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    FN01 - Advancing Indigenous Access to High Quality Virtual Care Solutions (ID 44)

    • Event: e-Health 2019 Virtual Meeting
    • Type: First Nation Session
    • Track:
    • Presentations: 2
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 7
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    OS05 - Mining the Gold! (ID 6)

    • 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 7
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      OS05.01 - Improving BCMA: Closing the Loop with OMIE (ID 399)

      Chris Byczko, The Hospital for Sick Children; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      This presentation demonstrates a practical framework for strategically improving scanning compliance in the closed loop medication administration process for the organizational and unit level. In June 2018, SickKids went live with a new information system and shortly there after achieved HIMSS EMRAM level 6. A criteria for achieving this level is the implementation of closed loop medication administration process (or also referred to as Barcoded Medication Administration, BCMA). BCMA is a proven process that helps to reduce medication and patient identification errors. A key factor for BCMA's success to improve patient safety is contingent on scanning compliance by front line staff. There currently is a lack of a conceptual framework to practically guide healthcare institutions to improve BCMA compliance after implementation of the technology.


      Methodology/Approach:
      A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses? perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


      Finding/Results:
      A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses? perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


      Conclusion/Implications/Recommendations:
      The OMIE Framework is an effective and useful conceptual framework to practically guide hospital initiatives in improving BCMA compliance rates. Utilizing the OMIE Framework to derive unit-level BCMA improvement strategies demonstrated effectiveness in increasing BCMA compliance rates at both the organization and unit level. Healthcare facilities can consider the use of the OMIE Framework as a conceptual framework to improve BCMA compliance rates on their journey to enhancing patient safety. Further exploration of contextual factors that hinder or enable implementation of BCMA improvement strategies is needed.


      140 Character Summary:
      A practical framework for improving scanning compliance in the closed loop medication administration process for the organizational and unit level.

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      OS05.02 - The Role of Health Informatics Professionals in Making AI Happen (ID 347)

      Julia Zarb, IHPME, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Artificial Intelligence in healthcare is, arguably, a solution in search of a problem. It is rife with potential in the domain of improving patient care and outcomes, yet who is leading the vanguard to make this actually happen? Despite our healthcare community valuation of collaboration, we see a proliferation of silos emerging to lead the challenges of integrating AI into the field. This presentation will consider whether such fragmentation in pursuit of AI excellence risks HI history repeating itself with cycles of missed opportunity, or whether more cohesive models for enhancing the ecosystem can emerge. The presentation will take the perspective that health informatics professionals are well positioned to make AI happen in healthcare?s complex system of systems. We have learned (the hard way via compromised projects and implementations) the critical importance of management and evaluation to prepare for change and ensure viability through adoption. As such, we are uniquely positioned to navigate ?upstream? challenges at organizational and systemic levels, where accountability and accrual of benefits are concentrated, to ensure the ?downstream? move into actual use of AI technologies to maximum advantage.


      Methodology/Approach:
      The presentation will investigate the current landscape of AI advancement in healthcare. It will build perspective from capstone and executive-stream projects underway within the Master of Health Informatics (MHI) at University of Toronto, under the leadership of presenter Julia Zarb. Content may be drawn from alumni contribution of a machine-learning algorithm to evaluate such activities, and will be developed with input from the MHI Modernization Committee. The presenter will draw on work underway as the Director of the MHI program, and in collaboration with Emily Seto, health informatics lead for the Institute of Health Policy, Management and Evaluation.


      Finding/Results:
      The presentation will deliver a comparison of current Canadian models for upstream AI leadership in healthcare, with specific references to viable cases for collaborative activity. The findings will reflect work underway within University of Toronto and within the local community, with extension into the province and nation with possible reference to international cases. The presentation will suggest critical considerations and viable models for building next generations of AI-competent professionals to manage upstream to maximize downstream viability of new technologies.


      Conclusion/Implications/Recommendations:
      Attendees will emerge with an understanding of the current state of AI upstream leadership in Canadian healthcare, and a sense of potential models for collaborative advancement. The presentation will contain recommendations on how to realistically move forward in planning for a full scope of AI integration, using lessons-learned in health informatics.


      140 Character Summary:
      AI in healthcare is a topic filled with hope and hype. HI professionals can use lessons learned about managing upstream to ensure downstream AI success.

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      OS05.03 - Early Intervention Solutions for PTSD Indicators in First Responders (ID 466)

      Michelle O'Keefe, Sierra Systems; Ottawa/CA
      Dan Thomson, Sierra Systems; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Police recognize that Early Intervention Solutions (EIS) can be invaluable tools for improving the effectiveness of supervisors, identifying at risk officers, and building public trust, but what impact would an EIS have on detecting warning signs of PTSD in first responders and front-line hospital workers, who are frequently exposed to traumatic, life-altering events? This presentation explores how combining data about at-risk events (e.g. complaints and critical incidents) with operational data allows agencies and health employers to provide early intervention for at-risk front-line staff, manage corresponding follow-up activities, and ultimately preserve careers and support mental health. Sierra Systems? Justice and Public Safety and Health Leads will explore how lessons learned from Police can help to support mental health for front-line healthcare workers.


      Methodology/Approach:
      With intense public scrutiny of relations between police officers and the communities, departments were looking for new ways to mitigate problems before they escalate. Police departments already have a lot of data available that could be helpful: use of force incidents, citizen complaints, praise of officers from other officers or the community. Even the number of calls they respond to, the type of call, the condition of victims and perpetrators, the shifts or locations, high-speed pursuits, canine use, and how relative peer groups compare can all impact the analysis. To sort through the data and draw the right conclusions, departments are turning to early intervention systems for predictive analytics. Analyzing the data allows for monitoring of early indicators of potentially risky behaviours, exemplary behaviours, and even indicators of officer wellness. The EIS gathers data from a dozen or so operational sources and maintains it in an EIS data warehouse. Configurable, standard deviation-based threshold criteria are established, examining simple event counts, ratios, presence of multiple of events, etc. Personnel are grouped into peer groups, with trends and optimal warning levels made available to supervisors. Notifications are automatically routed to supervisors, with links to additional information made available to support interventions. The solution also records findings, interventions, and employee responses. Staff have access to their own summaries, as well as comparisons to their peers, organization to organization, and trends.


      Finding/Results:
      Law enforcement agencies both large and small have seen improvements in proactive risk mitigation, transparent evidence-based staffing decisions, and public trust and communication. Agencies are now expanding use of the same operational metrics to flag early detection of potential PTSD-related work behaviours by comparing an officer to their own personal historical metrics and looking for material changes such as: -Increase in risky high-speed pursuits or acting before backup arrives. -Decrease in productivity, e.g. missed court appearances, or dropped charges due to incomplete investigations. -Changes to sick-time patterns. -Conflicts with other officers detected through scheduling requests. -Scheduling requests that suggest avoidance of certain neighbourhoods.


      Conclusion/Implications/Recommendations:
      EIS monitoring of first responder health worker performance, including exemplary, risky, and potential PTSD workplace behaviours, is something that should be pursued. While it is not a panacea and does not replace a professional diagnosis, it can help agencies get a better handle on the metrics and identify outliers.


      140 Character Summary:
      Exploring the impact of an Early Intervention Solution on detecting warning signs of PTSD in first responders and front-line hospital workers.

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      OS05.04 - The Last 15%: Closing the pan-Canadian Emergency Department Data Gap (ID 219)

      Isabel Tsui, Canandian Istitute for Health Information; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Emergency department (ED) data is a crucial component of understanding the effectiveness and efficiency of Canada?s overall healthcare system. CIHI currently has data related to 85% of ED visits that take place across Canada. CIHI?s ED data coverage has provided our health system with valuable information on ED wait time trends at the facility, regional, provincial, peer and pan-Canadian level, as well as highly needed information to manage the opioid crisis and insights into the use/overuse of ED services. Closing the data gap on the remaining 15% of ED visits that is currently not being reported to CIHI?s National Ambulatory Care Reporting System (NACRS) will provide a fulsome picture of the valuable indicators described above, and will be an effective predictor of demand for hospital inpatient services, availability of primary and mental health services, and insights into the care being delivered in other sectors such as long-term care. This presentation will provide an in-depth look at the strategies being put in place to accomplish 100% data coverage from EDs across Canada.


      Methodology/Approach:
      CIHI is actively working with each province and territory not currently submitting 100% of their ED visit data to NACRS to design a solution for data capture that minimizes burden and leverages technologies that have been put in place within EDs or jurisdictions. This includes innovative web-based data capture tools as well as leveraging hospital and/or health authority/provincial data warehouses with modern data extraction and transformation methods.


      Finding/Results:
      Rapid expansion and uptake of data submission requires careful planning and well-thought out processes to navigate unforeseen circumstances. The learnings from successes CIHI has had in bringing in ED data from Quebec and other provinces/territories will be described during this presentation.


      Conclusion/Implications/Recommendations:
      CIHI has been focusing on designing solutions that meet the needs of data submitters and minimize submission burden to get at the last 15% of ED visits not currently being reported, and expand on the data that is currently submitted to gain more clinical insights, notably the clinical diagnoses and procedures taking place in EDs. Key areas of focus from CIHI?s strategy to expand ED coverage and success stories will be described during this presentation.


      140 Character Summary:
      Flexible strategies and solutions to gather valuable emergency department data across Canada

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    OS08 - The Road to Digital Health Adoption (ID 12)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 4
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 7
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      OS08.01 - Engaging Physicians for GoLive: The Role of Physician Champions (ID 489)

      Melanie Buba, Department of Pediatrics, CHEO; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Physician Champions serve as department/division-specific representatives and subject-matter experts for items relating to the EMR build and operations. They liaise between the clinical operations of the hospital while engaging and supporting their colleagues. The purpose of this presentation is to provide an overview of the important role of Physician Champions as key stakeholders and drivers of change around the decisions and processes that contribute to the optimization and clinical relevance of the EMR. Specifically, the contribution of Physician Champions to decisions affecting EMR optimization will be explored.


      Methodology/Approach:
      A review of minutes from Physician Advisory Council (PAC) meetings for a two year period from October 1, 2016 to September 30, 2018 was undertaken, and the total number of decisions made was determined. Decisions were reviewed and a decision lead was identified. ?Physician-driven? initiatives were defined as having a physician as the decision lead.


      Finding/Results:
      Between October 1, 2018 and September 30, 2018, a total of 104 major clinical decisions were made. Of these, 34 (32.7%) were ?physician-driven? initiatives, of which 25 (73.5%) were made in the year after GoLive (October 21, 2017 ? September 20, 2018). Physician Champions also participated as leads in 10 identified high risk workflows. The overall attitude from physician end-users about the EHR improving quality of care was 28% prior to the start of the implementation, 50% one year post implementation and 74% two years after GoLive.


      Conclusion/Implications/Recommendations:
      Physician Champions have made a substantial contribution to decisions affecting EMR optimization. Physicians have led approximately one-third of these changes, with a large proportion of these ?physician-driven? initiatives occurring in the year post-GoLive. At the same time we have seen a significant increase in the physician perception that the EHR was improving quality of care. An EHR governance structure that supports physicians as key stakeholders is critical to enhancing the applicability and usability of the EHR system. They provide valuable clinical input into system design, implementation, optimization and training, and as experienced end-users, have help lead a large number of improvement initiatives, particularly after GoLive. Continued involvement of physicians in EHR optimization is crucial. Further research will include the impact of Physician Champions on physician end-user overall perception, satisfaction and engagement with the EHR system.


      140 Character Summary:
      Creating an EHR governance structure that includes Physician Champions has allowed physicians to make a substantial contribution to the optimization of our EHR.

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      OS08.02 - Co-Designing Digital Technology Evaluations with Service Providers, Vendors and Evaluators (ID 421)

      Vess Stamenova, Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The Office of the Chief Health Innovation Strategist (OCHIS) in Ontario supports a program called Health Technologies Fund (HTF). The program?s goal is to accelerate the evaluation, procurement, adoption and diffusion of health technologies made in Ontario. The program requires a partnership between publicly funded health service providers (HSPs), a technology vendor and a third-party evaluator. This partnership ensures that technology companies are supported in an implementation initiative within an Ontario clinical context by working closely with a clinical site that has an interest in the technology. The evaluation partner?s role is to conduct an evaluation that can support procurement decisions at the clinical site and provide evidence of effectiveness and potential cost-savings. The Women?s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) has acted as an evaluation partner for three rounds of HTF competitions. The goal of this panel will be to present key learning points from the perspective of each partner: the HSP, the technology partner and the evaluation partner. The key learnings will be presented in the context of one of our projects, the evaluation of the Cloud Dx Health Kit.


      Methodology/Approach:
      The Cloud Dx Health Kit is a web-enabled remote- and self-monitoring platform allowing Chronic Obstructive Pulmonary Disease (COPD) patients to take their vital signs (oxygen saturation, blood pressure, temperature, and weight). Data is displayed on the tablet via Bluetooth and sent to a healthcare provider via a secure cloud. To determine and ensure that all participating parties? interests are being met in the project design, we spent several months co-designing the project. The goals during this phase were to design a viable implementation plan that will have a high likelihood of adoption within the specific setting. Weekly calls between the vendor (Cloud Dx), the HSP (Markham Stouffville Hospital) and the evaluator (WIHV) were conducted. Several in-person meetings and half day co-design workshops were completed to establish viable value-proposition hypotheses and to determine each party?s interests. Qualitative interviews with patients, healthcare providers and administrators were also conducted, to test out value proposition hypotheses. The level of commitment of the vendor company and their capacity for technology modifications was also assessed at that time. Feedback received from users and administrators was directly used to make modification of the implementation plan and research study design.


      Finding/Results:
      The following key insights were gained from the above process (1) an on-site clinical lead is essential, (2) the development of relationships between all three parties facilitate progress, (3) allowing end-users to use the technology can uncover critical workflow and technology modifications that need to be well established ahead of the evaluation and (4) determining the value propositions for both users and payers is critical for adoption.


      Conclusion/Implications/Recommendations:
      In this panel discussion, we are going to provide an overview of the co-design methods we use in the planning and design of our evaluations. Representatives from each team will describe the challenges they faced in running such collaborative projects and present key learnings focused on implementation and evaluation of digital technologies.


      140 Character Summary:
      This panel will provide an overview and perspectives on a co-designing evaluations with vendors, clinical providers and evaluators.

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      OS08.03 - A Novel EMR Benefits Realization Program in the Canadian Context (ID 400)

      Tammy Degiovanni, Children's Hospital of eastern Ontario; Ottawa/CA
      Ken Farion, CHEO; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Implementing an enterprise-wide, integrated EHR solution is one of the largest and most complicated investments any hospital or health system can make to transform care and achieve better outcomes. Formally quantifying these benefits requires a structured approach against pre-established targets. As a small, independent, non-case costing academic pediatric institution in Canada, we encountered some notable barriers as we set out to establish a Benefits Realization governance structure and program that would achieve targets delineated in our Board-approved Total Cost of Ownership forecast. First, quantifiable Benefit Realization has been infrequently explored internationally in publicly funded systems where no competitive advantage to build/expand business and market share exists. Financial benefits in our environment must be gained through decreasing demand for services and efficiencies resulting in decreased costs, whether FTE?s, supplies or infrastructure. Next, Benefit Realization has typically been evaluated as part of a large system initiative as opposed to at a local level. Finally, most Benefits Realization programs succeed as a fully resourced, parallel structure to the implementation and operations team; this was not possible in our environment.


      Methodology/Approach:
      Based on best practices from other organizations, but tailored to the fiscal realities of our institution, we created a Benefits Realization governance model that was clinically led yet grounded in financial and statistical rigour. This structure was embedded within existing operational committees and targeted quantifiable clinical, operational, and academic benefits that aligned with the organization?s existing strategic directions. Where relevant, benefits that aligned to specific General Ledger cost centers were tracked and tallied against our targets. A graphicly-pleasing quarterly report to the Board of Directors dually served as accountability and as a key communication and engagement tool within the organization.


      Finding/Results:
      By creating a governance structure embedded within operations, we garnered benefit ownership and buy-in to achieve the targets. Further, by driving nine targeted core benefits while also collecting and evaluating smaller incremental benefits with rigor, the organization could rally around the effort, further reinforcing the vision and mission of both the EHR implementation and the hospital strategic directions. Tools were created that fostered operational leadership and engagement and allowed Benefit Realization to fundamentally link to and drive corporate strategy. The Board report template was repurposed to support other communication channels. Through initiatives solidly linked to the General Ledger, we demonstrated efficiencies through permanent cost reductions to meet the Benefit Realization targets within our Total Cost of Ownership. Further, we linked these initiatives to improvements throughout the organization to demonstrate the power of an integrated EHR as the foundation for change.


      Conclusion/Implications/Recommendations:
      Formal Benefit Realization following an EHR implementation is often a requirement and can be seen as an academic exercise parallel to the project and operations. However, by embedding the governance structure and linking solidly to the strategic directions of the organization, large scale and smaller incremental benefits can fuel the transformation. By sharing stories, fostering buy-in, and ensuring rigour, smaller organization can meet their Benefit Realization goals across clinical, operational, academic, and financial perspectives.


      140 Character Summary:
      Benefit Realization strategy within existing governance and linked to corporate directions to identify clinical, operational, academic, and financial benefits

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      OS08.04 - Connecting for Health with the Office of Virtual Health (ID 263)

      Michele Fryer, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In Fall 2017, the Provincial Health Services Authority (PHSA) established the Office of Virtual Health (OVH) to leverage and enhance virtual care as part of the care continuum for patients. In order to meet this mandate, the leaders of PHSA clinical and academic programs needed a clinically led organizational strategy that would see scalable virtual health solutions integrated into their existing service models. The governance structure for virtual health is directly aligned with the clinical governance, and a strategy is now being implemented by OVH. Principles of the strategy include patient-centred and clinically led, with technology partners as enablers. Solutions are focused to improve patient outcomes that are equitable, adaptable, scalable and sustainable.


      Methodology/Approach:
      The strategy of OVH includes clinically identified priority projects and enabling foundational supports. Examples of priority projects include: virtual health visits in patient homes, online cognitive behavioural therapy, and digital messaging. Enabling foundations have been created by OVH with stakeholder involvement, and include a PHSA Virtual Health Policy, clinical guidelines, communication strategy, toolkits for clinical programs, and an evaluation framework. These carefully supported projects include: patient engagement, program and patient readiness, sound project management, patient and provider education, clinical workflow redesign and evaluation.


      Finding/Results:
      The results of a governance structure shifts the governance and priority setting from technically to clinically led to deliver one system of care. Priorities, decisions and direction about the evolution of virtual health in PHSA are now being made by leaders of clinical programs. Foundations have been created that have removed barriers and created consistent, effective strategies across the organization, including an enabling risk and consent-based policy, clinical guidelines for virtual health and many tools and processes to move our agenda forward. Clinical teams and programs no longer work in silos on similar solutions. Important supports such as privacy, procurement, and information management and technology now have an integrating team to collaborate with and are able to apply their advice in an effective manner. Advancement of virtual health including ?anywhere to anywhere? virtual health visits, text/email, remote patient monitoring and online therapy is occurring. These results are evaluated through a framework that is aligned with the evaluation structure and dimensions of other clinical services. PHSA is beginning to see and report how virtual health services impact in the context of all health services and their alignment with specific goals to achieve a system of virtual health that is acceptable to patients and providers and provides improved accessibility to the appropriate services in an equitable way, and results in organization wide scale.


      Conclusion/Implications/Recommendations:
      OVH is leading a system wide transformation that will see virtual health integrated into clinical services, not as a separate system but as an integrated, effective, and efficient patient-centred set of solutions that respond to the digital world we live in. The proposed presentation will describe the processes, principles, successes and challenges which have resulted in successful virtual health services and plans to increase patient preferred virtual health services across British Columbia.


      140 Character Summary:
      Integrating virtual health in British Columbia?s Provincial Health Services Authority clinical programs in collaboration with the Office of Virtual Health.

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    OS11 - The Value of Moving to Digital...Realizing the Benefits (ID 18)

    • 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 7
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      OS11.01 - Enterprise Management of Clinical Media and Images at Sick Kids (ID 473)

      Amelia Hoyt, Enterprise Applications, The Hospital for Sick Children; Toronto, ON/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The hospital was experiencing an explosive volume of digital images and other digital media generated in various clinics on multiple platforms, such as microscopes and specialized cameras. This resulted in workflow inefficiencies for clinicians within the departments that needed to view images from more than one system and made sharing images with other departments nearly impossible. Moreover, the hospital administration could not guarantee the legal integrity and security of patient data captured during clinical encounters, and stored on many stand-alone, unmanaged platforms. The potential proliferation of ad hoc use of Smartphone cameras to capture patient images further added to the legal risks.


      Methodology/Approach:
      The hospital had already achieved efficiencies by centralizing images for radiology in a Picture Archive and Communications System (PACS). Initially, the hospital assessed the possibility of extending the PACS technology to include digital media other than radiology images. Radiology, such as x-rays, MRI?s, and CT-scans, use a mature set of standards for Digital Imaging and Communications (DICOM). Further consideration revealed serious limitations with the PACS/DICOM approach. SK found that PACS systems are oriented towards an ?order based? workflow, whereas much of the new digital media is created in ?encounter based? work flow where the care-giver creates the image during an examination or procedure. The DICOM standard could not encapsulate new digital media in their native format resulting in loss of fidelity. The DICOM annotation standards were not easily extensible to other types of media. And, the PACS system were not easily integrated with either the digital media capture systems, or able to link historical and current images to patient electronic records. The pathology department was already part of the Multi-jurisdictional Telepathology Project that enabled sharing images not only inside the hospital, but between hospitals in multiple provinces. The information systems group contacted the technology provider to see if the same technology could be applied to other specialities. As a proof of concept, the hospital and vendor jointly developed a pilot project in dermatology. Dermatology served as an excellent test-bed, as the department acquires and compares images that are taken over time ? resulting in many pictures that must be managed and coordinated.


      Finding/Results:
      Based on the success in dermatology, the system was expanded to include over 40 clinical departments. Workflow considerations were found to be essential in delivering value to clinicians. Besides providing easy capture and access to images, processes were added included patient consent and physician review.


      Conclusion/Implications/Recommendations:
      The SK architecture has enabled rapid deployment of new services and functionality. For example, a secure web site was developed that enables police, physicians and social workers to upload photos in cases of suspected child abuse and share legal evidence securely. These and other future projects will be presented.


      140 Character Summary:
      A new image management solution at The Hospital for Sick Children is computerizing all types of clinical images and making them easily accessible to care-givers.

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      OS11.02 - Primary Care: Analytical Value of Standardized and Linked EMR Data (ID 450)

      Michael Hunt, SPCS, CIHI; Ottawa/CA
      Rodney Burns, CIO, Alliance for Healthier Communities; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Standardizing Electronic Medical Record (EMR) primary care data for clinical and secondary analysis is a challenge across Canada. This session explores how EMR content standards and a systematic approach to structuring EMR data can improve the quality and usability of community-based primary care information. The session will also present evidence on the value of linking structured primary care EMR data to hospital administrative data to analyse the client journey across the continuum of care.


      Methodology/Approach:
      This initiative is a partnership between a pan-Canadian organization and a group of community-based primary care organizations in Ontario. In July 2018, linkable primary care EMR data from 570,000 clients across the primary care organizations was extracted from a data mart which houses the set of high-quality data. The 73 organizations use a common and innovative approach to standardizing data. As a first phase, the EMR data quality and structure was assessed according to the pan-Canadian partner?s Data Source Assessment Tool and Primary Care EMR Content Standard. Once deemed fit for use, the EMR data was linked to hospital data including emergency department (ED) visits and acute care in-patient stays. A proof of concept analysis was conducted on a cohort of primary care clients with Chronic Obstructive Pulmonary Disease (COPD), with a focus on their socio-demographic and prevalence characteristics, how they were managed in primary care and their journey through the continuum of care.


      Finding/Results:
      Key findings include: ? Minimal data processing was required to make quality EMR data fit for analysis ? Of enrolled clients, 76% had a valid health care number to enable linkage ? Diagnosis and related data are highly codified and complete ? The data are in good alignment with the pan-Canadian EMR content standard ? For the proof of concept analysis, COPD clients most commonly had between 10-19 primary care (PC) visits per year with multi-disciplinary care. Common reasons for PC visits included health advice/ instructions, medication renewal and discussion regarding the treatment plan. ? In exploring the client journey through the continuum, COPD clients had an average of 5 ED visits and 2 acute care stays over the 3 year study period, which is representative of a disease that has a significant impact on a patient?s quality of life. ? Results for prevalence rates and ED/ acute care utilization were comparable to recent Canadian studies. ? Rich information about health concerns, interventions, risk factors, social determinants of health, vaccinations, referrals and non-physician providers were highly valuable to explore the characteristics of clients and their management in primary care. ? Key challenges included the absence of EMR data about medications, lab results and risk factors in the data mart, as well as low completeness rates of certain data elements due to recent implementation


      Conclusion/Implications/Recommendations:
      Standardized EMR data that is also linkable provides opportunities to explore the client journey through the care continuum, in an innovative way beyond what other data sources can provide. Lessons from this partnership can inform future progress in EMR data standardization efforts in primary care models across Canada.


      140 Character Summary:
      Partnership shows value of standardized primary care data linked to hospital data, to understand the client journey across the care continuum

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      OS11.03 - Improving Information Flow to Support Continuity of Care: EMR Interoperability (ID 371)

      Lillian Ly, eHealth Saskatchewan; Regina/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      The goal of the SK EMR Interoperability Project is to build the foundation for broader information flow between providers and the various clinical information systems used throughout the province. Specifically, the project will enable the flow of clinical information from point of care systems to the provincial eHR. Data will be collected from the primary care setting (e.g. community EMRs) to the provincial eHR, as well as core clinical documents from the acute care setting (e.g. hospital CIS). The project also involves a notification solution that will notify providers using an EMR when new information is available for a patient within their circle of care. The notification solution to the EMRs will also involve the option for data consumption back to the EMR as appropriate. By doing so, this will allow providers to access the appropriate clinical information at the right time to support informed clinical decision making.


      Methodology/Approach:
      High level approach: - Minimize impact to providers? workflow and workload through early engagement of the provider community - Work with EMR vendors to auto pull data from known workflows within the POC systems - Identify use cases in which timely notifications regarding particular information helps support the coordination of patient care - Participate in national dialogues to assess the current state relative to a standardized Patient Summary data set to determine key information to submit to the provincial eHR - Review CIHI?s PHC EMR indicators/priority subset, academic literature, etc. to support establishment of key patient data set - Leverage FHIR STU3 as industry standard HL7 specification for clinical content data exchange and RESTful API behaviors - Establish necessary FHIR repositories to support the clinical data storage and exchange - Initial focus placed on existing provinical eHR data repositories and its transformation services to FHIR standards


      Finding/Results:
      The EMR Interoperability project is expected to go live in February 2019, and so findings and results are not available at this time.


      Conclusion/Implications/Recommendations:
      The EMR Interoperability project is expected to go live in February 2019, and so conclusions and recommendations are not available at this time.


      140 Character Summary:
      SK EMR Interoperability collects data from POC systems to make it available in the provincial eHR, coupled w/ a notification sol'n to support timely information flow

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      OS11.04 - Evaluation of an EMR-Integrated Innovation for Best-Practice Care (ID 177)

      Jonathan Thomas, Peninsula Family Health Team; Lion's Head/CA
      Rolf Sebaldt, Fig.P Software Incorporated; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      1. Learn about an innovative EMR-integrated technology solution's evaluation for enhancing delivery of patient-centred best practice care for up to 14 concurrent vascular chronic diseases and risk factors while reducing redundancies and increasing efficiencies in e-documentation. 2. Explore the usability of the solution that will expand the health care team?s capacity and help providers within the team work to their full scope of practice. 3. Augment your understanding of barriers and strategies for spreading health technology innovations beyond one clinical practice. Caring for patients who are often complex with multiple concurrent vascular diseases and risk factors presents many challenges. Multiple changing clinical practice guidelines that are not well-integrated into EMRs or workflows further compound the challenge. One innovative solution has been developed to meet these challenges. It is a secure, cloud-based, EMR-integrated evidence-based guidelines-aligned patient-care tool that supports the care of patients who have any combination of one or more of 14 common vascular conditions or risk factors. It is built on a scalable, standards-based architecture that permits future inclusion of additional chronic conditions. The Peninsula Family Health Team (FHT) partnered with the Software Developer and with eHealth Centre for Excellence, Centre for Effective Practice, CorHealth Ontario, Women?s College Hospital Institute for Health System Solutions and Virtual Care, and the Stroke Network of Southeastern Ontario to pursue an evaluation of the solution in an 18-month project.


      Methodology/Approach:
      A collaborative implementation plan included: ú A protocol and data analysis plan to measure the implementation and impact of the solution; ú Recruitment of 50+ health care providers across Ontario; ú Engagement of additional EMR vendors; ú A privacy impact analysis; A sustainability plan including reporting, monitoring, linking of quality improvement support, and guideline knowledge translation. The mixed methods evaluation, following the RE-AIM framework, examines the implementation of the solution in primary care clinics and its effectiveness for enhancing management of vascular patients. The analysis will inform widespread adoption and sustainability.


      Finding/Results:
      Early clinical validation was performed by Peninsula FHT, which has the solution fully integrated into their OSCAR EMR. Users said the tool: ?helped solve a clinically hard problem? and ?added more support for allied health to assess and manage patients.? The primary care physician lead at the FHT noted, ?improved workflow efficiencies with potential to increase roster size through the enablement of more health care professionals working to their full scope of practice with redistribution of the work to the most appropriate care provider.? The project team is piloting the use of this innovative health technology solution and aiming to support early adopter evaluation among primary care providers across Ontario.


      Conclusion/Implications/Recommendations:
      The project team is implementing and evaluating the impact of the solution in real life practices. A number of measures are being observed, including wait times to see providers and proportions of eligible patients who have self-management plans in place. The analysis will inform widespread adoption and sustainability.


      140 Character Summary:
      Findings will augment understanding of processes for clinically meaningful e-health technologies in clinical settings and impact on workflow & patient outcomes.

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    OS16 - Unleashing Telehealth (ID 26)

    • 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 7
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      OS16.01 - Unlocking the Possibilities: Telehealth in Corrections (ID 506)

      Linda Bridges, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      While most health services and some specialty health services are provided within federal institutions, the majority of specialist consultations take place in the community. In 2010 the federal offender population in the Atlantic region demonstrated a significant increase. Two thirds of this offender population were in institutions within the geographic area served by Horizon Health Network (Horizon), New Brunswick?s largest Regional Health Authority. The increase resulted in a corresponding rise in the number of offenders visiting Horizon facilities, where many of the community specialists worked. To put this in perspective, during an 11 month period, 880 federal medical escorts from Westmorland Institution and Dorchester Penitentiary, two of New Brunswick?s correctional institutions, were performed. This was an average of 80 escorts per month. Analysis of these escorts determined that 294, or one third of these could have been completed using telehealth processes and technology. That year, Horizon and Correctional Service of Canada (CSC) entered into a Memorandum of Understanding (MOU), resulting in a Telecorrections Partnership Project. The intended benefits were; to increase staff / patient safety by reducing and/or eliminating inmate transfers to The Moncton Hospital, provide an important opportunity for a broader range of medical specialists to deliver services via telehealth, and lastly to reduce security costs related to inmate transfers to and from this hospital.


      Methodology/Approach:
      Clinical and technical team members worked together under rigorous project management to review exisiting referral patterns and technological challenges.The clinical focus was the provision of medical services by plastic surgery,general surgery and ENT specialists. Expansion to other specialties within the 12 month time frame of the project ocurred as opportunities were identified and parties were in agreement. The deliverables of the project were; that both connectivity and interoperability be established between the hospital and the two CSC sites laying the foundation for future expansion of telehealth between other hospitals in the NB and CSC facilities. This came to fruition based on the results documented in the Final Evaluation Report and development of a Telecorrections Tool Kit. Both health professionals and clients reported satisfaction with this mode of safe service delivery.


      Finding/Results:
      Telecorrections has increased staff and patient safety by reducing or eliminating the need for inmate transfers to receive specialty care. Security costs and potential opportunity for elopement associated with escorts have been reduced. One tremendous advantage has been the ongoing knowledge transfer which occurs during these assessments for those CSC clinicians involved. Having these same clinicians present during sessions has been pivotal to maintain an open dialogue and general facilitation. This initiative provided the confidence and experience within Horizon to begin the recent provision of services to provincial correctional facilities as well.


      Conclusion/Implications/Recommendations:
      The Telecorrections model of care adheres to all national Telehealth Accreditation Standards and firmly established the practice of Telehealth in the CSC Atlantic Region. This presentation will describe the outcomes of this initiative and how Telehealth in Corrections continues to assist CSC Health Services in providing essential health services to offenders while contributing to public safety.


      140 Character Summary:
      Accessing scarce clinical resources to increase patient and public safety via the use of Telehealth.

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      OS16.02 - Designing Telemonitoring for Complex Patients in a NP-Led Clinic (ID 195)

      Kayleigh Gordon, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Complex patients are becoming increasingly prevalent throughout Ontario?s healthcare system, and yet chronic care continues to be focused on single conditions treated individually, often without consideration of greater care needs. An opportunity has arisen to address the challenges that complex patients face by combining the two innovations: telemonitoring and a Nurse Practitioner (NP)-led integrated complex medical clinic. Using a telemonitoring system in the NP-led clinic, patients will be able to monitor their multiple chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patients? ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. However, very few TM programs are sustained as part of clinical care, and those programs that exist are restricted to single conditions. The objective of this work is to determine the needs and requirements of a telemonitoring system which assists self-management of multiple complex chronic conditions. The results of a qualitative needs assessment and iterative usability testing will be reported.


      Methodology/Approach:
      A qualitative needs assessment and usability evaluation were undertaken as part of a larger case study to determine how to design and implement telemonitoring as a single system for complex conditions into an NP-led integrated clinic model. Semi-structured interviews were conducted to determine the specific needs and requirements of complex patients and anticipated challenges of implementing telemonitoring in this model. Interviews were also utilized to iterate on the telemonitoring application. Patients and care team members were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their needs, perspectives and challenges around managing complex chronic conditions, as well as any technical needs and requirements for a telemonitoring system.


      Finding/Results:
      Eighteen patients and thirteen care team members were interviewed to reach data saturation at WOHS. Patient interviewees were particularly interested in how telemonitoring could improve access to necessary health care services, coordinate overall care needs and symptoms under more consistent monitoring by multiple health care professionals in one place. The majority of patients felt telemonitoring could be helpful for managing blood pressure, monitoring blood sugar levels, pain, and possibly even mental health concerns, such as anxiety or depression. Usability testing is ongoing and preliminary analysis has informed application development as it occured in order to be contextually relevant. Up to two rounds of formal usability testing are anticipated before the application will be operationalized in the clinic model as a pilot study in January 2019.


      Conclusion/Implications/Recommendations:
      Based on this research, a six-month multi-method pilot study will be undertaken to determine the feasibility of implementing telemonitoring into the NP-led clinic model. The potential impact of this research includes a sustained program combining telemonitoring within this model which improves health outcomes, reduces unnecessary ED visits or hospitalizations and is scalable to other healthcare institutions for complex patients.


      140 Character Summary:
      Complex patients and their clinicians perceived a smartphone-based TM system in a NP led model to be an opportunity to better manage their health and care needs.

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      OS16.03 - Telenephrology and the Elimination of Geography for Hemodialysis Patients (ID 532)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      Telehealth promotes access to those scarce clinical resources most often located in more urban settings to which patients must travel large distances to receive treatment. Prior to the establishment of Horizon Health Network?s first satellite hemodialysis unit, patients requiring this life sustaining care had to do just that three times every week. The goal in establishing satelitte hemodialysis units was to ensure safe, comprehensive and evidence based local care for this vulnerable patient population by eliminating the geography between them and their nephrologist using Telehealth processes and technology.


      Methodology/Approach:
      In order for a satelitte unit to be established, the physical, technical and clinical environment must be replicated to match those of the main Dialysis center. The same clinical standards of care that are adhered to by the Nephrology Program clinicians in the main dialysis unit must be operationalized and maintained in the satelitte unit. This includes the weekly patient rounds conducted by the nephrologist in conjunction with the nurses at the patient?s chair side or treatment station while undergoing dialysis. In order for this to occur at a distance, Telehealth must be employed. The Nephrologist at the main unit connects to the satelitte unit via a real-time interactive audio and video telehealth modality and is able to discuss the patient?s treatment plan with both the patient and the nurse together, just as it would occur if the patient was being treated in the same building as the Nephrologist. This is what has become known as Telenephrology.


      Finding/Results:
      Currently there are four satellite units established and they treat 94 patients per week. Three of them are open six days a week and one operates three days each week. This eliminates 158 round trips per patient each year.


      Conclusion/Implications/Recommendations:
      Teledialysis is a safe and patient centric healthcare delivery mechanism that should be explored by all Regional Health Authorities currently offering Nephrology services.


      140 Character Summary:
      Elimination of geography thrice weekly for Dialysis patients.

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      OS16.04 - Virtual Palliative Care: Supporting Patients in Their Home (ID 234)

      Sandra Mierdel, Clinical Innovation, Ontario Telemedicine Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      A report released by Health Quality Ontario, Palliative Care at the End of Life (2016), advocates for early palliative care intervention as well as support for care in the location of choice. The report found that although most Ontarians prefer to receive palliative care and die at home, the majority die in hospital. The report also found that caregivers, who play a critical role for patients with a terminal or chronic illness, experience burnout which is a key contributor to trips to the emergency room for patients in the last stages of life. Evidence shows that virtual care solutions are effective in monitoring patient symptoms and that team-based care with direct patient contact significantly increases the likelihood of dying at home. The purpose of this demonstration project was to support patients with a progressive life limiting illness who prefer to receive care in their home. The objectives were to promote earlier identification of patient needs, improve patient and caregiver experience with care delivery, increase access for patients and families to resources, and improve patient outcomes.


      Methodology/Approach:
      The Ontario Telemedicine Network (OTN) worked with partners in the Champlain LHIN to co-design a virtual palliative care model that would enable a regional system with capacity for the delivery of in-home palliative care. Patients responded to a series of self-assessment surveys on a tablet from their home. Care providers received real-time feedback on the patient?s information which triggered specific events and corrective actions. Program evaluation included patient, caregiver and clinician experience and acute health service usage.


      Finding/Results:
      A total of 118 patients with an average Palliative Performance Scale score of 50% were enrolled in the project. In terms of patient satisfaction, 87% were satisfied with the experience; 85% were satisfied with the coordination of resources, use of technology, and information received; 75% were satisfied with the progress made towards care goals including location of care preference; 74% would recommend the initiative to others; and 73% agreed that virtual care saved them time by not having to travel to see their provider. Patient feedback showed the potential for emergency department usage to decrease from 68% to 27%. Family caregivers reported little to mild burden in caring for loved ones. Clinicians reported that the technology enhanced their ability to do their job, increased efficiency and allowed them to monitor the health conditions of their patient over time.


      Conclusion/Implications/Recommendations:
      Virtual palliative care, when integrated into community care models and in the hands of the patient, demonstrated effectiveness in supporting patients with palliative care needs and in decreasing acute health services utilization. There is a need to further model how patient information is consistently reviewed and managed, and how to best leverage existing palliative care teams, specialists and other healthcare providers to ensure necessary follow-up actions are taken.


      140 Character Summary:
      The project aimed to develop a virtual care model to support patients who prefer to receive in-home palliative care.

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    OS22 - eServices: Better Than Paper! (ID 35)

    • 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 7
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      OS22.01 - Screening While You Wait: Facilitating Primary Care Based Exercise Counselling (ID 384)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      Lack of physical activity (PA) is the fourth leading risk factor for global deaths annually. Yet, only 18% of Canadians meet PA guidelines despite known impact on mortality and well-being. Guidelines recommend that primary care providers use evidence-based screening and counselling to encourage PA during routine visits, but this is rarely implemented. Reported barriers include lack of time to appropriately discuss PA levels, lack of knowledge and training in PA counselling, and a lack of success in changing patient behaviour. This pilot trial aims to reduce these barriers by (1) examining the feasibility of integrating a technology-based physical activity counselling tool in routine clinical care, and (2) evaluating preliminary effectiveness of the intervention.


      Methodology/Approach:
      An intervention was developed through a user-centered design process. The resulting design automatically summarized results and creates 1) a customized exercise prescription in the EMR, and 2) a personalized, printable toolkit with online and local resources to increase physical activity. A pragmatic, step wedge trial was conducted at an urban academic family health team. The intervention was sequentially administered in a randomized order, with one of four cluster switching to the intervention per 6-week step, until all clusters were exposed. Eligible patients received a secure baseline e-survey prior to their appointment to assess PA levels (using Metabolic Equivalent of Task minutes (MET-minutes) per week). The difference in MET-minutes per week between intervention and control groups was assessed at four months follow-up; secondary outcomes include changes in intention and self-efficacy for PA. Process measures included patient satisfaction with PA advice, receiving the toolkit and prescription, and estimated minutes spent on PA counselling.


      Finding/Results:
      Of the 530 total patients, 82.5% provided baseline and follow-up data. MET-minutes per week in the intervention group was 10% greater than controls (count ratio, 1.10, 95% CI 0.86-1.41, p=0.44). After adjusting for baseline covariates, the effect of the intervention remained non-significant (count ratio, 1.18, 95% CI 0.90-1.53). 61.8% of patients exposed to the intervention completed a process evaluation; of these patients, 49.4% reported receiving at least a prescription, 48.9% reported spending 2-5 minutes discussing PA with their provider, and 86.8% reported being satisfied with their PA discussion. table 1-swyw.png


      Conclusion/Implications/Recommendations:
      The introduction of the e-health tool for PA was feasible to implement in a large primary care practice and in this pilot trial resulted in a non-statistically significant increase in PA. Process evaluations indicated a need for better training and modifications to ensure fidelity of implementation. Future studies require a significantly larger number of clusters to achieve significant power.


      140 Character Summary:
      This trial establishes the feasibility of an e-health tool to assess PA levels, motivators, and barriers prior to a clinic-visit for delivery of tailored resources.

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      OS22.02 - How to Maximize eConsult’s Impact?  Integrate! (ID 525)

      Amir Afkham, Champlain LHIN; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      BASE? eConsult service has experienced tremendous traction and growth within the clinician communities across Canada. Its managed service approach has offered primary care providers (PCPs) a reliable mechanism for obtaining timely advice from specialists, which ultimately results in better care for patients. Yet the systemic benefits of eConsult are far from being realized. A PCP may decide to eConsult a specialty that ordinarily is difficult to access (long wait times, geographical constraints), and consequently the positive impact for that particular patient will be evident. However, for an overall reduction in wait times for all patients of that specialty, the option to address patients? needs via eConsult must ultimately become embedded in its standard referral workflow. Data demonstrating the potential impact of merging eConsult into referral processes will be presented, along with key considerations.


      Methodology/Approach:
      Analysis of data across a number of specialties has been conducted, reflecting how eConsult currently represents a relatively small proportion of overall referral volumes. At the same time, research has been conducted on a statistically significant sample size of eConsult cases, demonstrating excellent average response intervals, and offering insights into the potential reductions in the number of unnecessary in-person referrals to specialists. A study of eReferral implementations that have embedded eConsult essentially as part of the triage step offers further evidence of the opportunities before us to make a bigger impact on improving access and reducing wait times.


      Finding/Results:
      A study of referral versus eConsult patterns indicated that with the current decoupled approach, PCPs on average make 250 referrals per year, compared to 10 eConsult per year. When eConsult was used, an analysis of surveys completed by PCPs for over 40,000 eConsult cases indicates that 40% of all eConsult cases were originally contemplated as an in-person referral which was subsequently avoided as a result of the eConsult step. Combining these findings with examples of integrated eReferral/eConsult processes in other jurisdictions, such as San Francisco and Los Angeles, highlight tremendous opportunities for further improvements in accessibility of timely care. Results from LA County?s Safety-Net program that has implemented an integrated eReferral/eConsult process indicate 25% of all referrals received are addressed via eConsult without the need for a specialist visit, which has also led to a 17% drop in the wait time to see a specialist. To make this possible in a Canadian setting, there are other considerations including specialist remuneration, integration with electronic medical record systems for both primary care providers and specialists, and overall better organized central intake models for referrals.


      Conclusion/Implications/Recommendations:
      Across many regions, strategies are being developed to better organize key specialty pathways, and establish/enhance Central Intake models to better, and more appropriately, distribute case loads. To make this all possible in a more automated fashion, eReferral solutions are being implemented. Inclusion/addition of eConsult as a simple option for a specialist during the standard triage phase of an eReferral will be a small process change with a significant impact on improving wait times. Governing bodies can promote, support, or even more boldly mandate this change for the better.


      140 Character Summary:
      Integrating eConsult into referral workflows will unleash its systemic benefits, significantly reducing unnecessary in-person visits and overall wait times

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      OS22.03 - Perspectives on Centralized Intake for Specialist Referrals (ID 495)

      Kevin Jones, Software Vendor; Calgary/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Objectives The ORGANIZATION offers a centralized referral intake service created by the PROVINCIAL Ministry of Health to facilitate timely access to specialized services for primary care physicians? (PCPs) patients. The HEALTH REGION manages these referrals on behalf of the GEOGRAPHY. Currently, the ORGANIZATION ensures appropriate triaging and booking for sixteen specialities, with plans to include another eleven. The objective is to streamline the referral process by booking appointments based on 3 criteria: - Referral priority
      - Patient?s location
      - Named specialist The goal of this innovative approach is for all patients to be seen within priority wait time targets.


      Methodology/Approach:
      Methodology The province-wide rollout is following an iterative approach, using a group of primary and specialist care physicians to standardize referral forms, reasons for referral, priorities, and prerequisites. Each regional ORGANIZATION decided what, if any, technical tools were used to support the workflow. The HEALTH REGION selected an eReferral and Central Intake tool, as well as being an early adopter of provincial initiatives, and an innovator in tackling inefficiencies in the process (e.g., fax, provider management). Process The ORGANIZATION initially transcribed referrals from faxes into the eReferral tool and followed a multi-stage intake process designed to ensure patients received appointments within the appropriate clinical delay. The VENDOR developed functionality to support brokering the optimal appointment, including: matching to specialists where no preference was specified; distance from patient to office (convenience); wait times (relative); amongst others. Ongoing efforts to streamline the process included attempts to automate inbound referrals using Optical Character Recognition (OCR) and direct EMR integration, which were undertaken with varying degrees of success. The Ministry ultimately introduced a provincial EMR interface hub to address these challenges, which distributes eReferrals to the appropriate ORGANIZATION. The HEALTH REGION also created a self-serve portal for the specialists to self-register, specifying their practice locations, inclusion and exclusion criteria. This creates the record within the tool and decentralizes the maintenance of the thousands of practicing specialists in the region. The HEALTH REGION continues to iterate on process, technology, and expansion activities to improve the efficiency and effectiveness of the referral intake and appointment brokering process.


      Finding/Results:
      Results To date, over 170,000 referrals have been processed through the central intake office. Efforts continue to achieve the ambitious targets set by the Ministry. Future efforts to improve will include onboarding specialists to directly manage their own appointments and waitlists, yielding significant efficiencies in several stages of the current process. Continuous improvement activities are also planned to revamp the matching logic to revamp the recommendation engine at the heart of the brokering process.


      Conclusion/Implications/Recommendations:
      Conclusion The ORGANIZATION and the VENDOR will continue to focus on people, process, and technology, iterating to improve access to specialist care. As other provinces and health regions look to tackle this, important lessons can be learned from the efforts to date.


      140 Character Summary:
      A critical review and analysis of the innovative primary care to specialist centralized intake model being implemented in one province.

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      OS22.04 - Impacts of Integrating Electronic Referrals in an Ambulatory Care Hospital (ID 270)

      Syed Rayyan Qadri, Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Faced with an aging population (65+) and growing need of specialized care services, hospitals are seeing an increase in referrals from health care providers. In turn, this is making it increasingly difficult to track, triage, and schedule faxed referrals. Handling of paper referrals continues to challenge hospitals due to incomplete documentation, filing, transcribing into the electronic health record (EHR), redirecting incorrect paper referrals, and linking referrals to scheduled appointments. This fragmented process is negatively affecting clinical/administrative staff workflows by delaying the scheduling of appointments that consequently increases patient wait times to receive care. Additionally, referral information is not easily accessible to providers causing redundancy in clinical visits (e.g. the ordering of unnecessary tests). The purpose is to present an electronic referral (eReferral) solution (CareLink) that enables Women's College Hospital (WCH) to receive/manage multiple referrals from community providers in different organizations. CareLink is integrated seamlessly with WCH's ambulatory electronic patient record (aEPR) system through a web-based application that allows community providers from various clinical organizations to submit referral information for a patient electronically, which gets directly stored in the corresponding patient's aEPR.


      Methodology/Approach:
      Referrals submitted through Care ink can be easily managed by the community providers and tracked by patients (through the patient portal) to view the referral progress from scheduling to completion. This is an innovative approach to removing paper referrals because WCH is using an extension of its aEPR system to establish a portal for eReferrals, which avoids the need for double documentation and/or printing of referral information at both ends.

      A mixed methodology will be used that includes telephone interviews, qualitative and quantitative electronic surveys, and data extracted from the system record, to assess the impact of the CareLink solution for eReferrals on the efficiency of workflows and quality of care provided to patients.


      Finding/Results:
      As an outpatient ambulatory hospital, WCH receives about 56,000 referrals a year from community providers for more than 60 unique clinical programs. The CareLink eReferral solution improves referral workflow efficiency of the clinical and administration staff, reduces wait times for patients by minimizing delays in appointment scheduling, encourages consistent referral completion/documentation, and improves the triaging and tracking of referrals. In addition, electronic referral data allows for rich data mining, analysis and detailed reporting for both WCH and the ministry. The initial response of the clinical and administrative staff has been extremely positive after embracing the idea that they would potentially get rid of the paper and faxing processes for referrals from their workflows.


      Conclusion/Implications/Recommendations:
      The use of eReferrals can greatly improve the workflow efficiency and the quality of care provided to patients, especially for an ambulatory setting like WCH. The notion of having the CareLink eReferral solution to digitally receive referrals and eliminate the associated paper-based processes between clinical organizations will improve the inefficient referral process in place and foster better connectivity across the care continuum. CareLink will require extensive stakeholder involvement through engaging dialogue, mapping of clinical and administrative workflows, and the resources to technically configure the extended web-based application to integrate with WCH?s aEPR.


      140 Character Summary:
      CareLink eReferral solution at WCH, an ambulatory hospital, will improve the efficiency of referral workflows and the quality of care being provided to patients.

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