcotics information) currently available in the integrated electronic health record (EHR) in south west Ontario (SWO). Purpose/Objectives – The objective of this work is to understand the organizational and clinical impact of the DHDR in acute and primary care settings across the four Local Health Integration Networks (LHINs) in south west Ontario. In particular, this study sought to document if and how the DHDR influenced opioid prescribing decisions and the Best Possible Medication History (BPMH) process for clinicians working in acute and primary/community care settings.

      Methodology/Approach: The study design included two data collection methods: individual interviews and online surveys. Individual interviews were conducted with clinicians and were digitally audio recorded and transcribed verbatim. Transcripts were thematically coded using a constant comparative method. Anonymous online surveys were completed by health care providers to understand the usability and functionality of the DHDR.

      Finding/Results: Findings from the interviews and surveys provide insight into key clinical workflows through which the DHDR contributes to quality patient care. In particular, emergency physicians and primary care providers found the DHDR supported responsible prescribing and contributed to improved patient safety. Findings also provide examples of how the DHDR could be improved and opportunities for enhancement.

      Conclusion/Implications/Recommendations: The DHDR is a reliable source of narcotic information that has the potential to improve patient safety and organizational efficiency when integrated into key clinical workflows. The DHDR can contribute to a larger strategy addressing the opioid crisis in Ontario.

      140 Character Summary: Research highlights benefits of using digital tools to support clinicians to make better-informed opioid prescription decisions

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      RF03.02 - Big Data in Healthcare: Where to Start (ID 440)

      D. Gutiw, Health Sector, CGI Group; V8W 2G2/CA

      • Abstract
      • Slides

      Purpose/Objectives: This session will present a methodology designed to help organizations better understand how to leverage both their internal data and external data sources to make high priority data driven operational and clinical decisions quickly. The methodology includes a framework to validate any organization or department’s current state of governance, data management, analytics, technology infrastructure and capabilities, as well as determining what extended data is needed to provide accurate, complete and high quality analytic analyses. The framework assesses the organization’s current state against its analytic needs and future vision, resulting in a clear implementable roadmap with sequencing of initiatives that are both sustainable and adaptable to changing priorities. The resulting strategy and roadmap includes tangible and achievable objectives that leverage existing technology investments, and demonstrate short term value using highest priority analytic questions. The benefit of this incremental and iterative framework is that the organization determines its own focus areas by starting with the analytic problem that needs to be solved and considers technical, organizational and governance required to move to a big data environment and capabilities.

      Methodology/Approach: The presentation will provide examples of how the methodology has been used to address clinical, operational and financial analytic needs. The presentation will walk through each stage of the methodology using a health specific example requiring data from multiple sources to result in a “what-if” analysis as well as comparative and drill down analytics. The presentation will also walk the group through each stage of the framework using the same example to help give context to the framework and approach being presented.

      Finding/Results: The findings suggest that by starting with a specific analytic problem an organization can better understand how to build an analytic architecture, governance and capability model that is scalable for ongoing needs and priorities. The incremental approach can help an organization understand where their current strengths lie, where change is needed and what steps are needed to achieve that change.

      Conclusion/Implications/Recommendations: The presentation will conclude with a recommendation on how organizations can evolve to using big data analytics for their current needs in the short term while developing a scalable roadmap to for additional analytic needs. At the end of the presentation the attendees will have seen the end to end framework in action and should have the knowledge of where to start within their own organizations to move towards big data analytics.

      140 Character Summary: Demonstrates a step by step framework to help organizations understand where they can start, within their own organizations, to move towards big data analytics.

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      RF03.03 - Value for Money: Approach to Quantifying Digital Health Solution Benefits (ID 577)

      D. Larsen, OntarioMD Inc.; /CA

      • Abstract
      • Slides

      Purpose/Objectives: How do you put a realistic dollar value on the good that digital health initiatives bring to the health system? This is a challenge that we in the digital health space face - one that makes it particularly difficult to implement large-scale initiatives. Quantifying the financial benefits of a digital health implementation while at the same time focusing on providing quality patient care is the ideal that few initiatives have been able to achieve. For this initiative, we measured the financial benefits and time savings accruing from a report delivery solution.

      Methodology/Approach: The organization implemented a province-wide electronic patient report delivery solution to improve communications between hospitals and specialty clinics and community-based physicians and nurse practitioners for timely follow-up care. Launched in 2013, today this service connects 189 hospitals and specialty clinics to nearly 8,000 physicians and nurse practitioners. A third-party consulting firm was engaged to conduct an independent valuation of the solution. They reviewed historical clinician and hospital surveys, ongoing operational costs, and the qualitative feedback from system user groups.1. Quantitative benefits that were measured included: 1. Workflow efficiencies 2. Savings – cost per page faxed/mailed 3. Administrative, legal and operational efficiencies

      Finding/Results: This analysis determined the solution has helped the province’s health system avoid up to $27 million in costs over 5 years. Every report not printed, faxed or mailed adds to that figure. Every hour saved from filing patient reports, or finding misplaced reports adds to that savings. Every extra minute that a physician can use providing patient care instead of locating paper reports, adds to that figure. The independent analysis found that up to 33 extra minutes a day is saved by each clinician user. It also found $30,000 in avoided costs at an average hospital within two years of implementation.

      Conclusion/Implications/Recommendations: With a quantified dollar amount to ascribe to the benefits of our digital health initiative, what can we do with this information? Firstly, we engage clinicians who have yet to adopt the service. Knowing the realized cost savings for the average user may help others understand the value of adoption. Secondly, re-engage clinicians and build their practice efficiencies by helping them realize the economics of doing so. Thirdly, use the quantified results to promote the initiative’s value proposition, including expansion, new features and functionalities to further benefit users. This report delivery service demonstrates how small efficiencies (30 minutes of time saved per physician per day, ink/toner savings each month for a hospital) add up over time. Digital health initiatives bring incremental savings and efficiencies to the health system. Those benefits can easily be overlooked if not quantified early on. There is still a long way to go in fully quantifying the benefits, particularly focussing on the clinical impact of technology. There are very real benefits in increased patient-care time and the accuracy of patient report delivery that are harder to quantify and have not yet been analyzed. Determining the dollar value of patient health benefits that digital solutions bring will be the next challenge we take on.

      140 Character Summary: Can you put a dollar value on the good that digital health initiatives bring to health systems? One initiative measured its value and found millions in cost savings.

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      RF03.04 - Heart Failure Telemonitoring: Pilot Project Findings and Full Trial Implementation (ID 548)

      A. Bhullar, Digital Emergency Medicine, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Patients with heart failure are vulnerable to their condition deteriorating and have high hospital readmission rates after hospital discharge. Optimal self-management and timely intervention in partnership with health professional support can reduce revisit rates as heart failure patients recover at home. The preliminary results from a 1-year feasibility study of a four-year research project studying how home telemonitoring can support the safe transition of heart failure patients from hospital to home show improved patient self-management, improved quality of life and reduced costs for acute care

      Methodology/Approach: Upon discharge from hospital, heart failure patients enrolled in the program receive health monitoring equipment including a touchscreen tablet, blood pressure cuff, weight scale, and pulse oximeter. Patients submit their measurements daily for 60 days and answer questions about their heart failure signs and symptoms (e.g., coughing, dizziness). Monitoring nurses remotely track patients’ data for abnormalities and early interventions. Monitoring is discontinued at the end of 60 days, and patients are followed for an additional 30 days. The study’s primary measure is assessing 90 day emergency department visits, hospital readmissions or mortality. Secondary measures include evaluating cost reductions as a result of hospital utilization, patients’ quality of life, and self-management. Primary measures are assessed via hospital administrative data, while pre and post surveys assess secondary measures. The feasibility study tested implementation and evaluation protocols. A subsequent randomized controlled trial beginning in 2018 will generate evidence from communities across the province to rigorously test the effectiveness of home telemonitoring.

      Finding/Results: A feasibility study was conducted from October 2016 to November 2017 involving 3 hospital sites, with 70 patients enrolled. Preliminary findings demonstrate a reduction in 90-day ED visits and hospital admission rates of 20 to 36%, average hospital length of stay reduction of over 2 days, and approximately 20% improvement in quality of life and self-management behaviour. Full results will be presented at eHealth 2018, together with insights to optimize the home telemonitoring experience for patients and providers.

      Conclusion/Implications/Recommendations: This project has received approval from the province’s health ministry and three health authorities to rollout a provincial stepped-wedge randomized control trial to 22 communities commencing in early 2018. At eHealth 2018, we will present progress to date and share the study design, which will provide comprehensive data from urban, rural and remote communities across the province, generate high quality evidence on effectiveness of home telemonitoring, and scale-up and spread home telemonitoring in the province simultaneously. This work is submitted on behalf of the TEC4Home Health Innovation Community.

      140 Character Summary: Supporting patient recovery at home with home-based patient self-monitoring.

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      RF03.05 - Analytics: Driving Outcomes with AI and Machine Learning (ID 502)

      D. Connors, Allscripts Analytics; Denver/US

      • Abstract
      • Slides

      Purpose/Objectives: •Show outcomes of artificial intelligence (AI) initiative to leverage Microsoft Azure solutions for predictive models for patient cost and care •Describe how analytics play a key role in the need for accurate risk stratification, predicting patients with rising costs, and enabling optimized care pathways for improved outcomes •Explain how incorporating insights into actionable information is key to bringing value to existing data assets •Demonstrate how utilizing predictive models can drive business decisions and promote adherence to current, evidence-based guidelines in chronic disease management •Highlight success stories and lessons learned in the race to derive value from big data

      Methodology/Approach: •Followed process of capturing data, creating predictive models, applying these models and using them at point of care •Selected and gathered necessary data based on analytics needs: collected from proprietary data as well as new information ?Proprietary data includes 50 million unique patients, 325 clients, linked cost data on 20 million lives •Incorporated machine learning on large amounts of health data to predict health outcomes

      Finding/Results: •Case studies on tracking and identifying factors for chronic conditions/high resource utilization, diabetes risk, and opioid abuse risk in patient populations •Use of predictive analytics enables us to identify gaps in care, optimize medical decisions, and prioritize highest risk patients into precision-medicine pathways Analytics Results in Chronic Conditions Case *US Chronic Conditions Condition Patients with Condition % Allscripts Lives National Prevalence Stats Annual Direct Cost Estimate Hypertension 11,100,000 30% 29.1% $64.5 billion Hypercholesterolemia 9,300,000 25% 31.7% $30 billion meds alone $400 billion (stroke & MI) Lower Back Pain 4,400,000 12% 12% $40 billion Allergic Rhinitis 3,800,000 10% 8.4% $18 billion GERD 4,200,000 11% 20% $10 billion Diabetes 4,500,000 12% 10% $56 billion Anxiety 3,900,000 10% 18% $42 billion Depression 3,200,000 9% 6.7% $45 billion Predictive Analytics to Identify High Resource Utilizers, based on Chronic Conditions* predictive analytics - chronic conditions map.jpg

      Conclusion/Implications/Recommendations: To grow and develop successful predictive modeling, consider the following future opportunities and vision: •Continue to leverage EHR neutrality and interoperability, promote data governance •Create holistic picture of health, bridging gaps from EHR data, including integration of alternative data (socioeconomic determinants of health) •Develop advanced analytics, sourced from clinical data, geo/social/environmental data, cost data, patient/consumer/social data and pharma and life science data •Use large scale predictive modeling and validation to facilitate precision medicine approach to care, embed into standard EHR workflows •Deliver on outbreak surveillance, risk stratification with longitudinal records, image recognition •Achieve outcomes including reduced cost of care, clinical performance optimization, and recorded impact of current and future therapies

      140 Character Summary: Highlights value of big data, while demonstrating how predictive models can promote adherence to evidence-based guidelines in chronic disease management.

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    RF05 - Consumer Digital Health Partnership (ID 27)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 5
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      RF05.01 - eHealth Interventions to Manage Perinatal Anxiety: A Systematic Review (ID 431)

      H. Bayrampour, Midwifery Program | Department of Family Practice Faculty of Medicine, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Anxiety is the most common mental health problem during the perinatal period, affecting one fifth of women. Addressing mental health needs in maternity care settings has been challenging due to various barriers such as treatment cost and access. Recently, more research has been focused on eHealth interventions as more accessible and cost-effective approaches to manage maternal mental health issues. Few reviews have been conducted to examine the impact of these interventions in improving perinatal depression. No review to our knowledge has specifically focused on anxiety. The aim of this systematic review is to examine the effectiveness of eHealth interventions in management of perinatal anxiety.

      Methodology/Approach: To identify the relevant evidence, the following databases were searched, beginning with the date that the electronic databases were available through August 2017: MEDLINE, CINAHL, EMBASE, and PsycINFO. Studies that examined the impact of an eHealth intervention on anxiety symptoms or disorders, as a primary or secondary outcome, during pregnancy or postpartum period and provided data to assess anxiety levels pre and post intervention were included.

      Finding/Results: Eight studies met the inclusion criteria and were included in this review. The interventions in seven studies included cognitive behavioural therapy (CBT) (online/computer-based) and one study used an internet-based cognitive behavioural stress management (IB-CBSM) therapy. Only in one study anxiety was examined as a primary outcome. Five studies reported interventions among pregnant women and three studies were conducted during the postpartum period. None of the included studies determined anxiety using a clinical diagnostic interview. Various scales were used to measure symptoms of anxiety or generalized anxiety disorders. Six studies reported reduced levels of anxiety symptoms/disorders post interventions.

      Conclusion/Implications/Recommendations: The evidence is amounting that eHealth interventions might be promising approaches for management of perinatal anxiety. More studies are needed to examine the effectiveness of eHealth interventions on reducing clinical anxiety during the perinatal period.

      140 Character Summary: Findings of this systematic review suggest that eHealth interventions might be promising approaches for management of perinatal anxiety.

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      RF05.02 - Is There an App for That?  Health Apps and Law (ID 240)

      R. Berger, Norton Rose Fulbright LLP; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Outline the legal considerations in designing and implementing an application which collects, uses, analyzes or transmits personal health information. Review of the privacy and regulatory issues in the US, Canada and EU. Key information for app developers as well as health care institutions looking to use emerging devices and apps.

      Methodology/Approach: See previous. Look at the issues from both sides: developer and health care instutution. Panelists will include: developer, health care institutional leader, legal expert.

      Finding/Results: See previous.

      Conclusion/Implications/Recommendations: A developer can navigate the patchwork of legal and regulatory issues in designing a health application. Health care institutions can ensure they are compliant with legal and regulatory when engaging a provider or using a new application.

      140 Character Summary: Is there an app for that? What developers and health care institutions should consider in new applicatons.

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      RF05.03 - Managing Chronic Disease with Digital Health – A National Update (ID 211)

      C. Frazer, Consumer Health & Innovation, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Canadian healthcare system faces a number of pressures that increasingly threaten its ability to provide high quality, universal care for all Canadians. Among these is the fact that Canadians are living longer than ever before and with increasing prevalence rates of chronic disease. Evidence suggests that digital health solutions have the power to enable the necessary transformations to ensure the sustainability of Canada’s healthcare system. A key aspect of understanding the potential benefits to be realized lies in understanding how these digital health tools are being used in today’s current environment to help Canadian’s manage their chronic conditions, and in identifying opportunities to scale what is working well.

      Methodology/Approach: An environmental scan was commissioned to examine what digital health solutions are currently available and in use by Canadians diagnosed with chronic disease. The scan, which will complete in January 2018, includes a focus on identifying what chronic diseases are covered by the solution(s); who is offering the solution (e.g. provider, agency, institution); any partnerships that may exist alongside the solution offering; a listing of information and/or services offered through the solution; and a description of how users (e.g. patients, providers, organizations/associations etc.) interact / engage with the solution. An overall assessment of the environmental scan findings will identify commonalities in approach and service offerings, with an aim to understand aspects that are best meeting Canadians’ needs and that could be scaled nationally.

      Finding/Results: More than one in five Canadian adults live with one of four major chronic diseases and nearly seven percent have been diagnosed with at least two of the top five major chronic diseases. There are varieties of ways in which Canadians use digital health solutions to help self-manage chronic conditions, and these are not necessarily connected or coordinated across an individual’s care continuum. The results of the environmental scan will help to identify opportunities to synthesize a common approach for chronic disease management in Canada.

      Conclusion/Implications/Recommendations: Results from an environmental scan of adopted digital chronic disease management solutions indicate that these solutions can improve health, enhance quality, increase access to care and reduce health systems costs. A coordinated, common approach will remove duplicity of effort while providing a consistent ‘look and feel’ to enhance the user experience for those Canadians managing one or more chronic diseases. It will also facilitate improved sharing of information between patients, providers and caregivers, and support improved ability to self-manage health conditions. These findings will be shared in an energetic, rapid-fire style format and will identify opportunities for a common, national approach for chronic disease management.

      140 Character Summary: This presentation will share results from a national environmental scan of adopted digital chronic disease management solutions.

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      RF05.04 - Older Adults use of Medical Services Facilitated by the OTN (ID 216)

      J. Lowey, Lakehead University; Thunder Bay/CA

      • Abstract
      • Slides

      Purpose/Objectives: As the population ages in Canada, telemedicine may help meet the challenge of providing care and services to older adults. There are medically underserved regions within Canada that may benefit from increased access to medical services facilitated by telemedicine. The purpose of this study was to determine what medical services, facilitated by the Ontario Telemedicine Network (OTN), were most utilized by older adults between April 2008 to March 2015, and determine if patient sex, and geography influenced utilization.

      Methodology/Approach: A secondary data analyses was performed on data from the Ministry of Health and Long-Term Care. Utilization was determined by Ontario Health Insurance Plan (OHIP) medical billing data that had OTN listed as the service location. All patients who were 65 years of age and older at time of service were included. Patient geography was determined by matching OHIP residence codes to Ontario census subdivision codes. Patient geography was divided into four regions: rural north/south and urban north/south. North and south boundaries were defined by the Local Health Integration Networks and urban and rural boundaries were defined using Statistics Canada's Statistical Area Classification System. Each OTN visit creates two or more distinct OHIP codes: one telemedicine encounter premium code and at least one specified medical service code. The telemedicine premium codes were used to determine general utilization, and the specified medical service codes were used to determine specialty utilization. Medical service codes were organized into therapeutic areas of care. The top utilized specialties were distinguished and reported. The remaining specialties were grouped into an "other" category. Crude and adjusted utilization rates were calculated, and associations between the age, sex, and patient geography were analyzed using multivariate Poisson regression.

      Finding/Results: There were 102,968 completed older adult patient sessions facilitated through the OTN from 2008/2009 to 2014/2015 fiscal year, representing approximately 11% of all recorded OTN sessions. At the population level, 39% (n=40,194) of all patients utilizing medical care through OTN were 65 years of age and older. Family/general practice services had the highest utilization rate in urban, Southern Ontario (20.4/1000). Dermatology services had the highest utilization rate in rural, Southern Ontario (16.1/1000). Oncology services were the highest utilized service in urban (35.6/1000) and rural (22.7/1000) Northern Ontario. Utilization varied by sex, region and age group, but overall, older male patients had higher rates of utilization when compared with female patients, especially in oncology, and urology/nephrology services. Although not consistent throughout all age groups, female utilization rates were higher in dermatology, and psychiatry/mental health services, particularly within the Southern, 65-74 and 75-84 year age groups.

      Conclusion/Implications/Recommendations: This research provides a detailed description of telemedicine use by older adults in Ontario, which has implications for medical service use in aging populations in Ontario and across Canada. Future research should compare OTN medical service utilization rates with in-person care services to determine what OTN facilitated medical services should be made more readily available or more frequently promoted. Increasing such services, would help make health care more accessible to older adults residing in northern, rural communities.

      140 Character Summary: Because of the OTN, older adults in Northern Ontario have increased access to specialized medical care- specifically oncology, internal medicine, and surgery.

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      RF05.05 - Breathr: Supporting Youth Mental Health Through an Innovative App (ID 396)

      A. Tugwell, BC Children's Hospital; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: The practice of mindfulness has recently received significant attention in the media for its usefulness in promoting social and emotional well-being and contributing to the ability to manage difficult or stressful situations. Mindfulness is all about encouraging awareness of oneself in the present moment, without judgment. While initial studies on mindfulness focused primarily on adults, practicing mindfulness has benefits for children and youth too. Youth are increasingly using the internet and mobile devices when seeking mental health information and resources. The rising trend of digitizing health care, and the desire to increase health care accessibility to tech-savvy youth, inspired the Health Literacy team at BC Children's Hospital to develop “Breathr” – a new app to help introduce the concept of mindfulness and create an easy access point for those who are new to this practice. Breathr provides opportunities for users to try out a variety of mindfulness practices, while also teaching them interesting facts about the brain science behind those practices. The aim is to show youth that mindfulness can be fun, easy to try, and that it can have very real benefits for their overall health and well-being. The app is also a tool that can help prevent mental health challenges such as depression and anxiety from developing or escalating. Breathr was developed in collaboration with BC Children’s Hospital medical professionals, mindfulness experts and youth, making it an informed and evidence-based resource. This rapid-fire presentation will be a live demonstration of the Breathr app, highlighting its engaging components and features.

      Methodology/Approach: The Breathr app is an example of one of the many youth-focused eHealth resources the Health Literacy Team has developed, in collaboration with youth and other key stakeholders, to address the mental health literacy needs of youth and emerging adults through evidence-informed approaches. The Team engages youth in a variety of ways when creating new resources; for example, youth are involved in content development and design to ensure that resources are appealing and relevant to the target audience.

      Finding/Results: The Health Literacy Team’s youth-focused initiatives have become widely recognized and utilized throughout British Columbia. The creation of websites and mobile apps, and province-wide dissemination through social media channels has increased accessibility of mental health information and supports for youth. Breathr has been downloaded over 5072 since its launch in May 2017 and feedback has been very positive. A youth who struggled with anxiety and depression and was involved in the development of the Breathr app commented: “I found mindfulness to be one of the most valuable tools to maintain my personal wellness and cope with the symptoms of anxiety and depression when they would come up. I believe that making mindfulness easy and accessible to youth – through platforms such as Breathr – will allow more young people to discover the benefits mindfulness can have in their day-to-day lives like I have.”

      Conclusion/Implications/Recommendations: Through the development of innovative and evidence-informed eHealth tools and resources, such as the Breathr App, the Health Literacy Team is supporting the mental health literacy of youth in British Columbia and helping to reduce stigma associated with mental health challenges.

      140 Character Summary: An overview of Breathr, an app designed in collaboration with youth and professionals, to help youth tackle stresses in their lives through practicing mindfulness.

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    RF07 - Techniques to Accelerate Innovation (ID 28)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Health Business Process
    • Presentations: 6
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      RF07.01 - Staying Agile in HCIS Development (ID 511)

      R. Campbell, Health Care Information Systems, Fraser Health Authority; Surrey/CA

      • Abstract
      • Slides

      Purpose/Objectives: To describe the creation and development of electronic documentation for clinicians following an agile philosophy that was adapted for use for a large organization with multiple stakeholders. We will review the process, outcomes, successes and lessons learned. In November 2016, the Fraser Health Authority (FHA) implemented electronic documentation at Abbotsford Regional Hospital and Cancer Centre. This was part of a large-scale project called the Integrated Plan of Care (IPOC) and began in 2015. The IPOC project involved multiple stakeholders and the utilization of many resources.

      Methodology/Approach: The IPOC project required iterative development with frequent inspection and adaptation, so an agile approach was needed. This philosophy also promotes a leadership style that fosters teamwork and accountability. Agile principles were applied to the IPOC project, with a breakdown of work into “sprints” and “scrums”. A sprint is a set period of time during which a defined package of work needs to be completed. A scrum is a short meeting that includes the design and build team to review progress and identify obstacles. In the IPOC, a sprint was the development of each clinical department’s documentation with the following phases: an opening day, daily or every second day scrums until complete, and a closing day. Each phase followed a pre-determined script for consistency from one sprint to another. Each sprint consisted of the preliminary build, quality assurance review, final build, stakeholder testing, e-safety and data integrity review.

      Finding/Results: Utilizing an agile philosophy for the IPOC project allowed us to identify a large percentage of documentation requirements early in the build, provided a platform for rapid development and accommodated unexpected changes. This also facilitated the detailed tracking of the build progress, and created opportunities for team members to connect on a regular basis with their clinical counterparts. Findings/Results include, but are not limited to: - Resourcing the build with part time staff or staff that had additional duties were a detriment as the project could not maintain the philosophy of an agile process. - Stakeholders reviewing the electronic documentation build need to be engaged as delayed response time slowed down the development cycles. - Unclear role definitions and expectations lead to assumptions around task responsibility and lack of communication. - Lack of predetermined build practices and not following naming convention guidelines and processes lead to inconsistency in product and frequent rebuilds.

      Conclusion/Implications/Recommendations: Using an agile philosophy in the IPOC project to implement electronic documentation contributed to the success of the project. Our recommendations include: use of an agile philosophy for informatics’ projects; ensure staff are dedicated solely to the project during the build, ensure roles and expectations are clearly defined, clearly define build practices and naming conventions and to guarantee stakeholders are engaged with defined timelines for feedback in order to keep the development cycles on track.

      140 Character Summary: To describe the creation and development of electronic documentation for clinicians following an agile philosophy that was adapted for use for a large organization with multiple stakeholders. We will review the process, outcomes, successes and lessons learned.

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      RF07.02 - Designing and Embedding Telemonitoring in an Integrated Care Model (ID 148)

      K. Gordon, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Chronic care continues to be focused on single conditions treated individually, often without consideration of greater complex multi-morbidity needs. In-between appointments, patients are left to provide self-care, as well as manage and monitor their health. An opportunity has arisen to address the challenges that patients with multiple chronic conditions (MCCs) face by combining the two innovations: telemonitoring and an integrated complex medicine clinic (CMC). The objective of this novel team-based clinic is to integrate care and stabilize ailing patients with MCCs by bringing together clinicians to create a comprehensive care plan. William Osler Health System (WOHS) is in the process of creating this integrated CMC model. In terms of the telemonitoring, patients will be able to monitor their chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patients’ ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. Furthermore, health professionals can track patient status through physiological readings in-between appointment visits. The aim of this study is to conduct a needs assessment to inform the design and implementation of telemonitoring into an integrated care setting for patients with MCCs.

      Methodology/Approach: A qualitative case study was undertaken to determine how to design and integrate telemonitoring into the development of an integrated CMC model at William Osler. Semi-structured interviews were conducted to determine the specific needs and requirements, desired workflow, and anticipated challenges of implementing telemonitoring in this model. Patients and healthcare professionals were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their work, clinical pathways, perspectives and challenges around managing MCCs, as well as their needs and preferences for development of the CMC model and telemonitoring system.

      Finding/Results: Six patients and ten care team members (including administrators, clinicians, and allied health staff) were interviewed to reach saturation at WOHS. Preliminary analysis indicates interviewees are positive about the opportunities for telemonitoring in this new clinic model but have common concerns related to affordability and digital literacy. Patient interviewees are particularly interested in how telemonitoring could improve their health and symptoms under more consistent monitoring by multiple health care professionals in one place, communicating seamlessly. Interestingly, most respondents view this integrated model as a bridge from hospital to family medicine in order to stabilize complex care needs effectively. Finally, interviewees indicated the nurse or the nurse practitioner should be responsible for monitoring alerts generated by the telemonitoring application. A preliminary workflow map for the CMC has been distributed for stakeholder-review. Once the workflow map is approved and operationalized in the model, the telemonitoring system will be embedded within this novel workflow design.

      Conclusion/Implications/Recommendations: Based on this research, a six-month mix methods pilot study will be undertaken to determine the feasibility of implementing the telemonitoring system into the CMC model. The potential impact of this research includes a sustained program combining telemonitoring within the integrated model that improves health outcomes, reduces healthcare utilization costs and is scalable to other healthcare institutions.

      140 Character Summary: Telemonitoring in an integrated care clinic presents an opportunity to design and develop a novel care delivery model for patients with complex chronic conditions.

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      RF07.03 - Spread of HIT Innovations: Social Franchising Applied to eConsultation Services (ID 450)

      B. Maciejewski, Telfer School of Management, University of Ottawa; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Canadian healthcare system has witnessed extensive innovation activity in recent years, but the system has been caught in a perpetual cycle of pilot projects, which precluded spreading and scaling up of potentially relevant and important innovations. Social franchising represents a governance and operating model that has been widely used to support the quick and successful scaling up of certain types of social initiatives. This project presents an overview of social franchising in general, and in the context of health care, discusses its applicability to health IT innovations, and proposes a governance and operational framework based on this model for the Champlain BASE™ eConsultation program.

      Methodology/Approach: A literature review on social franchising was performed to evaluate this model in non-healthcare and healthcare realms. A general search was performed in electronic databases (e.g. Medline (Ovid), ProQuest, Scopus) to identify relevant peer-reviewed articles on social franchising and gauge the scope of research. The initial search of the term “social franchising” yielded 438 hits, after which the yields were narrowed using more specific search terms (e.g., “social franchising” and “health”). Three systematic reviews on social franchising were identified in the process. Grey literature was used to supplement the use of social franchising in healthcare and non-health industries by filtering through organizations websites and news articles.

      Finding/Results: Social franchising has been enthusiastically embraced internationally in healthcare and non-healthcare industries. Peer-reviewed articles related to social franchising and healthcare generally presented low quality evidence and concentrated around patient outcomes in family planning and reproductive health programs implemented in low- and middle-income countries. Articles related to social franchising in high-income countries were largely absent. Overall, the lack of high quality peer-reviewed articles is due to the recent advent of this model. While the evidence is still scarce on the effectiveness of this model, there were strengths consistent across the articles. When used appropriately, social franchising has shown to increase patient satisfaction and program accessibility with the most impressive strength being its proven ability to rapidly spread programs in the healthcare sector without sacrificing quality. A National BASETM governance model is proposed for the Champlain BASETM program, using social franchising as the key linkage mechanism between the governing National BASETM Committee (franchisor) and the provincial franchisees.

      Conclusion/Implications/Recommendations: Social franchising is now the fastest growing approach of healthcare in low- and middle-income countries. Healthcare systems in high-income countries, such as the UK, Germany, Australia, and Denmark are taking notice and are beginning to experiment with the model as well. HIT innovation in Canada cannot be unleashed until the barrier of fragmentation is overcome. Social franchising has not been diversely tested within the healthcare industry, but with the strengths this model has shown in the healthcare systems of low- and middle-income countries and in non-health industries, this model appears to present opportunities that may benefit the healthcare system in Canada. The Champlain BASETM team and the Canadian healthcare system should consider the model as a viable governance and operating framework to scale and spread innovative health IT programs.

      140 Character Summary: Social franchising can overcome healthcare fragmentation and scale and spread HIT innovation. An application to the Champlain BASE project is conceptualized.

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      RF07.04 - The Future State of Technology in Home and Community Care (ID 19)

      R. Fulkerson, Tectonic Advisory Services Inc; Burlington/CA

      • Abstract

      Purpose/Objectives: This research and resulting report was focused on the current state, gaps and the optimal state of the use of health IT to access patient records and provide care to the home and community sector. The perspective that the research tool was on the end user consumer. The research was conducted nationwide with providers from National Home Care Agencies, Hospitals, Health Regions, LHINs, CCACs, and other speciality organizations including Ministry

      Methodology/Approach: This session explored the current state, gaps & the optimal state of health IT to access patient records and provide care to the home and community sector. Respondents provided advice on key considerations to success in this sector/ The Think Tank Series brought together leaders in the Home and Community sector and represented organizations including LHINs, CCACs, hospitals, home care agencies and speciality care organizations.

      Finding/Results: The Tectonic Think Tank found many ‘pockets of excellence’ in home and community care, technologies created within the system out of necessity, led by organizations committed to providing quality care to the families they serve. These technologies are implemented on such a small scale that they cannot contribute in a meaningful way to the system-wide culture shift needed to ensure a high-performing system that is truly client and family-centered. 6 Key recommendations were made that focused on the role such as Mobile, Telehealth, Virtual Care, Cloud, Blockchain and Leveraging current assets provided by multiple stakeholders Implementation of all of the recommendations can begin immediately, and most can be fully implemented within the medium term.

      Conclusion/Implications/Recommendations: The following themes emerged from the research Theme 1: Client and Family-Centered Care as well as Personal Care Theme 2: Support for Family Caregivers Theme 3: A “Basket of Services” Theme 4: Capacity Planning & Bundled Payments Theme 5: Primary Care Theme 6: Increased Accountability for Performance The Tectonic Think Tank found many ‘pockets of excellence’ in home and community care in Ontario, technologies created within the system out of necessity, led by many individuals and organizations committed to providing quality care to the families they serve. However, these technologies are often implemented on such a small scale that they cannot contribute in a meaningful way to the system-wide culture shift needed to ensure a high-performing system that is truly client and family-centered. These technologies need to be scaled and aligned. The challenge is to fully define family-centered care and how the system can best support clients and families in the community. There is a need to ensure accountability for delivering a high-performing home and community care sector in Ontario as a pre-requisite. Leverage current assets to support family-centered care and the circle of care in that role and introduce thought funding and innovation technology such as Mobile, Telehealth, and Virtual Care solutions. LHIN Reform – let’s hope it works! Debate - Should technology be paid for by the public sectors or be positioned as a differentiator for homecare provider agencies competing for LHIN contracts. Fix the procurement problem in Ontario and in the rest of Canada!

      140 Character Summary: Tectonic found ‘pockets of excellence’, technologies created out of necessity, assessing the current state vs future state, where scale & spread was identified.

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      RF07.05 - Hamilton Health's Ecosphere Pipeline for Digital Technology: Calling All Innovators (ID 138)

      K. Porter, Research and Innovation, Hamilton Health Sciences; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: One of the biggest challenges that health care startups face is gaining access to the health care environment while they are developing their products, in order to gain insight and feedback from end-users. How does a hospital build an innovation pipeline for health technology start ups? How can hospitals help accelerate commercialization, and create a market for the adoption, procurement and diffusion of these solutions? In the fall of 2017, Hamilton Health Sciences embarked on the Health Ecosphere project to create a launchpad for technology solutions that have the potential to transform the health care system. Hear the story of how the Hamilton Health Ecosphere curated innovative solutions directly related to our enterprise needs, and embedded them within our hospitals so that we could play a role in shaping the technology to best benefit our patients and the health care sector.

      Methodology/Approach: Our Health Ecosphere projects were grounded in mutually beneficial partnerships to health care providers, patients, and families. A common thread ran through these partnerships: a positive patient experience through technology. To begin, the Hamilton Health Ecosphere defined our requirements, and then put out a call to entrepreneurs for expressions of interest. We requested that they outline their solution, and provide an overview of themselves, their business, and their innovation. Selected entrepreneurs presented their innovative technology at a Health Ecosphere event, where we had the opportunity to listen to each company's pitch. After the event, we selected entrepreneurs to introduce to our clinical teams at Hamilton Health Sciences. Companies selected include Cloud DX, who have developed a connected health solution that provides a better way of collecting vital signs remotely, unifying the clinical and home monitoring experience, and shortening the patient length of stay. mHealth Solutions utilizes a holster to more consistently monitor post-operative patients, while also allowing suitable patients to be discharged from the hospital within 24 hours. GeneBlueprint empowers users with the ability to access, understand, and benefit from knowledge of their personal genetics so they can live healthier lives through personalized fitness and nutrition plans, while HealthQR simplifies medication management by connecting the patient, and their medical records, directly to nearby pharmacies through a mobile application. Each company's solution addressed a component of the patient journey, and leveraged technology to enhance and elevate the patient experience and overall patient outcome.

      Finding/Results: Our project is still underway. We anticipate that bringing researchers together with businesses to develop technologies that can help coordinate care across systems that previously operated in silos will be of benefit to both patients and the health care system.

      Conclusion/Implications/Recommendations: We are using leading practice to evaluate the benefits of the project, referencing Canada Health Infoway's Benefits Realization Framework. We have integrated a benefits evaluation plan into our project plan to ensure alignment. Given current fiscal pressures, hospitals face a strategic imperative to consider fundamental changes to their operating model. Leveraging technology to enhance and elevate the patient experience and overall patient outcomes will be a component of this transformation.

      140 Character Summary: Hear the story of how the Hamilton Health Ecosphere curated innovative technology solutions related to our enterprise needs and embedded them within our hospitals.

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      RF07.06 - Delivering Digital Solutions, Leveraging Expertise and Existing Solutions Across Ontario (ID 436)

      J. Williams, Regional and Provincial Portfolio Digital, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The delivery of the Specialists and Community Services Directory empowers primary care providers (PCPs) in Central Toronto region to access up-to-date information on specialty and community support resources, so patients are directed to the right care in a timely fashion. This project involved working with local primary care providers and five organizations – a delivery partner, regional health authority sponsor and three provincial solution providers. The success of the project depended on the ability of stakeholders to form an effective partnership and work towards a common goal of delivering an online Directory to PCPs across the Toronto region. For this presentation, the project delivery partner will demonstrate the unique engagement approach that facilitated collaborative design, development and implementation of the Specialists and Community Services Directory.

      Methodology/Approach: To construct the delivery partnership, the project team created an environment conducive to collaboration. Stakeholder engagement took place in a variety of formats and at three levels. Local At the local level, engagement objectives included understanding PCP needs to inform requirements and enlisting volunteers for co-design and development of the solution. To secure time in PCPs’ busy schedules, various methods were applied to encourage active participation of local providers across Toronto. These methods included in-person meeting presentations and interviews, as well as electronic engagements. Regional At the regional level, working collaboratively with the regional health authority and primary care physician leads proved crucial to project decision-making. This group was kept informed to help understand and respond to project developments as they unfolded. A governance model was established to enable the project team to leverage existing regional committees and forums to provide updates, garner advice and/or obtain approval on recommendations. Provincial At the provincial level, working with three provincial solution providers required clearly defined roles, understanding of each partner’s needs and capabilities, and shared goals. Delivering a solution aligned with PCP needs was at the core of the partnership. Consultation with solution providers in the early planning stages, involvement in decision-making processes and ongoing engagement throughout the project were instrumental to project success.

      Finding/Results: By forming strategic partnerships at all levels, establishing a common goal and converging expertise of partners, we were able to meet project objectives. Local PCPs contributed to developing business requirements and actively participated in the solution design process. The regional decision-making body was instrumental in providing project oversight including the selection of solution providers. As a result, partners worked together in harmony to develop and implement the Directory for PCPs.

      Conclusion/Implications/Recommendations: Participants at this session will learn about the engagement approach to facilitate collaborative design, development and implementation of the Specialists and Community Services Directory. In addition, insights will be shared regarding early benefits and lessons learned from the initial implementation efforts.

      140 Character Summary: Robust engagement efforts at local, regional and provincial levels contributed to the success of implementing the Specialists and Community Services Directory

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