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    HS01 - Digital Health Canada Host Session (ID 60)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/29/2019, 08:30 AM - 10:00 AM, Room 200 A
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    OS28 - Not Without the Patient (ID 49)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 6
    • Coordinates: 5/29/2019, 10:30 AM - 12:00 PM, Room 200 A
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      OS28.01 - Otherworldly Immersion: Using Virtual Reality in Complex Wound Care  (ID 230)

      Don Anderson, Clinical Telehealth, Alberta Health Services; Calgary/CA
      Jaclyn Frank, Alberta Health Services; Calgary/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Virtual Reality (VR) is a computer generated immersive and interactive experience that ?transports? the viewer into a 3D environment. VR has been shown to be effective for acute pain and anxiety, however, there are few reports of clinics using VR in Canada. The Rockyview General Hospital (RGH) in Calgary, Alberta is the first hospital in Canada to use Virtual Reality (VR) to address the management of pain and anxiety during complex wound care. The aim of this initiative was to explore and evaluate the feasibility and patient-reported effects of VR in a sample of hospitalized patients undergoing wound debridement treatments.


      Methodology/Approach:
      wound care and vr.jpgPrevious research has suggested that VR may be effective for pain reduction in various health settings (Mosadeghi, et al, 2016). The use of VR in a hospital environment poses unique challenges that community settings do not, including alignment with Infection Prevention and Control (IP&C) procedures and site policies. In collaboration with therapists in Allied Health Wound Care, the Telehealth team at the RGH selected and trialed a Samsung Gear VR headset, fitted with an Android phone to deliver VR images and sound during wound care. The immersive VR modules provided multisensory information that allowed patients the ?experience? of escaping to pleasant locations and realities, such as a virtual lakeside campground, observing dinosaurs or swimming with dolphins.


      Finding/Results:
      Patients were asked to rate their level of discomfort and overall experience using surveys administered before and after VR (using a scale from 0-10). Measures of patient discomfort included patient-reported ratings of pain, nausea and anxiety. Measures of patient experience include patient-reported ratings of feelings about future treatments and overall experience. Initial results were extremely encouraging. Patient surveys reflected a 75% reduction in the patients? perceptions of reported discomfort and a 31% improvement in overall patient experience during would care. No side effects were indicated and 100% of patients who used VR during wound care found it helpful. One additional unintended benefit of the application of VR during wound care was a qualitative decrease in the level of distress and tension reported by therapists delivering the treatment. The reported reduction in health-care practitioner stress during procedures was attributed to the overall improvement in the comfort level of patients during treatments.


      Conclusion/Implications/Recommendations:
      Building on the early success on this initiative, the team has expanded into other clinical environments including the Cardiac Care Unit and the Intensive Care Unit. Also under investigation are newer iterations of VR technology with an emphasis on improvements in IP&C, cost reduction and ease of use for both clinicians and patients.


      140 Character Summary:
      Rockyview General Hospital team evaluates the feasibility and effectivness of VR in a sample of hospitalized patients undergoing wound debridement treatments.

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      OS28.02 - Patients in Tech, a Digital Health Canada Community of Action (ID 152)

      Michael Savage, OntarioMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Increasingly, health care organizations such as Holland Bloorview Kids Rehabilitation Hospital, Patients Canada, Health Quality Ontario, The Change Foundation, and the Canadian Foundation for Healthcare Improvement (to name a few) have redefined the meaning of Patient Engagement, through both the advocacy and practice of creating formal partnerships between patients and caregivers and their providers. Through these efforts, Patient Engagement now encompasses a spectrum of empowering relationships between these key stakeholders in the health care system. Patients and their caregivers drive dialogue and fuel decisions with their stories and experiences of their care journeys across the health care system; they sit on councils and committees as advisors on decisions relating to topics such as research, strategic goal-setting, and recruitment; they spearhead the design and implementation of patient and family portal technologies which democratize access to their own health information; and much more. So where (and how) is Digital Health Canada's Patients in Tech Community of Action breaking new ground? Patients, their family members, and caregivers are now regularly and authentically engaged as partners in hospitals and policy-making organizations, but their presence remains comparatively absent in digital health technology companies. A cursory look at the landscape of digital health solutions indicates that products with patient access and context are quickly becoming the norm. At the very least, these stakeholders expect to have access and control of the data and information central to these solutions. Continuing to build digital health solutions without the formal input and assistance of patients, their families, and caregivers will lead to a widened disconnect between digital health?s intended and actual value. The long-term goal of Digital Health Canada's Patients in Tech Community of Action is to help grow the presence of authentic patient partnerships and engagement programs in health technology companies (ranging from early-stage start-ups to larger, mature solutions).


      Methodology/Approach:
      The primary deliverable of the Community will be a Whitepaper which combines and presents stories, experiences, insights, established best practices, and lessons learned from subject matter experts representing four key areas: Patients; Caregivers/Families; Patient Engagement Professionals; and Digital Health Technology Leaders.


      Finding/Results:
      As of Fall 2018, interviews and conversations with the Subject Matter Experts are underway. As mentioned in the earlier sections, the results of the interviews with the Subject Matter Experts will be comprised of the lived experiences of Patients, Family Members, and Caregivers with regards to being on-boarded in advisory capacities in Health Technology organizations; the interviews with the Health Technology SMEs will provide the complementary perspectives. In which areas of the product management lifecycle were there opportunities for them to provide their insight? Which areas should organizations look to as 'untapped' opportunities for patient / family / caregiver partnership opportunities?


      Conclusion/Implications/Recommendations:
      It is the hope that this Whitepaper, serving as a spotlight for best practices, success stories, and impactful experiences of advisory and partnership relationships, will ultimately function as a call to action for the creation of formal commitments, strategies, and tools for the development of in-house, efficient, and meaningful Health Tech Patient Partnership Programs.


      140 Character Summary:
      Patients in Tech is committed to bringing the successes and best practices of Partnership Programs into the Health Technology space.

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      OS28.03 - Electronic Medical Records- The Next Generation (ID 102)

      Karim Keshavjee, InfoClin Analytics; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Purpose: More people are living with chronic health conditions and multiple comorbidities into an older age leading to increasing medical complexity and continually rising health care costs. Electronic Medical Record (EMR) systems have great potential to improve public health, increase quality, efficiency and safety of care as well as health equity. However, current EMR systems are all text-based and require physicians to parse large amounts of text. We are designing a next generation EMR that provides high quality visualizations to assist health care providers to gain deeper insights about patients faster and easier.


      Methodology/Approach:
      Methodology: We used the British Design Council?s Double Diamond method to design interactive visualization of patients' clinical and medication utilization data. These visualizations have been tested with a variety of physicians to get their feedback.


      Finding/Results:
      Findings/Results: A visualization of past history with timeline was well-accepted by clinicians. The timeline enables physicians to quickly gain a sense of how often a patient has come to visit the doctor ?replacing a familiar ?thick chart is a sick patient? concept to the electronic chart. The 2-dimensional body image views provide clinicians with a quick history of patient diseases, their severity and recency. The visualization of ?future? medical history (i.e., predictive analytics) was also well-received, although there are many questions about how genomics will fit into the picture. The medication visualization allows clinicians to see current medications and reasons for prescribing, prior medications that were stopped and medication allergies. If given a new diagnosis, the medication visualization provides recommendations for new medications that will not interact with existing medications.


      Conclusion/Implications/Recommendations:
      Conclusions/Recommendations: We have developed several new visualizations of data in the EMR. The new visualizations support rapid review of past history, medication history, ?future? history (predictive analytics), patient engagement and team-functioning. Furthermore, it addresses emerging requirements including genomics, artificial intelligence and personalized medicine.


      140 Character Summary:
      140 Character Summary: New visualization designs point to features that will be in the Next Generation of Electronic Medical Records.

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      OS28.04 - An Analytic Framework to Enhance User Centered Digital Design  (ID 383)

      Derek Risling, RisTech Consulting; Saskatoon/CA

      • Abstract

      Purpose/Objectives:
      Purpose: There are unique challenges to the pursuit of user-centered design within the healthcare setting, yet this work is essential in advancing collaborative digital solutions. Engagement in user-centered development can alleviate barriers associated with the successful uptake, and sustained use, of new technologies. The value of interdisciplinary approaches for effective digital health design has also long been recognized, but there are difficulties in consistently enacting this. Disparate views and methods between health and computer science can create conflict when determining an ideal approach in digital design. The purpose of this project was to pursue a novel interdisciplinary approach to the development and evaluation of patient-centered technologies through the creation of a new analytic framework for these investigations.


      Methodology/Approach:
      Approach: There are foundational differences in how health and computer scientists engage potential users of newly emerging technology. Anticipating benefits for both process and user in seeking a collaborative solution to this variance, the use of an interdisciplinary framework was explored. By uniting the qualitative methodology and rigour of interpretive description (ID), originated in nursing, with an analytic framework founded on tools and best practices from the software development life cycle (SDLC), a new opportunity emerged. ID methodology was developed to address clinical healthcare questions or needs in a pragmatic and outcome focused manner. It is a qualitative approach that requires researchers to employ coding methods to ascertain a valid interpretation of the participant data. However, there is no particular prescribed analytic process. As such, the method served as an ideal foundation on which to layer a framework for analysis founded on software requirements required for successful solution development.


      Finding/Results:
      Results: The new framework has been deployed in two research projects: 1) The design of a mobile application to support pediatric patients with a specific chronic condition undergoing transition to adult care; and, 2) The development of an acute care pediatric portal for families and care partners. The analytic tool promotes potential code groupings or categories aligned with software development artifacts such as personas (amalgamated profiles of potential users), use-cases (descriptions of interaction between persona and software), and user stories. However, it also supports a full ID analysis, with the interpretations done to date providing insights into potential barriers for integrating the technology into the targeted healthcare context. The result has been an ability to take user data and determine not only the functional and non-functional requirements for a successful technological intervention, but also identify who might serve as champions during the implementation of the solution.


      Conclusion/Implications/Recommendations:
      Recommendations and Conclusions: This framework is a practical means to integrate a software perspective with an emerging health-focused interpretative description in the advancement of user-centered design. In this presentation, details of the framework development will be shared, along with data analysis examples of how it has been employed. Some interdisciplinary lessons learned, as well as feedback from patient and practitioner users will also be highlighted. Resources and recommendations on how to adopt this inclusive approach in numerous clinical settings will be provided.


      140 Character Summary:
      User-centered design in healthcare presents unique challenges. This new interdisciplinary analytic framework can be part of the solution.

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      OS28.05 - Development of a Toxicity Management Electronic Tool: Defining Functionality (ID 57)

      Vishal Kukreti, Clinical Programs and Quality Initiatives, Cancer Care Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Cancer treatment can result in numerous toxicities that can range from mild and temporary to severe, chronic and debilitating. Symptom burden and ineffective management of treatment-related toxicities can lead to high rates of emergency department (ED) visits and hospitalizations. Toxicities can be better managed through timely patient access to symptom screening, symptom management advice and alerts to the healthcare team via an electronic tool (eTool). In other jurisdictions, there are successful examples of tools/technologies, paired with models of care, to enable self-management of symptoms and toxicities during cancer treatment. Recent data has shown a survival benefit for patients using electronic symptom reporting during outpatient chemotherapy. To develop a toxicity management eTool for our jurisdiction, we undertook a rigorous process to define desired eTool functionality. The process included extensive stakeholder consultation to ensure user-centred design. The objective was to define functionality for a toxicity management eTool that would meet the needs of various users.


      Methodology/Approach:
      Defining ?user stories? was chosen as the process to identify eTool functionality. User stories are statements of a user?s need or expectation for what the eTool must do. To elicit user stories, a standardized template was given to oncology providers who were asked to write cases from their perspective/role. The exercise was first completed with clinical leaders and directors within the cancer agency, then validated with healthcare providers from various cancer centres. Interviews were conducted to identify user stories from patients. Patients were asked open-ended questions on potential eTool functionality i.e. symptom tracking and their desired use. Interviews were done first with Patient and Family Advisors (PFAs) and then validated with a convenience sample of patients from four hospitals.


      Finding/Results:
      The user story template was sent to 27 providers: 12 completed the exercise (including nurses, physicians, pharmacists, and administrators); 11 PFAs and 27 patients from four hospitals were interviewed to understand their desired eTool functionality. In total, 133 user stories were defined and sorted into 10 clearly-defined categories: symptom tracking, symptom management advice, self-management resources, alerts, personalization, treatment information, medication adherence, local configuration, integration, data capture and reporting. Subsequently these 10 categories were further validated in a structured workshop with 106 multidisciplinary stakeholders from various care settings.


      Conclusion/Implications/Recommendations:
      The user-story exercise was valuable to understand provider and patient perspectives and thus to define eTool functionality that will meet the needs of diverse user needs. Undergoing a robust process to define the functionality of a toxicity management eTool will result in a tool that will have greater uptake and impact on patient experience and outcomes. abstract image.png


      140 Character Summary:
      Defining functionality for a Toxicity Management Electronic Tool: understanding patient and provider needs through user stories.

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      OS28.06 - Exploring Telemonitoring for Pregnant Women at High-Risk for Hypertensive Disorders (ID 147)

      Maria Aquino, Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Hypertension complicates 2% to 8% of pregnancies and hypertensive disorders of pregnancy (HDP) poses short- and long-term risks for maternal and fetal morbidity and mortality. Blood pressure (BP) changes in pregnant women are usually detected during clinic visits but studies have shown that clinic BP measurements are more prone to error compared to home BP (HBP) measurements. Some clinical guidelines recommend using HBP measurements for the management and treatment of hypertension for pregnant women. HBP measurements between clinic visits can help to more accurately identify BP changes in pregnant women. This study aims to explore the current and potential use of telemonitoring for women at high-risk for HDP.


      Methodology/Approach:
      In the first phase of the study, we conducted a scoping review that follows the methodological frameworks described by Arskey et al. (2005) and Levac et al. (2010) to better understand existing interventions related to telemonitoring patients at high-risk for HDP and to identify the gaps in knowledge and research on this topic. The scoping review followed these six stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarizing and reporting the results; and (6) consulting with relevant stakeholders. In the second phase of the study, we will conduct a user needs assessment for a mobile-phone based telemonitoring program to promote self-care behaviours and monitor women at high-risk for pre-eclampsia. Specifically, we will conduct semi-structured interviews with patients at high-risk for developing pre-eclampsia and clinicians with pre-eclampsia expertise. Approximately 10 patients and 10 healthcare providers (HCPs) will be interviewed to: (1) understand their needs and support patients? self-management of hypertension during pregnancy; and (2) determine clinical requirements for the telemonitoring program. Two reviewers will conduct a thematic analysis of the interviews.


      Finding/Results:
      A methodological literature search was conducted for the scoping review. Of the 3904 articles initially identified, 20 articles met the inclusion criteria. All studies suggested that telemonitoring could improve HDP management through early detection of HBP changes. Most of the studies reported that telemonitoring interventions for monitoring women at high-risk for HDP were feasible and cost-effective. The scoping review revealed gaps in this research area, namely: many of the studies were pilot studies so the safety and effectiveness of these interventions were undetermined and their results could not be generalized beyond the criteria of the pilot design; the schedule of HBP measurements varied between studies and there are currently no guidelines on the appropriate frequency of HBP measurements; and there was no standard method of intervention delivery. We will analyze the semi-structured interviews by December 2018 and the results will be discussed during the presentation.


      Conclusion/Implications/Recommendations:
      The scoping review and user needs assessment could be used to help design telemonitoring interventions to meet the needs of women at high-risk for HDP. Findings from the second phase of the study will inform how an existing mobile phone-based telemonitoring program will be adapted for the management of women at high-risk for developing pre-eclampsia.


      140 Character Summary:
      Exploring the use of telemonitoring for women at high-risk for hypertensive disorders of pregnancy

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