OS01 - Implementation: Futuristic Thinking (ID 3)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 201CD
OS01.01 - The Tale of Two Data Conversions (ID 320)
Purpose/Objectives: To share the experience of two vastly different data conversion approaches - the first used vendor supplied tools not fit for the scale and the second used an Enterprise ETL (Extract Transform and Load) software.
Methodology/Approach: Review scope, approach, and technologies that were used in a two phase approach to data conversions from a legacy system (iPHIS) into BCs Public Health Information System Panorama. Phase 1 commenced with business requirements signed off two years prior to the implementation and with inadequate representation from the user community. Tools used were custom made and functioned in small batches, but were not designed for the volume of records. By the time the project team realized the tooling deficiency, the only viable option was to convert 45 million records in batches of 200,000 a very onerous, labour-intensive, and error-prone process. Following Phase 1, the project re-evaluated its approach and experimented with off-the-shelf ETL (Extract, Transform and Load) software on a minor dataset. With this success, the team created a model for Phase 2 that would leverage an enterprise ETL software, change the project structure and governance, and adopt a phased approach with seven incremental releases to users, each with a new set of data.
Finding/Results: Phase 1 Summary: Scope and Schedule: 44 million records converted over 10 full days plus workday evening conversions from 8pm until 6am for three weeks as well as effort on the weekends. Release Schedule: No opportunity to convert all data in advance of production run Defects: Two and half months required to address high priority bug fixes and missed data. Project Team: Team expanded to address challenges; exhausted team required heroic dedication. Phase 2 Summary: Scope and Schedule: 47.5 million records converted over 22 hours, including a lunch break. Release Schedule: Seven releases for the users to review, including three full production runs. This provided confidence of the quality of data and the process. Defects: Minor defects experienced; majority of team released after three weeks. Project Team: Controlled project environment requiring minimal overtime.
Conclusion/Implication/Recommendations: A significant investigation of the business signoff, process and tools is required prior to commencing any data conversion project. Use of Enterprise ETL tool was critical to success, and enabled incremental releases which built confidence in data quality and the conversion process. Incremental release did provide users with the ability to see data in the application prior to signing off on business rules. While this was useful in many respects, it did require rework from the project team when users didnt like what they saw.
140 Character Summary: Data conversion with the appropriate toolset and approach can be successful. For large conversions, an enterprise ETL software is critical.
OS01.02 - Successful Digital Health Systems: Guidelines for Healthcare Leaders and Clinicians (ID 215)
Purpose/Objectives: Health Canada describes eHealth as the utilization of information and communications technologies to support a variety of functions ranging from administration to health services delivery. There is general consensus that, when properly deployed and adopted, eHealth can increase efficiency, enhance patient safety and optimize health outcomes. However, the implementation of a digital health system is a large and complex undertaking with failure rates as high as seventy percent. Factors at the macro, meso and micro levels have been identified as contributors to these failed implementations. For these reasons, successful implementations require strong leadership at all levels as well as individuals (i.e. management and staff) with the appropriate informatics knowledge, skills and abilities to lead and support the initiative. There is a scarcity of evidence-based resources to adequately prepare individuals involved in the implementation of digital health systems to realize the intended benefits for patients, staff, healthcare organizations and the broader healthcare system. The recent development and publication of an evidence-based Guideline intended to enhance the informatics capacity of healthcare executives and clinicians is therefore timely. This presentation highlights the Guideline development process and provides an overview of the recommendations it contains.
Methodology/Approach: An international panel of experts was convened in January 2016 to collaboratively develop the Guideline. The panel members included healthcare executives, nurses and other healthcare providers from a range of settings including practice, education, research and policy. There were also two patient partners on the panel. All panel members with the exception of the patient partners had previous experience with digital health system implementations. A systematic review of the grey and peer-reviewed literature from 2006 to 2016 was conducted to identify relevant articles and other resources that met the search criteria. A total of 178 peer-reviewed articles and 56 grey literature resources were deemed relevant. Draft recommendations were formulated from these sources of evidence. A Modified Delphi technique was used to achieve panel consensus on the final 26 recommendations published in the Guideline.
Finding/Results: The expert panel identified individual, organization, education and system recommendations that address known micro, meso and macro level barriers to successful digital health system implementations. The individual and organizational recommendations focus on micro and meso level factors that contribute to the implementation, adoption and optimal utilization of high quality digital health systems that realize the intended return on the investment. The education recommendations focus on the eHealth education infrastructure required to facilitate the acquisition of micro, meso and macro levels informatics competencies by healthcare executives and clinicians. And, the system recommendations address the structure, process and policy requirements at the macro level to realize the long-term goals of nation-wide electronic health information exchange and health systems transformation.
Conclusion/Implication/Recommendations: This Guideline will be an invaluable resource for healthcare executive and clinical leaders, nurses and other healthcare professionals, health information technology personnel, patients and families as well as policy makers at the organization and system levels. By adopting the recommendations provided in this Guideline, individuals, organizations and health system administrators will pave the way for successful health system transformation.
140 Character Summary: This presentation highlights a recently published evidence-based Guideline that enhances the informatics capacity of healthcare executives and clinicians.
OS01.03 - Ready or Not...A Guide to Clinical Implementation Readiness (ID 293)
Purpose/Objectives: Organizations throughout Canda continue to invest , design and implement electronic health systems with a focus on improving interoperability and patient outcomes. Preparing an organization for a transformation of this kind requires a comprehensive understanding of orgnaizational current state. Using standardized methodologies in the capture of current state workflows, current documentation and ordering practices will provide insight into organizational readiness. At the conclusion of this presentation, participants will be able to: Understand benefits of using standard readiness methodoligies List key components used in determining organizational readiness Identify common barriers impacting successful system implementations
Methodology/Approach: There are many initiatives in Canada which are contributing to organizational drive to move forward with advanced clinical systems. Some factors include: · Adoption and untilization of electornic medical records benchmarked against the HIMSS EMRAM scale · Ministry mandated reporting · Patient safty intitiatives · Research Providing efficient, safe and high quality clinical services is complex and requires significant organizational investment. Using an inter-professional approach when defining current state provides a comprehensive assessment of orgnaizational readiness
Finding/Results: There are certain consistent characteristics associated with the successful implementation of a new electronic system or module. Understanding organizational and staff readiness, are as important as determining current process and practice. By using a consistent approach in determining readiness, an organizations ability to achieve its desired goals, and avoid barriers is greatly increased.
Conclusion/Implication/Recommendations: The presenters, using examples from numerous readiness assessments conducted across Canada, will share useful lessons learned. The presenters will guide the attendee toward an understanding of the benefits of using a standard interprofessional approach to readiness. By the conclusion of the session the attendee will possess the knowledge and understanding of how to determine an accurate picture of organizational readiness.
140 Character Summary: Join us on the pathway to success. Learn how to prepare your organization for change by using proven methodologies to determine readiness.
OS01.04 - Implementing a New Dose Range Checking Solution at SickKids Hospital (ID 44)
Purpose/Objectives: Discuss development and implementation of a new dose range checking (DRC) solution optimized for tertiary paediatric hospital practice. Topics include creation of DRC decision rules for soft and hard alerts, approach to configuration, training and implementation, and monitoring new DRC solution for safety and efficacy.
Methodology/Approach: SickKids has had computerized physician order entry with soft DRC alerts since 2008. The standard DRC tool lacked certain functionalities for tertiary paediatric practice, resulting in wrong-dose incident reports. In January 2016, SickKids assembled a multidisciplinary team (Medicine, Pharmacy, Information Services) to implement a new DRC solution with the electronic medical record (EMR) vendor (Allscripts). Compared to the standard DRC tool, the new solution had these key improvements: · Mandatory override reason · Concomitant soft and hard alerts · Set alerts, individually or in combination, by o Postmenstrual age o Weight o Age o Body surface area o Frequency · DRC stratified by clinical service Key components of implementing the new solution include: · Seek DRC approaches from other centres · Develop decision rules for setting soft and hard alerts · Obtain approval to implement hard stops and decision rules from various hospital committees: o Drugs and Therapeutics o Clinical Informatics Advisory Group o Medication Advisory Committee · Develop, test and implement new DRC solution with Allscripts · Develop reports to extract o Orders and doses entered in EMR by medication name o Alerts fired and overridden in EMR · Choose medications for go-live by o Identifying high alert medications without existing DRC o Selecting two prototype drugs (acetaminophen, tobramycin) · Establish DRC ranges for medications using decision rules, orders report and stakeholder input · Train users during July intake, through departmental in-services and via email communications o Pharmacists received in-depth training and support for hard-alert overrides · Evaluate dose range appropriateness using DRC alerts report and incident reports
Finding/Results: Decision rules were developed: · Upper limits (percentage above usual dose) o High alert: 10% soft, 20% hard o Non-High alert: 15% soft, 30% hard · Minimum limit: 10-fold below usual low dose · Exceptions: titratable medications This was ratified at various hospital committees and helps logically set and justify DRC ranges. Soft and hard alerts were implemented for 19 medications in July 2016: · Acetaminophen · Aminophylline · Epinephrine · Epoprostenol · Esmolol · Labetalol · Magnesium sulphate · Nitroglycerin · Nitroprusside · Norepinephrine · Phentolamine · Phenylephrine · Potassium chloride · Potassium phosphate · Procainamide · Propofol · Sodium phosphate · Tobramycin · Vasopressin In the month post implementation, 1253 alerts fired for 993 items in the standard solution. Eleven alerts fired for 37 items in the new solution; 2 were hard alerts. This difference was driven by fewer nuisance alerts with the new solution. All override reasons in the new solution were reasonable.
Conclusion/Implications/Recommendations: Consultation and education to front-line users, clear decision rules and new reports facilitated a successful launch, decreased nuisance alerts and improved patient safety. Next steps include monitoring and updating DRC settings and addition of medications to the new solution.
140 Character Summary: SickKids sought to optimize its DRC tool in 6 months. Decision rules were developed & soft & hard alerts implemented, resulting in decreased nuisance alerts.
OS01.05 - Lessons Learned: Applying Agile Methodology to Healthcare Technology Development (ID 211)
Purpose/Objectives: For years, healthcare software companies have been reluctant to fully embrace Agile development processes - the seemingly chaotic and constantly-shifting priorities of Agile seemed to fly in the face of FDA regulations that favored highly regimented, planned, and documented software releases. As more and more companies have taken on Agile, it has become abundantly clear that the Agile provides compelling competitive advantages that can be adapted for use with the Healthcare IT environment.
Methodology/Approach: Guided by the practices laid out in AAMIs TIR45 document Guidance on the use of AGILE practices in the development of medical device software. we'll share how to apply Agile practices while developing FDA-compliant, medical-grade software.
Finding/Results: I will draw from real world experiences implementing Agile in to provide participants a candid view of our Agile story.
Conclusion/Implications/Recommendations: You'll learn how to accelerate development while delivering quality medical software, thorough testing, and comprehensive project documentation.
140 Character Summary: Five key lessons in understanding and moving towards Agile software development.
OS01.06 - Multi-Sector Implementation of Evidence-Based Wound Care Order Sets: Lessons Learned (ID 218)
Purpose/Objectives: With a price tag of approximately four billion dollars annually, wound care is a significant financial burden to the Canadian healthcare system. This panel presentation will showcase a multi-sector wound care management strategy that targeted individuals with pressure injuries (PI) and diabetes-related foot ulcers (DFU) to optimize wound healing using evidence-based order sets. Panel members will each describe their implementation approach and lessons learned during the process. They will also discuss the net benefits derived from the project as these relate to patient safety, provider and patient/caregiver adoption, health outcomes and efficiency.
Methodology/Approach: Six nurse peer leaders (NPLs) were established in four healthcare organizations across the care continuum (i.e. ambulatory care, acute care, home care and long-term care). The NPLs received training that enabled them to provide technical expertise, leadership and mentorship to support the integration of evidence-based wound care order sets within their organizations health information system. Two healthcare organizations in the acute care and long-term care sectors implemented interprofessional order sets that were used to guide the care of patients/clients/residents with PI and to reduce their risk of developing additional PIs. Healthcare providers in the remaining two organizations used wound care order sets in ambulatory and home care settings for the assessment and management of DFUs. Each organization also implemented a self-management order set to actively engage patients/clients/residents or families in their care. A comprehensive benefits evaluation framework was used to design the evaluation strategy. Clinical analytics enabled each organization to monitor specific structural, process and outcome indicators.
Finding/Results: Approximately 1,000 healthcare providers integrated the evidence-based order sets into their practice. The order sets facilitated knowledge translation and evidence-based decision-making at the point-of-care resulting in reduced variation in wound care management at each site. There was increased patient safety resulting from patients and residents with PI or their families conducting an initial assessment of their risk for additional PIs using a web-based tool developed for the project and keeping a PI prevention diary in which they recorded their self-management activities on a daily basis. Patients with DFUs assessed their knowledge of diabetes and foot care and used a wound care App or web-based resource and electronic goal calendar to identify SMART goals that they wished to achieve, in collaboration with their healthcare provider. Overall, the order sets improved efficiency in wound care management and patient engagement.
Conclusion/Implications/Recommendations: This multi-sector nurse peer leader project has demonstrated the value of implementing evidence-based wound care order sets across the continuum of care. These order sets support the interprofessional care team model used in this project but they may also be integrated into other service delivery models such as the nurse-led models in the primary care sector. They facilitate knowledge translation and evidence-based decision-making at the point-of-care, resulting in safe, high quality wound care and optimal health outcomes.
140 Character Summary: This presentation describes the implementation of evidence-based wound care order sets in multiple sectors: acute care, home care, ambulatory care and LTC.
OS13 - PHR Storms Across Canada (ID 19)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 4
- Coordinates: 6/06/2017, 01:00 PM - 02:00 PM, Room 201CD
OS13.01 - Mustimuhw Citizen Health Portal – Centering Patients in First Nation Healthcare (ID 243)
Purpose/Objectives: First Nations have built an approach to health around an empowerment philosophy where the patient is an active member in their care. However, this approach has historically not included a patients ability to electronically communicate with their providers, nor have easy access and input to their own health records. The Mustimuhw Citizen Health Portal changes that. With funding from Canada Health Infoway, a project was launched in April 2016 to evaluate consumer health models in a First Nation community where patients are interacting with on-reserve health centre clinical providers and with physicians in the local division of family practice. Typically, barriers to effective clinical information sharing have impeded interaction between health centre providers and physicians and caused challenges for effective circle-of-care models. Patients have also not had the ability to directly interact with their health records, or communicate electronically with members of their care team. As the largest First Nation in BC, Cowichan Tribes is a national leader in leveraging health information management to enable member-driven, or consumer-driven, health services and care. The Mustimuhw Citizen Health Portal, now deployed, extends the consumer-driven healthcare model further by leveraging the use of increasingly popular PHR technology and connecting patients and providers. With the project proving successful, and foundational PHR interoperability established, the Mustimuhw Citizen Health Portal can now be extended to other First Nations both in BC and in other provinces where consumer-driven healthcare models may benefit the community and enhance coordination and information sharing between providers.
Methodology/Approach: The Mustimuhw Citizen Health Portal uses an Infoway-Certified PHR Platform that enables patients to provide and access targeted personal health information. Health Centre providers and local physicians are aligned and enabled to provide this information to their shared patients and to consume patient-provided information. Patients are empowered to self-manage privacy and access across providers, and within their family, to enhance the continuity of information to their benefit. Interoperability efforts have focused on information flow between the RelayHealth PHR, the Mustimuhw cEMR, physician EMRs and a private lab while parallel efforts focused on patient and provider engagement and PHR adoption and use.
Finding/Results: To date, response and willingness to adopt has been strong by the target user groups. Efforts are currently underway to improve interoperability, increase adoption, and support ongoing use of the PHR solution by patients and providers. Activities are now underway to extend the use the Mustimuhw Citizen Portal in other locations, and extend the scope of data and functionality.
Conclusion/Implication/Recommendations: Early results indicate that a PHR solution is a viable and beneficial consumer health tool within First Nations communities. Use of a PHR can address longstanding issues and challenges that previously have impeded patient access to health services and provider access to important patient data. Given that there are many similar health care requirements across First Nations communities in Canada, and many similarities in the challenges posed to effective information sharing between First Nations and provincial providers, a recommendation can be made to extend this projects model to other First Nations within Canada.
140 Character Summary: The Strengthening the Circle of Care project brings a practical consumer health solution to First Nations through use of the Mustimuhw Citizen Health Portal.
OS13.02 - From Pilot to Provincial Roll-out – Implementing the Personal Health Record (ID 120)
Purpose/Objectives: A lack of connectivity and breakdowns in communication within the medical infrastructure are some of the major issues challenging the Canadian health care system. So too is a growing call from patients demanding faster access to the right services, improved outcomes and more involvement in managing their own healthcare. This presentation will show how a Canadian province is building on the success of their Personal Health Record (PHR) demonstration project and leveraging Canada Health Infoway investment to complete the implementation of a PHR solution, thereby bringing the world of e-health to all citizens within the province who want to plug in. Objectives: Learn how an easily implemented connectivity is benefiting all stakeholders Understand how the solution empowers and engages patients in their own healthcare The planning and process that was required to get providers and patients to use the solution
Methodology/Approach: The province has completed a multi-year demonstration project that introduced a Personal Health Record (PHR) solution to the provincial health care system. This project involved 30 family physicians, who invited patients in their practices to participate in the testing of this technology. Patient recruitment targets were met early in the project and enrolment numbers were much higher than anticipated. Using information learned through the demonstration phase, the project is now ready to roll out a PHR solution to the entire province. This has the potential to be a game changer for the provincial health care system, and as such, requires a thoughtful change management approach, supported by strategic communications. The change management support required to ensure smooth implementation province-wide is not only to ready the provider communities and general public to adopt the solution, but in resolving key policy issues that will be necessary to pave the way. This includes supporting the articulation of a clear vision statement by senior government leadership in support of the PHR innovation, backed by a physician compensation model for eWork. Another key enabling condition is demonstrating interoperability with practice EMRs as well as interoperability with hospital-based lab/DI information systems, and provincial assets.
Finding/Results: In this demonstration phase, the PHR solution was implemented. Provider uptake was voluntary and the project target to recruit 30 family doctors was achieved . This group largely consisted of self-described technology innovators. Physicians were tasked with recruiting their patients to the PHR demonstration project. An overall target of 3,000 patient users was achieved early in project and was well beyond its goal by the end of the project with more than 6,000 records. The provincial roll-out is based on physicians volunteering to sign up, followed by a targeted geographic deployment strategy, where physicians will be approached and asked to participate.
Conclusion/Implication/Recommendations: Based on what was learned the demonstration project, further supported by a growing body of literature, the PHR has the potential to strengthen the provincial primary health care system and make publicly funded health investments go further. Ultimately, the PHR will be a key force in transforming health care in the province into a truly patient-centred system.
140 Character Summary: Connecting the circle of care utilizing technology such as the patient portal, with the person in the middle, empowers the patient to do so much more for themselves.
OS13.03 - Exploring Patient Empowerment: The eHealth Saskatchewan Citizen Health Information Portal (ID 365)
Purpose/Objectives: A strong commitment to patient empowerment has been identified as a crucial element in the achievement of lasting patient-centered transformations within healthcare systems. The promise of e-health interventions in supporting patient empowerment has been widely touted, however the concept itself remains ambiguous and lacking in substantiated concrete measures. Further, very little has been done to engage with patients to ascertain their views on empowerment, especially within an e-health context. In this study, participants enrolled in a pilot deployment of the e-Health Saskatchewan Citizen Health Information Portal (CHIP) had an opportunity to engage with researchers from the University of Saskatchewan to share their views on engagement, empowerment, and their introduction to the CHIP.
Methodology/Approach: This research employed a mixed methods approach in the exploration of patient empowerment and the CHIP in Saskatchewan. Led by an extensive scoping review on patient empowerment, specifically focused on e-health interventions including portal projects, the study also incorporated qualitative data from participant interviews. Interpretive description was used to analyze the qualitative results and provide a participant driven view of empowerment in relation to the use of the citizen portal. Lastly, the research team integrated the results of the scoping review with key findings on empowerment, to develop a pilot tool to support a more focused and precise measure of empowerment in e-health initiatives.
Finding/Results: This study has produced an e-health focused review of patient empowerment and a newly proposed pilot measure that can support further examination of the influence of this vital concept. While ongoing testing and validation of the measure will need to be undertaken, this research provided a means to maximize patient voice in the instrument development process, a unique consideration in the examination of this concept within the e-health context. The results of a scoping review further guided the delivery of the proposed measure.
Conclusion/Implication/Recommendations: The promise of e-health intervention in delivering improved opportunities for patient empowerment requires more substantiation. Often the concept of patient empowerment is introduced in association with researched interventions, but reported measures focus on a host of other outcomes without specifically addressing the empowerment component. Frequent notations have been made about the complex nature of the concept seemingly to serve as an explanation for inconsistencies in how it has been measured. Patient empowerment, although extensively examined, clearly remains difficult to operationalize and evaluate. Since patients are the object of these empowerment endeavours, it seems crucial to allow patient voice to direct the definition of key aspects of empowerment in e-health intervention. This research has begun that patient-directed consideration of empowerment in the hopes that it will provide a more substantial and meaningful foundation on which to advance this measure in future study.
140 Character Summary: A scoping review and participant voice directed this study of patient empowerment in e-health and the resultant development of a new pilot measure for this concept.
OS13.04 - Perks and Pitfalls of a Patient Portal (ID 41)
Purpose/Objectives: To discuss the potential perks and pitfalls of using a patient portal. While it leads to improved patient care and satisfaction, physicians are incredibly reluctant to use this technology. I will discuss Grandview Medical Centre Family Health Team's three years of experience of patient portal use with our 16 family physicians and their 30,000 rostered patients.
Methodology/Approach: I will include: How we obtained physician buy-in How we decided whether or not to charge for the portal How we decided who is eligible for the patient portal How we decided who the patients could securely message in our clinic How we 'got the word out' about the patient portal and had patients sign up How we dealt with inappropriate patient use of secure messaging How we dealt with specialists concerns regarding our portal How we started patient online appointment bookings How we dealt with surprise issues surrounding online appt bookings
Finding/Results: All 16 doctors are actively using portal in some shape or form. We have had 5,200+ people have signed into portal at least once. Out of 30,000+ patients Children not signed up User Breakdown Age 65+ usage surprisingly high During the last month of data available, we have had 90 patient appointment bookings and cancellations 77 bookings 13 cancellations
Conclusion/Implication/Recommendations: Through our expercience rolling out the patient portal in a private clinic setting of 16 family physicians in a family health team setting taking care of 30,000 patients, we learned that it can take some time to set up the portal and get buy in from physicians and patients. However, once fully in place, the portal has the ability to improve patient satisfaction, decrease unnecessary visits and overall improves patient care. We strongly recommend that practices give it a try by rolling it out to clinical and non-clinical champions first and then gradually expand to the the rest of the clinic.
140 Character Summary: The patient portal is one of the most difficult technological advances to obtain buy in for but has the most potential to be a game changer in a patient care.
OS24 - Evolving Approaches to Patient Care (ID 29)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 201CD
OS24.01 - Giving Patients the Power to Manager Their Health (ID 353)
Purpose/Objectives: A survey found that 72 percent of global leaders believe empowered patients create better value care[i] and, research tells us that patients who are less engaged cost the health system from 8 to 21 percent more than those who are engaged[ii]. With patients today playing a more active role in their own healthcare than ever before, access to personal health management tools and information are motivating people to be more proactive about their health and wellness goals. In a world where ubiquity of the Internet and powerful smartphones are transforming business models and entire industries, Personal Health Records (PHRs) can play a significant role in empowering patients to better manage their health. This presentation will illustrate how Personal Health Records empower people with the ability to access and manage their health information anywhere, anytime. [i] Impact of Home Health Monitoring on Clients with Heart Failure. Cheryl Beach, BSc(PT), MSc, PhD; Oluseyi Oyedele, BSc, MSc, PhD, MPH; Dion Bedard, BSc; Mark Lazurko, BSc(Pharm), MBA, 2014
Methodology/Approach: As the emphasis on managing chronic conditions and improving health and wellness, not just sick care, gains mainstream acceptance, its reasonable to expect that the use of digital tools and services to monitor and manage health are set to grow. This presentation will discuss how the use of Personal Health Records contributed to improving healthcare, to increasing engagement and empowered people to take greater control of their own health. We will also discuss how a patient-centred approach to healthcare delivery provided patients more control over and responsibility for their own health.
Finding/Results: Providing patients, and citizens, the ability to manage and view their health data place and proactively share this information with their healthcare providers results in better quality of care. By leveraging a pilot program, the roll-out of the PRH resulted in enhanced communication between patients and their doctors and other care providers, and empower patients to be an integral participant in the process, better managing their health conditions, and ideally, preventing illness.
Conclusion/Implication/Recommendations: By leveraging technology, and digital health tools such as a Personal Health Record, a patient-centred approach to healthcare delivery engages patients, and citizens, and ultimately, drives better health outcomes for all Canadians, for less money spent.
140 Character Summary: How access to personal health management tools and information are motivating people to be more proactive about their health
OS24.02 - The Last Clinical Mile of Precision Medicine – Challenges at POC (ID 140)
Purpose/Objectives: Medical history is notable for game-changing breakthroughs. Germ-destroying sterilization. Miracle drugs like penicillin. Lifesaving organ transplants. Precision medicine is equally revolutionary. It signals a significant shift from generalized medicine the traditional one-size-fits-all and trial-by-error approachto personalized medicine with testing and treatments tailored for individuals. But barriers exist. The most significant? The gap between genomic information and its timely, meaningful application at the point of care. Today, the science of genomics occurs in labs (blood, tissue testing), research facilities (omics, sequencing), pharmaceutical companies (biomarkers for specific drug efficacy) and clinical trial programs. But, its not accessible in actionable, meaningful clinical terms; nor is it structured and harmonized with the clinical context of the patient. And it is not available in the current workflow of the clinician.
Methodology/Approach: Up until now, medical knowledge and therapies were tested on broad populations and prescribed using statistical averages. And that meant they would work for some patients but not for many others. The potential result? Diagnosis and treatment delays or inaccuracies that might have catastrophic impact. Precision medicine factors genes, environment, lifestyle factors and family history into all clinical decision-making for earlier, accurate diagnoses, and more effective treatment and prevention. In other words, precision medicine overcomes the limitations of traditional health care by taking individualized factors into consideration. Clinicians are able to analyze the potential diagnosis, match and tailor the right treatment, and review the efficiency of current protocols.
Finding/Results: Here are just a few reasons why precision medicine is taking center stage in health care today: a. *Patients 9 out of 10 causes of death are influenced by genetics. b. Providers 30% reduced ED vists by applying molecular profiling treatment strategy. c. Payers - $25 billion annual spending on genetic tests by 2021. d. Pharma - $7.5 billion will be the size of the pharmacogenomics market by 2017. e. Government* - $215 million: President Obamas precision medicine initiative investment.
Conclusion/Implication/Recommendations: As physicians, we want to offer the best possible care plan for every patient, every time. When treating conditions, such as tumors or inherited diseases, we want tools that help us incorporate the many factors that affect each individual. This is where precision medicine comes in. As defined by the National Institutes of Health (NIH), precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person. The good news for patients today is that there is an increasing number of genetic diagnoses, while at the same time, the costs to sequence a human genome are dropping. We are in a better position than ever before to tailor medicine to the individual. For the first time, were seeing some alignment on the importance of precision medicine. All of these stakeholders are coming together to help realize the promise of genomic knowledge. When delivered at the point of care, precision medicine will have the greatest impact.
140 Character Summary: Precision medicine is revolutionary for healthcare and is taking center stage with patients, providers, payers, pharma, and government.
OS24.03 - Mental Health Coaching Using Cloud-Based Education and Behavioural Monitoring (ID 376)
Purpose/Objectives: Seventy percent of mental health problems appear before the age of 25 years. When untreated, these disorders become long-standing and significant, impairing all life domains. Although the problem is especially acute for youth from Indigenous and First Nations backgrounds, it is acute for all Canadian youth as 15-25 years is the most likely age-span for diagnosable mental health problems substance dependencies and suicide. For example, substance dependency and suicide are the 1st and 2nd most frequent causes of college and university student mortality. Cognitive behavioural therapy (CBT) is the best-validated psychotherapy, with proven effectiveness resulting in CBT being offered free-of-charge by the United Kingdom National Health Services. In recent years, CBT has been integrated with mindfulness meditation (e.g. mindfulness-based CBT), with strong evidence supporting its effectiveness. Research undertaken with student populations by our group has demonstrated psychometrically and neurophysiologically assessed benefits in web-based Randomized Controlled Trials of CBT-Mindfulness interventions. This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) with youth subjects (18 25 yrs) diagnosed with major depressive disorder.
Methodology/Approach: Two treatment groups (youth of Indigenous-First Nations background, youth of all other ethnic backgrounds) will be compared with wait list controls (50% Indigenous- First Nation, 50% other background) at baseline, 3 months (mid-intervention) & 6 months (post-intervention), using valid, standard self report outcome measures. Experimental subjects will receive additional intervention consisting of a mindfulness-based CBT online software program workbook (in collaboration with NexJ Health Inc.). Exposure to and interaction with the online workbook is combined with health coaching (duration of 24 hours) primarly delivered in phone/software interactions. Participants and health coaches will plan one face-to-face session per month. Content builds on two prior successful web-based CBT-mindfulness RCTs with students (Radhu et al., 2012 Arpin-Cribbie et al., 2012) and methods demonstrated effective in prior RCTs in other countries (Boettcher et al. 2014, Carlbring et al., 2013, Lappaleinen et al., 2014). The online workbook content consists of 24 chapters that cover multiple topics (e.g. Living By Your Truths, Overcoming Wired-ness and Tired-ness, Mindfulness and Relationships, Loss and Grief, and Resilience, Befriending Ourselves, Befriending Your Body with Exercise, Body Image and Mindfulness, Intimacy, Forgiveness, Overcoming Procrastination, Dealing with Negative Moods, Stress Resilience, Overcoming Performance Anxiety, Cultivating Inspiration) which are covered in sequence on a weekly basis with the health coach (over 24 weeks).
Finding/Results: Hypothesis: CBT-MM online intervention will be associated with statistically and clinically significant between-group differences (benefits) when treatment groups and control group are compared, using both intention-to-treat and per protocol analyses. Costs and cost-effectiveness of CBT-MM online intervention will compare favorably with office-based CBT services. Outcome Measures: Primary outcomes: Beck Depression Inventory; Secondary outcomes: Anxiety (Beck Anxiety Inventory), depression (Quick Inventory of Depressive Symptomatology) (QIDS), mindfulness (Five-Facet Mindfulness Questionnaire), pain (Brief Pain Inventory).
Conclusion/Implication/Recommendations: If significant differences are obtained, this will be a substantial advancement in our ability to offer high quality interventions without geographic restriction.
140 Character Summary: This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) for youth diagnosed with major depressive disorder.
OS24.04 - Computer Based Training for Cognitive Behavioral Therapy (CBT4CBT) (ID 97)
Purpose/Objectives: Created by Dr. Kathleen Carroll at the Yale School of Medicine, CBT4CBT is a revolutionary new substance abuse treatment program that is currently being rolled out in the United States. Introductory trials conducted among urban populations in major US cities have demonstrated CBT4CBTs effectiveness in providing a meaningful treatment option for challenging populations at moderately low cost and with lasting effects. A recent collaboration between Dr. Carroll and Drs. Juergen Krause and Michelle Patterson of the Centre for Health and Community Research (CHCR) at UPEI will bring this innovative treatment program to Canada for the first time. Using Prince Edward Island as a gateway, CBT4CBT is currently being implemented and evaluated in sub-populations of high-need individuals as part of a CIHR funded pilot and will subsequently be rolled out across Canada.
Methodology/Approach: The pilot program aims to determine the effectiveness and efficacy of this computer-based treatment option for addiction therapy within specific rural Canadian populations. This trial utilizes a similar methodological approach as the trials performed in urban communities of the United States, with participants at each trial site being randomly assigned to one of two groups, both including treatment as usual (standard counseling) but with one group additionally having access to the CBT4CBT tool. This simple add-on design has been shown to be effective at determining the extent to which CBT4CBT confers specific benefits over current standard practices.
Finding/Results: CBT4CBT is offered at trial sites in PEI and New Brunswick which have been selected as representative of high-needs populations who may benefit from improved addiction treatment options and support. The trial populations include First Nations, youth (age 18-24), post-secondary students, individuals maintained on methadone, and individuals transitioning out of inpatient facilities. Preliminary results from each of these populations will be discussed.
Conclusion/Implication/Recommendations: A larger-scale implementation of CBT4CBT across Canada will offer an innovative and in-demand therapeutic option for individuals struggling with substance abuse. A roll-out plan for the implementation of CBT4CBT across Canada is under development, and a list of priority revisions and enhancements for future iterations the program is being established and compiled.
140 Character Summary: CBT4CBT is currently being evaluated in sub-populations of high-need individuals as part of a CIHR funded pilot and will subsequently be rolled out across Canada.
OS24.05 - Achieving Quality in a Telemedicine Program – Engaging Referring Physicians (ID 347)
Purpose/Objectives: The Excellent Care for All Act formalized the quality improvement activities of all the hospitals. At St. Michaels Hospital (SMH) continuous quality improvement that focuses on patients has been an integral part of its rich history of providing excellent and compassionate care. In alignment with St. Michaels Hospitals culture of quality improvement the Telemedicine Program strives to implement at least one quality improvement initiative each quarter. This poster will demonstrate a Telemedicine Programs quality improvement initiative focusing on access to specialty care. SMH Telemedicine Program initiated the Respirology Telemedicine Clinic services in 2011 in response to referrals received from physicians in remote Ontario communities. The SMH Respirology telemedicine clinic provides consultation for a broad range of respiratory conditions such as COPD, interstitial lung disease, pulmonary nodules, and asthma. The SMH Telemedicine Program is now interested in knowing if the needs of the referring physicians are being met. The aim is to understand how the SMH Respirology telemedicine service is impacting the referring physicians daily practice. More specifically- does telemedicine affect their workflow and how they manage their patients respiratory conditions? Further, we want to assess the extent of impact of Respirology Telemedicine clinic services, which in turn will guide our efforts to provide the best possible services.
Methodology/Approach: In the past 5 years the Respirology Telemedicine Clinic has received referrals from over 30 Physicians from various communities across Ontario. To assess the efficiency and overall satisfaction with the service, the Respirology Telemedicine Clinic Referring Physician Survey was developed. All the physicians who had referred patients to the Respirology Telemedicine Clinic during the past 5 years were invited to participate in the survey.
Finding/Results: At the time of submitting this abstract the results from the surveys are still being collected. The analysis of the survey results will be available for the poster.
Conclusion/Implications/Recommendations: The SMH Telemedicine Programs initiative to engage with the referring physicians is in alignment with St. Michaels Hospitals commitment to continuous quality improvement. The Respirology Telemedicine Clinic Referring Physician survey results will provide us the referring physicians perspective and will help us to make improvements to our services. The SMH Telemedicine Program plans to roll out this quality improvement initiative in other programs like Geriatrics, Vascular Surgery etc. in the following year.
140 Character Summary: This poster presentation will describe a quality improvement initiative by a telemedicine clinic in a large academic health center.
OS24.06 - Dashboards Driving Quality: A Focused Example Using Suicide Risk Assessments (ID 130)
Purpose/Objectives: The Centre for Addiction and Mental Health (CAMH) is Canadas largest mental health and addictions facility. A strategic priority for CAMH is the promotion of safety, with a particular focus on the prevention of violence directed at self or others. A critical component of this strategy is focused on suicide risk prevention, with the expectation that all inpatients are screened for suicide risk within 24 hours of admission. At the time, available reporting tools were unable to communicate compliance and quality data to stakeholders, resulting in low compliance and accountability in assessing patients. Accordingly, a dashboard to monitor changes was developed as a resource to access just in time compliance data to ensure assessment completion.
Methodology/Approach: This performance management initiative involved four phases; beginning with quality assurance audits. Phase two involved working directly with stakeholders to determine what information would be clinically meaningful. Phase three focused on the development of a manual report which provided weekly data to Managers, allowing for monitoring of compliance rates over time. The final phase of the project included the development of an online dashboard with just in time completion rates, providing flexibility for comprehensive analysis.<img alt="image1 sra ehealthj.jpg" annotation="" id="image://21" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=0f336be8c9cf7736527856f012e5bf6593aa3496&id=21&width=350&height=350&download=0" title="image1 sra ehealthj.jpg" />
Finding/Results: In the second quarter of 2015/16, SRA compliance was significantly below the target of 90%, at 78% completion. The aforementioned dashboards were designed in Q3 and implemented in Q4 of 2015/16. Following dashboard launch, a increase in compliance was observed the following quarter (94%), and has remained above target since that time. <img alt="image2 sra ehealthj.jpg" annotation="" id="image://22" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=723007530ad2f64a8ba75ad354a1986a385bca8a&id=22&width=350&height=350&download=0" title="image2 sra ehealthj.jpg" />
Conclusion/Implication/Recommendations: This dashboard empoweres CAMH to set new standards in safety and meaningful reporting. By aligning strategic priorities with enterprise reporting, CAMH provides stakeholders the opportunity to push measurable improvement initiatives within their areas. Future integration of agreed best practices will expand these dashboards beyond compliance, into care planning and driving a higher quality of care for CAMH patients.
140 Character Summary: A performance management approach focused on increasing suicide risk assessment compliance rates through clinical engagement and implementation of dashboards.
PS01 - Architecting Jurisdictional Ecosystem (ID 10)
- Event: e-Health 2017 Virtual Meeting
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 201CD
PS01.01 - Canada's eHealth Secret: Northwest Territories Networked Health Ecosystem (ID 230)
Ewan Affleck, Office of the CMIO, Northwest Territories Health & Social Services Authority; 35S/CA
Geoff Rabbie, Sierra Systems; Edmonton/CA
M. Ali, Northwest Territories Health & Social Services Authority; Yellowknife/CA
Purpose/Objectives: The objectives of the presentation are to (3 - listed to align with 3 elements of panel): o Describe the principles of Networked Health by examining the Northwest Territories enterprise interoperable eHealth system (Big-thinking). o Illustrate the approach to implementation and system governance that contributed to the success of the project (Strategy) o Illustrate the approach and benefits realization of jurisdiction-wide analytics enabled by the Networked Health Ecosystem (Analytics). These objectives are of significant relevance to jurisdictions struggling with system design, interoperability, governance and/or enterprise analytics
Methodology/Approach: Unlike most jurisdictions in Canada the Northwest Territories has quietly taken a federated patient-centric approach to the design and deployment of its eHealth system. The strategic framework, Networked Health, is based on the foundational element of a patient-centric chart shared across all outpatient services and locations. The Northwest Territories boasts 42,000 people in 33 communities in an area twice the size of France. By the end of 2016 80% of the population will be served on a single charting system shared by almost all services and locations across the spectrum of care, including the first fully digital nursing stations in Canada. By the end of 2017 it is planned to have 100% of the population on the system. The implementation of a territorial Networked Health ecosystem has been a remarkable journey that is now bearing significant benefits, specifically: · Digital remote community support · Networked Home Care support · Federated eReferral / eConsultation · Federated analytics and clinical decision support · Economies of scale in deployment and support · Accountable health governance and clinical care · Staff satisfaction
Finding/Results: Early findings demonstrate: · Improved quality of remote community support (specifically time to care, continuity of care, provider satisfaction, efficiency of service, equity of care). · Improved Home Care support (specifically continuity of care, provider satisfaction, efficiency of service, equity of care) · Improved patient outcomes with analytics and clinical decision support (safety of care, appropriate care, provider satisfaction, efficiency of service, equity of care) · Nascent means of instituting enterprise appropriate care and limiting unwarranted care. · Demonstrable economies of scale with federated solution (single solution decreases cost of application licenses, training, support, hardware). · End-user (administration and staff) approval.
Conclusion/Implications/Recommendations: The Northwest Territories enterprise patient-centric digital charting solution has proven to be a significant success, with users across disciplines and locations requesting to be implemented on the system (demand is outstripping program implementation capacity). This project has become the foundational element of the strategic plan of the Territorial Health & Social Services Authority to implement a Distributed Health Home model of service, and to drive appropriate and limit unwarranted care. Once application deployment is complete in 2017, the program will refocus on maturity of system use, leveraging early successes with interdisciplinary communication, and centrally managed but distributed remote support, enterprise analytics and clinical decision support across all communities. Further this model of eHealth design offers economies of scale in terms of application cost, operations and management (application support, technical support), analytics, ever-greening, and data management.
140 Character Summary: Canadas best kept eHealth secret is the successful deployment by the Northwest Territories of a single charting system for all health services in the jurisdiction.
PS01.02 - SPARKing a Pathway to Access Patient Health Data (ID 271)
Shiran Isaacksz, University Health Network; Toronto/CA
Samantha Liscio, eHealth Ontario; Toronto/CA
Shivani Goyal, 20 Dundas St. W, Suite 331, University Health Network; Toronto/CA
Joe Greenwood, MaRS; Toronto/CA
Purpose/Objectives: Over the past 10 years, Ontario has made considerable progress on the eHealth front with the development and implementation of clinically significant point-of-care systems to allow clinicians to securely access and exchange information including lab, drug, diagnostic imaging, immunization, hospital, and community care data. As well, the demand for innovative care models and technologies that facilitate access to a patients electronic health record is growing exponentially. The need for a transparent, standardized approach to connect to this data is more important than ever. Despite significant advancement in ehealth and the growing demand for access to data, there remains a number of technical, policy and regulatory challenges that need to be addressed to improve patient health outcomes through the transformation of care delivery. These challenges include non-interoperable technology solutions, limited means for patients to access their own data, and lack of open standards and access to tools/ resources for development and diffusion of technology to market.
Methodology/Approach: With funding by the Ontario Ministry of Health and Long-term Care (MOHLTC), University Health Network (UHN) and MaRS Discovery District have established a collaborative partnership through Project SPARK (SPARK). SPARK is a multi-phased initiative designed to advance healthcare delivery and improve patient care for Ontarians. Specifically, SPARK aims to stimulate digital health innovation by facilitating access to core provincial data assets and creating a pathway for innovators (researchers, software developers, entrepreneurs, private industry, etc.) to scale their digital health technologies to market. To do this, SPARK will guide innovators seeking to plug-in to the provincial EHR infrastructure by developing a transparent and standardized set of processes and tools.
Finding/Results: In alignment with the Ontario MOHLTC Patients First Strategy and the forthcoming Digital Health Strategy, SPARK will promote the health and well-being of Ontarians, improve access to healthcare services, accelerate the next generation of ehealth assets, and liberate high-value data from core ehealth assets for use by patients and innovators. By leveraging investments in provincial ehealth infrastructure and by bringing together key stakeholders across the digital health technology ecosystem, SPARK will connect the patient consumer and their provider with their health data, creating a true collaborative partnership in care delivery and management. In addition to the benefits that SPARK will create for patient/consumers, providers, and health technology innovators, it will also create several benefits for the province of Ontario. SPARK will provide an ongoing R&D pipeline for the continuous improvement of assets such as ConnectingGTA and will contribute to the ongoing sustainability of Ontarios foundational eHealth investments (e.g., through data monetization strategies). The successful adoption and diffusion of made-in-Ontario health technologies will create economic wealth and jobs for Ontarians, validating the province as a leader in healthcare innovation, demonstrating public-private collaboration that incents innovation while improving the healthcare system, and realizing a cross-jurisdictional collaboration benefits from working together with other provinces and territories.
Conclusion/Implications/Recommendations: Panelists include thought leaders from eHealth Ontario, MaRS, and UHN. In addition to providing an overview of SPARK, they will share early insights on how the patient experience is changing.
140 Character Summary: SPARK will stimulate health innovation by facilitating access to provincial data and creating a pathway for innovators to scale their digital health technologies.