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    OS04 - Cool Tools for Digital Health (ID 25)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 6
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      OS04.01 - Streamlining communications for better patient outcomes #securemessagingworks (ID 364)

      Mona Mattei, White Oak Ventures Ltd.; Grand Forks/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Patient outcomes are reliant on ensuring communications between the right person at the right time. Easy right? Not always in a complex team setting across acute care sites, into community and allied health and across widely dispersed geography. When Interior Health was faced with the loss of pager supports at Kelowna General Hospital, they had to look for a new solution. Exploring beyond the needs of a pager replacement, IHIT opted for a system that addressed a broader variety of communications supports including: immediate access to the callboard for all departments, access to patient information for ADT notifications, secure messaging with upload capability. All the right information in one convenient place for all users.


      Methodology/Approach:
      Key for their selection process was: compliance with FIPAA, the integration into Meditech EMR, vendor flexibility and securing the system on IH servers. Two pilots at KGH in 2015 led to the adoption of the MicrobloggingMD messaging system at IH. Further implementations of the system proceeded in collaboration with hospital teams, Divisions of Family Practice, and Facility Engagement associations.


      Finding/Results:
      Detailed data has been collected to evaluate the uptake and engagement of the system with physicians, nurse practitioners, nursing teams. Initial super user survey feedback indicates: 57% feel the communications informs their care planning, 62.5% agree it is improving care for patients and communications between physicians.


      Conclusion/Implications/Recommendations:
      IHIT will provide an overview of the system, data on use of the system, and share their experience in implementing a new technology for teams including: - Finding and communicating with the right person, at the right time and according to their preferences, to engage in patient care. - Using secure messaging as a medium to reduce telephone tag and provide detailed patient information that will ultimately lead to well informed and improved patient outcomes. - Providing a reliable tool which means maintaining when and how a provider wishes to be paged/notified to engage in patient care. - The challenges in rolling out enterprise wide, and how they were overcome.


      140 Character Summary:
      Implementing secure messaging enterprise wide in Interior Health Authority is a leading edge project ready to share lessons and challenges learned on the journey.

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      OS04.02 - Building an e-mental health toolbox: An implementation toolkit for clinicians (ID 355)

      Danielle Impey, Knowledge Exchange Centre, Mental Health Commission of Canada; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Experience gleaned from a 2017 rapid review shows that the process of integrating e-mental health as a routine health care tool faces many challenges, is very complex, and requires significant time in most cases. When defining e-mental health, the Mental Health Commission of Canada (MHCC) borrows from the Centre for Mental Health Research in Australia: ?Mental health services and information delivered or enhanced through the Internet and related technologies?. To support the uptake, use and evaluation of e-mental health in a clinical setting, the MHCC undertook the development of an implementation toolkit. The purpose of the toolkit was to collect, synthesize and present best and promising resources on how to successfully implement e-mental health into clinical practice. It synthesises evidence-informed tools (e.g. templates, fact sheets, worksheets, assessment tools, etc.) and packaged them in a clear and comprehensive way. The goal is to provide practitioners working at the point of care with guidance and support around integrating e-Mental health with their existing client populations.


      Methodology/Approach:
      The MHCC partnered with Dr. Lori Wozney and the IWK Health Centre in Halifax, NS to undertake the development of the toolkit. Building upon the findings of a 2017 environmental scan and literature review, Dr. Wozney and team undertook a scan and content audit of current e-mental health implementation resources to identify key topics, current gaps in resources and evidence-based tools relevant for the target audience. Where necessary, content was either developed or adapted for inclusion in the toolkit.


      Finding/Results:
      Although there are tools that exist which are applicable to the Canadian mental healthcare system, there continues to be gaps in tools and resources that are specific to clinical needs. Since technology is evolving at such a rapid pace, it is important to stay abreast of changing needs of clinicians. Effort was made to contextualize itself within the larger e-mental health/e-health environment to avoid duplication of tools/resources, though work to enhance the toolkit will continue through 2018, into 2019. The toolkit is available in English and French (where French tools existed) on the MHCC website.


      Conclusion/Implications/Recommendations:
      More implementation tools for clinicians are needed. By providing evidence-based and evidence-informed implementation tools, clinicians may be better-equipped to assess things like organizational readiness, change management, and workflow management as it pertains to e-mental health.


      140 Character Summary:
      Building the Toolkit for e-Mental Health Implementation, an MHCC resource for mental health professionals to implement e-mental health innovations.

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      OS04.03 - Usage of Kiosks to Improve Patient Registration Workflow (ID 250)

      Dhara Hemant Desai, Information Management/Information Technology (IM/IT), Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      BACKGROUND: The use of kiosks for patient check-in will help reduce costs, reduce patient waiting time and less errors. The kiosk encourages patients to take control of their care information demographics to complete basic workflow on their own by checking in appointments, updating demographics and verify coverage (ie. OHIP), wayfinding, questionnaire and myHealthRecord (patient portal sign-up). The kiosk will help reduce the line at the front desk registration which will help reduce the wait times. OBJECTIVE: This presentation aims to contribute to an understanding of how direct patient engagement to their registration workflow affects the patients? delivery of care, experience and reduction of admin workload


      Methodology/Approach:
      A mixed methodology to search patients? identities will be used that include to scan patients unique barcode (generated by patient portal) received by email, swipe OHIP card, search by entering first name, last name and medical record number. The check-in rate and percentage will be determined by using Ambulatory Electronic Patient Record (aEPR) reports.


      Finding/Results:
      Simulation Results: Pilot phase for the Kiosks went live in November 2018 at Women?s College Hospital (WCH) for patient use. The proposed solution Kiosk like structure, where the information regarding patient demographics verification/patient portal sign-up/wayfinding/appointment check-ins can be easily performed by patients. Long queues to check-in with the receptionists can be avoided by using the kiosks. Aim is to have 30% patients to use kiosks during the first quarter of the year. The report generated by Ambulatory Electronic Medical Record will show the patient, the date and time of the appointment, and the appointment status, along with other information about the appointment. The Kiosk Check-In Statistics tab shows the total number of appointments by department and a graph of the percentage of appointments by status. ehealth2019_kiosk check in totals report.png Kiosk Session Exit Reason Breakdown Report: ehealth2019_kiosk session exit reason breakdown report.png


      Conclusion/Implications/Recommendations:
      The quality of the healthcare delivery will be increased, since the kiosk workflow brings together patients in front of the clinical workplace to verify patients' demographics. Strategies to expand services through wayfinding and fill out questionnaires according to the clinic visit types will deliver the tools necessary to create self-sufficient full check-in workflow for patients; consequently improving.


      140 Character Summary:
      Using kiosks to check-in patients for their appointments will improve patient engagement. This will enhance delivery of care and reduce administrative workload.

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      • Abstract
      • Slides

      Purpose/Objectives:
      The purpose of this panel is to share learnings from ?big bang? Epic HIS implementation at a tertiary care children's hospital ? SickKids Hospital, Toronto - using a Blood products case study, including: - Interprofessional team formation to deal with high risk issues - Urgent issues management - The role of process improvement in HIS implementation - End user engagement and education Following this session, participants will leave with an understanding of critical success factors and lessons learned related to ?big bang? HIS implementation.


      Methodology/Approach:
      The Blood products SWAT Team was formed in the first week following the implementation of Epic to address urgent issues related to blood products impacting patient safety. Specifically, issues with the blood products ordering and preparation processes were causing significant delays in blood products administration and impacting patient care. The SWAT team included a broad range of stakeholders, including representatives from Epic project team, process improvement, laboratory and clinical staff and organization leadership. In the 4 months following go-live, the Blood products SWAT team became the first point of contact for problem solving and issues management. Through the Blood products SWAT group following activities were performed to identify root causes of issues and to develop resolutions: Ongoing monitoring of relevant safety reports Comprehensive tracking of blood products issues Shadowing of Transfusion Medicine Department and clinical staff Addressing technical and build issues in Epic and HCLL (Transfusion Medicine System) using iterative system design Obtaining feedback from Subject Matter Experts (SMEs) Providing regular touchpoints for troubleshooting issues Establishing and management of key work groups to review specific issues Establishing SWAT Oversight Committee Establishing new processes and practices to align with new workflows resulting from Epic implementation Co-designing processes with inter-disciplinary teams Ongoing communication across the organization related to blood productss in Epic ? web site, presentations, email, meetings Re-education of clinical and Transfusion Medicine staff based on key issues Developing education materials The Blood products SWAT team took interdisciplinary approach to problem solving. This resulted in many departments across the organization being involved throughout the work of the BC SWAT Team, including: Blood Bank Epic Teams: Orders, Beaker, Beacon, Clin Doc, Op Time, Anaesthesia, Ambulatory Dialysis/Apheresis Haematology/Oncology ICUs Perioperative Services Inpatient Units Medical Day Care Provider Advisory Committee


      Finding/Results:
      Results are below: bb swat.png


      Conclusion/Implications/Recommendations:
      Despite being prepared, anticipate issues at go live. Importance of interprofessional engagement to identify and resolve issues post ?big bang? HIS implementation. Need for additional education post HIS training. Don?t underestimate the role of processes in HIS implementation and importance of interprofessional pre- work prior to go live.


      140 Character Summary:
      Learn how we managed blood product ordering, issuing and administration issues, following implementation of a new Epic HIS and Transfusion Medicine System.

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    OS07 - Spectrum of Virtual Care (ID 11)

    • 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 6
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      OS07.01 - Lessons in Scale and Spread in Virtual Care for Maternity (ID 362)

      Mona Mattei, White Oak Ventures Ltd.; Grand Forks/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Traditional patient care planning often involves a linear model of health care access and delivery. A particular patient with a clinical concern accesses a primary care provider (GP, midwife, nurse practitioner). The primary care provider (PCP) acts as a gate keeper to direct the patient to a specialist with expertise in the area of that particular clinical problem. The patient then sees the specialist in person or via telehealth with consult notes sent at a later date. The PCP will often recall the patient to discuss the specialist?s opinion and may need to contact the specialist again if there are further questions or a change in the clinical status. The Mobile Maternity (MOM) project is changing that traditional linear model to foster a triangular and tripartite model that provides for much greater efficiency and more comprehensive care planning. Using telehealth resources (ie: tablet and desktop computers), a patient, primary care provider and specialist can in real-time, all discuss the clinical problem at the same time. This reduces the time to relay the specialist?s opinion as the PCP will hear at the time of the initial consult what the proposed plan may be. The PCP and patient can also inform the specialist of particular challenges to the provision of care related to geography or local health resources.


      Methodology/Approach:
      Initial pilot phases of the Mobile Maternity project saw 14 tablets placed with primary care providers (PCP) (family physicians, nurse practitioners and midwives) in 8 communities across the Kootenay Boundary in B.C. These units connect with two OB/GYNs to provide patient consults inclusive of the PCP, specialist and patients. Observing the value of the model of care, an opportunity to spread the model to Vancouver Island to support remote sites on the North part of the island from Campbell River was seized and 4 tablets were distributed to PCPs and OB/GYNs to provide consults. In addition desktop units in exam rooms and work stations on wheels in emergency departments were added to the mix to provide additional access.


      Finding/Results:
      Testing a pilot with a small population base provides opportunities for proof of concept, taking that concept to scale for larger volumes of patients expands the ability to gather substantial information on outcomes and impacts of new programs. Mobile Maternity is being scaled up from one OB/GYN in Nelson to include teams in Campbell River, across the Kootenay Boundary and three new sites in the next eight months. Interviews with both patients and providers demonstrate that this model of care is a resounding success for strengthening care networks, and improving patient care.


      Conclusion/Implications/Recommendations:
      This tripartite telehealth model provides enhanced mutual education for providers and patients, removes geography as a barrier to timely access, and supports the stability of primary care networks. This pilot can become the standard model of care in integrating specialist care into rural and remote primary care networks.


      140 Character Summary:
      Mobile Maternity is changing the way physicians care for patients by engaging in tripartite care planning through telehealth technologies.

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      OS07.02 - Identifying Patient and Provider Value Propositions in Virtual Primary Care (ID 293)

      Lency Abraham, Mississauga/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The Ontario Telemedicine Network is working with local health integration networks (LHINs) to implement virtual primary care visits. Patients want to engage with physicians remotely and find the quality to be equal to or better than in-person. Previous experience shows primary virtual care can be used to manage routine conditions and reduce health system costs. Yet integration of virtual primary care visits remains low, due partly to unclear physician value and payment models. The study objective is to explore how virtual visits can create value for both patients and clinicians, to facilitate uptake within Ontario primary care.


      Methodology/Approach:
      Four LHINs across Ontario, including 138 physicians, have implemented a customized virtual visits platform. The technology enables clinicians to respond to patients? clinical requests using either asynchronous secure messaging or an audio/video visit. We conducted semi-structured interviews with providers and patients to understand the perceived value of virtual visits. We then extracted themes of value propositions for both providers and patients.


      Finding/Results:
      There is demonstrated value for patients to engage with virtual visits, due primarily to the convenience that it offers over in-person visits. Clinicians and patients generally agreed that it was appropriate to use this platform for simple visits, but not for new diagnostic issues. The most often used modality was asynchronous secure messaging (94% compared to 1% video and 5% audio). We identified several value propositions for both patients and providers. Patient value propositions: *Convenience: Easier access to clinician was of priority. Rapid response is not needed; rather, patients valued not having to take time off work, seek childcare, or drive long distances. Access: Can improve care continuity and access for patients who have moved out of the area but still have the same PCP, and homebound or low-mobility patients. Urgent issues: Patients identified an interest in accessing a platform that would provide rapid responses for urgent issues, particularly after hours. Provider value propositions: Efficiency: Increases the number of patients PCPs can see per day, while not overwhelming their workflow. Revenue: Increases provider revenue by enabling them to maximize care bonuses, or paying them for previously unpaid work (e.g. phone calls). Care quality*: Enables clinicians to improve the quality of care they can deliver to their patients. Table 1 presents some ways to use virtual primary care technology that align with provider and patient value propositions. Provider value Efficiency Revenue Patient care quality 1) Delegate work to administrative assistants and nurses 2) Send reminders, prescriptions, and follow-ups for disease management Convenience Patient value 3) Provide care to homebound patients 4) Provide care to rural/remote patients Access 5) Provide virtual after-hours care Urgent issues 6) Enable easier preventative care via reminders, education 7) Pay for work previously unpaid 8) Enable time for PCP to make informed decision on complex issues (asynchronous) No motivating value


      Conclusion/Implications/Recommendations:
      When implementing virtual visits, it is important to align implementation design with patient and provider value propositions to encourage maximum adoption. The value propositions and potential use cases outlined here can guide future implementation.


      140 Character Summary:
      Integrating virtual visits in primary care faces provider resistance; aligning implementation with patient/provider value propositions may improve uptake.

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      • Abstract
      • Slides

      Purpose/Objectives:
      Virtual visits have shown promising results in supporting a patient-centered healthcare system, with the potential of moderating primary care costs over time1. The objective of this presentation is to illustrate an approach for deployment and lessons learned from implementing an innovative virtual care technology in primary care settings, as well as to highlight the outcomes and benefits of virtual visits for both patients and providers.


      Methodology/Approach:
      Virtual care technology conveniently connects patients with their primary care provider, for appropriate concerns, over a secure, online communication system via chat messaging, phone or video, providing the opportunity to create efficiencies and improve access to primary care. Providers were engaged in the clinical model design and solution development to ensure that the technology meets their needs and is user-friendly. To support integration of virtual visits into clinical workflow and reduce barriers to adoption for providers, direct feedback from providers was continuously collected to inform enhancements to the solution. A change management framework was used with a focus on working with providers as partners to support the uptake of the technology. To better understand both the provider and patient experience with using virtual visits, user surveys were provisioned which assessed the value of virtual visits related to factors such as convenience, access, efficiency and navigation.


      Finding/Results:
      Leveraging existing relationships with providers and establishing a comprehensive approach for end user engagement was a key factor in the implementation of virtual visits. Change management support was critical to the integration of virtual visits into provider workflow and contributed to them more actively promoting the service and enrolling their patients. Within 6 months of going live with the virtual visits solution, 56 primary care providers and 30 support staff registered for the solution, over 2600 patients were enrolled and over 2100 visits completed. Preliminary results of the user experience surveys indicate that virtual visits make accessing care more convenient for patients and saved them time, while providers spoke to the use of virtual visits to enhance efficiencies in their office and increase capacity to see more patients. Providers also expressed additional value in the ability to initiate the visit with their patient for reasons such as following up on test results or following up on a previous in-person appointment.


      Conclusion/Implications/Recommendations:
      Complementary to existing workflows, the integration of virtual visits in primary care settings has shown benefits to both patients and providers related to convenience and improved access to care. Using a targeted approach to user engagement and adoption, primary care providers are able to understand how a virtual visits solution integrates into their workflows and context of their practice model, as the value proposition varied depending on organizational structure. The involvement of users throughout the design and development of the technical solution ensured user buy-in, acceptance and adoption of the virtual visits innovation.


      140 Character Summary:
      Developing and implementing a virtual care solution for primary care: lessons learned and impact on patients and providers.

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      OS07.04 - Humans Behind The Machine. Telemedicine Based Shared-Care Psychiatric Services  (ID 233)

      Benjamin Fortin-Langelier, Psychiatry, Royal Ottawa Health Care Group; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Background: The Royal Ottawa Health Care Group (ROHCG) has been a leader in the use of telemedicine to deliver psychiatric care. It has successfully integrated telemedicine in its regular clinical services and developed specific services based on technology. Those telemedicine-based services include correctional psychiatric care and shared-care (support to primary care) services. In psychiatry, shared-care refers to psychiatrists supporting groups of primary care providers. Typically, psychiatrists travel to family health teams and provide a blend of direct and indirect patient care. The rationale behind shared-care is to optimize the time of specialists and build capacity for primary care providers which then allows for more patients to receive the care they need in a location that is convenient. Purpose: We would like to present the case study of a shared-care partnership between a rural community health center where seven primary care providers support a community of 8000 and a tertiary care mental health center which was established in 2017 using telemedicine. Technology allows for patients to be assessed by a psychiatrist without travelling 250km and the humans behind the technology enable a lasting and successful partnership.


      Methodology/Approach:
      Approach: In this oral presentation, we will highlight the importance of the key players and their roles in creating a clinical service that benefits all stakeholders and allows harvesting the full potential of the technology. Preliminary contact with the community, training, in-person visit prior to first clinical consultation, iterative feedback loop and follow-up annual education visits have contributed to the success of the partnership and trust between partners.


      Finding/Results:
      Findings: In one year, we were able to set monthly psychiatric telemedicine consultations allowing 42 patients to receive care they would not have been able to access otherwise. This model has been demonstrated as effective and has been replicated in 14 other rural communities and translated for use in correctional institutions. At the moment, we observe two common mistakes in the design of consultation services in psychiatry. One is the over-reliance on technology at the expense of establishing strong relationships. In this mistake, there is a failure to establish consistent relationships and connections when rolling out telemedicine-based consultations. This creates a situation in which multiple remote communities are randomly connected with random providers at inconsistent times. It prevents specialists from understanding the context of the primary care providers with whom they consult and reduces trust as well as the quality and applicability of the consultations. The other mistake is the under-appreciation of technology. This is the belief that only in-person presence can lead to a solid relationship between primary care and specialists. While this is a reasonable model where geography permits, the drawback is lengthy travel time and the perceived impossibility to reach geographically distant communities.


      Conclusion/Implications/Recommendations:
      Conclusions: We believe we have found an effective balance between technology and human factor which enables trust and the development of sustainable partnerships. Appropriately implemented technology can lead to successful shared-care psychiatric services between geographically distant communities


      140 Character Summary:
      The Royal Ottawa will present a case study illustrating the implementation of shared-care psychiatric services using telemedicine in a rural community.

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    OS10 - Four Implementation Vignettes (ID 17)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 4
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 6
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      OS10.01 - e-Mental Health Demonstration Project: Implementing and evaluating Stepped Care 2.0© (ID 429)

      Danielle Impey, Knowledge Exchange Centre, Mental Health Commission of Canada; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2017, the Mental Health Commission of Canada (MHCC) launched an e-mental health (e-MH) demonstration project to improve access to mental health services in publicly funded health systems. The MHCC, the Government of Newfoundland and Labrador, and the core team at Memorial University of Newfoundland lead by Dr. Peter Cornish, are working closely together to implement and evaluate Stepped Care and e-mental health programming in 15 clinical sites across Newfoundland and Labrador. Stepped Care 2.0? is an evidence-based, rapid access system of delivering programs, including same day, flexible access to mental health resources, including face-to-face and e-MH components, while promoting client autonomy & resilience. Patients receive the least intensive treatment with the greatest likelihood of improvement. Care is stepped up or down depending on client need/preference and is continuously monitored. e-Mental Health refers to the use of the internet and other electronic communication technologies to deliver mental health information & care, and these services have been found to be an effective and complementary option. This rapid access approach aims to reduce wait times and to improve access. The objectives of the project are to: 1. Introduce innovative approaches and new technologies to mental health and addictions service delivery in the province (i.e. stepped care and e-mental health programming). 2. Reduce wait times for services. 3. Improve mental health outcomes.


      Methodology/Approach:
      Data for the evaluation component is collected from healthcare providers and site managers through training workshop and feedback surveys, usage data from pilot sites, outcome scales and interviews. Data is collected from clients via anonymous patient surveys developed by the evaluation team. A report will be produced amalgamating the feedback received during a quality improvement workshop on the project.


      Finding/Results:
      Preliminary results have shown a decrease or elimination of wait lists at some implementation sites. Feedback on the change management and training process by health care providers has been positive. We expect to show improved mental health outcomes through the introduction of stepped care and the e-mental health services offered. The final report will be released in spring 2019.


      Conclusion/Implications/Recommendations:
      The rapid access approach of the e-mental health demonstration project aims to reduce wait times and to improve access. Results from the project evaluation will inform opportunities to improve and scale-up Stepped Care 2.0? and similar mental health care approaches.


      140 Character Summary:
      The MHCC's e-mental health demonstration project seeks to improve access by implementing and evaluating Stepped Care and e-mental health rapid access approaches.

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      OS10.02 - Improving Care Transitions from Hospital to Home with Electronic Tool (ID 519)

      Terence Tang, Institute for Better Health and Program of Medicine, Trillium Health Partners; Mississauga/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Care transitions from hospital to home are vulnerable times for patients and caregivers as they sometimes cope with changing physical, cognitive, and functional status, assume increasing self-care responsibilities, and experience change in care plans. As a result, adverse events and unplanned Emergency Department (ED) visits and hospital re-admissions sometimes occur. Effective communication (both among the interprofessional team, and with patients/caregivers) is essential to ensure adequate discharge planning and support safe transitions. Our objective is to evaluate the impacts of an electronic communication tool used by clinicians and patients/caregivers on patient experience, ED visits/re-admissions, and care transitions.


      Methodology/Approach:
      We augment a previously built electronic interprofessional communication and collaboration platform used by hospital clinicians to coordinate care of complex hospitalized patients with new discharge planning and patient-facing components. We facilitate care transitions by adapting the Patient-Oriented Discharge Summary (PODS, developed at University Health Network Open Lab) into the discharge planning component, incorporating its electronic completion in clinical workflow via co-design with hospital clinicians, and making PODS electronically available to patients/caregivers after discharge. To evaluate the impact, we are conducting a mixed methods study on 4 general medicine wards. The quantitative component uses an intervention-control design where the intervention will be deployed on 2 wards (intervention arm) with the remaining 2 wards providing usual care (control arm). Outcomes will be measured on both intervention and control wards at 2 time points (baseline and 3 months after the intervention has been deployed in the intervention wards). The qualitative component consists of semi-structured interviews with clinicians and patients/caregivers exposed to the electronic tool to understand the perceived impacts, reasons for success and failure, and contextual factors affecting implementation.


      Finding/Results:
      Quantitative outcome measures include patient experience using 4 selected questions about communication from the Canadian Patient Experience Survey ? Inpatient Care (CPES-IC) and 1 question related to overall hospital experience, and care transition using the 3-item Care Transitions Measure (CTM-3). These outcomes will be obtained with post-discharge telephone surveys of patients. Outcome data of ED visit and re-admission within 30 days will be obtained using routinely collected administrative data. A chart review will be used to determine process measures relating to the completion of discharge documentation including PODS. A pre-defined subgroup analysis will be performed for patients with dementia to understand the effect on this complex high-need population. Semi-structured interviews with clinicians and patients/caregivers will explore the experiences more deeply and contextualize quantitative findings. We have so far completed baseline data collection and anticipate that preliminary analysis of full results will be available for the eHealth conference.


      Conclusion/Implications/Recommendations:
      As communication technology continues to advance and its adoption are increasing in the general population, the result of this study will inform if and how such technology may be leveraged to engage patients/caregivers to impact patient experience, care transitions, and outcomes.


      140 Character Summary:
      A mixed methods study assessing the impact of an electronic tool used by clinicians and patients/caregivers on patient experience, care transitions, and outcomes.

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      OS10.03 - Streamlining Electronic Emergency Department Order Sets Between CHEO and SickKids (ID 113)

      Daniel Rosenfield, Paediatric Emergency Medicine, SickKids Hospital; M5G1X8/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Tertiary paediatric care is delivered in only a few large centers in Ontario, and these centers often share patients. It is imperative that they maintain the most up to date and share similar standards when treating children, especially as they act as regional centers of excellence that often determine local practice patterns. One way to standardize care is to align order sets for commonly seen paediatric conditions. Order sets represent evidence-based treatment algorithms to promote standardization of practice amongst frontline providers. We describe the process used at Children?s Hospital of Eastern Ontario (CHEO) in Ottawa and the Hospital for Sick Children (SickKids) in Toronto capitalizing on a shared instance of our Electronic Health Record (EHR) to align Emergency Department (ED) order sets during implementation. This alignment has helped standardize care in the two largest paediatric EDs in the province. Additionally, through future expansion of the Kids Health Alliance (KHA), best implementation practices were shared between CHEO and SickKids for respective EHR rollouts.


      Methodology/Approach:
      As part of the larger KHA initiative, CHEO and SickKids are sharing one instance of Epic, the enterprise-wide EHR. As a result, there is a joint KHA Governance; however, each department is still responsible for building/maintaining its own content/order sets. Local ED subject matter experts (SMEs) reached out to one another to compare order sets, using the Epic go-live as a catalyst for collaboration. Order sets were compared in an iterative fashion, presented to local committees and integrated and modified accordingly to local preferences. The net result was an overall alignment of various order sets, as well as expansion of order sets at both institutions. This initial collaboration led to further understanding between institutions, resulting in further utility at go-live, when individuals from CHEO came to the SickKids ED to help local users navigate the system on go-live weekend.


      Finding/Results:
      Prior to collaboration, SickKids had 18 unique ED order set documents while CHEO had 37. Following review and internal consolidation of existing order sets, SickKids finalized 25 EHR-version ED order sets, including 8 order sets derived from CHEO original order sets. Similarly, CHEO developed 28 unique order sets and derived one of these from a SickKids order set. Many order sets were similar between institutions with only minor amendments introduced due to the collaboration.


      Conclusion/Implications/Recommendations:
      As large-scale EHRs and hospital alliances become more commonplace, collaboration between local divisions/department allow providers to implement local best practices and standardize care across multiple institutions. This can be achieved via the standardization of order sets, and further collaboration can be facilitated by having ?boots on the ground? from individuals from each institution help out at others during EMR implementation.


      140 Character Summary:
      Through the Kids Health Alliance and one shared EMR, several disparate ED order sets were aggregated and shared across CHEO and SickKids to promote best practices

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      OS10.04 - An Implementation Story: Public Health Digitization in Nova Scotia (ID 518)

      Latifa Mnyusiwalla, Gevity Consulting Inc. ; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Public health digitization is a silent stream in the eHealth landscape where acute care and primary care implementations dominate the conversation. Immunization registries and communicable disease management systems are key to modernizing public health practice, reporting and surveillance, and protecting and enabling a healthy population. This presentation aims to shed some light on public health system implementations in Canada, through telling the story of Nova Scotia?s journey in becoming one of the only provinces in Canada, and globally, to have a single, seamless system for the management of immunization, vaccine inventory, and communicable disease data.


      Methodology/Approach:
      In January 2017, Nova Scotia embarked on an ambitious project to configure and deploy the Inventory, Immunization and Communicable Disease/Outbreak modules of a comprehensive public health information system over a 23-month period. Each module is a distinct business area with different requirements, configuration, integration points, and users. A consulting firm partnered with the vendor of the system to serve as the implementation team. The large multi-disciplinary team to ensure that subject matter expertise for all components of the deployment was available. This included a team of business analysts, a public health subject matter expert, configuration experts, data migration and integration experts, report developers, a testing team, a change management lead, and a senior project manager. At time of abstract submission, the Inventory and Immunizations modules have been deployed, with the Communicable Disease module to follow at the end of 2018.


      Finding/Results:
      Some lessons learned that may be beneficial to other provinces/jurisdictions embarking on public health digitization projects: - Leveraging existing configuration from other provinces was not as beneficial initially thought. Though the goals of public health bodies across Canada are universal (e.g. health promotion, disease prevention etc.), how programs and services are delivered differs from province to province. - The intensity of the project scope, scale and timelines warranted a large multi-disciplinary project team to ensure that subject matter expertise for all components of the deployment was available. The cohesiveness and effective communication within the team, and between the team and the client was integral to successful deployments. - Engaging end users early in the implementation through the establishment of Working Groups that met weekly throughout the duration of the deployment, fostered ownership of the project and the configuration. Working Groups were key to driving decisions about business processes and configuration. Decision-fatigue, time-pressures to make decisions, and not being able to fully understand the implications of a decision surfaced as issues with this approach.


      Conclusion/Implications/Recommendations:
      Public health system implementation projects historically in Canada have been long and complex. Other jurisdictions have rolled out much less functionality over a longer period of time, so the Nova Scotia implementation was determined to be very aggressive with many potential points of failure. To date, this project is the fastest deployment of a provincial public health system in Canada. The project is on track within the original schedule. The project team and the province have risen to the challenge of delivering and experiencing three go-lives within an 18-month period.


      140 Character Summary:
      Nova Scotia?s journey in implementing a seamless information system for the management of immunization, vaccine inventory, and communicable disease data.

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    OS15 - Analytics Leads the Way (ID 10)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 6
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      OS15.01 - Enhancing Healthcare Accessibility for Canadians Through Virtual Care Technology (ID 311)

      Chris Engst, TELUS Health; Vancouver/CA
      Valerie Overin, TELUS Consumer Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Rising costs and overwhelming demand for Family Physicians are key challenges facing the Canadian Healthcare system. Over 5 million Canadians are without a Family Physician and over 77% of Canadians don?t have access to healthcare on evenings, weekends, or holidays outside of the emergency room. Virtual Care has the potential to address these challenges by complementing existing healthcare models with new digital health technologies such as Artificial Intelligence to offer timely and efficient communication between healthcare professionals and their patients.


      Methodology/Approach:
      This session aims to provide insights into the adoption of Virtual Care technology, how Canada can stand to benefit, and will touch upon the following topics: 1) Global and Canadian trends in Virtual Care
      2) Emergence of Artificial Intelligence (AI) and Machine Learning in Health
      3) Virtual Care in practice


      Finding/Results:
      The global market for Virtual Care/Telemedicine was $21 billion in 2017, and is forecasted to reach $93 billion by 2026. Rising healthcare costs as well as adoption of 5G spectrum technologies make Virtual Care an attractive complement to existing healthcare models. A recent study by the Canadian Medical Association found that 3 out of 4 Canadians believe that new technologies could solve existing issues in our healthcare system. In Canada, favourable consumer sentiment and current fee code regulations have paved the way for the emergence of new Virtual Care start-ups along with entrants backed by established health players including Babylon by TELUS Health. The development of Virtual Care is also being shaped by innovations in AI and Machine Learning. A recent collaboration between Babylon Health, a London-based Digital Health company and the Royal College of Physicians, Stanford Primary Care and Yale New Haven Health demonstrated the powerful application of AI to interpret medical information. The wide-ranging applications of AI include triaging patients before interacting with live healthcare professionals, as well as supporting practicing physicians in enhancing patient care. In practice, Virtual Care has achieved mass adoption in countries ranging from Rwanda to the UK. In Rwanda, Babylon Health partnered with the Rwandan government to develop an SMS-based Virtual Care solution that has provided care to over 2 million Rwandans to date. In the UK, Babylon Health also partnered with the NHS to develop GP at Hand, an app-based Virtual Care solution that had over 50,000 registered users within the first few months of launch. These innovative and vastly different implementation models showcase the impact Virtual Care coupled with AI can have on a healthcare system.


      Conclusion/Implications/Recommendations:
      New technology and services are needed to empower physicians to provide quality care to underserved rural communities, Canadians living with mobility issues or those without access to non-emergency healthcare on evenings and weekends. New models such as Babylon by TELUS Health aim to reduce barriers to care while maintaining continuity with the existing public healthcare system. Developments in Virtual Care and AI present an opportunity to make a profound impact on the way Canadians access care for both end users and providers by providing increased safety, efficiency and cost savings throughout.


      140 Character Summary:
      Virtual Care technology will allow Canadians to access quality care and communicate efficiently with healthcare professionals no matter where they are located.

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      OS15.02 - Availability and Utilization of Virtual Care and e-Services in Canada (ID 436)

      Chad Leaver, Performance Analytics, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Digital health technologies to support patient care at a distance (virtual visits) have long been available in Canada, largely through a broad suite of telehealth programs and service providers. Innovation in some international health systems has seen citizen utilization of virtual visits grow to over 50% of annual healthcare interactions. Canada?s digital health sector and healthcare marketplace are advancing availability and accessibility options for virtual visits, yet the current proportion of care in Canada that is virtual is not currently known.


      Methodology/Approach:
      We completed two national surveys between February and March 2018. The Canadian physician survey used a multi-method promotion and recruitment strategy with direct-distribution to over 45,000 primary care and specialist physicians in Canada currently listed in the Canadian Medical Directory (CMD). Physicians could complete the survey manually or online. A general population survey of Canadians was recruited from multiple online panel sources to ensure a representative sample of Canadians by age, sex, province; and rural and remote communities. Both surveys were administered in French and English and focused on access and utilization of virtual care and other e-services in Canada. We used descriptive and cross-tabular analyses to determine the current availability and use of virtual care and to estimate the proportion care in Canada that is currently virtual.


      Finding/Results:
      A total of 2,406 Canadians completed the general population survey; and 1,393 physicians: primary care (n=799); and specialists (n=594) completed the Canadian Physician Survey. Canadian?s interest in accessing virtual care and other e-services is trending positively with significant increases from 2016 for e-Rx renew, e-view, e-booking, e-visit (e-mail and messaging), and virtual visits (+4% to +8% increase). 6% of Canadians report they can currently visit with their health care provider virtually online by video, 3% of Canadians have done so in the past year. Men were more likely than women (5% vs. 2%); and younger Canadians (<35yrs) were more likely than older Canadians to have had a virtual visit in the past year. Virtual visit coordination was either patient initiated or coordinated by regular care provider/specialist clinics. Most virtual visits (53%) were conducted at a health care facility, with the remaining 47% in the patient?s home. For patient initiated virtual visits in the past year, 49% were of no charge to Canadians; the remaining 51% were charged a one-time (per visit) fee. Of the healthcare interactions reported by respondents to our survey 1.6% of these were virtual in 2018. Results from our physician survey highlight virtual care and e-services currently provided by physicians in Canada and key facilitators to advancing physician adoption and use.


      Conclusion/Implications/Recommendations:
      Canadians are increasingly interested in accessing virtual care and digitally enabled health services, yet currently only small percentage of Canadians say they can do so. We estimate that in 2018 1.6% of visits in Canada were virtual. Greater consultation to refine our methodology and assumptions informing this estimate and future trending is warranted. In order to realize the estimated health system value of virtual care, enabling citizen access, clinical practice integration and physician remuneration will be essential.


      140 Character Summary:
      Canadians are increasingly interested in virtual care. We estimate that in 2018 1.6% of healthcare visits in Canada were virtual face-to-face consultations.

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      OS15.03 - HIMSS Analytics's INFRAM Will Change How Healthcare Views Infrastructure Forever (ID 482)

      Shanti Gidwani, Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      We hear about organizations all over the world making enormous investments in EMR implementations ? millions (sometimes billions) of dollars. The EMR rollout, that?s the exciting part ? the opportunity for a healthcare organization to move from paper charts to a digital modality that touts efficiency returns, broader access to patient data, comprehensive clinical workflows and more. But all too often, the infrastructure upon which these highly complex systems must ride on are neglected or even forgotten; and if it isn?t current (i.e. powerful enough to support the application), Day 1 of a new launch can be disastrous. And guess who/what the clinicians blame? The application they are using, when perhaps it is the aging infrastructure it is riding on that is causing the issue? Enter the HIMSS Analytics's INFRAM (the INFRastructure Adoption Model). This model guides organizations through a specific process and assessment, and at the end creates a bespoke infrastructure architecture roadmap. The organization can then use this to map out their specific technology requirements based on what they already have in place, and where they want to go. If you?ve heard of the HIMSS EMRAM (Electronic Medical Record Adoption Model), you will quickly realize that the INFRAM goes hand in hand with the EMRAM and its corresponding levels. So if you think your organization is an EMRAM level 4, you can verify this by undertaking the INFRAM assessment and then planning the strategic architecture to get to a level 6 or even 7 ? also known to some as EMR nirvana. This talk will discuss the underlying principles of INFRAM, how it is linked to EMRAM and why health care leaders should care about this. Global announcements will be made on October 24th about INFRAM on the HIMSS Analytics website. For now, please refer to these two links. https://www.himssanalytics.org/news/infram-criteria-healthcare-infrastructure-maturity and https://gblogs.cisco.com/ca/2018/07/25/what-the-heck-is-the-infram-and-why-should-i-care-about-it/


      Methodology/Approach:
      This talk will outline how the INFRAM was developed, what it entails and why HIMSS Analytics asked for the intellectual property.


      Finding/Results:
      This part of the talk will discuss the number of INFRAM assessments done to date and how effective they have been.


      Conclusion/Implications/Recommendations:
      This part of the talk will include a call to action for those in the healthcare technology space.


      140 Character Summary:
      INFRAM will forever change how organizations can create strategic plans mapping infrastructure investments to their clinical application implementations.

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      OS15.04 - Assessing Quality of Mobile Applications in Chronic Disease Management (ID 391)

      Payal Agarwal, Womens College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      There has been great excitement and growth in the mobile health field, with over 40,000 new health and wellness apps. However, due to a lack of regulatory systems, it is likely that many of these apps are of poor quality, posing potential risks to patients -- including privacy breaches, wasted resources and poor clinical outcomes. In order to fully realize the potential of mobile technologies to improve care, health systems require validated methods for selecting and evaluating the quality of apps. The goal of this project is to complete a scoping review of the literature exploring the criteria authors use to assess the quality of mobile health apps outside of formal experimental evaluation, particularity for chronic disease management. Through this process, we aim to help clinicians, patients and system decision makers find and support high quality apps that have the potential to improve care and impact health outcomes.


      Methodology/Approach:
      We conducted a scoping review of Cochrane and MEDLINE databases to systematically find articles that include a direct review and assessment of quality for two or more patient-facing mobile applications intended to promote chronic disease management. Our search strategy included search terms representing 2 concepts: 1) mobile applications and 2) chronic disease. We excluded studies that evaluated apps through an empiric experimental design. All abstracts were screened for inclusion by 2 trained project team members and discrepancies were resolved by the principal investigators. For each article, we extracted all utilized quality criteria and conducted a thematic analysis using an inductive coding process.


      Finding/Results:
      Our initial search resulted in 8182 potential articles for inclusion. Ultimately, 66 articles were included in the final sample. The synthesized list of quality criteria resulted in 7 broad themes: 1) behavior change, 2) evidence of impact, 3) general characteristics, 4) health information quality, 5) technical features, 6) user experience and 7) user engagement. Overall, there was significant variability in the criteria authors used to measure quality. Readily available measures, such as user ratings (n=20) and price (n=25), were some of the most commonly used quality criteria. Despite the important place of privacy and security within digital health technologies, only 10 articles used security and 12 used privacy as a measure of quality. The inclusion of user engagement features, self-monitoring in particular (n=45), was the most popular method to assess quality. However, most articles based their review on the assumption that more engagement features were related to higher quality; based on the literature, this assumption is likely incorrect. Many reviewers recognized the importance of incorporating behavior change techniques into health apps (n=27), but there was rarely the explicit use of a validated frameworks for identifying evidence based techniques.


      Conclusion/Implications/Recommendations:
      The high number of articles found for inclusion in our review suggests a strong interest in using quality criteria to evaluate mobile health apps. However, the immense variability of included criteria indicates the need for a comprehensive, standardized framework to identify health applications that deserve further support and use by the health system.


      140 Character Summary:
      A scoping review of 66 articles exploring criteria used to assess the quality of mobile health apps for chronic disease management.

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    OS21 - Big Data Provision for Providers (ID 34)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 4
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Pod 6
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      OS21.01 - The HQCA Provincial Primary Healthcare Patient Panel Reports – Going Digital (ID 490)

      Walie Aktary, Health System Analytics, Health Quality Council of Alberta; Calgary/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The Health Quality Council of Alberta (HQCA) produces Provincial Primary Healthcare Patient Panel Reports that provide meaningful and relevant information to primary healthcare providers, teams, and primary care networks across Alberta. The reports contain aggregate information about patient demographic characteristics, health status, and aspects of patient management and utilization patterns across the healthcare system. User feedback collected as part of a return on investment (ROI) analysis demonstrated that the reports influence primary healthcare providers by offering new information about patients and is useful in identifying quality improvement opportunities. The reports have historically been sent out to recipients electronically as static documents; however, user feedback suggests that there is a need to expand the reporting modality of the reports to a digital platform where reporting is dynamic. Therefore, the HQCA explored how to digitalize the reports to create a new and interactive tool.


      Methodology/Approach:
      The HQCA used a two-stage collaborative approach to digitalize the panel reports and build an online reporting platform. The first stage consisted of building a pilot environment through an agile scrum process with experts familiar with digital reporting software. The scrum process is an iterative approach to software development where development occurs incrementally. The pilot process took place over a 1-month period and a 2-week post-production period was used to beta test the pilot environment. The second stage will consist of a full-scale build that is currently in process. The HQCA will conduct the full build over a 6-month period where development will be guided by a design working group consisting of report stakeholders. This working group will be comprised of report users, healthcare team members, and HQCA developers. The full build will follow an alpha testing model where the design group will identify bugs in test versions of the environment. A final round of beta testing will occur prior to deployment with external stakeholders.


      Finding/Results:
      Usability testing provided positive feedback regarding the introduction of a digital environment. The findings highlighted areas for improvement regarding user comprehension as well as provided a basis for future development. Test findings suggested that the environment could be more user-friendly by focusing on the language used to describe system features, such as the functionality that enabled users to focus on clinical populations of interest through data filters. Users identified the ability to customize the comparators used in the reports as a significant strength of digital reports as compared to the current reporting modality. Group feedback also indicated that the HQCA proceed with a full build suggesting that the pilot environment build was successful.


      Conclusion/Implications/Recommendations:
      Early indications suggest that the digital reports will be more clinically relevant and actionable. The new reporting platform for the panel reports will aim to provide users and their care teams with a mechanism to identify opportunities for improvement as well as areas of success to strengthen the patient's medical home by improving panel management, continuity, access, and quality of care for their patients.


      140 Character Summary:
      The HQCA is working with primary healthcare stakeholders to build an online reporting platform for providers, teams, and primary care networks across Alberta.

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      • Abstract
      • Slides

      Purpose/Objectives:
      To explore how CIHI plans to evolve by creating an enterprise data management architecture capable to govern and integrate health data in one place and simplify and standardize how users interact with our data. The vision is to free-up value in health information by making it available, explorable, usable, comparable and meaningful to all consumers while keeping it secure and traceable.


      Methodology/Approach:
      Making data available to stakeholders, including the public, is a key function within CIHI?s mandate. In addition, with the emergence of open data policies and digital transformation, there is an urgent need to improve our stakeholders? experience in finding and using CIHI data. Through a digital delivery model, product management and a multi-year roadmap, CIHI will design and build a front-end platform, called the Product Hub and a back-end platform called the Data Hub. The Product Hub will allow our users to interact with our data through governed products and will depend upon the Data Hub to provide integrated and comparable, meaningful data. CIHI will achieve this by using an enterprise architecture program designed to support current needs but with strong focus on future growth, including continued advancement in data governance, advanced analytics and artificial intelligence. To achieve these goals, CIHI will evaluate and take advantage of Big Data technologies.


      Conclusion/Implications/Recommendations:
      CIHI remains committed to our mandate to continuously improve the digital experience of our stakeholders and provide value to the Canadian health care system. To do this we need to implement a comprehensive enterprise health data management and access platform based on an enterprise data model, using Big Data/BI/data visualization technologies that eliminate the restrictions that come with traditional approaches.


      140 Character Summary:
      CIHI makes a vast amount of data publicly and privately available to stakeholders through our website(s). Through stakeholder engagement and environmental scans CIHI has learned about our main challenges in making data available in a user-friendly way. Examples include difficulties with search, navigation, standardization in visualization, data in one place (e.g., data and metadata), etc. Much of this can be attributed to our back end data management flows and processes as a result of siloed systems and outdated technology. A cost benefit analysis was conducted to highlight the continued reliance on manual processes demonstrating inefficiencies and creation of difficulties to scale. Research was conducted and proof of concept work completed with multiple vendors in the big data management space to decide on a technology platform that makes sense for CIHI. This will support continued work on the overall design of the Data Hub and Product Hub.CIHI will share plans to advance our digital delivery model that includes a comprehensive view of health information powered by a Big Data Management Platform.

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      OS21.03 - Digital Pathology Across Provinces - Multi-Jurisdictional Telepathology, Year One (ID 245)

      Gillian Sweeney, eHealth Clinical Programs, NL Centre for Health Information; St. John's/CA
      Andrew Evans, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The Multi-Jurisdictional Telepathology network is a partnership established between Manitoba, University Health Network in Ontario, Newfoundland and Labrador, with the support of Canada Health Infoway intended to connect local telepathology networks amongst the three jurisdictions. The solution, a first of its kind in Canada, went live in June 2018, connecting a scalable pathology network of specialists and sub-specialists. The vision of this solution is to create an environment where pathologists are able to obtain consultations, including speciality and sub-specialty areas not necessarily available at the pathologists respective locations, in a more timely and effective manner. Developing a solution that meets the needs of end users within a jurisdiction as well as amongst jurisdictions is challenging. These needs were addressed through the development of a solution that balanced the end user needs, system capabilities, personal health information and ongoing system management in order to maximize adoption will be addressed. This presentation will provide an overview of the solution, challenges associated with establishing a virtual multi-jurisdictional solution, ongoing maintenance and governance, as well as the value and benefits realized in the first year of operations.


      Methodology/Approach:
      In developing and implementing a multi-jurisdictional solution, it became apparent that a balance of the end user needs, the system capabilities and the ongoing system management was necessary. This implementation requires the balance of privacy, security, technical architecture, governance and ultimately clinical workflow to name a few of the considerations, not only within a province but additionally across multiple jurisdictions. Elements key to the early stages and implementation of such a solution include: Successful provincial implementations Engaged end users Privacy, security and technical subject matter expertise in each jurisdiction Governance ? project and program The presentation will include results from stakeholder evaluations including a benefits and evaluation report.


      Finding/Results:
      The presentation will detail the challenges and opportunities presented with the implementation of a multi-jurisdictional telepathology solution, connecting colleagues and enhancing access to specialised services across the country. Results of early benefits and evaluation work will include: Uses for the system - consultations, education and training, continuous quality improvement. Satisfaction with the solution ? majority of users feel that the removal of the solution in their laboratory would be a step backward. Perceived benefits to date - improved quality of service, harmonization of clinical practice within the laboratory, improved continuity of patient care, and an increase in the quality of patient care.


      Conclusion/Implications/Recommendations:
      The implementation of this solution connects pathologists, many working in smaller, more isolated areas ? in a timely, often more efficient manner, not only within their own jurisdiction but across jurisdictions. The established Multi-Jurisdictional Telepathology network is a pan-Canadian proof of concept, including a road map and lessons learned for additional jurisdictions as well as for similar pan-Canadian implementations in the future. This presentation will highlight the implementation of such a solution as well as the benefits to date experienced by clinicians in providing quality care to Canadians.


      140 Character Summary:
      The Multi-Jurisdictional Telepathology Network, live as of June 2018, connects pathologists across NL, ON and MB. Learn about the implementation and benefits.

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      OS21.04 - Pathology Data Analytics to Optimize Laboratory Utilization by Interactive Scorecards (ID 146)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      Pathology laboratories provide service to both primary-care and tertiary care providers, helping with disease diagnosis and therapeutic choices. Typically, physicians request a pathology test order which may contain multiple tests; the operational question is whether these tests are relevant and useful with respect to the patient?s profile. As service demands on pathology laboratories is increasing, there is a realization to streamline the operations with respect to clinical guidelines and local clinical workflows to optimize operational costs whilst improving order relevancy and result accuracy. A Canadian study has shown that physicians test ordering behaviour can be modified by education, personalized audit and peer comparisons. Pathology laboratories generate large volumes of clinical data that can be analyzed to monitor, manage and optimize laboratory utilization. This project aims to optimize pathology laboratory utilization by detecting superfluous (clinically irrelevant, unnecessary, repetitive) lab orders by physicians and then educating physicians about test ordering guidelines. Our specific objectives are: (1) To develop and deploy a Pathology Laboratory Utilization Scorecards (PLUS) platform that offers end-to-end pathology ?big? data analytics services to optimize laboratory utilization; (2) To provide primary care physicians personalized laboratory utilization scorecards so that they can examine their test ordering pattern and adjust their test orders accordingly; (3) To provide pathology laboratory managers a live dashboard showing the volume and type of orders to assist them with resource planning; and (4) To generate meaningful order-sets to improve test ordering patterns and guideline compliance.


      Methodology/Approach:
      Big data analytics approach is taken to develop PLUS that hosts a suite of health data analytics tools to (i) standardize pathology data using SNOMED-CT; (ii) integrate pathology data from feeder health information systems (such as ADT, EDS); (iii) analyze lab data using machine learning methods?clustering methods are applied to develop physician order profiles to stratify physicians with respect to their patient case-mix (as opposed to their order type and volumes) for inter-physician peer comparisons, and rule association methods are applied to generate order-sets and to evaluate test orders based on previous order patterns; and (iv) visualize analytical results as interactive scorecards?advance data visualization techniques are used to visualize the multi-dimensional physician scorecard, giving physicians the ability to dynamically interact with their scorecard to get personalized views of their ordering behaviour and comparisons with their peer-group. We performed data analytics on physician?s test orders for the period 2011-2017 with a dataset comprising around 8 million test orders from 200 physicians.


      Finding/Results:
      We have developed PLUS to optimize the pathology laboratory utilization in the central zone (Halifax) that annually performs on average 15 million laboratory tests for 200,000 patients. PLUS is securely web-accessible to physicians to privately audit their ordering profile in terms of volume of test orders with abnormal rates, repetition rates, yearly comparison and comparison to their peers.


      Conclusion/Implications/Recommendations:
      ?Choosing Wisely Canada? is promoting sustainable healthcare by optimizing the utilization of healthcare services. This project engages primary care physicians to help optimize lab utilization, and this will impact NSHA annual budget by reducing demand for diagnostic services whilst increasing patient safety in line with Choosing Wisely principles.


      140 Character Summary:
      A big health data analytics platform using artificial intelligence to analyze pathology lab data to optimize pathology lab utilization and increase patient safety

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    OS27 - Integrating the Community Sectors (ID 43)

    • 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 6
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      OS27.01 - Understanding the Technology Needs of Clinical End-Users for Care Coordination (ID 550)

      Daniel Cornejo Palma, WIHV; Toronto, Ontario/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Rural communities are a difficult place to try internet-based technology to improve health outcomes. Part of the difficulty stems from not incorporating the concerns of clinical end-users when implementing new technology. Traditional approaches to evaluating technology implementation focus on measuring patient outcomes. The importance of understanding clinical end-user interests is traditionally downplayed. Ignoring the concerns of users has lead to technology disuse and lacklustre patient outcome improvements in the literature. To improve the understanding of clinical end-user concerns, we created the Tool+Team+Routine (TTR) heuristic. TTR is based on principles from value proposition design, in which empathy for the user underlies the first step in implementing engaging solutions. TTR aims to improve the engagement in technology implementation by defining success metrics in terms that matter to clinical end-users.


      Methodology/Approach:
      We used TTR to define success metrics for a digital platform set up to improve care coordination efficiency in a population of rural complex care patients. During protocol development, the evaluation team discussed or observed each TTR element with coordinators. We learned from coordinators that to understand meaningful platform use (i.e. ?tool? use), we would have to track usage. Coordinators also taught us that meaningful collaboration amongst 'team' members meant having case conferences, which prompted the inclusion of case conferences as a secondary outcome. Finally, we also learned that improvement to practice (i.e. ?routines?) meant reducing communication delays between health professionals. Thus, we developed a primary outcome, time to maintenance (TTM), based on elapsed time to highlight communication delays among providers.


      Finding/Results:
      *Tool: Usage of the platform was low. Half of the cohort barely used the platform. Overall, 30% of all communication on the platform occurred between care coordinators and clients ?70% was between clients and family. The tool was designed to centralize patient-related conversations among health professionals but did not do so, due to lacking engagement from other providers. Team: We observed that case conferences occurred in only 15% of patients. Care coordinators noted that a minority of clients with health teams that adopted the communication platform seemed to experience an efficiency gain in reaching their goals. Routine:* Care coordinators? claim of an efficiency gain with app engagement was supported by observed data. Video call usage, a measure of engagement, significantly reduced the coordination delay per co-morbidity. The delay observed per comorbidity was 28.7 days without platform use (i.e.< 2 calls made in six months of follow-up). If patients made at least ten calls in six months, the coordination delay per comorbidity decreased from 28.7 to 19.9 days (p=0.035).


      Conclusion/Implications/Recommendations:
      TTR is a simple heuristic that identified metrics that were relevant to clinical end-users. The primary outcome reflected communication delays because coordinators identified delays as a vital concern to the efficiency of daily routines. Coordinator worries about the engagement of other care team members meant we measured clinician involvement closely. TTR-based evaluation results challenged decision-makers to consider clinical end-user concerns as vital next steps to address in this technology implementation.


      140 Character Summary:
      Traditional technology implementation approaches overlook end-user concerns. We present a practical framework to understand end-users: 'Tool+Team+Routine'.

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      OS27.02 - Clinical Value of Standardized Primary Care Data: Learnings from POC (ID 448)

      Michelle Cousins, The eHealth Centre of Excellence; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The connecting South West Ontario Program?s Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, enabled a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontario?s integrated electronic health record (EHR). A key objective of the POC was to support clinicians to improve data quality to enhance data sharing. This presentation demonstrates how structured EMR data can be used to enable clinical and organizational value for primary care providers and their patients


      Methodology/Approach:
      Data quality assessments were completed before and after investments to improve data quality that included chart reviews, surveys and EMR searches. Data quality investments included historical coding of EMR data to ensure coded patient data was current. The eCE consulted with program managers and clinicians to explore how improved data quality could generate value for each organization and developed case studies to demonstrate this value to clinicians.


      Finding/Results:
      During the POC the eCE PCDS project team learned that data quality initiatives, when positioned together with tools developed in line with clinical best practices, generate internal value for contributing organizations and clinicians. Improved EMR data quality allows primary care organizations to: identify patients with specific conditions (including patients who did not have a documented diagnosis); identify complex patients (high-users of the healthcare system); identify and understand patient population (i.e. prevalence of chronic conditions). Overall, findings demonstrated that primary care data quality improvement initiatives promote improved documentation and a more accurate depiction of the patient roster in the EMR, which has allowed primary care providers to be more proactive in the way they manage care internally to their practices as well as through better communication to community and specialist supports.


      Conclusion/Implications/Recommendations:
      The PCDS POC has demonstrated not only that data can be extracted from EMRs and viewed by clinicians across communities and the continuum of care, but generated improved value for clinicians and patients within primary care practices by improving data quality. When EMR data is up-to-date and standardized using codes, practices can identify and mobilize to care for specific patient populations. Moving forward, it is important to invest in a scalable model that can structure and improve primary care data quality and to learn more about the opportunity a high-quality dataset from primary care offers to achieve the quadruple aim (improved patient experience, patient outcomes, system cost, physician experience). For example, EMR tools that incorporate best practice guidelines could be developed in ways that enable clinicians to document specific elements in structured ways that can lead to easier more effective management of patient populations. In addition, those structured fields can be shared with specialists and community supports to support stronger continuity of care.


      140 Character Summary:
      This presentation will demonstrate how quality primary care data can enable clinical and organizational value for primary care providers and their patients.

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      OS27.03 - LTC eConnect: Supporting LTC Access to the Electronic Health Record (ID 346)

      Angela Lianos, Account Management, eHealth Ontario; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: The LTC eConnect solution leverages the provincial EHR clinical viewers, ConnectingOntario and ClinicalConnect, to provide clinicians working in Long Term Care (LTC) homes with simple, direct access to the provincial EHR from the existing secure resident record in the PointClickCare clinical information system, which is currently in use by LTCHs. This panel presentation will showcase the LTC eConnect solution that connects clinical users? patient information in a manner which supports their clinical workflow (i.e., with Single Sign-On (SSO) and Context Management (CM)). The project, went live with its first LTC site in March 2017, and is being delivered through a successful partnership between Canada Health Infoway, eHealth Ontario, PointClickCare and ThoughtWire with support from stakeholders across the sector, including the Ontario Long-Term Care Association (OLTCA), AdvantAge Ontario and LTC clinicians. This session will provide a demonstration of the solution, narrated by panel members, as well as an overview of project successes and lessons learned. LTC clinicians will explain how the LTC eConnect solution has benefited patient care and provided clinical efficiencies.


      Methodology/Approach:
      Methodology/Approach: Designed specifically for the LTC sector, the LTC eConnect solution provides clinicians access to the ConnectingOntario ClinicalViewer or ClinicalConnect directly from their PointClickCare EMR, while maintaining patient context. The solution was developed using Agile Methodology guided by two clinical advisory panels; one for each regional viewer. The solution was rolled out to a pilot site in each of the three regions before it was available generally.


      Finding/Results:
      Findings/Results: LTC eConnect has been rolled out to 73 Long-Term Care Homes in Ontario, and over 1,400 authorized users are now able to access residents? health information to support care delivery. An additional 200 homes across the province are scheduled to be using LTC eConnect by March 2019, which represents nearly half of the LTC homes in Ontario. The response from clinicians who have adopted the LTC eConnect solution has been overwhelmingly positive. Clinicians have reported: Greater access to residents? health information in real-time ? especially upon resident admission or transfer Easier access to labs, diagnostics and drug data Ease of use during medication reconciliation and access to a fulsome health profile during the patient assessment period Expanded use of information among registered staff supported by the controls put in place to access personal health information directly within the PointClickCare application Easier auditing controls for monitoring staff usage and access of the electronic health record


      Conclusion/Implications/Recommendations:
      Conclusion/Implications/Recommendations Implementation of the LTC eConnect initiative required stakeholder engagement from the LTC sector to ensure the digital health solution was appropriately integrated into clinician workflow. Both the complexity of the patients the LTC sector serves, as well as the diversity of the LTC clinicians themselves required unique considerations to ensure the success of the service. The development and implementation of the LTC eConnect solution was successful because it was designed around the people it serves. By putting LTC clinicians at the forefront of the project the solution could be tailored to prioritized needs of the sector.


      140 Character Summary:
      LTC eConnect: A sector specific solution created to support long-term care access to the electronic health record

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      OS27.04 - Discharge Optimization in the Emergency Department at CAMH  (ID 545)

      Gillian Saracino, Performance Improvement, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract

      Purpose/Objectives:
      The CAMH Emergency Department (ED) Discharge Optimization project will improve transitions and experiences of individuals discharged from the ED through: -Implementation of an electronic ?PODS? (Patient Oriented Discharge Summary) that is built within the EMR (Electronic Medical Record) and provided to patients on discharge. -More efficient completion and distribution of discharge summaries to community physicians to promote smooth transitions and continuity of care for patients. These discharge improvements have been successfully rolled out to all inpatient units at CAMH. As a result, this initiative will align with organization-wide standards and initiatives. Further, initial consultation with families as part of the ED Optimization project has acknowledged that a PODS-type discharge summary will fill a reported gap in regards to transition, safety and care planning in the emergency department.


      Methodology/Approach:
      The implementation of PODS will use Project Management tools and approaches within a Quality Improvement Science frame to plan, implement, study and improve: -The use of PODS for patient education and self-management post-ED visit -Efficiencies in completion and distribution of discharge summaries to community Physicians The project team consists of representation and expertise in Project Management, Quality Improvement, and Reporting and Analytics, wherein a measurement plan is being developed to identify current process measures as well as outcome measures. Achievements to date include: -Current state analysis, including process mapping, analysis of variation in current state process, and identification of technical challenges -Current state analysis to inform implementation of PODS in the ED discharge process -Inclusion of patients and families in the planning of PODS for the CAMH ED. -Collaboration with CAMH?s Clinical Informatics team to develop and implement solutions within the CAMH Electronic Medical Record (EMR)


      Finding/Results:
      Currently, this project is underway, with a goal of implementation by the end of the fiscal year. Baseline data collection indicates opportunities for improvement in dissemination of discharge notes from the CAMH ED. Specific areas of opportunity include usability of the EMR function for sending clinical documentation. CAMH-wide implementation of PODS on inpatient units has involved continuous monitoring through initial implementation and PDSA cycles. Currently, there is monitoring for sustainability to ensure continued success of PODS implementation. The same approach will be used for implementation of PODS in the ED.


      Conclusion/Implications/Recommendations:
      The combined implementation of PODS in the ED, and more efficient completion and distribution of ED discharge summaries, will support and maintain a patient-centred approach to promote vital transitions in care.


      140 Character Summary:
      The CAMH Emergency Department is implementing a patient-centred initiative to improve discharge processes and promote more effective transitions in care.