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    HS02 - Modernizing CIHI’s Data Flow: Starting in the Community (CIHI Session) (ID 52)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Not Rated
    • Presentations: 1
    • Coordinates: 6/07/2017, 08:30 AM - 10:00 AM, Room 202CD
      • Abstract
      • Slides

      This interactive panel session will highlight the work CIHI is doing to transform the way it collects data. It will provide specific examples of what is being done to change the way data flows to CIHI in our community sectors including home care, long-term care and child and youth mental health agencies.

      Overall, this transformation will:
      • Modernize data flow using interoperable standards such as FHIR;
      • Reduce data submission burden for CIHI’s data submitters and clients;
      • Increase the standardization of data across the health system;
      • Ensure business processes and technologies are sustainable and efficient; and,
      • Improve the ability to collect once and use many!

      Speakers:
      Greg Webster, Director, Acute and Ambulatory Care Information Services Christine Proietti, Manager, ITS Product Development Paulo Domingues, Manager, Architecture and Standards Adrian Dalloo, Manager, Home and Continuing Care, Standards and Support

      Moderator:
      Lynn McNeely, Special Projects Lead, Home and Continuing Care

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    OS04 - Mind the Access to Care Gaps (ID 4)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 202CD
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      OS04.01 - Promising Telehealth Opportunities for the Yukon Telehealth System (ID 272)

      Emily Seto, IHPME, University of Toronto; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: An evaluation of the current Yukon Telehealth System was conducted to determine areas of strengths and possible improvements, as well as to determine the opportunities to expand the Telehealth System. This presentation will focus on the possible future evolution of the Telehealth System to provide Yukon citizens with effective and timely remote healthcare while reducing costs.

      Methodology/Approach: A mixed-methods approach was used, guided by the Clinical Adoption Framework. Quantitative data included usage data collected by the Telehealth Coordinator, billing data, and responses from questionnaires administered to community nurses and patients. Descriptive statistics were used to determine longitudinal trends and patterns of use. In-person focus groups and semi-structured interviews were conducted with 23 stakeholders (Telehealth Coordinator, community nurses, physicians, managers, etc.). In addition, semi-structured telephone interviews were conducted with four community nurses, nine physicians who provide services in Yukon (specialists who fly into Whitehorse), and other telehealth stakeholders. The two evaluators discussed the findings from each of the interviews/focus groups, and determined the emerging themes.

      Finding/Results: The use of the Yukon Telehealth System has been consistent around 1000 sessions per year since 2008, with 1099 sessions occurring in 2015 (69% for clinical care, 16% for educational, and 15% for administrative purposes). While there was a consensus on the value of the Telehealth System, including its role in providing timely access to care and cost savings from reduced travelling, there were also several areas of improvement that were discovered. Interviewees believed that the system was underutilized and that the equipment was out-dated. The telehealth units were often inaccessible due to their location (room already booked) and the process to establish a telehealth session was not as quick and easy as desired. In addition, the system was heavily dependent on one single person to coordinate services. Several areas of particular promise for telehealth expansion were discovered. Psychiatric consults conducted via telehealth could eliminate hours of travel for patients and provide sessions at a frequency optimized for individual needs. Some interviewees believed that an initial in-person consult would be preferable, but follow-up consults through telehealth would be appropriate. Dermatology could benefit not only from high-resolution store-and-forward images, but live consultations with the patient which would enable viewing of relevant areas of the body by dermatologists that may not be obviously related to the issue. Telehealth could also be used for orthopaedic cases, where wait times to see an orthopaedic surgeon can be exceedingly long in Yukon. Triaging via telehealth to efficiently determine patients who require orthopaedic surgery and those who do not, as well as providing follow-up telehealth consults post-surgery were found to be of particular benefit.

      Conclusion/Implication/Recommendations: Many healthcare challenges exist due to the remoteness of the Yukon communities and the relatively small population. However, this also affords many opportunities to leverage telehealth services to provide Yukon citizens with efficient and effective healthcare. Telehealth for psychiatry, dermatology, and orthopaedics appear to be areas of particular promise in Yukon.

      140 Character Summary: This presentation will discuss the evaluation and areas of opportunity for the Yukon Telehealth System.

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      OS04.02 - Students Mental Health Virtual Community: Needs and Challenges (ID 359)

      Farah Ahmad, School of Health Policy and Management, York University; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Mental health problems are increasing at an alarming rate on university campuses across North America, including Canada. Yet, within the Canadian health care system, there are long wait-times for mental health and campus counselling services due to limited resources. System gaps are of particular concern for youth entering post-secondary education under the conditions of economic uncertainty. Indeed, innovative strategies are needed for early engagement of campus youth in health and mental-health promoting practices. With the objective of addressing growing mental health needs in post-secondary students, our team is developing and evaluating a youth-centered Mindfulness Virtual Community (MVC) platform with interactive discussion forums and group sessions led by mental health professionals. This three-phased project is an academic-industry partnership funded by the eHIPP grant initiatives of the Canadian Institutes of Health Research.

      Methodology/Approach: Using focus group, survey and usability-test methods, we have completed Phase 1 in examining the perspectives and behaviors of undergraduate students on: (1) online and offline activities when faced with stress or mood fluctuations, (2) extent of online activities and its interaction with stress, anxiety and depression, and (3) important and user-friendly features of the MVC platform. Finally, this approach led to additional academic-industry collaborative insights.

      Finding/Results: Our 3-pronged approach involved 8 semi-structured focus groups (to assist content selection), a large online survey (to understand online activities in relation to mental health), and usability testing of the derived platform. Our questions explored: (1) cognitive, emotional and physical responses to online material and resources, and (2) preferred platform features and topics. Our findings suggest that many students find connection and mental 'relief' through online activities, but this relief is temporary and accompanied by experiences of social pressure, social anxiety, exacerbations of negative emotions and lost time/lost productivity. Males and females differed in online preferences and willingness to seek assistance for mental health online. Males were much more reluctant re: both online and direct assistance. While students expressed some reservations re: online mental health support , they were eager to engage with a platform that overcame identified obstacles. Students saw many advantages in accessing mental health resources online vs. in-person mental health “support”.

      Conclusion/Implications/Recommendations: We conclude that enhancing mental health online and encouraging adoption of mindfulness practices are interacting aims as students tend to procrastinate and waste time online, increasing stress/anxiety, and reducing academic performance. Conversely, mindfulness practices help reduce stress/anxiety and procrastination, and prepare for productive academic activity.

      140 Character Summary: Learning what university students want and need in an interactive Mindfulness Virtual Community (MVC) platform to support mental health

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      OS04.03 - Collaborative Design: eReferral Implementation for Addictions and Mental Health Referrals (ID 94)

      Nala Sriharan, Central Intake Program, Halton Healthcare; oakville/CA
      Zoe Gordon, Halton Healthcare; Oakville/CA

      • Abstract
      • Slides

      Purpose/Objectives: one-Link is a single point of access for referrals to 10 community addiction and mental health service providers funded by the Mississauga Halton LHIN. one-Link provides screening, information, referral matching and supports to individuals. Led by Halton Healthcare, this initiative in partnership with the Mississauga Halton Central Intake Program have designed and implemented an eReferral solution with functionality to track referral status along the care continuum.

      Methodology/Approach: To enhance process efficiency one-Link collaborates with the Central Intake Program to design and implement an eReferral solution to manage the flow of referrals between referring providers, Central Intake, one-Link and receiving programs. Extensive stakeholder engagement and training was conducted during planning, testing and implementation phases for sustainability within agencies on boarded to this new process. An eReferral solution, designed by Novari Health, was already in operation in the region to manage referrals for diabetes education and regional foot care services. The addiction and mental health eReferral was an expansion of the existing platform to allow a single user to have access to multiple referral pathways. The one-Link eReferral initiative was implemented in phases to ensure sustainability prior to scale and spread. Phase one: referral sources continued to fax the referrals to one-Link and these faxes were transcribed into eReferrals at reception. Referrals are triaged and routed to appropriate programs in the eReferral solution. Receiving programs accept, decline, update referrals in the system. All parties within circle of care are able to see the status and location of the referral. Extensive training was provided for services to increase adoption and use. Additionally, eReferral champion training model was used to build capacity within each organization. Phase two: referrals that were received directly at the correct point of care are re-directed to one-Link via the eReferral solution. Phase Three: engagement of primary care physicians in the region to utilize the eReferral solution to submit and track referrals to addiction, mental health, diabetes and regional foot care program in the region.

      Finding/Results: The eReferral project for addiction and mental health referral management has shown the following benefits: - significant time savings in administrative processes compared to manual/fax based processes. - transparency in referral management between requester, one-Link and receiving programs - single platform for all parties has reducing duplication of referrals to multiple services through the system functionality. one-Link is able to review the status of the previous referral and provide care coordination as needed. - System wide data collection through single access point and single system allows true count of service need, demand and utilization for addiction and mental health services in the Mississauga Halton region.

      Conclusion/Implications/Recommendations: Using extensive stakeholder collaboration in the design and implementation of the eReferral solution for addiction and mental health referrals, one-Link has demonstrated success through enabling a transparent process for both the requester and the receiving program. Wait times and volume of individuals waiting by service type can be measured with live data for continuous quality improvement and priority areas for system improvement in this sector.

      140 Character Summary: Led by Halton Healthcare; the Mississauga Halton Central Intake and one-Link, collaboratively designed and implemented an eReferral solution with Novari Health.

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      OS04.04 - Data-Driven Change Management: Using Dashboards to Improve Appointment Data Capture  (ID 260)

      Anna Chyjek, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Centre for Addiction and Mental Health’s (CAMH) ambulatory care clinics serve clients across the spectrum of mental health and addictions diagnoses, providing enhanced care and programming based on their specialized needs. These clinics are a critical part of CAMH, accounting for 75% of the hospital’s total number of unique clients. As part of a recent ambulatory services review to improve accessibility and efficiency, an analysis of clinician utilization revealed that appointment data was variably complete. In anticipation of a prospective data collection period and a secondary analysis, a Clinician Hours and Appointment Volumes Dashboard – an interactive report that automatically calculates appointment volumes and the associated clinician time - was employed to allow for immediate access and resolution of data issues. Integration of date, clinician and appointment status filters permits managers to audit their clinic’s appointment data, enabling them to assess whether the appointment data was reflective of their clinic volumes and broadly gauge the utilization of their staff.

      Methodology/Approach: Initial efforts to improve data completeness focused on developing new guiding documents, providing refresher training sessions and facilitating data workshops, all with an emphasis on teaching standardized scheduling processes and establishing the common expectations of staff for data entry and audit. Improvements were also made to the scheduling system, allowing for the scheduling of multiple service providers in the same appointment. Finally, a dashboard was developed as a data auditing tool throughout the prospective data collection period.

      Finding/Results: An evident increase in the volume of captured appointments was observed between the original (September to December 2015) and secondary (July to September 2016) data collection periods: <img alt="clinicianhours_ehealthabstract_findingsimage.png" annotation="" id="image://42" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=92b8d9b47e88c2b57133bbde899d1bc220bed9bc&id=42&width=350&height=350&download=0" title="clinicianhours_ehealthabstract_findingsimage.png" />

      Conclusion/Implications/Recommendations: As a result of various change management tactics and a robust reporting tool, clinic staff demonstrated a greater aptitude for accurate data capture. In an ongoing effort to continue with these improvements, opportunities for further enhancement of the Dashboard are being discussed, including the addition of automated prompts and integration of appointment data with other data sources. Future efforts will focus on implementing a sustainability plan to ensure continued improvement and accountability amongst the clinics, enabling sustained data-driven decision-making for ambulatory redevelopment.

      140 Character Summary: Improved appointment data capture is achievable via flexible reporting, focused change management and clear accountability for data audit.

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      OS04.05 - Rapid Access to Consultative Expertise: An innovative Model of Care (ID 49)

      Margot Wilson, Providence Health Care; Vancouver/CA
      Garey Mazowita, Providence Health Care; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Timely access to specialist care is a major issue for patients. In support of family physicians (FPs) and their need for help in managing more complex patients, Rapid Access to Cardiovascular Expertise (RACE) was launched in Vancouver, Canada in 2010 to provide timely telephone consultation by specialists for FPs. The RACE model is a multi-specialty telephone hotline providing FPs with timely access to a range of specialist consultation services. FPs can call one number, choose from a selection of specialty services, and be routed directly through to the specialist’s cell phone for advice, usually within a few minutes. In 2010, RACE began with five specialty areas. The program has since grown to include 26 specialties, has logged over 25,000 calls, and has spread from a local to a provincial service.

      Methodology/Approach: The evaluation process involved a mixed methodology approach based on surveys, interviews, and a review of aggregated data on service utilization. Approximately 800 Vancouver-area FPs were invited to participate in an online survey about RACE. The survey focused on the perceived benefits of RACE and the user experience for FPs and specialists. interviews with 23 stakeholders (specialists, FPs and decision makerswere completed and transcribed for analysis. Service utilization was determined from the records of TELUS, the telephone service provider for the centralized RACE call-in line, and from data gathered by the specialists at the time of the call.

      Finding/Results: Survey results revealed an overwhelming majority of surveyed FPs (94%) knew about RACE, and amongst this group, 60% had used the service. Overall, FPs who used RACE were satisfied with the timely access to specialist consultations RACE provided, and with the quality and efficiency of the consultations Physician interviews suggested RACE was seen as a service with benefits for both FPs and specialists. Family physicians also said that access to timely consultations through RACE helped them manage care for their patients and helped their patients avoid unnecessary emergency department visits and referrals for specialist care. All interviewed specialists reported anecdotal evidence confirming the overwhelmingly positive experience of RACE. Detailed data gathered by the specialists at the time of the call indicated: • 78% of calls to the RACE line were responded to by a specialist within 10 minutes • 90% of all calls between FPs and SPs were less than 15 minutes in length • 60% of RACE calls avoided patients requiring a face-to-face specialist consult • 32% of RACE calls avoided patients needing to visit a hospital emergency department for treatment

      Conclusion/Implications/Recommendations: The RACE model was implemented to provide FPs timely telephone access to specialists, to support enhanced patient care by FPs as well as to improve collaboration between specialists and FPs. RACE appears to provide an effective solution for many of the challenges faced by specialists and FPs in providing effective and efficient care for patients. The RACE model is currently being spread across Canada, with additional interested sites in the UK and Australia.

      140 Character Summary: RACE is an innovative model where family physicians can call one number, choose from a selection of specialty services and be routed to a specialist for advice.

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      OS04.06 - Rural Communities Have e-ASE of Access to Specialists (ID 176)

      Mona Mattei, Kootenay Boundary Divison of Family Practice; Grand Forks/CA

      • Abstract
      • Slides

      Purpose/Objectives: This session presents e-ASE, a suite of electronic services that provides primary care teams in rural BC with access to specialist colleagues for timely assistance with patient management. E-ASE incorporates telephone, video and secure texting connectivity, with future e-Consult capabilities planned within a secure environment. Patients living in rural or remote areas are at increased risk of poor health outcomes than their urban counterparts. Some of these poor outcome may be due to limited access to specialists. Reduced access may be as a result of • small numbers of specialists available in rural and remote areas • the high costs of travel and road safety concerns when attending specialist appointments In rural areas, patients often travel to see health care providers in communities other than their own. Many patients choose not to access care services, delay accessing care or do so sporadically. In a 2016 patient survey 25% of patients surveyed either delayed or refused care if travel was required. Communications between providers in this setting is complex or delayed, potentially resulting in a lack of clarity between providers about patient care. Central to the support of patients in rural areas is access to specialist care either directly or through their primary care team. In partnership with Interior Health Authority of BC, Shared Care with the Kootenay Boundary Division of Family Practice, and Specialists Services Committee, Doctors of BC, e-ASE provides multiple points of access to specialist support in the Kootenay Boundary region of BC.

      Methodology/Approach: e-ASE offers a suite of electronic capabilities connecting primary care teams to specialist colleagues for timely collaborative patient care planning. It improves quality of care in remote sites by linking rural clinicians and patients to the central clinical hubs. The various communication modalities and embedded patient data allow specialists to prioritize response and include primary care providers in all aspects of care planning. There are three active clinical programs for telehealth: Mobile Maternity (MoM), critical care link and in-clinic video conferencing. MoM uses mobile devices (tablets and phones) for obstetric consultations prioritizing tripartite care planning model with FPs, NPs and midwives. In-Clinic software installed in rural family physician’s exam rooms provides consults with specialists in urban centers. Similar technology enables an early connection between critically ill patients in remote emergency departments and the regional Intensive Care Unit providing faster access and implementation of time sensitive critical treatments. Secure texting is delivered using an adaptation of a system successfully implemented in the urban centre of Kelowna. The system provides: · on-call schedules identifying specialists available; · instant messaging to connect with specialists providing return contact information; · ability to provide detailed patient information including photos, labs and x-rays; · linkage to the hospital EHR to provide ADT notification on patients.

      Finding/Results: Messaging cuts down call volume, saves time and makes patient care more efficient. Kelowna has experienced improvements in physician and nurse satisfaction, quality of communications and time savings.

      Conclusion/Implications/Recommendations: The team will present emerging data and provide an opportunity for facilitated discussion on goals and outcomes.

      140 Character Summary: e-ASE, a new suite of electronic services connects primary care teams in rural BC with specialist colleagues for timely assistance with patient management.

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    OS16 - Evolving Access for Remote Communities (ID 22)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical
    • Presentations: 4
    • Coordinates: 6/06/2017, 01:00 PM - 02:00 PM, Room 202CD
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      OS16.01 - Cedar Project: MHealth Among Young Indigenous People Who Use Drugs (ID 340)

      Kate Jongbloed, School of Population and Public Health, University of British Columbia; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Indigenous leaders and scholars continue to be concerned about high rates of HIV and barriers to HIV treatment among Indigenous young people who use drugs. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. The Cedar Project is a cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, British Columbia. In response to the paucity of evidence of mobile phone use among among young Indigenous people who use illicit drugs living with and vulnerable to HIV, we: (1) examine patterns of mobile phone ownership and use; and (2) explore acceptability of an mHealth program to support access to healthcare.

      Methodology/Approach: This multi-method exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth intervention. At enrollment, participants completed a questionnaire which included quantitative and qualitative questions related to mobile phone use and interest in mHealth. This data was linked to the main Cedar Project questionnaires and serodata. We present comparative statistics and results of a rapid thematic analysis related to mobile phone patterns and interest in receiving an mHealth intervention among young Indigenous people who use drugs.

      Finding/Results: Slightly less than half of participants (59; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smart phone (46; 78%). Most participants with a phone reported having an unlimited texting plan (39; 70.9%); using Internet on their phone (44; 74.6%); and texting daily (51; 67.1%). Participants were asked whether they felt using a mobile phone would be helpful for healthcare, and if they had any concerns using text messaging for their health. A majority reported that using a mobile phone for health would be invaluable (120; 92.3%). There were no differences in mHealth acceptance between participants who already owned a phone and those who did not. All participants living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (10; 12.5%). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits falling into six themes: (1) access to healthcare and emergency services; (2) convenience, privacy, and safety; (3) connection for emotional, mental and spiritual support; (4) connection to family; (5) staying in touch/being reachable; and (6) overcoming current barriers to phone use.

      Conclusion/Implication/Recommendations: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who use drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and wellbeing among the young Indigenous people in this study. These findings may be useful for health providers preparing to scale up mHealth programs to support HIV prevention and treatment with this population.

      140 Character Summary: Mobile phone use and mHealth to support access to healthcare are highly acceptable among young Indigenous people who use illicit drugs living with/vulnerable to HIV

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      OS16.02 - Clinical Decision Making Applications (ID 223)

      Merv D'Souza, meshMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Clinical decision making technologies assist doctors in diagnosing and treating patients in both acute and community care settings. Doctors are faced with making complex decisions, requiring them to take into account multiple inputs in a short time frame. Everything from lab results, clinical observations and patient history needs to be factored into decisions. Doctors are often stretched for time as they go through all the patient details. Additionally, When it comes to complex diseases with multi-step treatments there is a lot of new data and evidence that is being updated on an ongoing basis. Doctors aren’t always able to keep up with all the new data. Our applications house complex decision trees combined with machine learning algorithms to help doctors improve efficiencies in treating their patients and assist with their decision making process. The platform and algorithms incorporates data from new studies to provide doctors with tools that reflect the latest in evidence based medicine. Doctors that engage with the application have seen an improvement in patient outcomes, as well as quicker times to process patients.

      Methodology/Approach: The platform harnesses the decision making process of leading KOLs in each disease state. It incorporates input from doctors specializing in multiple diseases including Virology, Oncology and Immunology. Lab integrations, patient questionnaires and clinical observation flowcharts are used to capture data points during diagnosis. These data points are analyzed and a proprietary algorithm runs through millions of possible permutation and combinations to recommend possible diagnosis and course of action. As new data is fed into the system (ex. updated lab work), the algorithm re-computes the results and makes recommendations on staying course of treatment or adjusting the therapy

      Finding/Results: With our existing platforms we have been able to expand the population of patients that receive care for some complex diseases. In addition to high utilization by specialists, there have been two primary use cases for the platforms: The platforms have provided family physicians in rural areas the ability to diagnose, triage and start treatment on patients that would otherwise be left undiagnosed or underdiagnosed There has been a significant uptick in First Nation populations on reserves receiving treatment for chronic conditions by doctors who use our platforms

      Conclusion/Implications/Recommendations: Clinical decision making applications are ideal for hospitals and large clinics that are front-line in dealing with patients. The platforms assist doctors in diagnosing patients and automates the results from labs, clinical observations and patient history into the decision. The investment doctors make in learning to use the platform is quickly paid-off by allowing them to manage each patient more efficiently. Further, doctors are able to make better decisions with the most up to date data and evidence.

      140 Character Summary: Clinical Decision Making tools assists doctors in performing better diagnosis and implement improved treatment plans on patients suffering from complex diseases

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      OS16.03 - First Nations in Ontario – New Focus on Practical eHealth Pathways (ID 241)

      Karl Mallory, Mallory Consulting Ltd.; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: In another abstract an updated approach for the First Nations Panorama Deployment in Ontario (FNPDiO) project was explained. This presentation provides examples of project success/challenges at the level of the individual First Nation Health Service Organizations (FNHSOs) the project works with. Overall, the FNPDiO project has a goal to support FNHSOs in Ontario to identify and develop practical health information management processes. Our scope began with access to provincial immunizations tools and data, but has grown to incorporate broader requirements. Analysis makes a few things clear. First, FNHSO access to provincial eHealth tools is necessary to support effective circle of care for First Nations. Second, many challenges impede access to provincial eHealth tools. Third, provincial eHealth tools on their own are not complete solutions for FNHSOs as they are not designed to support specific First Nation requirements, and as a result local eHealth tools and solutions are also required. Given this clarity, the project developed a suite of eHealth “pathways” that are meaningful and relevant to FNHSOs. The term “pathway” describes an identified health information management priority, plus the methodology, templates, etc. that enable access to relevant systems/tools. By focusing our discussion on three FNHSOs working through the various FNPDiO “pathways” we will describe how progress is being made, how challenges are being resolved and how the overall model is validated/refined for possible expansion to other FNHSOs. Our examples will highlight access to provincial immunization data and systems (DHIR), implementation and use of community electronic medical records (cEMR), access to provincial clinical viewers (ConnectingOntario), and use of Personal Health Records in conjunction with other local health care providers. Multiple pathways may be applicable to a specific FNHSO, and local capacities for enabling and sustaining these pathways may vary between FNHSOs. However, the underlying requirements that must be met to enable any pathway are similar (e.g. network connectivity, P&S frameworks, etc.) and these will also be discussed.

      Methodology/Approach: With advice from our Advisory Group, the project team developed a set of detailed processes to enable the pathways that address priority FNHSO health information management needs. Our presentation will describe the pathways process from the perspective of three of our Initial Subscriber FNHSOs. We will identify and discuss the commonalities across pathways, describe the necessary collaboration with provincial partners, and share our experiences on FNHSO-level change management efforts and strategies.

      Finding/Results: The pathways developed through the project are proving successful with the project’s Initial Subscriber FNHSOs. Through our work with them and their provincial partners, the pathways approach is being refined and communicated to other FNHSOs in hope that the outputs of the project can be beneficial more broadly to First Nations in Ontario and support meaningful advances in First Nations eHealth.

      Conclusion/Implication/Recommendations: The project has been successful in using a systematic methodology to identify and support FNHSO health information management priorities. This approach can improve workflow and circle of care coordination with provincial partners. Other FNHSOs in Ontario should be supported to benefit from the project’s success.

      140 Character Summary: A “pathways” approach is being used in Ontario to bring practical and meaningful solutions to First Nation health centre information management priorities.

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      OS16.04 - First Nation Health Information Management – Aligning with Ontario eHealth Strategies (ID 168)

      Karl Mallory, Mallory Consulting Ltd.; Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: In 2008, the First Nation Panorama Deployment in Ontario (FNPDiO) project began between Chiefs of Ontario, First Nations and Inuit Health Branch Ontario Region and the Ontario Ministry of Health and Long-Term Care with a goal to support First Nations use of the Panorama Public Health Surveillance System. Time has passed and eHealth strategies have changed, including how Panorama is used in Ontario. However, the pressing need for on-reserve health information management tools and processes, including interoperability with provincial providers, remains largely unfulfilled. In response, the project restructured with expanded scope, emphasis on aligning First Nations requirements with evolving provincial eHealth strategies, and with a practical circle-of-care focus that includes significant collaboration with First Nations, Public Health Units and Local Health Integration Network staff. Immunization information management is still a priority interest, but it’s become clear that a more holistic view of health centre information management is needed. To this end, the project team is now supporting First Nations Health Organizations to assess their need for information management across their range of clinical program management and then match identified needs to eHealth systems available in the environment – from ConnectingOntario clinical viewers, to interaction with the Ontario Digital Health Immunization Repository (DHIR), to use of community EMRs, to Personal Health Records. Properly enabled, this broader range of systems can address long-standing challenges that have impeded First Nation from taking advantage of eHealth advances.

      Methodology/Approach: The FNPDiO project follows a needs assessment, provincial integration, and implementation toolkit methodology proven successful in similar First Nations eHealth projects. Guided by a First Nations-led Advisory Group, the project team developed tools to identify discreet health centre information management requirements and priorities and match these to available systems. The approach also supports facilitating system access/implementation. The methodology is flexible and accommodates varying requirements and priorities across health centres, plus it aligns strongly where necessary to the evolving and expanding set of eHealth tools and services being introduced by the province of Ontario (e.g. DHIR, ConnectingOntario, PHIX, ICON, etc.). At its core, the project methodology also takes into consideration the many non-system enablers of eHealth system access/use (e.g. P&S, information governance, ongoing support, etc.) and establishes a foundation that builds eHealth capacity within First Nations Health Organizations.

      Finding/Results: First Nations Health Organizations in Ontario have begun to access and use required eHealth systems through the project. We are now working to extend the successful methodology to others while continuing to work with partners to identify and support new system access/use models in an ever-evolving eHealth world.

      Conclusion/Implication/Recommendations: The First Nation eHealth environment is complicated. However, experience has demonstrated that with patience and a focus on practical clinical requirements, progress can be made. The methodology used to support First Nations in Ontario to improve their eHealth capacity should be made available to all who have a demonstrated need. This methodology and its outcomes likely have relevance in other provinces as well. Success on the FNPDiO project should be shared wherever possible.

      140 Character Summary: The FNPDiO project has developed an approach to support First Nation health info mgmt. priorities in alignment with provincial strategies. It is working.

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    OS27 - Empowering Consumers and Providers (ID 32)

    • 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 202CD
      • Abstract
      • Slides

      Purpose/Objectives: Access to mental health services continues to be a significant barrier to people getting the help they need. Changing Directions, Changing Lives: The Mental Health Strategy for Canada recognizes the important role that technological innovations can play in addressing mental health system problems. The Strategy recommends, “using technology to foster collaboration, increase access to services, and engage people in managing their mental health problems and illnesses”. Accordingly, a national effort is underway to spark action to advance e-Mental health in Canada. This presentation will present an overview of the status of e-Mental health in Canada and describe a national mental health organization’s plan and recommendations to advance this area.

      Methodology/Approach: Drawing on the research literature, as well as experiences from leading e-Mental health jurisdictions (i.e. Australia and New Zealand), has provided a foundation to move forward on e-Mental health. A national mental health organization has been convening e-Mental health thought leaders and stakeholders across Canada to identify recommendations to widen the adoption of e-Mental health across the country. An updated review of the research; a comprehensive scan of e-Mental health initiatives across Canada and a series of roundtables are a few key research and knowledge exchange activities taking place in 2016-17 to inform the development of a longer-term plan for e-Mental health.

      Finding/Results: Research demonstrates that e-therapies can be as effective as face-to-face therapies, including the delivery of cognitive behavioural therapy for mild to moderate anxiety and depression. E-Mental health services can also address barriers of under-served areas and populations, including First Nations, Inuit and Métis communities. There are examples of e-Mental health services and interventions integrated in health systems in different parts of Canada. These services are proving to be effective and showing promise for expansion and adaptation.

      Conclusion/Implication/Recommendations: Canada is still lagging behind in terms of accelerating the integration of e-Mental health into our mental health systems. By strengthening collective knowledge of the e-Mental health evidence base, facilitating knowledge exchange and engaging in strategic partnerships to support or scale up promising innovations, a national mental health organization aims to promote the uptake of e-Mental health as a way to improve access to mental health services.

      140 Character Summary: A national effort is underway to spark action to advance e-Mental health in Canada as a way to improve our mental health system.

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      OS27.02 - Development and Testing of a Touch-Screen Tablet-Based Patient Asthma Questionnaire (ID 108)

      Victor Lam Shin Cheung, Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Asthma affects 7.4% of the US adult population and carries an annual economic burden in excess of $56 billion. Guidelines indicate that primary care physicians should assess asthma control and medication adherence at each visit, however this is seldom performed. As a result, over 50% of patients with asthma are poorly controlled, resulting in significant morbidity, mortality, and health care utilization. An asthma action plan (AAP) is an individualized written plan produced by a health care professional which empowers patients to self-manage their disease, and has been shown to improve health outcomes. AAPs are rarely provided to patients due to a lack of time needed to acquire and process required information from patients. Collecting information from patients through a waiting room touch-screen tablet-based device may enable efficient data collection for assessing asthma control, adherence, and personalizing an AAP. Our objective was to design and evaluate such a questionnaire.

      Methodology/Approach: We employed a qualitative focus group-based rapid-cycle design process. In focus groups (FGs), adult asthma patients completed a demographic survey, an asthma touch-screen tablet-based questionnaire, and an exit questionnaire assessing usability. Analysts independently generated lists of suggested changes to usability and content features, which were used to iteratively revise the questionnaire after each FG. FG transcripts and field notes were also independently analyzed by 2 qualitative researchers using a descriptive content analytic approach.

      Finding/Results: There were 20 participants across 5 FGs [15/20 (75%) female, age 49.1 +/- 15.6 years]. Four participants (20%) had one or more emergency room visit for asthma in the last year, and 6 (30%) had previously received a written AAP. Five (25%) had never previously used a touch-screen tablet. Mean questionnaire completion time was 11.7 +/- 5.9 minutes. Eighteen participants (90%) rated the navigation structure as “straightforward and easy to use.” The mean System Usability Score (SUS) was 84.2 +/- 14.7. Usability themes included screen hygiene, familiarity with touch-screen technology, ease of use of the touch-screen, and questionnaire design (fonts, images, navigation). Content themes related to language used and nature of information collected. A plurality of revisions [to the questionnaire 10/29 (34%)] were made following the first FG.

      Conclusion/Implication/Recommendations: The majority of participants indicated that the questionnaire was easy to understand and to use, which was supported by a high SUS, favorable Likert scale responses, and a completion time compatible with wait times seen in a majority of primary care clinics. Our study identifies key usability and content features for a touch-screen tablet-based asthma questionnaire which can be used in a clinical setting to efficiently collect information on asthma control, adherence, and data required to build an AAP. Our usability findings can also be adopted by researchers seeking to design touch-screen tablet-based questionnaires for other conditions.

      140 Character Summary: Successful design process for a touch-screen tablet questionnaire for patients to provide asthma information while in the waiting room.

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      OS27.03 - Making EMRs Work for Physicians and Their Patients (ID 343)

      Gina Palmese, OntarioMD; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Most community-based family physician practices are using certified electronic medical records (EMRs), yet there is substantial variation in how well these tools are used. Physicians are aware of the potential benefits of EMR use for practice management and patient outcomes. However, barriers - financial, technical, time, psychological, social, legal, organizational and change-related - can prevent practices from harnessing the power of EMR technology. To move beyond these barriers, our organization employs a change management strategy designed to meet physicians where they are and help them understand how their EMR can drive improvement in practice management and patient care.

      Methodology/Approach: This EMR practice enhancement program deploys Practice Advisors to community-based practices to conduct current state analyses of data entry habits, raise awareness about data quality, identify gaps for improvement, and develop action plans with achievable goals. Practices can optimize their EMR use in these measures: Appointment Scheduling Practice Billing Communication & Messaging Encounter Documentation Data Quality & Nomenclature Consistency Document Management Results Management Referral & Consultation Tracking Prevention & Screening Complex Care/Chronic Disease Management The program provides insight into established workflows used to capture patient information; a practice’s desired future state for how they will use data entry tools and processes; necessary skills to sustain knowledge transfer; and how EMRs can be used in key areas like chronic disease prevention and management. The program focuses on discrete data to capture a current state, so that physicians have a baseline against which they can measure improvements in their EMR use. By establishing routine entry of standard quality data for practice level use, physicians can effectively leverage mechanisms such as custom forms and reminders to realize positive outcomes in patient care. The process reveals EMR functionalities to physicians and helps them achieve sustainable results in improving patient, and ultimately population, health.

      Finding/Results: One-on-one coaching has been critical to success of this program. To date, working with practices has shown: *Quantitative findings: 25% improvement in cancer screening compliance within 16 weeks of baseline capture 15% increase in smoking status capture within 8 weeks of baseline capture 37% improvement in use of standard CDM data entry tools for diabetes populations within 16 weeks of baseline capture Assessed improvement in EMR use post-baseline across four physician-selected priority areas: prevention/screening, nomenclature consistency, CDM/complex care (tools), encounter documentation Qualitative findings*: Demonstrated improvement in maturity of EMR use across a number of physicians Better understanding of rostering workflow for preventive care purposes and working towards decreasing variance between EMR and ministry data Improving standard nomenclature documentation such as smoking status to inform population health Root cause analysis, e.g. categorization challenges for documenting preventive care and chronic disease management, is critical to achieving sustainable change

      Conclusion/Implication/Recommendations: Physicians who have undergone an engagement in the program’s early stages have already experienced marked improvements in patient care and practice efficiency. Findings reported here are based on the 250 clinicians and administrative staff across over 25 locations the program touched between April and September 2016; engagements over the coming months will increase the data on which to report.

      140 Character Summary: Working with physicians on barriers to advancing EMR optimization and workflow efficiency to improve patient and practice outcomes

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      OS27.04 - Achieving Triple Aim Healthcare Improvement: Canada's Jumpstart (ID 292)

      Diane Gutiw, CGI; Mayne Island/CA

      • Abstract
      • Slides

      Purpose/Objectives: The purpose of this presentation is to provide an overview of the IHI Triple Aim model and how it is being addressed in the US, and to analyze where the Canadian investments in data centralization and standardization are seeing Triple Aim benefits. The presentation will wrap up with analyses of how the Canadian experience has rated in comparison with the projected benefits identified by the IHI. The Triple Aim framework was developed in 2008 by the Institute for Healthcare Improvement (IHI) to provide a holistic approach to improve the quality of care while reducing the overall cost of healthcare delivery. The model focuses on three critical objectives to improve overall healthcare delivery: 1. improving the health of a defined population; 2. enhancing the patient experience (quality, access and reliability); and 3. reducing/controlling the per capita cost of care. The presentation provides a definition of the healthcare reform model along with the need for reform and the projected benefits of each objective. The overview includes US initiatives currently being funded to help achieve the benefits. The presentation focuses on Canada’s investment in jurisdictional centralization and standardization of health data, and how cross-functional analytics are leveraged in Canada to achieve both the model and its benefits. This includes a review of how analytics are used to improve targeted population health through CIHI’s data content standards and population health surveillance initiatives. A review of patient access to quality care and improved accountability initiatives will also be presented. The presentation will wrap up with a comparison of the Canadian experience against the projected benefits of the IHI. The findings indicate that Canada is leveraging its existing investment to see immediate improvements in population health and quality of care.

      Methodology/Approach: The approach to developing the material for this presentation included a detailed analysis of the Triple Aim model including analysis on what the intended quantitative and qualitative benefits of each of the three objectives. This analysis on the framework provides a foundation for reviewing how Canadian jurisdictions are leveraging the existing central data repositories and registries, and supporting data standards, to develop analytic frameworks that address each of the three areas. The analysis of the Canadian approach will include case study examples from multiple jurisdictions. Finally the presentation compares the Canadian experience to the IHI objectives to determine if the benefits of the investment in achieving the Triple Aim model are realistic and if the projected outcomes are achievable.

      Finding/Results: Canadian investment in centralized and standardized data has provided a solid foundation for analytics that support each of the Triple Aim improvement objectives. The scope of jurisdictional data sharing increases the immediate benefits for targeted population health and the quality of patient care. The benefits of improved patient access to care and reduced cost of care have not been as quick to realize but initiatives are underway to address these.

      Conclusion/Implication/Recommendations: Recommendations for continued analytics in Canada for further improvements in patient access to care and reduced cost of care will be provided.

      140 Character Summary: Dr. Gutiw is a health informatics professional with CGI with a Ph.D. in heath IT. Diane has been engaged in analytic strategies in Canada and the US.

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      OS27.05 - Caging the Chaos: Electronic Clinical Decision Support in Mental Health (ID 237)

      Michael Seiferling, Mental Health, Five Hills Health Region; Moose Jaw/CA

      • Abstract
      • Slides

      Purpose/Objectives: The diversity in mental health care can make it difficult to find consistent and reliable treatment recommendations for clients. Similar to 'chaos theory', small changes in initial conditions of a client can greatly impact their trajectory in the system of care. Where a person presents for care, what professional assess them and what the main issue the client presents with all effect a treatment plan. This presentation will describe how LOCUS, a clinical decision support tool was used to create a standard report for client care. This report includes a "level of care" recommendation that is used to match a client to a specific service menu. This allows for reliable and consistent service offerings for all clients based on their current level of need.

      Methodology/Approach: The LOCUS measures six key dimensions of a clients current situation. The tool provides guidelines for scoring that produce a remarkably consistent inter rating reliability from a wide range of clinicians. The tool also provides guidelines for the types of services that should be available to the client based on their level of need. This allowed for the creation of a method in which all clinical and support services offered in an area could be 'matched' to a client based on the level of care recommendation. This matched menu of service is then used to discuss care options to clients to ensure are they are able to make informed decisions about their care. This ensures that the right client, is always offered the right service at the right time, regardless of who they are assessed by or how they enter the system.

      Finding/Results: LOCUS has been applied in practice in Five Hills Health Region with findings showing that more clients in need now receive care based on their level of need. As such, improved client outcomes and reductions in hospitalizations have been measured. Based on this success, an electronic application has been developed to expand the use of the tool and the stepped care approach supported by the service matching process. This allows for a province wide approach to care.

      Conclusion/Implication/Recommendations: The use of electronic clinical decision support for the LOCUS tool allows us to "cage the chaos" that can reduce the quality and reliability of services for patients. The method for service matching allows a complex and overwhelming number of options for care to be filtered down so that clinicians can engage in shared decision making with a client while discussing treatment plans.

      140 Character Summary: The LOCUS tool has been used as the base for an electronic clinical decision support system that ensures the right client gets the right care at the right time.

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      OS27.06 - Progress in Psychiatric Informatics: From Patient Engagement to Deep Learning (ID 289)

      Jane Paterson, Centre for Addiction and Mental Health; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: CAMH implemented a hospital information system (HIS) in mid-2014. Amongst post-implementation projects since launch, three will be presented during the panel: 1) *Clinical optimization in behavioral health. The objective was to balance narrative documentation requirements of mental health professionals with the hospital goals of reducing variation in care, enhancing data quality, and enabling analytics capabilities. 2) Engaging mental health clients/patients in closed loop medication administration (CLMA). The purpose was to engage mental health clients/patients about their perceptions of the medication administration process. 3) Applying deep neural networks to free text notes for research recruitment of depressed youth.* Because clinical research study recruitments regularly miss up to 60% of eligible participants and the literature indicates that applying computational methods can increase participant recruitment substantially, we sought to employ such procedures.

      Methodology/Approach: 1) *Optimization. The components of unmet clinician functionality needs from our issue tracker and corporate quality objectives were melded together in this project. This was accomplished by a series of foundational guiding principles that were the base on which the work was completed. 2) Engagement-CLMA. Engaging clients/patients provided valuable insights in regards to the use of technology for safe medication administration. Surveys (n=50) were distributed by a Peer Support Worker to inpatient clients/patients -- quantitative and qualitative responses were analyzed. 3) Deep learning.* REB approval was obtained. Six months’ free text notes from the correct age group were extracted, de-identified and annotated Brute force and deep neural network methods were applied.

      Finding/Results: 1) *Optimization. Frequently used assessments were simplified including the Suicide Risk Assessment, Mental Status Examination and others. New order sets were created for Seclusion/Restraint, Addictions and Hospitalists. ECT order sets were improved. New documents were introduced for aggression, Addictions and Neurology. Physician workflow view was launched. 2) Engagement-CLMA. Themes identified innovations for the medication administration process. Clients/patients value the nurse-client relationship, being engaged as an active participant in the process, and having choice in client/patient identification methods. Concerns about the intention of personal identification, physical comfort of wristbands, and having photos taken were raised. 3) Deep learning*. Brute force methods gave inconsistent performance. Using the deep neural network of the H2O.ai package, two models resulted: a sensitive non-specific model (sensitivity 89%; specificity 53%) and a specific non-sensitive (sensitivity 45%; specificity 97%) model. Specific and sensitive models were combined and validated on an independent test set.

      Conclusion/Implications/Recommendations: 1) *Optimization. A spectrum of content for documentation and ordering went live. The changes support improved client care and recovery, improve the clinician experience and align with CAMH’s strategic directions and mission to transform lives. 2) Engagement-CLMA. Feedback was incorporated into education for inpatient staff, and considerations for organizational practices, policies and procedures were identified. Client/patient education material, including brochures and posters, were also developed. 3) Deep learning.* Our recommender was assembled by first training two deep neural networks, one that accurately identifies client/patients who are not suitable, and another that accurately identifies the suitable. Future work will enlargen the corpus, use discrete data, and employ other machine learning algorithm types.

      140 Character Summary: Post-implementation optimization, patient engagement and deep neural networks suggest the HIS is a continually evolving entity.

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    PS04 - PIA’s to Telehealth: A Journey (ID 13)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Panel Session
    • Track: Clinical and Executive
    • Presentations: 3
    • Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 202CD
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      PS04.01 - Privacy Impact Assessments: Looking for a Common Understanding (ID 315)

      Andrea Peebles, Canada Health Infoway; Toronto/CA
      Abigail Carter-Langford, eHealth Ontario; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: A Privacy Impact Assessment (PIA) is a formal risk management tool that includes consideration of other risk management documents as well, assists in identifying potential privacy risks associated with a new activity, allowing for the development of risk mitigation strategies that reduce the likelihood of adverse privacy events. In Canada, some jurisdictions require a PIA in legislation, others in policy or in some cases, as a best practice. This variation and inconsistency affects the efficiency resulting in a costly PIA process. Work was conducted to examine the differences and to determine if a more consistent approach could be developed to promote consistency, enhance efficiency, and build trust in the emerging digital health environment, particularly for projects that cross jurisdictions.

      Methodology/Approach: Canada Health Infoway, in collaboration with the Health Information Privacy Group (HIPG) conducted an environmental scan of the legislative requirements as well as guidance provided by Privacy Oversight offices across the country to determine the requirements for PIAs acceptable to all jurisdictions. The environmental scan was used to develop 10 Common Understandings related to PIAs. The development of Common Understandings involves considerable debate and discussion by Ministry and eHealth privacy specialists as well as input from the Oversight members from the Infoway sponsored Privacy Forum. The HIPG believe adopting the PIA Common Understandings will promote consistency across the country when completing these assessments.

      Finding/Results: The Environmental Scan and the PIA Common Understandings identified that these assessments are an important component in the risk management process of an entity and are much more than a simple compliance check. A PIA is an integral part of the business activity planning process. Conducted early enough, this document can help shape the business activities development and ensure that privacy is considered from concept to deployment. A thorough PIA is used by privacy regulators to understand the implications of a business activity on an individual’s privacy and is the first document requested by regulators when conducting investigations into privacy breaches.

      Conclusion/Implication/Recommendations: The core principles of the HIPG PIA Common Understandings can be applied to any project or activity across a jurisdiction with impacts on the privacy of an individual. This move towards consistency could promote trust and trans-jurisdictional disclosures of personal health information across Canada.

      140 Character Summary: The PIA Common Understandings outline 10 principles that promote efficiency, consistency and trust in the digital health environment.

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      PS04.02 - Organizational Privacy Transformation:  Award Winning Success & eVisit Case Study (ID 325)

      Sylvie Gaskin, OTN; Toronto/CA
      M Macmillan, OTN; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: OTN is one of the world’s largest telemedicine networks, serving over 300,000 patients using 1600 sites and 3,300 systems. We know that Telemedicine plays an important role in supporting health care transformation and innovation as it enables better integration and quality of care and a more sustainable health care system. We also know that Privacy must not only be a statement at the bottom of a webpage but rather a business differentiator; an integral strategic partner and component of OTN’s business and technology transformational agenda in order to meet the high privacy standards expected of OTN in today’s virtual health care revolution. The presentation will examine a cross-functional team approach, leveraging a case study, to adopting “Privacy by design principles;” building relationships, and the implementation of a holistic approach that seeks end-to-end opportunities to enhance privacy in Telemedicine. We will share how OTN has embedded privacy into the Organization at all levels, including its Project Management Officer (PMO) and the different perspectives on what that means for VP’s, Chief Privacy Officer, Privacy Specialists and Project Managers.

      Methodology/Approach: This presentation will describe the multi-layered/holistic & integrated business approach OTN’s Privacy Team has taken with its eVisit product line to ensure Privacy is an enabler to technology innovation and not a barrier: The approach will focus on the following: Streamlined project management lifecycle & gating process that include key privacy deliverables; privacy threshold assessment (PTA) privacy requirements and safeguards and Privacy Impact Assessments (PIA) Privacy review & PIA results that are translated into a work plan which is shared with/implemented by the project team Risk registry that track and monitor PIA risks and recommendations Introduction of product privacy scorecards for assessing and monitoring results and identifying improvement opportunities

      Finding/Results: The result is the assurance privacy is embedded into technology and telemedicine solutions at the onset of the project management lifecycle. This assurance inspires adoption by health care providers, organizations, and consumers.

      Conclusion/Implications/Recommendations: Privacy is not a barrier. Privacy builds trust and breeds Innovation. Privacy at OTN is more than compliance with legislation. Legislation is the floor and the starting point not the ceiling. OTN’s Privacy Program strives to create and sustain an environment that breeds continuous learning & innovation and champions strategies and tactics that align with and support key organizational initiatives and meet the expectations of consumers, funders, partners and the healthcare community.

      140 Character Summary: Telemedicine plays an important role in supporting health care innovation as it enables better integration & quality of care & a more sustainable health care system.

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      • Abstract
      • Slides

      Purpose/Objectives: Telemedicine is transforming the way healthcare is delivered, by breaking down barriers that limit access to care such as geography, maldistribution of expertise, and geography. Telemedicine, has evolved significantly over the past two decades, facilitated by improvements and access to technology, increased provider and patient comfort. Toronto is the largest provider of telemedicine in Ontario, delivering care to primary care sites, such as Family Health Teams, Community Health Centres, Nurse Practitioner-Led Clinics, as well as between tertiary care centres. Throughout Ontario, it has become evident that a collective approach to access and utilization of telemedicine would be beneficial. Toronto is well-positioned to lead innovations and support best practices in telemedicine. The Toronto Telemedicine Collaborative was created with representation from academic health science centres and community level healthcare with the goal of reducing isolated programs while addressing gaps in practice protocols, evaluation, and implementation. This presentation will describe how the Toronto Telemedicine Collaborative was established, the goals and how we are able to ignite the unique experience and perspectives of individuals in breaking down barriers while increasing evidence-based models of telemedicine.

      Methodology/Approach: In early 2014, informal discussions between colleagues at three large academic health centres, the University Health Network, St. Michael's Hospital and the Hospital for Sick Children, on existing barriers within their telemedicine programs illuminated the siloed nature of telemedicine To advance telemedicine in a coordinated way, a collective approach was necessary. An electronic survey was circulated in June 2014 to all the known Toronto telemedicine services. The result was significant interest in developing a collaborative with common goals and terms of reference,. Regular quarterly meetings were established and individuals were given the encouraged to contribute to the agenda of each meeting. Common concerns and opportunities were established, and eventually, government funders were invited to join ongoing meetings

      Finding/Results: The participation is high with over 50 individuals from 20+ organizations. One priority is the forming of a collective voice for government and policy makers, to inform decisions and drive system change. This grassroots approach to system reform shows great promise in becoming a source of consultation by stakeholders to discuss ideas, assess feasibility, and encourage system change. We have become an advocate against decisions negatively impacting the sector, and have become a consortium with significant expertise to inform best practices and evaluation models.

      Conclusion/Implication/Recommendations: Since the TTC collaborative commenced in 2014, there has been increased clarity in telemedicine practices and procedures within our region, a collective approach to addressing barriers and system challenges, an elevated interest in supporting decision/policy makers to understand system factors, and an improved ability to advocate and express concerns and opportunities to stakeholders. We sit as content experts within our sector with funders and policy makers. Future opportunities include development of validated tools, the contribution to collective research opportunities, advocacy to reduce barriers, development of best practices and protocols and a user level voice to ongoing development and expansion of telemedicine. In short, our voices in addressing systemic issues and burgeoning opportunities are stronger together than they are alone.

      140 Character Summary: The Toronto Telemedicine Collaborative has created a unique and powerful voice for Telmedicine best practices, research opportunities and collaboration

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