Purpose/Objectives: A literature review on causes of physician concerns about adoption of EHRs showed that privacy and safety are very high on the list of barrier issues. In fact, privacy and safety were second only to cost and equal with level of functionality across a review of 25 studies. It is increasingly understood that the software vendor community plays a key role in addressing and improving privacy and safety as application software is a major potential cause of vulnerabilities. We wanted to develop an innovative process for management of application vulnerabilities, safety and privacy risks from the use of our software that aligned with the COACH e-Safety Guidelines. Over the course of the last several years, we have built such a process and applied it initially to detection of safety risks. More recently we have also adapted it to the management of privacy risks. In 2015 we self-assessed our processes as being at level 3, the structured program level. We had a structured approach to identifying safety and privacy vulnerabilities that derive from the use of HIT / EHRs and had many years’ experience dealing with individual issues.

Methodology/Approach: Over the last five years, we developed and enhanced a rigorous process for detecting, confirming and addressing possible safety related software defects. In the last three years we have adapted the process to address privacy vulnerabilities as well. During that time, new key privacy requirements have emerged rapidly. Prominent amongst them includes D4P (data segmentation for privacy,) increasing consumer requests for control of their health record information, fine grained consent policies, and progressively moving personal health information to the cloud. These new emerging requirements served as rich grounds for improving our privacy capabilities even while increasing complexity has brought potential for software defects to have unexpected impacts. Once identified, software defects were tracked to root cause and remediated. To move from level 3 “structured” to level 4 “managed and measured” we developed a classification model in a “from the ground up” approach.

Finding/Results: A process was developed and deployed that successfully detected and addressed safety and privacy issues in advance of live use by clinicians and patients. We presented part of the process to eHealth Canada 2016 conference. In 2017, we would like to show how we adopted a similar process for addressing privacy issues, and the steps we took to move up the COACH pyramid. Additionally, we have learned a great deal about balancing privacy and safety issues that we will illustrate with detailed examples. Getting the balance right can require sensitive handling of both priorities and in-depth discussion with clinical governance teams and patients.

Conclusion/Implication/Recommendations: Understanding the nature and categories of potential safety and privacy issues that arise from integrated environments can improve the quality of the solution and make such solutions more deserving of trust by clinicians. By initiating a discussion on safety and privacy implications of EHR solutions, high quality, robust approaches can be developed across Canada to deal with common areas of concern.

140 Character Summary: This presentation addresses the privacy and safety issues that limit physician adoption, as well as differing approaches to implementation.

Purpose/Objectives: Digital health solutions can positively disrupt and transform healthcare but innovators still face many challenges. Among the most common issues we find the lack of access to personal health information stored in EHRs. There are several legacy reasons why this is still the case, but the time has come to change this situation. Patients must have the right to electronically access their data and use it as they wish. This presentation will describe recent research on digital health and provide ideas on how to improve on the level of data liquidity and its impact to the innovation ecosystem. It addresses the main issues required for the implementation of broad data access across large healthcare domains, including: - policies and incentives - privacy and security - technology and innovation - data and interoperability standards - adoption and change management The presentation concludes with suggested approaches and roadmap for a successful liberation of health data.

Methodology/Approach: This work involved: 1) national and international scan of digital health initiatives and experiences 2) oral interviews and written surveys with over 50 professionals and health leaders in Canada and internationally 3) creation of a digital health framework centred on consumer solutions 4) development of 5 level maturity scale for data fluidity of digital solutions 5) implementation roadmap and recommendations for an open API for enabling broad access to health data 6) identification of key adoption enablers, including policies, standards and health information platforms

Finding/Results: There are clear and present challenges to accessing health data. Although there are significant amounts of digital data today, in hospital and clinic systems, in regional and provincial repositories, these are almost always locked in and under tight control by the organizations and their IT departments. These constraints are frequently identified as one of the key barriers to innovation. There are many reasons for this situation, the most common explanations being: - privacy laws and policies - technical limitations of existing systems - concerns about security breaches - lack of trusted digital ID sources for patients and consumers - lack of appropriate standards and adoption At the same time, a new generation of digital health solutions are challenging the status quo and continuously pushing the envelope of what is possible. New approaches and compromises are required to meet the increasing consumer demand for their health data.

Conclusion/Implication/Recommendations: Several factors have conspired positively to change the current state and allow new ideas that increase data liquidity without compromising privacy or security of this information: - health consumer ready and willing to make use of this information - active ecosystem capable of developing new solutions and services with access to PHI - new lightweight health standards suited for web/mobile applications - advanced tools to protect large data - need to improve quality/cost effectiveness of healthcare services The recommendations cover a series of complementary actions, addressing both short and mid term: - policies on patient's rights to their data - increasing maturity levels of data fluidity - open APIs - health innovation platforms as accelerators

140 Character Summary: Liberating health data is a fundamental requisite to promote innovative digital health solutions

Purpose/Objectives: The Canadian diabetes clinical practice guideline specifically recommends that diabetes patients should be assisted to self-manage their disease. Our objective is to implement a decision support environment to (a) empower Family Physicians (FP) to administer Behaviour Modification (BM) by helping them design personalized behaviour modification strategy for their patients; and (b) motivate patients to adhere to their BM strategy by monitoring and messaging so that they achieve efficacy to self-manage their condition at home. We present “Diabetes Web-Centric Information and Support Environment” (D-WISE) that features the following functionalities: (i) Assessment of FP readiness to administer BM interventions to patients; (ii) BM educational support to FP; (iii) Personalized self-management programs to help patients modify their behaviors; (iv) Monitoring the patient’s progress as per their BM program and motivating them to comply with it

Methodology/Approach: D-WISE is grounded in Behavior Modification Models (the knowledge content) and Healthcare Knowledge Management (the knowledge translation method). We have computerized constructs of Social Cognitive Theory (SCT) and the BM protocols used by the Halifax Behaviour Change Institute (BCI) in terms of readiness assessment tools, BM strategies and corresponding educational material. D-WISE supports the patient to achieve BM for diabetes self-management by facilitating goal setting, behavior shaping, stimulus control and reinforcement management based on the SCT constructs. D-WISE assesses the readiness of patients and then accordingly guides them to specify their barriers and goals, thus ensuring that adherence to the BM strategy is feasible. Our BM approach is to: (i) assess FP’s readiness to administer behavior modification counselling to patients; (ii) guide FP to assess patient’s readiness and self-efficacy and then design a personalized behavior modification plan in a shared-decision making setting whereby patients set short-term behaviour goals and design a feasible action plan; (iii) motivate patients to achieve their goals through motivational messaging sent on their mobile phones. We employ a knowledge management approach that uses a BM ontology to model: Patient’s Medical Profile; FP Readiness Assessment to administer BM; Decisional Balance Assessment to measures positive and negative perceptions of FP and patients towards BM; Self-efficacy Assessment of the FP and the patient in providing/adhering to BM interventions; and Diabetes management knowledge as per Canadian clinical guidelines.

Finding/Results: D-WISE is implemented as an interactive web-based system for physicians, whereas for patients their behaviour modification program is delivered through smart phones. D-WISE has been evaluated using a cognitive and usability engineering framework; both FP and patients evaluated using three case scenarios. Our results confirm the correctness of the BM content and user satisfaction.

Conclusion/Implication/Recommendations: We present an innovative digital health based point-of-care BM application that operationalizes evidence-based BM models to generate personalized BM strategies for diabetes patients to help them self-manage their condition. D-WISE presents a unique shared decision making environment for both providers and patients to administer personalized BM interventions. Our BM approach is scalable in nature, such that can be readily applied other chronic diseases. As next step, we are working to deploy D-WISE in clinical settings and diabetes care centers in Halifax

140 Character Summary: Digital health application targetting personalized behaviour modification for diabetes self-management

Purpose/Objectives: Adoptions of healthy behaviors are crucial for maintaining good health after type 2 diabetes mellitus diagnoses. However, adherence to behaviors that promote optimal diabetes management like regular exercise and balanced diet can be challenging. Developing innovative interventions and tools that facilitate chronic disease self-management is important for improving quality of life and the sustainability of health care systems, but must be thoroughly evaluated prior wide scale adoption. The purpose of the presentation is to describe the methodology and results from an innovative health coaching intervention using a cloud-based client management platform to support adoption of healthy behaviours in an underserved population with poorly controlled type 2 diabetes.

Methodology/Approach: Pilot and pragmatic randomized controlled trials were conducted at the Black Creek Community Health Centre in Toronto, Canada between 2010 and 2014. During this time, researchers partnered with NexJ Health Inc. to develop an online platform called NexJ Connected Wellness (NCW) to enable remote monitoring of relevant health indicators (ie: blood glucose, meals, exercise) to support of health behaviour change. During the trials, participants received 6 months of health coaching with access (intervention group) and without access (control group) to NCW. Upon completion of the RCT, patient experience was explored using semi-structured interviews (n=11), and usage patterns of the online platform from n=29 participants were analyzed using association rule algorithm data mining techniques. Primary Outcome: Glycated Hemeglobin (HbA1c) Secondary Outcomes: Weight, BMI, Waist Circumference, satisfaction with life, depression and anxiety, positive and negative affect, and quality of life.

Finding/Results: Pilot: In the pilot, a total of n=19 participants completed the 6-month trial; n=12 had baseline HbA1c levels >7.0% and these participants demonstrated a mean reduction of 0.43% (P<.05). RCT: In the RCT, n=131 participants were allocated to the intervention (n=67) and control (n=64) groups. Primary outcome data were available for 97 participants (74.0%). There were significant differences in improvements of HbA1c between groups at 3 months (P=.03), but this difference reduced at 6 months as the control group continued to improve, achieving a reduction of 0.81% (P=.001) compared with a reduction of 0.84% (P=.001) in the intervention group. Intervention group participants had significant decreases in weight (P=.006) and waist circumference (P=.01), with both groups reporting improvements in mood, satisfaction with life, and quality of life. Interview: Qualitative data analyses revealed four major themes that describe participant experience: (a) smartphone use in relation to health behaviour change; (b) how client/ health coach relationships were assisted by smartphone use; (c) perceptions of the overall intervention; and (d) ‘frustrations in managing the complexities of T2DM management. Data Mining: Analyses indicated that nearly a third (9/29, 31%) of participants used a single tracker, half (14/29, 48%) used two primary trackers, and the remainder (6/29, 21%) used three primary trackers.

Conclusion/Implication/Recommendations: Health coaching using an online behaviour change portal helped improve clinical outcomes of a poorly managed T2DM population. The intervention was well received, and data mining usage patterns of the technology revealed connections to health outcomes.

140 Character Summary: Health coaching using a secure cloud-based behaviour change portal helped improve clinical outcomes of a poorly managed T2DM population.

Purpose/Objectives: There is increasing interest by researchers, clinicians, and policy makers in improving care of chronic disease by engaging patients in eHealth activities. There are few data on patient access, confidence, concerns and interest as they relate to eHealth, in particular among those with multimorbidity. We examined the prevalence of internet and wireless internet access, device use and attitudes towards eHealth among patients attending a primary health care appointment. This study aimed to gather these data, with a focus on those with multimorbidity, using *>* 5 medications as a proxy measure.

Methodology/Approach: Using a cross-sectional study design, consecutive patients attending all physicians in the McMaster University Sentinel and Information Collaboration primary care research network were surveyed. Data was collected as Likert scales, pre-coded categories and free test responses. Means and proportions and statistical comparisons used OpenEpi and SPSS. Text responses were analysed using thematic analysis.

Finding/Results: There were 693 respondents and a response rate of 70%. The majority of respondents reported access to the internet at home (87%), although this dropped significantly with age (p<.001) 82% of the overall sample felt comfortable using the internet, however those *>70 feel significantly less comfortable (p<.0001). A number of factors were associated with disinterest in eHealth and this relationship remained significant for patients on >*5 medications when these factors were included in a logistic regression model. Privacy and loss of relational connection were key themes in the qualitative analyzes.

Conclusion/Implication/Recommendations: We found significant negative associations between increasing age and multimorbidity and; internet access, comfort with using the internet and interest in eHealth. The results of this study provide important information to consider when developing strategies with eHealth components to ensure equity and effectiveness in improving health outcomes in the group with greatest need.

140 Character Summary: Significant negative associations between multimorbidity and interest in eHealth with important implications for health equity.

Purpose/Objectives: To design and implement an online, interactive PHR system by considering security and privacy of people as the data owners, as well as the right and ability to revoke access of any of their authorized health professionals. A proactive alert feature is also considered based on the person’s health needs and conditions, as well as the health alerts that become active by various agents from the person’s circle of care.

Methodology/Approach: The PHR framework includes six agents; Authorization Server: handling registrations and authorizations; Decentralized Trusted Authority: securely generating and transmitting secret keys upon valid requests; Revocation Server: issueing decryption tokens and maintaining Revocation List; Storage Provider: providing storage service; Patient: health data owner; Health Professional: accessing to patient data with proper authorization in a hierarchical structure. PHR System Model: <img alt="phr-model.png" annotation="" id="image://9" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=3a5b8a3251b089445875c35adfc9edda7da6f8ce&id=9&width=350&height=350&download=0" title="phr-model.png" /> Sample Screenshots: <img alt="app_reg.png" annotation="" id="image://10" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=dec46f82bbe5027fda1570bf92a05996c6d356d2&id=10&width=350&height=350&download=0" title="app_reg.png" />

Finding/Results: The proposed PHR system is in the development phase. Currently, the prototype and simulation of the mobile application with the fundamental features and necessary agents, such as trusted security, cloud storage and revocation server have been designed and developed. The next steps would be developing the interactive features and initial testing of the system, and extending the system to desktop version, using the same backend of the system. Then a complete integration and system testing of the whole software will be performed before deployment of the system.

Conclusion/Implication/Recommendations: We are developing an online, secure and revocable PHR system, by which people securely store their health data and sharing with their caregivers. It provides people the capability to delegate their role to other persons in case of inability to perform required actions. The system has a proactive alert feature to give people and their caregivers the ability to set thresholds based on health statuses. This addition arms the system with autonomous interactive feature for automatic communication by sending and receiving instant messages.

140 Character Summary: An online, secure, interactive, and revocable Personal Health Record (PHR) system has been designed and implemented to be used by patients and their circle of cares.

Purpose/Objectives: The Image Capture system serves as a case study of how leveraging DICOM and HL7 as interoperability standards can provide an extremely low cost strategy to communicate and archive visible light medical images through a centralized PACS (Picture Archiving and Communication System). Leveraging this approach could allow for regional/provincial management of endoscopic, surgical, retinal, dermatologic, and other medical images for clinical care and quality management purposes.

Methodology/Approach: Our system was originally developed in 1995 to run on commodity hardware and capture medical images generically from medical video processors. It has been in production at a large multi-site health sciences center since then with very little cost, training and support requirements. The capture system consists of a Microsoft Windows software program written to interface with a USB NTSC video capture device and a HD-SDI capture card. Still bitmap images are captured and converted to DICOM and then routes to PACS. Digital mpeg video is archived and available through a web review application. Other features include a custom developed hardware interface to the endoscopy image processors for endoscope hand switch capture control, as well as an HL7 patient work list interface to the hospital ADT information system. Upgrades have included privacy and data security controls and secure wireless network transmission for emergency cases performed on mobile procedure carts in areas such as the ICUs and emergency departments. The system is currently being adapted for newer generation HD image processors.

Finding/Results: This system’s simplistic yet functional features have served the needs for electronic documentation of patient procedures for the past two decades with average usage statistics of 800 cases per month and 10 images per case. The usage areas include Endoscopy, Cystoscopy, Neurosurgery, Orthopedic surgery. In leveraging the existing PACS system, operating costs are negligible and clinicians access the images through their preferred review application along with traditional medical images without the need for additional applications and training.

Conclusion/Implication/Recommendations: Medical data interoperability requires different information systems to communicate and exchange meaningful data across all medical facilities. DICOM and HL7 are two medical data standards that contribute to the eventual “plug and play” interoperable model. Ongoing work to achieve interoperability is being done by IHE (Integrating the Healthcare Enterprise), a worldwide organization that supports interoperable healthcare to improve quality, ensure patient safety and reduce cost through the adoption of standards for healthcare by publishing guides for how to use those standards. Our case study serves as an excellent example of an affordable scalable approach to medical interoperability. Within Canada, this approach to interoperability could affordably support provincial initiatives for cancer screening and endoscopy quality improvement programs.

140 Character Summary: Health Information data interoperability: a case study leveraging DICOM and HL7 standards to improve management of medical images and clinical care quality.

Purpose/Objectives: In 2009 Manitoba was involved in the pan-Canadian EMR Adoption Program in partnership with Canada Health Infoway. After a competitive RFQ process, 4 Manitoba-Approved Vendors were selected. Over the next several years, and for a variety of reasons including acquisitions, the list decreased to one Approved Vendor. Though the concept of one provincial vendor can be appealing, the Manitoba primary care physician community raised a call-out for more choice in the EMR marketplace. Join our session to learn about the steps taken in Manitoba to respond to the physician community through the development and implementation of a new EMR Certification process. The objective of this session is to share Manitoba’s new EMR Certification process, including how the framework was developed, how requirements were gathered, inclusion of physicians as key stakeholders during the consultation process, the implementation strategy, and the end results.

Methodology/Approach: Through key stakeholder consultation and a pan-Canadian jurisdictional scan and analysis, Manitoba developed a new framework and approach to evaluate EMR products against provincial standards. Provincial standards were developed to support the core administrative, clinical and privacy needs of primary care clinics in Manitoba while aligning with provincial primary care strategy. A non-competitive open certification approach was selected as part of the new framework, providing flexibility for vendors to enter the marketplace at a level appropriate for their business goals while meeting the needs of Manitoba primary care clinics. In this session we will share Manitoba’s new EMR Certification process including how the framework was developed, how requirements were gathered, and how primary care clinics and physicians were part of the consultation process as key stakeholders. Learn about the final results of the Certification journey and the next steps for primary care clinics and EMRs in Manitoba.

Finding/Results: The Certification process is underway at this time. Final results are expected by the end of 2016 and will be shared at this session including details on adoption, implementation and ensuring provincial EMR standards have been met.

Conclusion/Implication/Recommendations: Lessons learned from the development of the new Certification process will be shared. This will include the benefits and challenges of including physicians and primary care clinics in the consultation process, as well as feedback from EMR vendors on our Certification approach and comments on the scope of Manitoba provincial EMR requirements.

140 Character Summary: Learn how Manitoba responded to call-outs for more choice in the EMR marketplace through the development and implementation of a new EMR Certification process.

Purpose/Objectives: The poster will explain how data standards can improve patient care and health system planning if implemented/adopted at the outset of an eHealth system implementation project. CIHI will provide an overview of the activities it has undertaken since launching the data standard and some upcoming opportunities will be addressed with the support of various partners, including vendors and data submitters, across Canada’s health care system.

Methodology/Approach: As part of CIHI’s efforts to operationalize the principle of collecting data once and using it for multiple purposes, an Acute and Ambulatory Care Data Content Standard has been launched. The intention of this document is move Canada towards standardizing data collection at the point-of-care, so data can flow seamlessly throughout the system including to CIHI for secondary use purposes.

Finding/Results: To realize health system use benefits from eHealth solutions, it is essential to incorporate CIHI’s data standards at the planning and implementation stage for essential downstream health system use. These data standards also support key aspects of interoperable patient care. After launching the data standard, CIHI has completed a number of activities to promote its adoption amongst the vendor community, hospitals and ministries of health. An overview of these activities, including key learnings, will be presented.

Conclusion/Implications/Recommendations: Health delivery organizations and their funders need timely, quality and affordable data. eHealth systems are integral to patient care and effective planning and health system management. In order to build a truly interoperable system across the continuum of care, including health system use, data standards need to be considered at the outset. Adoption of data standards in eHealth systems is essential for access to better data for both patient management and planning purposes.

140 Character Summary: Data standards can improve patient care and health system planning if implemented/adopted at the outset of an eHealth system implementation project.

Purpose/Objectives: A business need exists in the Canadian health care sector to address the current gap of trained and experienced human resources in the use of clinical terminologies, including SNOMED CT and LOINC, to support the implementation and maintenance of e-health solutions. CHIMA and assistance from Infoway will identify how this gap will be addressed by a Canadian Terminology Standards Certification process.

Methodology/Approach: Human resource sector studies, survey data, and a Canadian advisory group were used to confirm the business need. A business case to create the Terminology Standards Certification was developed. A multi-stakeholder committee led by CHIMA and Infoway representatives identified key components required.

Finding/Results: Human resource sector studies, survey data, and a Canadian advisory group validated that a business need exists in the Canadian health care sector to address the current gap of trained and experienced human resources in the use of clinical terminologies, including SNOMED CT and LOINC, to support the implementation and maintenance of e-health solutions. The use of clinical terminology across the country has been growing as part of the increased investments in health information technologies. In the context of this increased use of e-health solutions using clinical terminology, new and evolving human resource role requirements to support eHealth are emerging. Key stakeholders identified the development of a clinical terminology professional certification in Canada as a priority to help address this resource gap. A business case to create a Terminology Standards Certification was approved by senior representatives from Canada Health Infoway and the CHIMA Board of Directors. Regenstrief Institute and the International Health Terminology Standards Development Organization confirmed support in working towards launching a clinical terminology professional certification in Canada. Support and commitment from the Canadian academic community was also received. A multi-stakeholder committee led by CHIMA and Infoway representatives completed the following work: Development of three (3) Terminology standards (TS) role descriptions (e.g., the development of key TS roles that are required in the current eHealth workplace) Development of a Canadian TS competency framework Creation of learning content items to support curriculum development

Conclusion/Implication/Recommendations: Stakeholder input to the certification process has not yet been completed. Based on significant international interest, this work has been brought to ISO TC 215 to ultimately make this become an international product. Further input and feedback and a process to keep the material relevant is required and currently underway.

140 Character Summary: The role descriptions and Canadian competency framework will be introduced and a discussion on the learning content items will take place in this session.

Purpose/Objectives: Wound care management is a challenge for Canada’s healthcare and community home care systems. Wounds are common manifestations of several chronic conditions and can cause pain, infections, hospitalizations, and decreased quality of life. With chronic condition rates increasing by 14% annually, the burden of wound care management is expected to proliferate. It is estimated that half of the care delivered by community care involves the management of wounds. Wounds cost the system ~$4 billion annually, accounting for ~3% of total healthcare expenditures. The application of eHealth from clinical settings into community care through the unification of neoteric principles of eHealth, the dogma of community self-management care, and deep-rooted best practice guidelines can curb the growing burden of wound care management from the individual level to the systemic. Through the Registered Nurses’ Association of Ontario (RNAO) and Canada Health Infoway, Bayshore Home Health (Bayshore), embarked on the RNAO Nurse Peer Leader Network (RNAO-PLN) project to promote the adoption of advanced clinical e-functions to support clinician and client (patient) engagement in evidence-based wound care management. Being an innovative leader, Bayshore, with QoC Health, developed: (1) the Bayshore Client Self-Management App to empower clients to build self-efficacy/confidence to manage their diabetes and wound care, improve their quality of life, and be able to effectively communicate with their healthcare team; and (2) a Clinician Decisional Support Portal for health coaches to engage and support clients.

Methodology/Approach: The project utilized co-design (“think-aloud”) methodology and engaged in usability testing to gain insights to improve the usability, navigation, and intuitiveness of the solutions. QoC Health’s experienced co-design facilitators, conducted the sessions, engaging with expert clinicians, Clinical Practice Leaders, strategic senior leaders and Bayshore clients. Recognizing the importance of aligning eHealth technologies to organizational practices, Bayshore extensively engaged with its Clinical Practice Leaders to develop a new service delivery model that optimally and meaningfully embeds the technology into practice and in the lives of clients.

Finding/Results: The eHealth tools will be deployed in an 8-month pilot, October 2016, with clients of the Bayshore Barrie branch. The objectives of the pilot are to improve: (1) clinician and client engagement in self-management; (2) client health outcomes; (3) clinician ability to provide proactive care; (4) client ability to identify when to seek care; and (5) health system efficiencies related to wound care management.

Conclusion/Implication/Recommendations: We anticipate the RNAO-PLN project will result in improvements to wound care management in a community care setting at both the client and systemic levels; with learnings that are easily transferable to other areas of healthcare and patient populations.

140 Character Summary: Bayshore and QoC Health created a Self-Management App and Clinician Portal to engage/support clients to manage diabetes/wound care and link with the care team.

Purpose/Objectives: At Hospital X, we believe it is essential to both the health of individuals and their communities to fully engage patients in their mental health care. To continue to drive patient engagement forward, we have employed three strategies, including the launch of an EMR-integrated patient portal; implementation of a mobile (mHealth) experience for patients to manage their care (with actionable interventions through a secure mobile cloud technology platform); and the piloting of a virtual clinic, which will utilize e-therapy.

Methodology/Approach: HealthCheck Patient Portal was launched in December 2014, and was aimed at enhancing patient access to their personal health information. The implementation of the portal also supports the paradigm shift towards patient-driven care, evolving current practices and culture from the provider as the “keeper of the information” to one where the provider and the patients are partners in care. Also, we are partnering with a technology based company that offers a mobile health solution that integrates with the EMR. It will enable mobile remote-patient-monitoring and empower patients to be actively engaged It will also support predictive analytics capabilities, enabling clinicians to more proactively monitor patients and respond to changes in behaviours and assist with identifying patterns and triggers that could prompt early clinical interventions. Hospital X is also implementing a virtual clinic as an adjunct to the current ambulatory Traumatic Stress Clinic following a stepped-care approach. The virtual clinic is aimed at bridging the long wait times for this clinic with the goal of maximizing patient access to care, utilizing evidence-informed virtual treatments, while more efficiently utilizing clinical resources. The virtual clinic has the potential to target improved population health, to optimize the patient experience and increase value for money.

Finding/Results: • Increased patient activation • 10% decrease in missed appointments for portal users • 86% reduction in portal users’ release of information requests, and an administrative time savings of between 10.5 and 40 hours per portal user. Mobile technology solution and virtual clinic implementation are currently underway, however expected outcomes include: • Improved treatment and clinician workflow efficiencies • Decreased missed appointments • Improved care plans • Improved patient flow and access to services(currently 247) • Reduced average wait time (currently 391 days) Preliminary findings presented at the conference in June 2017.

Conclusion/Implication/Recommendations: Recommendations are centered on the development of a solid change management plan focused on the following key areas: • Alignment to IS/T strategic plan and corporate goals • Extensive engagement of patients and clinicians throughout all phases of the project to ensure needs are well understood and being addressed • Effective communications are key to supporting patients and clinicians • Engage clinicians and patients to determine current state processes and establish future state processes that will benefit and support these stakeholders • Create training materials with input from patients and clinicians • Generate reports that will extract evaluation metrics to allow for auditing and measure impacts and benefits

140 Character Summary: Hospital X has employed to advance patient engagement, including a patient portal; an app integrated with the hospital's EMR; and a virtual clinic.

Purpose/Objectives: BACKGROUND – The use of electronic health records (EHR) is becoming an industry standard across the hospital sector. A central major hub for patient data, EHRs provide healthcare organizations an opportunity to enhance the delivery, accessibility and relationship of patient care. In Canada, however, patient portal access remains in its infancy as hospitals strive to complete legacy EHR system upgrades. There is little context on the direct impact of patient portal deployments on patient care and potential operational efficiencies; particularly amongst ambulatory hospitals. OBJECTIVE - This presentation aims to contribute to an understanding of how direct patient access to their medical records and an expansion of services affects the patients’ delivery of care, experience, provider workload, and relationship. The patient portal under review is myHealthRecord at Women’s College Hospital (WCH).

Methodology/Approach: METHODS – Made public on August 9, 2016, a mixed methodology will be used that includes telephone interviews, quantitative and qualitative electronic surveys, provider interviews and the extraction of modular use from system data accrued over time

Finding/Results: RESULTS – To date, myHealthRecord has shown a steady rate of patient interest; 68% of patients take home an activation letter and 30% of interested patients register within five days. Despite concerns of the older ambulatory patient base, 55% of active myHealthRecord users are ?50 years old. Patients have reported higher rates of service satisfaction at WCH due to the return of lab results in a timely manner as well as their ability to contact their care team regarding post-visit questions. Inspired true events have demonstrated an enhanced quality of care leading to the timely improvement of external patient diagnoses as a result of mobile access to medical records. Overall access to medical records did not increase phone volumes nor did it lead to abusive use of medical advice requests to the care team. On the contrary, 148 request have been sent since August 9th accounting for 2386 patients; averaging 0.06 a message per patient. Providers have mentioned no impact of their workload or administrative practices. In light of the patient portal, providers and administrators have shown a positive reception to automated pre/post appointment instructions and after visit summaries.

Conclusion/Implication/Recommendations: CONCLUSIONS – Patient Portals are an effective and powerful tool to enhance the delivery of care and improve patient outcomes. Often being defined as a tool for the patient, patient portals offer outcomes that not only enhance the patient care experience, but also how hospitals can drive the delivery of patient care through improved services, workflows and processes. Patient enrollment only goes as far as the portal’s ability to satisfy gaps and needs in everyday patient care delivery model; lending ongoing value to the patient, providers and organization. Strategies to expand portal services through eCheck-In, eVisits/eConsults, eReferral and ePrescribing will deliver the tools necessary to create a self-sustaining patient portal; consequently improving patient access, enrollment and most importantly, patient care for years to come.

140 Character Summary: Andrew is a Clinical Project Coordinator for Women’s College Hospital; currently leading the roll-out of their patient portal and eReferral solution.

Purpose/Objectives: Increasingly, healthcare providers understand that patients with chronic conditions derive great benefits from being actively engaged in their care. And, patients feel empowered when they have the knowledge, skills and confidence to self-manage the physical and emotional aspects of their chronic conditions. Engaging patients and assisting them to actively participate in their care is known as self-management support. While it is recognized that healthcare providers should promote patient engagement to facilitate self-management support, this has not been integrated into clinicians’ routine practice in Canada. This presentation will share the strategies taken across two varied healthcare settings, (i.e. community care and ambulatory care) to optimize patient engagement and self-management support for individuals with diabetes-related foot ulcers with the common objective of promoting earlier wound healing. It will also discuss the results of a comparative analysis of the findings from each setting and the lessons learned.

Methodology/Approach: Both healthcare organizations integrated evidence-based wound care order sets related to the assessment and management of people with diabetes-related foot ulcers within their health information system. In addition, they each implemented strategies to engage patients diagnosed with diabetes-related foot ulcers and provide supports to facilitate their self-management of their condition. Patients in the ambulatory care setting used a web-based tool to assess their knowledge of diabetes and foot care and to identify self-management goals in collaboration with their healthcare provider. They used an electronic goal calendar to track their progress over time. In contrast, patients in the community care setting used a wound care App to identify self-management goals in collaboration with their health coach and to track their progress. Patients were able to communicate with their health coaches through the App, as needed.

Finding/Results: There was successful adoption of the evidence-based order sets in both care settings by more than 300 clinicians. The order sets facilitated knowledge translation and evidence-based decision-making at the point-of-care resulting in reduced variation in wound care management at each site. Preliminary results from the participating organization suggest that there was a significant difference in the patient experience of the self-management support in both settings resulting from the differences in the technology and the accessibility of the health coaches. Overall, the order sets improved efficiency in wound care management and the patient engagement increased self-management support for patients with diabetes and foot ulcers.

Conclusion/Implication/Recommendations: This initiative highlights the significance of implementing evidence-based wound care order sets and the benefits of patient engagement strategies that facilitate self-management of chronic conditions across multiple healthcare sectors. The evidence-based order sets optimized wound care management while patient engagement was facilitated through technology that empowered them to self-manage their conditions.

140 Character Summary: This presentation compares technology-enabled patient engagement strategies aimed at increasing self-management in individuals with diabetes and foot ulcers.

Purpose/Objectives: Remote patient monitoring (RPM) is a healthcare intervention that aims to improve the management of chronic diseases where information and timely access can improve healthcare as well as reduce system costs by eliminating unnecessary 911 calls and emergency room visits. One of the greatest challenges of a remote patient monitoring (RPM) program is to identify patients who are the best candidates for the technology, patients that will respond well and enable the most benefit. Research focused on value-based approaches to care, such as the Center for Connected Health Policy and the University of Mississippi Medical Center in the United States, have recognized patient identification as an important part of RPM and are leveraging predictive analytics to identify optimal candidates but do not have an answer yet[1]. The Community Paramedic Remote Patient Monitoring program (CPRPM) has used the aggregate data of patients to explore the impact of specific patient characteristics (e.g., age, gender) as well as aspects of RPM training and education that drive better outcomes for patients as well as savings to the health care system. [1] http://m.healthcareitnews.com/news/ummc-pinpoints-ideal-patients-remote-monitoring-predictive-analytics-artificial-intelligence?mkt_tok=eyJpIjoiWW1ZMU16bGxabUptWVRkaiIsInQiOiJKcnk2YmlcL3hHbTVtTWdGQ1BWMjIyM1E0YmIwKzUxZVhMXC9vZTRVbk0wbjR6VFcxelZsSXc4VWIzaGx0RkJFUUhJV0hDRnV6Z3hHR2t5YlNxdW1jWHcyajRidnl0b3hqS3B3dnR4aDVGU0Y4PSJ9

Methodology/Approach: Data for the study was gathered from three administrative datasets. First, Interdev is a private firm that provided information about the number of 911 calls made by patients on the program, and the number of patient transports to the ER. Patient enrollment forms were used to gather demographic data, namely age, gender, and community. Finally, daily readings from patients’ remote monitoring devices were used to measure number of alerts and compliance rates. Although the study is ongoing, Wave 1 analysis of 79 patients and over 600,000 patient device readings and alerts is complete. Transcripts from interviews with 15 paramedics across seven communities was also used to understand the impact of RPM training and education.

Finding/Results: Our research team specializes in the study of 911:Tranport conversion rates. Our conceptual approach is developed from the perspective that RPM should inform and educate patients to call 911 only when appropriate – that is, when they actually need to be transported to the hospital. Our preliminary results show that overall the RPM program increased the conversion rate; however, perhaps more interesting is that patients that were 100% compliant in using the technology had significantly higher conversion rates than patients that were less compliant. As illustrated in the graphs below, compliance rates in using the devices (specifically scale and blood pressure cuff) significantly vary across communities. Our team is currently exploring results further by examining the impact of patient characteristics (e.g., age, gender etc.) as well as provider support and training on conversion rate improvements.

Conclusion/Implication/Recommendations: Our research provides evidence that the ability to select the best candidates for a RPM program will significantly improves both patient and system outcomes. Although RPM has its benefits, it is possible that this approach to care is not for everyone. Knowing what patients are most likely to generate the most value will make RPM programs more efficient.

140 Character Summary: Developing accurate selection tools that identify optimal patients charateristics is critical for a successful and sustainable remote monitoring program.

Purpose/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission and re-admission (1) and is predicted to become the 3rd leading cause of death worldwide by 2030 (2). Home health monitoring (HHM) in Island Health has been shown to improve client self-management and decrease hospital visits and costs for the heart failure population. Island Health is expanding HHM services to the COPD patient population and set out to develop the COPD monitoring protocol to define the questions, biometrics, and educational messages that will be presented to patients in their home, through the HHM technology. Patient engagement into the design of the COPD protocol was identified as a critically important factor. Objectives for patient engagement were to: · help ensure that patient ideas and perspectives were considered and reflected in the COPD protocol · enhance the usability of the COPD protocol, and · promote a positive client experience with the HHM solution and HHM service. 1. CIHI All-Cause Readmission to Acute Care and Return to the Emergency Department, 2012 2. The Lung Association of British Columbia, Nov 2013. https://bc.lung.ca/news/media-releases/treatable-manageable-radically-under-diagnosed-%E2%80%93-what%E2%80%99s-problem

Methodology/Approach: The COPD monitoring protocol was developed as follows: 1. Project team developed a first draft HHM COPD protocol based on national and BC clinical practice guidelines. 2. Respiratory therapists and community chronic disease nurses worked with the HHM Coordinator and project team to refine the COPD protocol. 3. The Patient Voices Network and the Lung Association’s Better Breather’s Club helped to identify 5 patient partners to participate in usability testing. 4. Patient partners participated in an orientation telephone call to prepare them for the usability test sessions. 5. Usability tests were conducted and recorded using visual mock-ups of the draft protocol and patients were guided to ‘think out loud’ as they were stepping through the COPD protocol. 6. Patient partners also participated in a two-week usability trial for the pedometer device that was being considered for use in the COPD protocol. 7. Respirologists were engaged to review and provide final approval for the HHM COPD protocol.

Finding/Results: Patient feedback, and comments were summarized and consolidated, and reviewed with the project team. Suggestions and edits to improve the wording of questions and education messages were incorporated into the final version of the COPD Protocol. Patient partners consistently reported that the protocol questions and educational messages were meaningful and important for self-management of their COPD condition.

Conclusion/Implication/Recommendations: Collaboration with these partners has been highly valued by the project team. Patient partner contributions are anticipated to promote positive COPD client experience and outcomes. Patient partners have expressed excitement about the new COPD service and their intention to promote it to friends and others in their network.

140 Character Summary: Patient partners were engaged into the development of the COPD monitoring protocol to promote optimal usability of the protocol and a positive client experience.

Purpose/Objectives: Capturing information on patient experience at the point of care gives patients a voice in driving quality improvement, aligning with Cancer Care Ontario’s (CCO) goal in the Ontario Cancer Plan IV to ensure the delivery of responsive and respectful care across the cancer care continuum. Electronic Patient Reported Experience Measures (ePREMs) is an electronic platform that hosts tools for the systematic collection of cancer patient feedback in near real-time at any point in their journey. Your Voice Matters (YVM) was the first validated questionnaire launched through ePREMs in March 2016, asking patients to share their experience from their most recent visit to the hospital or Regional Cancer Centre (RCC). For the first time in Ontario, the ability to link ePREMs data to other administrative databases enables a holistic view of the cancer patient experience, thereby identifying ways to improve the cancer system.

Methodology/Approach: The ePREMs YVM Screening Rate is a measure derived by linking ePREMs data with administrative data collected on cancer activity at each RCC. This linkage allows CCO to quantify the proportion of cancer patients that completed an YVM questionnaire out of all visits to an RCC in a given month. The Screening Rate draws on three CCO data holdings: (1) ePREM; (2) Activity Level Reporting (ALR); (3) ISAAC Your Symptoms Matter (YSM). The rate numerator, count of patients with a complete YVM questionnaire in a given reporting month, is calculated using ePREMs and YSM data. Patients are considered to have completed the questionnaire if they viewed all 28 assessment questions. Any patient record lacking identifier information, including invalid health card numbers, missing facility information, or respondents with non-cancers (such as benign) are excluded from the numerator. The ALR database records each patient encounter with the cancer system, whether it be for treatment or outpatient oncology consultations/assessments (clinic visits). ALR data is used to calculate the rate denominator, the count of unique cases that had a clinic visit/treatment in a given reporting month.

Finding/Results: As of October 2016, 9 of 14 RCCs in Ontario were administering YVM. The data from the three CCO data sources were linked to derive screening rates for each of the participating centres. The linkage provided an early view on the spread of YVM throughout the province.

Conclusion/Implication/Recommendations: The YVM Screening Rate draws on three data sources that are collected independently, but together provides a more fulsome picture of the patient’s visit and experience across the cancer care continuum. The ePREM YVM Screening Rate highlights the potential to better understand the patient experience. The collection of linkable PREMs data will allow CCO to understand and improve on the cancer patient experience across any phase, disease site, age, gender, clinician seen, and type of treatment. This will enable CCO to map patient experiences to specific aspects within the cancer care continuum, and ultimately tailor quality improvement interventions to patient preferences.

140 Character Summary: Data linkage of Electronic Patient Reported Experience Measures data enhances the understanding and improvement of patient experience at all points of care.

Purpose/Objectives: Pathology laboratories provide service to both primary-care and tertiary care providers, helping with disease diagnosis and therapeutic choices. Typically, physicians request a pathology test order which may contain multiple tests; the operational question is whether these tests are relevant and useful with respect to the patient’s profile. As service demands on pathology laboratories is increasing, there is a realization to streamline the operations with respect to clinical guidelines and local clinical workflows in order to optimize operational costs whilst improving order relevancy and result accuracy. The optimization of pathology laboratory utilization is approached by detecting superfluous (clinically irrelevant, unnecessary, repetitive) lab orders, predicting lab utilization for specific tests, resource planning in response to test volumes, educating physicians about clinical guidelines around test ordering and result interpretation. In this project, our objectives are: (1) To develop and deploy a Pathology Laboratory Utilization Scorecards (PLUS) platform that offers end-to-end pathology ‘big’ data analytics services to optimize laboratory utilization; (2) To provide primary care physicians personalized laboratory utilization scorecards to visualize their test ordering pattern and adjust their test orders accordingly; (3) To provide pathology laboratory managers a live dashboard showing the volume and type of orders to assist them with resource planning; and (4) To generate meaningful order-sets to improve test ordering patterns and guideline compliance.

Methodology/Approach: Pathology laboratories generate large volumes of clinical data that can be analyzed to monitor, manage and optimize laboratory utilization. We take a big data analytics approach to develop the PLUS platform that hosts a suite of health data analytics tools/applications to (i) standardize pathology data using SNOMED-CT; (ii) integrate pathology data from multiple health information systems (such as ADT, EDS, EMR); (iii) link non-health data sources such as geo-location data and environmental data; and (iv) visualize and interact with analytical results to gain specialized insights. We have applied machine learning and statistical methods to develop specialized physician order profile comparison models to stratify physicians with respect to their patient demographics and their conditions, thus ensuring that inter-physician comparisons are adjusted by patient population they treat as opposed to just order volumes.

Finding/Results: PLUS is web-based system that is currently deployed in Nova Scotia and is used to optimize the pathology laboratory in the central zone (Halifax) that annually performs on average 15 million laboratory tests for 200,000 patients. We provide web-accessible lab utilization scorecards for (a) primary care physicians to highlight their ordering profile in terms of volume of lab test orders with abnormal rates, repetition rates, yearly comparison and comparison to their peers; and (b) lab managers to illustrate the volume, type and location (on a map) of orders, and gross prediction of the orders for chronic patients and seasonal diseases.

Conclusion/Implication/Recommendations: We demonstrate a ‘big’ pathology data analytics platform to optimize pathology lab utilization. The project involves primary care physicians as users. PLUS is expected to significantly optimize lab utilization by reducing the rate of unnecessary orders, and by offering ‘live’ operational intelligence to pathology lab managers. The approach can be extended to otehr provinces.

140 Character Summary: A big health data analytics platform, using advance analytics methods, to analyze pathology lab data in order to optimize pathology lab utilization

Purpose/Objectives: Health care in Canada is shifting – more care is being provided in ambulatory or outpatient settings in the hospital or community. Most jurisdictions have summary information, but there is a gap in patient-level clinical, operational, quality and utilization data that CIHI is starting to fill. CIHI's low-cost, low-burden ambulatory care data holding provides timely, comparative information for local planning and decision-making and for health system accountability and improvement. Its standardized data bridges information across sectors and the care continuum, providing one more piece to the overall health care picture by capturing clinical and operational patient level information on number of visits, population served and reasons for receiving health services. This presentation will provide information on ambulatory care activity in Canada from a system planning and management perspective based on early findings from pilot projects that are underway and taking advantage of CIHI’s ambulatory care data holding.

Methodology/Approach: NACRS Clinic Lite, CIHI’s ambulatory care data holding, is currently being piloted in organizations across the country, ranging from outpatient clinics at large hospitals to community-based clinics. Approximately 20 clinics providing services to various patient populations have submitted high volumes of patient visit records to date. CIHI has used this data to provide information back to the data submitters and jurisdictions such as: reasons that patients are seeking treatment in outpatient clinics, type of organizations that are referring patients to outpatient care, and number of clinicians participating in a patient’s episode of care.

Finding/Results: Findings from the first two projects participating in this new option, rehabilitation clinics and paediatric clinics, will be presented. Information is being provided to address key system planning and management issues, including: what are the sources of referral to outpatient rehab; and how much time is being spent with patients. The current state of technical infrastructure in ambulatory settings and conclusions on how digital solutions can efficiently be put in place to provide benefits will also be presented.

Conclusion/Implication/Recommendations: In line with the shift in care into the ambulatory care sector and high volumes of activity, advances in technology are making data collection and submission for secondary purposes possible in a streamlined and efficient manner. This provides the healthcare system with insight into a sector that has not historically been mandated to report data, which facilities improved use of resources and better patient care.

140 Character Summary: High volumes in the ambulatory care sector and advances in technology are making efficient data reporting possible. Findings from CIHI's projects will be shared.

Purpose/Objectives: Alternate level of care (ALC) data in the Discharge Abstract Database (DAD) is important for understanding the needs of patients in acute care beds that are waiting for more appropriate services. Historically ALC data has not been comparable across regions due to differences in clinician criteria used for ALC designation. To standardize ALC reporting, CIHI has released new ALC Guidelines for clinicians in acute inpatient care. As part of the Emergency Department Waits and Patient Flow Initiative, Saskatchewan Health Quality Council (SK HQC) has implemented new guidelines and tools to improve ALC reporting in the province. In this presentation, CIHI and SK HQC will promote new ALC guidelines and lessons from Saskatchewan’s implementation, including toolkit and approach to standardization.

Methodology/Approach: In 2015, at request of the Western Canada CEO Forum and in collaboration with the Western Patient Flow Collaborative (WPFC), CIHI launched a project to standardize ALC designation practices in acute inpatient care. CIHI worked with administrative and clinical leaders to develop and pilot clinical guidelines in western regions. ALC reasons were streamlined and clarified for reporting to the DAD. Implementation across western regions is currently underway. Saskatchewan’s initiative was established in April 2013 to aggressively address ED wait times and by 2014, ALC emerged as a priority. A survey on regional ALC practices was completed, followed by a Rapid Process Improvement Workshop to reduce variation in ALC data collection and reporting. A Patient Flow Toolkit was released to operational leaders and point-of-care staff to increase their awareness of ALC data standardization in the context of changes in the health system. Stakeholder engagement and use of provincial implementation teams were key to successful implementation.

Finding/Results: To facilitate implementation, CIHI released the clinical guidelines, a mobile friendly clinician tool, and job aids to help interpret coding requirements. New codes were implemented in the DAD. In Saskatchewan, although ALC is a known contributor to long ED wait times, understanding of ALC population was incomplete without standardized ALC data. A standardized ALC data collection form was implemented with daily, electronic collection as of May 2016 about ALC details, such as reasons, barriers to discharge and timelines. The initiative is now starting to use the provincial ALC data for recommendations around strategic investments. The Regions are also beginning to use the data to guide some of their operational work.

Conclusion/Implication/Recommendations: Accurate and comparable ALC data is important at every level of health system for informing discharge planning at facility to measuring system gaps at regional/provincial levels and identifying access inequalities nationally. CIHI continues to work with stakeholders to broaden adoption of the guidelines across Canada. Saskatchewan expects to release a dashboard with performance indicators updated daily at hospital, regional and provincial levels. Information about ALC patients is expected to be used for health system planning at all levels–not only in acute hospital care, but also in community care. Initiative focused on ALC data standardization but change management and working from a base of influence as opposed to authority has been the key to successful implementation.

140 Character Summary: CIHI will introduce new ALC guidelines and Saskatchewan HQC will share lessons from their implementation, including toolkit and approach to standardization.

Purpose/Objectives: Preparations for hosting the Pan Am and Parapan Am Games (PPAG) in 2015 accentuated the need for a tool to facilitate communications and coordination among a diverse group of healthcare organizations in Ontario to respond to planned and unplanned events. To address the need, the Toronto Central Local Health Integration Network (TC LHIN) initially sponsored 7 LHINs hosting the PPAG to implement a scalable and sustainable Emergency Management Communication Tool (EMCT) for health organizations within Ontario. Subsequently, EMCT was expanded to the remaining LHINs. This presentation will provide an overview of the initial implementation, expansion approach and a demonstration of EMCT.

Methodology/Approach: The project involved consulting with several emergency management experts at over 30 organizations, along with leveraging lessons learned and best practices from Vancouver BC’s experience during the 2010 Olympics. As a result, the requirements for the Emergency Management Communication Tool (EMCT) have been defined. Consequently, a solution was selected through a competitive bidding process. In spring of 2015, health organizations from seven LHINs were selected to participate in the initial implementation of EMCT whereas those of the remaining seven LHINs joined the expansion phase in early 2016. UHN was the delivery partner managing the implementation of EMCT. Facilitated sessions with key emergency management experts and collaboration with the vendor ensured that the solution was customized to support business processes and best practices for any emergency events. Lessons learned from the initial implementation were transformed into strategies for success in the expansion phase to improve user adoption, including: 1) Hosting on-site roadshows to obtain leadership buy-ins 2) Onboarding organizations in rolling phases to accommodate users’ schedules and priorities 3) Sharing success stories and tangible real-life applications of EMCT to better educate users 4) Conducting demonstrations of EMCT with simulated scenarios for users

Finding/Results: The Emergency Management Communication Tool has grown its footprint from the initial implementation to the expansion phase with over 1400 registered users from 200 health organizations in Ontario. The user base is comprised of a diverse group of emergency planning and management organizations such as: Ministry Emergency Management Branch, Local Health Integrated Networks, hospitals, first responders, Public Health Ontario, the Public Health Agency of Canada, etc. It has proven success in both coordination and communication of large scale planned events such as the Pan AMAm games and Syrian refugee resettlement, as well as at the local level for health service providers in codes. For operational practices, seasonal influenza reports and bed availability in emergency departments were information readily available in the tool. Acting as a central hub to promote peer-to-peer collaboration and information sharing, this tool was capable to deliver pertinent situational awareness to health organizations in any large scale emergency events.

Conclusion/Implication/Recommendations: The implementation of EMCT provided the foundation to support Ontario’s vision for a standardized incident management system that was interoperable across all levels of emergency management. Health organizations in Ontario can now further integrate their EMCT tool into their emergency management practices and collaborate with other organizations in the region to prepare for cross-organizational emergency responses.

140 Character Summary: The implementation of a web-based communication tool across Ontario is instrumental in emergency management during planned and unplanned events

Purpose/Objectives: There is wide variation in vacancy turnaround times (TAT) for residential care (RC) beds in Vancouver Island health Authority (VIHA). This is an access and flow issue for patients awaiting RC. By combining analytic tools with process improvement methodologies TAT can be reduced resulting in smoother flow, timelier access and enhanced patient safety and experience. This project demonstrates how analytics and reporting systems can drive process improvements in healthcare.

Methodology/Approach: By using the Strata IQ reporting system and Lean Healthcare methodology the project team reviewed RC bed TAT across all owned and operated RC facilities. Two facilities (sites ‘a’ and ‘b’) were selected for the pilot based on sponsor input and notable TAT variation between the sites. The regional TAT target is 4 days. Pre Improvement TAT for site (a) was 1.3 days, and site (b) was 11.1 days; a difference of 9.8 days. Quality and Patient Safety consultants engaged operational stakeholders at both sites to evaluate current state workflows and processes. The project team constructed two current state process maps from consultative sessions with management and staff. Processes, roles, responsibilities and challenges were defined, and improvement opportunities were identified. Differences in demand demographics and workflows between the pilot site and others were considered. RC facilities then reviewed improvement recommendations and worked with the pilot sites to identify revalent process measures, targets and standard work. Facility specific process measures varied due to differences in demographics, specialized care models, resources, and workplace culture. Strata IQ was used to report TAT as the primary outcome measure for the project.

Finding/Results: Overall, vacancy TAT improved by 2.1 days regionally. Site (a) reported a 0.3 day increase in TAT, and site (b) reported a 6.4 day decrease in TAT (a 58% favorable reduction). Routine performance audits and continuous improvement efforts targeting vacancy TAT are ongoing.

Conclusion/Implications/Recommendations: By leveraging data and reporting systems, variable processes in multiple RC facilities were standardized with consequent reductions in bed TAT. This resulted in improved access for patients and families and better provider experience in some instances. Results suggest that the use of analytics and reporting systems can help drive improvement in healthcare and should be a topic of future research.

140 Character Summary: This project describes how VIHA was able to reduce Residential Care bed Turn Around Time by 2.1 days using data and reporting systems to drive process.

Purpose/Objectives: Panelists will share their experiences applying eSafety in real-world projects and processes. The objective is to learn from and hear from vendors, clinicians, provinces, hospitals, privacy officers and agencies on their application of eSafety to reduce patient safety risks in designing and implementing e-health applications.

Methodology/Approach: This initiative, originally led by COACH, and now spearheaded by Ontario and Alberta eSafety Working Groups, and organizations themselves, aims to study cases for eSafety on both projects and organizational processes. The eSafety journey is underway here in Canada. Supporting a culture of patient safety, promoting “e” solutions for safer patient care and protecting patients against harm from unintended risks throughout the lifecycle of our e-health software, systems and solutions is our collective responsibility. Hospitals are embedding eSafety into their risk management methodology. Others are applying eSafety to products, services and integrations. Vendors are designing their solutions with eSafety and usability in mind. Provinces are expanding their understanding of eSafety and through a series of workshops to assess potential risks and develop mitigation plans, are increasing education and awareness about eSafety in their regions.

Finding/Results: Evidence has shown that asking “What could go wrong?” and preparing for potential risks have paid off to mitigate and avoid risks before they become real-world issues. Adopting a culture of eSafety within the organization, with openness and transparency about risks and incidents, and leadership support of eSafety has led to positive behaviour, early prediction and effective response to potential adverse events, near-misses and unsafe conditions.

Conclusion/Implications/Recommendations: Many key stakeholders are embracing and growing the eSafety culture already. Real-world applications in Ontario, Alberta and internationally have shown that applying eSafety pays off in protecting patients against the risk of harm due to unintended safety risks in the development, implementation and use e-health systems, software and solutions. Embedding eSafety does not need to be a significantly complex exercise and many organizations already have operational processes and risk management processes in place where eSafety can be tied in.

140 Character Summary: Provinces, clinicians, hospitals, agencies and vendors share their experiences applying eSafety in real-world projects and processes.

Purpose/Objectives: The Provincial eConsult Initiative is a program initiated to support the implementation of a provincial eConsult service to enable faster and improved access to specialist care. Three provincial organizations are working together to evaluate existing eConsult services for widespread access and use by physicians and nurse practitioners. The Provincial eConsult Initiative is a complex, multi-faceted project involving technology implementation, business process design and implementation, and the establishment of the program governance framework. This panellist presentation will profile the methodologies leveraged for the provincial initiative, learnings and research from clinical champions, user experiences, and establishment of the service model.

Methodology/Approach: Utilizing a service development approach that would ensure the long-term success and sustainability of the Provincial eConsult Service was a cornerstone for the initiative. This included establishing a project governance structure and ensuring effective stakeholder engagement and change management strategy in this complex multi-stakeholder initiative. Additionally, a detailed benefits evaluation was conducted under the guidance of the provider advisory group to confirm the clinical value of eConsult. The approach included partnering with other provincial agencies and EMR vendors, leveraging existing assets and offering multiple service models is guided by the clinical leads. From the learnings of the implementation approach, the operating model for service adoption, change management, clinical governance and policies have been defined.

Finding/Results: Phase 1 was a pilot that generated a Benefits Evaluation to inform a broader provincial strategy. In response to the success of the pilot, the initiative received approval from the ministry to continue with a next phase to March 2017 so that family physicians, nurse practitioners and their patients can continue to benefit from better access to specialist advice. The key accomplishments include: Over 7,000 physicians and nurse practitioners have joined an eConsult service and have sent over 31,900 eConsults to 127 specialties (including sub-specialties and special interests) since the beginning on the initiative in January 2015. A formal benefits evaluation was conducted which found average response times are within 3 days and 99% of clinicians surveyed agree that eConsult improves patient care. Developing a single provincial service that accommodates multiple models of care. Leveraging provincial assets such as single sign on for the Proof of Concept and enabling increased adoption by complimenting clinician workflow through the EMR. Defining a tool-kit and approach to assist clinicians in the change management and adoption of eConsult within their practice.

Conclusion/Implications/Recommendations: The ongoing use of eConsult demonstrates the continued clinical value and reaffirms the results of the benefits evaluation. Critical elements for the success of a provincial initiative include establishing a robust governance structure, incorporating workflow considerations into adoption strategies, effectively managing delivery partners, and leveraging a standards-based implementation. The panel will share their successful approach and lessons learned, which offers a consideration for other jurisdictions in implementing eHealth initiatives.

140 Character Summary: Learn about the methodologies used to develop and deliver a complex, multi-faceted Provincial eConsult Initiative.