Purpose/Objectives:
With digital health journey advanced, number of new applications and computing devices increases dramatically and so does support demand. Hospital IT support team is facing a number of challenges in maintaining the SLA (Service Level Agreement) and struggles to do more with the same level of resources on hand. At North York General Hospital (NYGH) Information Services Helpdesk (IS Helpdesk), compliance rate of SLA drops below 60% and the team requires 25% more FTE to keep up the demand at its peak time. Hospital users waited much longer in receiving the support or getting their working devices back. Patient care is suffering and directly impacted ? delayed or sometimes cancelled. Will be sharing with audiences on what methodology/innovated solutions were developed and implemented; how the team went from 25% under-resourced to giving back 6600 hours to patient care; and how they turned IT support from largely reactive mode to more consistent proactive actions.


Methodology/Approach:
NYGH IS Helpdesk has implemented many innovated solutions, highlighted solutions in last 18 months below. 1. Shift Left Methodology: Shift-left for the IT Helpdesk is the movement of IT support closer to the operational frontline and the end user/customer. 2. Walk-in Support Centre: A community focal point that bridges the gap between hospital personnel and traditional IT support (level 0 and level 1). 3. Preventive Maintenance (PM): Time spending on Preventive Maintenance is much less than the time spending on recovering a system after an incident. 4. Scan to reset password: an in-house tool was developed and equipped at the Walk-in support centre aiming to cut down the password reset process from minutes to seconds. By scanning a hospital badge, staff can obtain a new password and come back to their normal duty in 30 seconds.


Finding/Results:
- System incidents has dropped more than 550 tickets every month (23%) from its peak time. - IS Helpdesk team shifts its workforce from Incident Resolution (drop from 58% to 37.5%) to Proactive Maintenance (increase from 0% to 20.8%). - Phone support is among the top performers comparing to other professional support centres: Item Professional Support Centre NYGH IS Helpdesk Average Speed to Answer 28 secs 14 secs Abandon Rate 8% 7% Call Duration 4 mins 3.05 mins Percentage of Password Reset Calls 33% 4%


Conclusion/Implications/Recommendations:
This presentation provides quick tips, pros & cons, and lessons learned from NYGH?s experiences. Audience takes away a solution of improving employee productivity, increasing efficiency and enabling innovation & value creation in the healthcare environment.


140 Character Summary:
Technology is the backbone of digital health. IT teams can get from this session on how to keep innovating solutions and show the values to the senior leadership team.

Purpose/Objectives:
CHRISTUS implemented computer workstation single sign-on (SSO) in 19 community hospitals. SSO technology utilizes a badge reader placed at each workstation where clinicians ?tap? their identification badges for expedited access to the EHR and related software. Executive management at CHRISTUS had expressed concerns about the costs and value of SSO implementation, thus a team assessed how much impact, if any, SSO was having on clinician workflow, efficiency, and value.


Methodology/Approach:
Following implementation of SSO, login time duration was sampled systematically in 128 logins during a 7 day period across 8 hospitals selected randomly from 19 facilities, one from each of the 8 regions within the CHRISTUS enterprise. Mean first of shift login duration and mean reconnect login duration was compared to durations pre-SSO implementation. Dollar values of time saved were assigned to 3 groups of clinical end users: physicians, nurses and ancillary service providers. Total per facility and enterprise-wide clinician time liberated from keyboard are reported in hours and dollars saved per week and per annum.


Finding/Results:
Following SSO implementation, first of shift login was reduced by 5.3 seconds and reconnect login duration in the balance of the shift was reduced 20.4 seconds. Total weekly time savings enabled by SSO was 943.4 hours across 19 hospitals, a mean of 49.7 per facility. Annually, 49,056.8 hours of mixed clinician time was liberated from keyboard, a mean of 2584.4 hours per facility per year. The annual dollar value of clinician time liberated from keyboard was $3,201,001 and $168,474 per hospital per annum.


Conclusion/Implications/Recommendations:
A critical implementation lesson learned was the recognition that in order to achieve the best performance of SSO technology, migration to the cloud and a virtual desktop with a thin client should be considered before implementation. In these 19 hospitals, SSO is an effective and highly cost-effective method to liberate clinician time from repetitive, time consuming logins, and delivered real, meaningful liberation of clinicians from keyboard. The recurrent, ongoing annual dollar value of this time liberated by SSO for clinicians to focus on providing patient care exceeded the one time initial implementation costs of SSO, and far exceeded its recurrent annual cost to the system.


140 Character Summary:
CHRISTUS Health?s new computer workstation single sign-on (SSO) platform reduced clinician log-in time, improved workflow, and delivered bottom-line savings.

Purpose/Objectives:
The goal is to make working rounds efficient, to share relevant data with the team more effectively, to process the data and arrive at diagnostic and therapeutic considerations for each patient every day in a more timely manner than presently implemented.


Methodology/Approach:
Clinical (?work?) rounds, can take anywhere from 3-4hrs in length depending upon the complexity and the number of patients being managed by the medical team. The primary goal is for the central core of providers to use distribution or sharing of cognition to create and follow a plan for each patient while giving effective continuity of care. Multiple levels of staff will have obtained data from: a) sign-out from covering house staff, b) review of paper and EMR; and, c) direct questioning and examination of the patient. We propose to increase efficiency and effectiveness of walking rounds, through a simple modification of existing hardware tools used during rounds, i.e. the mobile battery powered EMR computer carts, found in most hospitals today. Modifications include; the addition of a digital projector for projecting onto existing walls or curtains and/or by adding dual 30? monitors to the cart. In addition to the hardware modifications, the creation and use of a web application will be designed to navigate the EMR by creating a simple face-sheet in an easy to read user interface (UI) with all pertinent information laid out using the space available intelligently.


Finding/Results:
Working memory has limitations, EMR tools will assist in the process. One of the tools most commonly utilized during rounds is a battery powered mobile computer cart for EMR access. There are several restrictions and limitations with this approach including; a) suboptimal computer arrangement ? with screen size limitations and; b) requirement to have most meaningful data held in working memory, c) fragmented nature of rounds, with multiple distractions and interruptions, and, d) lack of closure relating to patient plans. These changes will accomplish multiple goals; increasing actual image size allows for easier reading and sharing of information in a group setting; visual representation of relevant information cuts redundant and inappropriate information from the EMR during rounds, and including visual memory tools and cues i.e. a picture of the patient and other types relevant infographics make for better working memory utilization.


Conclusion/Implications/Recommendations:
Ultimately, we predict these changes will ease the cognitive burdens on the clinical team, reduce medical error and improve the quality of patient care. Multiple problems may arise in this type of public sharing of information including possible HIPAA concerns and social ramifications and will be addressed in the poster.


140 Character Summary:
Shared cognition tool to increase efficiency, share relevant data effectively, diagnose & arrive at therapeutic considerations in the most timely manner.

Purpose/Objectives:
Canada?s health sector is increasingly relying on the adoption and successful use of information and communication technologies (ICT) in all care settings. Therefore, care providers, such as registered nurses, must possess the required knowledge and skills to effectively utilize digital health tools in the provision of safe, quality patient care in today?s technology intensive clinical settings. As the largest group of care providers in Canada, the development of core digital health competencies among practicing and future registered nurses is of the utmost priority. The purposes of this study were to: (1) describe the current state of Canadian nurse educator integration of digital health in nursing education and the current state of digital health content integration into nursing curricula, (2) to understand needs of nurse educators in promoting their capacity and future development of digital health integration, (3) to identify teaching and learning exemplars of digital health integration in nursing curricula, and (4) to identify recommendations for advancing the development of informatics and digital health in nursing education.


Methodology/Approach:
Research questions were addressed using multiple methods including surveys, telephone interviews, and a focus group; target participants included nursing educators and administrators within Canadian schools of nursing.


Finding/Results:
The results depict the current state of digital health content integration in nursing curricula in Canada and identify nurse educators? capacity to integrate and utilize this content, and the impact of efforts to increase nurse educators? capacity in informatics to date. The qualitative and quantitative findings from this study indicate that a number of schools of nursing have incorporated informatics content within their basic curricula, while others offer elective courses at the graduate and undergraduate level, and the remainder provide little to no content in any of their nursing programs. These discrepancies exist even though Canadian core nursing informatics competencies for new graduates have been available since 2012.


Conclusion/Implications/Recommendations:
Recommendations for next steps in faculty and pedagogical development needed to further advance the curricular integration of digital health will be discussed. This study was made possible through the support of Canada Health Infoway and the Canadian Association of Schools of Nursing.


140 Character Summary:
Findings from a national study of digital health curricular content and faculty capacity in Canadian schools of nursing will be discussed.

Purpose/Objectives:
eHealth Ontario helps health care stakeholders integrate with provincial digital health solutions. This session introduces eHealth Ontario?s Innovation Lab, discussing how the lab has grown since inception, its promotion of innovation in Ontario what we have learned and our vision for the future.


Methodology/Approach:
The lab was built to help eHealth Ontario drive risk out of our own technology projects. Along our journey, we recognized the opportunity to enable innovation on a broader scale. The approaches used for growing the Innovation lab include: Cast a wide net. Attract talent that is interested in health care, but is unfamiliar with health care-specific standards and protocols. Offer various services which enable knowledge transfer: Lite Services are designed for anyone to access high value interactions for proof of concept, garnering initial clinical and financial support. These are for ?getting started? and freely accessible. Specs and Standards documentation which provides pertinent information to innovators in a central location Code Sharing allows innovators to repurpose work which has been successfully tested, it is also a platform for near-real-time feedback from the development community Discussion board empowers innovators to have conversations with their peers enabling support, shared lessons learned, and a gathering point for innovators. Keeping in step with Healthcare technology trends Introduction of the FHIR (Fast Healthcare Interoperability Resource) standard for a number of our assets Introduction of Innovation Lab 2.0 in support of eHealth Ontario?s new technology modernization priorities (Cloud, API Management, web viewlets, containerization, modernized data holdings) to expedite development, prototyping, and conformance testing.


Finding/Results:
There are currently over 800 registered users from the vendor community, academic institutions, small incubators, and teaching hospitals using the Innovation Lab Through feedback from Innovation Lab users, and building on the services of Mohawk College?s Mohawk eHealth Development and Innovation Centre (MEDIC) and workshops with stakeholders, we discovered the following: - Numerous organizations across Canada (from individuals to large academic institutions) have used the various Innovation Lab services to familiarize themselves with the healthcare space, interact with fellow developers, use code that has already been complied, as well as build and validate Proof of Concept - 1500 site visits per month - 11 code project shared with 3600 combined views


Conclusion/Implications/Recommendations:
Our ?start small and grow? approach has allowed us to fund the lab with a modest budget and experience success from our initial services. Moving forward, the Lab will evolve to keep pace with modern services and upgraded technology to empower innovators. The Lab will take advantage of cloud services to consistency benefit from new technologies and seamless hosting. APIs, common elements, containerization, Kafka solutions will be employed to keep pace with IT developments. Most importantly, we will continue to engage stakeholders from across the province to develop a consortium community for the Lab, where all parties feel part of the solution. Partnerships with other EHR service providers are key. Nobody owns technology innovation; much like the Lab it should be open, transparent and collaborative.


140 Character Summary:
eHealth Ontario?s Innovation Lab our open digital health sandbox, enables ehealth solution testing in a virtual environment to prototype new ideas.

Purpose/Objectives:
Patients requiring specialist care in Canada often face poor access and excessive wait times which can lead to patient stress, missed appointments, and ultimately, poorer health outcomes. The implementation of innovative e-Health technology such as electronic consultation (eConsult) and referral (eReferral) systems has aimed to improve access and reduce wait times for specialist care. Electronic consultation allows the specialist to give advice to the primary care physician through an electronic platform, often without the need for a face-to-face visit. Electronic referral is the automation of the referral process allowing for the secure exchange of patient information. In this presentation, we examine what private and publically funded services are available in Canada and compare their operations in the context of the Canadian healthcare system.


Methodology/Approach:
An environmental scan consisting of 2 stages was conducted in Fall 2018. First, a grey literature search was performed using four different search engines (Google, Duckduckgo, iOS App Store, Google Play Store) using an established keyword matrix. The next stage of the environmental scan is a key informant interview. From the stakeholders that the grey literature search generated, a list of potential interview candidates was created and contacts were emailed. Maximum variation sampling was employed to ensure sufficient breadth of participant experience. Semi-structured interviews are currently being conducted over the phone using a guide based off of the RE-AIM framework. We will then conduct a qualitative review of interview transcripts using a thematic synthesis approach.


Finding/Results:
The grey literature search yielded 24 systems offering eConsult services and 15 systems offering eReferral in Canada. Ontario had the most eConsult (29%) and eReferral (67%) services followed by Alberta (25% and 20%, respectively). Private vendors comprised 42% of eConsult systems and 60% of eReferral systems. The most common technology platform utilized was web-based for both eConsult (78%) and eReferral (60%). There were 4 service providers (11%) who offered both eConsult and eReferral services. Interviews are currently underway. Full analysis of recurring themes will be completed prior to the presentation.


Conclusion/Implications/Recommendations:
The potential of eConsult and eReferral systems to improve access and patient satisfaction have been recognized across Canada with the emergence of new and innovative services. The Canadian healthcare climate has the capacity to support both public and private systems. Further analysis into the state of eConsult and eReferral services is needed to guide decisions around integration of the two services and appropriate spread and scale.


140 Character Summary:
An environmental scan of the public and private eConsult and eReferral systems available within the Canadian healthcare system.

Purpose/Objectives:
There is a growing concern that a majority of nurses in leadership roles in Canada may not have the requisite informatics competencies to meaningfully participate in making strategic decisions related to the acquisition and use of ehealth systems. Core informatics competencies for Canadian nurse leaders must be identified, validated and disseminated. The aims of this study were to: 1) identify and build consensus on the informatics competencies of relevance to Canadian nurse leaders; 2) obtain the perspectives of nurse leaders on appropriate dissemination strategies for the identified informatics competencies; and 3) disseminate the informatics competencies to nurse leaders across Canada.


Methodology/Approach:
These objectives were met through the completion of a Delphi study of nurse leaders with informatics expertise from across Canada, interviews with a sample of nursing leaders from across Canada, and identifying knowledge translation activities, including an open-access publication, and presentations at relevant meetings and conferences attended by nurse leaders. A Delphi technique was used to achieve consensus on the informatics competencies of relevance to Canadian nurse leaders. Through a series of structured surveys and feedback reports, a panel of experts in the field was consulted to identify and prioritize informatics competency statements specific to nurse leaders. This iterative process used four rounds of data collection; further details of this process will be presented. Qualitative content analsyis will be completed from interviews being conducted with fifteen (n=15) nurse leaders using a semi-structured interview technique to determine the most appropriate dissemination strategies for the identified informatics competencies. The results of these interviews will inform the following: 1) target journal for an open-access publication; 2) target national and regional meetings/conferences/nurse leader groups for presentation of the identified competencies to be completed either face-to-face or via webinar; and, 3) additional strategies to consider for the dissemination of results (e.g., relevant websites to post competencies).


Finding/Results:
This study was in progress at the time of this abstract writing. The presenter will provide the outcomes of the Delphi study and the nurse leader interviews and discuss additional knowledge translation activities to be completed as per the findings of the nurse leader interviews.


Conclusion/Implications/Recommendations:
As a result of the study activities, it is expected that: 1) informatics competencies of relevance to Canadian nurse leaders will be identified and endorsed by national nursing organizations; 2) nurse leaders from across Canada will become aware of the informatics competencies required to be effective in their roles; and, 3) nurse leaders will actively inform strategies for the acquisition, implementation, use, and evaluation of eHealth systems in all healthcare settings. The study activities will catalyze work that will eventually result in the improved selection and use of eHealth systems that effectively support the delivery of safe, quality care that will positively impact the health system and clinical outcomes. In turn, this work will contribute to the obtainment of improved eHealth system outcomes in Canada.


140 Character Summary:
Discussion of validated requisite informatics competencies for Canadian nurse leaders and strategies to develop, disseminate and increase awareness of same.

Purpose/Objectives:
BORN Ontario has partnered with the Ministry of Children, Community and Social Services (MCCSS) and Public Health Units (PHUs) to enhance the way in which key maternal child screening information moves between hospitals and public health care providers to help facilitate care and transitions from hospital to community. Enhancement of the current data collection mechanisms support its transfer to public health units and eliminates the need for manual data capture, faxing and re-keying of personal health information. Objectives: Improve outcomes for children and families in Ontario by applying innovative strategies with accurate, complete screening as well as the potential to identify populations that decline the offer of screening. Enhance knowledge of the initiative and understand the use of innovation to provide a standardized mechanisms for universal postpartum screening for more timely client follow-up in the community Illustration of the reduction in data quality issues through pre-population, data entry and data validation rules Understand how this initiative has reduced the risk of privacy breaches by eliminating non-secure transfer methods of Personal Health Information (PHI)


Methodology/Approach:
Current practice for the HBHC Screen involves a hard copy of the completed form being faxed or manually transported from the hospital to the PHU and then entered into the Public Health database. Faxing, often results in transcription errors, legibility issues, and transmission delays, which is especially problematic for a time-sensitive screen. The risk of a privacy breach is also inherent in the faxing process. BORN has developed an electronic version of the HBHC Screen which is housed within the BORN Information System (BIS).


Finding/Results:
A pilot study was performed to examine whether leveraging BIS infrastructure and existing data collection mechanisms would support increased data quality and timeliness of data transfer. The lessons learned from the pilot provided opportunities to enhance both systems and processes. Use ? There were 4,182 HBHC Screens completed in the BIS during the pilot and 3,125 Screens transmitted to ISCIS from pilot hospitals during the HBHC pilot time period User Satisfaction ? Overall participants were satisfied with the communications, training and support they received during the HBHC pilot. Quality ? During the pilot period, 88.5% of births had a completed HBHC Screen. Duplicate Screens remained an issue throughout the pilot, and has been addressed in the technical fixes for the provincial roll out. There was a significant increase in completeness of the 36 HBHC Screen questions (99.7%). Access ? 77% of respondents reported that they had the technology needed to complete the HBHC Screen in an efficient and timely manner. HBHC Screens were being received by PHUs faster, and families with risk were being contacted sooner. Productivity ? The survey and focus group noted strengthening of relationships between hospitals and PHUs.


Conclusion/Implications/Recommendations:
The BORN-ISCIS Integration HBHC pilot project demonstrated that data from the HBHC Screen can be transmitted from the BIS to ISCIS seamlessly while protecting PHI. This project has led to provincial roll-out of this technology to support and facilitate care to at-risk families in Ontario.


140 Character Summary:
Support the transfer of the HBHC Screen to PHUs by eliminating the need for manual data capture, faxing and subsequent re-keying of personal health information.

Purpose/Objectives:
Incomplete, lost or unclear referral forms resulted in rework, required follow-up, or delayed hospital discharge were identified as potential patient safety concerns within the region. In 2012, a time limited study identified that approximately 90% of a potential 12,000 referrals submitted to home and community care from acute care were missing a significant amount of the mandatory information. Each referral was estimated to take approximately 10 to 15 minutes to transcribe from the faxed original. To address these concerns, the project was initiated with the following goals: Increase patient safety by ensuring that referrals are complete, correct and timely; Reduce the risk of privacy breaches related to the faxing of referral documents; Increase system sustainability by avoiding unnecessary hospital days.


Methodology/Approach:
All five NSM hospitals committed to the electronic adoption of the provincially standardized Resource Management and Referral form. A collaborative project team structure was formed where a Project Manager from Orillia Soldier?s Memorial Hospital (OSMH) led the project with Royal Victoria Hospital Regional Health Centre (RVH) being the initial pilot site. The LHIN provided funding in the first year to support these efforts. Collingwood General and Marine Hospital, Georgian Bay General Hospital, Orillia Soldiers? Memorial Hospital, and Muskoka Algonquin Healthcare have also implement the solution building off the lessons learned and expertise of the preceding sites. The Information Technology teams within each of the hospitals worked with HSSO to design the bi-directional interfaces at their respective sites with support from their hospital information system (HIS) vendors as necessary for custom builds.


Finding/Results:
Improvements have been achieved through a standard electronic Referral Management and Referral (RM&R) form, compulsory form fields and bi-directional communication to close the loop on any outstanding referral components. Additionally, the referral is embedded at both ends: within Hospital?s Information Systems (HIS) (including Meditech and Cerner systems) and the LHIN?s CHRIS system. This integration with the existing point of care systems ensures the quick and seamless transfer of information. Efficiencies are gained as existing or previous patients in CHRIS are automatically matched to eReferral allowing some fields to be pre-populated and information to be updated.


Conclusion/Implications/Recommendations:
AT the time of the submission of this abstract, 3 of the 5 hospitals have gone live with the solution Results included: Patient Safety and Access Transcription errors avoided No rework leading to increased waits for the patient Bi-directional communication allowing for status updates, feedback or referral cancellations Cross Organizational Collaboration Reinforced local IT expertise and capacity within acute care facilities Cross organizational focus on common goals Partnership and positive working relationships fostered between organizations System Integration/Interoperability User convenience as hospital and LHIN staff access referral via their point of care systems Ability to close the loop on outstanding eReferrals Performance Monitoring Ability to monitor the number of referrals and wait times from referral to placement Ability to log each step of the referral with date/time and user thereby enabling reporting, performance management, and accountability System Sustainability Increased administrative efficiency in referral transcription No time needed to obtain missing information Ongoing base costs avoided


140 Character Summary:
Five NSM LHIN hospitals and HSS Ontario are adopting an eReferral solution to facilitate 1000s of referrals annually from acute to home and long-term care

Purpose/Objectives:
NYGH has one of the busiest operating rooms in the Central LHIN and operates one of the largest cataract centres in the province. As such, its operating room (OR) relies on a large inventory of medical equipment and supplies to provide care to its patients. Due to funding constraints and other factors, the OR has developed highly manual and fragmented supply chain management processes and uses a number of disparate technology systems for inventory tracking. This has created significant challenges in maintaining appropriate inventory levels, cost control, data analysis and quality improvement. Our hospital is on a modernization journey that will transform our inventory management processes and technology for perioperative services by leveraging private and public partnerships.


Methodology/Approach:
This is a two year project that will be delivered in three phases: Phase 1 will represent the foundational stage and will focus on project planning, developing baseline metrics and future state workflows. Phase 2 will deliver data cleansing, space renovation, technology build/implementation and end-user training. Phase 3 will focus on outcomes evaluation against key performance indicators and knowledge translation. Through a partnership with the University of Toronto's faculty of Healthcare Engineering and Plexxus Shared Services, NYGH has established a diverse team of clinical, supply chain, technical and quality improvement experts to achieve the project's goals.


Finding/Results:
The expected results of this project are to: -Reduce inventory levels by 5-10% -Reduce surgical instrument waste by 10% -Improve process efficiency resulting in a 5% decrease in OR turnaround times -Enable highly accurate surgical case costing and reduce variability Key performance indicators (KPIs) will be developed to measure our success in achieving these goals and to support ongoing quality improvement.


Conclusion/Implications/Recommendations:
While this project will focus on improvements to the OR supply chain, the results of this project can be scaled to provide value to other areas of the hospital and to the broader health sector. Being able to transfer the technology we implement as part of this project throughout the hospital in improve efficiency and effectiveness through the standardization of processes. NYGH will work with the University of Toronto to translate the knowledge gained from this project into useful analytical tools that can be utilized by other hospitals. Additionally, our partnership with Plexxus Shared Services will provide a channel to disseminate our learnings to leadership at other Plexxus hospitals. This project represents an opportunity to produce significant cost savings for the broader health cate system through digital health technology, while enhancing patient experience and outcomes, reducing waste, enhancing the quality of data for provincial reporting and allowing clinicians to spend more time caring for their patients.


140 Character Summary:
Transforming inventory management processes and technologies in a community teaching hospital by leveraging public, private and academic partnerships.

Purpose/Objectives:
Heart failure (HF) is a common diagnosis with high prevalence, reduced life expectancy and a significant clinical and economic burden. The Heart and Stroke Foundation estimates that nearly 700,000 Canadians are living with heart failure, about 50,000 new cases are diagnosed every year, and heart failure costs the Canadian health-care system $2.8 billion annually. Large-scale randomized controlled trials have demonstrated that combination drug therapy, optimized to maximal tolerated doses, improves clinical outcomes in HF patients. However, evidence suggests that in clinical practice many patients never achieve target doses. Barriers to medication titration include provider and patient-related factors, as well as limited time and support facilities to enable regular monitoring. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support, alerting, and patient self-management. The primary objective of this study is to evaluate the efficacy and safety of the implementation of telemonitoring to facilitate HF medication titration. The secondary objective is to obtain a deeper understanding of the experience of clinicians and HF patients taking part in the remote titration program.


Methodology/Approach:
The study will be conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, in Toronto. It will be based on a mixed methods effectiveness-implementation hybrid design and incorporate process evaluations alongside assessment of clinical outcomes. The effectiveness research component will be assessed via a 2-arm randomized controlled trial (RCT), which will enroll 42 patients in total. The RCT will compare a predefined remote titration management strategy, which will utilize data from a smartphone-based telemonitoring system, with a standard titration management strategy consisting of regular in-office visits, and assess the efficacy and safety of the telemonitoring system in facilitating titration. The implementation research component will consist of a qualitative study based on semi-structured interviews with a purposive sample of clinicians and patients, and assess the factors that can positively impact the implementation and effectiveness of the intervention.


Finding/Results:
Data collection has begun and will be completed in the spring of 2019. The results of this study will be presented at the conference.


Conclusion/Implications/Recommendations:
Successful use of telemonitoring for the purpose of medication titration has the potential to alter the existing approach to titration and provide evidence for the development of a care delivery model that combines clinic visits with virtual follow-ups. This model could decrease the number of visits that patients make to the clinic, increase the proportion of patients who achieve optimal doses and impact the median time to dose optimization. Our study will be the first to provide evidence on the potential of telemonitoring to optimize the medication titration process, and thereby reduce healthcare resource utilization, the burden on the patient, and the cost of the process from the patient?s perspective.


140 Character Summary:
Use of telemonitoring to facilitate heart failure medication titration in order to reduce the amount of clinic visits made by patients.

Purpose/Objectives:
Actigraphy is a method to monitor human activity such as sleep, physical activity and sedentary behaviour using an accelerometer in a wrist-worn device called an actigraph. Motion data from the actigraph are sampled and recorded, and validated algorithms are applied to the data to determine sleep-wake and other health behaviours. Current actigraphy platforms (e.g. Phillips, Ambulatory Monitoring Inc [AMI]) are expensive due to device cost ($600-$1000 per unit) and personnel hours to initialize, download, analyze data and manage device tracking. Researchers who use these systems are locked into a proprietary platform with set data analysis options. Our objectives: To develop a cloud-based platform (OpenActigraphy) which can process sensor data from consumer wrist-worn devices and inexpensive Bluetooth-enabled accelerometer devices using research validated algorithms for research and clinical purposes. To evaluate sensitivity and specificity for sleep-wake, physical activity, and sedentary behaviour determined by OpenActigraphy?s integrated, inexpensive high-quality Bluetooth accelerometer device (mBientLab Metawear [MWRG]) units).


Methodology/Approach:
Following REB approval and informed consent, participants (19 adults, 8 school age children, recruited in January 2018) wore the MWRG and a traditional research-grade accelerometer device (Octagonal Basic for adults, MicroMini Motionlogger for children, AMI, Yardsley NY) concurrently, on the same wrist for one day and two nights. We compared objective sleep classification via the OpenActigraphy system and MWRG to sleep classification using the AMI research-grade accelerometer system. Using two features of motion data from the MWRG device, we built a model for the OpenActigraphy system to determine activity counts comparable to those calculated by the Phillips Actical device and determined thresholds in our model that best aligned with the activity count thresholds used by Colley & Tremblay (2011).


Finding/Results:
Using 64,538 epochs from 27 participants across two nights and one day of recording, the ability of the MWRG device to accurately determine sleep and wake was established with 97.4% Sensitivity and 91.1% Specificity. We established good Sensitivity and Specificity for sedentary behaviour (Sensitivity 86.7%, Specificity 85.3%) and moderate-vigorous physical activity metrics (Sensitivity 93.8%, Specificity 98.3%).


Conclusion/Implications/Recommendations:
The OpenActigraphy platform can accurately leverage data from inexpensive consumer devices and sensors and generate sleep and physical activity health metrics as accurately as research-grade devices. OpenActigraphy offers researchers and clinicians a low-cost, accessible, higher quality system for health monitoring. With OpenActigraphy, more researchers will be able to afford inclusion of sleep as an outcome in their projects, and researchers? ability to conduct large scale, population-based, real-time examinations of sleep and health will be greatly enhanced. This work was awarded the Healthy Behaviour Data Challenge sponsored by CIHR, Public Health Agency of Canada, and MaRS Innovation.


140 Character Summary:
We investigated how inexpensive consumer-grade wearable devices can be leveraged to generate high quality sleep and physical activity health metrics.

Purpose/Objectives:
Background: Electronic health records (EHRs) are transforming the way healthcare is delivered. They are central to improving the quality of patient care and have been attributed to making healthcare more accessible, reliable and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Objective: To develop a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs.


Methodology/Approach:
Methods: A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low).


Finding/Results:
Results: An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist.


Conclusion/Implications/Recommendations:
Conclusions: Safe implementation of EHRs requires consideration of both technical and socio-technical factors through close collaboration of health IT and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.


140 Character Summary:
The eSafety Checklist offers 642 evidence-based user interface configuration recommendations, categorized by topic, to support safe configuration of EHRs.

Purpose/Objectives:
To illustrate the value of digital health technologies to the Canadian healthcare system and the patients and healthcare providers it serves, the paper highlights six emerging technologies and their importance to healthcare. It also provides eight recommendations on how to successfully adopt such technologies in Canada.


Methodology/Approach:
The ITAC Health Advocacy Committee developed a white paper to draw attention to emerging technologies to accelerate the adoption of solutions to our current healthcare challenges. The ITAC Health Advocacy Committee focuses on promoting investment in health ICT and represent the interests of the Canadian health ICT industry to government, key decision makers and opinion leaders.


Finding/Results:
The six highlighted emerging technologies include virtual care, precision medicine, consumer health, the Internet of (health) things, cloud computing and blockchain. Note that these are illustrative examples only and were chosen from hundreds of emerging technologies deployed in healthcare systems already. ITAC Health recommends that industry and government: * Measurable steps to reinforce dependencies and actions between the public and private sectors, topic should have advisory panels and consultations between all stakeholders, including vendors. * Provide incentives and encourage the stakeholders to share information and commitment to sharing. * Make long term commitments to annual funding of digital health, by required reporting and tracking of commitments and expenditures * Invest in standardizing efficient and effective public procurement practices and mechanisms for engagement between the public and private sectors to manage timelines and costs of procurement. * Jointly encourage models of ICT investment, deployment and operation that bring the public and private sectors, large and small corporations, and academia together to grow the labour force and advance the skills needed to successfully implement digital health technologies. * Aggressively push solutions between and across provinces to gain experience and lessons at scale, through the use of tools and processes to safely liberate patient data enabling access to public patient data sets and solutions for use in a managed way by the private sector to fuel growth and innovation. * Invest in national privacy and security standards and practices to reduce risk and friction. * Ensure that sufficient broadband capacity exists equally in all areas of the country to support the new digital economy for all Canadians.


Conclusion/Implications/Recommendations:
To accelerate the adoption of emerging digital health technologies in Canada, the Canadian public and private sectors must be far more engaged together around common objectives of sustainable investment, standardized procurement practices, and taking innovation to scale across the Canadian digital health marketplace. ITAC Health calls for more structured collaboration between industry, and all provincial, territorial, and federal governments.


140 Character Summary:
Accelerating the adoption of emerging digital health technologies in Canada, ITAC Health calls for collaboration between industry and all levels of government.

Purpose/Objectives:
Overdesign of a clinical information system?s (CIS) documentation tools can have a significant impact on clinical decision making, CIS adoption, data integrity, as well as a complete and meaningful patient record. Our organization set out to address these challenges head on and identify the essential clinical dataset based on an identified framework of clinically led quality improvement.


Methodology/Approach:
The focus of our initial activity to reduce documentation burden looked at our ?Adult Admission History? form. This document?s purpose is collecting the important historical data that can support clinical decision making and care planning as related to their acute diagnosis. This form was chosen due to the consistently voiced concerns from acute care nursing regarding the length, duplication of questions, as well as unnecessary documentation. We set out to use a methodology that supported the clinicians leading the decisions using practice informed evidence, regulatory requirements and organizational policies. In our planning phase we sought to understand current practice challenges in using the Adult Admission History form; time and motion studies as well as data audit supported this. Our current understanding identified that within just a 1-week period, 142 forms were started but never completed (approximately 142 hrs of wasted nursing time); an incomplete status meant this documentation was not visible or usable within the patient record for clinical decision making. We also identified that due to the volume of questions presented on this form, there was significant duplication of questions through the patient journey, and significant interruptions in completing the documentation leading to decrease in staff capacity. Our next efforts focused on an environmental scan to understand accreditation and organizational requirements. Our final planning phase activity was to engage with the clinical leaders of the organization to understand and support this important body of work. The development phase began with a workshop with clinical staff from a varied geographical and program background representative of the population of users. This group reviewed data around individual question usage over a one-year period. The clinicians used this information in partnership with clinical practice guidelines and policies, as well one principle motto; is the right person documenting the right information at the right time for the right reasons. This principle was used to ensure clinicians were documenting clinically relevant information that supports clinical decision making, and information that could be documented by another health care professional, at a different point in the care journey.


Finding/Results:
Through this methodology the Adult Admission History form was reduced from 14 sections and 150 questions, to 7 sections and 40 questions. Our preliminary evaluation of our methodology has determined the clinicians felt this is a clinically led process supporting and providing an essential clinical documentation set that values nurses time in support of patient care.


Conclusion/Implications/Recommendations:
In conclusion, the objective we set out to achieve by identifying an essential clinical data set for adult admission history is in the process of being realized?improved clinical decision making, CIS adoption, data integrity, increased staff capacity, and a complete and meaningful patient record.


140 Character Summary:
Overdesign of our EHR?s documentation tools has had significant impact on clinical practice and EHR adoption; the answer is an essential clinical dataset.

Purpose/Objectives:
The Ministry of Health has issued a strategic priority towards patient-centered integrated primary and community care. It has been identified systems that can enable the sharing of patient data across organizations considerably supports this strategic direction. Fraser Health (FH) has developed a health information exchange (HIE) system called Unifying Clinical Information (UCI), providing substantial benefits in communication by enabling coordinated and connected care across the continuum of care.

Currently, there is still patient data mailed, faxed, or in some cases, available only within the system it is originally documented in. Physicians may not have access to this information; by the time they receive the information, it may no longer be of value or outdated. The FH UCI project team is driven to solve this by providing community physicians access to an integrated patient record within UCI, bridging the gap between acute and primary care to provide the best possible care to our patient population.


Methodology/Approach:
The project team identified the following challenges for UCI EMR Launch and a project approach was developed to take these challenges into consideration to deliver a successful outcome. 1. Privacy and Security of Data The team established a working group of representatives from privacy, security and legal, and collaborated with Doctors of BC to develop privacy and security documentation to support the initiative. 2. Authentication of users across health organizations The team designed an enrollment process to support onboarding community physicians. This process was designed and developed to accommodate credentialed and non-credentialed physicians and enable validation of user identity. 3. Usability The team recognized the importance of establishing a clinical advisory group to gather feedback throughout the design process.
End users were involved and informed during the requirements, testing, and prototype phase. In addition, the team collaborated with all EMR vendors to design a solution that is feasible and usable.


Finding/Results:
*Governance*
Early establishment of a governance model has been key for decision making, it has led to an engaged user group and increased adoption. This has also enabled the project team to develop a solution that was 90% adoptable across EMRs. *Technical Infrastructure *
Connectivity was achieved through collaboration between EMR vendors and the technical teams. The development of an enrollment process has led to improved operational workflow for future implementations of the solution. *Privacy and Security*
Early collaboration with privacy and security enabled the team to incorporate new agreements and guidelines in the design of the solution.


Conclusion/Implications/Recommendations:
Early identification of the challenges required the team to think outside of the box and consider a wide array of solutions. To address the barriers and design a usable solution, it was imperative to engage and collaborate with all stakeholders, vendors, and establish a governance group. This has enabled the team to deploy UCI EMR Launch to 20 clinics within the Fraser Health region, enabling physicians to view their patient?s journey through the healthcare system at the time of care, supporting the continuity of care and bridging the gap between the health authority and community physicians.


140 Character Summary:
The UCI EMR Launch project was delivered as part of Fraser Health?s Primary & Community Care Health Informatics Enablement Program.

Purpose/Objectives:
Health professionals across disciplines and practice areas spend a significant portion of their workday charting. Even with the introduction of electronic medical records (EMRs) -- despite their significant advantages for care coordination, privacy and reporting -- an EMR per se typically does not tend to reduce a clinicians? charting time. VHA?s strategic commitment to ?leverage technology to increase productivity & uncover inefficiencies? provided impetus to comprehensively overhaul provider documenation practices, with the intent to ensure improved efficiency *and* simultaneous improvement to the adherence of regulatory/best practices standards in the course of developing a homecare rehab EMR.


Methodology/Approach:
The process began by developing an in-depth understanding of all the documentation and college standards required in the chart. This foundation allowed the design team to develop accurate and precise field requirements, and to differentiate between what is truly needed to achieve high quality documentation and clinical decision-making vs. items which remained in the chart without distinct purpose. An accompanying chart audit examined current paper-form fields usage, enabling user-workarounds and obsolete fields to be detected and modified to better align to real point of care practices. Alignment of data fields to workflow, and not pre-exsiting forms, helped identify significant opportunities to merge data to reduced documentation volumes. The application of tick-boxes to quickly enable documentation of required and repeated standard practices was applied to promote adherence and efficiency, and all modifications were pre-tested in paper versions prior to the sumbmission of development business requirements. The practice change these processes then effected was supported through user-led championing and change-management leadership.


Finding/Results:
The re-design of documentation fields and workflow has dramatically changed the structure of rehab data entry and its clinical use in day to day practice. Paper version of the form re-design alone effected a 50% reduction in the volume of documentation required for the initial assessment. Chart audit data reflects the success of building documentation standards and clinical best practices right into point care charting, enabling more consistent application and provider awareness of these required fields. Provider response to the new system has been very positive and early formal survey results strong satisfaction by users.


Conclusion/Implications/Recommendations:
It is important to consider documentation best practice as well as workflow and clinical best practice guidelines when developing EMR?s that impact client outcomes. Employee burnout remains a topic of high interest especially among healthcare staff. When combining this with improved client care, the effective design and implementation of EMR?s becomes paramount in the context of the limited resources we have in healthcare. In combining documentation standards with clinical best practice and provider workflow, we can positively impact both client outcome and provider well-being in community care.


140 Character Summary:
EMR design that is efficient and drives best practice is achievable by re-evaluating data fields requiremts that are accurate and precise.

Purpose/Objectives:
Guided by the findings of an internal working group, our policy regarding the age at which competent youth control access to their personal health information (PHI) was changed from 16 to 12 years to align with current legislation and clinical practice standards. This policy applied to traditional access to medical records as well as our patient portal. Implementation required the development of a systematic, fail-safe process to ensure that youth have appropriate opportunity to control access to their PHI while at the same time for children and youth with exceptions to the age policy, that their capacity (in this context) is appropriately assessed, documented and flagged in the patient?s chart (proactively or retroactively).


Methodology/Approach:
A working group with membership from all stakeholders was tasked with this implementation and used our EMR as a primary tool alongside an updated patient portal activation strategy. An existing hospital form (clinician tool) was modified to include an alert for exceptions to the policy. When submitted to health records, this form triggers the creation of a flag in the EMR and requests for Release of Information or patient portal access are not compromised or delayed unnecessarily. Similarly, this flag is visible to clinicians so that they are also aware of the exception. Generally, this visibility enhances the communication and reinforces the linkages between health records and the clinical staff. Clinician resources were created to support the change and an evaluation plan was implemented to monitor impact of change and guide modifications to process. The activation strategy for the patient portal also includes two milestones where youth are required to confirm proxy access to their account. The above process for noting exceptions to the policy ensures that access is not delayed unnecessarily. Outside of these milestones, youth may adjust proxy access to their information at any time.


Finding/Results:
The working group met at regular intervals post go-live to review outcomes of implementation. Over the first year there were 10 concerns noted (7 from staff, 3 from families), no privacy breaches, no requests to mental health department to assess capacity and 9 requests to clinicians to complete release restriction alerts. Qualitative outcomes included smooth implementation and absence of suggested revisions/modifications. Health records staff reported some delay in time to release requests, a sense of surprise from some parents, some confusion re: crossover between consent to release of PHI and consent for medical decision making but also cited many positive examples of youth engagement in the process.


Conclusion/Implications/Recommendations:
A policy change at a pediatric hospital necessitated a streamlined process to ensure lawful release of PHI. A strategy including stakeholder engagement and leveraging existing EMR tools resulted in a successful implementation. A clear definition of capacity for and disclosure of PHI and how it relates to the EMR and secure patient portals in a pediatric setting, a representative working group and effective communication and education strategies were crucial in implementing workflow changes with broad impact. This general implementation model may prove useful for future hospital policy changes.


140 Character Summary:
We describe the development, implementation and evaluation of an EMR-enabled process for appropriate release PHI in a pediatric hospital.

Purpose/Objectives:
Healthcare has long been challenged to address some pretty fundamental things, specifically related to data exchange and access. Can we uniquely identify a patient? Can we link data records created in different settings? Can we integrate patient-reported data? And, most importantly, can we trust the integrity of the data, its source, and control of its access? Blockchain is a decentralized, distributed public ledger of transactions, using an encrypted, structured network of systems to run those transactions, which are recorded chronologically in growing blocks. A key feature enabled by blockchain is that of a smart contract. These contracts define and execute the rules that parties use to process transactions. Blockchain has been applied to financial transactions for some time now. The question is whether it is a fundamental underlying technology that can finally address some of healthcare?s more vexing challenges.


Methodology/Approach:
This presentation will highlight examples where blockchain has been applied in a healthcare setting, both domestically and abroad. It will dissect the projects to extract the lessons and applicability for broad application. The objective being to provide real world guidance on where blockchain might be a real answer to health data exchange and access challenges, vs. where it is simply a technology looking for a home. Several blockchain initiatives were examined. These spanned the US and Canada, and addressed topics of patient generated data, supply chain management for drugs and medical devices, and clinical research. For each the project objectives were checked to the results generated, key insights were examined and the broad applicability derived.


Finding/Results:
It is clear that blockchain has a place in healthcare. However it is no ?silver bullet? ? indeed healthcare is too complex for such a notion. There are clear examples of good use cases that can propel data integration, exchange and secure access forward. These will be essential to manage those that live with chronic illness, to reduce the administrative burden on the system; to truly allow patients to be integral parties to managing their care; and ultimately to enable a system based of payment for health outcomes.


Conclusion/Implications/Recommendations:
Trust is needed when data is to be shared and accessed for both integrated health service delivery and health system management. Blockchain seems to provide one ingredient for enabling trust in the system. However it will require diligent application and strong governance before care providers and patients alike will be comfortable with their data being accessible and usable across the care continuum.


140 Character Summary:
Healthcare is challenged to integrate/ share data in a reliable and trusted way. Blockchain can enable this, moving us to a patient-centred, outcomes-based system.

Purpose/Objectives:
To explore the privacy issues related to the procurement, design, development and roll-out of shared health records systems, outside of provincial EHRs. A panel made up of privacy leads from hospitals and possibly other health care providers, a privacy lawyer, and a privacy consultancy will review the lessons learned from procuring, developing, designing and rolling out shared health records systems. Among other considerations, the panel will address the cost of viewing privacy as a pre-go-live ?checkpoint? instead of a factor at the planning, design and development stages, including the cost of system redesign and/or reconfiguration at a late, critical stage. The discussion will also touch on the benefits of shared records systems, for providers, patients and the health system and the barriers to fully realizing those benefits.


Methodology/Approach:
The panelists are seasoned professionals who have been involved in planning, developing and implementing shared health records systems in their various roles, including at Grand River Hospital and other health care organizations The participants will provide their perspectives on building in and operationalizing privacy requirements from early planning stages through go-live and ongoing operational management. The issues are likely to include: - solution procurement and development of a model for a shared health records system - the roles and relationships among system users - development of privacy and governance models, including the sharing model - the advantages of privacy program alignment among system users - addressing limitations for heath information sharing Further issues and opportunities stemming from implementation experience will be explored in the presentation.


Finding/Results:
The panelists will emphasize key factors for health care providers to consider in relation to participation in shared health records systems including: - Identification of the objectives for using a shared health records system - Early consideration of the sharing model to ensure it aligns with the objectives - Identification of a privacy governance model, management roles and standards - Development of accountability mechanisms (including acceptable use policies, agreements and enforcement) - Understanding how to translate the models and policies into operation


Conclusion/Implications/Recommendations:
Shared health records systems are complex, regardless of the number of health care providers and their agents using a system. Considering privacy in the early stages of project design may appear a low priority, but privacy can be a driver that helps clarify shared objectives and priorities. Early consideration of privacy will also help to identify and reduce risk associated with the need for legislative compliance (including permitted sharing of personal health information), encourage dialogue with clinician end users and contribute to effective program design for shared system management.


140 Character Summary:
Shared health records system planning should include consideration of privacy in early stages to understand options, establish goals, and limit risk.

Purpose/Objectives:
Change management is a commonly-known element determining the success of information system implementations. This can involve internal and external human resources for education, training, and to champion the cause. Nova Scotia is embarking on the goal of pervasive health care system transformation through the ?One Person, One Record? (OPOR) vision, allowing for unified health information for effective person and system care. We demonstrate the first province-wide informatics rounds in Canada, ?Let?s Talk Informatics?, which has been operating since April 2016. These rounds have achieved accreditation with CPHIMS-CA and Mainpro+. The primary goal of the rounds was to increase informatics literacy of the health care sector in the province prior to and after OPOR implementation. The secondary goals of these rounds was to create a venue to identify upcoming leaders and disseminate state-of-the-art knowledge locally and globally.


Methodology/Approach:
?Let?s Talk Informatics? are an hour-long rounds open to clinicians, employees of Nova Scotia Health Authority, Izaak Walton Killam (IWK) hospital, primary health, Department of Health and Wellness, Government, universities, health associations, colleges and anyone in the public. Participation is done in person, via Skype or conference line. Rounds presentations are vetted by a committee consisting of clinicians and individuals from Information Management/Information Technology to ensure freedom from vendor bias. Sessions are recorded and available for future viewing. Evaluations are performed using a survey tool. The distribution list and invitations are handled through Eventbrite.


Finding/Results:
There have been 23 ?Let?s Talk Informatics? sessions during the period between April 2016 and June 2018). Of the sessions, 3 (13.0%) were delivered remotely by speakers using Skype for Business (two were from other provinces and one was from the United States) and 20 (87.0%) were in-person. There have been a total of 2097 registrants (average 110 registrants per session; range 45-212), with three sessions missing attendance counts. Actual attendance was captured during the period of October 2017 to June 2018, whereby there were 637 registrants and only 510 attended the sessions in person, via Skype, or using the conference line for a deviation of -14.1 (less attendees than registered) per session, or a 19.9% no-show rate. Since the evaluation process began in February 2017, 287 evaluations have been completed during those 14 sessions at a rate of 20.5 evaluations per session, and the completion rate among attendees during the period of October 2017-June 2018 was 101/510 (19.8%). During this timeframe, the attendance via Skype was the most popular at 292/510 (57.2%), followed by in-person at 177/510 (34.7%) and 41/510 (8.0%) via conference line. The qualitative trend over time is that Skype attendance is becoming more popular. There have been attendees from New Brunswick, Prince Edward Island, and Alberta. There are also currently 1654 people on the regular distribution list.


Conclusion/Implications/Recommendations:
We demonstrate a successful low-overhead methodology to broadly disseminate health informatics knowledge within a health care system. This grand rounds methodology is something that is easily scalable and transferable to other health care systems.


140 Character Summary:
?Let?s Talk Informatics? rounds is a successful and scalable methodology used to disseminate informatics knowledge and facilitate system change in Nova Scotia.

Purpose/Objectives:
The healthcare system in Canada continues to evolve rapidly. Investments made over the last 30-40 years have paid off: Canadians are living longer and with fewer disabilities. However, Canadians are now living with more chronic diseases than ever before, putting greater pressure on the system and placing more responsibility on them for the management of their own health. As Canada moves into a brave new world, it requires new policies, perspectives and practices that will enable it to embrace change and thrive in a rapidly changing healthcare world. The new policies and practices need to consider the complex interactions that are necessitated by a more complex stakeholder environment. The new policies and practices need to be coordinated to ensure synergies between players and ensure that all benefit from the investments and efforts put into the system. We propose to institute an academic-led policy observatory to provide an independent and objective assessment of how well Canada and its political processes are moving toward achieving important pillars and practices for the digitization of the healthcare system.


Methodology/Approach:
We conducted a stakeholder analysis to identify key stakeholders in the health information technology arena. We identified the key needs of each stakeholder using business analysis methods. We obtained feedback through key informant interviews and email review of a first draft of the proposal for a digital health policy and practices observatory (N=7). Ongoing feedback and discussion allowed for iterative improvements and progress with this initiative.


Finding/Results:
As Canada moves forward, it faces the following issues: 1) difficulty in coordinating the efforts and incentives for multiple stakeholders to move in tandem, 2) patients who lack the ability and resources to participate meaningfully in system change, 3) innovation policies that generate world-class innovations that do not reach the market, 4) an inability to kick-start interoperability projects that can catalyze system transformation, 5) an inability to procure early-stage innovative technologies at scale and 6) an inability to share data seamlessly across organizational silos for improved patient coordination and care, health system management and research. Canada needs the following practices and policies to enable system transformation: ? Multi-stakeholder governance structures
? Patient engagement and empowerment policies
? Federal and Provincial innovation policies that support dissemination of invented-in-Canada technologies
? An interoperability research agenda
? Technology and innovation procurement policies
? Policies for the governance of shared health information


Conclusion/Implications/Recommendations:
The Digital Health Policy and Practices Observatory will: ? Establish an observatory of digital health policy and practices in Canada;
? Develop credible, respected, transparent and easy to understand policy assessment tools;
? Conduct and report on assessments of policies and practices that can help us move the digital health agenda forward;
? Provide a credible, independent and unbiased source of high quality information about digital health progress in Canada;
? Influence the development of digital health policies and practices in Canada in a manner that is consistent with the best interests of society and the stakeholders who work to make healthcare a valuable cultural asset in Canada.


140 Character Summary:
Digital health policy observatory provides report cards on Canada's policies for use of technology to improve patient care and outcomes.

Purpose/Objectives:
As EMR use increases within the physiotherapy community, development and implementation of digital health core competencies is necessary to promote digital health literacy at a grass roots level. The family medicine experience has demonstrated a need to implement digital health core competencies at minimum in parallel with adoption and implementation of clinical systems to maximize success. High rates of EMR adoption exist in Manitoba within family medicine. Despite this fact, a lack of digital health literacy has been clearly identified limiting the ability to leverage data to enhance patient care. A foundational barrier to digital health literacy is the lack of educational content within the Rady Faculty of Health Sciences at the University of Manitoba. Although digital health core competencies exist for medicine, nursing and pharmacy curricula, a lack of implementation has contributed to challenges with effective use of clinical systems. Robust digital health literacy can inform and enhance clinical practice, facilitate interprofessional communication and enhance learning and innovative research. It can play a critical role in supporting health system planning, policy development and advocacy for physiotherapy services within Manitoba?s health-care system. The purpose of this study is to better enable physiotherapists in Manitoba to adopt, implement and optimize use of digital health tools, systems and applications in clinical practice to enhance patient care.


Methodology/Approach:
1. To generate a baseline digital health literacy profile of registered physiotherapists in Manitoba via an online survey; 2. To identify factors and any potential relationships between factors that may influence digital health adoption, implementation, and optimization in Manitoba physiotherapists; and 3. To develop a digital health core competency framework, aligned with the existing national physiotherapy role-based framework, focused on improving digital health literacy.


Finding/Results:
The survey is being distributed in September 2018 to gather information about digital health awareness, knowledge, use and attitudes. Respondent data will be used to generate a profile of digital health use in Manitoba physiotherapists and as a needs assessment and gap analysis tool to target areas for education on digital health concepts. Themes identified after survey data analysis and synthesis will be used to develop a digital health core competency framework.


Conclusion/Implications/Recommendations:
Next phases of the research will involve development of digital health Essential Competencies and Entry-to-Practice Milestones across the seven Domains of Physiotherapy included in the Competency Profile for Physiotherapists in Canada along with a knowledge translation strategy to implement the developed core competencies into the Masters of Physical Therapy program at the University of Manitoba.


140 Character Summary:
As EMR use increases within the physiotherapy community, development of digital health core competencies is necessary to promote digital health literacy.

Purpose/Objectives:
To demonstrate how the application of innovation including machine learning and analytics to the search and retrieval of extensive literature can improve the efficiency and quality of systematic reviews to inform clinical decision makers and policy groups.


Methodology/Approach:
Medical errors are an under-recognized cause of death. However, newly calculated figures suggest medical errors are the third highest cause of death in the U.S. Adherence to clinical practice guidelines (CPG) is one of the simplest ways to prevent medical errors while ensuring care is appropriately aligned to a supportive evidence base. Enhancing the accessibility of CPGs represents a behavioral nudge that may increase the likelihood that appropriate medical practices are followed. In order for CPGs to be adhered to along with corresponding evidence informed practice, these tools need to be accessible and easy to use. CPGs are based on the objective evaluation of supporting evidence provide by systematic reviews. Systematic reviews provide accessible evidence to inform clinical decisions. In healthcare, they may target patients, clinicians, managers, and policymakers. The current process is time and resource intensive, requiring expenditure of human capital and potentially impeding critical decision making within the health systems suggesting that patients may not have timely access to promising new forms of treatment. Machine learning technologies can improve the usefulness of systematic reviews for healthcare managers and public policy-makers by eliminating searching, retrieving and analysing data. The EmBER solution aims to achieve the following 3 objectives: Efficiency ? Achieve the minimum amount of time, money, people or other resources required Quality - Improve the precision and recall of studies Access ? Increase the breadth of data and enable development of new relationships To support the development of this rapid evidence synthesis tool, a partnership has been developed to capture key knowledge competencies. Key competencies in Natural Language Processing (NLP) and Machine Learning (ML) have been provided by experts from the Alberta Machine Intelligence Institute (AMII) from the Department of Computing Science at the University of Alberta.


Finding/Results:
Emerging evidence from the field of machine learning suggests that algorithmic approaches to natural language processing may provide a viable solution to reducing the time required to conduct systematic reviews. Specifically, the application of machine learning approaches to process large amounts of the available evidence could result in shorter completion for evidence based clinical decision and policy making. The EmBER solution produces a marketable product and service that operates to collate, analyze, and present global research papers and recommendations to decision makers and policy makers. EmBER is anticipated to increase the efficiency and standardization of the process, and augment the analysis utilizing additional data sources.


Conclusion/Implications/Recommendations:
Evidence suggests that the rate of medical errors is increasing despite the large investments in patient-safety initiatives. Innovative solutions are required that allows clinicians treating patients access to immediate information. The EmBER solution shows promise to provide the right information, at the right time.


140 Character Summary:
Machine learning has the ability to support clinical decision making that requires integrating ever-increasing volume of research knowledge.

Purpose/Objectives:
In 2018 St. Joseph?s Healthcare Hamilton (SHH) introduced a patient portal (app and web based) to its patients and care providers in the mental health and transplant programs. MyDovetale aimed to: ?Provide patients with the ability to self-schedule, self-monitor and enhance self-care ?Show a change in reported outcomes and experiences ?Demonstrate innovation in the provision of care and the interaction between care teams and patient stories


Methodology/Approach:
MyDovetale provides users with the following functionality: ?Patient/ proxy access ?Secure Messaging ?Scheduling workflows ?Access to health information (including lab results, medications, questionnaires and active health issues) A benefits evaluation was conducted, including the administration of a survey. The evaluation assessed the impact of MyDovetale on quality, productivity and access.


Finding/Results:
Quality Benefits: 1. Self-Scheduling: ?Patients found the ability to request appointments beneficial and easy 2. Self-Management & Self-Efficacy ?88% of patients feel that MyDovetale allows them to better self-manage their care ?Care Team Providers agree that MyDovetale improves the quality of care provided Productivity Benefits: 3. Patient Travel Time & Costs ?Some patients expressed that they saved 2 ? 3 hours of travel time and $40+ in expenses 4. Participation ?Care Team Members agree that MyDovetale enhances their ability to coordinate continuity of care ?All patients agree that MyDovetale makes accessing care more convenient Access Benefits: 5. Future Functionality ?Patients expressed interest in the addition of e-visits, prescription refill requests and direct scheduling 6. Overall Satisfaction ?All patients are satisfied with MyDovetale ?75% of care providers agree that MyDovetale makes providing care more convenient Patient Qualitative Responses ??Messaging to my providers is great and so is the access to appointments? ?"Love the lab results feature as I am able to review results in between appointments. The med listing is very useful"


Conclusion/Implications/Recommendations:
Time Savings & Ease of Use ? Clinicians can send questionnaires, such as the PHQ-9, to their patients, and have their patients complete them ahead of their appointments. The results are viewable electronically from within the SJHH EMR upon completion. Patient Efficacy & Self-Monitoring ? Serving the patient community is enhanced further with notifications that are sent to the patients for upcoming appointments, new lab results and for new messages from their care team. Patient Safety ? Providing a list of current medications is beneficial, and provides practical patient safety benefits. For example, a patient had confusion over medications at a pharmacy and prevented a medication prescription fill error by sharing their MyDovetale information with the pharmacist for follow-up. SJHH is working to expand the implementation of MyDovetale, and to expand its functionality withn features like video visits.


140 Character Summary:
MyDovetale (St. Joseph's Patient Portal) was implemented to enhance the patient-provider relationship, empower patients, and support care between visits.

Purpose/Objectives:
Patient-centred care (PCC) is currently identified as one of the essential elements of an efficient healthcare model. PCC warrants patients? easy access to healthcare services, short wait-time to access care, and timely feedback on their referral processes and outcomes. The System Coordinated Access program (SCA) supports the development and deployment of an innovative eReferral solution, which aims to increase efficiency and improve patients? access to care. The use of the solution not only streamlines the referral process for healthcare providers (HCPs) and improves their communication, it also offers an enhanced experience for patients who can now receive email notifications on the status of their referral and communicate directly through Self-Referral. This presentation will focus on outlining patients? perception of the electronic referral process and email notification system.


Methodology/Approach:
The SCA program assessed patients? experiences with the eReferral process and notification system using an ongoing online survey questionnaire. Beginning in November 2017, all patients of HCPs using the system who provided their email address received an invitation to complete a satisfaction survey embedded within the confirmation email of the booked appointment. Note: Only patients who provide their email address will receive email notifications of their booked appointment through the solution.


Finding/Results:
To date, more than 10,000 patients were referred for different health services using the eReferral solution. The mean age of patients referred electronically was 56.7 (ñ24.8) years, 63% were females and 37% were males. Currently, 80% of the referred patients have a booked appointment. Of those, 33% have received email notification of their booked appointment. Of the patients who received email notification of their booked appointment, 355 have completed the patient satisfaction survey (response rate 10%). Overall Satisfaction Overall, 88% were satisfied/very satisfied with their experience using the electronic referral process. Moreover, 94% agreed/strongly agreed that the electronic referral process was easy to follow. Compared to their past referral experiences, 82% of patients agreed/strongly agreed that they felt more informed throughout this electronic referral experience and that they were able to get the needed care within a reasonable time. Furthermore, 95% of patients agreed/strongly agreed that receiving a confirmation email about their booked appointment improved their experience with the referral process. Patients? overall qualitative themes of the critical successes of the electronic referral system emerged from the survey?s open-ended questions and were categorized as follows: (a) electronic system is quick and rapid, (b) system is efficient and simple, and (c) empowers patients.


Conclusion/Implications/Recommendations:
Evidence from our survey shows that the positive effect of the eReferral system on patients? experiences with the referral process is linked to their ability to track their referral for routine healthcare service and receive alerts and timely feedback from their HCPs. Using patients? feedback, the program aims to improve the implementation of technology in healthcare, ultimately enhancing efficiency and access to care.


140 Character Summary:
The SCA program supports a convenient, innovative eReferral solution. It empowers patients and improves their experience with access to care.

Purpose/Objectives:
Design thinking provides a structured approach that can enable educators to empathize with end-users (i.e., patients) to uncover challenges and explore innovative solutions to best meet the needs of patients. This approach was used to guide the development of an online education course on medicinal cannabis for patients with non-chronic cancer pain. Patients were engaged in the design, development and testing processes of the online course.


Methodology/Approach:
The core stages of the design thinking approach are: empathize, define, ideate, prototype and test. In the empathize stage, data was gathered from a variety of sources including semi-structured interviews, patient surveys, physician and subject matter experts surveys, and course evaluations from in-person classes. The data was used to conceptualize the end-users (i.e., target patients who will take the course) through ?empathy? and ?as-is? scenario maps. In the define stage, ?How might we? questions were developed based on the themes that emerged from the maps allowing the identification of key challenges and opportunities. In the ideate stage, innovative ideas to address challenges were generated and prioritized based on impact and feasibility. Prototypes were then developed and tested. During the development process, patients engaged through a focus group, provided input on the prototypes as well as the course goals, key messaging and content areas. The feedback from the focus group session was then used to inform the final prototypes that will be incorporated into the online course.


Finding/Results:
The collected data was used to create empathy maps that represented end-users. Data from the empathy maps was then used to develop ?as-is? scenario maps which illustrated examples of what the end-user may do, say, think and feel during different stages of the scenarios (e.g., patient taking an online course, patient talking to their healthcare provider about medicinal cannabis, patient taking medicinal cannabis for non-chronic cancer pain, etc.). ?How might we??? questions (e.g., How might we engage patients in a meaningful way?) were generated based on themes that emerged from the ?as-is? scenario maps. Two key prototypes that were developed included patient characters that represented end-users (based on the empathy maps) and e-learning modules. Through patient engagement the course goals, key messages, key patient questions and key content areas were refined and additional resources (e.g., patient handouts) and components (e.g., FAQ section and anonymous online forum) were identified. Patient input also led to refinement on how the characters would be used within the e-learning modules to engage end-users in an authentic and relevant learning experience. Qualitative feedback from the focus group participants was also gathered providing process evaluation information.


Conclusion/Implications/Recommendations:
A design thinking approach can lead to the development of an innovative patient education program that can best meet the needs of patients. Engaging patients through the use of this approach provides the opportunity for the patient voice to be incorporated into patient education initiatives. Process evaluation information provides insight into patients? experiences in the process and can be used to improve future patient engagement activities.


140 Character Summary:
Engaging patients through the use of a design thinking approach can lead to the development of innovative patient education that can best meet the needs of patients.

Purpose/Objectives:
The Centre for Mental Health and Addiction (CAMH) is working to standardize the reporting of patient data to better facilitate the characterization of our patient population and coordinate services to meet our population?s needs. This initiative includes three phases: 1) gathering an inventory of current clinical assessments, 2) standardization and implementation of core assessments, and 3) establishment of a governance structure to ensuring oversight and appropriate selection of tools for future use. Our objectives are: - Equitable and accurate alignment of service delivery - The ability to measure what works and identify areas of improvement - Release time to care through assessment rationalization


Methodology/Approach:
In order to conduct a thorough review of assessments, meetings were organized based by clinical domain (e.g. anxiety, depression, etc.) and guided by an evaluative framework (Table 1). The framework categories were chosen to reflect the values of standardizing validated assessments within the organization and to showcase the efficiency and alignment of assessment with the organization?s goals and objectives. A Standardization of Care Committee (SCC) was established with the authority to steer strategic direction by ensuring alignment with CAMH?s strategic plan and oversee the standardization of clinical tools across all department at CAMH. For the implementation phase, the SCC will act as champions to support the project by communicating decisions to clinical directors and actively engage the Electronic Health Records (EHR) technical team as needed. Table 1: The Evaluative Framework consists of four subcategories and 27 questions pertaining to evidence-based literature. Below is a sample of some of the questions. Criteria Sample Considerations Psychometric Properties Is the tool established, peer-reviewed for diagnostic purposes? Ease of Use What is the structure of the questions and how are scores calculated? Accessibility Are there alternative methods of completion? Operationally Aligned Is the data easily extractable to support organizational and clinical decisions?


Finding/Results:
To date, the project team has completed a current state analysis of clinical assessments used on inpatient and outpatient units. Results revealed that 567 unique assessments are in use across the hospital.


Conclusion/Implications/Recommendations:
The SCC has completed a review of 7 domains and selected validated assessments to be used across CAMH (Table 2). The first assessment to be implemented across CAMH WHODAS 2.0. From an analytics perspective, the data from WHODAS 2.0 can be used to pull outcomes and assess our population. Table 2: A list of the 7 selected assessments to be implemented across CAMH. Category Assessment Anxiety GAD-7 Depression PHQ-9 Alcohol Use AUDIT Psychosis BPRS Function WHODAS 2.0 Cognitive MOCA Pain BPI-Short


140 Character Summary:
CAMH is working to standardize and implement a core assessment set to improve patient outcomes and develop Canada?s first mental health Learning Healthcare System.

Purpose/Objectives:
This presentation will outline three key capabilities that enable vendors to advance interoperability in a healthcare organization, and thereby deliver clinical and financial value to their clients. Today?s vendors must look beyond their own technology and services, and understand how they can help healthcare organizations integrate their solutions in the ecosystem within which they will operate. This means: 1. Ability to integrate their solutions to other solutions through private or public cloud infrastructure 2. Enabling APIs and supporting modern data standards and interchange 3. Ensuring a patient focus in all solution offerings


Methodology/Approach:
It is no longer sufficient to look at procuring a new digital health solution as a stand-alone transaction, but rather it is important to maintain a sustained partnership to ensure the desired value and benefits are accrued. To achieve these benefits and value outcomes, healthcare organizations need to evaluate vendors? capabilities in three domains: 1. SaaS / Cloud / Managed Services capabilities 2. Support for modern and emerging data standards and access to open APIs 3. Patient-centric focus and design


Finding/Results:
When vendors adopt interoperability by design, there are three key components to achieve meaningful outcomes: 1. Managed Services i.e. SaaS in private or public cloud space. Benefits include: - Provides interoperability between systems - Eliminates or reduces expensive hardware and maintenance of on premises systems - Takes on full responsibility for a customer's integration solution - Establishes a competitive pricing model - Enables highly available deployment and service recovering from failures automatically while minimizing downtime 2. Open APIs and modern data standards, including FHIR, HL7, and support for clinical terminology services. Vendors that provide open access to data models, and interchange data via HL7 or APIs reassure healthcare organizations that future solutions can be built that access their data, even before those needs are understood. Canadian EHRs, for example, provide a broader view of longitudinal health data across the care continuum, typically with a clinical portal viewer as the access point. 3. Patient-centric focus. Start by providing patients with access to their digital health information using a validated, authorized account. The patient is then invited as a decision-making participant in their circle of care and maintains control over access to their digital health record. This includes: - Access any time, anywhere on any device - Bi-directional communication with care providers/care team - Possibility for substitute decision-makers and family members to access patient data as part of the extended care team, or in an emergency - Reconciled medications list and curated problems/procedures/test data - Support and integration for consumer health devices


Conclusion/Implications/Recommendations:
There are multiple levels and layers connected to business, clinical, patient/public and financial concerns that digital health vendors must consider. A successful vendor must be fully invested, understand its clients' priorities and predict and articulate those needs through interoperability by design. From this perspective, a vendor becomes responsible for the short and long-term sustainability and the commitment to service level agreement targets of the solutions, and most importantly, the ongoing interoperability of the solution within the healthcare ecosystem.


140 Character Summary:
This session will discuss three key components to a successful ?Integration By Design? solution: 1. Managed services, 2. Open APIs and 3. Patient-centric focus.