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    PS01 - AI and Smart Technology in Patient Safety Management (ID 3)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Technical/Interoperability
    • Presentations: 2
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 4
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      PS01.01 - Smart Home Technology Detecting Nighttime Wandering in Persons with Dementia (ID 476)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA
      Steve Burton, /

      • Abstract
      • Slides

      Purpose/Objectives:
      The Wander Detection and Diversion (WDD) system is designed to assist caregivers and persons with dementia (PWD) that are at risk of wandering at night. Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the system detects when the PWD gets out of bed and automatically provides cue lighting to guide them safely to the washroom and back. It will also guide them back to bed through audio prompts if they near an exit ? all without disturbing the caregiver in any way. The caregiver is only woken if the PWD opens an exit door. The system has a flexible design allowing it to be adapted to meet the needs of diverse residences and users such as protection for multiple exit doors or coverage for higher risk areas of the residence such as a kitchen or stairs. The message to the PWD is also customized both in the content and the voice. The goal of the system is to improve the caregiver?s sleep and reduce their stress while supporting the safety of the PWD.


      Methodology/Approach:
      Our team of researchers installs the smart technology devices into participants houses for a 12 week trial period. Before the installation the caregiver is asked a series of questions regarding their stress, depression and anxiety levels, as well as questions regarding how many hours of sleep in a night they are getting and how often their PWD exits the bed during the night. During the 12 weeks the participants are contacted every 2 weeks to ensure satisfaction with the technology. At the end of the 12 weeks the caregiver is asked the same questions as the date of the install, comparing their stress, depression and anxiety levels after having the system in their home for 12 weeks.


      Finding/Results:
      3 male and 1 female participant, age range from 59 years old to 98 years old, had this system installed in their houses for a 12 week trial period. There was an average depression rate of 6.5 and an average anxiety rate of 8 at the beginning of the trial, at the end of the trial the average depression decreased to 4.5 and the average anxiety rate decreased to 6.7. The only issues caregivers have had thus far in the research is that there were a few technical issues and that at the end of the 12 weeks the system had to be uninstalled.


      Conclusion/Implications/Recommendations:
      The study is not completed, however thus far, all participants have been satisfied and said that they felt less stressed, depressed and anxious. All participants were able to get more hours of sleep in a given night, and those who did not had reasons unrelated to the system and their PWD. Next steps include testing other types of sensors and looking for a private sector partner.


      140 Character Summary:
      An off-the-shelf smart home technology solution is installed in participants? homes for a 12 week trial to detect and redirect nighttime wandering in PWD.

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      • Abstract
      • Slides

      Purpose/Objectives:
      This panel will examine ways to inspire greater innovation in healthcare by discussing the existing innovation landscape in Canadian Healthcare and the barriers standing in the way of innovations that can improve the efficiency and effectiveness of care delivery. These experts will explore potential solutions based on decades of experience working within health technology innovation and studying the system.


      Methodology/Approach:
      These four experts will explore potential solutions to the problem of low rates of health-tech commercialization based on decades of experience working within health technology innovation and studying the system. Rohit Joshi - Heath tech CEO and lawyer with experience on both sides of the border who has lectured on compliance and patient privacy across North America Feisal Keshavjee - National Chairperson of the Canadian College of Health Leaders, Managing Director KWC Consulting (a boutique health strategy consulting firm), former head of Health strategy for Ernst & Young Consulting Dr. Deepak Kaura - Chairman of the Board of Directors at Joule, Chief Medical Officer at 1QBit, Founder at Imagine Innovation Framework Dr. Ewan Affleck - Family physician, Board of Directors at Canadian Medical Association, Former Chief Medical Information Officer in Northwest Territories where he was awarded the Order of Canada for his work to bring all patients and providers onto a single EMR.


      Finding/Results:
      Canada ranks 9 out of 11 top developed nations when looking at Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Canadians spent the equivalent of 10% of GDP on healthcare in 2014 while many higher-ranked countries spent less (https://globalnews.ca/news/3599458/canadas-health-care-system-lower-performing-compared-to-its-peers-study/). Commercialization of health technology innovations can create cost efficiencies and improve health outcomes. These speakers have experienced what works first hand,


      Conclusion/Implications/Recommendations:
      Examining the Canadian health innovation landscape will provide insight into what?s holding us back, and provide guidance for a strong path forward.


      140 Character Summary:
      Canadian healthcare innovation suffers from barriers in ideation, pilots, commercialization and procurement. What?s working in Canada?

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    PS02 - Collaboration for Informed Patient Care (ID 9)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 3
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 4
      • Abstract
      • Slides

      Purpose/Objectives:
      SickKids and CHEO, through the Kids Health Alliance (KHA,) have been working together for the past two years to develop a structure that has enabled them to share the same platform for their EHR. Despite different implementation timelines and organizational objectives, this goal has been met. We believe this is unique in comparison to other ?Hubs? as our partnership is based on alignment from a patient population and clinical perspective as opposed to geographical proximity. This work was done to support the strategic direction of KHA, which is to improve care for the pediatric population across Ontario. The challenge that we are now faced with is how to operationalize the structure given that we have two different application support teams and both organizations have their own unique strategic directions and stakeholder requirements. A key factor in the success of this partnership was the development of a governance structure both at the KHA leadership level as well as the application leadership level. We will continue to use and build on this governance to ensure continued success.


      Methodology/Approach:
      We will approach the discussion based on our implementation experience and lessons learned.


      Finding/Results:
      We will present our structure for shared roles including: ú A shared training manager - whose mandate is to align training across organizations to ensure a consistent training approach, with shared resources and materials ú Application analysts - we will show how the teams currently works together and how we will optimize these roles to create efficiencies that will allow for benefits to both organizations ú Technical infrastructure teams - a shared team supports the technical environments. We will share how these teams work together to support the primary site (located in Toronto) and the disaster recovery site (located in Ottawa) We will provide and discuss examples of how we will work together on upcoming projects. Specifically related to a 2018 Upgrade of the EHR, Special Updates that occur approximately every 8 weeks and shared build decisions that we need to align on for each application (e.g. ED, Inpatient, Outpatient) - We will include examples of how the need for shared build decisions has facilitated opportunities to align clinical care and best practices. Included in the discussion will be our strategy for developing a shared roadmap as we roll out more modules, features and functionality


      Conclusion/Implications/Recommendations:
      As with any endeavour of this scale there are many lessons learned which we will share and use to improve our process. Some of the key areas of challenge include: ú Change control - keeping the system safe as teams are working in it. Challenges with communication since teams are located at different organizations ú Timeliness of decisions - the need for a solid prioritization process and decisions matrix to ensure decisions are made efficiently and in a timely manner. Differences in clinical practices between the two organizations that require discussion and alignment on system build We will highlight areas where groups are working well together and use that experience to inform our approach moving forward.


      140 Character Summary:
      The session will highlight opportunities, challenges and risks as we leverage a shared EMR to support clinical care and decision making.

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      • Abstract
      • Slides

      Purpose/Objectives:
      In partnership with over 12 health service providers in 5 LHINs in Ontario, the Ontario Telemedicine Network (OTN) implemented and evaluated three models of ?digital self-care? in the area of diabetes, mental health, and chronic kidney disease through a Canada Health Infoway (CHI) funded project. To determine efficacy and potential for scale, OTN partnered with the Women?s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) to rapidly evaluate the tools and inform a provincial roll-out. One of these three solutions (Big White Wall) is now available for anyone with mild to moderate anxiety and depression in Ontario.


      Methodology/Approach:
      Instead of a traditional RCT, an innovative, non-traditional approach was applied to the evaluation, which was integrated and multi-stakeholder. The evaluation was an active piece of the implementation, in place of the typical analysis that takes place at pilot conclusion. Efforts were made to generate the data as quickly as possible using a mixed-methods approach. This practical rapid cycle evaluation as an approach was shown to offer broad utility and support effect decision making. In some cases, implementation continued according as anticipated however in some instances, data served to support a change in direction. The value of real-time evaluation was the ability to course correct in some instances or identify different value propositions altogether Also integrated was the Institute for Healthcare Improvement?s Triple Aim focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs -- thereby informing a sustainability model on a provincial scale.


      Finding/Results:
      Of the three pilot projects, one of the solutions was able to move to a full scale provincial rollout. Today, all Ontarians are able to access the Big White Wall - an online peersupport solution for people with mild to moderate depression and anxiety. The panel will share key outcomes from the evaluation, as well as what conclusions were drawn to inform moving from a pilot to a province-wide solution (and why some did not). There are many factors involved that are based on the findings from the initial implementation and the readiness of the healthcare sector.


      Conclusion/Implications/Recommendations:
      The evaluation underscored that the following factors contribute to the ability to scale to a provincial solution: ? A patient-centred approach to implementation focused on building and maintaining engagement is important. Many types of patient personas can benefit from technology, at all stages of their chronic disease. Provincial rollout needs to consider each persona. ? Digital Self-Care technology can be used to help patients better manage their chronic disease ? if integrated with clinical care, but sometimes without clinician intervention. Provincial rollout is significantly impacted by the level and types of clinical intervention required. ? RCT evaluations have their place, but rapid and rigorous evaluations of technology implementations are necessary not only to assess efficacy of technology, but also to know how best to optimize its utilization in practice and potential funding models. Provincial strategies need to consider payment aligned with rates of usage.


      140 Character Summary:
      Province-wide digital self-care can be achieved with pragmatic evaluation, an understanding of patient personas & aligned health system priorities.

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      • Abstract
      • Slides

      Purpose/Objectives:
      Ontarians expect that the wealth of their health information held by the province will be made available to them in the near term through the digital solution they choose. To best enable patient choice, application innovators need a clear and replicable process for connection. The current pathway to connect consumer applications to provincial digital health assets (PDHA) (e.g. labs and prescription information) lacks transparency, clarity and a defined connection process. The SPARK initiative, funded by the Ministry of Health and Long-Term Care (ministry), aims to make it easier for innovators to safely and securely flow provincial health information into the hands of patients and their health service providers. By March 2019, SPARK will make it possible for approximately 60,000 patients to digitally access their lab and prescription information stored in the PDHAs, through applications like myUHN, MedChart, and Medly. This panel will provide the opportunity for candid insights to be shared from the perspectives of the program team, innovators and patients to discuss the challenges of connecting a consumer health application to provincial digital health repositories and review what changes have been implemented to date.


      Methodology/Approach:
      The SPARK program worked with the ministry and eHealth Ontario to create an efficient, repeatable and sustainable connection process by: - Identifying policy and regulatory challenges, along with areas for potential improvement through a series of 6 workshops with our partners, 8 feedback sessions with 10 innovator groups and lessons learned from connection-related activities to create, for the first time, a comprehensive end-to-end view of the entire process. - Documenting and optimizing a transparent, clear and defined pathway innovators can follow to connect applications to PDHAs and flow health information into the hands of patients - Partnering with hospitals and pilot applications to work through the process of connection, identify areas for improvements and create efficiencies where possible


      Finding/Results:
      This panel will highlight the lessons learned, helpful tips and tools gained from the program?s pathway optimization activities by: - Developing consumer-access policies and drafting a new streamlined assessment process that is in compliance with privacy requirements, and also shortening the assessment process from 2.5 years to approximately 4 months - Drafting one set of harmonized requirements across all stakeholder groups that meets provincial security standards - Creating an Innovator?s Guide that outlines requirements for connecting a consumer application to PDHAs By enabling Phase 2 innovators to connect their applications to PDHAs in a timely manner, SPARK will make it possible for patients to digitally access their medical records.


      Conclusion/Implications/Recommendations:
      Bringing together key stakeholders across the digital health technology ecosystem, SPARK will connect patients and their providers with their health data, creating a true collaborative partnership in care delivery and management. Participants at this session will learn about the unique approach taken by the project and insights regarding early benefits and lessons learned from the initial implementation efforts, successes, and challenges. In addition to providing an overview of SPARK, this panel will share early insights on how the patient experience is changing.


      140 Character Summary:
      SPARK enables patient access to digital health information by creating an efficient, repeatable and sustainable connection pathway for consumer health apps.

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    PS03 - Models of Home Care Using Technology (ID 15)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical and Executive
    • Presentations: 3
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 4
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      PS03.01 - Healthy at Home – Sharing Stories (ID 492)

      Heather Harps, TELUS Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Over 2200 patients have participated in the BC Home Health Monitoring (HHM) program, a service free to BC residents that lets clients learn more about and manage their health and chronic condition from home. The program has saved over $4.8M in acute care costs alone, while saving the entire health system about $15.9M. While these results are truly impressive, in this panel we welcome a patient, a family care giver, a clinician and a program sponsor to share the qualitative impact of home health monitoring (outside of the system-level benefits that are typically the focus of such presentations). Participants will share the multi-faceted impact of HHM on care experience: more peace of mind and education, with less stress and anxiety.


      Methodology/Approach:
      Following the HHM program, clients and clinicians completed surveys that helped measure and improve impact. In addition to health system benefits such as reduced emergency visits and fewer hospitalizations, patients and clinicians reported high levels of satisfaction. HHM clinicians rated overall satisfaction with the HHM service, likelihood to recommend HHM to a colleague, and HHM?s impact on care delivery. Patients were asked about their overall satisfaction with the HHM service, progress towards health goals, and impact on quality of life, on self-management, and on family/caregiver confidence that the patient is receiving the care they need.


      Finding/Results:
      In 5 recent studies: -Client satisfaction with HHM ranged from 92% to 99%[1] -Client self-care activation increased 34% [2] -Overall quality of life increased 101% [3] In this panel presentation, we will hear directly from patients, family and/or caregivers, and clinicians as they discuss self-care, self-management and quality of life, with stories such as: - "Dealing with a heart issue was new to us, and having the equipment was a security blanket. It gave me the confidence that we were doing the right things and that my husband is ok. My husband is back to feeling as good as he did before the event.? - ?The monitoring system makes you feel supported and like you have a team behind you. You don?t feel abandoned. They help you with your condition and monitor you on a daily basis.? - "I had some health concerns this morning, and before I knew it my nurse was calling me and talked me through it. I feel much better already." - "I sure like this equipment. By seeing the readings I am able to tell how I'm doing each day and feel confident in managing my health." [1] Island Health HHM - Heart Failure & COPD 2015 ? 2017, Interior Health HHM ? Heart Failure - 2017 [2] Island Health & Interior Health HHM Heart Failure Limited Production Rollout 2013 ? 2015 [3] TEC4HOME Heart Failure, UBC feasibility study, Phase 1 - 2017


      Conclusion/Implications/Recommendations:
      Ongoing feedback from patients, family members and clinicians is a critical input in designing sustainable solutions to improve the lives of patients with chronic diseases and co-morbidities such as high blood pressure and anxiety. HHM programs are having a positive impact on patients? quality of life.


      140 Character Summary:
      Qualitative patient, family and clinician feedback on a program?s potential to reduce anxiety from chronic disease is critical input for successful design.

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      • Abstract
      • Slides

      Purpose/Objectives:
      London Health Sciences, South West LHIN, and Sensory Technologies have partnered to develop an innovative service delivery model to support chronic patient populations admitted with CHF and COPD. The model was developed in 2015 to reduce the ALC burden hospital and LHIN?s alike face today. Most importantly the program is designed to bridge the information gap that occurs between patients, families, caregivers, and physicians when patients are discharged from the hospital.


      Methodology/Approach:
      LHSC utilizes and integrated care team across Hospital, primary care and home care. Following hospital discharge, an eShift enabled home care intervention transitions into the community to execute the collaborative care plan developed by the integrated team. Prior to discharge, the in-patient team coordinates with the bridging team which consists of the COPD/CHF navigator, clinical care coordinator (RN) and specialist. The in-home team utilizes the directed care technology of eshift to execute the care plan through a directing RN, care technician, Physiotherapist, Occupational Therapist, Respiratory Therapist under the oversight of the primary care physician. Patients have access to a nurse through a 24/7 line reducing the need to return to hospital. Patients receive clinical support and monitoring as well as education to accelerate their transition to independence.


      Finding/Results:
      The Connected Care to Home Program (CC2H) helped deliver a superior level of care to patients across the SW region suffering from COPD/CHF diseases and has also greatly benefited both the LHIN and the Hospitals involved. We have seen significant reductions in hospital length of stay, 30- and 60-day readmission rates, ED visits and overall cost of treatment. There has also been a significant increase in patient and caregiver satisfaction picture1.png


      Conclusion/Implications/Recommendations:
      One of the key successes of the CC2H program was the ability to close informational gaps between patients, families, caregivers, and primary care physicians post-discharge from hospital. Real-time updates enabled clinicians to track patient progress, make recommendations to changes care as they progressed through recovery, and provide a point of contact for the community of care to reach out to in the event of an unexpected event. We continue to see interest in surrounding LHIN?s and hospitals due to the ever increase ALC crisis that looms over Ontario. We believe that with the right tools this issue can be managing with minimal organizational changes while utilizing existing infrastructure and resources available.


      140 Character Summary:
      The CC2H model has demonstrated an effective solution to safely discharge COPD and CHF patients from ALC beds earlier and accelerate treatment in the community.

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      • Abstract

      Purpose/Objectives:
      Ontario has a population that is aging and expanding. Within this context, seniors (65 years and older) and Indigenous populations are two distinct demographics that face barriers to accessing care. Seniors are the fastest growing age group in Ontario. By 2041, it is projected that 25 per cent of Ontario?s populations will be 65 years or older, a 50 per cent increase to 4.6 million seniors from 3 million seniors in 2016. This places significant pressure on the province?s healthcare system. More than 22 per cent of all Canada?s Indigenous population lives in Ontario. Almost half the Indigenous population in Ontario live on reserves and settlements. A majority of these settlements are small, remote communities, accessible only by air or, in winter, by air or ice road. Supporting these demographics poses challenges within the health system. (e.g. How to increase efficiencies with home health while maintaining quality of life?). One proven way of delivering better patient outcomes as well as better value for limited healthcare dollars is to treat patients in their communities or in their homes, where they are most comfortable and don?t incur the costs of time, money and stress involved in travelling long distances to receive care. Through the Health Technologies Fund (HTF), a program of the Government of Ontario?s Office of the Chief Health Innovation Strategist (OCHIS) and administered by Ontario Centres of Excellence, we would like to highlight two projects that deliver innovative healthcare remotely ? one for a rural Ontario community and one for a remote Indigenous community.


      Methodology/Approach:
      The first project is tablet-based and allows healthcare providers to keep in touch with patients, including video consultations over the device, appointment reminders and reassurance. The second project aims to provide diabetes clients with an easy-to-use digital health solution for mobile health and tele-monitoring and secure communication among all members of a client?s circle of care. HTF supports the development of made-in-Ontario health technologies by accelerating evaluation, procurement, adoption and diffusion in the Ontario health system projects of up to 24 months in duration. HTF fosters partnerships between publicly-funded health service providers (HSPs), patients, academia and industry to drive collaboration that improves patient outcomes, optimizes the impact of investment in health innovation and scales health innovation companies. HTF projects are evaluated by third-party teams with expertise in technology adoption and diffusion, design and implementation and health economics. The evaluation component of the projects supports the development of a plan to support wider-scale procurement and/or adoption of the technology in Ontario.


      Finding/Results:
      These two projects were deployed in 2017 and are good examples of demonstration projects deployed in remote communities that include both clinician and patient engagement aimed at improving health outcomes, minimizing complications through early interventions, and reducing cost of care delivery for patients with complex chronic illnesses.


      Conclusion/Implications/Recommendations:
      Mobile health and telemedicine technologies hold significant potential to provide high-quality basic and advanced monitoring/diagnostics to an aging population with increased incidence of mobility challenges as well as those in remote communities.


      140 Character Summary:
      Innovative projects enable technology demonstrations that can more efficiently and effectively deliver homecare in remote and indigenous communities.

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    PS04 - Breaking the Silos: It's Not All About Technology! (ID 23)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical Delivery
    • Presentations: 2
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 4
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      PS04.01 - It’s About Time! Engaging Patients by Closing “The Loop” (ID 510)

      Mary Jane McNally, William Osler Health System; Brampton/CA
      Andrew Asa, William Osler Health System; Brampton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      A key objective for Osler is to enable patient activation and engage with patients as true partners in their care. Encouraging patients to direct their system of care increases their confidence and ability to self-manage their own health condition. Commencing with an eReferral, key fields are electronically captured leading to a complete and thorough appointment booking. At home, automated appointment reminders (Voice, Text, Email) are sent 48 hours prior to an appointment. Patients can request to cancel, re-schedule or check-In to their appointment using their smartphone. When they arrive at the hospital, self-serve kiosks register patients and provide them with printed directions to their clinic appointment. Reports and test results are published in Osler?s patient portal (MyChart); which a patient can choose to share with his primary care physician.


      Methodology/Approach:
      Methodology and Approach: Initiating Savience?s appointment management and kiosk system was key. The overall design was iterative, beginning with a basic fit-for-purpose system that was followed up by subsequent improvements based on real-time feedback from patients, their families and staff. In parallel, an in-house proof of concept eReferral system was being developed for the Peel Memorial Centre - Urgent Care Centre (UCC) and Sunnybrook?s MyChart patient portal system was acquired and customized for Osler?s patient population. Constant communication among the project managers leading each of the different projects along with consultation with Osler Patient and Family Advisors was critical. wohc.png


      Finding/Results:
      Osler has optimized the eReferral, appointment and results process. Osler strives to create systems of care that are truly patient centric thereby compelling staff to collaborate with patients and their families, leading to both a more meaningful and engaged patient and provider experience. 1. Nearly 82% of total check-ins were performed via kiosks; used by all ages and cultures 2. Increased appointment attendance rates (i.e. reduced no-shows) via appointment reminders 3. Reduced time spent registering patients (i.e. 70 seconds per kiosk registration on average) and reduced patient registration queues 4. Overall improved patient engagement and patient satisfaction 5. Overall improved staff/physician engagement


      Conclusion/Implications/Recommendations:
      Osler strives to empower patients with a seamless interaction between home and their hospital care. Follow along Osler?s journey as they close ?the loop? by implementing a series of related projects; beginning with a registration, appointment management and queuing system (Savience UK), developing an in-house eReferral application and acquiring a user-friendly patient portal (Sunnybrook?s MyChart). The patient experience will be illustrated through actual patient testimony.


      140 Character Summary:
      Follow Osler?s journey as they close ?the loop? by implementing Reg, Appt Mgmt and Savience UK Queuing, dev in-house eReferral apps & acquiring Sunnybrook?s MyChart

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      • Abstract
      • Slides

      Purpose/Objectives:
      In 2013, Digital Health Canada conducted extensive research across Canada and around the world, in collaboration with a host of subject matter experts, to develop the e-Safety Guidelines. Input from eight leading healthcare organizations? trial use of the resource was used to document and maximize its relevancy and usefulness in real-life situations. e-Safety, in the guidelines, is classified into 8 principles 1. Accountability 2. Safety and Culture 3. Quality Management 4. Human Factors 5. Security Safeguards 6. Risk Management 7. Effectiveness Response 8. Reporting This panel will discuss the application of these guidelines and risk management techniques to reduce the probability and severity of key risks materializing in clinical practice. Additionally we will review insights from a survey and interviews of key stakeholders from across Canada


      Methodology/Approach:
      To identify gaps in the implementation and success of the e-Safety Guidelines, an initial survey of health care practitioners across Canada was conducted. Every effort was made to reach Digital Health Canada members from all jurisdictions, however the responses were relatively limited in number. In order to further explore the results, and provide additional understanding of the gaps, individual interviews with key stakeholders occurred. Key stakeholders include Canadian Patient Safety Institute, Canadian Medical Protection Association, Several major jurisdictional and hospital e- safety representatives


      Finding/Results:
      From the initial survey, it was identified that: 40% of the responders stated that their organization had no e safety program at all and no obvious plans to introduce one Of those who did have a program almost all were at an early stage of the COACH Maturity model (2013.) Only one facility had a structured program The major barrier to advancing e safety was listed as inadequate resources 1. 40% said they did not have a person in their organization who was accountable for e safety 2. 40% said they did not have a formal mechanism for staff to report any adverse events or near misses During the interview cycle, the following key risks were identified: 1. Technology does not eliminate and, in fact, can increase existing process and communication issues. 2. Identifying critical information, such as planned procedures, allergies and medications can be difficult. 3. Technology can create alert fatigue for clinicians


      Conclusion/Implications/Recommendations:
      It was identified in the interviews that implementing an e-Safety system and working to follow the e-Safety guidelines can significantly reduce the risk associated with technology implementations. The panel will discuss best practice for the implementation of an e-Safety Program. This will include discussion around: 1. Implementation and process improvement 2. Identification and remediation of technology risk 3. Incident and near miss reporting standards and management systems 4. Clinical and data governance best practices


      140 Character Summary:
      This session will discuss the benefits, implementation and risk management associated with implementing an e-Safety Program drawn from pan Canadian observations

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    PS05 - How We Figured Out That It Really Worked! (ID 32)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 2
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Pod 4
      • Abstract
      • Slides

      Purpose/Objectives:
      Evidence shows that interoperable health information exchange positively impacts care continuity, care quality, and patient safety. Interoperability is especially important in the primary care setting to support the management of non-communicable diseases (NCDs), which represent Canada?s most significant disease burden. At eHealth 2018, ITAC Health introduced the country?s first provincial Interoperability Scorecard. This presentation updates the Scorecard?s findings and engages with key jurisdictional, industry and patient-advocate panelists to discuss implications regarding: support for disease management initiatives; patient safety and quality of care; analytics and research; and future ICT investment strategies.


      Methodology/Approach:
      The research leverages datasets regarding primary care physicians? digital health adoption rates; meaningful use of EMR data; patients? access to and use of EMR data; and care coordination with other providers. Based on each dataset, comparative metrics are developed and reported, province by province. The 2019 Scorecard will also draw in qualitative information from jurisdictions regarding population health priorities, health system management metrics, and the alignment between digital health investment strategies and specific health initiatives.


      Finding/Results:
      The research and analysis will further the work of the provincial Interoperability Scorecard to better support comparative evaluation of Canadian health authorities in a consistent, constructive and measurable way. ITAC Health, in cooperation with academic, jurisdictional, and industry partners, will present and explore the implications of its updated findings at the eHealth Conference in May 2019.


      Conclusion/Implications/Recommendations:
      The intent of the provincial Interoperability Scorecard is to support better-informed decision-making regarding health policy and digital health investment. It provides stakeholders with a credible, comparative metric that goes beyond simple EMR adoption figures. The Interoperability Scorecard helps measure the meaningful use of digital health to support high-quality, patient safe, coordinated care.


      140 Character Summary:
      ITAC Health reports the 2019 Interoperability Scorecard. How do the provinces compare? What are the policy and investment implications?

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      • Abstract
      • Slides

      Purpose/Objectives:
      Strategies for evaluation, implementation, spread, and scale of digital health technologies depend on their level of maturity. Technological maturity is intrinsically linked to contextual factors, including stakeholder interests, features of the implementation site(s), evidence of impact, and the alignment between the technology and the proposed problem. This panel outlines a process for assessing technological maturity and a roadmap for identifying evaluation needs. It adopts the NASA Technology Readiness Level (TRL) measurement system as a macro-level conceptual framework to assess technological maturity, outlining the evidence requirements and relevant guiding frameworks at each stage. The purpose of this panel is to help attendees (1) understand technology readiness; (2) identify relevant evaluation objectives; (3) identify appropriate micro-level (stage-specific) evaluation frameworks; and (4) recognize which stakeholders to engage across each stage.


      Methodology/Approach:
      This work reflects the thematic consolidation of learnings across evaluations involving 33 digital health vendors, over 20 clinical implementation sites, and more than 75 digital health stakeholders in Ontario. We outline the *Digital Health Evaluation Technology Readiness A*ssessment (DTA) as a comprehensive tool to help stakeholders navigate the evaluation of digital health technologies. The DTA is focused on evaluation of digital health technologies across the innovation continuum, from development to system procurement. A rapid review was used to identify prominent digital health evaluation frameworks, which we mapped to the corresponding evaluation domain within the DTA. This panel will provide an overview of the literature followed by a synthesis of field experience. We will then present the framework, highlighting how it can be used to address the needs of innovators, evaluators, and system stakeholders using real-world examples from past and present engagements.


      Finding/Results:
      The notion of readiness extends beyond the technology itself. Digital health technology readiness must consider the intersection of the technology, its user(s), their context/site, and the nature of the problem to be solved. The extent to which these factors align determines the stage of readiness. The DTA framework (Table 1) includes descriptions of key objectives, evaluation domains, and associated evaluation process(es). Ten pragmatic evaluation frameworks emerged during the rapid review which map to evaluation domains. Table 1- Digital Health Evaluation Technology Readiness Assessment table 1.jpg DH=Digital health; HTA=health technology assessment.


      Conclusion/Implications/Recommendations:
      Health technology readiness is a product of complex interactions between stakeholders (including government, administration, clinicians, and patients), system context, and setting-specific factors. The burden of evidence required to ensure uptake extends beyond basic functionality to include feasibility, acceptability, impact, and scalability. The DTA framework provides a roadmap to help innovators, evaluators, and system stakeholders navigate the evaluation requirements from technology development to adoption.


      140 Character Summary:
      The Digital Health Evaluation Technology Readiness Assessment provides a framework to guide evaluation from digital solution development to system procurement

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    PS06 - Digital Health Innovation Across Canada (ID 41)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 2
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 4
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      PS06.01 - Digital Health Transformation through an Economic Development Lens (ID 131)

      Dale Vandenborre, Opportunities New Brunswick; Fredericton/CA
      Joel Dewolfe, Opportunities New Brunswick; Fredericton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Digital Health brings the promise of transfromation to a sector traditionally challenged to embrace change. For many jurisdictions, health spending trends, increased chronic disease prevalence and aging populations are driving the need to embrace healthcare transformation and digital solutions. An economic development strategy for digital health can allow a juristions to rally around change and spur both positive economic outcomes and new health outcomes for a region. Hear how investment in innovation, specifically in digital health technologies such as Biofabrication & Medical 3D Printing, artificial intelligence and consumer apps are changing the narrative in one of Canada's poorest regions.


      Methodology/Approach:
      By - bringing healthcare subject matter expertise into the agency focused on economic development - placing increased emphasis on long term financial stability of the region - bringing all healthcare stakeholders together under a common vision, - embracing realities, both strengths and weaknesses, that define us - understading roadmaps, challenges, performance indicators and inhibotors of various stakeholders - understanding what is possible at the edge of digital disruption internationally - picking winners - partnering strategically ... we changed the narrarative.


      Finding/Results:
      We are at the early stages of our journey ... and will have findings/results to report at the e-Health conference. Early noteworthy successes/results include establishing a pan-Canadian partnership with the Health & Technology District in Surrey, BC.


      Conclusion/Implications/Recommendations:
      Economic Development agencies are not commonly considered to be such a key role player in Healthcare transformation, but ... ... (1) looking at Health through an ecoomic development lens first was a missing ingredient to acheiving digital healtcare transformation in our region. (2) it takes a community.


      140 Character Summary:
      Economic development agencies must work in lock step with healthcare agencies and vice versa, and there is no better time to do so - inside a digital health revolution.

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      • Abstract
      • Slides

      Purpose/Objectives:
      A foundational level of digital health capacity is a necessity for First Nations health centres to manage their service delivery responsibilities. Not only is this true simply for efficiency, client-safety and privacy, but interacting electronically is the de-facto standard for coordinating care with provincial partners ? essential given the limited scope of health services available on-reserve. Recognizing the importance and urgency for digital health capacity in First Nations health centres, the First Nations Health Information Management in Ontario Initiative (FNHIMiO) developed a Digital Health Roadmap to support transition from paper-based processes and position First Nations in Ontario to access and use digital health tools best suited to their needs. Guided by a group of experienced First Nations Health Directors and clinical champions, FNHIMiO has systematically assessed requirements, identified corresponding tools, developed implementation processes and successfully supported several First Nations to build a foundation to effectively work in a 21st Century healthcare environment.


      Methodology/Approach:
      The FNHIMiO Roadmap approach follows a simple, pragmatic sequence: First Nation Health Centre Health Information Needs Review and Initial Change Management Privacy and Security Enhancement and Change Management Assist with Local System Adoption, Use and Change Management Support Access To/Use of Provincial eHealth Systems Develop and Implement Sustainment Model Key to this is the willingness of an initial group of First Nations to experiment with, refine and validate the Roadmap approach. Once validated, the approach is extended to other interested First Nations. In this way, FNHIMiO is now extending foundational P&S support to many First Nations, establishing information sharing agreements with provincial agencies, enabling immunization program coordination with provincial systems, and enabling access to provincial digital health assets.


      Finding/Results:
      The Roadmap approach is currently being followed by several First Nations across Ontario. The number of First Nations health centres who are benefiting from enhanced P&S capacity, digitally-enabled communications with provincial partners, and local digital health tools that improve efficiency, ease reporting burdens and improve client safety is steadily growing. Requests from other First Nations for assistance is similarly growing, as is support from First Nations leadership to leverage the work of FNHIMiO, and digital health capacity in general, to address inequities in health care for First Nations community members and support First Nations Health Transformation objectives.


      Conclusion/Implications/Recommendations:
      The FNHIMiO Roadmap approach is working. It is helping First Nations take a needs-based approach to build digital health capacity. By taking a methodological and pragmatic approach to integrate care processes with provincial partners, FNHIMiO is reducing overhead and enabling the adoption of standard models that can be extended and sustained. It is recommended that provincial partners explore opportunities to coordinate around the Roadmap approach and that First Nations in other regions explore its adaptability for their own benefit.


      140 Character Summary:
      A digital health Roadmap is bringing benefits to First Nations clients, providers and partners and supporting Health Transformation.

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