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    OS03 - Secured Communication in Circle of Care (ID 4)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 4
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 5
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      OS03.01 - Secure Messaging and Clinical Communication Solution (SMaCCS) Across Care Continuums (ID 541)

      Sean Spina, Pharmacy, Royal Jubilee Hospital; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Delivering patient-centered care requires an ability to collaborate and communicate across care settings and organizational boundaries, including hospitals and community care settings. Without a secure system available, care providers (including family physicians, specialists, hospitalists, nurses and pharmacists) resort to using their personal Smartphones and non-secure applications to communicate about patient care. The SMaCCS project involved an application that was installed on a participant?s own Smartphone. The app had a user directory that included user specialty area, enabling participants to connect with other health care providers in a secure environment. The purpose of this first-in-Canada project was to determine if the introduction of a SMaCCS for use by community and hospital-based health care providers would improve clinical communication, thereby increasing efficiency and enhancing patient care.


      Methodology/Approach:
      This study used a mixed methods approach, which has been found to be useful in other examinations of secure mobile communications. A before-and-after evaluation approach was used to compare providers? work experiences and proportion of successful contacts using existing communications methods to those achieved using the SMaCCS. The study evaluated the impacts of introducing the SMaCCS on switchboard operators, pharmacists, and physicians using a quality of experience framework to examine; the degree and nature of adoption of the SMaCCS; Effects on user workflow and experience; Effects on care provision


      Finding/Results:
      In total, 2,806 messages were sent in 636 conversations. Of these, 582 conversations occurred between care providers. According to the tracked data, 25% of provider-provider conversations that were initiated were not responded to. Overall, 53% of participants surveyed (59 of 111) reported being satisfied with the SMaCCS app. 75% of survey respondents (85 of 114) were satisfied or very satisfied with the security of the app. Interviewees (n=11) noted that the security was the biggest benefit over using a regular texting application, since it allowed them to send patient information, including PHNs and images, which supported valuable clinical conversations. Six interviewees specified that having the app allowed them to communicate when it was most convenient for them. Only a small percentage of participants (4% of survey respondents; 4 of 113) indicated that the messages interrupted their work day. When the SMaCCS app successfully connected care providers, it allowed them to share secure information to support better clinical care. Furthermore, 51% (57 of 111) agreed or strongly agreed that having the app made it easier to send or receive information that was important for patient care. 80% felt more comfortable sharing patient information using the secure communication tool, which will enable further collaboration for patient care.


      Conclusion/Implications/Recommendations:
      The SMaCCS pilot project provided valuable learnings regarding use of secure messaging between community and hospital-based care providers, and within-hospital communication. Having a secure mobile communication solution was identified as a key component of safe, connected health care system in the future. [results of a FOLLOW-UP PROJECT: *Investigation into the Cleaning Methods of Smartphones and Wearables from Infectious Contamination in a Patient Care E*nvironment (I-SWIPE) may also be presented for the first time at EHealth19 if selected]


      140 Character Summary:
      First-in-Canada research identifies how a common secure communication solution between hospital and community practice improves patient care

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      OS03.02 - Clinical Communication & Collaboration at Fraser Health – Secure Messaging (ID 396)

      Sihong Huang, Fraser Health; Surrey/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Care coordination requires effective communication and the proper communication tools and channels help providers communicate, collaborate and deliver care across the care continuum. There is an emerging need for Secure Messaging (SM) from care providers. Currently, clinicians are using unsecure methods of text messaging to support clinical care by sending personal health information through text messaging on their personal devices. At Fraser Health (FH), Secure Messaging solution has been implemented to allow personnel to securely communicate confidential clinical and corporate information on their corporate and personal devices. The objective was to enable Clinical Communication and Collaboration (CC&C) and layer clinical systems integration capabilities such as, On-Call, alert notifications, MEDITECH modules and pager replacement. Without progress in this space, physicians will continue to insecurely text message colleagues to risk security of sensitive data, patient safety and fall behind in communication efficiency/effectiveness.


      Methodology/Approach:
      The approach to implement SM was to leverage Enterprise Mobile Management (EMM) platform to support mobile device management of personal and corporate smartphones. Formal project management methodology has been applied. The project first focused on the delivery of procurement, design, build and integration for SM solution in a Proof of Concept (PoC) fashion prior to expanded rollouts. With the successful completion of PoC at one of FH sites, our workflow-based phased rollout approach has been confirmed and supported by a clear Bring-Your-Own-Device (BYOD) strategy. A change management strategy to support a transformational app has been defined to support the wide range of use cases and to manage user expectations. An initial top-down communication and engagement strategy was created and executed to ensure effective rollouts across the health authority, followed by a targeted site-focused engagement so as to bolster the sense of ownership thus increase the adoption.


      Finding/Results:
      The SM solution provides a simplified process for clinical users; supports the enhanced and timely communication between care providers, the coordination of care via optimal & timely decision making between care providers and the enhanced clinical workflow by reducing the need for phone calls/faxing/chasing providers. As part of the completion of PoC, we have conducted lessons learnt and post implementation review. One of the key learnings is to ensure all stakeholders who communicate with one another need to be enrolled. Also, the complexity around supporting various smartphones and BYOD challenge has been identified. Providing SM access to non-privileged physicians presents new questions to our security, privacy, legal and professional practice policies as well as funding model. The challenge of managing expectations for those keenly interested while supporting those concerned with change needs to be balanced and well addressed, top-level executive leaderships' support is crucial and effective.


      Conclusion/Implications/Recommendations:
      Delivering a successful mobile app at an enterprise level requires effective design, implementation, engagement, adoption and use. SM is a basic functionality but could be a disruptive technology if it immobilizes users' access to information and effective communication workflows. The greatest opportunity will come as we integrate systems, interoperability between other Health Authorities and create policies to ensure professional practice are supported.


      140 Character Summary:
      Introducing Clinical Communication & Collaboration solutions to support clinicians? mobile workflow, while effectively securing PHI on personal devices.

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      OS03.03 - Digital Health: Evolving and Disrupting the Boundaries of Traditional Healthcare (ID 166)

      Krisan Palmer, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Horizon Health Network is New Brunswick?s (NB) largest Regional Health Authority and is a recognized leader in implementing and sustaining innovative telehealth solutions across all levels of the healthcare system. Horizon?s Stan Cassidy Center for Rehabilitation (SCCR) has recently celebrated 60 years as a North American leader in neurological rehabilitation. SCCR?s newest initiative is another example of empowerment of patients and clinicians to facilitate timely access to scarce clinical resources via telehealth. The purpose for the development of this application was to provide secure capture, delivery and storage of videos taken of those pediatric patients referred to SCCR with significant neurological impairments. These videos obtained by families, as well as established community partners, in various non clinical settings, are critical tools through which rehab professionals at this tertiary center can now provide more timely access, recommendations, treatment and follow-up.


      Methodology/Approach:
      Horizon embraces the philosophy that technology is an enabler. The key to success is to ensure the design and selection of technology to be used is driven by clinical needs. Two clinical needs were identified by SCCR when asked to formally outline the challenges they regularly encounter while providing care to patients throughout rural NB. The first, that situational behavior cannot be appropriately assessed for treatment recommendations unless witnessed by the attending MD or therapist. Secondly, ensuring that assistive/supportive equipment prescribed is safely and correctly applied. Up to this point any attempt to send pictures or videos to the clinicians demonstrating either of these, had been fraught with barriers regarding privacy, security, size and storage. In frustration, many families found their own work around and posted them on u-tube to provide clinicians access. Using Horizon?s established telehealth browser based portal, a mobile app was developed specifically to address SCCR?s need. Patients now use their own devices to download the app from Google Play or Apple store to record and upload videos to their individual patient folder. Clinicians are immediately notified via text and / or email that something new has been added for review and can then communicate their treatment recommendations. Innovative clinical processes and technical architecture are imperative to success in any sustainable telehealth initiative and will be shared specific to this application during the presentation.


      Finding/Results:
      Early intervention by way of increased accessibility permits clinicians to be proactive versus reactive in the detection of safety and treatment requirements for this vulnerable patient population; positively impacting quality of life and overall clinical outcomes.


      Conclusion/Implications/Recommendations:
      Improved access to services that would otherwise not be available in rural or remote communities continues to be seen as the primary contribution of telehealth. However, there is evidence that telehealth can enhance quality of care by better supporting application of best practices, improvement of knowledge and skill development in local care providers, and improvement of care coordination, with decreased costs for payers. Furthermore, telehealth can improve patient/caregiver engagement and enable them to become more active participants in their own care and well-being often from the convenience of their own home, wherever that may be.


      140 Character Summary:
      Provision of a collaborative approach to patient centric rehabilitative care via the use of a Health Authority custom designed mobile app on patients own devices.

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      OS03.04 - Blockchain: Activating patients to take control in our health system (ID 376)

      Selina Brudnicki, University Health Network; Toronto/CA
      David Wiljer, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Patients, caregivers, and care teams are challenged with the fragmented health system which prevents easy movement and sharing of patient health records. This results in barriers for patients in managing and partnering in their health, and timely decision-making to determine best treatment options. Now imagine an opportunity where patients can securely control, share and monitor the use of their data! A consortium of Blockchain Accelerator Program founders representing healthcare, government and private industry is in the early stages of co-design with patient, caregiver, clinician, research and privacy representatives to deliver a minimal viable product (MVP) that will start to break down fragmented health systems. The MVP will demonstrate how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The long-term goal will be to enable patients to become more active participants in managing their health; contribute to data-driven insights to improve communication, safety and health outcomes; and support research to find effective treatments and cures.


      Methodology/Approach:
      Co-design with patient, caregiver, clinician, research and privacy representatives ensures that varied perspectives are considered to inform the design and delivery of the MVP. An architecture solution framework has been established to enable patient consent, control and access of their own health data from government, healthcare and private sector sources. This MVP demonstrates how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The project will undergo frequent Stage Gate Reviews to assess and evaluate performance, lessons learned and risks to ensure ongoing delivery of value for patients and the health system.


      Finding/Results:
      Findings and results are three-fold: 1. Delivery of a working MVP and prototype through co-design with patient, caregiver, clinician, research and privacy representatives. This ensures the creation of a usable and value-driven product, taking into account privacy and consent considerations as part of patient control of their own health data; 2. Findings, learnings and value of the project are transparent and shared with key stakeholders and the general public as the project progresses. They have opportunities to dialogue and inform future investment decisions; and 3. Future strategy and planning considerations are well-documented and range from examining and addressing identity management and authentication, to ensuring data governance and trust in a future business network. This MVP informs the next stage of the project to establish a formal Patient Control Blockchain Consortium that oversees data governance, and ensures that a future business network is transparent, trusted and secure. Grounds for further investment can then be substantiated to pilot the Patient Control Blockchain in a real-life setting and address movement of data.


      Conclusion/Implications/Recommendations:
      Through patient control of their own data, a collaborative partnership made up of health care organizations, government, and private industry can be established in order to advance health ecosystem partnerships, accelerate innovation in medical research and inform efforts to deliver value for patients and the health system.


      140 Character Summary:
      This session will share results of a Patient Control of Data Blockchain project that enables patients to securely consent, share and monitor use of their health data.

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    OS06 - Innovations to Process Non Digital Data (ID 24)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 5
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      OS06.01 - Using Natural Language Processing for Improving Coded Data (ID 269)

      Majid Sharafi, Scarborough and Rouge Hospitals; Scarborough/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Inpatient coding is a complex and tedious process that has not changed in the past thirty years. Health records departments are under constant pressure to meet tight timelines and compete for a shrinking pool of expert coders. Furthermore, the introduction of quality-based funding models increased the pressure on hospitals to improve quality of their data. Missed diagnoses are costly to hospitals. A possible solution is to leverage digital data: computational coding employs tools to ?read? clinical documents to recognize evidence and make recommendations on coding of diagnoses and procedures at a higher level of specificity. Scarborough and Rouge Hospital (SRH) embarked on a journey with 3M in 2017 to introduce Computer-Assisted Coding (CAC) to improve coding productivity and data quality. A prerequisite for CAC is availability and access to clinical documentation and other data feeds in electronic and computer readable form. Coders are trained to use the evidence and recommendations made by the computational tools to select appropriate codes. A year later, we conducted a study to understand the impact of this tool on data quality. The study?s objective was to measure the accuracy of the codes captured and whether using this tool influenced weighted cases.


      Methodology/Approach:
      The study was conducted jointly by SRH and 3M, as a before and after intervention comparison of the number of diagnoses and procedures coded by coder and their impact on weighted cases. Multi-variable regression analysis used to measure differences in weighted cases based on variables: diagnosis/procedure count and coder. Charts were randomly assigned to coders pre- and post-implementation; length of stay and weighted cases of charts coded were similar across coders, before and after CAC implementation.


      Finding/Results:
      Number of diagnoses coded post-CAC implementation was significantly higher, as was both, the Comorbidity Levels and Resource Intensity Levels of charts coded. More importantly, there was a statistically significant increase in Resource Intensity Weights (RIW) and Health Based Allocation Model Inpatient Grouper (HIG) weighted cases. Impact on inpatient data (excl. Newborns, Pediatrics and Obstetrics) 6 months post-CAC implementation within 2017/18 FY # of Diagnoses Coded 7% Increase Comorbidity Level 3% shift from Level 0 to Level 2 Resource Intensity Level 4% shift from Level 1 to Level 2 Average RIW 2% Increase (up to 9% for one coder) Average HIG Weighted Case 5% Increase (up to 13% for one coder)


      Conclusion/Implications/Recommendations:
      Results showed clear increase in weighted cases through use of CAC; increase was significant from hospital funding perspective. We anticipate further improvements in coding efficiency; the limiting factor is quality of underlying documentation. The next phase of our journey is to embark on a clinical documentation improvement (CDI) initiative to bring these tools closer to physicians and provide evidence based and data driven tools to improve accuracy and completeness of documentation. Another exciting opportunity in our CAC roadmap is the benefit from advances in natural language processing (NLP) and artificial intelligence (AI) that are incorporated in CAC.


      140 Character Summary:
      Scarborough and Rouge Hospital implemented 3M?s Computer-Assisted Coding tool using NLP engine. Results shows increase in coding quality and weighted cases.

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      OS06.02 - Realizing Patient Movement through an application adapted to your EMR (ID 352)

      Jennifer Backler, Clinical Informatics, St. Joseph's Healthcare; Hamilton/CA
      Andriana Lukich, St. Joseph's Healthcare Hamilton; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The purpose of this presentation will be to share our journey with patient movement within an academic health care setting located in Hamilton, ON during an EMR implementation and share creative strategies that enabled providers and front line staff to navigate the transfer within a complex environment through the developmen of an "app" that could be navigated to within the EMR. The opportunity for attendees to see the application and also understand the complexities of patient movement from the provider and front-line staff perspective. The opportunitity for developers, to consider the neeeds working wtih acute care and between multiple facilities to achieve the necessary patient movement in order to ensure that the right care provisions are available at the point of care.


      Methodology/Approach:
      The SJHH had an implementation of "Big Bang" EMR with leading practices December 2, 2017. We were aware of the complexity of patient movement having detailed patient flow with a hanbook to assist staff and providers with successfully navigating through the EMR tool. We benefited from the work of another organization who went live before us. We mapped out every patient journey with the 80:20 principle to ensure that we did not get caught up on examples which occured infrequently. It was the learnings in the post-live environment that helped us to develop an application that would ease and support the transitions of the patient through a tool that was supportive to front line users and would give them the results needed to successfully move a patient. It was born though the collaborative work on interdisciplinary team including IT professionals, clinical managers and staff and Clinical Informatics.


      Finding/Results:
      The result of this methodology was an "app" that was accessible within the journey of the patient at the time the individual provider needed to complete a discharge or transfer for the patient. This could be during a very acute episode of care and needed to be timely and accurate. The tip sheets that had been developed at go-live were extremely beneficial but were lengthy for staff to acccess. This "app" was the direct result of staff listening to provider and staff feedback about what was required to make them successful. A demo of this application will be reviewed as part of the presentation.


      Conclusion/Implications/Recommendations:
      This application development has enabled us to consider how we merge our own abiliites and developers skills with the well developed documentation and the powerful application of EMR that we have adopted. We have had the opportunity to consider this type of app for many of our clinical parameters used within the EMR.


      140 Character Summary:
      This presentation is an opportunity for industry and health care practitioners to come together to see evidence of the importance of integration.

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      OS06.03 - Automated Patient Location Identification in Pediatric Emergency Departments (ID 307)

      Raza Abidi, Faculty of Computer Science, Dalhousie University; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Pain, dehydration and anxiety in children are common paediatric Emergency Department (ED) diagnoses but are not well managed. In particular, long ED wait times are well known to increase the anxiety of the patients. We aim to mitigate the anxiety of patients, as well as their families, by providing personalized and location-specific therapeutic and educational interventions while visiting a pediatric ED. Our focus lies on customizing the content with respect to the child?s current location in the ED as well as the current healthcare task, as they move through the stages of examination, investigation and treatment. Using interactive adventure-based scenarios, we aim to proactively collect data about the child?s condition, reduce the child?s anxiety, and lead them to give more meaningful responses about their condition.


      Methodology/Approach:
      In partnership with a Canadian children?s hospital, we extended a mobile, game-based, e-therapeutic and patient education app with personalized and location-aware features. This app leads children and parents through a series of screens asking questions about the individual, their condition and other related information. Based on their responses, the app invokes a variety of therapeutic protocols (e.g., self-administration of Pedialyte for vomiting) and educational videos. The platform is made accessible to children and their parents using an iPad, to mitigate their anxiety, fear and discomfort while waiting in the hospital ED. By leveraging the child?s current location, as well as detected wait and dwell times, the platform is able to dynamically customize the educational content. We designed an intelligent indoor localization method based on (Bluetooth Low Energy) beacon signals, which detect the relative proximity between the iPad and detected beacons as (immediate, near, far, unknown). Based on these proximities, we applied machine learning methods to create an indoor localization model, which can accurately classify the child?s location by correlating multiple beacon signals.


      Finding/Results:
      Our intelligent indoor localization methods have been implemented and validated in a children hospital ED, where 14 beacons where deployed. Data from 29 locations were collected to build indoor localization models (classifiers). Using a hierarchical clustering approach, our approach supports merging multiple locations into cohesive regions to balance localization accuracy with the fine-graininess of indoor localization. Our indoor localization approach was able to recognize the current location of a child with 79% accuracy on average.


      Conclusion/Implications/Recommendations:
      With the proliferation of smart sensors and devices, this innovative project provides numerous opportunities to deliver personalized and timely location-sensitive services to patients.


      140 Character Summary:
      Indoor localization to personalize a mobile e-therapeutic platform for mitigating anxiety, fear and discomfort in children while waiting in the ED waiting room.

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      OS06.04 - Dementia Talk App - Empowering Dementia Caregivers through Technology  (ID 264)

      Einat Danieli, 60 Murray St L1-012, Sinai Health System ; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Dementia Talk App: An award winning smartphone App designed to support dementia caregivers in tracking and managing challenging behaviours and in enhancing their communication with other care providers in the circle of care. Nearly 12% of Canadians are caregivers for a person with dementia. Up to 90% of people with dementia (PWD) experience significant behavioural and psychological symptoms (BPSD) that challenge and upset caregivers. Currently, there is no easy way for caregivers to manage and track behaviour-related symptoms in the care recipient, making it difficult to improve care and share information across the circle of care. OBJECTIVES: This presentation will discuss the development of a mobile application called the Dementia Talk App, designed to empower dementia caregivers to manage and track behaviours in the person with dementia as well as enhance communication among care providers. The presentation will showcase key features of the App and share highlights from beta testing results to demonstrate the importance of caregiver driven development process in creating meaningful and accessible digital solutions for clients and their caregivers.


      Methodology/Approach:
      This qualitative study involved 16 caregivers for PWD, recruited through the Reitman Centre Sinai Health System. Participants were asked to use the application for a period of 3 weeks, starting from the date that they received the link. Once the 3-week trial period is completed, a semi-structured phone interview was conducted to seek feedback from users in three main areas: 1. technology and usability 2. clarity of the content 3. The level of relevance of the App to caregivers? concerns in dealing with behaviour-related challenges. Their responses were summarized in written notes and analyzed and organized in main themes using the ?framework analysis? approach. Inclusion criteria: Age 18+; caregiver to a PWD; PWD presenting behavioural symptoms; Grade 3 literacy level; English speaking; ability to use one of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad. Exclusion criteria: Under 18 years of age; Not actively involved in caring for someone with dementia; PWD not demonstrating any behavioural symptoms; Less than Grade 3 literacy level; not English speaking; Unable to use any of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad


      Finding/Results:
      16 eligible caregivers were recruited to participate in the study, 1 participant dropped out for personal reasons. Complete data was obtained from 10/15 participants. All participants that were interviewed agreed that the content of the App was relevant to their concerns as caregivers, and most found the triggers and coping strategies to be very useful. This is a validation of the contents, as one of the most important aspects of the application for its success. Limitations: The 3-week trial period may not have been enough time to completely evaluate the usability of the app. Small sample size.


      Conclusion/Implications/Recommendations:
      Conclusions: Overall, the feedback received was overwhelmingly positive and there is great potential for the app as a meaningful tool for caregivers and other stakeholders in dementia care. Further evaluation needed to validate benefits of the application and long term impact with a larger sample size for a longer period of time.


      140 Character Summary:
      Dementia Talk App: An App designed to support dementia caregivers in tracking and managing care and enhancing communication with members of the circle of care.

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    OS09 - Internet of Things Enhances Care (ID 16)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 5
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      OS09.01 - Socially Assistive Robots for Children with Autism Spectrum Disorder (ID 345)

      Sabrina Tang, Dalhousie University; B3H3H5/CA

      • Abstract

      Purpose/Objectives:
      Socially assistive robotics run by machine learning algorithms are becoming exponentially powerful. This presentation explores the use of socially assistive robots for children with autism spectrum disorder and the implications of this innovation for patients, families and care providers.


      Methodology/Approach:
      520,000 individuals in Canada are estimated to have autism spectrum disorder. The waitlists for therapy are long and getting longer. in Ontario, for example, the waitlist doubled from March 2013 to 2015. As well, the cost of therapy is steep - $75K per child per year. In 2017, the Senate of Canada called on the federal government to determine the appropriate level of funding for autism spectrum disorder due to the excessive financial burden on families. Applied Behavioural Analysis therapy is the standard of practice for autism spectrum disorder to help children with communication and social skills live more productive lives. In Canada, the use of socially assistive robots Nao (by SoftBank Robotics) and Milo (by Robots4Autism) is currently being evaluated. The anticipated benefits are lower costs, higher clinical outcomes, and reduced burden of care over children's lifespan. Pilot studies show increased social behaviours, reduced repetitive behaviours, and increased spontaneous language. In addition to a review of these potential benefits, this presentation will review potential harms, possible mitigation strategies, and remaining challenges from the perspectives of patients, caregivers, providers, and provincial governments.


      Finding/Results:
      Machine learning algorithms and socially assistive robotics are improving exponentially and there is enormous potential to benefit children with autism spectrum disorder. However, concerns remain regarding trust, relationships, employment, and regulation.


      Conclusion/Implications/Recommendations:
      Socially assistive robots are a promising intervention for children with autism spectrum disorder. The government-funded health care system should fund socially assistive robots when they become evidence-based practice.


      140 Character Summary:
      Socially assistive robots can potentially improve therapy for children with autism spectrum disorder

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      OS09.02 - Telemedicine for Assessments of Essential Tremor Patients for Focused Ultrasound (ID 150)

      Valerie Sutherland, Telemedicine, Sunnybrook Health Sciences Centre; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In Canada, brain scientists at Sunnybrook Health Sciences Centre in Toronto, Ontario have pioneered the use of MR-guided focused ultrasound to successfully treat Tremor patients since 2012. Until 2015, it was the only centre in the country offering this treatment. Numerous people located in communities across Canada suffer from debilitating tremors in their arms and hands that have not responded to medication. These tremors make it difficult for people to eat, drink, write and dress themselves. Previously diagnosed tremor patients must be assessed for the severity of their arm and hand tremors before being considered for the treatment. Sunnybrook is now using telemedicine encounters as an option to assess previously diagnosed essential tremor patients from across Canada for their suitability for MR-guided focused ultrasound treatment to save them the expense, time and physical challenges (many cannot travel without assistance) of travel.


      Methodology/Approach:
      Based on the need to assess patients across Ontario and all other Provinces and, the challenges for patients to travel from far distances to Toronto, protocol creation occurred mirroring the in-person neurosurgery assessment tools that would be appropriate, and effective for the assessment of a patient via two-way videconferencing.


      Finding/Results:
      Use of the protocol for assessment of patients has been successful in identifying candidates across Canada. The use of telemedicine means the patients deemed suitable candidates to come in person for the treatment only travel to Sunnybrook for it rather than coming for the assessment and then returning for the treatment.


      Conclusion/Implications/Recommendations:
      Thanks to the provincial and national adoption of two-way video conferencing technologies as a means to deliver health care services, patients can be assessed and learn more about the treatment by interacting with one of Sunnybrook's neurosurgeons via telemedicine. As well, it is effective for post treatment appointments. Patients and their families save the time, expense and physical challenges of travelling to Toronto. To date, over 100 encounters have occurred with patients located in nine of Canada's provinces.


      140 Character Summary:
      Protocal for telemedicine assessment for MR focused ultrasound treatment of arm and hand tremors has been successfully implemented by neurosurgery at Sunnybrook.

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      OS09.03 - The Virtualists: Introducing the Next Generation of Primary Care Physicians (ID 232)

      Francis Nwakire, Think Research; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The purpose of this presentation is to share an overall picture of the virtual care landscape:, from history to present state, and to explore the ?sickcare-healthcare? dichotomy. We?ll show how virtual care technologies can help us evolve ?sickcare? silos into a more robust, preventative form of healthcare, and how the role of today?s primary care physician will evolve into that of the ?virtualist?.


      Methodology/Approach:
      By outlining the roots of virtual care and some of its current iterations, we hope to provide a foundation for audiences to understand how this critical and innovative technology will change our notion of the word ?health? and the role that community care providers play in our healthcare system.


      Finding/Results:
      During this presentation, Think Research will discuss the ways in which virtual care technology is shifting: - The role of provider vs. patient (patient-directed care) - Changing care models: from reactive and prescriptive to self-directed and preventative - Future directions: how AI and machine learning technologies will change virtual care


      Conclusion/Implications/Recommendations:
      Today?s care providers of all sectors in the continuum need to embrace virtual care technology as it will become woven into the fabric of healthcare systems around the world. By understanding how virtual care is (and will continue to) transform healthcare, clinicians, government bodies and patients alike can prepare for this new, exhilarating age.


      140 Character Summary:
      This presentation will outline the virtual care landscape, showing how virtual care technologies is evolving healthcare systems around the world.

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      OS09.04 - Mobile Health for Personalized Behavior Modification by Personalized Action Planning (ID 306)

      Raza Abidi, Faculty of Computer Science, Dalhousie University; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Chronic illness is affecting a large number of Canadians, with ca. 16% of the population having a multi-morbidity as shown by a recent report from the Canadian Chronic Disease Indicators framework (2017)1. Behavior plays a significant role, with behaviors such as physical inactivity, unhealthy diet and smoking often causing or exacerbating chronic illnesses. To realize long-term positive health behavior change, we present a personalized behavior modification framework called Engage, which computerizes key constructs from the evidence-based Social Cognitive Theory (SCT). 1https://infobase.phac-aspc.gc.ca/ccdi-imcc/


      Methodology/Approach:
      We present a knowledge-based, action-planning and community-driven approach to maximize key SCT indicators such as knowledge and self-efficacy, guided by a knowledge model computerizing SCT constructs. Our approach formulates behavior modification programs as sequences of short-term action plans, which are personalized to the patient and designed to overcome perceived barriers to long-term behavior change (mastery experience). The knowledge indicator constitutes knowledge on the risks and benefits of (un)healthy behaviors, and is influenced by frequent educational messages tailored to a patient?s current situation, personal barriers and behavioral goals. To maximize the self-efficacy indicator, which measures one?s perceived ability to perform a long-term goal, multiple SCT constructs are leveraged, such as mastery experience, social modeling and social persuasion. By performing similarity analysis and data mining on detailed patient profiles and patient feedback, our approach leverages the experiences of similar patients in the community (e.g., regarding health, social status and physical characteristics) to (1) suggest action plans with a strong likelihood of success; (2) offer motivation to patients by seeing similar patients succeed (social modeling); and (3) encourage them to connect, exchange advice and provide encouragement on barriers to be overcome (social persuasio


      Finding/Results:
      The Engage framework implements a holistic approach to behavior modification, including (a) collecting an up-to-date patient profile and assessing patient-specific SCT indicators; (b) selecting and tailoring a behavior modification program, based on individual patient profiles and collective patient experiences; (c) delivering timely educational and motivational messages; and (d) monitoring patient compliance and aggregating community-wide feedback on behavior modification programs. The framework includes a number of key components: 1) A core back-end service, which keeps the knowledge model, patient profiles and algorithms for similarity analysis and data mining. 2) A front-end web portal, allowing patients to enter their personal profile, fill out questionnaires for weekly monitoring, and selecting between different action plans to perform. 3) A tailored social network that facilitates patients to connect with other similar patients, post their progress, receive encouragement and see others, similar to their individual situation, succeed. 4) A mobile app (Android, iOS) used by patients to submit progress towards their weekly action plan, receive tailored educational and motivational messages, and serving as a portal into the social network.


      Conclusion/Implications/Recommendations:
      The Engage framework currently includes behavior change content for the long-term goal of increasing physical activity ? although other content can be easily plugged in ? and is undergoing usability tests. We are planning an extensive clinical evaluation of the system, including patients with high risk factors for chronic illness and those suffering from chronic illness.


      140 Character Summary:
      To realize long-term health behavior change, we present a knowledge-based, action-planning and community-driven system guided by the Social Cognitive Theory.

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    OS14 - Keeping Patients Healthy at Home (ID 5)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 5
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      OS14.01 - Using Wound Monitoring Technologies to Demonstrate System-Level Digital Health Barriers (ID 418)

      Leah Kelley, Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      WIHV collaborates with the National Research Council?s Industrial Research Assistance Program to provide advice to small-to-medium size enterprises in the digital health sector. Innovators experience several system-level barriers, including a lack of visible incentives to providers and patients to adopt such solutions. We use a collection of wound care applications accessing our program as a window to demonstrate recurring system-level barriers to their adoption.


      Methodology/Approach:
      Three digital wound monitoring applications were assessed through our program. For the purpose of this analysis, we focused on the use of wound monitoring applications in patients accessing provincially-funded homecare services. We extracted system barriers to successful clinical integration and placed these barriers within the context of current funding and incentive models.


      Finding/Results:
      Three primary system challenges to integrating a digital virtual wound care solution into the homecare setting were identified: *1) Unclear payer: There is no obvious payer for most digital solutions; incentives aligned to in-person visits so virtual care often creates cost for the user despite system savings. 2) Lack of integration with surrounding system: Key processes, such as escalation in the care pathway if adverse events occur, are poorly defined. 3) Lack of data governance models*: There are no consistent processes for defining who is responsible to capture data, who must review it, and where it should reside. The value propositions for homecare agencies and clinicians to purchase and utilize wound monitoring apps are unclear, despite potential improvements in patient health outcomes (Table 1). First, the benefits may be accrued elsewhere in the system (e.g. reduced emergency department utilization). Second, the siloing of homecare from key participants in the tool?s success (e.g. primary care providers and dermatologists), creates a system whereby homecare must try to govern processes where they have no control. It is essential to capture the value proposition of the tool for each relevant stakeholder, especially payers and users, as these value propositions may not be aligned. The challenge is to create ?wins? for all core parties. A non-bundled, fee-for-service context given is a significant disincentive for institutions to adopt a virtual service model. Alternatively, outcomes-based bundles could offset some disincentives by encouraging institutions to improve outcomes through methods (e.g. virtual technology) that maximize their efficiency. Table 1. Understanding stakeholder funding and value propositions Stakeholder Payment Engagement Value proposition Homecare agency/PSW Fee-for-service (in-person) Use application to monitor healing; Escalate care as needed Fewer visits of value because high homecare demand Primary care provider Fee-for-service (in-person/e-consult) Review application data; Escalate to specialist if needed No incentive to reduce in-person visits Dermatologist Fee-for-service (in-person/e-consult) Review application data in consult No value proposition Local Health Integration Network Fixed homecare budget from Ministry Purchase application If app reduces visits, can increase patient coverage


      Conclusion/Implications/Recommendations:
      The current system creates an entanglement of complex incentives and payment models that stifle the success of digital innovations. Outcomes-based funding models, such as bundled payments to homecare agencies, would enable institutions and clinicians to utilize innovations to improve the quality and efficiency of care provision, as demonstrated by the above use case.


      140 Character Summary:
      Digital health solutions face barriers in system incentives due to funding models; use case of wound monitoring application demonstrates key challenges.

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      OS14.02 - Spreading Provider-to-Provider Remote Consult Solutions: Lessons from a Pan-Canadian Collaborative (ID 218)

      Sarah Olver, Collaboration for Innovation & Improvement, Canadian Foundation for Healthcare Improvement; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Long wait times for specialist care is one of the most significant problems in Canadian healthcare. Remote consultation has emerged as an innovative approach to address this issue. Two leading Canadian initiatives, the Champlain BASETM eConsult service and BC?s Rapid Access to Consultative Expertise (RACETM) telephone advice line, are at the vanguard of enhanced provider-to-provider communication and were spread as part of the Canadian Foundation for Healthcare Improvement?s (CFHI) Connected Medicine Collaborative. CFHI launched this 18-month Collaborative in June 2017 to support 11 pan-Canadian teams to adopt and adapt RACE? and/or BASE? to their local contexts. This session will present an overview of the Collaborative, including an introduction to the RACE? and BASE? services, outline the approach used to scale and spread the innovations across jurisdictions, including methods of addressing technological and workflow challenges associated with the new systems, and to showcase Collaborative results. The session will include perspectives from CFHI, the RACE? and BASE? innovators as well as patients and providers who use the remote consult services.


      Methodology/Approach:
      Overall, BASE? results show that 40% of cases in the service avoid unnecessary face-to-face specialist referral. RACE? results show that 60% of calls avoid an unnecessary face-to-face specialist visit, and 32% avoid an unnecessary ED visit. Additionally, these services are shown to enhance the experience of care for both the provider and patient. The Collaborative aimed to support the spread of these services and produce similar impressive results through an in-person workshop, 14 interactive webinars, and direct coaching with expert faculty. Many teams designed for provincial scale or jurisdictional spread with active engagement from their respective regional health authority or Ministries of Health and key regional stakeholders. The Collaborative design and innovative technology solutions pushed towards three overall aims: 1. Support participating healthcare delivery organizations design, implement and evaluate remote consult solutions to improve primary care access to specialist consultation; 2. Improve the quality and experience of care for patients and providers using remote consultation; and 3. Build organizational proficiency and capacity in quality improvement and change management.


      Finding/Results:
      Final collaborative data will be available before the eHealth Conference. Measurement plans and data collection strategies were co-developed by CFHI and teams and include a range of qualitative and quantitative results that address topics such as: quality of care, patient experience, policy and culture changes as well as sustainability, spread and scale of the models. Preliminary data collected throughout the collaborative indicates that teams are adding specialties, the models are reducing unnecessary referrals, improving timely access to specialist care, consult requests are often being answered in less time than required, and patients and providers are responding positively to the service.


      Conclusion/Implications/Recommendations:
      The Collaborative specifically addressed issues of continuation beyond the program, including questions around remuneration policies, return on investment of the models, sustainability and spread. While we are working together to support continued implementation, we believe that these models should continue to be supported in their spread and scale across Canada, as they positively impact patient care as well as provider satisfaction.


      140 Character Summary:
      Results and lessons learned from spreading remote consult services for better patient care through a pan-Canadian quality improvement collaborative.

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      OS14.03 - Leveraging Smart Home Technology for Monitoring of Behavioural Risk Factors (ID 191)

      Kirti Sundar Sahu, School of Public health and health systems, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The UbiLab is developing an innovative health surveillance platform to improve monitoring of behavioural risk factors using real-world data collected through smart home technologies. This powerful system will be able to deliver real-time health insights to public health professionals. The purpose of this project is to explore individual- and household-level health indicators collected in the home via smart thermostats. This method enables the delivery of personalized insights to monitor individual- and population-level health behaviours.


      Methodology/Approach:
      The Ubilab partnered with ecobee, a Canadian smart wi-fi thermostat company, leveraging ecobee?s technology and data from over 10,000 households in North America collected through the Donate Your Data (DYD) program. A small pilot study (n = 8) was done to validate the use of sensor readings of movement between rooms through a cross comparison with Fitbits. The DYD dataset was analyzed for patterns using Python, pandas, Elasticsearch, and Kibana.


      Finding/Results:
      A positive association between Fitbit and ecobee data was found (Spearman?s Correlation coefficient = 0.7, p > 0.001) from 380 person hours from the pilot study. Indicators (sleep, interrupted sleep, daily indoor activity, sedentary) based on the Physical Activity, Sedentary Behaviour and Sleep (PASS) Indicators Framework from the Public Health Agency of Canada were measured using DYD data. Single occupant ecobee households in Canada averaged 7.2 hours of sleep in 24-hours, 2.1 hours of interrupted sleep, were active for 85 minutes daily, and spent 4.44 hours being sedentary. Traditionally, PASS indicators are measured through surveys including the Canadian Health Measures Survey, and the Canadian Community Housing Survey administered by Statistics Canada. Using this technology, it is possible to enable public health agencies to collect additional novel health indicators, monitor health in real-time and deliver health insights to Canadians to increase health literacy. Since presenting at eHealth 2018, we have improved data collection adding Fitbit Charge 2 HRs, upgrading to capture sleep and heart rate not previously possible with the Fitbit Zip. Adding more sensors functionality is crucial for our algorithm modifications, this includes collecting additional data via the Samsung SmartThings Hub, (presence in the home via Bluetooth), bedroom light usage, and luminance. ecobee is sharing participants and data from their own study, increasing variability within data. We have improved our data storing and analysis process, moving the big data architecture from python to Elastic Stack for real-time data streaming and analysis. We are also actively collaborating with PHAC and improving our algorithm and analysis process using their feedback.


      Conclusion/Implications/Recommendations:
      This is a key opportunity to innovate traditional data collection methods, empowering patients through education and leveraging technology infrastructures to enable healthcare and policy decisions to be made with relevant and real-time data. Lessons learned at the individual and community health levels will be shared with community members and researchers. Implications include understanding short-term impacts with minimal effort and new health policies at the community level. This awareness and improvement can help to better physical activity, sleep and sedentary behaviour which may result in improvements in overall health and wellbeing.


      140 Character Summary:
      Smart home technology platform to visualize and understand in-home health behaviours and monitor chronic disease risk at a population level

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      OS14.04 - TEC4Home COPD: Home Health Monitoring to Improve Outcomes (ID 156)

      Jennifer Cordeiro, Digital Emergency Medicine, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Chronic obstructive pulmonary disease (COPD) is a condition associated with high morbidity and mortality, reduced quality of life, and significant health system utilization due to frequent Emergency Department (ED) visits and hospitalizations. TEC4Home COPD is a benefits evaluation examining how Home Health Monitoring (HHM) technology can integrate into the health system to support patients with COPD at home after leaving the hospital or clinic to improve outcomes, including: 90-day ED revisits and hospitalizations, Length of Stay (LOS), quality of life and self-efficacy.


      Methodology/Approach:
      Patient participants were recruited from the Emergency Departments (ED), in-patient, and out-patient units at 3 hospital sites and various COPD community programs in an open trial study design. Upon enrollment, all participants received a HHM device kit supplied by TELUS Health, which includes a tablet, blood pressure cuff, pulse oximeter, weight scale and pedometer. Participants submitted biometric measurements (i.e. blood pressure, oxygen saturation, pulse and weight) and answered a series of yes/no questions about their symptoms (ex. I feel more short of breath today) on the tablet daily over 60 days. Monitoring data was reviewed by monitoring nurses, who followed up on signs of deterioration, shared monitoring updates with the participants? primary care providers, and provided COPD education to participants over the phone. Pre- and post- surveys comprised of validated scales were used to collect and compare data about quality of life, self-efficacy, healthcare utilization, and overall experience. Administrative data related to ED visits, hospital admissions and LOS were accessed to assess impact on healthcare service utilization.


      Finding/Results:
      Seventy five patient participants were enrolled in the study (61% male/ 39% female; average age 71 years) over a 10-month period. Early preliminary analyses (n=31) of the administrative data showed a decrease in overall ED visits and hospital admissions, along with a decrease in the median LOS when comparing the 90-day periods before and after patient participation in TEC4Home COPD. Further, pre-to-post survey results showed some improvement (not statistically significant) in quality of life and self-efficacy regarding COPD self-management. Overall, participants expressed satisfaction with the TEC4Home COPD HHM program. Results and recommendations from the full final analysis will be shared at the eHealth 2019 conference. This will include an overall pre-to-post comparison on identified outcomes (i.e. healthcare utilization, quality of life and self-efficacy). Further, it will include a sub-analysis and comparison of outcomes for participants enrolled immediately following an exacerbation versus those in stable condition to highlight differences.


      Conclusion/Implications/Recommendations:
      This trial demonstrated improved outcomes for COPD patients using HHM, and will provide insights in to how this technology can be used for patients in exacerbation versus stable condition to best support them at home after hospitalizations or clinic visits. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.


      140 Character Summary:
      How can Home Health Monitoring be used to support better outcomes for COPD patients after leaving the hospital or clinic?

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    OS20 - Integrating Circle of Care (ID 33)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 4
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Pod 5
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      OS20.01 - Community Paramedics and Remote Monitoring in BCs Rural /Remote Communities (ID 491)

      Heather Harps, TELUS Health; Vancouver/CA
      Chris Michel, Boehs; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The evaluation of innovative care delivery models to address inequities in health service access is a priority. Access is a particular issue in rural and remote communities across the country. In BC, 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. By introducing home health monitoring (HHM), CPs aim to: 1. Reduce the likelihood of patients experiencing exacerbations resulting in ED visits or inpatient stays 2. Empower CP patients with the assurance and confidence that their chronic illness is being monitored on a regular basis Perhaps one of the more significant challenges facing CPHHM adoption is ongoing stakeholder engagement with clinicians and administrators from regional BC health authorities. The introduction of Community Paramedicine was a departure from standard model of care.


      Methodology/Approach:
      In August 2017 BC introduced Community Paramedics (CPs) to improve access to care. By March 2019, approximately 110 CPs will have access to Home Health Monitoring (HHM) solutions to better serve the populations in 99 rural and remote communities across the province. CPs install the HHM equipment at the patient?s home and help them enter their first day?s data. Then patients enter their metrics daily for about 90 days, or sometimes longer. Daily monitoring may provide the patient?s care team with early warning of a deteriorating condition, perhaps before the patient even notices symptoms. The opportunity for the 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 is done, 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:
      Initial feedback from patients is that they feel more connected and safe being monitored remotely. CPs are quickly becoming proficient with ? and trusting of ? this new service provided to their patients. The success of CPHHM will be evaluated against factors that include: 1. reduced emergency department visits 2. reduced (or avoided) patient hospital admissions 3. increased patient self-management 4. improved coordination of care and communication between patients and care providers 5. increased effectiveness and efficiency of the initiative itself. Findings/results are expected in time to be presented at eHealth in May.


      Conclusion/Implications/Recommendations:
      The results of CPHHM are expected to 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. We recommend that clinicians and administrators continue to be engaged to understand the CP scope of practice and where CPs and CPHHM can continue to add value in the continuum of care.


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

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      OS20.02 - Expanded ClinicalConnect Data Integrations Create a Powerful Patient Care Tool (ID 180)

      Dale Anderson, HITS eHealth Office, Hamilton Health Sciences; E/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      This presentation will showcase the latest features of ClinicalConnect, the regional clinical viewer for south west Ontario. Since 2005, ClinicalConnect has grown to become the single, common portal used by tens of thousands of healthcare providers across a wide geographical area. Providers in multiple sectors use ClinicalConnect to gather patient data in real-time, resulting in quicker diagnosis, treatment and improved patient care and safety. ClinicalConnect's evolution has been fast-paced, and the past year has seen key enhancements, resulting in an even more fulsome view of patient records. Perhaps most significant is that diagnostic images/reports from community-based Diagnostic Imaging clinics ? known as Independent Health Facilities (IHFs) ? are now available. Historically, this was an information gap, given that approximately 60% of ultrasounds, x-rays, etc. are conducted in community clinics, not hospitals. This IHF data is now in ClinicalConnect, complementing the images and reports available from hospitals across Ontario, via direct integrations, or integrations with the Southwestern Ontario Diagnostic Imaging Repository and the Diagnostic Imaging Common Service provincial repository. Other updates include: - New Cardiology Module and how images and reports display - Data display enhancements in the Digital Health Drug Repository (DHDR) to enhance the clinical user experience - Provincial Client Registry integration, augmenting data matching for patients who haven?t had a non-SW Ontario hospital visit - Expansion of Home & Community Care Data to include data from HCCs operated by LHINs outside of SW Ontario - New enhanced mobile user interface with intuitive layout and enhanced navigation, providing remote access to patient records di cc image.png


      Methodology/Approach:
      Health Information Technology Services (HITS), a division of Hamilton Health Sciences, is the solution provider deploying ClinicalConnect across south west Ontario, and HITS? eHealth Office manages enhancements, often based on requests from ClinicalConnect users. Enhancements made to the portal follow a standard Change Management methodology, leveraging repeatable integration processes as much as possible.


      Finding/Results:
      Presenters will discuss how the portal?s new features and intuitive design are supporting increased usage, including portal metrics. The presenter will recount real-life examples of how ClinicalConnect has supported smoother transitions between care settings and having to rely less on patients/families to recall information about their healthcare; just two of many benefits afforded to patients themselves.


      Conclusion/Implications/Recommendations:
      Since ClinicalConnect was last presented, audiences will see its evolution and work undertaken to maintain a leading-edge digital health tool that consolidates patient information from disparate health information systems, into one viewer. Not only that, but how a growing a growing number of community-based providers too are using ClinicalConnect, launching the portal directly from their EMR, to support the delivery of care outside of hospitals.


      140 Character Summary:
      Latest ClinicalConnect updates give doctors access to diagnostic imaging data from community clinics, plus other exciting functionality, expanded data sets.

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      OS20.03 - Increased patient engagement and team continuity in Community-based care  (ID 294)

      Jeff Mackay, Brightsquid Secure Communication Corp; Calgary/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Calgary Foothills Primary Care Network (CFPCN) has a membership of 450 family physicians and serves more than 379,000 patients. CFPCN launched its health home community (HHC) initiative in 2014 to enable local partnerships and better meet patients' health needs. Access to timely relevant patient information is essential to providing good patient care. The current state of fragmented communication systems in Alberta creates barriers to continuity of care. Patients play a vital role in the management and coordination of care; however, the current system essentially denies patients access to their own health information and limits their ability to communicate with healthcare providers in modern ways. As part of the HHC initiative, CFPCN has implemented a test of Brightsquid secure messaging within the Health Home Community to: 1. Improve information continuity and collaboration across health and cross sectoral teams. 2. Improve the patient experience and engagement through interaction with their care team providers and access to personal health information and education resources.


      Methodology/Approach:
      Community Social Workers (CSW) are community-based team members who assist patients with navigating community resources related to meeting basic needs surrounding the social determinants of health. The CSW works closely with the patient, the patient?s family physician, other teams co-located in the health home and community agencies to facilitate a patient centered approach to care. The CSWs are using secure messaging with patients, family physicians, other health providers, and community partners to unite the entire patient care team through one secure and convenient communication channel for the exchange of information. The project is using the Prosci ADKAR change management method to implement in stages with minimal disruption to the provision of care and the functioning of the HHC. ADKAR stands for Awareness of the need for change, Desire to support the change, Knowledge of how to change, Ability to demonstrate skills and behaviours, Reinforcement to make the change stick.


      Finding/Results:
      While the project is ongoing, preliminary results show enhancements in the communication between patient and provider, and amongst the provider team which has created efficiencies in the coordination of care. The typical patient invitation acceptance rate on the Brightsquid system is 70%, through adaptations, this program has achieved a 90% patient invitation acceptance rate. Secure messaging usage data is being collected throughout the program, outcome measures for patient experience and engagement, accessibility to care, improved coordination and integration of care and improved communication between physicians and CSWs will be collected at the program end in February of 2019. Early usage shows that CSWs have added roughly 3 additional contacts or more convenient contacts instead of in-person visits (which helps with treatment adherence) per patient participant in a 6 month period.


      Conclusion/Implications/Recommendations:
      Based on initial findings secure messaging in community care can improve continuity of care and patient engagement. Patient acceptance is high and care team access is increased. These benefits, while still being quantified, will create system efficiencies and a better patient experience when used more broadly across the PCN and the healthcare system.


      140 Character Summary:
      The use of team-based secure messaging to improve patient experience and engagement through remote interaction with care team members.

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      OS20.04 - Videoconferencing to Support Intraoperative Surgical Coaching: Are We Ready Yet? (ID 255)

      Caterina Masino, General Surgery, UHN University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Intraoperative coaching between peer surgeons can support the professional development of surgeons in an increasingly complex surgical environment. However, this activity can be time intensive as surgical coaching requires the physical presence of a surgeon coach in the operating room. The use of a telementoring platform may be a less intrusive form where the coach participates virtually. This pilot study aimed to evaluate the feasibility of introducing a telecoaching program to facilitate intraoperative surgical coaching activity.


      Methodology/Approach:
      Telecoaching was implemented using the Karl Storz VisitOR1? remote presence system with two way live audio and video communication. Technical quality was assessed using a modified Maryland Visual Comfort Scale. Exit interviews were conducted with the participating surgeons and the operative teams that were present during the telecoaching sessions. Two independent reviewers coded the interview data using a conventional content analysis method.


      Finding/Results:
      A total of two out of six telecoaching events were completed during a 12-month period. Logistical issues with timing and scheduling coordination was the top barrier identified by the surgeon participants. For the completed sessions, 16 participants from two OR teams formed part of this feasibility study. Exit interview response rate was 75%. Participants interviewed included the surgeon coaches, surgeon mentees, operating room nurses, anesthetists, surgical fellows, and surgical residents. The overall technical quality was rated as average by surgeon participants (3.5/5 for coaches and 3/5 for mentees). Participants identified privacy and consent, internet connectivity, and optimal unit positioning in the operating room as important factors to consider for future implementation. Operative team participants did not find that the videoconferencing equipment had a negative impact on their work environment and viewed the intervention favorably as a learning tool. Overall, participants felt that videoconferencing during surgery has potential benefits for learning in complex cases as well as facilitating intraoperative consultations between peer surgeons.


      Conclusion/Implications/Recommendations:
      This pilot study demonstrated that is it feasible to use videoconferencing to support intraoperative surgical coaching. Operative team participants viewed the intervention favorably and identified practical considerations for its continued use in an operating room environment. Lessons learned and practical considerations for the design of a telecoaching program will be shared.


      140 Character Summary:
      The implementation of a pilot telecoaching program to facilitate intraoperative coaching is technically feasible but the surgical culture may not be ready yet.

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    OS26 - Telehealth in Action (ID 42)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 4
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 5
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      OS26.01 - Digital Health Enhances the Continuum of care for Oncology Patients (ID 539)

      Krisan Palmer, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The overall driving factor for provision of Teleoncology in New Brunswick is the concentration of clinical oncology specialists in the southeastern and southwestern regions of the province. Patients not in these locales, with their families or caregivers, must travel in order to interact with their clinicians. The goal of Teleoncology is to provide safe, evidence based practice in the nearest community to where the patient resides.Thus eliminating exhaustive travel for those patients already in a weakened physical and emotinal state.


      Methodology/Approach:
      Oncology referral patterns were analysed and in conjunction with the established satelitte chemotherapy clinic locations, Oncologists were approached to explore the potential use of Telehealth for patient follow-up appointments. Inclusion and exclusion criteria were established based on the clinical presentation of patients. The was determined during this exercise that Teleoncology provides the ability to deploy a wide range of services including clinical consultation, diagnostic services, knowledge exchange in the form of clinician and patient education, peer support and professional development. Exploration of access to required information electronically, such as electronic health records,was also explored to ensure that all of the required information was available, irrespective of geography. Technology plays a supportive role in that clinical needs are what drive the selection. Innovative clinical processes are the key to success in any sustainable Telehealth initiative and will be outlined specific to this application during the presentation. For example, the engagement of primary care physicians in performing the physical assessment for the specialist prior to each visit has definitely been a positive force in enhancing the patient care continuum, and physician knowledge transfer.


      Finding/Results:
      Teleoncology has facilitated the national clinical standard of patients being seen by an oncologist or a general practitioner in oncology (GPO) prior to each cycle of chemotherapy. This method of care delivery has greatly diminished the need for oncologists to visit outlying areas on a rotating basis, giving oncologists the opportunity to follow up on their own patients. As well, it now provides the opportunity for many patients to become engaged in clinical trials whereas prior to Telehealth, distance and access eliminated them as recruitment candidates. One very real challenge for the remote hospital sites is that of nursing resources. This is net new activity and must be taken into consideration. Other care delivery impacts, challenges and lessons learned will also be discussed.


      Conclusion/Implications/Recommendations:
      Teleoncology offers the potential for improved access to a wide variety of cancer support services, leading to benefits for patients and their families closer to home. It can provide wider scale access to cancer related educational programs. The provision of opportunities for patients to receive clinical and support services much closer to their home community will reduce the cost to them and their families in terms of time and finances, as well as reduce the costs to our provincial healthcare system. Currently one group of Oncologists within one urban center in New Brunswick visit over 30 sites virtually on a regular basis to facilitate their patient care delivery.


      140 Character Summary:
      Engagement of primary care physicians in teleoncology delivery.

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      OS26.02 - A Comprehensive Telestroke Solution for New Brunswick (ID 521)

      Jennifer Sheils, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The goal of the provincial Telestroke program is to provide a solution that allows every New Brunswick (NB) citizen experiencing an acute stroke the potential to receive leading edge stroke care for this emergency event as well as thrombolysis therapy; specifically a medication known as TPA. The real issues arise with correctly identifying candidates who would benefit from TPA, as well as having a system that is equipped to respond in the rapid manner required and with the additional opportunity to provide this treatment at remote or rural locations and centers that do not ready access to stroke specialists.


      Methodology/Approach:
      Telestroke NB is built upon NB's existing Telehealth capacities, for which we have been previously recognized as a leader in using innovative technologies to provide high-quality intervention, prevention, follow-up, and educational resources to patients throughout our province. Telestroke NB links every 24 hour emergency room, which has computed tomography (CT) access, in the province to an on-demand stroke specialist in real time, regardless of the location of the patient or specialist. Neurologists connect to the hospital network using a virtual private network (VPN) from their home or office to review the CT image within seconds of the scan being completed. This system also allows them capacity to view older CT scans performed on that patient from additional NB sites. They document the necessary clinical assessment performed while connected in real time via interactive audio and video to the emergency room where the patient has presented. In this manner, benefits and risks are communicated to the patient, family and staff at the referring site who also receive advice and support for thrombolysis decisions.


      Finding/Results:
      Telestroke NB is a system that was developed cooperatively between two provincial health authorities (Horizon and Vitalit‚), Ambulance NB, and Heart and Stroke Foundation of NB with the support of the government of NB. This sustainable system was built to align within existing programs and all partners worked collaboratively. It is an innovative, province-wide system for delivering evidence-based acute stroke care and thrombolytic therapy. Each health authority supported the development of consistent guidelines and processes to ensure patients receive care in both official languages as mandated in a bilingual province. Emergency room staffs were integral to the program success as they developed ways to support the remote specialist with performing needed clinical assessments and dialogue with patients and their families.


      Conclusion/Implications/Recommendations:
      Telestroke NB is a sustainable program; improving health by increasing access to quality, evidence-based stroke care in the hyperacute setting. This results in better health outcomes by directly reducing disability caused by stroke. It results in cost-savings by reducing the burden of care for patients who might otherwise require longer hospital stays and long-term nursing care. It also reduces unnecessary transfers and demonstrates the power of cross regional program collaboration. Telestroke NB is one step of a truly comprehensive stroke system; moving towards using Telehealth for primary and secondary stroke prevention. It was launched in collaboration with every facet of the New Brunswick health care system.


      140 Character Summary:
      A province wide innovative technological solution to provision of hyperacute healthcare services.

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      OS26.03 - Explaining Longitudinal Patient Adherence in a Heart Failure Telemonitoring Program (ID 117)

      Patrick Ware, Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Telemonitoring can improve heart failure outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients adhere to taking the expected physiological readings. While the literature is rich with studies exploring barriers and facilitators to patient uptake, few have studied longitudinal patient adherence to telemonitoring programs existing outside the context of clinical trials. The objective of this study was to quantify and explain longitudinal patient adherence in a heart failure telemonitoring program offered as part of the standard of care in a Toronto-based specialty heart function clinic.


      Methodology/Approach:
      A mixed-method explanatory sequential design was used to first quantify patient adherence rates over a 12-month(m) period and subsequently explain adherence using semi-structured interviews. As patients are instructed to take readings daily before noon, monthly adherence rates were defined as the percentage of completed morning readings (weight, blood pressure, and symptoms) over each 30-day period. Generalized linear models were performed to predict adherence rates using independent variables related to demographics, disease severity, and time since program start. Semi-structured interviews containing probes based on the constructs in the Theory of Acceptance and Use of Technology 2 (UTAUT2) were conducted with a subsample of patients.


      Finding/Results:
      Two years after program launch, longitudinal adherence data for 12m was available for 179 patients (mean age 58 +/-16; 80% male). Overall mean adherence over the 12m period was 70% +/-25 with average adherence rates declining from 80% +/-24 at 1m to 65%+/-35 at 12m. Time since starting the program was the only significant predictor of adherence accounting for 81% of variation in adherence over time (R2=0.81). Characteristics of interviewed patients included a range of ages (22-83), sex (70% male), time since onboarding (0-12m), and overall adherence rates (30-96%). Key themes explaining patients? motivation to adhere include: (1) perceived benefits of the program (self-management support, peace of mind, and improvement in clinical care); (2) ease of use; (3) a positive opinion of the program from family and friends; and (4) supporting services (training and technical support). Themes explaining low and imperfect adherence include: (1) technical issues that periodically prevented the transfer of readings and/or which led to patient frustration; (2) life events or circumstances that interfered with the ability to take readings; and (3) the perception that the benefits of the program were suboptimal due to the system?s inability to adequately capture additional context related to the readings.


      Conclusion/Implications/Recommendations:
      Despite a 15% drop in adherence after one year, an overall mean adherence of 70% is considered high given our strict definition of adherence and because the pragmatic nature of this study meant that we could not account for periods when patients were unable to take readings (e.g., travelling, inpatient stay, etc.). This limitation meant that true adherence was likely underestimated. Consistent with the UTAUT2, this study found that longitudinal adherence is not so much predicted by patients? demographic or health characteristics but rather their perception of a telemonitoring program?s benefits, its ease of use, and the presence of supportive individuals and supporting program components.


      140 Character Summary:
      Although declining over time, patient adherence to a telemonitoring program remained high and was primarily explained by patients? perceptions of the program.

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      OS26.04 - Intra-institutional Teledermatology: Results of a mixed methods case study (ID 84)

      Trevor Champagne, Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Historically, teledermatology?s benefits have been mostly realized through improved access to rural or underserviced areas. This study examines the benefits and the overall impact of teledermatology in an urban, intra-institutional environment.


      Methodology/Approach:
      A store-and-forward teledermatology service was created between family medicine practitioners and a consultant dermatologist in the same urban ambulatory ?intra-institutional? hospital. Mixed methods analysis was then applied to chart reviews, electronic surveys to clinicians and patients, and semi-structured interviews with referring providers and dermatologists within a framework developed from the Canada Health Infoway Benefits Evaluation. Survey questions were designed to assess benefit quantitatively and interviews were subjected to qualitative thematic analysis. The final results were tabulated, triangulated, and compared against existing literature.


      Finding/Results:
      84.2% of the 76 consultations reviewed over 18 months of service were manageable solely with teledermatology. Subgroup analysis revealed that skin ?lesions? had a much lower success rate ? with 40.9% requiring transition to an in-person consult, as opposed to skin ?rashes,? of which 94.3% were manageable through teledermatology. All patients agreed they would use the service again. Cited benefits included savings in time, money, and missed work. Referring providers were satisfied with service reliability, timeliness and quality of responses, and the educational value of the consult opinions, but it did increase their administrative time.


      Conclusion/Implications/Recommendations:
      Patients were satisfied with intra-institutional teledermatology and felt it saved them time, money, and prevented them from missing work. Providers were similarly satisfied despite the increased administrative burden. This study demonstrates strong benefits of teledermatology even when used in populations that are not underserviced or geographically restricted. Future research should include assessments of cost-effectiveness and the impact of teledermatology services targeted exclusively at subgroups such as rashes.


      140 Character Summary:
      Intra-institutional teledermatology helped patients save time and money and providers were highly satisfied with the service.

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