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    OS02 - Strategic Integration: A Global Perspective (ID 1)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 5
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 201EF
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      OS02.01 - Health Information Network – Connecting the Dots and Beyond (ID 110)

      Teemu Lehtonen, Internal Servises, NS Government; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: In Canada we have built on the Canada Health Infoway Blueprint and the concept of HIAL (Health Information Access Layer) as the hub of all health information exchange within jurisdictions. The blueprint left the design and implementation of the concept to provinces, and as a result, we have seen a plethora of different and incompatible versions of HIALs in Canada. Meanwhile, the rest of the world have landed on the idea of HIE and Health Information Networks, recognizing that relevant health information exchange is not only technical issue; it requires standards, data sharing agreements, policy making, privacy controls, business incentives – and technology. Also, in the modern IM/IT architecture HIE should be seen as the Ecosystem Platform (Gartner), not only a hub that moves data between points A, B, and N. A modern platform provides data, APIs, and services to participants of the ecosystem. In Nova Scotia, we decided to pilot the HIE/HIN CMM (Capability Maturity Model) developed by Infoway in collaboration with Gartner. CMM would help us to build a roadmap to the next generation HIE that enables the “One Person, One Record” vision in Nova Scotia. This presentation describes our journey, where we have landed on, and what will (should) happen next.

      Methodology/Approach: The presentation is a case study documenting and reflecting on work carried on during 2015-2016 in Nova Scotia, Canada with the help from Canada Health Infoway.

      Finding/Results: After 10 years of intentional and well-funded development the health system in Nova Scotia still finds major gaps and shortcomings in their implementation of Canada Health Infoway Blueprint. CMM model helps to identify areas of strengths and weakness, and to create an ongoing process that builds towards a cohesive vision. It is important to connect all kinds of stakeholders into collaboration, and understand that technology has only a helper role, albeit an important one.

      Conclusion/Implication/Recommendations: The experience using HIE/HIN CMM was very good, and it has already shaped our way of thinking and approaching the challenge. We are committed to adopt that as a strategic aid and tool for. We have already shared our experience with many jurisdictions, and there has been a certain level of excitement on the air.

      140 Character Summary: Nova Scotia piloted the HIE/HIN CMM developed CHI and Gartner. That helped us to build our strategy and roadmap for the next generation Digital Health ecosystem.

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      OS02.03 - Developing a Health Sector Enterprise Architecture for the Philippines (ID 156)

      Derek Ritz, ecGroup Inc., ecGroup Inc.; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The purpose of this presentation is to discuss the processes employed to develop a Health Sector Enterprise Architecture (HSEA) for the Philippines. The presentation will particularly focus on the ways digital health infrastructure is to be leveraged to improve universal health coverage, health equity, and population health outcomes in a lower middle income country. Aspects of the HSEA that presented challenges will be explored, including: governance; low resource care delivery settings; health human resource shortages; financial barriers to care-seeking; and mis-alignments between national and sub-national health adminstrations.

      Methodology/Approach: The presentation will describe the use of a "storytelling" approach to health enterprise architecture development. This methodology is particularly well-suited to use in LMIC/developing country environments. It was developed and published by the Joint Learning Network for Universal Health Coverage and published in a 2014 eBook: Connecting Health Information Systems for Better Health -- Leveraging interoperability standards to link patient, provider, payor, and policymaker data (https://jln1.pressbooks.com/). The presenter will focus on how this "storytelling" methodology augmented other stakeholder engagement techniques and was employed to evolve, harmonize and itegrate prior enterprise architecture efforts conducted within the Philippine Department of Health (DOH) and the national health insurer, PhilHealth.

      Finding/Results: Over the course of a short but intensive donor-funded engagement, existing enterprise architecture artefacts were analysed, stakeholder "stories" were gathered and rigorously processed, and a new, harmonized HSEA was developed. The presentation will review the attributes of this comprehensive health enterprise architecture and how it is being leveraged to inform the construction of durable, re-usable, standards-based digital health infrastructure within the Philippine health sector.

      Conclusion/Implication/Recommendations: Digital health infrastructure is a key enabler for improving health equity and population health outcomes in low resource environments. There is a moral imperative to investing wisely. Given competing uses of funds, effectiveness and efficiency improvements must result from successfully implementing such infrastructure -- or else the money should be spent elsewhere. In a country like the Philippines, this moral imperative informs the goals of a HSEA undertaking. In wealthy countries like Canada, there is a motivation to divest efficiency improvements to "bend the cost curve" -- to try to accomplish the same degree of "health production" from a reduced expenditure of resources. In the Philippines, or any LMIC environment, the motivation is the invest the efficiency improvements -- to be able to increase the "health production" that may be realized from the scarce resources available. The presentation will compare and contrast HSEA approaches and motivations between Canada and the Philippines and draw out, for attendees, particular lessons that might be taken by each, from each other's experience.

      140 Character Summary: This session describes the development of a comprehensive health enterprise architecture for the Philippines and the particular challenges LMICs face to do this.

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      OS02.04 - On the Road Again…Driving Ontario’s Connectivity Strategy into 2017 (ID 275)

      Peter Bascom, Architecture and Standards, eHealth Ontario; Suite 701/CA

      • Abstract
      • Slides

      Purpose/Objectives: Ontario’s Electronic Health Record (EHR) Connectivity Strategy was first published in July 2015 and describes how health care information will be connected to create a safe, cost-effective, provincially integrated EHR. It outlines the transition steps that will take us from where we are today to a future state where health care providers have timely and secure access to critical health care information. The strategy identifies sources of EHR information in Ontario, and describes how health care information will be connected to create an integrated EHR that provides a lifetime record of an individual's health history. Since the initial 2015 publication the eHealth landscape in Ontario has changed, provincial repositories and registries have come online, and an updated version of the strategy was required. This presentation outlines how the strategy has changed as well as lessons learned from its initial engagement and adoption.

      Methodology/Approach: The initial engagement approach for the Connectivity Strategy involved several months of internal stakeholder meetings and discussions to develop a draft that could be shared with external stakeholders. Subject matter experts and technology leaders were then engaged to validate the draft. Finally, it passed through eHealth Ontario’s governance process which provided wide internal and external reviews. Over 500 comments from 28 organizations resulted in changes to the 2015 version of the document.

      Finding/Results: Within and without the agency, the strategy is now recognized as an authoritative source of EHR information. Most use it as a reference, focusing only on sections that relate to their domain (labs, drugs, acute care, etc.). The strategy provides an excellent orientation into Ontario’s ehealth landscape for those entering the field. External engagements identified existing assets that were used in siloed domains, helping identify how they could integrate with provincial assets. Developing the strategy was an excellent tool for building relationships, opening a dialogue and setting a common language for discussions. The open and transparent approach built trust and fostered support. The initial release of the strategy highlighted the challenge of conveying a technical strategy to multiple audiences (e.g. both information technology professionals and clinicians). Supporting materials for the strategy, including clinical scenarios, use cases, an asset inventory, and integration requirement guides, were developed to aid communication to the broader audience.

      Conclusion/Implication/Recommendations: An EHR IT strategy cannot be static. To remain relevant and maintain buy-in, it needs to reflect the landscape of the day. Engagement for version 2.0 of the Connectivity Strategy started with internal product and account management teams to ensure alignment with product roadmaps and stakeholder requirements. Only after the internal engagement were external partners engaged. As new systems come online and strategies change, current state models need to be updated. Using a UML modelling tool to document provincial systems has allowed us to continuously update key dependencies and inter-relations between systems described in the strategy. Many sections that were considered ‘Evolving Needs and Emerging Technologies’ in the 2015 version, such as HL7 FHIR, have now become core to both the current and future state of connectivity in Ontario.

      140 Character Summary: Discover how changes in Ontario’s ehealth landscape and lessons learned from the 2015 publication of the EHR Connectivity Strategy have affected version 2.0.

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      OS02.05 - Manitoba's Home Clinics: Aligning Continuity of Care, ICT, and Remuneration (ID 300)

      Michelle O'Keefe, Primary Health Care Branch, Manitoba Health, Seniors and Active Living / Sierra Systems; Winnipeg/CA

      • Abstract
      • Slides

      Purpose/Objectives: Manitoba is implementing a Home Clinic model to support primary care clinics in providing their patients with comprehensive, continuous, and coordinated care. Ensuring Manitobans have a Home Clinic, which serves as the home base for the majority of their primary care needs, is a key step towards achieving a longer term vision of a robust, equitable, and accessible primary care system. Home Clinics are based on the model described in the 2011 College of Family Physicians of Canada publication, A Vision for Canada, Family Practice, The Patient's Medical Home.

      Methodology/Approach: The development and implementation of the Home Clinic model in Manitoba has been a collaborative effort including Manitoba Health, Seniors and Active Living, The College of Family Physicians of Manitoba, Doctors Manitoba, Manitoba eHealth, fee-for-service clinics, and Manitoba's Regional Health Authorities. In 2015, a new Comprehensive Care Management Tariff, designed to support the adoption of the Home Clinic model, was negotiated with an implementation date of April 1, 2017, and focuses on the provision of comprehensive care to "Enrolled" patients with complex needs. The annual management tariff encourages a team based approach to care and requires that fee-for-service physicians use an EMR that can submit Manitoba's Primary Care Data Extract. This extract leverages the Primary Care Quality Indicators and includes prevention, screening, and management of chronic diseases, based on CIHI's primary care indicators. The implementation of Home Clinics has also required the development of a Home Clinic Registry, Patient Enrolment Repository, and changes to the Claims Processing System to support the new tariff. Extensive communications and change management supports have been established to help Home Clinic implementation.

      Finding/Results: The Home Clinic implementation is underway at this time. By April 1, 2017, it is anticipated that the majority of eligible clinics will have registered, worked through the details of enrolling patients, and will start claiming the Comprehensive Care Management tariffs for their eligible enrolled patients. Lessons learned and the results of the early implementation will be shared at this session.

      Conclusion/Implications/Recommendations: Home Clinics, Enrolment, and the Comprehensive Care Management Tariff are just the beginning of the evolution towards more comprehensive, continuous, and coordinated care for Manitobans. The Home Clinic and Enrolment Registry will serve as the foundation to allow improved information sharing and coordination between Home Clinics and episodic care providers. The next phase will focus on the ability for Home Clinics to publish a patient summary to eChart Manitoba, and to allow episodic encounter notes to be sent to the Home Clinic when a patient seeks episodic care outside of the Home Clinic. Driving policy change requires ongoing collaboration, understanding, and good faith negotiations between all parties, and a focus on ensuring that patients have access to continuous, comprehensive quality care.

      140 Character Summary: Advancing Patient-Centred Medical Home in Manitoba: Aligning Continuity of Care with ICT and remuneration - a lived experience.

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      OS02.06 - Provider Registry: 15 Years of Successful Multi-Jurisdictional Collaboration (ID 30)

      Andrea Dutchak, eHealth Saskatchewan; Regina/CA

      • Abstract
      • Slides

      Purpose/Objectives: For over 15 years, multiple jurisdictions have collaborated to define, build, implement, maintain, and evolve a shared Provider Registry solution. This session will highlight this unique collaboration as an example of success. Panel members will discuss the management structure, standards process, sustainment challenges and engage in discussion with the audience on lessons learned.

      Methodology/Approach: In 2001, the Western Health Information Collaborative, WHIC (Manitoba, Saskatchewan, Alberta, and British Columbia), with BC as the lead; established requirements and design for a Jurisdictional Provider Registry. In partnership with WHIC; Canada Health Infostructure Partnerships Program; and Canada Health Infoway; Sierra Systems developed the Provider Registry System (PRS) as a standards-based repository of core provider data that can be implemented by any Canadian Jurisdiction. The solution and collaboration continues today.

      Finding/Results: History Founding the initial collaboration, BC Ministry of Health and the WHIC partners, through a series projects, produced a fit-for-purpose software solution including: -Provider data and communication standards; -Common business processes and rules; -A registry infrastructure (the PRS); and, -Multi-jurisdictional problem, change, and release management processes. As jurisdictions conducted their own implementations their experience fed back into the collaborative. Extensions refined core services; added new functionality; enhanced portability features; developed and adopted national standards (HL7v3); and created an implementation toolkit. Realizing the goal of implementation beyond WHIC, the PRS was also deployed in Quebec and Newfoundland. Currently, the Provider Registry System Collaborative (AB, SK, and NL) is responsible for product management. The group meets regularly to set priorities and maintain the product roadmap. Managing collaboration Multi-jurisdictional collaboration adds a significant overhead for projects and requires strong governance and stakeholder commitment, far beyond what is typical for in-jurisdiction projects. -Appropriate funding and cost sharing models are required -Significant effort is required to reach agreements on standards and core requirements -Ongoing development requires agreement on vision and re-investment -Realizing that benefits pay off over a longer term is key. Members were able to strike a balance resulting in a core solution, data standards, terminology, processes, and implementation guides that are shared by all implementations. Where jurisdictional variants are necessary, they are designed as replaceable plug-ins to facilitate customization. Standards contributions With a significant footprint in Canada, the collaborative is an active and influential participant in standards development. Early work by the WHIC team defined a data model and terminology for the Provider domain which eventually seeded the HL7v3 pan-Canadian standard. The partners continue their contributions in the HL7 community, jurisdictional implementer groups, and most recently towards Canadian FHIR profiles for Provider Registry.

      Conclusion/Implications/Recommendations: Multi-jurisdictional collaboration on informatics solutions is difficult, however, the benefits are significant. The PRS is an enduring success story. -The common solution fostered a community of interest around the Provider domain. -Standardization within the group seeded the pan-Canadian message sets and terminology. -Designing for portability resulted in ease of implementation with minimal need for customization. -Ongoing costs are shared and fully re-invested into the solution. In closing, we offer this ongoing, successful, collaboration and lessons learned as precedent for new multi-jurisdictional initiatives such as PrescribeIT.

      140 Character Summary: 15 years of successful multi-jurisdictional collaboration on the Provider Registry System sets a positive example for other collaborative initiatives

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    OS14 - Successes in Quality and Efficiency (ID 20)

    • 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 201EF
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      OS14.01 - Transcription Services Project - Improving Quality, Efficiency and Accessibility  (ID 133)

      Naomi Brooks, Health Information Management, Providence Health Care; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Transcription Services Project (TSP) was a successful large scale initiative led by Health Information Management – a department of Providence Health Care – focused on getting patient reports to clinicians and patients quicker and more securely. The project was designed to improve service levels, reduce costs, keep up with growing dictation volumes, standardize processes and systems, leverage new speech recognition technology, address patient safety and privacy concerns, and improve report distribution, including a patient-centered solution.

      Methodology/Approach: This initiative implemented a ground-breaking business and technology Application Service Provider model where both the transcription labour and technology was outsourced to a third party provider (M*Modal Canada). The project used an agile iterative development approach, at a high level, was similar to most large technology enabled transformation initiatives. One of the project’s biggest achievements and a first in BC, was the piloting of “my ehealth” via Excelleris Technologies, a secure online report distribution portal that provides patient access to their transcribed reports.

      Finding/Results: As a result of the project, over 65% of transcribed reports are now delivered directly to physician electronic medical records as compared to fax or mail, eliminating significant internal manual printing and mailing efforts as well as improved data, security and privacy controls. Patient reports are reaching clinicians and patients within 1-2 days (as compared to 7-25 days turnaround previously) across four of British Columbia’s health organizations. “The new system has definitely led to much faster transcription of dictated reports, thereby considerably improving patient care.” Endocrinologist, St. Paul’s Hospital Close to 10,000 clinicians now use a standardized dictation system with 1.4 million reports processed in 2015 leveraging new speech recognition technology. The pilot evaluation found that my ehealth met its objectives and that patients are benefiting and highly satisfied with the service (93% satisfaction rate). Transcription Services is now looking to expand my ehealth to better meet the needs of patients that will include further consultation with patients, families and clinicians. “Prior to my ehealth, for every appointment, I drove to the Cancer Agency, go to Health Records and get them to print off a copy of my report. Now it’s so easy! I only wish other sites had this service.”

      Conclusion/Implication/Recommendations: Through eight multi-site deployments at 242 sites over 25 months, the TSP achieved its objectives, was completed under budget and generated almost three times the expected savings target. These savings ($7.9 million annually) are now being put back into the health care system for spending on direct patient care while also providing clinicians and patients easier and timelier access to their health information. The TSP has been instrumental to BC’s health care system in the continuous improvement journey of health information getting to the right person at the right place at the right time. The project scope has impacted more than 60% of the BC population. Since the project close, eleven sites have implemented the solution with four additional sites/clinics joining in the next few months. Discussions are underway to onboard another two hospitals on BC’s central coast.

      140 Character Summary: The Transcription Project resulted in patients and clinicians receiving reports < 2 days across four of BC’s health organizations with $7.9 million annual savings.

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      OS14.02 - Leveraging Chartmaxx for Tracking Radiology Reviews (ID 311)

      Andrew Dobrenis, Medical Records Department, Jewish General Hospital; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives: The objective was to find a way to implement a system of tracking when and if a Radiology report has been reviewed within the Emergency department. Additionally, this new system must be easily adoptable by the users and inexpensive to implement.

      Methodology/Approach: Our approach was to leverage an existing Hospital application: Chartmaxx - the hospital's electronic patient record. Using Chartmaxx we were able to design workflows that: - Flag Radiology reports arriving from the Radiology system into Chartmaxx that pertain to an Emergency Department (ED) visit. - Using built-in worklist capabilities, assign the report to the original requesting physician in order to be reviewed. - Provide the flexibility of allowing one physician to review another's report through built-in delegation tools; - Supervise physician response through the tracking tools within Chartmaxx; - Regularly notify physicians as to their personal number of pending reports to review. Furthermore, from the Chartmaxx database we could: - Create customised reports to assist ED management in monitoring progress. - Have a full audit trail of interactions with the reports. In order to make this a reality, a full cooperative effort between the Emergency Department, Medical Records Department, IT, IM and the application vendor Quest Diagnostics.

      Finding/Results: Our experience in this project was, as hoped for, that the use of existing software allowed for a quick adoption and acceptance of the new workflow. Users did not have to learn a new application or remember another password. Additionally, we found that with the new process in place there was an easy way to see any pending Radiology reports from other shifts that are waiting to be reviewed. That is day shift personnel could easily see what reports have not been reviewed by their evening shift colleagues and vice-versa. A clear audit trail was created to allow for analysis of when any Radiology report arriving in the ED was seen and by whom.

      Conclusion/Implication/Recommendations: The approach of leveraging in-house software to manage the review process of Radiology reports was successful in allowing for a speedy acceptance of the new workflow and provided for immediate reporting feedback on performance. Its success means we can use a similar approach to solving similar problems within the Hospital.

      140 Character Summary: Leveraging existing in-house software, (Chartmaxx), made a quick and cheap solution possible for live tracking of the report review process within our ED.

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      OS14.03 - STIX – A Multiple Provincial, Multiple Ministerial, Multiple Health Authority Implementation (ID 60)

      Oliver Thompson, eHealth, PHSA; Vancouver/CA
      Penelope Nica, PHSA eHealth; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: To share lessons learned and opportunities realized as a result of the implementation of an Ontario Ministry of Health & Long-Term Care (MOHLTC) application in BC to consume student data from the BC Ministry of Education to share with BC’s Health Authorities in support of Public Health Mass Immunizations programs.

      Methodology/Approach: In 2013, the Ontario MOHTLC developed a tool to support public health school immunization assessment and administration programs. The Student Information Exchange (STIX) tool automates the uploading and matching of student demographic records with the correct records in the provincial immunization repository. BC and Ontario entered into an agreement to share the application code Approval of the minimum data set required to support client matching and public health program requirements Customization of code to meet BC requirements Relationship with the BC Ministry of Education, who worked on behalf of BC’s School Districts, to develop a single extract of student data from their provincial student information system and facilitate collection of the necessary agreements Utilization of a BC Ministry of Health sFTP service to securely transfer data between the BC Ministry of Education and Provincial Health Services Authority Signing of a Provincial Privacy Impact Assessment to allow for the new process Configuration of BC’s Public Health system, Panorama, to accept data Implementation of solution at two Health Authorities, as a pre-curser to wider adoption

      Finding/Results: Hugely successful implementation, laying the foundation for the use of Mass Immunizations functionality in Panorama BC’s project metrics included: 80% return rate of agreements from targeted School Districts within two weeks 84% match rate of data from the Ministry of Education’s system and Panorama 85% reduction in work effort to reconcile student data and 60% reduction in work effort to support Mass Immunization event Clinical and business benefits included: Improved data quality for surveillance and clinical care Mass Imms and Personalized Consent Adoption advancing clinical best practice and use of immunization decision support Per clinic vaccine and supply management preventing wastage Coverage and catch up at school level advancing disease prevention Management of school outbreaks Readiness for legislative change requiring immunization status reporting for all students Presentation will also compare and contrast an assorted challenges each party faced and approaches we took to be successful (e.g., legislative changes required to enable use of the Ontario Education Number; privacy challenges requiring an independent security assessment)

      Conclusion/Implications/Recommendations: BC’s public health system benefited significantly from Ontario MOHLT’s investments Workflow improvements were significant enough to enable use of functionality previously deemed too resource intensive Relationships are key to bring project to success Patience is required when dealing with multi-dimensional implementations

      140 Character Summary: Share opportunities realized from the implementation of the Ontario-developed application in BC in support of public health immunization programs.

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      OS14.04 - HDC: A Physician-Led Information System for Practice Reflection (ID 285)

      Catherine McGuinness, Health Data Coalition; Vancouver`/CA

      • Abstract
      • Slides

      Purpose/Objectives: Canadian provinces and international jurisdictions are initiating a powerful push in the direction of a Health Quality Agenda. Established to enable quality improvement in primary care and support a learning health system, the Health Data Coalition (HDC) was formed with the support of BC’s General Practices Services Committee and the Doctors of BC. An independent not-for-profit organization, the HDC is governed by physicians, for physicians and their medical care partners across British Columbia. The adoption of the Privacy by Design framework and certification program allows the HDC to protect patient and health care provider privacy, while increasing trust, knowledge sharing, and collaboration.

      Methodology/Approach: Our technology is designed to aggregate patient level data from individual physician practices, across disparate EMR systems, to support self-reflective practice and facilitate system change using coaching support and small learning groups. Building on the work of its founding organizations (AMCARE and the Physicians Data Collaborative), the HDC is unifying the technical assets of the two entities to create a robust, reliable, flexible solution to enable clinician data contributors and their clinical support staff to engage in quality improvement, continuous learning and collaborative research. The technology is open source licensed, reflecting the community-building spirit of the HDC. The HDC’s relationships create a culture of continuous improvement by inspiring curiosity and professionalism among individual physicians and creating a positive, collegial and supportive culture among physician peers.

      Finding/Results: Learning from the experience of its founding partners, we developed a governance framework inclusive of our health care and technology partners, while maintaining a physician-led approach for the measures used, the context of information reported, and who sees the aggregated practice information. Physician engagement amongst early adopters has shown that the HDC approach to the use of clinical data has tremendous power to change physician behaviour and build a collaborative culture between providers and health system planners by asking and answering questions together. Establishing trust is essential. The HDC distributed data model in combination with the adoption of the Privacy by Design framework and certification program ensures that the HDC can build and maintain the trust of its members by proactively embedding privacy into the design specifications of information technologies, the networked infrastructure, and business practices of the organization.

      Conclusion/Implications/Recommendations: Canada can play a leadership role in this innovative approach to the use of healthcare information for performance management in primary care. Improving the quality of care requires a continuous learning process which in turn needs to include the ability to reflect on one’s work. The basis for this reflection is a need to document what is done and monitor changes over time. The HDC supports this learning culture by providing secure access to comparative data in a cost effective, transparent and inclusive approach that could spread across Canada. Engaging physicians in both the governance and development of the toolset encourages an ownership perspective and helps ensure the work of the HDC maintains its relevance to the practising physician and the patient receiving care.

      140 Character Summary: A physician-led practice reflection IT solution using a Privacy by Design approach enables a positive and trustworthy continuous learning process for physicians.

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    OS22 - National First Nations eHealth Innovations in Healthcare (ID 49)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Not Rated
    • Presentations: 4
    • Coordinates: 6/07/2017, 08:30 AM - 10:00 AM, Room 201EF
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    OS25 - Connecting Care: Virtual Realities (ID 30)

    • 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 201EF
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      OS25.01 - Telehealth Brings Oncology Care Closer to Home in Northern BC (ID 129)

      Stacy Miller, Radiation Oncology, BC Cancer Agency, Centre for the North; Prince George/CA

      • Abstract
      • Slides

      Purpose/Objectives: In the fall 2012, British Columbia Cancer Agency (BCCA) opened its 6th Regional Cancer Center in Prince George to serve cancer patients in northern BC. Due to its expansive geography only one third of northern cancer patients live near the Center for the North, leaving two thirds who need to travel, at times quite a distance, for their care. Having already recognized benefits of telehealth at BCCA, the Centre was built to provide oncologic consultations and follow up care remotely, where appropriate, over videolink technology. Today the Centre connects nine Community Oncology Network clinics across the north as well as 25 other telehealth stations located in smaller community clinics. Patients are seen by videolink at one of these 34 locations, using the broad variety of clinical supports in place in each location. The purpose of this project was to examine utilization of Telehealth technology for oncology services in Northern BC over the first four years of Center’s existence, including utilization trends and a qualitative assessment of the benefits and limitations of the use of this technology for our patients and our clinical team.

      Methodology/Approach: Telehealth utilization data was obtained for the Center’s first three years of operations. Trends over time were examined and compared to utilization in other regions of the province. A qualitative assessment of this telehealth services from the both patient and clinician perspectives is currently underway.

      Finding/Results: Northern BC has experienced almost 300% growth in videolink oncology services since the Centre opened. While there has been growth in all BC Cancer Agency Centres, the north represents the fastest adoption of telehealth-enabled clinical services in the province. Telehealth offers clear advantages for patients including the ability to receive care close to home and family, avoided travel costs and increased safety by avoiding travel-related risks, particularly during winter months. Patients increasingly request this service. There are also clinical scenarios and conditions that do not lend themselves to remote care, where the best approach requires in-person assessment or aspects of physical presence. It has been recognized that optimizing multidisciplinary care for patients having Telehealth oncology assessments improves patient assessment, decision making, education, and safety.

      Conclusion/Implication/Recommendations: Telehealth Oncology Care in BC’s north is a rapidly growing method of service delivery with clear benefits for our patients. Ongoing assessment and development of this program is underway to optimize patient care and safety. Findings will inform the implementation of other telehealth-enabled provinical clinical programs in BC.

      140 Character Summary: BCCA incorporates telehealth in day to day oncology services. We will present qualitative and quantitative insights underlying successful adoption in the North.

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      OS25.02 - Child and Adolescent Psychiatry Delivered to the Inuit of Nunavut (ID 154)

      David Willis, Clinical Informatics/Telemedicine, The Hospital for Sick Children; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Participants will hear and discuss learning’s on service delivery from a Physician perspective on how models of care are evolving to address unique cultural, environmental and societal factors. Participants will have a clear understanding of the clinical needs and requirements in serving Inuit populations. Understanding program management perspectives on the funding, technical and contractual requirements needed when developing agreements and launching services with remote communities, regions and governments will be discussed. The experience from the recipient’s perspective will be presented through presentation and discussion of the territories, the communities and individual clinician needs and requirements. Participants will leave with a better understanding of programmatic needs, clinical requirements and cultural competencies needed when creating a sustainable long term partnership for the delivery of Psychiatric care with Aboriginal and Inuit partners.

      Methodology/Approach: Nunavut is Canada’s newest Territory, home to the Inuit people who have inhabited Nunavut “our land” over 1000 years. In the last 100 years this region has seen its greatest changes. Mental health issues such as Developmental Trauma, Suicide, Isolation and Addictions are exploding in most communities. Suicide rates for Inuit are among the highest in the world at 11 times the national average, rates for young Inuit men are 28 times higher. (Mental Health Commission of Canada, 2012) Aboriginal and Inuit people have a holistic view of mental wellness, a state of balance with family, community and the larger environment. European models of treatment that remove the person from their surroundings tend not to work. (Khan, 2015) Estimates suggest 30 to 40% of children in out-of-home care are Aboriginal, yet Aboriginal children represent fewer than five per cent of children in Canada. (Mental Health Commission of Canada, 2012) Despite this, there are experiences of collaboration, creativity and empowerment that are leading to successful outcomes for patients and families.

      Finding/Results: Through video conferencing technology Child and Adolescent Psychiatry was introduced to the Territory in 2013, partnering remote nursing stations, mental health teams, nurses and physicians to psychiatric expertise in southern Canada. Clinical assessments, capacity building and education are tailored to each community and clinician group to increase skill sets and support the continuum of care for patients with the goal of allowing patients and families to remain their community.

      Conclusion/Implication/Recommendations: Video conferencing has opened pathways to care previously non-existent within the territory. Relationship development, capacity enhancement, knowledge translation and communities of care are being supported across the territory allowing children and youth to remain in their communities while recieving specialist services. This partnership between Sickkids and the Government of Nunavut has opened the door to further expansion of clincial services delivered through technology to communities and health care organizations. Mental health workers are connected to leading Psychiatrirst as they support families who have historically been shut out of the health care system in Canada.

      140 Character Summary: Technology has enabled the delviery of specialized mental health services to the Inuit of Nunavut creating pathways to care for families, children and clinicians

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      OS25.03 - Home Health Monitoring Implementation in BC: Lessons from TEC4Home (ID 188)

      Kendall Ho, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Telehealth for Emergency-Community Continuity of Care Connectivity via Home monitoring (TEC4Home) project aims to demonstrate that home health monitoring supports safe discharge of patients with heart failure (HF) from hospital to home and fosters high quality convalescence, thereby reducing emergency department (ED) revisits, and improving patients’ quality of life. This abstract focuses on the change management approach and lessons learned to date as TEC4Home is implemented within a health authority.

      Methodology/Approach: TEC4Home is a four-year study funded by Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and BC Ministry of Health. It is led academically by UBC Emergency Medicine, clinically by Vancouver Coastal Health/Providence Health, with industry partner TELUS Health. Partnerships include Cardiac Services BC, HF clinics, Vancouver Division of Family Practice, and diverse clinical disciplines. Issues, emergent principles, and lessons learned have been documented from the outset of the project.

      Finding/Results: We highlight *four* fundamental lessons learned: 1. Distributed Leadership. It was important to start with highest levels of leadership within organizations involved. Each organization provides necessary leadership in its domain, but individually is insufficient to advance health system change. Diffusion of leadership within each organization was necessary to link management to operations. Early engagement of leadership ensured commitment and participation in TEC4Home’s governance. 2. Harmonized Language. To facilitate communication across organizations, we used three terms to organize the project’s key components: a. Model of Care is the set of activities outlining clinical patient inclusion criteria, workflows, care practices, and clinical operations team engagement required to implement TEC4Home. The model of care was developed with the support of clinicians and patients. b. Model of Technology is deployed to track patients’ biometrics, facilitate patient education, and self-management. It includes Patient Station, Biometric Measurement Hardware, and Monitoring Nurse Station. Synchronizing components requires collaboration of technical experts, clinicians, patients and family members. c. Model of Research establishes a rigorous approach to evaluate clinical outcomes, experience, and cost factors. This requires leadership of clinical trialists and diverse evaluation expertise to ensure robust measurement of clinical, economic as well as social-behavioral outcomes and processes. 3. Realization of Shared and Individual Aspirations. Introducing innovation into the health system presents opportunities and challenges. Understanding pain-points and aspirations of each stakeholder group is vital to achieve mutual understanding and co-created goals. Using the three models was an effective foundation for dialogue to reconcile diverse perspectives. Formation of clinical, technical, steering, and evaluation subcommittees created necessary spaces to enable contributions from diverse partner organizations. 4. Patient Involvement for Clinical Innovation. Having HF patients and family caregivers involved on all committees from the outset ensured clarity, focus, and practicality. A dress rehearsal with patient representatives was instrumental in refining project workflows. Understanding the patient journey was essential in defining the model of care.

      Conclusion/Implication/Recommendations: TEC4Home is a context in which cross-sectoral collaboration can be explored, documented and enabled while contributing to patient care through the services of a monitoring nurse facilitated by home health monitoring technology. This work is submitted on behalf of the TEC4Home Health Innovation Community.

      140 Character Summary: Implementing home health monitoring in hospital-community transition – 4 key lessons

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      OS25.04 - New Models of (Telehom) eCare: Diabetes, Mental Health and CKD (ID 314)

      Rhonda Wilson, Ontario Telemedicine Network; ON/CA

      • Abstract
      • Slides

      Purpose/Objectives: The success of Telehomecare - a self-management program for patients with CHF and COPD that includes remote patient monitoring (RPM) and health coaching - has prompted the Ontario Telemedicine Network and key healthcare sector partners to explore new innovative models of care for three new groups of patients with diabetes, mental health and chronic kidney disease (CKD). Three virtual care applications have been selected for pilot testing in Ontario based on their potential for province-wide applicability and sustainability. This panel presentation will include perspectives from researchers, clinicians and healthcare program administrators, reflecting the experience of implementing these new programs for approximately 1,400 patients. The first initiative is evaluating the impact of a mobile application (an FDA-approved ‘mobile prescription therapy’) shown to improve self-management and lower HbA1C among individuals with Type 2 diabetes across different diabetes centres located in three cities. The second initiative is evaluating the innovative use of a social media-based platform already extensively used in the UK’s National Health System. With long waitlists for mental health services, this new model of care will be able to support individuals from their home on a 24/7 hour basis. The initiative is focused primarily on people with a diagnosis of anxiety and/or depression. Patients are selected from a number of mental health programs and the emergency department, from three different hospitals in Ontario. The final initiative leverages an Ontario-based mobile application to help patients stay in their home by providing RPM support for individuals with CKD receiving in-home peritoneal dialysis. Providing access to care in the home and the community for diabetes, mental health and CKD can both enhance the management of chronic illness and patient well-being and significantly bend the cost curve for these conditions. The pilots, which are funded by Canada Health Infoway and the Ontario Ministry of Health and Long-Term Care, run until June 2017.

      Methodology/Approach: All three of the pilot projects are being evaluated by the Women’s College Hospital Institute for Health System Solutions and Virtual Care using a mixed-methods approach, combining the rigour of a quantitative trial with in-depth qualitative assessment, aiming to answer three key questions: 1. How does it work? (Realist Evaluation) 2. How is it implemented? (Consolidated Framework for Implementation Research) 3. What is the impact? (RE-AIM Framework) Also integrated is the Institute for Healthcare Improvement’s Triple Aim, focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs, thereby informing a sustainability model on a provincial scale.

      Finding/Results: Metrics include clinical outcomes such as improved control of risk factors, decrease in symptoms, improved person-reported health status, as well as reduction in hospital admissions and ER visits, and patient and provider satisfaction with the experience and the technology.

      Conclusion/Implications/Recommendations: The process of implementing healthcare interventions is complex and context-dependent. The evaluation project results and experiences will be shared first hand. Discussion will look at how these new models of Telehomecare will lead to improved value for individual patients and the broader healthcare system.

      140 Character Summary: New Models of (Telehom)eCare in Ontario: Diabetes, Mental Health and Chronic Kidney Disease

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      • Abstract
      • Slides

      Purpose/Objectives: Efficient and effective sharing of personal health information (PHI) is recognized as a key enabler of health system integration – a core principle of such initiatives such as Ontario’s Patients First plan. Regional and provincial PHI-sharing initiatives are intended to support this integration, but may not accommodate the needs of every health care organization. If an organization believes that existing initiatives cannot support its specific care model, where can it turn? The Temmy Latner Centre for Palliative Care (TLCPC) and Toronto Central CCAC (TC CCAC) answered this question while looking for a PHI-sharing solution to their palliative care services - when they realized that they could use TLCPC’s existing EMR solution as an information sharing platform. But what should a small, resource-constrained organization have in place to share its EMR? TLCPC and TC CCAC knew that it would take more than just creating new user accounts. For organizations working at the grassroots level, the shared use of an EMR presents clear benefits, as well as challenges around such issues as service provider responsibilities that TLCPC is still working to answer.

      Methodology/Approach: TLCPC physicians provide in-home palliative care as part of a care team that includes providers from TC CCAC. TLCPC developed a collaborative care model for in-home patients with complex care needs, to enhance care team communication, and assure patients that they were receiving coordinated health care. But TLCPC and TC CCAC still saw barriers to care team collaboration, which could likely be overcome through more effective information sharing. TLCPC settled on a modest approach: its own EMR. In collaboration with TC CCAC and MD+A Health Solutions, TLCPC developed a business model and shared policies for the use of its EMR and, with substantial project support from TC CCAC, launched the pilot phase in of the Shared EMR Project in summer 2016.

      Finding/Results: The pilot phase has met TLCPC’s and TC CCAC’s expectations: care team members seamlessly exchanged high-quality patient information in a timely manner, enhancing care team integration. TLCPC and TC CCAC identified opportunities to expand the in-home care model beyond palliative care, to patients with chronic disease. The project has also presented challenges: the privacy obligations of project participants were not clear at the start of the project, and needed clarification. TLCPC also had to address its limited capacity to act as a service provider for the EMR. And there were challenges in defining the nature of a joint patient record within the EMR. Nonetheless, TLCPC managed to address these challenges, and launch the Shared EMR Project, all without the resources and direction typically available to participants of provincial-scale initiatives.

      Conclusion/Implications/Recommendations: The PHI-sharing needs addressed by the Shared EMR Project are shared by many health care organizations seeking to enhance care team collaboration. The Shared EMR Project represents a resourceful, grassroots response to this need. TLCPC’s next steps in for the project may therefore form the basis for an alternative PHI-sharing framework, suited to a resource-constrained context, but that still aligns with regional and provincial health system objectives.

      140 Character Summary: The Shared EMR Project represents a resourceful, grassroots response to the need for effective PHI sharing at the grassroots level.

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      OS25.06 - Connected Care: Emerging Interprofessional Priorities (ID 220)

      Melva Peters, Gevity Consulting Inc.; Vancouver/CA
      Patricia Rothney, Gevity Consulting Inc.; Winnipeg/CA

      • Abstract
      • Slides

      Purpose/Objectives: Connected care is defined as real-time, electronic communication between a patient and a provider, including telehealth, remote patient monitoring, and secure email communication between clinicians and their patients (Alliance for Connected Care (Alliance for Connected Care, 2014). Two key themes are influencing the emergence of connected care, including the progression of decentralized models of care and the ubiquity of technology and connectivity (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). The burden of chronic illness, shifting population demographics, escalating demand for improved results for investments in electronic health information systems, and shortages of health care professionals are driving demand for innovative models of care and communication with health care consumers (Hussey & Kennedy, 2016, Rajakulendran, MacIntosh, Salah, & Khayat, 2014). New models of care reposition the consumer at the center of healthcare (Hussey & Kennedy, 2016) and will necessitate a shift in both delivery options as well as professional practice and processes. Person centered models of care offer greater flexibility in terms of healthcare delivery options across the full spectrum in the home and community (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). Such models of care are being advanced across Europe, Asia-Pacific region, and North America. Examples can be located aross Canada, notably in Manitoba, Nova Scotia, and Ontario (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). The purpose of this presentation is to discuss the interprofessional priorities emerging from the connected care movement. Clinical priorities from four specific perspectives will be discussed in this panel, including acute care reconfiguration, public and community health collaboration, pharmacy and medication management, and clinical leadership and policy.

      Methodology/Approach: Not applicable.

      Finding/Results: Not applicable.

      Conclusion/Implications/Recommendations: Clinicians and heath care executives must go beyond awareness of connected care to the point where clinical priorities, policy, data use and analytics, program planning and funding, and practice implications are firmly on the agenda for change. This panel offers an opportunity to consider an interprofessional perspective on some of the key challenges and opportunities.

      140 Character Summary: Connected care links consumers and providers across healthcare. This panel provides an interdisciplinary perspective on shared clinical priorities.

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    PS02 - Data Sharing: Thinking Beyond Acute Care (ID 11)

    • 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 201EF
      • Abstract
      • Slides

      Purpose/Objectives: In Ontario as elsewhere, the drive to build digital health capacity – specifically, enabling the flow of patient data through electronic medical records (EMRs) and related tools - originates from the need (at system and practice levels) to monitor its effectiveness at providing quality care for the population. In a complex health care environment, large-scale solutions sometimes require smaller scale precedents: demonstrations by key system actors on how to take responsibility for population health data.

      Methodology/Approach: This proposed panel will showcase examples of data stewardship from three provincial organizations. Panel members will discuss best practices, share lessons learned from their experience, and consider future directions for data stewardship in the context of health system transformation. Discussion will centre on activities and instruments of data stewardship, addressing these areas: · *Data quality: Currently in a physician-led proof-of-concept phase, we describe a dashboard project that allows physicians to view their EMR data and benchmark against a standard set of indicators, as the foundation for practice-specific projects to improve their data quality in real time. This was created in partnership with three provincial organizations to support accountability thinking in the new provincial transformation agenda. · Quality improvement: We will describe a program that, leveraging a set of resources including hands-on support at practice sites, helps physicians identify and remedy EMR data quality issues within their practice. This converts policy thinking into action. Collaboration is key and linked to provincial domains for quality measurement in primary care. · Connectivity*: We will describe tandem applications, a health report delivery solution and electronic notifications, which are industry leaders in connectivity and enable a primary care providers’ EMRs to receive patient hospital discharge reports. Other projects are in development to connect family practices to specialists and to existing provincial data assets (a lab information system). We further support connectivity through delivery of provincial EMR specifications. All of these are poised to pivot physician action and behaviours in improved practice efficiency and effectiveness.

      Finding/Results: This is not a research-based abstract, but rather highlights a collaborative process across multiple system level leadership agencies and associations toward a common goal of transformation and improved care.

      Conclusion/Implications/Recommendations: The most tenacious challenges facing the health system require an approach that draws on deep system knowledge and collaborative approaches, like those represented in this panel. Partnerships to secure data quality and flow are the route to achieving improvements across the spectrum – from practice-level patient outcomes, to regional connectivity, all the way to population health measurement. We envision that initiatives like those described in this panel could enable not only system performance accountability but also applied population health research efforts.

      140 Character Summary: Panel on health data stewardship initiatives, presenting experiences with scalable projects for data quality and connectivity in Ontario.

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      • Abstract
      • Slides

      Purpose/Objectives: Primary care data has been identified as an urgent priority in Ontario for the fulfillment of a longitudinal integrated Electronic Health Record (EHR). There is recognition amongst stakeholders that a more comprehensive patient record, that includes primary care data, will help to enhance care delivery by ensuring providers in the patient’s circle of care have more timely information to inform and support their care decisions. The connecting South West Ontario Program (cSWO), funded by eHealth Ontario, is one of three “connecting” programs across the province, working together to deliver electronic health records for every patient. The cSWO Program identified at its outset that a key component of achieving a fully integrated EHR is the inclusion of and the ability to, share primary care data. cSWO’s Primary Care Data Sharing (PCDS) project is being led by the eHealth Centre of Excellence and is enabling a sub-set of clinician-identified primary care data to be shared as part of Ontario’s integrated EHR. PCDS will help optimize meaningful clinical and organizational use of the integrated EHR by incorporating a new and valuable data set.

      Methodology/Approach: The PCDS project involves conducting a Proof of Concept (POC) involving up to four Primary Care Teams in south west Ontario that will contribute a sub-set of their EMR data to a provincial repository at eHealth Ontario, to be securely accessed by other authorized healthcare providers within the circle of care through the cSWO Regional Clinical Viewer, ClinicalConnect™. PCDS will explore the feasibility, challenges and value of sharing patient data from primary care practices. The project will help to identify the processes, integration requirements and data standards that need to be in place for primary care data sharing to demonstrate clinical and/or organizational value. The POC will also inform the broader Provincial primary care data sharing strategy.

      Finding/Results: The panel discussion will focus on PCDS project approach, outcomes and key activities contributing to successful adoption: · Clinically-Driven Data Set: One that will provide value to providers and inform their care decisions. · Data Quality Improvements: Data that is relevant, available in real time and consistently collected provides more value for data sharing and primary care practice-specific analysis. · Data Set Alignment: Exploring synergies and aligning data sets across provincial projects, where clinically relevant and feasible. · Benefits Evaluation: Developing and imbedding a benefits realization strategy at the outset to ensure the clinical value of sharing primary care data can be appropriately measured and adequately assessed.

      Conclusion/Implications/Recommendations: The panel will highlight the approach taken to ensure a clinically relevant data set is developed; that data quality is appropriate for sharing; and mechanisms are in place to assess the clinical value being realized by those accessing the data. The panel will also highlight the challenges to primary care data sharing and mitigation strategies applied. The multi-stakeholder initiative is a priority project for the Province of Ontario and the south west Ontario region. The panel will reflect stakeholders offering varying perspectives and insights on lessons learned, including primary care sites involved in the initiative.

      140 Character Summary: The PCDS Project in Ontario is exploring the value, challenges and feasibility of sharing patient data from primary care practices as part of the EHR.

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