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    Closing Keynote (ID 58)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
    • Now Available
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      From Paper to Pixels - and Beyond (Now Available) (ID 561)

      André Picard, The Globe and Mail; Toronto/CA

      • Abstract
      • Presentation
      • Slides

      Purpose/Objectives:
      My mother, born in 1927, had a medical file that was several inches thick. It was all paper. Nobody ever read it. She was deferent ? did exactly what her doctor told her. Had her pills in a plastic pill box to remind her when to take them. My Mom?s biggest privacy concern was that when she was lying on a stretcher in the ER, her butt was hanging out of a paper gown.

      My daughter, born in 1999, has an electronic health record. She can access some of it online. When she visits the doctor, it?s a conversation: The physician proposes a treatment, and the patient discusses what she found online ? some of which is legit and some of which is nonsense . Her biggest privacy concern is someone stealing her identity online.

      I?m somewhere in-between: Semi-deferent and half plugged-in.

      There have been big changes over the generations but the transitions is not yet complete. Patients should own their records and be able to access them on their phones or via apps. They should be able to add to the records, not just read them. They should have e-reminders for appointments and medication. Links to practical information should be embedded in the EMR, to encourage self-care and compliance.

      Virtual visits to the therapist or physician should be as available as IRL appointments. We should have point-of-care instructions for patients (who remember a fraction of what physicians tell them) instead of having them rely on unreliable Dr. Google.

      The future of medical records though is not just about more access, it?s about re-thinking the way information is presented to make it easier for patients and practitioners. Words will give way to data visualization, and maybe even 3D imagery. For example, you could watch a virtual cancer surgery on your phone before visiting the surgeon.

      Similarly, lab test results, which are largely incomprehensible, need a makeover to make them more readable and digestible. When you are prescribed drugs, they should come with a link or an app, with instructions, programmed reminders, and icons about the side effects.I also foresee the day ? in the relatively near future ? where every child has their genome decoded from the heel prick they get at birth. We will carry our genomic information around on our phone, and it will be an integral part of the medical record. We have a good idea ? or at least an inkling ? of how technology is changing and how it will have a profound effect on e-health.

      The tough part of the equation is: How will Canada ? which has been a laggard in adopting innovation ? will respond to the changing landscape and consumer demand.In other words, how will you meet the expectations of my grand-daughter?

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    Opening Keynote (ID 55)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
    • Now Available
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      Health Care and eHealth in the Age of False News and AI (Now Available) (ID 560)

      Michael Decter, LDIC Inc.; Toronto/CA

      • Abstract
      • Presentation

      Purpose/Objectives:
      Timothy Caulfield wrote a powerful critique of ill informed celebrities reshaping public opinion on health and health care. He titled his book Gwyneth Paltrow is Wrong About Everything. Professor Caulfield has 30,991 twitter followers. Gwyneth Paltrow’s has 2.9 million twitter followers.

      In a social media age where the American President with 20 million twitter followers makes public policy by tweet, how can health and healthcare be based on evidence and knowledge.

      How can dangerous ideas such as the anti-vaccine movement be counted and repelled?

      As technology is ramping up its disruption of healthcare, artificial intelligence (AI) can play a huge role in solving many high cost healthcare problems. The FDA recently set up a new division with AI expertise. and permitted the marketing of an AI based medical device. At first, most of the approvals will likely be analytics that assist doctors but in certain cases the AI will be allowed to provide diagnostics. Radiology is seen as ripe for disruption by AI.

      The role of eHealth is essential. If health care providers are to make evidence based decisions as well as combatting fake health news they need real time access to both evidence and to patient level information. Canada has made a large investment in eHealth and evidence at all levels of the healthcare system. The next few years will be a time of delivering the results to providers and most importantly to patients. As the Boomer generation increases its contact with the health services system due to chronic disease they will be seeking a much more informed journey. Boomers also come equipped with Iphones and an addiction to the eWorld. They are surprised when a physician or pharmacist in Canada faxes their prescription. Will we be able to deliver that informed journey and supported patient journey that they expect?

      Michael Decter will base his presentation on his three decades of experience as Ontario Deputy Minster of Health, Chair of CIHI and the Health Council of Canada as well as Chair of Saint Elizabeth Healthcare. His recent experience as Chair of Patients Canada, Medavie Blue Cross and Ontario SPOR-OSSU will also be drawn upon.

      He will explore this challenge with humour, wit and optimism. Yes there are reasons for hope- yes the Internet is not all false news and yes we as a species are getting healthier on a global basis due to better evidence and better communication. And there is much to be done by the eHealth community to support our progress.

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    Plenary Panel (ID 57)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
    • Now Available
      • Abstract
      • Presentation
      • Slides

      Purpose/Objectives:
      Artificial intelligence (AI) has become the buzzword bingo term in healthcare today. Everywhere from health care conferences to organizational strategic plans tout the benefits of AI for addressing health outcomes, efficiencies, and cost barriers we face today in health systems. Exciting as it may be, how do we square this with the current state of health care in Canada? Do we have the quality and quantity of data required to optimize clinical care? Can we implement these tools into existing systems? What are some instances of AI being used today in Canada and what impact is it having? And importantly, where do our policy and regulatory frameworks stand in terms of readiness for AI tools in medical practice. Today?s panel hopes to spark a conversation about what?s required to make the most of AI, and be realistic about the practical approaches we need to take to implement these tools.

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    Plenary Panel (ID 56)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
    • Now Available
      • Abstract
      • Presentation

      Purpose/Objectives:
      This session will Explore investment, analytics and data science. Data helps coaches teach professional athletes how to maximize their strengths and realize incremental but important gains. Why don?t we treat healthcare providers like star athletes? Healthcare in Canada is like five people playing pickup without a coach: leaders should be able to access and analyze health data to make sure their most valuable resources - frontline healthcare providers - are able to achieve success by always playing to their strengths.

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    Plenary Panel (ID 54)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Keynote Session
    • Track:
    • Presentations: 1
    • Now Available
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      The Impact of Virtual Primary Care Visits on Continuity of Care, Friend or Foe? (Now Available) (ID 562)

      Brett Belchetz, Maple; Toronto/CA
      Ed Brown, OTN; Toronto/CA

      • Abstract
      • Presentation

      Purpose/Objectives:
      With the increasingly active virtual primary care visit landscape both in Canada and internationally, many across health systems have accepted that virtual visits are here, and they’re here to stay. But what do we know about virtual primary care visits and their impact on continuity of care? One of the central tenets of primary care in Canada is that it stands as practice grounded in relationships and relationship building. Indeed, provincial governments historically endeavoured to set targets to attach their populations to a primary care physician in recognition of the benefits that the continuity of a single relationship can have on health outcomes and experience for patients. So how do we reconcile this historic approach with the incumbent technologies that stand to disrupt the way we deliver primary care by making available, ‘physicians on demand’? What should we be mindful of as these technologies enter the primary care space and what are the arguments for or against continuity when we have such a dire access situation nationally?

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    OS18 - Increasing Digital Access for Patients (ID 30)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
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      OS18.01 - Patient-facing Health Information Technology for Decision-making: Evidence/Implications for Design (ID 536)

      Selena Davis, Faculty of Medicine, Department of Family Practice, University of Bristish Columbia; vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Today there is growing interest in patient-facing health information technologies (HIT) that engage self-management decision making. Shared decision making (SDM) is an optimal and collaborative approach to decision making between the patient and care provider. It is neither about convincing the patient to follow the provider?s recommendation nor about leaving a patient to decide on his/her own 1. SDM is fundamental to person-centered care, increases patients?- and providers? satisfaction, improves quality of life and clinical outcomes, and fosters a better patient? provider relationship 2, yet it has been difficult to embed into clinical practice 3. Personal health record (PHR) technology is a promising approach for overcoming its implementation barriers 4. SDM has been conceptually framed to include four sequential elements - Acknowledge, Consider, Decide, Act ? and mapped to patient-facing HIT functionality 5. The purpose of this research was to validate, from the perspective of the user, a functional model for an integrated patient-facing HIT that enables SDM.


      Methodology/Approach:
      Functional requirements analysis is widely accepted to be the most crucial part of system design and indeed implementation success can largely depend on how well this activity is carried out. In this research, the user-centered design approach allowed the patient and providers? needs and interests to influence system design process. The mixed methods included an SDM task to PHR function mapping exercise followed by a semi-structured interview to collect the system functions that each user requires for the different tasks that they perform. User-centered design is argued to increase the likelihood that the system will fit with users? expectations and preferences and ultimately promote usability, effective use, and sustained usage 6.


      Finding/Results:
      The research developed an enhanced SDM?PHR (e-PHR) functional model justified by patients and providers (n=22) with a moderate level of agreement (Cohen's kappa 0.60-0.74). Located within an interconnected EHR ecosystem and accessible across mobile computing platforms, e-PHR integrates 23 PHR functions for the SDM process, described as an action of the patient, and characterized as foundational, essential or optional. Many notable design implications were also identified and will be presented, such as notification functionality, tracking the decision-making process, intelligent decision support tools, integrated support networks, cultural safety, health literacy, structured vs. unstructured and manual vs automated data entry.


      Conclusion/Implications/Recommendations:
      It has become increasingly important to implement patient-facing HITs that are designed for self-management decision making, such that the patient and their care team stay better connected and informed, share in the decision-making process and improve care and outcomes. Together, the e-PHR functional model and other design aspects identified may be translated into detailed system design, implementation and operational requirements. The failure of EHR systems to provide patients access to their health information, incorporate patient self-reported data into interconnected systems, and enable the collaborative SDM process, may have undesired consequences for patient health. Just as PHR technology designed on an interconnected architecture with the required functionality has the potential to enable SDM, so too does the integration of the SDM process into the PHR have the potential to drive its value and adoption.


      140 Character Summary:
      User-centered design investigation of a functional model for an integrated patient-facing health information technology that enables shared decision making

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      OS18.02 - Patient Empowerment: A Review of Current and Emerging Approaches (ID 380)

      Brian Lefebvre, eHealth, PHSA IMITS; Burnaby/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Consumer health is a burgeoning field and many organizations and governments are seeking to empower patients and improve outcomes by providing electronic access to health information and health systems. This review examines both the academic and grey literatures for evidence regarding the use of personal health records (PHR) and patient portals. Key functionality and critical functions for these approaches were identified. The literature was further examined to understand what constitutes an optimal approach to provide a patient-centric solution for patient access and engagement.


      Methodology/Approach:
      A rigorous literature review was undertaken to identify and outline theories, narratives, ideas, and themes from a variety of studies. Additionally, an advisory panel consisting of senior healthcare leaders was established to review and validate findings of the literature review.


      Finding/Results:
      It is clear from the literature that the evidence that PHRs or portals will lead to better health outcomes for patients is not convincing. However, there is ample evidence suggesting the use of portals and PHRs will facilitate enhanced patient-provider communication, patient engagement, and a positive change in health behaviours. Much of this benefit is dependent on patient characteristics such as health and computer literacy, demographics, and current illnesses. There is a lack of research that fully considers the patient perspective. Much of the research available looks at solutions designed as extensions of electronic health record (EHR) or electronic medical record (EMR) solutions, with minimal patient input into design and functionality. Several portal and PHR solutions are provider- or product-centric and don?t fully appreciate the full spectrum of patient information needs. In addition, research shows there are several barriers to and facilitators of these solutions. The literature indicates that patients want access to a wide range of functions including scheduling appointments, renewing prescriptions, communicating securely with health care providers, viewing health records, and journaling about health status. Many of the functions desired by patients may be partially available in the current PHR and portal solutions, but there currently is no approach that takes into account the wider context of patient-centric solutions. A significant part of this review looked into potential solutions through a patient-centric lens. It was evident that neither portal nor PHR approach would provide the optimal solution for patient engagement. Limitations of these approaches include dependence on the availability of the host system in the case of the patient portals, and the effort required by the patient to input or acquire information in the case of the PHR.


      Conclusion/Implications/Recommendations:
      With this in mind, an emerging concept referred to as open digital solutions was seen as the optimal approach. Open digital solutions is an approach wherein the information needed by a patient is borderless and not tethered to one particular system. Open digital solutions are focused on providing information through the use of applications and standards that are not tied to any one product or provider. This is a product-agnostic solution and has the ability to provide for a patient-centric approach.


      140 Character Summary:
      A review of evidence regarding the use of personal health records and patient portals to identify an optimal and patient-centric approach for empowering patients.

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      OS18.03 - Engaged and Empowered: SK Citizen Health Portal (ID 318)

      Lillian Ly, eHealth Saskatchewan; Regina/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Citizens often do not have enough personalized health information to take an active and meaningful role in managing their own health care. In 2014, a Citizen Health Portal (CHP) was identified as a strategic breakthrough initiative aimed at providing individuals with access to their health system information and empowering them to participate in achieving better health outcomes. By providing individuals with access to their health information, it helps improve the health literacy of Saskatchewan citizens and allows for proactive conversations about their health with their care teams. Saskatchewan?s consumer health solution, CHP, is a web-based service designed for citizens to access their personal health information. It provides opportunity for input of self-generated information, as well as interactive tools that enhance lifelong health quality for individuals and their families. eHealth Saskatchewan (eHealth) went into the pilot with a focus on speed to deliver, cost and benefits evaluation of a citizen centric portal. The portal leveraged existing assets from the provincial repositories such as lab results, immunization history, prescription history and visits to acute care facilities, to provide citizens with valuable health information in CHP. Based on the results from the pilot, it is eHealth?s intent to proceed with a full implementation of CHP. A full production rollout of CHP could result in a transformative change within the health system. CHP could be leveraged by health and other partners to be the gateway for citizens to health information and services.


      Methodology/Approach:
      CHP Phase 2 will be looking to scale from a pilot group of about 1,100 citizens to the general Saskatchewan population. The estimated timeframe for the project is 24 months, which includes the: design and development phase, soft launch or technical go-live, and provincial go-live followed by benefits evaluation activities. Highlights include: Account and Access Management - Revamp the registration process to provide a seamless user experience, while integrating the provincial client registry to offer alignment with identity management in SK. A mobile interface will also be offered for those accessing their CHP accounts via tablets and smart phones. Personal Data Entry & Tracking - Optimize the workflow and work effort of data entry and personal tracking by offering direct integration to wearable devices and mobile health applications so that linked data seamlessly populates citizens? CHP profiles. Integrated Data Sources - Design and architecture for provincial repository integration will be improved using FHIR which will allow for flexibility to scale to target adoptions and not negatively impact other integrated services. Provincial data sources will include lab results, medical imaging report, immunization history, hospital visit history, and prescription information. Citizen-Provider Interactions - Features and functionalities that offer services and tools that bring together shared care plans to improve health and wellness through collaboration with providers via secure messaging, provider directories, and interactive shared widgets.


      Finding/Results:
      CHP Phase 2 is anticipated to go live in 2019, and so findings and results are not available at this time.


      Conclusion/Implications/Recommendations:
      CHP Phase 2 is anticipated to go live in 2019, and so conclusion/recommendations are not available at this time.


      140 Character Summary:
      SK?s consumer health solution is an online service designed to help improve the health literacy of citizens and promote proactive conversations about their health.

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      OS18.04 - Selling a No-Brainer (ID 128)

      Stewart Cameron, Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2016 the government of Nova Scotia announced the intention to provide a personal health record (PHR) to all its citizens, the first province to do so. The ?MyHealthNS? portal offered patients secure online access to their health summary, their test results, appointment booking and two-way secure communication with their provider (eMessaging). Providers could also send confidential communications to each other. There is evidence that such portals can improve patient safety, satisfaction with care and clinical outcomes.


      Methodology/Approach:
      The provincial rollout followed a very successful 2 year demonstration phase. Patients and physicians had expressed high levels of satisfaction with MyHealthNS. Physician participants advised that widespread adoption of this technology would require integration with practice EMRs and a physician funding model for the provision of virtual care. In response, the Department of Health and Wellness mandated that approved EMRs must integrate with MyHealthNS. However, the newly minted Master Agreement did not make provision for physician payment. Stakeholders agreed that a limited implementation would be presented. It would offer the eResults function but would leave eMessaging as optional. MyHealthNS was offered free to all. Providers choosing to use it received one-time compensation for their training and set up. As in the demonstration phase, patients were enrolled by the online practices.


      Finding/Results:
      After six months, family physician adoption plateaued at about 21%. Patient enrollment by physician offices was less effective than was seen in the demonstration phase. On average, each provider only sent 2-3 new invitations to patients to connect with their practice each month. Most providers were not using all features of the portal. Only a very small number of family doctors chose to activate the eMessage capability of MyHealthNS. A new pilot program was announced by government in March 2018 with improved funding for fuller use of the platform. To be eligible, physicians were required to offer an open invitation policy to their patients, share results and reports to the portal and to enable the eMessage function. After considerable delay in implementation, the pilot went live in August. Two months after the launch, only 135 of the province?s 900 family physicians had signed up. While this tripled the number of physicians using MyHealthNS for patient messaging, there has been feedback from non-participating doctors expressing concern about the potential for increased workload. Some felt patients might experience harm from accessing their reports. Some physicians regarded the recommended two business day response time for eMessages as unacceptable. Many physicians were migrating their EMRs and prioritized this over the portal adoption.


      Conclusion/Implications/Recommendations:
      The majority of citizens and their doctors still do not have access to the benefits of the PHR. For a number of reasons the program has not been fully embraced by the provider community. As well, the plan to have patents enroll through their providers has proven to be problematic. A permanent physician funding model will be needed. Only when these issues are addressed will the full benefits of the portal be available to the population.


      140 Character Summary:
      Lessons learned and barriers encountered in implementing a province-wide patient portal in Nova Scotia

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    OS24 - Co-design Clinician/Patient Interaction (ID 39)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
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      OS24.01 - Development of a Person-Centered Patient Portal Using Stakeholder Co-Design (ID 301)

      John Kildea, Medical Physics, McGill University Health Centre; 1001 Boul Decarie Montreal/CA

      • Abstract

      Purpose/Objectives:
      To share our experience in designing and developing Opal (opalmedapps.com) a person-centered patient portal for cancer patients at the McGill University Health Centre following a participatory stakeholder co-design approach.


      Methodology/Approach:
      Our stakeholder co-design approach comprised six core elements: (1) equal co-leadership including a patient, (2) patient preference determination, (3) security, governance and legal input, (4) user evaluation and feedback, (5) continuous staff input, and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of data access, all medical data should be contextualized with explanatory content, and educational material should be personalized and timely.


      Finding/Results:
      As a person-centered patient portal, Opal provides patients with access to their electronic medical records (appointment schedules, lab results, clinical notes, etc) and empowers them with automatically-personalized educational material tailored to their disease and phase of treatment. For example, it can automatically advise a patient on how to prepare for an upcoming appointment, provide a map of where to go and facilitate appointment check-in. Further, on check-in, Opal can automatically send the patient a symptom questionnaire before seeing the doctor, allowing both the patient and the doctor to focus on the patient?s needs and providing the doctor (and future researchers) with valuable patient-reported outcomes data. Opal is a unique patient portal in five important respects: (1) it was designed and developed from inside the Quebec healthcare system using a stakeholder co-design approach including patients, clinicians and other stakeholders at all levels including co-leading the project; (2) it was designed to encourage patients to submit their symptoms in real-time and/or by engaging them while they wait for appointments; (3) it has been developed with the participation of a large number of medical physics and computer science students at McGill University, thereby exposing the next-generation of researchers to real-world healthcare problems; (4) it facilitates patient self-management by personalizing and contextualizing the provision of information to patients according to diagnosis and stage of treatment; and (5) it was built in a modular way to allow expansion to include data from any EMR in any medical discipline. Presently, the Opal team, in collaboration with St-Mary?s Hospital in Montreal and the Direction g‚n‚rale de canc‚rologie de Qu‚bec, are expanding the app?s use to five other cancer centres in Montreal (St-Mary?s Hospital, CHUM, Cit‚ de la Sant‚-Laval, HMR and Ste-Justine). Funding is being provided by the Canadian Partnership Against Cancer. The expansion will ultimately allow Opal to become multi-institutional such that patients who receive care at more than one of the participating centres will see all their medical data from each centre seamlessly integrated.


      Conclusion/Implications/Recommendations:
      Inclusion of all stakeholders in the design and development of patient-facing software can help ensure person-centeredness, clinician/patient acceptability, and informatics feasibility. That Opal was developed from the ground up inside a Quebec healthcare institution and is now used by patients in a pilot release is an initial measure of the success of the design and development approach followed. Further measures will be evaluated as the pilot project matures.


      140 Character Summary:
      This presentation is about Opal, a person-centered patient portal smartphone app developed in a Quebec hospital using a stakeholder co-design approach.

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      OS24.02 - A Complex Virtual Care Hub Supporting Perinatal Mental Health (ID 247)

      Ian Chalmers, Founder & Creative Director, Pivot Design Group; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Leveraging Design Research and Service Design to better understand the perinatal mental health system (service/delivery/treatment) and create a digital solution offering patients and stakeholders virtual assessment, resources, and treatment.


      Methodology/Approach:
      Our user-centered design approach is informed by primary and secondary research so designers can uncover and act on opportunities to improve experiences and ensure project decisions are based on real people, their real-life scenarios and lived experience. Discovery began with a project/stakeholder team of leading Perinatal Mental Health Psychiatrists in a kick-off work-session. We identified three main users?Patients, Providers, Partners?and developed personas detailing their usage scenarios and context of engagement; who is directly impacted by the challenge/problem we?re trying to solve for; and who is experiencing the most challenges. We conducted a thorough audit of the current marketplace - the mental health system, strategic action plans (federal, provincial), academic studies/research, and any other existing services, tools, and resources that users might be used to and/or allow us to identify areas of opportunity/innovation. User interviews were conducted to better understand lived experiences with mental health in pregnancy (before/during/after), the home support system, and gain key insights of the perinatal journey. Patients: women (range of racial/ethnic/socioeconomic backgrounds) Providers: specialists (obstetrics, gynecology, psychiatry), primary care, nursing Spouses: typically men


      Finding/Results:
      Research findings were translated into a journey map identifying key users, where they are in the continuum of self-awareness; level of care/service; and ranked to prioritize who?s directly impacted. It provided a vivid but structured visualization, telling a story based on experiences while conveying all influential factors, the accompanying emotions, and detailing current/potential service interactions and touch-points. Having identified key user issues/challenges, we developed an early concept for a comprehensive perinatal mental health Virtual Care Hub that supports the needs of end-users and the researchers whose primary goal is identifying, effectively supporting and treating people with mental health concerns at all stages of pregnancy and pre and postpartum. This complex virtual care hub is comprised of: > six main components - the building blocks to improving access to services/treatments > built-in AI and data collection > a virtual care team > end-to-end user feedback gathering for ongoing evaluation/testing.


      Conclusion/Implications/Recommendations:
      Together, these 4 design outputs were the proof-of-concept and core piece of the business case needed to validate the idea and secure future funding to fully design, test & build this Virtual Care Hub. Patient Personas & Journey Map of three patients with acute, chronic, atypical signs/symptoms of mental illness, constructed from their own perspectives. Strategic Design/Product Roadmap highlighting key communication elements that clearly articulate the vision of the network concept, a detailed requirements document, and how this will function on a design and operational level. Virtual Care Hub Concept visualization articulating key users of the health system, providers delivering care, family units, and the direction/flow for use of the hub. Preliminary Wireframes/Mock-ups demonstrating how integration of the various features/functionality address and support the severity stages/need states for perinatal mental illness.


      140 Character Summary:
      A Service Design approach to better understand perinatal mental health and improve access to assessment, resources and treatment for patients and stakeholders.

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      • Abstract
      • Slides

      Purpose/Objectives:
      People with multi-morbidity and complex care needs face some of the greatest challenges of any patient population. These individuals struggle to manage their many health conditions, which may be exacerbated by psychological and social challenges. Primary care providers working in integrated interdisciplinary integrated teams also find it difficult to manage these patients? multiple discordant conditions and symptoms, and their often complex social challenges. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges through supporting goal-oriented primary care delivery. Using the tool patients and providers collaboratively develop health care goals on a portal which is linked to a mobile application to help patients and providers monitor and track progress. Multiple providers on the patients care team can view patient goals and work together to care for patients. This presentation describes the technology, development approach, and findings from the exploratory trial.


      Methodology/Approach:
      User-centered co-design principles were integrated with interpretive descriptive qualitative research methods to capture user priorities, experiences, feedback and expectations through 3 phases of development and usability testing. Development was informed by patient/family and provider focus groups, and interviews to develop an initial prototype which was then iteratively modified through user-working groups. Prior to full-scale evaluation (currently underway) we conducted a 4-month multi-method exploratory trial to uncover contexts, mechanisms and relevant outcomes prior to full-scale evaluation. The exploratory trial took place in two interdisciplinary primary care practices in Toronto, Ontario from 2015-2016.


      Finding/Results:
      The iterative user-centred design approach, informed by interpretive description qualitative methods resulted in several changes in direction for the technology. Critically was the need to ensure both usability and meaningfulness of the technology which was achieved through the multi-phased approach which engaged over a dozen patients, caregivers, and providers. Eight providers and 16 patients (7-control, 9-intervention) participated in the exploratory trial, and while little changes was seen in primary quantitative outcomes of quality of life (captured using the AQoL-4D) and patient activations (captured using the PAM), qualitative data revealed important impacts at the patient and provider levels. Patients reported meeting and exceeding their goals of care (which included physical, social and mental health related goals), and providers reported an improved understanding and goal-oriented care processes. Perhaps most notably, usability concerns around efficiency (particularly around fit to provider workflows) were overshadowed by tool effectiveness. Despite the challenges of adopting the technology into primary care practice, patients desire to use the tool and their positive outcomes meant providers were more willing to modify behavior to adopt the technology.


      Conclusion/Implications/Recommendations:
      : While mobile health technologies are not yet pervasive in the primary care space, the experiences in developing, implementing and testing the ePRO tool are instructive. Developing tools that resonate with what is important to end users, in this case patients and primary care providers, can mean a greater willingness to change processes and behaviours to adopt innovative technologies. Overcoming that first hurdle can lead to greater adoption and subsequent improved outcomes at the patient, provider and system level.


      140 Character Summary:
      Exploring the development, implementation of testing of ePRO: a mobile health tool to enable goal-oriented care in primary care settings.

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      OS24.04 - Application of Virtual Care Models into Palliative Care (ID 470)

      Megan Nguyen, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      An aging population, rising chronic disease prevalence, and desire for a quality end-of-life are increasing demand for hospice and palliative care services throughout Ontario. Virtual care solutions have the potential to reduce unnecessary travel for both patients and healthcare providers and decrease the use of costly acute health services and hospital admissions while simultaneously fulfilling the growing desire to die in-home. The purpose of this project was to identify major gaps in palliative care in Ontario that potentially could be addressed using digital health technologies. The overarching goal was to inform how a virtual care model could be implemented and sustainably scaled and spread to maximize its value at the health systems-, patient- and provider-levels. Our investigation was embedded within the context of two virtual palliative demonstration projects in two Ontario regions. The technology consisted of remote symptom monitoring, videoconferencing, and electronic medical management for patients receiving in-home palliative care.


      Methodology/Approach:
      Eighteen qualitative, semi-structured interviews were conducted with administrative stakeholders, policymakers, healthcare providers, and patients involved in the demonstration projects. Participants were identified using a purposive and snowball sampling technique whereby the demonstration project leads provided eligible contacts for interviewing. Interview questions were open-ended and exploratory to gain insight into participants? experiences with the technology with respect to its features, aspects of implementation into existing models of care, and suggestions for improvement. A qualitative content analysis was conducted to analyze participants? feedback and identify major themes.


      Finding/Results:
      Our interviews confirmed major gaps in palliative care including inadequate access to services, particularly among rural areas and non-malignant patients, lack of early identification of patients, and lack of communication and integration within patients? entire circle of care. Based on the interviews, two technology features were identified as high-value: videoconferencing and remote-monitoring. Videoconferencing supports access to and efficiency of palliative care by enabling providers to interact with patients remotely. Remote monitoring (e.g. self-monitoring tools to virtually track pain and symptoms) was found to promote patient engagement in self-management of their care while also enabling the care team to remotely track and respond to important changes in patients? health status. The evaluation highlighted critical factors for the implementation, scale, and spread of virtual palliative care including: the identification of target users that can benefit more; engagement of end-users in the design of technology; establishing a clinical model that fits into existing workflows; supporting the integration of care; determining a clear value proposition for end-users; incorporating champion leaders to drive adoption of technology onsite; and ensuring the ease-of-use and feasibility of the technology.


      Conclusion/Implications/Recommendations:
      Though the pilot project surfaced many challenges regarding implementation, virtual care models in palliative care could address scarce resources, improve access to services, and support the efficiency and quality of palliative care delivery. Our study provides a list of technological features with high potential and recommendations on implementation strategies that can increase adoption.


      140 Character Summary:
      The project aimed to inform how virtual care can support palliative care in Ontario in the context of two demonstration initiatives.

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