Purpose/Objectives: In March, 2016 Island Health implemented a closed loop medication system in a tertiary hospital, where all stages of the medication cycle are supported electronically (ordering, verifying, dispensing and administering) with decision support where relevant. Research has shown that roughly three of every four medication errors occur at either the ordering or administration stages of the medication order and delivery cycle (JAMA 1995 Vol 274, No. 1, pp. 35-43). This presentation focuses on the provider ordering and nurse administration stages, and evaluates the influence of decision support alerts on preventing medication errors during these stages

Methodology/Approach: Clinical decision supports implemented at the physician ordering stage included drug allergy and drug interaction alerts (major contraindicated interactions only), duplicate anticoagulants and range dose checking. The influence of these alerts on provider ordering was measured as the proportion of instances where an alert fired and the provider heeded the warning; either didn’t place the order, or discontinued the active interacting medication and continued to place the order. In both of these cases the alert served the intended purpose. Several medication administration alerts were implemented at the nurse administration stage, including: Wrong drug: A medication scanned with no corresponding active order in the system, in any form, due at any time. Wrong dosage form: A medication scanned that matched the generic drug formulation of the order, but dosage form didn’t match (e.g. regular vs extended release). Wrong dosage time: The correct medication scanned, but the task to administer is not within the timeframe.

Finding/Results: Island Health implemented a closed loop medication system and the influence of relevant clinical decision support alerts on ordering and administration of medication is presented. Specifically: - Provider ordering: roughly a quarter of clinical decision support alerts lead to a change in ordering. - Medication administration alerts: in an average month, nurses receive 377 alerts signalling that they are about to administer the wrong drug to a patient. Alerts for wrong dosage form and wrong time are much more frequent.

Conclusion/Implications/Recommendations: Interpreting the influence of clinical decision support alerts on provider ordering is difficult. When interpreting changes in provider ordering following interaction alerts, it is important to note that there are few ‘hard and fast’ contraindications (when on Drug A never give Drug B). Most are open to context (patient age, comorbidities, etc.) or subject to the clinical judgement of the physician. On the other hand, we need to be mindful that providers are only getting major contraindicated interactions. The influence of medication administration alerts on nurse administration is much clearer. Near misses, preventing the administration of wrong medications to patients, are frequent enough that they can be counted per day. Other administration alerts, wrong dosage form and wrong time, are more frequent, but their potential for patient harm is less severe. Collectively, these results show that the electronic closed loop medication system implemented by Island Health has prevented a significant number of medication errors – errors which are known to cause or lead to inappropriate medication use or patient harm.

140 Character Summary: Island Health examined the prevention of medication errors at ordering and administration, following the introduction of a closed loop medication system.

Purpose/Objectives: Ontario’s Comprehensive Drug Profile Strategy (CDPS) aims to improve the health and wellness of Ontarians and the quality of care received from health care providers through integrated secure access to a patient drug profile for all Ontarians. The CDPS will enable the Best Possible Medication History for a patient, and supports Ontario’s response to the opioid crisis. The CDPS leverages existing assets where possible to build a comprehensive drug profile that captures information on dispensed drug events (and potentially prescribed events in the future) for all Ontario residents. The Digital Health Drug Repository (DHDR), the foundational first project of CDPS, provides a clinical data repository and corresponding secure web services that enable provincial Electronic Health Record (EHR) integration and facilitate expanded access to ministry drug data holdings (i.e., Ontario Drug Benefit (ODB) claims data and Narcotics Monitoring System (NMS) data). This data store provides the capacity and security necessary to share clinical data appropriately and meet user access demands expected of the system, as well as support the long-term CDPS vision of a repository containing ‘All Drugs, All People’ and contribute to the broader goal of a fully integrated EHR in the province.

Methodology/Approach: Using a HL7 FHIR® enabled repository, the DHDR provides access to patients’ medication information, including ODB claims and NMS data. The DHDR is currently available to Ontario clinicians through regional clinical viewers (Clinical Connect and Connecting Ontario). Clinical access will be expanded to include integration with hospital information systems and electronic medical records. Public access to their drug data will be enabled by DHDR integration with consumer portals and applications. In the future, DHDR will be expanded to include additional clinically relevant data (e.g., dosage information) as well as additional data sets (e.g., electronic prescriptions and privately-paid and other medication event data).

Finding/Results: The DHDR provides clinicians in Ontario access to more complete information on patients’ medication history to improve the health and wellness of Ontarians and the quality of care received from health care providers through integrated, secure access to a patient drug profile, enabling the Best Possible Medication History and supporting the Ontario Opioid Strategy.

Conclusion/Implications/Recommendations: The DHDR advances the goals and objectives of the CDPS vision of ‘All Drugs, All People’ and contributes to the broader goal of a fully integrated EHR in the province by providing clinicians and consumers access to a patient’s medication information.

140 Character Summary: Development of a HL7 FHIR® based repository that supports clinician and consumer access to patient medication information in Ontario.

Purpose/Objectives: Since 2013, Quebec is operating a centralized e-prescribing network allowing for the electronic transmission of prescriptions between prescribers and pharmacies in primary care. The objective of this study is to describe the system, its utilization and the experience of users.

Methodology/Approach: Longitudinal analysis of usage data between Jan 2016 and April 2017 was performed. Interviews and observation sessions were conducted with frequent users on the prescriber side and the pharmacy - the receiver - side to compare usage patterns and experience of users with different commercial systems (2 EMR systems and 4 PMS). E-prescribing strings were analyzed from the receiver side to determine the quality of data being transmitted electronically.

Finding/Results: The e-prescribing network is a centralized pull model providing for a paperless process. So far, only the patients are outside the loop. They are still receiving a paper copy of the prescription when it is electronically sent to the central warehouse. Pharmacists have to wait for the paper copy of the prescription to retrieve it from the warehouse. No alert is sent to their system when a new prescription is available for one of their patient. In April 2017, more than 2 800 prescribers were using the system (while at least 5 000 could technically do it with their EMR). Of all the e-prescriptions sent, only 16% were retrieved electronically in pharmacies (Table 1, Figure 1). The experience of users was heterogeneous depending on the commercial system they were using. In pharmacies, the most problematic feature was the absence of a view of the original e-prescription to be able to compare with what the local PMS was generating. All e-prescribing strings needed to be manually corrected in the PMS to be dispensed. The main factor influencing the completeness of the e-prescribing string was the pharmaceutical form of the medication (solid oral forms, creams, inhalers, drops, etc.). The fields with the most frequent corrections were the “instruction” field, followed by the quantity, the duration, and the prescriber ID. Table 1. Number of prescribers, prescriptions and retrieved up to April 2017 Details n(%) Number of prescribers (in the month) 2 851 Number of e-prescriptions sent (cumulative) 10 703 194 Number of prescriptions retrieved (cumulative) 1 767 138 (16%)

Conclusion/Implications/Recommendations: For the promises of e-prescribing to be realized, additional work is needed to improve the standardization of interoperable data exchanged between EMR and PMS.

140 Character Summary: This study analyzed utilization and experience of users with the e-prescribing network implemented in Quebec since 2013.

Purpose/Objectives: Missed or missing laboratory test results may hinder physicians’ diagnostic process, cause important delays and jeopardize patient safety. Many efforts have been made to significantly reduce laboratory turnaround time and to improve the quality and continuity of care. However, there are still persistent errors both before the specimens reach the laboratory and after the results are produced. To overcome those challenges, many IT systems, such as laboratory information systems, electronic medical record systems, clinical information systems and interoperable electronic health records (iEHR) have been implemented in various settings. The present study focuses on iEHR use for laboratory medicine. More precisely, it aims to measure physicians’ use and perceived benefits of the iEHR deployed in Quebec (called DSQ for Dossier Santé Québec).

Methodology/Approach: A cross-sectional survey of 9,005 Quebec physicians having authorized access to the provincial iEHR was conducted. A web-based survey platform (Qualtrics) was used to collect data. Descriptive and bivariate statistics were performed using the IBM SPSS statistical package. A total of 1,917 questionnaires were returned (21% response rate). Of these, 405 were removed due to incomplete data leaving us with a final sample of 1,512 valid responses. In terms of profile, 48% of our respondents are primary care physicians (PCPs), 41% are hospital care physicians (HCPs) and 11% are emergency care physicians (ECPs). 56% are women and 44% are men.

Finding/Results: A large majority (80%) of respondents use the Quebec iEHR system for laboratory medicine purposes; although this percentage is somewhat lower in the ECPs’ case (73%). Physicians who use the iEHR make a relatively extensive use of the system. On average, they use 65% of the system functionalities and they use the iEHR in 78% of the cases for which it may be used for laboratory medicine. The latter ratio even reaches 84% for ECPs. Interestingly, less experienced physicians consult the iEHR system more frequently than more experienced ones. The perceived benefits associated with the use of the iEHR for laboratory medicine can be broken down into two categories, namely, efficiency and quality of care. With regard to efficiency, physicians (especially PCPs) said the iEHR saves them lots of time (i.e. due to the quick access to lab results anywhere and anytime) and it reduces the duplication of tests. With regard to quality of care, a majority of physicians perceive the iEHR system improves the continuity of care, allows them to make better, more informed clinical decisions, and increases the safety of their patients. Importantly, the system improves the way ECPs evaluate patients in the emergency room.

Conclusion/Implications/Recommendations: While the vast majority of physicians who participated in this study use the iEHR deployed in Quebec and perceived numerous benefits associated with its use, 20% of them still refuse to use it. About half of our respondents made numerous and constructive suggestions for improvement (e.g., biometric access to the system, greater interoperability with EMRs and LISs, more rapidity when downloading data, especially in the ER). Quebec authorities need to pay attention to these suggestions so to increase adoption rate and physicians’ satisfaction.

140 Character Summary: Physicians’ use and perceived benefits of the iEHR system deployed in Quebec (called DSQ for Dossier Santé Québec) to support laboratory medicine.

Purpose/Objectives: To improve patient safety, medication reconciliation is required at admission, transfer, and discharge for hospital accreditation in several countries. Medication reconciliation is expected to improve patient safety by preventing inadvertent discrepancies between community and hospital medications that lead to medication errors, and avoidable morbidity. However, the process is resource-intensive, resulting in poor adherence. We developed an e-medication reconciliation application (RightRx), and report on the impact of using population- and hospital-based drug information systems to pre-populate and align community and hospital drug lists and thus reduce workloads and enhance adoption and completion of medication reconciliation.

Methodology/Approach: We developed a web-based e-medical-reconciliation software and are evaluating it in a cluster-randomized trial at an academic hospital network. We used agile development processes and user-centered design to develop features aimed at enhancing adoption, safety, and efficiency. We implemented RightRx in medical and surgical wards, where field staff and unit champions provided training and support. Using data retrieved from provincial health administrative databases, RightRx pre-populates the patient’s community drug list with all drugs dispensed in the 3 months preceding admission as well as all drugs dispensed, stopped, or placed on hold during hospitalization. The two lists are aligned, sorted by pharmacologic class, and displayed to physicians to enable reconciliation at admission, transfer, and discharge. Physicians reconcile and review the lists to generate the discharge prescription, which displays all changes, additions, and discontinuations, along with the reasons for those changes. Rates of medication reconciliation completion rates were measured using chart review and data retrieved from the RightRx application in the intervention and control units. In the intervention unit we also measured the time professionals spent using the application.

Finding/Results: User feedback identified required adjustments to RightRx, including addition of dose-based prescribing, clarification of discharging physicians’ roles in prescribing community-based medication, and providing access to the clinical reasoning behind medication decisions made during hospitalization. In intervention units, pharmacists and physicians were involved in reconciliation at discharge for 71.9% and 96.1% of patients, respectively. Pharmacists spent a mean time of 10.9 min (SD 10.9 min) per RightRx session, compared to 5.8 min (SD 7.8 min) spent by physicians. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in intervention units, and 0.7% (surgery) to 82.7% (medicine) of patients in control units. After adjusting for differences in patient characteristics, the odds of medication reconciliation completion were 9 times higher in intervention versus control units (OR 9.0, 95% CI 7.4-10.9).

Conclusion/Implications/Recommendations: Automated prepopulation and alignment of community and hospital medication lists helped achieve high medication reconciliation completion rates.

140 Character Summary: Right-Rx increased the efficiency and completion rate of medication reconciliation by automating the retrieval and alignment of community and hospital drug data.

Purpose/Objectives: Invariably, all health organizations experience an unacceptably high incidence of medication errors and adverse drug events (ADEs). The Institute of Medicine said it well nearly 20 years ago – To Err is Human (1999). But if to err is human, what happens when the human is technologically enabled to help reduce ADEs? Island Health (IH) asked this question while planning the functionality of the electronic health record, which ultimately resulted in the launch of a closed-loop medication administration system, including barcoded medication administration (BCMA). Endorsed by the Institute of Safe Medication Practices, well-adopted barcode medication administration systems reduce the incidence of bedside medication errors by 50%.

Methodology/Approach: Using BCMA as an adjunct to existing Island Health medication administration procedures and workflows, nurses are now better able to assure verification of the patient and medications to be administered. Nevertheless, implementation of BCMA represents a significant practice change that is not without its challenges; although BCMA promises 100% accuracy to match the right patient with the right medication, route and time, the benefits are only realised when the technology is applied. From unit-dose packaging to individual physical limitations, IH has acknowledged, accepted and overcome significant barriers to BCMA adoption.

Finding/Results: Since BCMA’s inception in March 2016, IH has observed high rates (74%) of BCMA use in adult medical inpatient settings. Care areas that have not fully adopted other components of the closed-loop medication administration system, like computerized provider order entry, experience significantly lower rates (36%) of BCMA. Over 2,500 BCMA warnings have been issued at the point of care to alert nursing that there was a mismatch between the patient, the medication product being scanned and what was ordered. Notoriously, we cannot measure what did not happen; however, 2,500 fewer medication administration errors to date is a benefit any health authority cannot afford to pass up.

Conclusion/Implications/Recommendations: Despite early successes, future BCMA implementations can benefit from the lessons learned following the initial deployment. The transformation to BCMA was concurrent with the release of advanced EHR functionality; this resulted in significant workflow changes to nursing beyond BCMA. There was less focus on BCMA than might have been if the change had occurred independently. IH recognizes that changes often need to be concurrent; nevertheless, expressing the benefits of the change with express focus on the benefit to nursing, such as having a second line of defense for catching errors at the point of care, may have positive benefits on adoption rates of BCMA. Further, where halls are narrow and rooms are small, nurses have a challenging time maneuvering computerized workstations to meet their patients. This is further compounded when a patient is on isolation precautions or has greater-than-average equipment needs. BCMA continues to be an effective means to decrease medication administration errors at the point of care. Greater attention to the information needs of nursing and nursing’s capacity for change, in combination with thorough infrastructure analysis, may help increase adoption for future BCMA implementations.

140 Character Summary: BCMA can reduce medication administration errors but only when used appropriately. A robust change management strategy may improve adoption of the technology.

Purpose/Objectives: The need for digital personal assistants and chatbots in healthcare is obvious. This presentation explores the various use cases for digital health assistants for health promotion, counselling, behavioral change and supporting seniors living.

Methodology/Approach: SE Health has reviewed many new and innovative digital assistants driven by knowledge bases, predictive analytics, machine learning and AI engines. We share our early experience using digital assistants for access to health information, care automation and Chatbots. Health Information According to Stats Can, seventy percent of Canadians go online to search for medical or health-related information, making the Internet the first source of health information for many people. With the appearance of intelligent personal assistants (IPA) such as Siri, Google home and Alexa, accessing health information online has never been easier. We look at the providers of content and how natural language is improving access to health information. Health Symptom Triage and Advice Chatbots, intelligent personal assistants and messaging apps supported by artificial intelligence have the potential to respond to asily diagnosable health concerns and take the burden off off of medical professionals regarding. We review some of more interesting implementations of Chat Bots in healthcare, including our own implementation of Tess™, an AI chatbot that provides real-time and personalized mental health care for everyone. Defining Normal with Predictive Analytics Seniors want to live and age in the place they call home. However, physical and mental decline eventually limits our ability to care for ourselves, placing burden and worry on family caregivers. Enter the smart digital assistant that uses IoT sensors throughout the home to build a profile of “normal” behavior. Using predictive analytics, the assistant identifies activities that are cause for concern, providing guidance to the resident and alerting their caregivers as necessary.

Finding/Results: The number of digtal health applications, devices and algorithms are growing exponentially. Concerns remain about the trustworthiness of information. Will Alexa keep your secrets, secret? Do AI engines propagate biases? How can intensely proud seniors retain privacy, dignity and security while big brother is watching.

Conclusion/Implications/Recommendations: Digital health assistants in our homes and on our phones, are becoming trusted sources of health information and medical questioning. They can make our lives more comfortable and provide health guidance through curated content, coaching and advice. In a consumer- driven healthcare world, Digital Assistants can take the burden off medical professionals by responding to easily diagnosable health concerns or quickly solvable health management issues.

140 Character Summary: Digital health assistants can make our lives more comfortable, respond to medical questioning and repond to easily diagnosable health concerns.

Purpose/Objectives: Patients told us they want real-time access to their health information so they can be informed partners in care! Our enterprise patient portal was designed and built in collaboration with patients and their caregivers. This session will provide insight into the value and benefits of patient access to their online medical records. Successes, challenges and key learnings will be discussed.

Methodology/Approach: Patients prioritized their need for timely access to their online medical records. Our Patient Portal enables them to see their appointments and receive appointment reminders; see lab results with links to patient education; see clinical documentation, such as assessments, discharge summaries, clinic notes, and reports (including sensitive information such as mental health notes and pathology reports); share their health information with others; and find programs, clinic information and patient education resources. Medical records are released to patients at the same time information is made available to their care providers. Our Patient Portal was first made available to early adopter clinics in May 2015, and expanded to the rest of the organization in January 2017. Successes, challenges and key learnings will be presented and discussed.

Finding/Results: Real-time patient access to their online medical records was shown to improve the patient experience and reduce preventable harm. 94% of patients report being more prepared for their appointments; 94% report better communication with their care team; and 91% said that online access helps them make decisions about their care. 10% of patients report that their information was out of date or incorrect (n=9827), which could have implications to their patient experience or patient safety. 94% of patients prefer to look at results as soon as they are ready, even if they could be worrisome. 92% prefer to see results even if they have to wait until their next appointment to understand what they mean. Prior to roll-out, 86% of staff supported the idea of patient access; however, access to information in real-time was challenged. Staff concerns include real-time release of sensitive reports (e.g. mental health notes and pathology), potential impacts to clinic call volumes, and fear of increased patient anxiety.

Conclusion/Implications/Recommendations: Patients prefer timely release of information. Engaging patients in all stages of planning, design and delivery of patient portals is key to delivering value for patients. Although 86% of staff support the idea of patient access to their online medical records, real-time access and access to sensitive reports were challenged. Management of large-scale organizational culture change through staff engagement and education, supported by senior-level leadership are critical to success.

140 Character Summary: This session will provide insight into the value of real-time patient access to online medical records. Successes, challenges and learnings will be discussed.

Purpose/Objectives: MyChart is a personal health management and continuity of care record solution that enables patients-consumers to directly access their medical records and personal health information from anywhere at any time with strong sharing capabilities. Patients can share their medical health record information with family members, multiple hospitals, physicians, care teams, caregivers and individuals who participate in their care and health decisions. Offers strong sharing capabilities, e-services, self-monitoring tools, resources to support users at home and in between visits. MyChart’s focus: Improve the patient and family health care experience Enhance the patient and care team relationship Empower patients with electronic access to their medical record information Improve information sharing across the continuum of care Support patient self-monitoring and management of personal health and information Support health care services and communication

Methodology/Approach: The MyChart Program is developing strategic alliances with health organizations and industry partners. MyChart is positioned well to support continued growth and recognized as a great success story in Canada with out of country interest. The expansion of the MyChart can provide a national and global forum and platform where member organizations can work collaboratively to empower the consumer with timely access to own health information and self-monitor for improved outcomes no matter where they are. Acting as a service provider, MyChart optimizes the broad network by continuously adding services that benefit consumers and providers. MyChart data provides insight to the health consumer’s healthcare requirements and supports the consumer in their own health management.

Finding/Results: 1. MyChart’s alignment to Provincial Digital Health Strategy improves engagement and transparency, enables patients to access their information, improves sharing of patient records and information across the circle of care and improves the patient experience. 2. Enhanced patient experience: e-View access to personal health records, convenient e-Booking services, self-monitoring and entering of data, ease of access through device integration, automated alerts and e-Notifications, medication tracking and refills 3. MyChart is positioned well to support Primary care and Community Services with e-services such as automated reminders for important screenings and appointments, online bookings, educational information, self-monitoring tools, pre/post care questionnaires device integration and announcements. 4. Good chance of addressing/mitigating the acute health issue without impact on other resources. MyChart is data rich. We can realize and trend shifts in health care utilization, patient and family role, reduced no shows, identify complex patients, access provider services, reduced visits to the ER, reduce drug errors , increased mobile access/opportunities.

Conclusion/Implications/Recommendations: MyChart is flexible and customizable, allows for easy expansion of added features and functionality; MyChart is open technology, flexible with other technology systems and platforms. 1. Industry: Enable consumer access to their medical and personal records with sharing capabilities. 2. Practitioners: Better informed patients, earlier follow ups, and improved patient self-monitoring for healthier outcomes. 3. Patients: Increased patient and family experience and satisfaction, increased self-monitoring, decreased travel and wait time, increased access to medical records from multiple care providers, increased access to information and transparency

140 Character Summary: MyChart is a personal health management and continuity of care record solution that enables patients-consumers to directly access their medical records

Purpose/Objectives: The purpose of this study was to describe the use and utility of a Patient Portal (PP) tethered to a shared Electronic Medical Record (EMR). In Canada there is ample evidence that citizens want electronic access to their health information, and a growing trend for access through web-based PPs. Proven benefits of PPs include enhanced satisfaction, decreased postage, decreased no-show rates to clinic appointments and time answering phone calls, fewer inpatient visits, more efficient medication refills, improved understanding of health information, better relationships with doctors, better quality adherence and compliance, and improved self-care and empowerment. Organizations with electronic medical records in the United States report online access rates of 22-75%, but despite this PPs are relatively rare in Canada – in 2013 only about 10% had online access to their own information, or the ability to email their care providers. We report early experience with over 2200 patients using a PP called eCLINICIAN MyChart (“MyChart”) tethered to an EMR call eCLINICIAN (Epic systems corporation) being used in the Edmonton Zone of Alberta Health Services.

Methodology/Approach: The MyChart PP was deployed as a pilot project accross five clinics - one family practice clinic and four specialty clinics: rheumatology, inflammatory bowel disease, multiple sclerosis, and diabetes. Enabling patient access to MyChart required extensive policy work and multi-disciplinary engagement. After Health Ethics Board Approval, we built in informed consent to be contacted for online surveys via email into the MyChart signup process. We also examined system audit logs, kept as part of rountine delivery of the system, matched to other EMR scheduling data.

Finding/Results: Since February 2016, over 2200 patients have accessed MyChart. There was a high degree of usability and general satisfaction: 96% of respondents said MyChart was easy to use, 83% answered it made communication more convenient, and 75% answered it saved time when scheduling an appointment (38.7% responnse rate). Among respondents, 50.3% stated MyChart had helped them avoid a clinic visit, and 13.8% stated it helped them avoid an emergency department or urgent care visit. Users of MyChart had fewer missed or “no-show” appointments. The baseline no show rate in clinics not using MyChart was 12.7% (range: 12.0%-13.7%). Amongst MyChart users there were 12,436 visits and a no show rate of 7.4% (range: 5.7%-8.7%), a 42% relative reduction.

Conclusion/Implications/Recommendations: PPs are rapidly gaining popularity in Canada - patients expect increased access to their health information, and better ability to interact with the health system as consumer. Clearly, health systems will be forced to shift towards offering self-service options, and secure messaging channels, and away from physician offices arbitrating how and when such communications occur. While many local EMRs have portals for their patients, provincial efforts to provide meaningful interaction (beyond just access to results of tests) are in their infancy, and it is unclear what effect they will have on patient health, or system efficiency. As MyChart is rolled out more widely in Alberta, we anticipate that reductions in no-show rates, clinic and ED visits will contribute to increasing health system efficiency.

140 Character Summary: We describe early postive feedback and decreased missed appointments resulting from a new patient portal tethered to an enterprise electronic medical record.

Purpose/Objectives: The present study examines Canadians’ use of mobile apps and smart devices to monitor aspects of their health and well-being. It is the first national survey of its kind in Canada, and the largest ever, world-wide.

Methodology/Approach: We conducted an online survey with a sample of 4,109 Canadian adults. The questionnaire was developed based on a review of the scientific literature on the subject and pre-tested on 50 respondents. The survey was available from January 11 to February 2, 2017. To ensure a representative sample, the quota method was used (sex, age) following stratification by province. The maximum margin of error associated with our sample size is estimated at 1.6%, 19 times out of 20. The results were weighted based on the following variables: province, age and gender.

Finding/Results: Our findings reveal that a majority of Canadian adults (66%) regularly track one or more aspects of their health or well-being. We defined two specific groups, namely, traditional trackers (39%) and e-trackers (61%). While traditional trackers monitor their health using mostly paper-based tools such as a notebook or a journal, e-trackers do so with the help of mobile apps and/or smart connected devices. About one third (32%) of Canadian adults use one or more mobile apps while 24% owns at least one smart connected device to monitor aspects of their health. Canadian e-trackers are typically younger adults (41%), employed (59%), university educated (55%) with an annual family income of over $80,000 (46%); and generally healthy - only a small segment (28%) of those who use mobile apps or smart devices reported living with a specific chronic illness or condition or self-rate their health status as ‘fair/poor’. The most popular smart device is by far the bracelet or watch, which is owned by 88% of respondents with at least one smart connected device. Mobile apps and smart devices are mainly used to monitor aspects of well-being such as physical activity, nutrition, weight, sleep, sports performance and, to a much lesser extent, medical or clinical data such as chronic disease condition indicators. The level of satisfaction with digital devices is reflected in respondents’ intentions to continue using such tools (88% for smart connected devices and 72% for mobile apps). About half of Canadian adults who do not currently own a smart connected device for health do not see the interest in owning one. Comparisons with other international survey findings will be presented.

Conclusion/Implications/Recommendations: The present study shows an opportunity to advance the health of Canadians through mobile apps and smart devices; and highlight important nuances to better understand key market segments and opportunities. Our results can also be used to set the national baseline for future studies on the diffusion of connected health technologies. Importantly, findings are useful for IT developers as well as clinicians and administrators across all health settings to better understand the current digital market, the profiles of e-trackers, traditional trackers and non-trackers, the value proposition these tools provide to users, and health system transformation.

140 Character Summary: A survey of 4,109 Canadian adults allowed us to study the current use of mobile apps and smart connected devices to monitor aspects of their health and well-being.

Purpose/Objectives: This presentation will bring together patients, clinician, technology providers and change implementers to share the experience of deploying, and adopting, a regional patient portal. With a shift to patient-centred care, it is critical that providers have a single source of access to their patient’s aggregated health information. This has been made a reality through ClinicalConnect, a regional clinical viewer utilized by 40,000+ authorized provider users practicing in South West Ontario. Just as important in the paradigm of consumer-driven care, it is critical that patients have a single point of access to their health information. Currently, many standalone and tethered patient portals exist, forcing patients to log into multiple solutions to interact with various healthcare verticals. The South West Ontario Patient Portal Project, led by Hamilton Health Sciences, leveraging Sunnybrook Health Sciences Centre’s MyChart, brings patients one step closer to a solution in which they can access health information from any of the 67 acute care sites within SWO they have visited, and homecare data from 4 LHINs (previously CCACs). We will share the experience of bringing together the provider’s digital experience with the patient’s digital experience to facilitate more efficient collaboration in the delivery of care, truly putting patients first.

Methodology/Approach: ClinicalConnect currently integrates data from provincial assets DHDR, DI Common Service, OLIS and aCDR, and in South West Ontario, 67 acute care sites, regional cancer programs and four LHINs (previously CCACs) for providers to have a consolidated view of their patient’s health history. Sunnybrook’s MyChart is integrating with ClinicalConnect to leverage a single data broker to populate patient health information from multiple clinical sources and move towards the vision of a truly integrated patient portal. Targeted to begin deployment in April 2018, patients will be provided access to clinical information from multiple sources and a personal health record (PHR) component to manage and contribute to a holistic record of their health information. The presentation will explain the governance, communications, stakeholder (patient and clinical) engagement and change management structure established for a project of this scale.

Finding/Results: Patient & provider consultations were instrumental in developing models of data release. SMEs from health records, privacy, patient registration, patient education, and experience were consulted to support change management activities.

Conclusion/Implications/Recommendations: The project has started to bring together information for patients from acute sites and will work to integrate more data sources to give patients a fulsome view of their health information as it phases in information from provincial assets and primary care. As additional data sources are being added, it is important to consider privacy and workflow implications for non-acute care institutions.

140 Character Summary: Hamilton Health Sciences, through the HITS eHealth Office, is integrating Sunnybrook's MyChart with ClinicalConnect and deploying it across South West Ontario.

Purpose/Objectives: This presentation will explore technology innovation from the perspective of a legacy eHealth solution.

Methodology/Approach: We tend to think of new and novel uses of technology when we talk about technology innovation. Today we think apps, connected devices, analytics, consumer health, etc., but what about yesterday’s innovation? Canadian jurisdictions invested hundreds of millions of dollars on innovative solutions in the past 20 years, and those solutions are aging. The Provider Registry System used in multiple jurisdictions is a prime example of a foundational eHealth architecture service, that, despite its age, still fulfills its original intent – centralizing and standardizing access to the many pockets of provider data across jurisdictions. The Provider Registry System Collaborative has adopted a practical approach to modernize the solution, utilizing a relatively small sustainment fund.

Finding/Results: Custom enterprise solutions are incredibly expensive to build, and we all understand that software has a lifecycle, beginning with an idea, and concluding with disposition. We seek to maximize the longevity (and value) of these solutions through regular sustainment, but we need to be practical about such investment. We monitor solutions throughout their lifecycle and direct investment based on current need and vision. We rationalize solutions and their context, and monitor the market of similar solutions. Are they still necessary, and are there better alternatives? In the case of the Provider Registry System, the governing collaborative continues to get good value from the PRS solution. - The core requirements of the solution still exist and the solution works well and meets those requirements. - The solution is integrated with EHR Architectures, and difficult to replace - The solution is economical to operate. Therefore the solution is good candidate for sustainment and modernization. In their approach to modernization, the PRSC has adopted the following strategy: - Maintain an application roadmap, including not only vision of new functionality, but lifecycle state and planned replacement of existing components. - Clear understanding that just maintaining compatibility with a deployment environments is not modernization - Include modernization of existing components as a key component of each release. - Balance extensions and enhancements with continuous improvement of the core solution. - Accept that some aspects of the solution are best maintained “as-developed” even if there are more modern alternatives. PRS modernization approach is realized by focusing on the following: - Ensuring an up-to-date user experience - Alignment with evolving interoperability standards - Streamlining development, configuration, testing, and operations This approach ensures the application remains viable while preserving the investment in core business logic that forms the largest, most expensive portion of the application.

Conclusion/Implications/Recommendations: Key success factors: - Maintaining a roadmap that balances sustainment of existing components with addition of new functionality. - Focus modernization where it has most impact: User Experience, Operations Experience, Interoperabilty. - Recognizing the scope of what can be achieved with sustainment funds can’t include sweeping redevelopment of components for the sake of change. Sometimes modernization is not necessary or offers little value.

140 Character Summary: Applying a sustainment and modernization strategy to ensure jurisdictions continue to get value out of their investment in the Provider Registry System.

Purpose/Objectives: Complicated funding structures and the absence of clear incentives create challenges for small-to-medium size enterprises (SMEs) in the digital health space. Many SMEs struggle to navigate the Canadian health system to gain insight into opportunities for purchase or procurement by public and private funders. The objectives of this work were to: (i) identify common challenges faced by SMEs in the digital health space; and (ii) explore effective methods of rapidly assessing and improving the performance of these SMEs within the Canadian health system.

Methodology/Approach: To help promote innovation and entrepreneurial success in digital health in Ontario, the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), supported by the National Research Council of Canada Industrial Research Assistance Program (NRC IRAP), is developing a structured assessment to support SMEs in digital health. The process engages experts in key domains (clinical, technology design, health administration policy, venture capital, and business development), using a tailored evaluation framework to assess the Innovation and Business Model, the Innovators, the Health System Impact (including, patients, clinicians, and institutions), Policy and Economic alignment, and Regulatory compliance. This abstract presents content analysis of the final recommendation reports produced for ten companies assessed by WIHV in 2016-2017.

Finding/Results: Two key challenges when developing and marketing digital health tools in the Ontario health care system emerged: (1) Understanding funding models and the role of incentives within the Canadian healthcare system (e.g. SMEs incorrectly assumed that improved patient outcomes, provider efficiency, or reduced patient visits to the clinic would result in a direct financial benefit to the physician). (2) Establishing clinical efficacy and safety owing to a lack of clear pathways into real-world clinical settings for testing. Our most common recommendations to SMEs were to: (1) Identify at what level of the health system your product is likely to be purchased: Difficulty understanding funding models created ambiguity around who to target as a potential payer (e.g. government, providers, institutions, clinics, insurers, or patients); (2) Demonstrate the value proposition to the primary payer: Without the ability to identify the appropriate payer, SMEs struggled to clearly articulate their value proposition or to devise the most appropriate outcomes to target in an evaluation; (3) More clearly understand the workflows of patients and clinicians: SMEs often focused on financial and administrative benefit of their tools, without explicitly evaluating the impact on patients and clinicians, whether positive or negative. When users were not considered viable payers, their needs (usability, patient reported outcomes) were often overlooked, creating a large risk to uptake and long-term success.

Conclusion/Implications/Recommendations: Identification of common missteps and challenges facing SMEs in the digital health space will assist the entrepreneurial community in navigating the health system. Findings from this work will be developed into a checklist of considerations for digital health entrepreneurs to assist with strategic planning throughout digital tool development. In addition, this work aims to develop a standardized evaluation framework that can be used by other Canadian and international organizations to assess the investment potential of digital health SMEs.

140 Character Summary: Common challenges and recommendations from a structured assessment of digital health companies’ potential entrepreneurial success in Ontario.

Purpose/Objectives: Expansion of the NS synoptic reporting program to support electronic clinical documentation is discussed including the processes implemented, successes, challenges and opportunities. The presentation will use case examples to present how synoptic reporting has met diverse clinical needs in NS.

Methodology/Approach: The system benefits of synoptic reporting established in 2012 in Nova Scotia include improved quality, timely, consistent, and comprehensive clinical documentation. Building on this foundation, the synoptic reporting program continues to expand for surgery and pathology as well as discharge summaries, follow up notes, mental health and addictions clinical reports, and children in foster care comprehensive reports. Although the development and implementation of new or expanded synoptic reporting initiatives follows a similar approach, each new initiative has unique requirements which requires flexibility, modifications to the foundational structures as well as realistic timelines and deliverables. These customizations and modifications provided new opportunities to enhance the overall application. The success of these new initiatives is credited by ensuring adequate development, modifications and testing of standards; developing new or revising existing technical requirements; completing necessary documentation; partner engagement; and clinical champions.

Finding/Results: Clinicians and administrators continue to explore new opportunities to improve clinical documentation and clinician work flow through synoptic reporting. Uptake by end users varies depending on numerous factors including clinical champions, dependence on other projects, number of templates available for use, known benefits to practice, ease of use and level of commitment/ mandate by leadership for implementing a specific initiative. However, the biggest factors contributing to uptake for clinical users is engagement by clinician users and responsiveness to accommodate known work flow processes. For example the surgical spine template has a 100% uptake by users as a result of a comprehensive engagement strategy whereas in pathology the initial rollout of standards in April 2017 received resistance from pathologists not initially consulted. Meeting end user needs can lead to a significant benefit for all involved. This is seen for vascular surgery where surgical synoptic reporting was dependent on another initiative, and integrated together lead to a positive overall result. Finally, implementing synoptic reporting supports a change management approach that engages and readies clinicians for a true electronic EMR.

Conclusion/Implications/Recommendations: As clinical users become increasing comfortable with standard templates/ clinician documentation new requests are being brought forward to explore how synoptic reporting can improve clinical workflow and needs. Understanding the overall organizational environment as well as unique clinician requirements, offers opportunities for synoptic reporting to be a leader in developing and implementing standards as well as providing a supportive role for data collection in a discrete electronic format to meet organizational and departmental needs. The success of the program rests with clinical engagement, responsiveness, flexibility to adapt and change focus as required, balancing user needs as well as playing not only a leading role in developing standards but a supporting role in using standards to meet organizational requirements.

140 Character Summary: Using case studies, processes, lessons learned, benefits and challenges for the continued expansion of Nova Scotia’s synoptic reporting program is discussed.

Purpose/Objectives: Digital health information infrastructures and integrated virtual care technologies support quality outcomes of clinical practice, enable patient engagement, and drive system transformation and governance in high performing health systems. This session provides a national update on clinician and citizen adoption of digital health technologies and current perceptions of value and barriers to use-optimization. Results from the new 2018 Canadian Physician Survey - focused on adoption and use of digital health technologies in practice, will be showcased. Findings from the recent 2017 national Nurses’; and 2016 national Community-Pharmacist’s surveys will also be shared along with results from a 2018 national survey of citizen’s access to their health information and other digital health/virtual care technologies (e.g. e-visits: secure e-mail to providers; and virtual visits: real-time video consultation).

Methodology/Approach: In the absence of the long running National Physician Survey, the 2018 Canadian Physician Survey: Adoption and Use of Digital Health Technologies in Practice was developed and launched in January 2018. The survey ensures continuation and evolution of national metrics to support Canada’s broad community of clinical, industry and digital health governance and innovation stakeholders. The detailed survey methodology will be provided in the session along with national-level results. The national survey of community pharmacists (2016) and Canadian Nurses’ survey (2017) were completed through an online recruitment and survey administration process in collaboration with the Canadian Pharmacists Association (CPhA); and the Canadian Nurses Association (CNA) and Canadian Nursing Informatics Association (CNIA) respectively. Canadians’ online access to their health information and utilization of virtual care services in 2018 was conducted online with a nationally representative sample of Canadians.

Finding/Results: The 2018 Canadian physician survey captures a nationally representative sample of primary care and specialist physicians, by age, sex and region. Detailed national and regional specific adoption and value/ impact results will be shared. Nationally representative samples of Canadian nurses (2,058) and community-based pharmacists (N=535) were achieved in 2017 and 2016 respectively. Use of electronic records/clinical information systems varies substantially across nurses’ clinical practice settings. The majority of nurses providing direct patient care (55%) report that the main record keeping system for patients in their setting is a combination of paper and electronic systems – which emerges as the primary barrier to realizing value. Areas of value identified by nurses include: improved quality of patient care (56%); improved practice productivity (50%); and improved continuity of patient care (71%); and use of data to inform quality initiatives (42%). Results from the latest national survey of Canadians will summarize access, use and citizen perspectives on digital health services in Canada.

Conclusion/Implications/Recommendations: The use of digital health information infrastructures across Canada have made substantial progress and represent the “technical backbone” of a high-performing health system - advancing integrated capability for performance measurement and accountability. Their use and optimal integration to clinical practice and patient access to their health information and virtual care services do, however, face relevant barriers to realizing citizen and system value and demonstrating impact on patient and system outcomes.

140 Character Summary: Get the latest results from national citizen, physician, nursing, and pharmacist surveys – focused on use/value of digital health technologies.

Purpose/Objectives: This presentation will highlight the key findings of investigations into nurses use of digital health technologies, specifically electronic clinical information systems (CIS) and electronic health records (EHR). A national survey was conducted in early 2017 to understand the current use of these digital health technologies by Canadian nurses, across multiple clinical practice settings. The survey also explored attitudes and perceptions related to access, implementation and the impact of use on quality outcomes. The study compares progress to the first national survey (2014). Seondary analysis workshops convened with nursing leaders and researchers contribute to the findings.

Methodology/Approach: An online survey in English and French was conducted between January and March of 2017. (n2,108). The majority of the results focus on Canadian nurses providing direct care (n=1,342). The survey was open to all Canadian nurses using digital health in various capacities within their main practice setting including community, hospital, academic and private industry. The data was statistically weighted to ensure a reliable representation of the nursing workforce in Canada. Secondary analysis of the findings was conducted by a group of nursing leaders and researchers to identify qualitative correlations, additional research questions emerging from the data, and to increase meaning of the results as well as recommendations.

Finding/Results: Nurses who are solely using electronic systems are much more positive about the impact of digital health on productivity, improved quality of patient care, and confidence in their skills. However a number of challenges are identified. The majority of nurses are in work environments that use a combination of paper and electronic systems and use numberous log ins to access disparate and multiple systems. The satisfaction with continuous learning about the systems is low, and the level of consultation prior to implementation is also low. Additionally it was reported that nursing education does not incorporate training versions of CIS / EHR systems in the teaching of nursing skills in the majority of cases. New users report steep learning curves, especially in hybrid environments and high levels of dissatisfaction.

Conclusion/Implications/Recommendations: Nurses who are not in a hybrid environment report higher levels of satisfaction and confidence to use digital health systems and are much more positive about the impact on productivity and quality of care. True benefits can be realized when full transition to electronic solutions occurs. The majority of nurses continue to work in hybrid paper and electronic environments which is reported as the most significant barrier to satisfaction and confidence. A key learning from this study is the need to ensure better engagement and participation of nursing in the selection, design and implementation of the electronic solutions they will use in their clinical workflow as a critical success factor. There is an opportunity to influence change and improvement in future projects through broader communication of these results to health care leaders, implementers, and solution designers.

140 Character Summary: Recent investigations of Canadian nurses use of digital health technology (CIS and EMR) in multiple practice settings and the impact on quality of care.

Purpose/Objectives: CIHI provides comparable and actionable data and information to accelerate improvements in health care, health system performance and population health across Canada. The Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) are two of CIHI’s highest volume and most commonly used data sets for planning and management purposes in the health care system. As the health care data landscape evolves to become increasingly integrated and interoperable, CIHI’s pan-Canadian data holdings must evolve in tandem to ensure relevant and timely data can continue to be made available for planning and management purposes. This panel presentation will discuss how investments made in eHealth/digital technology can be leveraged to access near real-time data and the role data standards play in this work. Findings on a recent demonstration project that CIHI completed with the Vancouver Island Health Authority (VIHA) will be presented, including an overview how data directly from VIHA’s hospital information system can be used beyond clinical care. The panel will also discuss how learnings from this project will support the development of CIHI’s future Integrated Hospital (iHospital) system, which is being planned for launch in April 2021. This system will integrate CIHI’s hospital-based systems, starting with DAD and NACRS, and improve efficiencies while reducing data collection and submission burden. The integrated system will be the first step towards a ‘one patient, one record’ based secondary use system in acute care.

Methodology/Approach: CIHI is currently in the planning phase of the iHospital project, which includes business transformation. The goal of this work is to streamline data requirements and gain efficiencies in business processes by leveraging technology and automation. A key part of this phase is incorporating learnings from demonstration projects. This presentation will describe how data representing 12 sites across VIHA has supported this work to date.

Finding/Results: Initiating a major change project is generally met with numerous challenges, including resistance, requirement for clarity and the need to identify all impacted stakeholders and processes as early as possible. In order to ensure smooth change management, CIHI will complete a longer planning phase in the project. This presentation will provide insights into change management approaches from this large-scale business and IT project.

Conclusion/Implications/Recommendations: As part of its 2016-2021 strategic plan, CIHI is committed to being a trusted source of standards and quality data, which includes making data collection easier and improving timeliness. CIHI is also committed to ensuring it brings value to its stakeholders and evolves to keep pace with the health care system. This and other demonstration projects are providing CIHI and hospitals with important information about the reliability and quality of data in point-of-care systems. CIHI will describe how these learnings will result in data flows that don’t require extensive manipulation to, or fragmentation of data by hospitals before it is submitted to CIHI. Additionally, VIHA will discuss the processes it is putting in place to change data collection practices at the point of collection, in an effort to put more seamless data flows from clinical care to secondary use in place.

140 Character Summary: As the health care landscape becomes increasingly integrated and interoperable, CIHI’s pan-Canadian data is evolving in tandem to provide relevant and timely data

Purpose/Objectives: Less than half of Ontarians are able to see a primary care provider when they are sick1. Among patients with a family physician who visited the Emergency Department (“ED”), 15% went there because their doctor was unavailable. Virtual technologies that facilitate new ways of interaction between patients and providers pose an opportunity for improvement in access to primary care in Ontario. The objective of this presentation is to illustrate how health sector partners have worked together to identify and procure an innovative health care technology that can link patients with clinicians via secure messaging, clinical video-conferencing, email, and phone. 1. Health Quality Ontario. (2015). Quality in Primary Care: Setting a Foundation for Monitoring and Reporting in Ontario. Toronto: Queen's Printer for Ontario.

Methodology/Approach: The Virtual Visits initiative used an innovative procurement approach to identify a virtual solution with the potential to enhance access to primary care. Provider and patient engagement was key in designing advanced models of care such as this. An outcomes-based request for proposal (RFP) was released to vendors previously qualified under a provincial Vendor of Record (VOR). Proponents were required to participate in a Design Contest and provide their price bid for a technology solution to be developed for a Proof of Concept (POC). An interdisciplinary team was chosen to evaluate vendor capacity to provide the solution and to assess the innovation through an on-site process against pre-established criteria. The successful vendor was invited to negotiate a Statement of Work (SOW), under the terms of a Master Agreement already in place to deliver an initial Proof of Concept. A phased approach beginning with the POC to test and refine the business and clinical model will be used to support scaling of the model and provincial priorities.

Finding/Results: The Innovation Procurement process allowed for a more engaging and enriching experience for the healthcare providers involved by discussing desired outcomes rather than the traditional procurement approach of gathering technical requirements. It also provides greater insight on stakeholder needs, ensuring that the solution will address them, thereby leading to successful adoption and enhanced access. Aligning with the province’s “Patient’s First” focus, an outcomes-based procurement model also engaged patients as key stakeholders in non-technical discussions in order to understand what matters to them.

Conclusion/Implications/Recommendations: The initiative wishes to investigate whether virtually-enabled care is better for the patient, and its learnings will drive the requisite policy change to build a sustainable province-wide model. In measuring the sustainability of the initial demonstration, indicators within efficiency, integration, and appropriate resources will be targeted. Furthermore, in the interest of fostering innovation within the health care space and discouraging one model of thinking, it is anticipated that the outcomes-based procurement and VOR will provide clinicians with a choice of solutions to best meet their needs. Patients will have more convenient and timely access to their providers as this approach will inform the reform that is occurring in primary care so that patients across the province can benefit from similar virtual care technology to improve their health and experience.

140 Character Summary: Using an innovative procurement approach to identify a virtual solution with the potential to enhance access to primary care.

Purpose/Objectives: Community paramedics (CPs) are boldly tackling one of Canada’s biggest health delivery challenges: providing equitable access to health services for older people living in rural and remote communities. A home health monitoring (HHM) project for CPs (CPHHM) will demonstrate the value of introducing HHM to patients receiving care from CPs in rural and remote areas of the province. We expect the results of the project to show that HHM for CPs will: Reduce the likelihood of CP patients experiencing exacerbations resulting in ED visits or inpatient stays Empower CP patients with the assurance and confidence that their chronic illness is being monitoring on a regular basis

Methodology/Approach: The project builds on a preceding initiative to introduce CPs to more than 70 rural and remote communities in the province. The CPHHM solution for CPs launched in August 2017 and will continue through March 2018, by which time we expect approximately 80 CPs to be using HHM. CPs will install the equipment at the patient’s home and assist in entering their first day’s data. The patient will enter their metrics daily for approximately 90 days. If any of the patient’s entries fall outside ranges prescribed by the patient’s care team, the CP will see alerts which will trigger a consult with the patient’s doctor/care team regarding an action plan. Daily monitoring may provide the patient’s doctor/care team with early warning of a deteriorating condition, perhaps before a patient notices symptoms themselves. The opportunity for the doctor/care-team to course-correct may result in avoiding a more serious intervention and reduce the strain on the healthcare system. Additionally, the CP will provide continued education to the patient on how to better manage their illness. The CP will also share progress reports with the referring provider on a regular basis. Once monitoring completes, the CP will discharge the patient from the program and a member of the project team will contact the patient to capture their experience with CPHHM through a survey.

Finding/Results: Early feedback from patients and community paramedics is that patients feel more connected and safe being monitored remotely and CPs are quickly becoming proficient-with and trusting-of this new service provided to their patients. The success of CPHHM will be evaluated using data-driven outcomes that may include: reduction in the number of patient emergency department visits; reduction or avoidance of patient hospital admissions; increased patient engagement in self-management; improved coordination of care and communication between patients and care providers; and increased effectiveness and efficiency of the Community Paramedicine Initiative. Initial findings/results are expected in time to be presented at eHealth in May.

Conclusion/Implications/Recommendations: It is expected that the results of CPHHM will demonstrate a positive patient experience, increased overall health of the CP patient population and a reduction in both acute and community healthcare utilization. The primary benefit is that through HHM, CPs will provide patients with tools to better understand and manage their own illnesses.

140 Character Summary: Home health monitoring for community paramedics improves outcomes for seniors in living with chronic illness in rural and remote communities.

Purpose/Objectives: Social media technology, such as Twitter, allows users to communicate with each other by sharing short messages. Users often share their thoughts, feelings, and opinions on these social media platforms and as a result, social media data could be used to provide real-time monitoring of psychological and behaviour outcomes that inform health behaviours. The growing body of social media data is becoming a central part of big data research as these data can be modeled alongside other datasets (e.g. physical activity level) and used to predict outcomes from these datasets. Research has already shown that data from social media technologies can be used for novel approaches to identifying infectious disease outbreaks such as influenza transmission and HIV outbreaks. Currently, it is unclear whether these methods used to analyze social media data for predicting infectious disease outbreaks could be applied to physical activity research. Thus, the purpose of this study seeks to establish methods of using Twitter data to monitor physical activity level by assessing 1) whether geolocated conversations about physical activity behaviors can be extracted from Twitter, 2) the feasibility of using physical activity related tweets as a method to monitor physical activity levels across the United States.

Methodology/Approach: Tweets were collected from Twitter's Advanced Programming Interface (API) between January 30, 2017 and October 15, 2017. We used Twitter's ‘garden hose’ method of collecting tweets, which provided a random sample of approximately 1% of all tweets. Geo-tagged tweets were filtered. A list of physical activity keywords was compiled using the guidelines for exercise testing published by the American College of Sports Medicine. A tweet was classified as physical activity-related tweets if it contained one or more related keywords to physical activity (e.g. exercise, running). Latest data on physical activity level at each county across the United States were obtained from Center for Disease Control, Behavioral Risk Factor Surveillance System. Negative binomial regression model was used to model the association between county-level physical activity level and physical activity-related tweets while controlling for GINI index. GINI index was used as a standard measure of income inequality.

Finding/Results: There were 330,551,865 Tweets collected between January 28 to October 15, 2017. 50,844,874 contained geo-location information within the United States. Preliminary data analysis has shown that physical activity related tweets can be extracted from Twitter data and may be used to provide information about physical activity level across the United States. Detailed analysis results to use Twitter data to monitor physical activity level are forthcoming.

Conclusion/Implications/Recommendations: Using social media data to monitor physical activity level can be a valuable tool for public health organizations as it can overcome the time lag in the reporting of physical activity epidemiology data faced by traditional research methods (e.g. surveys, observational studies). Consequently, this tool could have the potential to help public health organizations better mobilize and target physical activity interventions.

140 Character Summary: This study examines the feasibility of using real-time social media data as a method to monitor physical activity levels across the United States.

Purpose/Objectives: This presentation will describe the strategies being utilized to advance nursing data standards adoption in Canada, the benefits to be derived, and the current state of adoption. Strategies to be addressed encompass activities in the areas of clinical practice, administration, nursing education and research, and health policy including concrete examples of achievements to date.

Methodology/Approach: This presentation will focus on the follow-up activities and outcomes of a nurse leaders’ symposia held in 2017 and highlights of the 2018 meeting. Supported by the vendor community and sponsored by the Canadian Nurses Association, Canada Health Infoway, and the Canadian Institute for Health Information, the 2017 symposium was attended by more than 85 participants representing every provincial and territorial jurisdiction across Canada. Building upon the foundations of the action plan established in a 2016 symposium, the 2017 meeting included a broader engagement of nurse leaders and key stakeholders and continued the evolution of strategies to advance the adoption of nursing data standards across Canada. The symposium included plenary sessions from key stakeholder organizations, large group discussions, and working group deliberations to identify specific objectives and activities for 2017-18.

Finding/Results: The outputs of the 2017 symposium to be described will include: 1) the identification and development of actual clinical demonstration projects to illustrate the value of adopting and using clinical data standards, 2) a strategy to delineate the competencies required by nurse leaders to advance the uptake of clinical data standards, 3) the identification of research needed to better understand the impact of using clinical data standards and continue the advancement of same, 4) strategies to advance the understanding, value and use of clinical data standards in undergraduate nursing education, and 5) the details of a policy advocacy strategy to broaden stakeholder engagement nationally. Further activities to heighten awareness, align with other initiatives (e.g., accreditation, patient safety, use of quality indicators), and extend participation to an increasing number of health care provider organizations will be described. With the 2018 symposium being held earlier in May, the attendees will also get a preview of the outputs arising from this most recent meeting.

Conclusion/Implications/Recommendations: The May 2018 Symposium will provide an opportunity to review, refine and and extend the plans and activities identified in the 2017 meeting. Hence the 2018-19 action plans arising from the 2018 meeting for the 5 working groups will be also be briefly discussed. Attendees will be invited to offer suggestions and recommendations for further development of the work.

140 Character Summary: Describing the strategies being utilized to advance nursing data standards adoption in Canada, the benefits to be derived, and the current state of adoption.

Purpose/Objectives: Humber River Hospital, in collaboration with Central LHIN Hospitals, Central Home and Community Care and Central LHIN, worked together on identifying gaps in processes related to ALC management/avoidance, and prioritized areas for improvement resulting in the development of the Discharge Planning Pathway and Discharge Planning Application iPlan.

Methodology/Approach: Our innovate approach to discharge planning combines standardized clinical workflows with a newly developed application, implemented across the Central LHIN. The Discharge Planning Pathway allows for the early identification, engagement and management of patients that require discharge planning interventions, and is supported by literature and leading practices. iPlan is a new technology that integrates with hospital electronic medical records, and brings together information from Central LHIN Hospitals, Central Home and Community Care and Resource Matching and Referral (RM&R). This application captures the flow of patients through the hospital from admission to discharge, provides real-time situational awareness, improved communication between patients/families, hospital and home and community care teams with shared accountabilities to better manage patient transitions, a platform for future community engagement, and system level data to inform decision making and future planning.

Finding/Results: Humber River Hospital implemented the pathway and observed an initial decrease in ALC numbers, and prevented some avoidable ALC’s to Long-Term Care. Two months post implementation, our number of ALC cases have decreased by greater than 20%.

Conclusion/Implications/Recommendations: The discharge planning pathway and iPlan are dynamic and can be implemented at any hospital. iPlan understands where patients are in the discharge planning pathway from data received from the hospitals EMR and staff interactions with the application, and generates notifications for standardized interventions enabling consistency in practice and promoting a high reliability culture. Central LHIN Hospitals are currently implementing this solution in a phased approach.

140 Character Summary: iPlan is a “smart” application that understands where patients are in their hospital journey, and pushes notifications for standardized clinical interventions.

Purpose/Objectives: Health care organizations across the world are seeking ways to optimize electronic health record (EHR) adoption and use for benefits realization. Specifically, there is a need for a data-informed tool that can inform the design and delivery of end-user support (e.g., EHR coaching, training, etc.) to optimize EHR adoption, use, experience and efficiency after EHR Go Live. Island Health is the first health care organization in Canada to adopt Cerner Advance, an advanced data analytics tool that provides expert analysis to inform the design and delivery of end-user support to achieve these goals. The purpose of this presentation is to share Island Health’s methodology, barriers, facilitators and benefits realized in using the Cerner Advance tool.

Methodology/Approach: In May 2017, Island Health adopted Cerner Advance, a Web-based analytics tool that helps to optimize individual use of the EHR based on recognizing opportunities to create user efficiencies. The tool organizes data with multiple levels in an easy-to-use visual display that can be sorted by different views. Using stoplight coding, the tool identifies high-, medium- and low-opportunity users (i.e., opportunity to increase efficiencies in EHR use). Since June 2017, Island Health has used Cerner Advance to develop targeted EHR optimization projects to support EHR adoption/use, using five metrics: (1) Time in EHR; (2) Patients seen; (3) Computerized Provider Order Entry %; (4) Electronic Documentation %, and; (5) Adoption Score. To design an individual EHR optimization plan, the following methodology is used: (1) Review Cerner Advance data before an end-user coaching meeting; (2) Approach the targeted physician/nurse and share goals of optimization; (3) Observe the workflows of the provider/clinician using the EHR; (4) Provide suggestions that will improve EHR adoption or efficiency, and; (5) Share Cerner Advance data with the physician/nurse when appropriate.

Finding/Results: Island Health has proactively leveraged Cerner Advance to identify “high-opportunity” users who can be provided post-implementation end-user support and optimization coaching to improve their EHR adoption/use and efficiency. From April (baseline) to September 2017, this data-driven end-user support has resulted in increased: (1) Quick Orders Selection (45% to 51%); (2) Orders via MySearch (40% to 46%);CPOE % (94.25% to 94.65%), and; Electronic Documentation (96.8% to 98.4%) for all physicians. At the same time, physicians’ active time per patient in the EHR has decreased from 5:40 to 5:11. However, limitations/challenges of the tool include (1) Targeted physicians must have seen at least 40 patients to have reliable EHR usage data and (2) EHR usage data was initially unavailable for nurses.

Conclusion/Implications/Recommendations: Island Health is the first health care organization in Canada to use Cerner Advance, a proactive, data-driven approach to EHR optimization. In addition to targeting end users based on adoption, efficiency and organizational goals, this data-based approach to end-user support helps increase user satisfaction, as well as build capacity in understanding/applying data to EHR optimization conversations with end users. Canadian health care organizations can apply Island Health’s methodology, barriers and facilitators to their own planning, design and delivery of EHR optimization efforts for benefits realization.

140 Character Summary: Island Health is using a proactive, data-driven approach to EHR optimization to increase EHR adoption/use and user satisfaction for EHR benefits realization.

Purpose/Objectives: Champlain BASE eConsultation service, established in 2009, connects primary care providers (PCPs) to specialists through a secure webbased platform. Approximately 80% of all PCPs in our region and over 170 specialists from 105 different specialty services participate. Objective: New healthcare technologies often fail due to poor provider experience. Understanding key drivers of provider experience and how to measure will enable health service delivery partners to successfully launch new health technologies. We will discuss three areas of focus: 1. Successful primary care engagement strategies used in BASE eConsultation 2.Specialist motivation to participate in BASE eConsultation 3.How eConsultation services can enhancing provider relationships and continuing professional development

Methodology/Approach: The panel will discuss their extensive experience in implementing and sustaining provider engagement in an eConsultation service. We have obtained provider experience in several ways: Who uses eConsultation services? We linked usage data from our eConsult data to physician characteristics retrieved from the CPSO database and determined characteristics associated with usage A survey of specialists participating in two eConsult services (OTN and BASE) was conducted A qualitative analysis of free text comments made by primary care providers when closing an eConsult was done.

Finding/Results: We have engaged over 1300 PCPs submit 1000 eConsults per month. Neither sex, being an international graduate – documented predictors of EMR adoption- nor proximity to specialists were found to explain usage. Only length of time in practice was found to be predictive. Lower use by veteran physicians may reflect their lower need for services like eConsult given their well-established specialist networks, or their greater confidence in practicing medicine. Of the 175 specialists who completed the survey, there was strong agreement that participation in eConsult services was driven by the goal of improved communication with primary care providers, desire to provide innovative care and need to reduce wait times. (figure 1) PCP's included comments related to educational value and collegial value in 223 cases which highlighted the impact of eConsult services in improving the primary care and specialist relationship. (see figure 2)

Conclusion/Implications/Recommendations: Health care providers highly value eConsult services as an opportunity to improve patient care and reconnect primary care to specialty care.

140 Character Summary: Health care providers highly value eConsult services as an opportunity to improve patient care and reconnect primary care to specialty care.

Purpose/Objectives: Attendees will learn about challenges and rewards of the eHealth Centre of Excellence (eCE) approach to supporting primary care providers (PCPs) with the adoption and use of digital health technologies. The approach merges organizational engagement strategies and change management methods to support PCPs in their strategic selection of tools that support care delivery.

Methodology/Approach: The eCE has grown their efforts to enhance the quality of patient care across several digital health programs. Current programs include System Coordinated Access (SCA) eReferral, Quality Based Improvements in Care (QBIC) which develops best practice electronic medical record (EMR) based tools, eConsult, virtual visits and more. The eCE is also Delivery Partner for the connecting South West Ontario (cSWO) Program offering the cSWO Regional Clinical Viewer, ClinicalConnect™, and Health Report Manager (HRM), deployed in collaboration with OntarioMD. Within this varied work the eCE provides a collaborative process, a “one-stop shop”, to PCPs. Clinicians are supported to make decisions and customize their adoption of solutions. The central idea at the eCE is to work with clinicians to understand challenging elements in their practice and to enable best fit solutions to produce clinical value for patients. To get to agreement the eCE uses a set of strategies that includes: 1. Engaging in deep relationships with primary care providers developed over time to learn about delivery model requirements and clinical workflow; 2. A change management framework designed to support the unique requirements of the primary care environment, developed iteratively with input from PCPs across the region; 3. Development and communication of benefits realization cases providing evidence of the clinical and system value created during adoption; and 4. Internal use of client relationship tools to track and optimize stakeholder engagement activities as well as developing adoption targets based on the knowledge of practice.

Finding/Results: Even though the eCE has a refined method and strategy, the key finding in our work lies in the dedication to working through tensions and complexities. Our focus on enabling PCPs and pursuit of their informed choice of a solution that best enables their work requires acknowledgement that engagements change directions and our people need to adjust and avoid collisions.

Conclusion/Implications/Recommendations: Managing within a regional, centralized service organization that supports the PCP adoption and meaningful use of digital health solutions involves patience, communication and skill. The rewards for remaining focused on enabling clinicians to produce value are: appropriate information accessed by PCPs to produce clinical value for patients and improved efficiencies for the system as a whole.

140 Character Summary: The eHealth Centre of Excellence provides a one-stop shop of digital health tool solutions and supports for PCPs across the Waterloo Wellington LHIN.

Purpose/Objectives: The BC Ministry of Health Rural policy paper calls for improved access to health care services in rural communities, a reduction in travel for clients/patients in these communities and the use of technology to assist in service delivery. At present patients/clients face considerable expense and hardship travelling to the city for rehab services or go without the benefit of these programs. Telehealth units are present in each rural community but are not well utilized. There are very limited Rehab resources available in the Coastal Rural & Remote communities due to a shortage of skilled Rehab staff, the challenges of recruiting to rural/remote communities (other employment, housing, isolation, few services), and underutilization of technology and virtual care. The TIDES (Telehealth Innovation Deployment Education & Sustainment) Rehab team is a Rural & Remote Rehab service located in Sechelt BC. The TIDES team services the Sunshine Coast, Powell River, Bella Bella, Bella Coola and Sea to Sky communities with the goal of providing early discharge service to patients coming from hospital/rehab centers to home for local rural rehab. The mandate is to fully utilize the potential of Telehealth as a platform for Rehab service delivery

Methodology/Approach: The OT/PT/SLP provide therapy to patients in person at their local hospital Rehab area, and virtually via Telehealth. Therapists will work closely with the Rehab Assistants to carry out treatment. Rehab is short term and goal directed with an emphasis on building connections with community resources and programs. Ipads are used as a tool in all therapeutic work with clients. Clinical sessions are held via Telehealth with the Therapists, Rehab Assistants and clients. Remote communities are accessed via Telehealth for client sessions in First Nations Health Centers in cooperation with First Nations Health Authority Telehealth Services.

Finding/Results: *Population Health: ·Strengthened chronic disease management programs ·Lower mortality rates ·Heightened feelings of cultural safety ·Improved collaboration with partners in care delivery (FNHA, First Nations Health Centers) ·Stronger understanding of patient needs and community complexities Experience of Care: ·Improved access to healthcare services within the community ·Reduction in travel outside of the community ·Improved continuity of care due to consistency of providers ·Quicker repatriation of patients back to their communities ·Consistent quality of care delivered across the CoC Per Capita Cost:* ·Reduced patient travel costs ·Faster discharge of rural patients from acute settings ·Reduced ED visits and acute care utilization ·Greater flexibility to address shifts in demand/volume ·Less reliance on in-community FTE via the virtual healthcare delivery model

Conclusion/Implications/Recommendations: *Quantitative:* -Client journey -Service Delivery model based within home communities in rural/remote settings -Reduced travel to the city- patients/clients seen in their home communities -Reduced expenses for patients/clients and VCH -Recruit skilled professionals to go into rural/remote communities -Meet the needs of the community to provide rehab services closer to home. -Better health for communities, innovate for sustainability in health care

140 Character Summary: Virtual Rehab delivery through the TIDES Rehab proram allows us to leverage and promote the use of technology to care for clients in rural and remote communiteis.

Purpose/Objectives: Background: Improving the quality of the electronic medical record (EMR) and reducing medical errors are critical factors in the provision of successful patient care. Embracing the use of information technology and EMR to provide evidence-based medicine readily available at the point of care has had a major impact on achieving these goals. Incorporating evidence-based information into patient care requires making the right information available at the right time. EMR documentation using templates can play a key role in improving the efficiency of data collection, and ensuring all relevant elements are collected in a structured format. In addition, consistent and standardized clinical data play a key role in measuring and monitoring the quality of healthcare delivery. Context: The North York Family Health Team (NYFHT) is one of the largest in Ontario serving 92,533 active patients. NYFHT comprises of 84 family physicians, 52 Interdisciplinary healthcare professionals, 20 physical sites, two different EMR systems operating on seven in-house servers. Purpose: We identified the need to create a centralized process to review and update all existing EMR forms and templates, particularly the chronic disease management forms and templates across our multisided organization.

Methodology/Approach: Approach: To improve consistency of patient care, data sharing and quality of reports, the NYFHT has formed a data standardization committee responsible to promote and support standardization of EMR data entry. Terms of reference were developed to define the goals and objectives, responsibilities and the scope of work. The committee meets every other month and reports to the Information Management/ Information Technology Committee at the FHT.

Finding/Results: Findings: The committee has identified the following priorities to work on: periodic health review templates, diabetes flowsheet, asthma action plan, UTI encounter form, EMR reminder installation in patient charts, and renewal of existing vaccination lists within the EMR systems. Once these forms are reviewed and revised, they are trailed to evaluate their accuracy by volunteer physicians and nurses prior to releasing to the entire FHT. Currently, the committee has accomplished the task of reviewing and updating several forms against current best practice guidelines. These forms have also been standardized and released for use among FHT physicians across the two EMR systems. In 2016-2017, 7 EMR forms and templates reviewed against most recent clinical guidelines and revised, 4 EMR system reminders and alerts were developed to prompt providers to provide care needed, 62% of NYFHT providers adopted the newly developed Periodic Health Review templates.

Conclusion/Implications/Recommendations: Implications: EMR documentation and data optimization are the cornerstone of effective patient care. The quality of healthcare data impacts every decision made along the patient care continuum. The demand for accurate and reliable data has never been more important. Involving the right team members and ensuring effective implementation and adoption across the team is the foundation for building an effective and successful process that will help improve patient care through meaningful use of EMR systems.

140 Character Summary: EMR standardization, involving the right peple and ensuring effective implementation and adoption across the team play a key role in improving patient care.

Purpose/Objectives: Healthcare policy supports inclusion of patient experience ratings in healthcare quality measurement & reporting. • Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is gold standard for collecting patient perceptions and experiences with care. • Traditional mailed CAHPS surveys have low response rates (~30%) • Racial/ethnic minorities and older adults are less likely to respond. • Mobile technology can be used to capture perceptions of patient experience at the point of care.

Methodology/Approach: Survey Adaptation & Design • Partnered with start-up company Shift Health to create tablet-based survey interface that was visually attractive, icon-based, and simple. • Adapted Clinician and Group CAHPS (CG-CAHPS) survey to lower literacy levels of questions and shorten survey length. Patient Feedback & Validation • Elicited feedback from 3 existing patient advisory councils to refine survey questions, interface, and workflow for administration. • Conducted 25 in-depth interviews with patients to: • Elicit perspectives about care experiences and preferences for reporting feedback to providers/clinics. • Validate a tablet-based survey compared to the standard paper-based CG-CAHPS (patients received both surveys in randomized order). • Collect feedback about the interface and content of a tablet-based survey to inform future iterations.

Finding/Results: Preferences for Survey Administration • Timing of data collection – Value of collecting feedback at the point of care to avoid mail delay, occupy time in waiting room. • Prefer tablet-based survey administration – Novelty, color, interactivity, “fun” factor, familiarity with mobile platforms. • Prefer paper-based survey administration – Tradition, lack of technology skills or interest, privacy. Usability of Tablet-Based Survey • High ease of use – Tablet quick, easy, and convenient to use. • Few technical barriers – Difficulty with key-in answers, lack of flexibility in answering questions. Importance of Reporting Patient Experience • Survey not capturing positive feedback/experiences – Value of reporting good experiences to recognize staff and providers. • Survey capturing the need for clinic improvement, but not personal negative experiences – Value of reporting bad experiences to get resolution or drive changes in quality of care. Perceptions of Survey Capture of True Experience • Quality of provider communication, staff respect, and access to care were prioritized concepts. • Need for open-ended reporting format.

Conclusion/Implications/Recommendations: A majority of patients served in safety net healthcare settings are interested in using tablets to provide timely feedback to their clinic. • Engaging patients in the design process produced a tablet-based survey with high usability and appropriate content. Clinics can integrate quality improvement & patient experience efforts with enhanced data collection . • Current CAHPS questionnaires capture some core concepts of diverse patient care experience, but not the full range of responses. Federal policy should support improved content and format for collecting patient experience data from diverse populations.

140 Character Summary: Using the Tickit platform improved the completion rate and cultural inclusivity of San Francisco Department of Public Health's CAHPS survey.

Purpose/Objectives: HL7’s FHIR (Fast Healthcare Interoperability Resources) has quickly become a cross between the Holy Grail and a household name for health IT implementers. The past year has seen much in the way of leadership activity that has taken hold across the country. Although a number of countries have embraced FHIR as the interoperability solution of choice for in health IT, Canada is just getting started. Early implementations have been initiated with some learning on what to avoid. How we ensure this new technology becomes embraced and used by all includes a number of factors including the use of the early adopter experience to build best practices for Canada.

Methodology/Approach: A community has united and convened to identify priorities, discuss opportunities and collaborate on the building blocks of a national strategy. Various tools and resources have been identified and secured to support the advances in health IT in order to improve access to health information and care.

Finding/Results: FHIR is truly an international standard with early adopters in Canada amassing a wealth of knowledge and experience. FHIR is not without its operational challenges that must be recognized. It is these experiences in development and delivery that could lay a strong foundation for a united national strategy.

Conclusion/Implications/Recommendations: A panel of experts and early adopters will demonstrate the level of due diligence required to form a national FHIR strategy facilitating scalable implementations.

140 Character Summary: Early adopter experience may be the secret sauce to inform all future successful FHIR adoption in Canada.

Purpose/Objectives: In Québec, the rapid adoption of mobile devices by consumers (Cefrio, 2015), an aging population, and increasing incidence of chronic disease (Émond, 2011) have encouraged the development of "mobile health”, notably facilitated by the proliferation of mobile applications and the marketing of health-related connected objects (WHO, 2011). Nevertheless little is known about the factors influencing consumer adoption of these applications or mobile health platforms. The objective of this study is to measure the influence of several determinants on the intention of consumers/patients (aged 40+ in Quebec) to adopt a free mobile health management platform and their interest in personalized follow-up by the pharmacist via the platform. More precisely, the study examines the influence of mobile technology characteristics (ease of use and perceived utility) (Davis 1989), personal variables (social influences and innovativeness with technology), health behavioral factors (Rogers, 1975) (perceived health-related vulnerability and severity), as well as relational variables such as trust in, and commitment to, their pharmacists. As such, it uses variables and models from the marketing, information technology and health.disciplines in a single theoretical framework.

Methodology/Approach: An online survey was conducted on 356 representative Québec respondents owning a mobile device and having visited their pharmacist at least once over the past year. The results were analyzed using structural equation modeling software (EQS 6.0).

Finding/Results: The results revealed that 50% of respondents would be willing to adopt the mobile health management platform. The main determinant of adoption intention is perceived usefulness of the technology, followed by innovativeness with technology and the perceived vulnerability of one's state of health. However, interest in personalized follow-up by the pharmacist depends on the quality of the relationship with the pharmacist and the perceived severity of threats to the respondent’s health. Interest in personalized tracking by the pharmacist does not influence intention to adopt the mobile application.

Conclusion/Implications/Recommendations: We suggest that providers of this type of technology target consumers that are open to new technologies, and for whom perceived utility is an important factor in adopting the platform, for example, patients with a chronic disease. It would also be advisable to target consumers who have already developed a certain relationship with their pharmacist. This research is original by taking a multidisciplinary approach in focusing on consumer/patient intentions to adopt a mobile health management platform. It is also original in its interest in the concept of the patient-pharmacist relationship. Its social contribution is important given current economic and public health issues and improvement of the health system. Indeed, while (1) the health system is in a funding / resource crisis, (2) the role of pharmacists has recently been expanded in Quebec, and (3) patients are increasingly exposed to this type of service technology focusing on health, exploring the potential of new technologies in the context of the individual /pharmacist relationship is part of a process of reflection relevant to the Canadian, society.

140 Character Summary: This study tests the effect of various factors driving the intention of patients to adopt a mobile health management platform and personalized monitoring by their pharmacist.

Purpose/Objectives: Healthcare providers are facing challenging times as they look to find a balance between decreasing inpatient volumes, continued aging of the Canadian population, the diffusion of new healthcare technologies, increased pressure for other public spending and as the trend moves towards value-based care accelerates. Clinical and data analytics leverage big data with clinical evidence to manage health and drive decisions. However, analytics alone will not lead to value-based outcomes. How does Operational Excellence leverage data analytics and Continuous Quality Improvement (CQI) methods to drive value?

Methodology/Approach: A 3 step examination of how Continuous Quality Improvement methodologies have been utilize in healthcare, a look at Operational Excellence as a systematic alternative and examples of how it has been successfully applied in the Alberta health system. 1. A high level review of popular quality and analytics methods that have been utilized in the Canadian healthcare sector and their progression, strengths and weaknesses. Including: - Lean - Six Sigma - Agile 2. Exploration of Operational Excellence as a holistic approach to drive improvement in operational, clinical and financial results throughout a health organization. 3. Review of the application of Operational Excellence to Alberta Health Netcare Support Services and how selected OpEx techniques were applied to translate data into valuable quality outcomes.

Finding/Results: The majority of Canadian Healthcare organizations are lagging behind in implementing an improvement system, or they are still early on in their journey. The application of improvement methods in the healthcare sector vary in the level of sophistication. Evidence indicates adoption in most health authorities however they are rarely managed holistically. The next step to increase maturity is the systematic coordinated planning and execution of value-based performance management and improvement. Operational Excellence case studies (including Alberta Health) have demonstrated: - OpEx has improved financial efficiency as significant operating dollars were tied up in unintended variability - Drive decision making and continuous improvement through the initiation of 11 improvement projects - Process control and effective planning - True transparency throughout organization and accurate reporting

Conclusion/Implications/Recommendations: Achieving Operational Excellence is one of the most important contributors to an organization’s sustainable performance and growth. Many approaches to quality improvement have been tested in healthcare with varying levels of complexity, adoption and success. However, it is proven that organizations that reach for a higher level of Operational Excellence reap numerous benefits – a systematic, evolving and effective approach to business operations; a continually productive and innovative workforce; and an organization that consistently realizes sustainable and continuous improvement. In a big data era, an approach to leverage clinical, financial and operational data is required to understand the integrated outcomes.This requires moving away from traditional “silo” based measurement and improvement to a structured approach that takes into account the entire organization.

140 Character Summary: OpEx is "doing the right things right, consistently." OpEx leverages big data, analytics and Continuous Quality Improvement methods to drive value.