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    EP02 - Application / Implementation / Adoption and Use 1 (ID 13)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 6
    • Now Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 8
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      EP02.01 - CPT®: A Key Step Along the Path of Digital Health (Now Available) (ID 446)

      Dean Parisi, International Business Development, Health Solutions Group, American Medical Association; Chicago/US

      • Abstract
      • Slides

      Purpose/Objectives:
      Locally-defined physician service descriptions have several underlying challenges in Canadian provinces and territories. Attend this session to learn how and why the Current Procedural Terminology (CPT?) product suite consisting of a set of clinical terms including clinician, consumer and long descriptors along with thorough documentation and guidelines for their use (hereafter referred to as the Suite), is a strategic, innovative digital health solution for a recognized pan-Canadian problem: the lack of a physician-based universal clinical terminology to describe, record and report physician services. 1. State why a single terminology for physicians? services reporting across Canadian provinces and territories eliminates identified challenges 2. Define the characteristics of a clinical terminology for physicians? services and how CPT clinical terms addresses them 3. Explain the clinical and interoperability benefits of the Suite as a Canadian digital health solution for reporting of physicians? services 4. Identify how the CPT framework can facilitate digital health initiatives


      Methodology/Approach:
      The American Medical Association (AMA) completed a cross-Canada environmental scan in 2018. Objectives of this effort were to assess current challenges with the reporting of Canadian physicians? services as well as exploring the potential use of the Suite as the reporting solution across Canadian provinces and territories. The environmental scan execution included: ? A review of physicians? manuals and fee schedules for each of the provincial/territorial jurisdictions. ? Formal interviews across Canada including provincial/territorial governments, medical associations, clinical or performance measurement programs, national associations, and electronic medical record vendors. ? Follow-up meetings to share a summary of the environmental scan results. Next, the AMA proposed a CPT implementation framework along with the creation of resources needed to assist with CPT implementation.


      Finding/Results:
      There are a number of clinical and interoperability benefits of implementing the Suite as a Canadian digital health solution for physicians? services reporting. For example, CPT clinical terms support innovative clinical practices and technologies. Furthermore, several CPT use cases already exist in Canada. Hospitals in several provinces participate in the American College of Surgeons National Surgical Quality Improvement Program? (ACS NSQIP?). CPT clinical terms are used to monitor patient outcomes following surgery with the goal of improving the quality of services delivered and reducing adverse outcomes and complications. Five years ago, the Nova Scotia Department of Health and Wellness and Doctors Nova Scotia began the process of adopting up-to-date clinical terminologies for reporting physician diagnoses and procedures. The Suite was selected as the clinical terminology solution. Recognized as a common language utilizing a uniform methodology for representing clinically relevant physician service terms, additional uses of CPT clinical terms are possible as well.


      Conclusion/Implications/Recommendations:
      Implementation of CPT clinical terms, a physician-based clinical terminology, offers a strategic, innovative digital health solution for Canada. The Suite addresses the pan-Canadian need for a clinical terminology for physicians? services and can capture what a Canadian physician does in the current health care environment. It also has the ability to adapt to the evolving digital health environment. Resources to support implementation, such as maps and educational materials, are also accessible to those who require them.


      140 Character Summary:
      Bold Action in Digital Health: Implementing the CPT product suite as a strategic, innovative solution to describe, record and report physician services in Canada

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      EP02.02 - Innovative Realizations and Attributes of Academic Health Centers Throughout Canada (ID 82)

      Jonathan Lapointe, Montreal/CA

      • Abstract

      Purpose/Objectives:
      Implementing IT innovations that can grow beyond the pilot or research phase in healthcare have been shown to be difficult. In Canada, also known as the land of pilot projets, we want to know how the important advances in IT can be harnessed to drive positive changes in Canada?s health system. To do so, we decided to look at the 17 academic health centers (AHC) in Canada and draw a map of their main caracteristics, their partnerships and innovative projects making innovative use of patient data using next level IT tools like AI and Big Data. AHCs were chosen because of the strategic position that they occupy in the healthcare innovation landscape by their mission in clinical care, research and teaching and their role in spreading new ways of providing care. The objective of this project is to first paint the landscape of all the AHCs in Canada and then develop an analytic framework of the innovative capabilities of AHC, helping stakeholders, managers and partners to have a better understanding of what factors drive new and successful data driven innovations in Canada?s AHCs. This project is part of a greater endavour on how AHCs can sustain innovation through the creation of Learning Health Systems.


      Methodology/Approach:
      The first ongoing step of this project is to collect descriptive information on each of the 17 AHCs in Canada from their websites, research centers, patient-data related IT innovation projects they worked on and press releases. The composition of the AHC, the size and expertise of the research teams, the financing partners, the private sector collaborators and government funding are also extracted from the available documentation. After a first analysis, each AHC will be contacted to make sure that the extracted information is both correct and complete, to make sure no important information has been overlooked. The caracteristics of the AHCs and of their environment will then be compared to the number, complexity and status of the innovations A descriptive analysis of each source of information will be performed, separetely and globally according to thematics emerging from the data.


      Finding/Results:
      To our knowledge, the results of this project will present for the first time the internal context of each AHC in Canada as well as the external context and mix of private and public partnership that works with them. This alone will allow us to gain a valuable insight on the area of expertise, network and innovative characteristics of each AHC. It will also give us an understanding of how internal and external funding and partnership might promote the emergence and long term use of innovations in Canada.


      Conclusion/Implications/Recommendations:
      The results from this project will help AHCs, funding agencies and private sector partners to have a better outlook on ways to engage and promote IT innovations in the healthcare sector in Canada and lay down the foundation for learning health systems. It will also contribute to better collaboration between AHCs. We recommend that the portrait of the canadian AHC be maintained on a yearly basis.


      140 Character Summary:
      Learning health systems depend on innovative IT systems to share and analyze patient-data. Teachings from current IT projects in Canada can help us reach this goal.

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      EP02.03 - Safe Step: Falls Risk Screening Project (Now Available) (ID 97)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      According to the Government of Ontario?s, Injury Prevention Guideline, 2018[1], ?The most common injury type associated with falls in older adults is fractures, followed by sprains or strains. These injuries can lead to significant disability including the potential for institutionalization in long-term care settings.? In Champlain, falls are a leading cause of injuries and ER visits and among older adults; with 85% of injury related hospitalizations and $55M of annual healthcare costs. Public Health prioritization of falls prevention is indicative of the fact that injuries do not occur by chance (i.e. they are not accidents), but are predictable and preventable. However, seniors are not routinely assessed for falls risk early enough to motivate preventative measures that could delay frailty. Often identification of an issue occurs when a condition has deteriorated or a fall has already occurred/ imminent. Ontario Centres of Excellence, Health Technology Funding, MOHLTC OCHIS, indicate strong support for technology driven innovations that will help fundamentally reshape prevention, care services and/or their costs. [1] http://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Injury_Prevention_Guideline_2018_en.pdf


      Methodology/Approach:
      Our objective was to determine value in an innovative broad, early screening and prevention program that increases self-awareness and motivation for falls prevention. The program, Safe Step, used evidence based sensor technology. It engaged 1500+ seniors, in more than 230 events, across 110 locations, with over 60 partners offering social, health and/ or support services. This innovative technology, QTUGTM is an electronic version of a standard mobility assessment used to screen for balance problems. It enabled preventative screening in a more cost-effective[1] way, than any other falls prevention program to-date by using trained technicians (non-professionals i.e. PSWs, therapy assistants). Sensors on shins monitored and analyzed movements during a short (approximately 10 to 15 seconds) TUG test (get up from a chair, walk three metres, turn around, walk back, sit). Combined with basic clinical questions embedded into the application, multiple data points produce personalized frailty and falls risk scores. Medium/high risk participants were provided a physician letter and information on free exercise and falls prevention programs, and told to discuss with physicians. [1] https://www.kinesis.ie/qtug-calculator/


      Finding/Results:
      Quadruple-AIM evaluation work is in-progress. Our data will provide valuable information on the participants? and technicians? experiences, the cost of operating a program, the locations/events that are the most opportunistic and the clinical value of the program. Preliminary findings showed 62% were unaware of their falls risk, 40% surprised, and 85% indicated they?ll talk to their physician. Observations indicated that participants were very engaged in this interactive screening and the falls prevention information.


      Conclusion/Implications/Recommendations:
      With 85% of high risk seniors, now indicating that they will talk to their physicians, this program has proven its value as a part of comprehensive, community based, early falls prevention programs. Based on our learnings, we are planning to implement new programs designed to engage seniors after the onset of frailty but prior to a fall. Evaluation results and learnings will design program strategies and appropriate business models across various organizations in the health system.


      140 Character Summary:
      Falls is a leading cause of injuries & health-care costs. Learn how technology has reshaped falls-prevention services, costs and effectiveness.

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      EP02.04 - Telehealth Wound Care in Nova Scotia  (Now Available) (ID 216)

      Cathy Cruz, Nova Scotia Health Authority; Bridgewater/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Nova Scotia Health Authority (NSHA) Virtual Care recently partnered with Ambulatory Care at the Cape Breton Regional Hospital (CBRH) to develop a program that would allow inpatients requiring wound care at rural hospitals to connect virtually with a specialist located at the regional hospital using telehealth. Prior to this, patients were being transported to the regional facility to receive this care. The purpose of the virtual clinic is to provide wound assessment, prescribe treatment and follow-up in an efficient and timely manner, while maintaining the comfort of the patient. The main objectives were to: Improve the patient experience Improve outcomes due to earlier diagnosis/treatment of wounds Eliminate congestion in Ambulatory Care/Emergency Department at the Cape Breton Regional Hospital


      Methodology/Approach:
      Specialists in Sydney are connecting to wound inpatients across 6 smaller rural facilities including: New Waterford, Glace Bay, North Sydney, Cheticamp, Inverness, Neil?s Harbour, and Harbourview health centres (NSHA hospital facilities). The connection occurs using polycom telehealth equipment that is already located in each NSHA facility. The receiving site (where the patient is located) has a nurse present with an AMD camera to accurately show the wound to the clinician. Quantitative data was collected in 2018 to measure: changes in number of patients being seen, number of referrals made, and time saved for patients. Qualitative data was to collected to capture overall health care provider and patient experience.


      Finding/Results:
      After implementation of the virtual clinic, results showed that patient appointments, on average, increased from 4 in-person visits to 12 virtual visits during the weekly clinic. In 2018, between April-August, 75 patients were scheduled for virtual visits, and 70 referrals to the clinic took place between mid-May and end of June. Further data showed that on average the virtual clinic saves 3.6 hours median of 128 minutes of travel time that was taking place via ambulance transport. It was also noted that patients were waiting up to 90 minutes to return to the hospital where they were an inpatient and by starting the virtual clinic, this was completely eliminated. A patient who participated in the clinic indicated: ?[This] will be great in winter time, terrible to travel those roads and is so unpredictable?. A staff member also noted: ?This is great! Patients are seen quicker?.


      Conclusion/Implications/Recommendations:
      After the implementation of the wound care virtual clinic, there were many positive outcomes including an increase in the number of patients seen, increased referrals, reduced patient travel time, and increased patient satisfaction with their health care experience. The success of this project allows for consideration of virtual wound care clinics to other areas of the province. The development of home-based wound care has also been considered (partnering with VON or other community health services) for future expansion of this initiative. This type of initiative could also be mirrored in other service areas. Recommendations for future adoption of this type of clinic include: nurse resources at inpatient facilities, engaging health services managers early in the planning/development, and having a champion can be extremely beneficial to the success of a program.


      140 Character Summary:
      NSHA Virtual Care developed a program for inpatients at rural hospitals in Cape Breton to connect with a wound specialist at the regional hospital using telehealth.

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      EP02.05 - Data Driven Insights for the Ambulatory and Outpatient Care Sector (Now Available) (ID 221)

      Anne Forsyth, CIHI; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Until now, little has been known about the value and outcomes of care provided in our ambulatory and outpatient sector. CIHI has expanded its National Ambulatory Care Reporting System (NACRS) to include a low-cost, low-burden reporting option that provides timely, comparative information for local planning and decision-making and for health system accountability and improvement. Its standardized data bridges information across sectors and the care continuum, providing one more piece to the overall health care picture by capturing clinical and operational patient level information on number of visits, population served and reasons for receiving health services. This presentation will provide an in-depth look at the first clinical areas that are taking advantage of CIHI?s NACRS Clinic Lite data reporting tool and the value they and the healthcare system overall are deriving from it.


      Methodology/Approach:
      CIHI is working with the Ontario Ministry of Health and Long-Term Care to support the bundled funding hip and knee program that kicked off in April 2018. Over 80 outpatient rehab sites across the province are submitting data to NACRS Clinic Lite on a variety of data points that will provide information on collaboration across care sectors, improve efficiency by reducing time spent in hospitals and encourage evidence-based care. CIHI is also working with the Canadian Association of Paediatric Health Centre?s (CAPHC?s) to support the Paediatric Rehab Reporting System (PRRS) via NACRS Clinic Lite. Paediatric rehab sites from across the country are actively submitting data for this project The data is critical for supporting improvements to outcomes for patients with autism and cerebral palsy, and incorporates patient-reported outcome measures.


      Finding/Results:
      Rapid expansion and uptake of data submission requires careful planning and well-thought out processes to navigate unforeseen circumstances. Some of the common challenges that arose during implementation, and how each was overcome, will be described during this presentation.


      Conclusion/Implications/Recommendations:
      Health care in Canada is shifting ? more care is being provided in ambulatory or outpatient settings in the hospital or community. Most jurisdictions have summary information, but there is a gap in patient-level clinical, operational, quality and utilization data that CIHI is starting to fill. This project, focusing on a priority population in Canada, showcases the benefits that access to data and information can have on understanding patient populations and improving outcomes. These will be described in detail as part of the presentation.


      140 Character Summary:
      Modernizing data collection to close secondary use data gaps in outpatient settings.

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      EP02.06 - Health Information Exchange: An Effective Use of Evaluation Study (Now Available) (ID 244)

      Jaskaran Bains, eHealth - Health Information Exchange, Fraser Health Authority ; Surrey/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Fraser Health (FH) is continuously expanding their Health Information Exchange (HIE) system branded Unifying Clinical Information (UCI). To understand if UCI was being used to its optimum value and to ensure that the project team was working on priority initiatives for end users, an evaluation and usability study was conducted. Based on the study, initiatives were prioritised to address the three major gaps that were identified.


      Methodology/Approach:
      The study used a mixed approach of both quantitative and qualitative research methods. Qualitative research was conducted to collect data from interviews, focus group, survey and observations. The quantitative method was used to understand how frequent users accessed UCI and what the benefits were. All clinical program areas in the acute and community services areas were included in the study, and involved both clinical and administrative staff. The data collected helped the project team to identify key priority items for end users and informed the approach taken to projects. The key focus of the projects was to deliver high value to end users and resolve the major gaps that were causing a barrier to adoption. The data collected in 2016 has been kept as a baseline to be used to compare future data collections to measure the adoption of UCI within FH.


      Finding/Results:
      Clinical departments & program areas participated in the evaluation and usability study. Three major areas of improvement were identified: product, information and change management. As part of the study, users were also asked to score what the benefits of using UCI have been. These were compared to the second evaluation conducted, which found benefits in 5 categories that were realized by the majority of clinical programs. The results show that both the clinical value and user experience has improved for the UCI users. The evaluation and usability study allowed Fraser Health to better understand why there were infrequent users of the HIE, how to increase adoption (where possible) and determine where to allocate resources that will deliver the greatest value to users.


      Conclusion/Implications/Recommendations:
      Following the completion of the UCI Expansion Project, the major gaps identified through the evaluation study have been resolved. There was considerable value of conducting an evaluation and usability study as it informed which projects were initiated along with the priority of these. End users were involved throughout the project life cycle to ensure their needs continued to be met. A new change management strategy based on the PROSCI ADKAR framework was effective in developing and supporting all the changes made to UCI.


      140 Character Summary:
      An evaluation and usability study was conducted to inform the expansion of UCI at Fraser Health and optimize clinical deliverables.

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    EP04 - Application / Implementation / Adoption and Use 2 (ID 19)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 6
    • Now Available
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 8
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      EP04.01 - Innovative eRehab Transforms In-Home Stroke Rehabilitation Services (Now Available) (ID 120)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      Innovative rehab technologies inspires transformations in delivery model and patient experiences for Stroke Rehabilitation Services. Champlain region has 1000+ stroke patients yearly; those living in rural areas have no access to local out-patient stroke rehabilitation services and occupy acute beds to access rehab or go without. Sub-acute capacity planning sees the value of moving patients to in-home care for stroke rehabilitation. Traditional in-home rehabilitation services combine a therapist and rehabilitation assistant for twice weekly, hands-on care with paper instructions for homework. By leveraging technology we can support the delivery of personalized stroke rehabilitation services while giving patients unparalleled access and control over their consumption of those services. By augmenting hands-on therapy via eRehab applications we improve patients? motivation; resulting in the creation of a new service experience. In-home stroke rehabilitation now offers an instructor-led, patient-centered, self-initiated, service that enables the patients? Physio/Occupational/Speech Therapy exercises to be consumed whenever they want and enhances twice weekly hands-on therapy visits. Additionally, some technologies may create a seamless treatment pathway bridging the time and service gap between hospital and in-home rehabilitation.


      Methodology/Approach:
      Simple technologies that deliver approved professional exercise applications over gaming-like devices/tvs/tablets can completely modernize and revolutionize service delivery. For example, interactive game-like technology enables patients to be guided and monitored through personalized rehabilitation programs with increasing intensity levels. Patients often describe this rehab as fun and friendly rather than exercise/work. Additionally, by leveraging personal computing devices, on-line speech rehabilitation apps offer significant opportunities to initiate services in those critical first few days post stroke. Therapists remotely monitor and update programs to deliver real-time adaptations to meet patients? ever changing needs. Quadruple AIM evaluation data defines successes in patient and therapist experiences, outcomes and cost-effectiveness and drives recommendations to sustain and spread this service.


      Finding/Results:
      Technical trials proved feasibility. Current in-home trial evaluation data will help us learn how our innovative approach to combining technology and professional health-care empowers the patient to experience and consume their rehab services when they want and as often as they want and may result in improved clinical outcomes. Participants will gain insight on population profiles appropriate for the technology, treatment needs, benefits, and impact/cost of delivery.


      Conclusion/Implications/Recommendations:
      Continued research and partnerships are essential for health-care organizations to understand how patients respond and adapt to technology-enabled care, while organizations cost-effectively operationalize, coordinate and modernize services in order to meet ever-growing demands. On-going, in-home trials indicate positive feedback; patients report feeling more motivated and indicated games are more valuable than following traditional paper instructions. By leveraging innovative eRehab technology solutions within the home-care delivery model, we are creating a patients-first experience and transforming traditional service models and delivery expectations while expanding availability of in-home post-acute rehabilitation services for stroke patients. Technology and health service partnerships between acute, sub-acute and home-care settings, can help inspire, create and celebrate an integrated stroke rehab program where patient rehab is enabled as early as possible in a seamless manner and grows across their continuum of care.


      140 Character Summary:
      Innovation combining technology & professional health-care empowers patients to experience/consume rehab services differently and improve clinical outcomes.

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      EP04.02 - Adapting Technology Through Co-Creation with Indigenous Communities to Improve Outcomes (Now Available) (ID 390)

      Sandy Whitehouse, Medicine, UBC; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      To co-create patient engagement tools with three indigenous communities in Australia using the Tickit patient reported data platform. Indigenous communities in Australia face similar challenges to those in Canada with poorer health outcomes compared to the general population. Patient engagement and capturing patient reported data is challenging, but important to detect healthcare issues and direct appropriate care. Tickit Health has developed a versatile digital platform that is designed to accommodate hard to reach populations to collect patient reported data and support patient education. Over a period of 4 years, three separate remote indigenous communities, in NSW, Arnhem land and the Kimberley engaged the Tickit team to adapt the technology to suit the needs of their community. Tools developed included a smoking cessation educational tool, an intake assessment tool and a research psychosocial screen.


      Methodology/Approach:
      Each community had a designated champion, community council and local healthcare team. The community worked with the Tickit team to co-create a culturally sensitive and safe tool to meet the needs of their population. Adaptations included changing colours, text, language, images and icons as well as adding locally relevant content, while maintaining core data capture. Local workflow issues were also addressed. Multiple iterations were developed and reviewed to reach consensus on a final product.


      Finding/Results:
      Each project is at a different stage. One is completed, one has been reviewed by the Ministry of Health and will be expanding to other communities, and the third is at co-creation stage. The presentation will highlight the similarities and differences between the needs of the communities, the co-creation process and lessons learned with implementation and where possible the clinical impact of introduction of the tools. For example, the clinical assessment tool implementation resulted in a 5 fold increase in STI screening.


      Conclusion/Implications/Recommendations:
      Working with the indigenous communities can be a slow process. Relationship building, open communication and understanding community priorities, with respectful reassurances regarding privacy and inclusion are key factors for success. Technological considerations and troubleshooting for remote communities is also critical. The findings suggest these challenges are worth overcoming. With appropriate engagement, innovative technology can have a positive impact on patient care.


      140 Character Summary:
      With respectful co-creative processes, digital patient engagement tools can support indigenous to detect healthcare issues and direct appropriate care.

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      EP04.03 - Improving EMR Use through Video Tutorials (Now Available) (ID 404)

      Andre Kushniruk, Health Information Science, University of Victoria; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Electronic medical records (EMR) can be used by Primary Care Physicians (PCP) to support diabetes care in a proactive manner. Although the majority of Canadian PCPs have adopted an EMR, advanced use of EMRs is limited. The literature widely suggests that training, intended to help PCPs to better use their EMRs, is a critical success factor for increasing use of advanced EMR features, such as diabetes registries and recalls or reminders. However, many PCPs receive little or inadequate EMR training, especially following the implementation of an EMR. Specifically, there is a dearth of literature on the use of video tutorials to improve EMR use. Video tutorials are video demonstrations of how to accomplish tasks using software, and can support faster initial learning and reduce cognitive processing. The purpose of this study was to evaluate the potential for EMR video tutorials to improve process measures for type 1 and type 2 diabetes care for PCPs using OSCAR EMR in British Columbia


      Methodology/Approach:
      EMR video tutorials were developed based on the Chronic Care Model and evidence-based guidelines for video tutorial design. PCPs were recruited for a mixed methods(QUAN(qual) study through the Divisions of Family Practice and OSCAR BC Users' Group. Data were collected from July 2017 to May 2018 at two pre- and two post-intervention time points using a Diabetes Care questionnaire, as well as a demographic survey at baseline. Semi-structured interviews were conducted with PCPs at three and six months following the intervention.


      Finding/Results:
      In total, 18 PCPs completed the study, and 12 of them participated in 21 follow up interviews. The study results demonstrated that the intervention combined with a Hawthorne effect elicited a statistically significant increase in EMR feature use for diabetes care, with a large effect size (i.e., F(3, 51) = 6.808, p <.001, partial ?2 = .286). Multiple barriers and facilitators to applying the tutorial skills into practice were found at the physician, staff, patient, EMR, and policy levels. Three pairs of PCP characteristics had strong and positive associations, which were statistically significant: (1) age and years of practice; (2) years of experience using OSCAR EMR and number of EMRs used; and (3) computer skills and EMR skills. PCPs' years of medical practice was statistically significant in predicting their baseline use of the EMR for diabetes care. Graphical trends indicated that higher increases in mean composite EMR use (MCEU) score for diabetes care over the duration of the study were associated with PCPs with the following characteristics: (1) being female, (2) being aged 35-44, (3) being from Vancouver Island, (4), having less than four years of medical practice, (5) having 3-4 years of EMR experience, (6) having 1-2 years of OSCAR EMR experience, (7) using four EMRs, and (8) having prior post-implementation EMR training.


      Conclusion/Implications/Recommendations:
      This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalizability.


      140 Character Summary:
      This small-scale efficacy study demonstrates the potential of EMR video tutorials to improve EMR use for chronic diseases such as diabetes.

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      EP04.04 - The SCA Program: A Successful Model for eReferral Implementation (ID 419)

      Charlotte Nethercott, eHealth Centre of Excellence; Waterloo/CA

      • Abstract

      Purpose/Objectives:
      In response to the healthcare wait time challenges in the province, the System Coordinated Access (SCA) program is supporting the deployment of electronic referral (Ocean eReferral) across five LHINs in Ontario. The SCA program?s goal is to support standardization and coordination of service intake and an eReferral ecosystem that allows input from system users.


      Methodology/Approach:
      The SCA program provides the supporting infrastructure to bring together an innovative technology solution with a collaborative, systematic and local approach to deployment. By providing centralized expertise in the areas of Project Management, Technology Design & Architecture, Privacy & Security, Benefits Realization, Integrations, Communications, Change Management, Reporting and Standardization, participating LHINs can access a shared community of resources to support their local deployment and help clinicians understand how adoption of the eReferral solution can positively impact workflow processes. To achieve the level of stakeholder engagement necessary to deploy and sustain the adoption of the solution, the program applies a three-dimensional approach to change management. This approach encompasses strong communication, influential adoption efforts and hands-on-training that provide clinicians with tools, solutions, and skills to improve patient care and outcomes. The success of the program is built on its commitment to continually improve the solution by engaging clinicians, central intakes, healthcare providers and patients to better understand their needs, while feeding that input back into the solution design.


      Finding/Results:
      The success of this model is evident in the steady adoption of the SCA program eReferral solution since it went live in August 2017. The continued active use of Ocean (86% over the past 3 months), and the quantitative data collected using post-adoption end user surveys demonstrate that the SCA program is enabling the long-term sustainability of eReferral. Image 1: Total # of eReferral senders and total # of eReferrals sent in the first year of operations: SCA Program Image 2: Results from SCA Program Post-Adoption User Satisfaction Survey, Oct 2018


      Conclusion/Implications/Recommendations:
      Evidence shows that the SCA program?s multi-dimension model has the potential to stimulate a better practice flow and shape a standardized coordinated system that facilitates active communication that benefits and meets the needs of clinicians and patients.


      140 Character Summary:
      The SCA Program?s model for eReferral development, implementation and meaningful use is demonstrated by the steady adoption and user satisfaction of the solution.

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      EP04.05 - Inspiring the Next Generation – Celebrating Digital Health FACTS in Education (Now Available) (ID 500)

      Anne Fazzalari, -/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      There has been a movement afoot in clinical education in Canada. With the ever-changing digital landscape, educators and students in the Faculties of Medicine, Nursing and Pharmacy have been engaged in the development of a national Canadian clinical informatics competency program. Commonly known as the Digital Health ?Faculty Associations Content & Training Solutions? (FACTS) program, this unique program has national organizations participating in a collaborative focused on advancing clinical informatics in medical, nursing and pharmacy education. Discipline specific knowledge assets such as medical, nursing and pharmacy informatics competencies, along with interprofessional resources will be shared that are relevant to policy, research & practicing clinicians.


      Methodology/Approach:
      The national Digital Health FACTS program has evolved to an interprofessional collaborative approach, yet still enabled a discipline specific and regional implementations. The program leveraged a national Change Management (CM) Framework as well as Peer-to-Peer Networks across Canada to facilitate educators in supporting their colleagues and preparing students to practice in a digitally enabled environment. These educators, known as ?Faculty Peer Leaders? act as change agents in medicine, nursing and pharmacy faculties, providing hands on support and guidance to their peers as well as students via face-to-face meetings, workshops and webinars. Engaging clinical faculty led to the development of pharmacy, nursing and medical resources around electronic prescribing and other real-life case studies for teaching and learning.


      Finding/Results:
      The program impacts all educators and students in the Faculties of Medicine, Nursing and Pharmacy in Canada. To date, there have been thirteen successful projects whereby over 40 Faculty Peer Leaders have engaged over 9,700 of their colleagues/educators. Each discipline-specific project within the interprofessional program conducted evaluation activities such as focus groups and in-person/online surveys were utilized when engaging Faculty Peer Leaders, their colleagues/peers and students. Interprofessional guidelines and resources that have been recently developed will be shared with the audience, along with evaluation results, emerging themes and lessons learned.


      Conclusion/Implications/Recommendations:
      A unique ?people project? has been unfolding across the country over the last number of years to engage educators and students in digital health dialogue, learning and teaching. Faculty Peer Leaders have engaged colleagues, along with their students, in an interprofessional, collaborative patient-centred care approach and momentum has been built around the development of e-Prescribing resources. This national program will continue to address the demand for digital health content by educators and students, support strategic national initiatives and better equip the next generation of clinicians in Canada to integrate technology into their clinical settings.


      140 Character Summary:
      Calling students and faculty ? do you know about the #digitalhealth FACTS movement? #medicine #nursing #pharmacy #education #faculty @AFMC_e @CASN43

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      EP04.06 - A provider documentation journey from telephone based dictation to FESR (Now Available) (ID 556)

      Naomi Brooks, Transcription Services & Health Information Exchange, Vancouver Coastal Health; vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      FESR (Front End Speech Recognition) was approved as part of implementation of provider documentation in Cerner as part of the CST Project as a key enabler. Transcribed documents form part of the patient health record which provides the following: - A communication and decision making tool for care providers; - A historical record of a patient?s medical care; and, - The source document from which health and service quality planning, evaluation, and monitoring data is extracted The goals of the HIM VPP FESR Project are to improve patient safety and quality of care, enable high EHR adoption and reduce transcription costs by implementing the M*Modal FESR solution. The primary objectives of the project are as follows: - Reduce to zero, the TATs for the reports dictated by FESR. - Facilitate the providers? documentation in Cerner.. - Maintain or improve report quality. This includes supporting physicians with the creation of standardized report templates and content where appropriate. - Achieve annual cost savings through reduced M*Modal transcription costs. - Mitigate cost pressures and service risks associated with dictation volume growth, stat reports and the increasing demand for M*Modal transcription services.


      Methodology/Approach:
      FESR will be deployed across VPP in two phases as follows: - Phase I - Approximately 6-9 months prior to each CST site deployment, FESR using M*Modal?s Fluency Flex application. Dictating authors will review, edit and sign their documents in the Fluency Flex application. Training will occur in 1:1 sessions. -Phase II - As Cerner is activated through the CST deployments, the FESR users will be converted to dictating directly into Cerner using the M*Modal Fluency Direct application. The reason for two phases is to have FESR in use at the sites before the Cerner system becomes active so providers have more time to train and become proficient with using the new FESR tool. The Phase I conversion of telephone dictation to FESR dictation is also what generates the annual savings and addresses some of the current operational challenges


      Finding/Results:
      The introduction of FESR alongside the rollout of provider documentation in an EMR has been shown to reduce documentation times, reduce transcription costs and deliver more complete patient narratives. With Cerner, providers see minimal impact from EMR tools alone, but high impact on all three areas with the addition of FESR tools (KLAS Research, 2014). In the absence of FESR, experience has shown poor provider adoption and engagement of the implementation of electronic documentation modules within a clinical information system. (Park, Lee and Chen, 2012).


      Conclusion/Implications/Recommendations:
      Over 8000 dictating authors will be substantially impacted by the change from telephone dictation to FESR dictation and resistance by some can be anticipated. Dictating authors will be further impacted by the transition to provider documentation in Cerner. A robust and supportive change management approach will be developed to guide the dictating authors through the changes. Strong commitment and support from medical leadership in supporting and communicating the changes will also be required. At the 4 sites that have gone live with Cerner, 80% of providers use FESR.


      140 Character Summary:
      FESR is being rolled out in Lower Mainland Health Authorities as an enabler to provider documentation within Cerner.

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    EP07 - Application / Implementation 1 (ID 36)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Health Business Process
    • Presentations: 6
    • Now Available
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Pod 8
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      EP07.01 - Emergency Department Discrepant Radiology Workflow (ID 108)

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

      • Abstract

      Purpose/Objectives:
      Discrepant diagnostic imaging reading between radiologists and emergency department (ED) physicians is a cause of morbidity in the pediatric population. Most EDs order dozens of diagnostic imaging studies for review per day and clinical actions are typically enacted based on initial ED physician review with subsequent radiology oversight (often hours to days later). Individual ED physicians are medicolegally responsible for following up any test they order (regardless of when the results are available), which is often not practical. Typically therefore a system of shared responsibility between ED providers exists to support following up of radiology reports. Breakdown in this complicated workflow therefore can result in missed test results and harm to the patient. We describe a technology-enabled system to assure that no clinically important findings are missed, while acknowledging the reality that the individual clinician will rarely be able to follow up all of their own test results.


      Methodology/Approach:
      Working closely with radiologists, ED providers, EMR analysts and others, we created, refined and finalized an electronic workflow to identify discrepant results and assure their followup. This was subsequently piloted, tested and utilized at go-live using an enterprise-wide EMR.


      Finding/Results:
      After any plain film x-ray is completed on an ED patient, an ?interpret? button appears in the EMR next to the study. The ED physician is forced to input a preliminary interpretation prior to being allowed to discharge the patient. Subsequently, the radiologist will see this interpretation when they over-read the film. If their interpretation is discrepant, an electronic report is generated into a pooled list, which is followed up the next day for all non-critical results. Discrepant results deemed critical by the radiologist are still communicated directly by phone to an ED MD. Specific providers are assigned daily to review the list of discrepant results. Once the result has been identified and rectified (ie. by calling the family, arranging for referrals, etc), the discrepancy is electronically ?resolved?, and it drops out of the report list. Films that are not discrepant (ie. the ED physician and radiologist agree), normal films, and films that contain information irrelevant to the chief complaint are not put in the discrepancy workflow. Using this workflow, approximately 10-15 discrepant films are generated per day. This workflow has eliminated the possibility that discrepant test results will ?fall through the cracks?, improving patient care and minimizing medico-legal risk to ED clinicians. Ongoing auditing of discrepancy reports occurs to ensure data integrity.


      Conclusion/Implications/Recommendations:
      All physicians in Canada must follow up the results of any test they order. This is not always practical in the ED however, as many radiological studies are not formally reported until well after an individual ED physicians shift. As such, it is impractical to require ED physicians to follow these tests. A technology-enabled solution is the ?discrepancy? workflow described, enabled by an enterprise-wide EMR. This system assures that the radiologist is aware of the ED physician?s interpretation, and allows ED providers to followup any necessary discrepancies, resulting in improved patient care and risk mitigation.


      140 Character Summary:
      We describe an electronic method to track and address late arriving or discrepant radiology results in ED patients when the ordering clinician is not available.

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      EP07.02 - Canary Clinical Alerting: Infinite Possibilities (ID 122)

      Laurie Macdougall Sookraj, UHN Digital, University Health Network; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Teams at University Health Network have successfully implemented a highly configurable system for generating notifications about clinical events. The purpose of this talk is to describe the solution, technology stack, and lessons learned, to highlight the benefits of the solution and to share knowledge about the possibilities for creating such a system at other sites.


      Methodology/Approach:
      The solution went through several iterations from its initial release to the current version, each time restructuring how it was put together. Through monitoring usage by clinical users and how they interact with the system and feedback collected from clinicians, as well as monitoring the type of support requests we got from users, we have been moving towards a better system each time. We've grown from a small group of beta users to notifications that are used across the entire organization for both clinicians and patients, and have plans to expand out customized notifications to the entire organization as well. This talk follows that journey from initial go live to future projections.


      Finding/Results:
      Canary is a clinical alerting and notifications system built at University Health Network. It receives HL7 feeds from multiple source systems, looks at every message to determine if it should trigger a notification, and if so, records it and sends it out. This system is incredibly powerful, because, firstly, it triggers in real time, so there's no lag between the event being documented and the notification going out, secondly, it can reach into other systems to get additional context - if you want to know the value of a test result from a year ago, or what type of surgery was done, but that's not in the message, we can go get it, and finally, the possibilities for configuring a rule are literally infinite, any combination of factors that you can imagine can be used. Here are some of the current uses for the system:

      1) UHN Patient Portal subscribers receive email alerts on any new or updated appointment booking at UHN, as well as real-time or daily batch emails about new or updated results available.

      2) Infection Control Practitioners are notified any time a result comes back MRSA positive, or a previously MRSA-positive patient returns to the hospital, so they can take action to isolate the patient. Notifications are directed to the appropriate infection control practitioner based on which area of the hospital they are responsible for monitoring.

      3) Project RED (Health Links) receives a notification for any patient that repeatedly comes in to the ED and has no family physician on record, to follow up with the patient about getting appropriate care.


      Conclusion/Implications/Recommendations:
      University Health Network has developed a very powerful system for configurable notifications based on clinical events. We think this method of watching HL7 feeds for specific trigger events is something that could be applied at any hospital, although the actual implementation at this time is specific to UHN systems. Delivering the right message to the right person at the right time is a step towards delivering the best possible patient care.


      140 Character Summary:
      Canary is a notifications system built at University Health Network. It allows infinite possibilities for alerting physicians and patients about clinical events.

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      EP07.03 - Case Study:  Clinical Standardization for a Regional Clinical Information System (Now Available) (ID 367)

      Elizabeth Nemeth, Healthtech Consultant; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Nursing Leaders and client providers have an opportunity to improve the quality of care provided by reducing unnecessary variation. Current evidence and expert consensus can be used to develop a standardized model that can be used by all members of a clinical team. Process management and continuous quality improvement can be applied to measure process, health, and patient satisfaction outcomes (Lavelle, Schast, & Keren, 2015). However, there still seems to be a gap in the adoption of standards and best practices. Clinical standardization and the interchange of information can facilitate early diagnosis, variations in treatment, decrease re-admissions and improve operational efficiency. Best practice and evidence in the development of standards results in improved care, accountability, reporting/bench-marking and interoperability of information.


      Methodology/Approach:
      When investing in a regional HIS, there is a greater necessity to support clinical adoption involving nursing leaders and client providers in the development of standardized, evidence based tools. There are a number of objectives for HIS implementation such as: (1) to increase the quality and efficiency of care; (2) to reduce the operating costs of clinical services; (3) to reduce the administrative costs of running the healthcare system; and (4) to enable entirely new models of healthcare delivery. As a result, a level of standardization is required and is pivotal for the above objectives to be realized. Rocha & Rocha (2014), describe the added value created by the adoption of nursing practice standards. As well, Adler-Milstein, Ronchi, Cohen, Winn, & Jha, (2014) highlight the value of comparable data between countries stating the lack of consistent terminology and approach has made cross-national comparisons and learning difficult.


      Finding/Results:
      Through a case study, which led 24 hospitals through clinical standardization, the authors will describe the pivotal role nursing leaders and client providers have in HIS implementation, the trials and tribulations of establishing effective governance structures and decision making frameworks required to support high levels of clinical standardization; tactics to support engagement; and meaningful approaches in the development and implementation of evidence based standardized content.


      Conclusion/Implications/Recommendations:
      Nursing Leaders and client providers need to have understanding of their role in design and implementation of HIS and the impact of embedding best practice and clinical standardization in electronic documentation tools, templates and interventions. Outcome of Presentation 1. Understanding of the role of nursing leaders and client providers in peer group review of best practice and development of clinical standardization of nursing documentation tools/templates and interventions. 2. Knowledge and awareness related to governance structures and decision making frameworks to support a standardization. 3. Sharing lessons learned in implementing clinical standards and impact on design and build of a regional HIS.


      140 Character Summary:
      Nursing Leaders and client providers have an opportunity to improve the quality of care provided by reducing unnecessary variation in clinical documentation.

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      EP07.04 - Operating Room Workflow and New Electronic Health Record – Simulation-Based Study (Now Available) (ID 449)

      Elaine Ng, Hospital for Sick Children; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Background The transition from a hybrid, yet predominantly paper-based system to an integrated electronic health record (EHR) system in the operating room (OR) can be challenging, and the impact on workflows may not be fully understood or elucidated. Simulation-based assessments in the workplace allow users to perform real world tasks and workflows in a controlled, reproducible and observable environment with no impact to patients. Objectives To determine the impact on our current workflows in the OR with the new EHR using simulation.


      Methodology/Approach:
      Areas of concerns for OR workflow were identified by key stakeholders in the operating room. Key informants representative of the interprofessional healthcare workers were invited to participate in simulated scenarios that were created based on real life cases. The scenarios were conducted in the real work environment. Results were collected by mixed method approach including observations, self assessments including the NASA-TLX index and qualitative interviews, results of which were analyzed to generate themes.


      Finding/Results:
      Two main areas were identified for simulation study: 1. Key informants from nursing and anesthesia participated in simulation studies in a busy OR area, 2. trainees in anesthesiology were observed in a simulated OR. In both areas, the EHR imposed a high cognitive load resulting in divided attention and near misses even though the participants did not report a high task load index. Simulation was considered a safe place to reveal our gaps in workflow familiarity and for learning with a coach. As a result of the simulation studies, a new workflow was recommended for the busy OR area and a simulation-based orientation process is being introduced for trainees.


      Conclusion/Implications/Recommendations:
      Simulation provides a safe environment for assessment of workflow and fluency with EHR which revealed areas of concern. This in turn allowed us to promote a new workflow for safe patient care with introduction of EHR. Orientation and familiarization with the new EHR and workflow is ideally obtained by repetitive practice with a coach.


      140 Character Summary:
      Simulation-based assessments in the workplace informed the impact of the transition to an integrated electronic health record system in the operating room.

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      EP07.05 - Building a High Performing Epic Team with Local Talent (Now Available) (ID 480)

      Sarah Muttitt, SickKIds; Toronto/CA
      Diane Salois-Swallow, IT, Mackenzie Health; Richmond Hill/CA
      Robert Slepin, HIT, SickKinds; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      During 2015 and 2016, both Mackenzie Health and The Hospital for Sick Children (SickKids) made independent decisions to migrate their EHR platforms over to Epic. These were the first two enterprise-wide Epic implementations in Canada, and both needed support locating certified Epic talent. Upon deciding on Epic, the health systems were immediately faced with a series of challenges to fill Epic?s recommended staffing levels for the implementation team, and meet their targeted Epic training dates. Both health systems were interested in utilizing local talent to meet the recommended staffing levels. Our panelists will discuss their experiences and lessons learned with rapid recruitment, hiring, on-boarding and training talent. The panelists will outline how both Mackenzie and SickKids were concerned about the process for selecting the right talent to ensure they assembled a high-performing teams. The Panelists will outline how they needed to quickly and efficiently develop a cost effective and sustainable certified Epic workforce. Collectively the two health systems needed to identify over 70 Epic certified analysts from the local labor market ? and this all needed to be completed within a tight time period.


      Methodology/Approach:
      Both hospitals utilized a screening and baselining process to assess the performance characteristics of their internal talent. The recruitment delivery team conducted baselining interviews of internal employees to measure the aptitudes, behaviors, competencies and desires of the top-performing talent within Mackenzie Health and SickKids. From there, they utilized the baseline data to screen local talent interested in joining their Epic team. The recruiters used this data to interview and select the highest performing external talent to join the Epic implementation.


      Finding/Results:
      Mackenzie Health: Internal Mackenzie employees placed onto the project: 49 External local candidates placed onto the project: 44 External local candidates converted to full time: 39 SickKids: Internal Sickkids employees placed onto the project: 49 External local candidates placed onto the project: 36 External local candidates converted to full time: 31


      Conclusion/Implications/Recommendations:
      The Epic implementation teams at both Mackenzie Health and SickKids, comprised mostly of local candidates, brought the hospitals to an on-time and within-budget go-live. Over 70 local jobs were created between the 2 health systems. Furthermore, both organizations avoided potentially millions of dollars in expenses from using an overabundance of experienced, U.S.-based Epic consultants. With appropriate planning and forecasting, Epic health systems in need of certified Epic talent can consider building their own local workforce of certified talent. Epic?s implementation methodology speaks to training the end-user and avoid using high priced external consultants. Using a local talent pool builds a long term strategy that is fiscally responsible, creates local jobs, allows the health system to convert the external talent into full-time status, as needed.


      140 Character Summary:
      Enhancing the Epic implementation methodology while creating local jobs: Building a high performing Epic team with local talent

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      EP07.06 - Integrating Operational IT Service Desk at Go-live (ID 549)

      Nour Alkazaz, PMO, Information Services, The Hospital for Sick Children; Toronto/CA

      • Abstract

      Purpose/Objectives:
      SickKids implemented the Epic EHR on June 2nd, 2018. We planned for a 24/7 technical Command Centre for a period of 4-weeks post-live. The goal was to integrate the Operational IT Service Desk as part of the Command Centre issue triage process to support transition from go-live to operational issue logging processes.


      Methodology/Approach:
      We adopted the MyTSM service management tool and worked with the Service Desk team to create Epic-focused consoles and categorization structures. Members of the Service Desk team attended two training workshops. A decision support aide was developed to support appropriate issue triage, and underwent iterative improvements during go-live.


      Finding/Results:
      Integrating the Operational IT Service Desk as part of the go-live command centre offered a first-hand, learning opportunity for the Service Desk agents that is invaluable. Lessons learned from the integration helped inform the transition from command centre mode to operations. Next steps are to further expand the Service Desk team?s knowledge and understanding of the Epic EHR, and enable the Service Desk agents to offer some level of Tier 1 support.


      Conclusion/Implications/Recommendations:
      Integrating the SickKids Operational IT Service Desk with our Command Centre processes offered invaluable learning opportunity to the Service Desk team and enabled a smooth transition from Command Centre mode to day-to-day operations.


      140 Character Summary:
      Leveraging your Operational IT Service Desk offers learning opporutnities and benefits in transitioning from Command Centre to operations post EHR go-live.

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    RF01 - Foundational Methodologies (ID 7)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Health Business Process
    • Presentations: 5
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 8
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      RF01.01 - Modernizing Nova Scotia’s Digital Health Architecture (ID 256)

      Richard Liu, Province of Nova Scotia; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2018, NS Department of Health and Wellness (DHW) initiated an enterprise architecture project to define a Digital Health Architecture Blueprint for the Province of Nova Scotia. Core objectives for this project are as follows: - Establish a shared vision of architecture across programs - Define a target state architecture that leverages existing investments; offers flexibility in deployable solutions, and accommodates evolutionary change - Provide guidance for developing program and solution roadmaps. - Support Nova Scotia?s Digital Health Strategy


      Methodology/Approach:
      For this project we focused our effort on seven major programs operated by DHW. We worked with each program to accurately document the current state architectural capabilities, dependencies, challenges, and opportunities. We then assessed the overall adherence to the Canada Health Infoway EHRS blueprint and highlighted key foundational services that are still essential today. We developed and communicated a high-level view of the target digital health architecture. Using this view as guide, we are working collaboratively with programs to support planning and road mapping.


      Finding/Results:
      The current state of Digital Health in Nova Scotia evolved through a continuing series of initiatives addressing specific program needs. Solutions in production cover both clinical and administrative functions and are in varying stages of solution lifecycles. Many initiatives used the EHRS Blueprint for architectural guidance. This blueprint introduced the concept of interoperable electronic health records. While the EHRS blueprint is still relevant for the core, foundational components it defined, there are new realities that architecture strategy needs to consider: - New models of care including virtual care - Consumer Health Solutions - Ways to leverage and derive value out of the data through analytics Program administrators are also facing the realities of solution lifecycles: - Some solutions are nearing end of life, so alternatives must be explored. - Some solutions are evolving in pace with innovation, so we might leverage solutions in new ways. - New initiatives introduce solutions which must align with both the existing foundation and strategic direction. Key findings: - Adherence to the original EHRS Blueprint varies across programs. Many solutions keep a separate copy of data rather than reading a central repository. Registry integration does not extend to some important solutions like EMRs. Registries and repositories are not easy to interface with. Many point-to-point integrations. - Programs maintain lists of desirable future enhancements however: Alignment across programs on objectives is limited. The lack of a digital health architecture makes it difficult to plan/roadmap. - Attention to critical core services like registries, repositories, standards, and common services has diminished. - Having up-to-date architectural views is critical for leaders to communicate complex ideas, and support decisions.


      Conclusion/Implications/Recommendations:
      The resulting Digital Health Architecture Blueprint helps align initiatives with key building blocks in a flexible architecture, that facilitates design choice, leverages emerging technology, and supports strategic planning. The blueprint provides senor leadership with an updated backdrop to support cross program planning and coordination in support of the province's Digital Health Strategy.


      140 Character Summary:
      Developing a modern, flexible Digital Health Architecture for Nova Scotia to facilitate program planning and support of the provincial Digital Health Strategy

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      RF01.02 - Data & Analytics Governance at CCO – Enabling Actionable Insights (ID 475)

      Angela Copeland, Data & Analytics Governance, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Cancer Care Ontario (CCO) is respected for its analysis and reporting of data to inform decision-making in the cancer and renal systems, as well as Ontario?s Wait Time Strategy. Over the years, the number of data assets collected and stored by CCO have increased substantially, and analytics is used across the organization. What didn?t occur was the establishment of standardized practices to support data & analytics usage. Each lines of business developed their own data management processes and analytics practices to meet their requirements. In 2016, CCO recognized an enterprise approach to data management, analysis and reporting of data was required to ensure on-going sustainability, continued growth and innovation within the data & analytics space.


      Methodology/Approach:
      Data & Analytics (D&A) Governance is a multidisciplinary approach that applies business management principals to the life-cycle of our data & analytic information assets. To support this philosophy, CCO embarked on a journey to create an Enterprise D&A Governance department with the key responsibility to set authorities, accountabilities and controls to formalize and consistently guide the management of enterprise data & analytics assets. A D&A governance framework has been developed that includes policies supported by guideline and procedural manual. An overarching D&A management guideline is drafted for key governance domains: Architecture, Data Quality, Metadata, Master Data, Concept/Methodology management, Security & Privacy, Lifecycle Management that describes principles and practices to be consistently performed on CCO?s data and analytics assets. The guideline describes the processes and stewardship model to effectively collect, process, provision, evaluate and archive CCO?s data assets and to effectively manage the information and analytics assets produced by internal analytics teams. Procedural manuals are data asset specific controls that provide step by step instructions to assist staff in implementing the various policies, standards and guidelines. A D&A governance structure is in place to approve guidelines, policies and standards; review consistently for changes in enterprise D&A artifacts; bring forward enterprise-wide data & analytics issues and act as a champion to formalize the practice within their business areas. The advisory forum ensures D&A priorities align with CCO?s strategy and are accountable to management committee. The community of practice (tactical groups) contribute to the development and maintenance of guidelines and help identify continuous improvement opportunities but are not part of the formal governance structure.


      Finding/Results:
      CCO?s data & analytics governance provides a coordinated approach to manage data and analytics assets in the most efficient way. Standard data governance and business processes reduce duplicate data management efforts and improve data understanding among analytics teams. Defining consistent analytics methodologies will standardize analytics concepts used across the organization which will lead to consistent analytical reporting at enterprise level. Integrated Data & Information stewardship model helped establish clear and consistent enterprise accountabilities and practice expectations for data management and analytics teams across CCO.


      Conclusion/Implications/Recommendations:
      Robust Data & Analytics governance will ensure CCO has reliable, high quality and trustworthy data available that will enable business users generate actionable insights.


      140 Character Summary:
      Provides an overview of CCO?s Data & Analytics Governance implemented enterprise-wide to manage, control and have oversight over CCO?s data and analytics assets

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      RF01.03 - Removing Barriers to Sharing Drug Information (ID 252)

      Tanya Achilles, Canada Health Infoway; Winnipeg/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Highlight how the Canadian Drug Dictionary (CCDD) is being used identify drug products in digital health solutions such as e-prescribing, and how it can be used for medication profiles and secondary use such as adverse drug monitoring.


      Methodology/Approach:
      Identified use cases for the CCDD partnered with Health Products and Food Branch of Health Canada (who agreed to own the CCDD) to leverage the Drug Product Database to develop the CCDD content Establish a governance framework to manage content and issues Influence knowledge base vendors to integrate the CCDD within their commercial product Market and communicate the value of the CCDD Improve consistency of drug information within EMR, pharmacy and hospital systems


      Finding/Results:
      The CCDD has been published monthly for over a year. The CCDD content will be complete by March 2019 and include all medicinal products with a Health Canada drug identifier that are being used in Canada. The CCDD has been integrated into at least 3 knowledge base vendor commercial products by January 2019. The CCDD is being used in interoperability projects.


      Conclusion/Implications/Recommendations:
      The CCDD was launched in September 2017 to bridge the gap between systems that don?t speak the same language. For example, electronic medical record (EMR) systems are typically supported by knowledge base vendor databases that provide proprietary coded content that cannot be understood by pharmacy systems that use different knowledge base vendors. When these vendors map their proprietary content to the CCDD, the data can be understood, enabling the sharing of medicinal product data. Doctors can use their EMR to identify the product they wish to prescribe (at the level of detail they wish to use) and the pharmacy can receive, understand and determine the product to dispense. The Canadian Clinical Drug Data Set (CCDD), is receiving tremendous interest from knowledge base vendors who want to integrate it with their commercial products. This will enable more prescribers and pharmacists in Canada to use PrescribeIT?, Canada?s national e-prescribing service and enable other interoperability projects share vital drug information safely and reliably.


      140 Character Summary:
      The CCDD will support more efficient workflows and improved safety in medication management, the national opioid strategy and improve care for individuals.

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      RF01.04 - CCO’s Journey to Enterprise Metadata Management (ID 462)

      Angela Copeland, Data & Analytics Governance, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      To enable Cancer Care Ontario?s (CCO) mandate supporting Ontario government on cancer and kidney care systems, and key health priorities such as wait times on health services, CCO collaborates with healthcare partners to improve the performance of our health systems by driving quality, accountability, innovation, and value. Metadata documentations were inconsistent, incomplete, and scattered across muiltiple artifacts, thus has been identified as a foundational pillar of enterprise data governance practice to deliver CCO?s mandate using data and analytics capabilities. Implementing Enterprise Metadata Management (EMM) ensures data users can access consistent supplemental documentation across clinical domains, understand the underlying meaning of the data they use or may want to use, leading to better trusted information for decision making.


      Methodology/Approach:
      EMM approach has been developed by defining and implementing a policy, guideline, procedural manuals, processes, and identification of roles and responsibilities (R&Rs) that center around a work cycle. To enable EMM practice adoption, CCO has introduced technology to support the implementation and maintenance activities to keep metadata current, complete, and correct at all times. Guideline establishes enterprise R&Rs, standardized repeatable and scalable process steps, and standardize templates to gather metadata, resulting in robust and maintainable EMM repository. Procedural manuals are established to ensure data asset specifics are captured. Customized sessions are conducted to ensure data stewards and users understand benefits of this work and how it can positively impact their work. Data Stewards receives close mentorship to ensure metadata content gathered reflect EMM standards. Technical teams standardizes the approach to link between technical and business metadata across data assets, a single scalable data model is used to capture business metadata across all data assets, and the technology supports organization wide access to the metadata. metadata work cycle.png


      Finding/Results:
      EMM implementation improves CCO data users? understanding of the underlying meaning of CCO data, reducing unnecessary time to determine information accuracy, enable identification and resolution of conflicting information, thus increasing users? trust and confident use of the data. People, process, and technology are all required to ensure the EMM practice is sustainable. Having commitment from all levels of organization (from executive team to junior analysts) to undertake this initiative is critical. By ensuring stakeholders are included in the process development and refinement, they feel they are part of this journey. The technologies meet current needs while also scalable to meet future requirements. This initiative may change how users interact with information to understand data; ongoing change management support is recommended to assist users through this transformation.


      Conclusion/Implications/Recommendations:
      Enterprise metadata management is required for organizations looking to realize value by leveraging its data and analytics assets


      140 Character Summary:
      CCO?s Journey to Enterprise Metadata Management is essential to transforming CCO to an insight driven organization.

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      RF01.05 - All-in-One: Comprehensive, Current, Cost-Effective, Practical Privacy & Security Training (ID 403)

      Ariane Siegel, OntarioMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Concerns about protecting patient privacy and growing risks related to cybersecurity are dominating the digital health agenda. There was an increasing need for comprehensive, up-to-date, convenient privacy and security training with attestation that addressed important topics such as legal obligations around PHI, best practices for protecting PHI, and dealing with privacy breaches. Training needed to be practical, accessible 24/7 and recognized by all digital health partners. Learn how we delivered this scalable, cost-effective solution for clinicians and their staff.


      Methodology/Approach:
      Previous attempts at providing a robust privacy and security training solution did not fulfill the objectives for the health care system because they were either not comprehensive, not updated, could not be audited to ensure completion and often involved a cost to the end-user?s organization. Our organization took a unique, transformative and strategic approach to providing privacy and security training. Our strategy was to work with key health care partners to develop a practical solution to privacy and security training recognized by all organizations and scalable to thousands of clinicians, allied health professionals, administrative and IT staff who may come into contact with PHI. An online solution was the most cost-effective for the partners and the health care system. Partners included organizations responsible for digital health infrastructure, regulatory bodies, and associations representing physicians and liability protection, and risk-management education for physicians. The strategy incentivized users of the Privacy and Security Training Module by making the training mandatory for access to EHR systems, providing a printable certificate of attestation, and providing CME credits for physicians. The strategy provided flexibility so the training could be ?white-labeled? for any health care organization or other jurisdictions to spread the benefits of the training to more clinicians and prevent more cybersecurity incidents.


      Finding/Results:
      In less than 9 months, almost 1,000 users have completed the Privacy and Security Training Module. In October, a French version of the Module became available. The reviews are very positive. After completing the Privacy and Security Training Module: - 91% of users understand PHI and ownership of medical records - 90% of users indicated that they were able to identify and appropriately respond to privacy breaches and security incidents - 89% understand ways to safeguard PHI. This comprehensive training is helping to instill privacy and security best practices at the practice level, avoid breaches and ensure EHR systems are used appropriately.


      Conclusion/Implications/Recommendations:
      At a time when health information is shifting to digital platforms, security and privacy training is critical for all clinicians and partners. The Privacy and Security Training Module is convenient, accessible and accredited training that clinicians want and need. It is an innovative learning solution that encompasses change management principles that include the people and process sides of change. Users can access the free training from any Internet-enabled mobile device and complete it at their own pace. As privacy legislation and technology evolves, the module will be updated. It is recommended that users take the training once a year to keep current on best practices and protocols.


      140 Character Summary:
      The Privacy & Security Training Module with attestation provides comprehensive, 24/7 training accessible from any Internet-enabled device.

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    RF02 - EMR Adoption: Are we there yet? (ID 27)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Executive
    • Presentations: 5
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 8
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      RF02.01 - A Human Factors Approach to Optimizing EMR User Experience (ID 205)

      Catherine Dulude, Information Services, CHEO; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      CHEO, a teriary care Pediatric hospital has implemented an integrated, enterprise wide EMR. We used human factors methods to study clinical workflow and EMR user requirements for Inpatient units and ED to inform and support user experience through appropriate selection and space planning of EMR hardware. The purpose of the current investigation is to identify guiding principles appropriate to Inpatient and ED environment and commonalities with Ambulatory Care.


      Methodology/Approach:
      Multiple methods within an iterative human-centered design (HCD) framework were used to develop hardware and access solutions supporting future EMR workflows in Inpatient and ED. Context of use analysis, participatory design methods, preliminary analysis of evaluative simulations and tacit knowledge of the project team led to development of guiding principles for hardware implementation and solutions supporting just-in-time documentation within the constraints of existing facility design.


      Finding/Results:
      Key themes from the preliminary thematic analysis included clinicians? appreciation for: 1. mobility, placement and small size of devices; 2. ergonomic features/postural supports on devices; and 3. device features that support patient relations. The study revealed concerns with the current state of some devices including: poor usability; physical attributes interfering with patient interactions; digital design interfering with patient interactions; design deficiencies impacting patient privacy; safety or organizational control features; design for IPC; and inability to fully replace cueing power of paper notes. Some of the key user needs and design requirements identified include the: ability to log in/out of the EMR quickly; ability to maintain line-of-sight to patients/family; need to support IPC; and need to provide ?focus? areas. This assessment was used to develop a hospital-wide implementation strategy and unit-specific implementation plans within challenging constraints. The strategy included: addition of fixed computers in central/shared areas to support communication amongst the care team, completion of individual clinical documentation and chart review; addition of single articulating wall-mount computers in the middle of the footwall in two-bed patient rooms; providing a total number of devices exceeding the number of providers working at peak times ensuring equipment is available in locations that support clinical workflow and just-in-time documentation; and development of a secure tap-access configuration allowing providers to log in/out of the EMR on shared workstations in less than 5 seconds.


      Conclusion/Implications/Recommendations:
      Improving healthcare design through a variety of iterative or progressive methods is beneficial but also requires time and resources to do comprehensively. The use of multiple methods including observation, focus groups, co-design sessions, simulations, questionnaires and technology assessments, allowed the team to study how the EMR implementation would impact clinical workflow from multiple perspectives. Some of the challenges were related to the limitations imposed by the use of the existing space. The methods used helped the project team understand key themes, user needs and design requirements to assist with implementing EMRs within IP units and the ED. But working under the pressing realities of tight time constraints combined with limited human resources to collect and analyze information, factors all too common in healthcare design, resulted in a preliminary analysis and reliance on tacit decision-making to guide the EMR integration.


      140 Character Summary:
      Use of multiple methods within a human-centered design framework to optimize user experience and clinical workflow by supporting EMR hardware and access solutions

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      RF02.02 - Learning Health Systems: Conceptualisation, Characterisation and Examplar Works (ID 139)

      Scott McLachlan, EECS (RIM), Queen Mary University of London; Mile End/GB

      • Abstract

      Purpose/Objectives:
      Learning health systems (LHS) lack a reference framework and taxonomy within which solutions could be characterised. This gap is illustrated in recent proceedings of ICHI 2017and MIE Informatics for Health 2017conferences where only a handful of relevant works were aware of being LHS. This gap prevents formation of the critical massof research efforts on LHS. The main objectives of this work are to present and demonstrate: (1) a conceptual approach to characterise the domain of LHS; (2) investigation into a comprehensive LHS framework and taxonomy; and (3) application of the approach, framework and taxonomy to three LHS research works.


      Methodology/Approach:
      For the first objective, a conceptual approach was investigated to characterise LHS based on abstraction of the clinical learning lifecycle into a design thinking-based triad. For the second objective, we developed a taxonomy for LHS by applying concept and thematic analysis on a body (n=230) of LHS literature. The conceptual approach and taxonomy were then used in the development of an LHS framework, considering the learning healthcare organisational model. For the third objective, the approach, framework and taxonomy were applied in three significant research works in the LHS domain.


      Finding/Results:
      The approachpresented provides researchers with clear and accurate conceptualisation for LHS. Presented as a triad covering learning, predicting/deciding and practice the approach provides strong demonstration of how under-representation of one part of the triad leads to the entire health system becoming ineffective. The taxonomyunifies under one model the taxonomic knowledge in the LHS domain, providing a complete representation of all of the currently known types of LHS. Successfully validation of the entire body of LHS literature using this taxonomy led to a key secondary finding that: while each of the nine types of LHS can be found independent from others, the Cohort Identification LHS type is consistently found as a component the other types. The framework unifies health technology, the learning health organisation and LHS, identifying where each LHS type is applied and how such application leads towards the provision of precision medicine. The LHS paradigm allowed us to fully exploit the routinely collected data from the healthcare system.Thus, the development of knowledge-intensive methods for generating synthetic EHR was successful, making it easy to create collections of realistic synthetic EHR for use in secondary uses where privacy concerns prevent release of real data. Furthermore, the development of knowledge-intensive models is enabled to allow predicting patient risk for particular negative outcomes or recommending appropriate and potentially more effective treatments based on the patient?s characteristics, history and current condition.


      Conclusion/Implications/Recommendations:
      LHS are a significant evolution of evidence-based medicine. Greater awareness of LHS is required if we are to achieve success in our goal of delivering precision medicine. LHS may be used in a wide range of systems and application domains, providing benefits to all areas of health care. Use of the approach, taxonomy and framework helps address the challenges in realising all that LHS promise.


      140 Character Summary:
      New conceptualisation of Learning Health Systems (LHS) is demonstrated in three significant healthcare challenges to help in correctly characterising LHS works.

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      RF02.03 - A Virtual Ambulatory Hospital: Video Visits to Enhance Patient-Centered Care (ID 361)

      Andrew Schroen, IM/IT, Women's College Hospital; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Heath care is no stranger to telemedicine. However, technological advancements have created opportunities to make the health care system more accessible and all-inclusive for everyone. Improved health information system (HIS) interoperability and the Canadian government?s declaration of ?high-speed? internet as an essential for quality of life provides the essential requirements for telemedicine to thrive. In turn, heath care sites are looking to new models of virtual care for patient visits to change the face of access in Canada; addressing access barriers due to distance and stigma as well as patients who have mental and/or physical constraints. This presentation will demonstrate how Women?s College Hospital (WCH) ambulatory model is adopting virtual care through the use of video visits while integrating seamlessly with their existing HIS applications; (1) electronic health record (EHR), (2) patient portal, (3) community provider portal and (4) mobile apps.


      Methodology/Approach:
      The fist video visits will be scheduled for winter 2019 and will be gauged for its effectiveness using measures of patient satisfaction with their experiences with video visits. This data will gathered using a mixed methodology of interviews and electronic surveys that contain both quantitative and qualitative questions.


      Finding/Results:
      To date, myHealthRecord has continuously demonstrated a high level of interest with over a 21,000 patients using the portal. This provides WCH an opportunity to meet patient needs by leveraging a widely used tool that?ll optimize the delivery of care and enhance the patient experience by developing WCH?s partnership in patient care. Patient engagement efforts (surveys and working groups) have identified that video visits are desired amongst WCH diverse patient population. WCH?s strategic plan to build a virtual hospital will ensure appointments are patient-centered and all-inclusive. Specifically, WCH?s goal is to provide 25% of visits virtually by 2022; consults, follow-ups, addictions outreach, post-surgery monitoring, etc. Moreover, the above is feasible as a result of WCH?s successful interoperability between Ontario Telemedicine Network (OTN) and WCH?s HIS applications (EHR, patient portal, community provider portal and mobile app) that enable versatile video visit connectivity between any of the HIS applications simultaneously (i.e. allowing for 2+ participants to partake in a session from different locations).


      Conclusion/Implications/Recommendations:
      Video Visits build the foundation of a virtual care model. When integrated into the health care system, they provide opportunities that drive patients care by enabling direct and self-managed care as well as increased access and equity. The true benefits of how vide visits impact patient care is through effectively measuring the data that comes directly from patient?s feedback to ensure that on going efforts are centered at improving the functionality of video visits. Utilizing video visits to deliver a new model of technology-enabled care will build a virtual hospital, where clinicians are able to remotely care for patients as well as support locale care providers through consultation.


      140 Character Summary:
      Adopting video visits while integrating seamlessly with HIS applications; electronic health record, patient portal, community provider portal and mobile apps.

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      RF02.04 - Creating Consensus with 100+ Physicians for Better and Safer Communication  (ID 90)

      Donald Fung, North Bay Regional Health Centre; North Bay/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Traditional physician communication (paging) is prone to missed or late calls and gaps that can impact patient care, safety and satisfaction. There also many other limitations of paging: one-way communication, insufficient clinical context, and no way of confirming message receipt. Therefore, a new generation of physicians are using smartphones to collaborate; and while texting has tremendous benefits, it can also pose privacy risks if not done right. To address these challenges, North Bay Regional Health Centre (NBRHC) implemented a mobile communication solution that enables secure texting and intelligent clinical workflows. Clinical and IT leaders at NBRHC felt a purpose-built healthcare solution that could be adopted by all physicians would lead to a more accountable and safer way to connect and collaborate. With a secure and flexible mobile app, physicians can use their device of choice to share contextual information that empowers them to consult quickly, easily and accurately.


      Methodology/Approach:
      Changing a traditional communication pathway and replacing deeply ingrained process required a culture and behavioral shift. Simply putting apps on physicians? smartphones would not work; and would likely create greater gaps. Therefore, the IT team engaged physicians in the change process every step of the way with full support from the chief of staff, medical leadership and senior leadership.

      Physician, nursing and allied health influencers were identified and regularly consulted to inform many important aspects of the project?including the creation of the RFP, communication and engagement strategies, etc. This key group familiarized themselves with the technology and were then able to share the benefits, challenges and potential barriers to adoption. Through regular PDSA (plan/do/study/act) cycling, the technology and workflows were tested. When potential issues were identified resolutions happened in real time. Champions were invited to weekly strategic meetings, including physician, nurse, medical affairs IT, switchboard, and quality representation. There, training and delivery programs were created to target the unique needs of each group. By proactively supporting users in identifying solutions and removing barriers to adoption, they gained confidence and trust in the system.


      Finding/Results:
      NBRHC is the only hospital in Canada to have 100% physician adoption of this technology and to have standardized physician communication using one platform. It is now a success story for other hospitals leader to consult before evaluating and implementing an enterprise-wide communication solution. NBRHC has effectively taken the middleperson out of communication and accomplished: 100% adoption of Vocera Collaboration Suite, which enables secure texting. Implemented a single communication system for our medical staff to simplify workflows and improve collaboration 152 physicians, 24 locums, 3 physician assistants and 35 residents 11 physician services with 27 on-call groups


      Conclusion/Implications/Recommendations:
      Success was achieved because of the strong partnership between IT, quality and clinical leaders. We sought out physicians and nurses who were respected and influential among peers. These clinical leaders were able to understand how the technology could benefit clinical practice and inform how it should be implemented. They were more than sponsors; they were active participants and champions. Transformation was about more than IT improvement. It was about elevating patient care.


      140 Character Summary:
      How NBRHC got 100% physician adoption on a better, safer and secure communication platform that standardized communication and improved patient care.

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      RF02.05 - Leading Change in the Face of Healthcare Technology Revolution- 100% On-Board (ID 132)

      Laura Copeland, Healthtech; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Health technology implementation and adoption is a risk for many organizations. Terrifying tales of failures of multi-million dollar projects introduce fear to all those embarking on health IT change. Simultaneously, healthcare worker satisfaction has become a recognized aim for improvement in the healthcare system and there is significant concern around the possible relationship of information technology implementation to physician burn-out. This presentation will take a closer look at change models, successful case studies and propose innovative new methods of leading health professionals through change. In preparation for transitioning the physicians at a 650+ bed hospital from their predominantly paper environment into a fully digital hospital, many change models were considered and a very careful engagement, readiness assessment, communication, training and support plan was crafted and implemented. This resulted in 100% adoption of the new systems by physicians. It also provided an opportunity for lessons learned and awareness of the need to further explore other methodologies and case studies. Objectives include: ?Describe a successful change methodology ?Share lessons learned from case studies and industry standards ?Integrate wisdom from models that were not considered during the design, specifically focusing on the value of introducing Indigenous perspectives ?Present a proposal for future implementations and research in the area of change leadership


      Methodology/Approach:
      A combination of personal experience, literature review and interviews with experts will be utilized as sources in this presentation.


      Finding/Results:
      There are many commonalities between methodologies of change across cultures, all aligning with the psychology of transition. In reviewing organizations with successful implementations of health IT systems, it becomes clear that the key success factors are positive relationships and a commitment to supporting people through change. Yet, so often this important component is set aside by those trying to create a technically functional system.


      Conclusion/Implications/Recommendations:
      If we take the time to teach the important people-centred behaviours to our IT team and organization as a whole, we can create useful systems and happy users. There is ample room for education, research and best practice sharing on this topic.


      140 Character Summary:
      Coming from an evidence and experience informed perspective, learn the best way to have a successful implementation: It's about the PEOPLE, not the technology!

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    RF03 - Patient Empowerment: It's about Time! (ID 45)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical and Executive
    • Presentations: 5
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 8
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      RF03.01 - Advanced use of EMRs yields greater benefits: 2018 Canadian Physician Survey (ID 432)

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

      • Abstract
      • Slides

      Purpose/Objectives:
      Clinicians, governments and the digital health sector have all made significant investments supporting adoption, use, and interoperability of Electronic Medical Records (EMRs) and associated digitally-enabled health services. We sought to update the current use and value of digital health technologies in practice by specialist and primary care and specialist physicians in Canada. The objective of this presentation is to highlight key insights from the 2018 Canadian Physician Survey while focusing on three main themes: advanced use of electronic medical records (EMR); use of functions related to medication management; and advanced use of consumer-facing e-services such as patient access to their own health information, e-visits, and e-booking of appointments.


      Methodology/Approach:
      A total of 1,393 physicians completed the survey: primary care physicians (PCPs) N=799; and specialists N=594. The survey was conducted in French and English using a multi-method promotion and recruitment strategy. A weighting methodology, developed by the Canadian Institute for Health Information (CIHI), was applied to all responses representing the (estimated total) 78,839 of eligible physicians in Canada. Weighted and unweighted results of the survey were compared; and comparison of the unweighted demographics to the 2018 Canadian Medical Association Masterfile physician profiles demonstrated no statistically significant differences between the 2018 CPS and the CMA Master file via Chi-Square test.


      Finding/Results:
      Use of EMRs is demonstrating significant efficiency benefits for physicians and the health system as evidenced by 82% of PCPs and 77% of specialists who stated that they provide more efficient care with electronic records. However, not all physicians are using EMRs in the same way or have access to the same functionality. While PCPs frequently access lab results (80%) and diagnostic images (74%), other functions such as ?generate lists of patients who are due or overdue for tests or preventive care? or ?electronically exchange patient clinical notes with any doctors outside your practice? are more rarely used. Use of more advanced clinical functions such as these is correlated with higher perceived efficiency and higher satisfaction with physician EMR systems than basic use (use of just 1 or 2 functionalities). A key finding is that 84% of highly optimized PCP EMR users (using 6 to 9 functionalities) are satisfied with their EMR, compared to only 49% of PCPs using 1-2 functionalities. Similar findings were observed when correlating use of medication management functions such as generating an electronic prescription with an EMR and use of electronic warnings for drug interactions and perceived efficiencies. Additional findings related to physicians? use of virtual care and consumer-facing e-services were also captured in the survey.


      Conclusion/Implications/Recommendations:
      A majority of primary care and specialist physicians use EMRs and have access to connected patient information from care settings outside their main practice. The methods of electronic access to clinical data from connected health information systems differs across jurisdictions and community-based and hospital care settings. Furthermore, there are various levels of integration with point-of-care EMRs such as viewers, in-context single sign-on, and direct data feeds. Altogether, these findings show growing adoption of digital health across physician practices.


      140 Character Summary:
      The 2018 Canadian Physician Survey maps use of EMRs in primary care and specialist practices. Advanced use is correlated with higher efficiency and satisfaction.

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      RF03.02 - Deploying Ontario’s Largest Regional Patient Portal: Keys to Success (ID 182)

      Mark Berry, HITS eHealth Office, Hamilton Health Sciences; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      This presentation offers an update to what was presented last year about the massive, first-of-its-kind patient portal deployment in south west Ontario ? an initiative led by the HITS eHealth Office at Hamilton Health Sciences, leveraging Sunnybrook Health Science Centre?s MyChart solution. MyChart was officially introduced to patients at select Hamilton Health Sciences and London Health Sciences clinics in the fall of 2018. A significant collaborative effort from project stakeholders preceded MyChart?s deployment, including the intricate data integration into MyChart from ClinicalConnect, a regional clinical viewer utilized by 40,000+ authorized providers practicing in south west Ontario. Panelists will each bring their own unique perspective on managing a complex, multi-stakeholder technology transformation project ? the largest regional deployment of a patient portal platform in Ontario ? sharing lessons learned, challenges, and opportunities.


      Methodology/Approach:
      Part 1 of this project was to complete technical work to allow reports from hospitals and regional cancer programs, and LHINs? Home & Community Care Services, to flow through ClinicalConnect to MyChart. Part 2, actively underway at the time of abstract writing, is to deploy MyChart to patients registered at the hospitals whose data now also viewable in MyChart. mychart graphic.png


      Finding/Results:
      A deployment of this magnitude presented challenges that could be categorized as cultural, technical, clinical and legal. Some key findings from each: Cultural - Gain regional-buy in through a shared vision and inclusion of stakeholders from LHINS, hospitals, and MOH in project decision making - Educate organizations and health professionals regarding the evidence of benefits noted from Canadian and international patient portal deployments Technical - Determine limitations of systems to understand confines of what was possible - Educate stakeholders about limitations to ensure expectations managed - Co-design technical architecture with solution vendors (Aptean and Sunnybrook) - Usability review and testing Clinical - Comprehensive stakeholder consultation, including: - Patients and families - Clinicians - Pan-Canadian industry review - Health records policies and procedures - Legislative reviews (PHIPA) Legal - Develop a collaborative agreement framework, outlining roles and responsibilities Note: An overview of number of registered MyChart users/usage stats to date will be presented and will be current up to the conference.


      Conclusion/Implications/Recommendations:
      This project compiled patient information from acute sites and worked to integrate more data sources to give patients a fulsome view of their health information as it phases in information from provincial assets and primary care. The result has been an effective integration of a vast amount of personal health information from hospitals across south west Ontario, in addition to giving patients data access they may have at other existing partner sites (i.e. MyChart?s non-SWO data contributors).


      140 Character Summary:
      Integration of south west Ontario hospitals? personal health information, via ClinicalConnect, with Sunnybrook?s MyChart for patients and their caregivers.

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      RF03.03 - In Pursuit of Patient Empowerment: Collaborative Advances in Measurement Design (ID 281)

      Tracie Risling, Nursing, University of Saskatchewan ; Saskatoon/CA

      • Abstract

      Purpose/Objectives:
      Purpose/Objectives: Patient empowerment has emerged as a crucial element in the ongoing evolution of healthcare delivery. Connections have been established between patient empowerment and improved engagement in care, commitment to healthy behaviours, and more active participation in shared decision-making. Research supports patient empowerment as a means to improve outcomes and lower healthcare costs. The challenge in advancing empowerment interventions however, is a lack of clarity regarding how best to capture the concept in a comprehensive and scientifically sound measure. The purpose of this research is to collaborate with patients to address this urgent measurement need in empowerment research. This presentation includes results from the first year and phase of this research where Q methodology was employed to engage participants in identifying priority aspects of patient empowerment for inclusion in a newly designed measure.


      Methodology/Approach:
      Methodology: This study is being conducted in three phases, each with a distinct methodological focus. In the first phase, Q methodology was used to support patients in sharing their views of empowerment as well as prioritizing key characteristics of the concept for operationalization. Q methodology unites the strengths of qualitative and quantitative research to capture personally held subjective views often expressed by attitudes, appraisals, or through reflections on life experiences. In this approach, participants form a P set, and rank order statements contained in a Q set that is then subjected to factor analysis. The Q set for this project was drawn from past pilot work on patient empowerment, led by members of this study team, with patients who had been given access to their electronic health record (EHR,) and through an extensive review of the literature on empowerment, engagement, and activation.


      Finding/Results:
      Results: More than 100 patients completed the Q-sort exercise representing a broad range of ages, reported health status, and a self-identified technology adoption using Rogers? Diffusion of Innovation Theory. In addition to completing the Q-sort exercise, participants provided a 5-minute digital download interview where they spoke to choices made during the sort. This interview data was coded and themed using a qualitative approach. The Q-sort data was processed with software specifically designed for the method, producing factor analysis results which were then used to identify essential elements for a new patient empowerment measure.


      Conclusion/Implications/Recommendations:
      Recommendations and Conclusions: Patient empowerment is a key aspect of the trifecta of patient empowerment, engagement, and activation, and yet there are significant deficiencies in existing measurement for this concept in particular. This first phase of this research has revealed patient selected essentials for measuring patient empowerment within the digital health context. These elements and the emerging measurement tool will be detailed in this presentation, along with qualitative commentary from patients themselves on the important role of empowerment and digital health in their daily lives.


      140 Character Summary:
      Patient voice was needed to correct deficiencies in empowerment measure and this presentation includes patient identified essentials in developing a new approach

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      RF03.04 - Uncovering the Mysteries of Electronic Medication Reconciliation (ID 420)

      Kristie McDonald, Clinical Informatics, Island Health Authority; comox/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Electronic medication reconciliation (eMedRec) is a complex process. For some, medication reconciliation is a new concept; for many, the first implementation of eMedRec within Island Health Authority?s Nanaimo Regional Hospital may have had unintended consequences on ordering practices, end user experiences, and the delivery of patient care.


      Methodology/Approach:
      An Island Health Authority interdisciplinary Think Tank was formed to closely examine eMedRec. Think Tank participants consisted of clinical informaticists, providers, pharmacists, pharmacy informaticists, medication safety and professional practice consultants, and educators. Workflow analysis and detailed testing were conducted over a series of four workshops. Simulating clinical and provider BPMH and reconciliation workflows, participants observed the flow of data and how it ?behaved? differently when using different synonym orders. As participants shared stories and knowledge, risks were tracked and analyzed, education and practice gaps were uncovered, and mitigation strategies unfolded. Through didactic conversation, open dialogue, and interprofessional discourse, knowledge from multiple perspectives was shared. This supported a deeper understanding of why the data behaved differently; some of the mystery and unknowns were uncovered.


      Finding/Results:
      Throughout the workshops, the Think Tank experienced data behaving in a seemingly mysterious or unpredictable fashion. Through a lens of curiosity and focused effort, members of the Think Tank identified three of the most challenging components to navigate: 1. Search struggles with result returns when searching for medication orders: 2. Conversion confusion regarding auto conversion and failure resolution: 3. Prescription paralysis related to difficulty with prescribing:


      Conclusion/Implications/Recommendations:
      Prior to the Think Tank sessions, understanding of synonyms and conversion logic was only understood by Pharmacy Informatics. It was through the common and vested interest of the Think Tank that several recommendations are underway. These include but are not limited to: -Conduct a third party vendor analysis of system parameters that might impact on auto conversion rates and ordering practices -Review Think Tank recommendations with Executive Steering to determine which will be actioned -Develop a plan for implementation of Think Tank recommendations -Host change management events -Provide education to fill current state gaps -Establish a governance structure that will clearly outline roles, responsibility, monitoring, and accountability -Implement and support front line users with changes -Create a permanent Working Group to continue to enhance eMedRec process -Build provincial networks to share ideas related to eMedRec While eMedRec continues to be a complex process within the CIS, it is vital to remain curious and unrelenting in uncovering remaining challenges. A Think Tank or small working group can provide further insight through interprofessional discussion and discourse, testing of system enhancements, and providing end users with the ability to provide ongoing feedback. Patients? care remains at the heart of why healthcare exists; unsolved challenges of eMedRec should not result in a discharge medication list that is a ?mystery? to providers or patients. Patients deserve to have a clear understanding of which medications they should be taking following discharge in order to stay safe.


      140 Character Summary:
      A Think Tank seeks to understand why end users experience challenges documenting home medications, managing conversion failures, and writing prescriptions.

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      RF03.05 - SmartMom: Delivering Prenatal Education Through Text Messages in British Columbia (ID 441)

      Pooja Patel, Office of Virtual Health, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Only one third of women attend childbirth education classes in Canada. Women living in rural and remote areas of British Columbia (BC) cannot always access in-person education in their community. Pregnant women increasingly use the Internet and mobile apps for pregnancy and childbirth information, and we are cognizant that these are often developed by lay groups or for-profit organizations, which can be unreliable. SmartMom is Canada?s first evidence-based prenatal education program delivered by text messaging. SmartMom provides women with accurate, timely and relevant information based on their stage of pregnancy and directs them to local resources, all reacted by a group of researchers, clinicians, and allied health professionals. The program is endorsed by the Society of Obstetricians and Gynaecologists of Canada, BC Ministry of Health, and Optimal Birth BC. The main goal of SmartMom is to improve health literacy and motivate health behaviour change among pregnant women. Currently, it is implemented in the Northern (NHA) and Fraser (FHA) Health Authorities in British Columbia.


      Methodology/Approach:
      Women who are pregnant, have access to Short Message Service (SMS) communication, and understand English can enrol in SmartMom. Pregnant women can enrol in SmartMom at any time during the pregnancy and can opt out at any point as well. They are invited, and asked for consent, to provide demographic information, complete a knowledge quiz and standard surveys about fear of childbirth and depression. An interim descriptive statistics analysis was conducted.


      Finding/Results:
      As of August 9, 2018, 48 women living in the FHA and 210 women living in the NHA were enrolled in SmartMom, totalling to 258 women completing the enrollment surveys. In both groups, most women owned smartphones (FHA=100%; NHA=97.6%) and the average age of participants was twenty. Knowledge gaps were demonstrated through questions most often answered incorrectly, which included healthy weight gain during pregnancy (% incorrect: FHA=71.1; NHA=80.7) and the safety of caesarean section vs. vaginal birth for both mothers and babies (% incorrect: FHA=55.6%; NHA=54.4%). Participants? fear of childbirth, on a scale with a maximum of 66, averaged 34. Valuable information has been obtained highlighting knowledge gaps about childbirth and pregnancy and general confidence in labour and childbirth.


      Conclusion/Implications/Recommendations:
      Using innovative and patient-tailored approaches, the SmartMom program can address the knowledge gaps and childbirth fear identified in our analyses. SmartMom delivers reliable prenatal education in a format that meets the needs of pregnant women in British Columbia and beyond, especially for those living in rural and remote communities. Equitable prenatal education access remains an issue in Canada, and creative technology facilitates greater access and increased knowledge. Expansion and scaling-up of SmartMom is currently ongoing to other British Columbia health authorities and the Northwest Territories and is met with positive feedback from patients. Supported by clinicians with evidence-based roots, pragmatic and simple harnessing of technology can fill gaps and meet patient needs for prenatal education for pregnant women using SmartMom.


      140 Character Summary:
      British Columbian women are using SmartMom, Canada?s first evidence-based prenatal education program delivered by text messaging.

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