The following sessions/presentations have been identified for the search result: Room 205B
  • OS07 - Virtual and Mobile Technologies in the Home (ID 7)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 205B
    • OS07.01 - TELEPROM-G: Access and Delivery of Telehealth Services Among Community-Based Seniors (ID 68)

      Cheryl Forchuk, Mental Health Nursing, Lawson Health Research Institute; London/CA

      • Abstract
      • Slides

      Purpose/Objectives: Mental illness is strongly associated with poor health outcomes in the older adult population, with depression being a particularly pervasive and complex issue. Evidence shows that the current model of healthcare is not meeting the needs of older Canadian adults. As this population continues to increase, the healthcare sector will have to find ways to adapt in order to improve accessibility to healthcare services. The innovative use of technology may be one such strategy facilitating greater access to healthcare and increased communication between patients and health care providers. Healthcare support delivered via mobile technology may be an effective method for addressing the complex needs of older adults living in the community, but there has been limited research assessing the implementation of this technology. The primary objectives of this pilot study were to: 1) examine the feasibility of implementing and evaluating a mobile-based health care delivery platform in the older adult population; and 2) determine if further modifications to the CHR or deployment would be necessary.

      Methodology/Approach: This one year pilot project, completed in March 2017, evaluated the use of TELEPROM-G, a mobile-based TELEmedicine and Patient-Reported Outcome Measurement (PROM) platform designed to enhance delivery of health services among community-based older adults. This technology uses an existing mobile software platform called Collaborative Health Record (CHR) that has the ability to track patient-reported health outcomes, facilitate clinical evaluation, and support video-conferencing. Multidisciplinary healthcare providers (HCPs) used this technology to clinically assess patients living in the community by monitoring the CHR. Approximately 30 adults (aged 65 or older) with depressive symptoms living in the London community assessed the ability of this technology to safely and effectively meet their health care needs. The research team used a mixed-methods (quantitative and qualitative) design to assess the feasibility of implementing the CHR in the older adult population. They conducted individual interviews and focus groups with clients and conducting separate focus groups with HCPs to evaluate how TELEPROM-G potentially enhances their work with clients.

      Finding/Results: The findings from the interviews and focus groups with participants will be discussed.

      Conclusion/Implication/Recommendations: A pilot study was conducted to assess the feasibility of using this technology with the senior population, and to identify and correct implementation issues before wider-scale adoption of the technology. It is envisaged that this pilot study will provide information to enhance the technology and lead to further larger cohort studies across multiple sites in England and across Canada.

      140 Character Summary: This pilot tested a system for treating community-based older adults living with depressive symptoms using mobile devices equipped with eHealth services.

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    • OS07.02 - Mobile Device Management: BYOD, Apps, and Access to Clinical Data (ID 85)

      Tiffany Chui, eHealth and Corporate Services, Fraser Health; VTX/CA

      • Abstract
      • Slides

      Purpose/Objectives: The area of Mobile Health requires agility and creativity when implementing Enterprise Mobility Management (EMM) solutions. Its complexity is often underestimated due to the prevalence and consumerization of mobile solutions, but the impact at an enterprise-level within the health sector is significant. At Fraser Health (FH), a mobile device management (MDM) platform has been implemented to enable secure access to FH data from personally-owned or corporate-provided devices. Our MDM solution can support all major smartphone platforms (iPhone and Android) and all types of mobile apps including FH clinical and business information. Further, it can be leveraged to enable secure work-related use of a personally-owned device instead of a FH-provided BlackBerry device.

      Methodology/Approach: The approach to implement an EMM solution required significant effort in procurement, architectural design, and app management to be successful. Furthermore, organizational leadership, IM/IT and clinical departments had to agree on the business requirements, enablement options and strategies to support the development of an MDM platform. A BYOD strategy and an app roadmap was created with the enterprise in mind for the acute and community sites . The complexity around including smartphones and tablets, whether personally-owned or corporate-provided, impacted our security, privacy and legal policies and procedures. Further, a change management strategy that was effective for mobile solutions was required to support the diverse groups of stakeholders impacted. This also necessitated a well thought out communication and roll-out strategy given the pent-up demand for mobility from our end-users and business areas. The challenge was managing expectations for those who were keenly interested and others who had concerns and pre-conditions for utilizing BYOD for work.

      Finding/Results: The MDM solution has gone live this year with key user groups across the organization. We have completed a limited production rollout for Procura Mobile, which supports Community Health Workers, and Boxer, which securely manages email/calendar/contacts functionality. MEDITECH Mobile rounds, which supports Physician rounding will be coming soon. The solution enables a 'Bring Your Own Device' program, which provides choice to staff and physicians who are interested in using a personal device, instead of a FH-provided BlackBerry at work. It ensures network security requirements are met to support mobility and wireless use cases. Further, dedicated Wi-Fi and 24/7 unlimited end-user support from our vendor specialists in Managed Mobility Services enhances our service offering. Finally, organizational cost savings is achieved for MDM enrolled smartphones, when offset from the current Corporate BlackBerry costs.

      Conclusion/Implication/Recommendations: Developing a successful mHealth portfolio and EMM solution allowed FH to achieve great successes in this advancing and complex space. It is a disruptive technology which supports the mobilization and access to information or front-line technologies. It has optimized, simplified and integrated workflows, which thereby allow staff and clinicians timely access to clinical and business information. Finally, as more mobile apps become available, the utilization of mobility use cases will promote the advancement of all areas within the health authority and a future for mHealth possibilities.

      140 Character Summary: Introducing an Enterprise Mobility Management platform promotes mobile health for the Health Authority and secure access to clinical data on personal devices

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    • OS07.03 - Advancing Healthcare Technology: A Virtual Rehab Program for Cardiac Patients (ID 132)

      Helena Van Ryn, Division of Prevention & Rehabilitation, University of Ottawa Heart Institute; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: Purpose/Objectives: To assess the feasibility of a Virtual Rehab offering for cardiac rehabilitation patients. Background: Despite the known benefits of Cardiac Rehabilitation (CR), as little as 10-30% of eligible patients attend. Access barriers include transportation and time. The Internet holds great promise in improving access to care as it requires little infrastructure or cost and is readily available. Although there is much enthusiasm for technology-supported healthcare, the evidence to support such use in cardiac rehabilitation is limited. The University of Ottawa Heart Institute designed a "Virtual Rehab" program in response to this care gap.

      Methodology/Approach: Methodology/Approach: The Virtual Rehab Program is an online cardiovascular health management system that provides best practice strategies to control and manage risk factors. The system includes personal care plans, wellness trackers, integration with fitness devices, reminders, the ability to invite friends and family, peer support groups and more. Individuals are motivated to improve their risk factors through health education. Patients are assigned a personal Health Coach and complete eight one-on-one behavioral-based health coaching sessions over six months. Sessions are offered through Virtual Greetings, either video chat or phone. Together, the patient and health coach develop a personalized care plan and track progress for feedback and reinforcement.

      Finding/Results: Results: Since March 2016, 42 patients (33 men, 9 women) have been referred to the program, 40 agreed to register, and two did not. Among the registered users, four have discontinued/dropped out and one died prior to start. Health coaches documented successful coaching sessions, illustrating a 98% completion rate.

      Conclusion/Implication/Recommendations: Conclusion: Together these results suggest that recruitment and retention of cardiac patients in a virtual rehab program is feasible. Participation rates strongly indicate engagement and program acceptance. Further evaluation assessing program impacts on health-related outcomes is currently underway. Implications: The adoption of technology in the delivery of healthcare is slow due in part to the lack of robust evidence, privacy concerns, lengthy policy changes, and some resistance toward a more consumer-based focus. Using a "SaaS" (Software as is) platform includes the delivery of continuous, mandatory updates affecting all clients. Released changes may deviate from original beta tested versions. Recommendations: At the planning level, ensure the supplier understands the needs of the health care organization (privacy concerns, IT limitations, liability etc). Integrating process into current workflows of CR programs is highly recommended for program adoption and staff buy-in. A noticeably common misperception is that online programs serve only the “tech-savvy”, reflecting the importance of addressing staff beliefs when referring patients. Ideally the platform should contain features that reinforce patient engagement in an effort to maintain interest however constant adaptations should be mitigated to minimize disruption to the users (e.g., interrupting submission of questionnaires, changing navigation pathways and confusion). As life expectancy is increasing, people are more likely to develop chronic conditions, placing a tremendous strain on the healthcare system. The solution of providing effective and ongoing health management will not only involve innovative technology but also a change in culture on the role of technology in providing patient-centered care.

      140 Character Summary: A Virtual Cardiac Rehabilitation program was assessed for feasibility. High enrolment, retention and participation rates showed engagement and acceptance.

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    • OS07.04 - Towards Data-Driven Design - the Case of <30 Days (ID 64)

      Plinio Morita, School of Public Health and Health Systems, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: As part of the design of the original <30 Days app, our team embedded usage analytics that allowed the Heart and Stroke Foundation to track users' progress and user behaviour though the app. Embedded metrics enabled our team to evaluate how the different parts of the app were used and the users’ progression over time. We will explore how the usage data from the first generation of the <30 Days app was used to tailor the updated version and how persuasive design methods informed the integration of a new feature set on the app targeting its deficiencies.

      Methodology/Approach: The original <30 Days - The original <30 Days focused on collecting valuable health data and on fostering small daily challenges that promoted behavioural change that could lead to improved health. The app was initially composed of an in-app risk assessment, in-app challenges, progression dashboards, and app metrics. The latter allowed us to collect usage data.

      Finding/Results: Usage data – The analytics platforms logged information about users' characteristics, challenges completed and skipped, and trophies awarded. With that information, our team was able to extract important data used in the creation of new features, such as challenges completed by different subgroups of the user population, types of challenges skipped more often, behaviours as excessive skipping of challenges, preference of one risk factor over others, frequency of usage, etc. This information served as the basis for the redesign of <30 Days. Our goal was to increase adherence and sustained use of the app, maximizing the number of users completing 30 challenges in less than 30 days. Deficiencies in the design, identified in the previous generation of <30 Days and addressed through persuasive design include: challenges from specific risk factors being skipped too often; and users showing high levels of engagement on the first couple of weeks, with multiple challenges completed per day, but losing interest over time. Persuasive design – In order to redesign the app to improve user engagement and consequently user adherence, we resorted to exploring persuasive design methods to incorporate features that could address app limitations. Examples of new features include: the ability to tailor challenges, the ability to browse through challenges, increased gamification, novel trivia features, the ability to track your detailed progress through the use of dashboards and timelines, as well as improved visuals, animations, and user experience. New version of <30 Days - Using the principles outlined above, we followed UCD methods for creating a new and engaging version of <30 Days. Newly designed features include: new trivia questions, redesigned challenges mechanisms, updated progress screen, integration with fitness trackers, and improved graphics and animations.

      Conclusion/Implication/Recommendations: Through a hybrid approach to UCD, usage data from an existing version of the app can be used to inform the design of the new generation. The content of this lecture will provide the audience with guidelines on how to collect important usage data that can later be converted into insights for re-designing mHealth interventions.

      140 Character Summary: Explore how the analytics from the first generation of <30 Days were used to update the design using persuasive design methods for the integration of new features.

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    • OS07.05 - Extending Wound Care Teleassistance to the Patient's Home (ID 157)

      Jonathan Lapointe, Centre de Coordination de la Télésanté, CIUSSS de l'Estrie - CHUS; Sherbrooke/CA

      • Abstract
      • Slides

      Purpose/Objectives: In October 2009, the CeCoT (Centre de Coordination de la Télésanté du CIUSSS de l’Estrie - CHUS) which is part of the CIUSSS de l’Estrie – CHUS launched its first Wound Care Teleassistance service (WTC) This service aims at improving access and care for patients needing complex wound care. Built on standardized methods and grounded in a clinical network of specially trained nurses, the TASP service model is unique in Canada. In 2016, 47 health facilities were using it with over 3700 virtual clinics completed since the launch of the service. Since the first years of the service, enterostomal therapists and resource nurses requested that they’ll be able to reach patients in their own homes. Many patients can’t easily go to a nearby clinic to receive proper care for their complex wounds, mainly because of mobility problems. Even though they are followed at home by nurses, these patients cannot benefit from the expert advice on their wounds which can lengthen the healing process and sometime cause further complications. In 2016, following the complete overhaul of the original WCT service, an emphasis was put on the possibility to enventually go at the patient’s home with the same technology. The enterostomal therapists and resource nurses could then use the same tool for all patients.

      Methodology/Approach: A pilot project was launched in the summer of 2016 to design and validate what is needed insure the success of taking WCT at the patient’s home both in an urban and a rural setting. The main questions to be answered by this pilot project were: what is needed to successfully transpose the WCT service from a hospital based service to the patient’s home and how to handle the technical challenges it this non-standardized and often inhospitable environment. To do so, we set up a steering committee composed of nurses and clinical managers and a project team. We analysed the needs of the home nurses, evaluated different way to manage the heterogeneous environments in which WCT would need to happen, planned for connectivity issues and worked with the clinical staff to find validate the proposed prototype in real world scenarios. Following the design phase, the implementation phase allowed the team to gather feedback from the clinical persons and from the patients.

      Finding/Results: This pilot project presents how it is possible to take the existing WCT service and extend it in the patient’s home. It provides insight on what is needed for such a project to work both from an organizational and a technical point of view. It shows what was done to organize this service in order for it to have the expected effects and secondly, what works or don’t work on a technical standpoint for this specific environment and the particular challenge it poses.

      Conclusion/Implication/Recommendations: Following the observation report, a recommendation was made to the CIUSSS de l’Estrie – CHUS on the requirements and lessons learned providing insight on how we should move forward with the implementation of this WCT service at the patient’s home on a larger scale.

      140 Character Summary: Following the success of the Wound Care Teleassistance service, we did a pilot project to identify how to successfully extend it to the patient’s home.

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    • OS07.06 - A Real-Time Analytics Platform to Evaluate mHealth Apps (ID 81)

      Plinio Morita, School of Public Health and Health Systems, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: With the advent of ubiquitous smartphone penetration on a global scale, mobile health applications (mHealth apps) are being developed to support the self-management of chronic diseases like asthma, diabetes and chronic pain. However, even though over 165,000 mHealth apps are currently available to Canadians for download, less than 1% have been evaluated for efficacy. By 2017, Canada is expected to be among the top 10 mHealth markets in the world; this puts into question how current regulatory policies will govern the vast supply of mHealth apps looking to satiate this consumer demand.

      Methodology/Approach: Given the need for an evaluation methodology that is sufficiently rigorous to ensure app efficacy, but also lean enough to be rapidly implemented on the tremendous volume of unregulated mHealth apps, our research will examine the effect of a web-based analytics application on the evaluation of mHealth apps for chronic conditions. We hypothesise that this resource will support mHealth researchers to conduct more optimised – defined as rapid, efficient and inexpensive – evaluations of their apps, which will lead to the development of effective and evidenced apps with demonstrable health benefits. Our objective is to build a Real-time Analytics Platform (RAP) integrating *behavioural usage data (e.g. frequency and duration of app use, usage patterns, in-app achievement of goals and tasks, user-generated content) and patient-reported outcome measure (PROM) data* (e.g. validated clinical questionnaires, quality of life measures, sensor-collected health and fitness data, treatment adherence logs) to generate continuous findings that relate app behavioural patterns on health outcomes.

      Finding/Results: RAP will enable mHealth researchers to (1) use RAP-enabled apps to recruit and onboard large sample sizes remotely to a research study (i.e. determine eligibility, obtain informed consent, collect demographic and baseline data); (2) collect usage and PROM data and continuously upload it to a secure RAP server; (3) visualise collected data on the RAP Researcher Dashboard in real time, conduct preliminary exploratory analyses, and export study data; (4) make mid-study changes through the RAP Researcher Dashboard based on identified data trends from large datasets (e.g. deploy new app builds to study subgroups, send in-app alerts, turn on and off app features and components).

      Conclusion/Implication/Recommendations: The proposed platform will enable innovative methods in clinical research by facilitating the conduct of alternative trial designs such as single-case, factorial, n-of-1, registry-based, and adaptive trials in mHealth research, which require high frequency, high volume data to generate meaningful study findings. RAP can further support scaling mHealth research toward epidemiological studies, which may support the provision of predictive, prescriptive and preventive care. We posit that the value of RAP within a clinical research ecosystem lies in its potential to* lower access barriers to research participation, increase the volume of evidence-based apps that are proven to be effective, and ultimately improve patient safety*. With the platform as a resource, researchers can leverage integrated data analytics to conduct comparative effectiveness research on their mHealth apps. As a result, RAP can inform the design and development of effective mHealth apps that produce improved chronic health outcomes.

      140 Character Summary: We propose the design of a real-time analytics platform to support the conduct of optimised – rapid, efficient and inexpensive – mHealth app evaluations.

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  • OS10 - Disease and Clinical Management with Technology (ID 16)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 6
    • Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 205B
    • OS10.01 - The Concepts of Canadian Population Grouping Methodology and Its Application (ID 173)

      Yingjun (Victoria) Zhu, Case Mix, Canadian Institute for Health Information; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: CIHI’s newest product – a Canadian based population grouping methodology looks at an individual’s experiences with the healthcare system across many sectors, including inpatient stays, day surgeries, physician visits, ED visits, hospitalizations for mental health illnesses and stays in long-term care (LTC) and complex continuing care facilities. Using data collected over an extensive time period, the grouping methodology classifies individuals, including healthy people, into cohorts with similar clinical characteristics; producing cost weights which compute the population’s current and future burden of morbidity, their number of primary healthcare and ED visits, as well as the likelihood of being admitted to a LTC facility. Using these outputs, users are able to quantify the health burden of the population, identify high cost users, provide inputs into funding models, monitor population health and diseases and profile/predict future healthcare usage.

      Methodology/Approach: The population grouping methodology starts with everyone who is eligible for healthcare and then looks at interactions with the healthcare system and diagnosis information over a 2-year period to describe a person’s health status and predict their future morbidity and system use. This means, everyone, including individuals who haven’t had any interactions with the healthcare system and those with no health conditions are also included in the analysis, providing a true picture of the entire population. By using age, sex, health conditions and the most influent health condition interactions as the predictors, regression models have been applied. These models produce predictive indicators for the concurrent period as well as one year into the future. While the data is produced at the individual level, the power of the model lies in the user’s ability to aggregate the data by population segments and compare healthcare resource utilization by different geographic regions, health sectors, socio-economic status and health status.

      Finding/Results: By comparing with other similar products in the world, CIHI’s population grouping methodology has been proved to have similar or better predictive power.

      Conclusion/Implication/Recommendations: CIHI’s population grouping methodology is a very useful tool for profiling and predicting healthcare burden and future system use, with key applications for health policy makers, planners and funders. The presentation will focus on how these user groups can apply the outputs of the methodology to aid in their decision making and planning processes. For example, we will demonstrate how the cost weights can be used in large-scale funding models, to set physician capitation rates and identify/monitor high system and high-cost users. We will demonstrate how the clinical profiles created across the continuum of care can be used for disease surveillance and monitoring. Finally, we will demonstrate how the outputs from the models can be used to predict future system use patterns, such as visits to a family medicine physician.

      140 Character Summary: A very useful tool for profiling and predicting healthcare burden and future system use, with key applications for health policy makers, planners and funders.

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    • OS10.02 - Digital Health Based Ambient Assisted Living to Improve Medication Adherence (ID 177)

      Raza Abidi, Dalhousie University; Halifax/CA

      • Abstract
      • Slides

      Purpose/Objectives: Patient-centerd healthcare involves strategies to engage and motivate patients to self-manage their health conditions in home-based settings. Medication adherence is an important aspect in disease self-management since sub-optimal medication adherence leads to ineffectiveness of the therapy and discomfort for the patient. In order to overcome the limitations of self-reported medication adherence, our objective is to use ambient assistive living (AAL) technologies in smart environments to monitor, remind and motivate patients to adhere to their therapy plans. Our intent is to exploit sensor technologies and consumer health devices to remotely monitor and collect self-management related information, infer adherence through activity recognition, and send personalized reminders and motivational messages based on the observed patient’s behaviour to help them improve medication adherence. We present an AAL framework that monitor activities related to medication adherence.

      Methodology/Approach: We take a data analytics and AAL approach that entails: (a) data collection for activities related to medication adherence; (b) patient’s high-level activity model generation based on their activity data; (c) recognition of medication related activities state based on the collected patient data and high-level activity models, and (d) contextual message generation from the activity recognition results. Medication adherence is monitored from a smart pillbox (Bluetooth Low Energy) that send events (accelerometer, reed switch on pill compartment’s lid) to a smartphone, and from smart home sensors that include: passive infrared sensors to detect motions in specific zones, reed switches on doors and radio-frequency identification tags on objects to detect when objects (e.g. cup or glass) are used by the patient, and (c) flow meter sensors to detect when the patient uses water tap in order to get drinkable water. Smartphone and smart home services allow to obtain contextual information about the patient and medication adherence’s activities from the collected data: localization service (patient’s current location) and action recognition (e.g. opening pillbox, opening door).

      Finding/Results: We implemented our AAL based medication adherence system, comprising a sensor infrastrure for data collection and a mobile health app for patients to receive messages. We evaluated system performance for three activities related to medication adherence as performed by different individuals. The Taking medication activity is carried out when the patient takes pills from the pillbox (Take pills sub-activity), then gets a cup of water (Get water sub-activity), and finally swallows the pills. The activities were validated with 780 scenarios of activity realisation with six uncertainty levels (from certain observation to complete ignorance about the observation value). Our system is able to recognize the patients’ activity in these scenarios with 79% accuracy. When the system is enabled to predict the most plausible patient’s activity then the system’s accuracy is around 98%.

      Conclusion/Implication/Recommendations: Ubiquitous and pervasive solutions to ensure patients adhere to their medication are challenging, yet important to improve therapy outcomes and reduce healthcare costs. We have presented an innovative digital health application to remotely monitor patients for specific activities and send them timely reminders and messages to help improve medication adherence and behaviour modification. Our framework extend to other self-manageent activities pertaining to chonic disease management

      140 Character Summary: Remote patient monitoring and motivational messaging to improve medication adherence using ambient assisted livign technologies

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    • OS10.03 - Technology Streamlines Screening Techniques and Saves Lives (ID 277)

      Jerome Foster, New Brunswick Department of Health; Fredericton/CA

      • Abstract
      • Slides

      Purpose/Objectives: The New Brunswick Department of Health has implemented an innovative, centralized Cancer Screening System that saves lives and reduces the cost of treating cancer. Colon cancer is New Bruswick's third most common cancer and the second deadliest cancer. Using existing information held within Department of Health databases, probabilistic algorithms identify and enable the selection of candidates for Colon cancer screening by evaluating information held in Medicare, the Client Registry, and the Cancer Registry. Where other provinces use mostly manual processes, the availability of these data sources to New Brunswick Cancer Network has enabled this system to operate with increased automation.

      Methodology/Approach: The Cancer Screening program leverages investments made in the New Brunswick Electronic Health Record and data registries to support decision making while reducing effort and cost duplication. The current screening program would not be possible without the foundation of the One Patient One Record infrastructure. The provincial Client Registry is used to determine who to invite to the screening. Patients who agree to participate send their requisition sample into a provincial lab to have the test performed, and the Laboratory results are transferred via the Rhapsody Integration Engine to the Orion Clinical Data Repository. The Rhapsody messages are also transferred to another Cancer screening data repository that supports the screening processes. The EHR, Orion Clinical Portal, displays the results and nurses review with patients as they complete the pre-Colonoscopy assessment over the phone. Since results are electronic, the nurses who currently work in Fredericton can work from anywhere in the province. After the colonoscopy, the pathology report is reviewed by the nurses via the EHR. It's important to note that other health care providers have access to these results as well, through the EHR, for continuity and ongoing care of the patient. The notification of the physicians or nurse practitioners is an important factor to ensure that the patients receive appropriate follow up. Relevant information is routed to the patients’ care team NextGate Provider Index. Provider Index, the EHR viewer and Rhapsody messages enable the flow of information and build the foundation for the screening’s highly-automated, algorithm-based cancer screening.

      Finding/Results: As of July 31, 2016 there has been a 30% participation rate of solicited persons in the screening. To date, we have found 37 cancers in asymptomatic individuals. Additionally, 390 persons had polyps removed preventing cancer development. These screenings identified patients before cancer could progress, avoiding significant health risks to patients, and realizing cost savings to the province.

      Conclusion/Implication/Recommendations: Before the integrated Cancer Screening's implementation there was no centralized, systematic way to identify and invite participants to be screened. By leveraging investments in existing provincial information technology systems and integrating data to build an automated algorithm to identify at-risk patients, New Brunswick has prevented cancer in many patients. The “business process automation” in the integrated Cancer Screening now enables proactive invitation of eligible NB citizens to engage in early detection of cancers. This technology allows for efficient delivery of the screening and ensures all providers are able to access test information.

      140 Character Summary: The NB Department of Health has implemented an innovative system to support Cancer Screening that is saving lives and reducing the cost of treating cancer in NB

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    • OS10.04 - NephroPort™: Innovative Partnership for Automation of Renal Data Reporting (ID 307)

      Helen Chen, School of Public Health and Health Systems, University of Waterloo; Waterloo/CA

      • Abstract
      • Slides

      Purpose/Objectives: Missing or erroneous data not only compromise patient care and quality improvement initiatives, but also lead to significant revenue lose for care providers. Increased pressure for data reporting and data accuracy to substantiate and generate contingent funding is taxing already resource-strapped healthcare organizations, and highlighting the need for access to data, and HIT interoperability. We present the joint development of NephroPort™, an automatic data quality and reporting software between Grand River Hospital and the University of Waterloo. Advantages and challenges facing medium-sized community hospitals in fostering and sustaining innovation with academic partners are also discussed.

      Methodology/Approach: All renal programs in Ontario are required to report patient and administrate data through the Ontario Renal Reporting System (ORRS). Manual data entry into ORRS was the only option to report data until 2015, when an interface for uploading batch files was made available. The project was established based on a strategic partnership agreement between Grand River Hospital and the University of Waterloo. Agile development methodology Scrum is used throughout the project. NephroPort™ software is developed as a result of this close collaboration. It is a web-based data extraction, validation and reporting system. Data completeness and accuracy were assessed at the baseline, and assessed again 6 months post implementation. <img alt="nephro - nephrport.png" annotation="" id="image://52" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=d19864cbb8dcd0577740f9035550dbcfee87af9a&id=52&width=350&height=350&download=0" title="nephro - nephrport.png" />

      Finding/Results: At baseline, only 45% of required data elements were captured in the renal program's patient management system (source). Post deployment assessment shows an increase of data capture to 95% of the mandatory ORRS data in the source system and the time for data entry is reduced 70%. NephroPort™ enables the renal program to identify data quality issues on a daily basis and corrections can be made in the source system immediately. This project has led to new collaborative projects and research activities between the development partners.

      Conclusion/Implication/Recommendations: NephroPort™ brings efficiency, accuracy and cost savings to the renal program. To address the demand for high quality data, medium-sized hospitals increasingly seek to automate data input and reporting. However affordable and appropriate off-the-shelf solutions for specific reporting needs, often involve high variable data extraction mechanisms and validation logic that depend on hospital business rules and source data systems. Academic-health system partnerships that provide experiential learning opportunities for students and address real-world problems are a win-win for hospitals and the system. However, the benefits of job-ready graduates must be balanced against the absence of receptor capacity for risk assessment and sustainability of software outputs.

      140 Character Summary: NephroPort™ is an automatic renal data reporting software jointly developed via partnership between the University of Waterloo and the Grand River Hospital.

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    • OS10.05 - Connecting Patients to the Clinic Through Community Volunteers and Technology (ID 356)

      Larkin Lamarche, McMaster University; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: This presentation will describe the Health TAPESTRY approach as part of a randomized controlled trial in Hamilton, Ontario in a sample of older adults (N=312). The Health TAPESTRY approachis a way to proactively gather information about health goals and needs of patients in their homes through a volunteer-facilitated software application (TAP-App). This approach offers a new connection in healthcare in terms of how (and what) information comes into the family health setting to be acted upon by the healthcare team (See image below for information flow). <img alt="health tap information flow.jpg" annotation="" id="image://51" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=015b2566ca2b55d3cde303db361190568a2c5b19&id=51&width=350&height=350&download=0" title="health tap information flow.jpg" />

      Methodology/Approach: A mixed-methods approach to data collection and implementation of this application of technology was used. Quantitative data tracked how information flowed from the home to the clinic (via TAP-reports) and how the clinic used the information to develop a care plan. Interviews/focus groups were conducted to gain a deeper understanding of the strengths and challenges of the application of this technology in this manner.

      Finding/Results: Seventy-eight volunteers completed 393 home visits, for 174 participants. On average, the TAP-App took 80 minutes to complete over two visits. There were 173 reports auto-generated and electronically sent to the clinic. Reports included an average of 3.4 key issues for the clinic team to address. Care plans were developed for 172 reports. Qualitative findings showed that the TAP-App was generally easy to use by volunteers; however, challenges with the goal setting survey were noted, which led to changes to the script and its placement in the series of surveys on the TAP-App. Early on, clinical staff had concerns about the responsibility for, and accountability to, the information. Concerns about the quality and quantity of information were also noted, although this lessened over time. The one-way flow of information was noted by volunteers who wanted to know more about the care plan that was developed. Despite early challenges, the clinic noted the added benefits of having the health goals as a source of information to consider and thought the paperless information flow “worked well”.

      Conclusion/Implication/Recommendations: The TAP-App successfully enabled the collection, collation, and transfer of information by trained volunteers from people living in their homes to the healthcare team. This offered a novel method of collecting and delivering health information to the clinic. Ways to facilitate the exchange of information using the volunteer, rather than the one-way flow of information, may further strengthen the Health TAPESTRY approach. This approach may extend primary care in a new way not yet fully realized.

      140 Character Summary: Health TAPESTRY is a new approach to care planning; it gathers health goals & needs from patients in their homes through volunteers & tech

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    • OS10.06 - Self eReferrals for Youth Mental Health: Canadian Research Initiative (ID 258)

      Shalini Lal, CHUM Hospital Research Center; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives: The majority of mental illnesses begin in adolescence and young adulthood. In Canada, over 75% of youth with mental health concerns do not receive the services and supports they need. Barriers include geographical distances, having to navigate and rely on multiple others for referral, limited choice in terms of when and how to access services, and stigma and embarrassment. Accessing appropriate services can take weeks, months, and even years, while symptoms, distress levels, and risk for suicide can progressively increase over time. Young people are increasingly going online to seek help, creating a need for innovation in online pathways to facilitate young people’s trajectories to mental health systems of care. This presentation will describe a novel eHealth solution to facilitate rapid and direct access to youth mental health services that is currently being developed, implemented and evaluated in 6 Canadian healthcare settings. The eHealth solution is an online self-referral pathway composed of three integrated components: a youth-friendly online self-referral tool, a robust referral management system, and a secure communications platform. The ultimate objective of this innovation is to empower young people to seek help for mental health concerns, and improve the capacity of service providers to efficiently triage, manage, and monitor referral pathways and outcomes.

      Methodology/Approach: The project involves multiple stakeholder collaboration and partnerships between public and private industry, youth and family consultants, service providers, decision makers, and community organizations to adapt, customize, and integrate the eHealth solution in ‘real-world’ settings, and evaluate its benefits and cost-effectiveness. The evaluation is embedded within a larger, multi-site pragmatic trial evaluating a model of service transformation for youth across the country through early case identification, rapid access to services, appropriate care, youth and family participation, and continuity of care. We will also use qualitative methods to document and evaluate the process of tool development, pilot testing, implementation, and impact on referral processes, practices, and experiences from the perspectives of youth, service providers, and families. An economic evaluation will provide insights into the extent to which the eHealth solution adds value in terms of efficiency and cost-savings from a societal perspective.

      Finding/Results: This is a four-year project that is currently underway. The presentation will present the prototype of the online self-referral pathway, highlight key achievements to date, and discuss lessons learned thus far in relation to public-private partnerships, context-driven implementation challenges and opportunities, and youth and family engagement.

      Conclusion/Implication/Recommendations: This project can help to reduce the large unmet need gap in Canada with over 75% of youth with mental health concerns not receiving the mental health services and supports they need, at the time they need it. It can also improve efficiencies within the healthcare system. It will provide a seamless and rapid portal of entry to mental health services offered by the public healthcare system, through modalities popular with youth, ultimately improving young people’s pathways to care. This online self-referral strategy could eventually be scalable to a variety of other types of settings including adult mental health care and other health and social services-related settings.

      140 Character Summary: An innovative online self-referral pathway to facilitate rapid and direct access to youth mental health services in Canada.

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  • OS19 - Experiences in Adoption & Use (ID 25)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical
    • Presentations: 4
    • Coordinates: 6/06/2017, 01:00 PM - 02:00 PM, Room 205B
    • OS19.01 - Addressing Complex Clinical Documentation Through Human-Factors & Human-Computer Interaction Principles (ID 18)

      Mikael Ragbar, Whitby/CA

      • Abstract
      • Slides

      Purpose/Objectives: Upper gastrointestinal (GI) endoscopy and colonoscopy are common procedures with complex documentation requirements. Research indicates there is significant variability in the clinical reporting quality of these procedures. Although documentation solutions are currently available, adoption remains poor due to challenges with workflow, functionality and ease of use. With support from Canada Health Infoway and Canadian Partnership Against Cancer, national data models for reporting colonoscopy and upper GI endoscopy procedures were created to provide a framework for standardized reporting and improve procedure documentation, data quality and patient care. The data models were designed to incorporate standard terminologies and classifications with endorsement from the Canadian Association of Gastroenterology (CAG). At a large multi-site academic health sciences centre, the existing electronic clinical documentation application was updated to incorporate the national data models for colonoscopy and upper GI endoscopy. To accommodate the complexity of the documentation required and the variability in patient population and clinical practice we released a working prototype as part of an iterative design approach based on human-factors and human-computer interaction principles. The purpose of this presentation is to share the lessons learned in the design, implementation, and adoption of complex electronic clinical documentation applications. These principles may be broadly applied to a wide variety of clinical documentation environments.

      Methodology/Approach: Semi-structured interviews and observational studies were conducted to evaluate the content, workflow, and usability of the application. Completed electronic procedural notes were quantitatively analyzed to examine adoption and performance. Human-factors and Human-computer interaction principles were applied to the application in the production environment.

      Finding/Results: Common themes emerged from the interviews. Despite motivation to adopt the data models, clinicians found that it did not meet their workflow or usability requirements and took longer to complete than a dictated clinical note. In some circumstances, the application did not support Human-factors and Human-computer interaction principles such as consistent user commands and informative field labels. Users also had misconceptions regarding the purpose of the application; some thought it was solely for research. Many users found the generated synoptic report failed to capture sufficient patient narrative and context. Engaging with users is essential; their feedback combined with the results of the quantitative analysis guided the iterative re-design of key components of the application. Concurrently, the Human-factors evaluation of the application helped to identify areas of improvement in terms of usability, readability, and speed.

      Conclusion/Implication/Recommendations: Currently, the feedback and results of our analysis are being integrated into the application. Upon the next release, feedback and usability testing will be conducted to continue the process of iteratively designing the application to fit the needs of the clinicians. The national data models contain best practices and guidelines that are important for improving patient care and clinical documentation. Clinicians must be aware of the intent and share in the benefits of changing their workflows and practices. Iterative engagement, feedback and use of the application at the point of care are important for supporting implementation, training, adoption and benefit realization of complex clinical documentation.

      140 Character Summary: Adoption of complex clinical documentation systems is limited. Human-factors principles and clinician feedback can aid in the adoption and use of these systems.

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    • OS19.02 - Use of Digital Health: How Does Canada Compare? (ID 141)

      Sukirtha Tharmalingam, Evaluation Services, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: In Canada and internationally, there have been significant investments made in health information technology. This presentation will examine the use of digital health by primary care physicians and patients in Canada and how it compares to peer countries. Provincial electronic medical record (EMR) adoption rates, use patterns and impact on patient care will be discussed.

      Methodology/Approach: Findings are based on responses from the Commonwealth Fund’s International Health Policy (IHP) Survey of Primary Care Physicians in 2015 and the IHP Survey of the General Population in 2016. A total of 11,547 Physicians from 10 countries participated in the 2015 survey (Canada, n=2,284 ). The survey included topics such as access to care, coordination of patient care, organization of practice, use of information technology and performance measurement. Comparable data from previous surveys of primary care physicians (2006 and 2009) are used to analyze trends. Data for each of the countries are weighted to reflect the local physician population. The 2016 survey of the general population targeted adults (18 and older) in 11 countries including Canada (n=4,712) and focused on patient experiences with the health care system.

      Finding/Results: The adoption of EMRs among Canadian primary care physicians has tripled over the past nine year (23% to 73%). Provincial adoption of EMRs ranges from 36% to 85%.Canada shows room for improvement in EMR adoption to reach levels seen in peer countries (Fig 1). Canadian physicians with EMRs report the ability to better manage their patients’ care. For example, 79% of physicians with EMRs report that they are able to generate a computerized list of patients by diagnosis compared to 20 % without an EMR. Canadian physicians’ use of advanced EMR functions that support patient care varies and shows room for improvement. Canadian physicians are more likely to use some functionalities (reminders for guideline based care, review data on preventive care) and less likely to use others (alerts related to medications, tracking results, patient reminders) when compared to the 10 country average from the Commonwealth Fund survey. Canada lags behind in allowing patients to access their digital health records or communicate electronically with their doctors. All countries show room to improve in offering patients access to health information.

      Conclusion/Implication/Recommendations: EMR adoption and use has nearly tripled in Canada over the last decade, equipping doctors with an important tool to better manage patient care. The survey findings show that Canada and its international counterparts have room to improve in the use of advanced EMR functionalities that could positively impact patient safety, prevention and chronic disease management. The surveys also highlight room for improvement in electronic information exchange and online services for patients.

      140 Character Summary: Canada is catching up but still lags behind in use of digital health in primary care; who can we learn from internationally and where can improvements be made?

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    • OS19.03 - Usage Patterns of a Health Information Exchange Network in Quebec (ID 115)

      Aude Motulsky, Research Centre, Centre hospitalier de l'Université de Montréal; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives: The objective of this study is to describe the usage patterns of a medication health information exchange (HIE)1 network in Quebec 2 years after its full implementation. (1This system is also described as a Drug Information System and an Electronic Health Record by Canada Health Infoway)

      Methodology/Approach: Longitudinal analysis of usage data of the HIE network between January 1st 2015 and July 30th 2016 was performed to describe the number of users, number of accesses and tools used to access the data. Usage data were obtained from the Health Ministry of Québec.

      Finding/Results: During the 18 month study period, a total number of 30 996 unique users accessed the medication data of the HIE. Access was possible using a Viewer application, an electronic medical record (EMR) application, or a Pharmacy application. In 2015, only 5% of users accessed the medication data through an EMR, while this proportion increased to 19% in the first 6 months of 2016. This suggests that a greater number of clinicians were using the advanced features of an EMR to access the data. Figure 1 shows the mean and median number of accesses to the medication data per month, and per tool used. The level of use was higher when clinicians accessed the data through an EMR (mean number of accesses per month in 2016 was between 101 and 264 per user) compared to the Viewer (between 42 and 90). Table 1 presents a detailed description of the number of users per year, the tool used to access the data, and the number of accesses for all users. <img alt="table1.jpg" annotation="" id="image://18" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=bbd43344205533a2c762e94b594350bcdc2afb71&id=18&width=350&height=350&download=0" title="table1.jpg" /><img alt="figure1.jpg" annotation="" id="image://19" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=68f2ff60e95f4b90e839036b9a75772ce52c6d3f&id=19&width=350&height=350&download=0" title="figure1.jpg" />

      Conclusion/Implication/Recommendations: These results suggest that using an EMR application facilitates the integration of medication data from an HIE network into clinical activities. Further research should explore the heterogeneity between commercial EMRs in terms of integrating data from HIE networks.

      140 Character Summary: The level of medication data usage from the HIE network was higher when clinicians used an EMR versus a Viewer application

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      • Abstract
      • Slides

      Purpose/Objectives: The focus of ReDiLink is to investigate the standardized collection and transfer of Cancer Systemic Therapy (CST) data from provincial Drug Information Systems (DIS) into the provincial Cancer Registry Information System (CRIS). From a Department of Health and Wellness perspective this represents the first use of the DIS for linkage to other data sets and will start the process of understanding impacts and opportunities for how this system can be used to support provincial level drug surveillance, both from a technical and clinical perspective.

      Methodology/Approach: The purpose of ReDiLink is to explore the use of provincial DIS data to identify CST drugs dispensed at community based pharmacies and to link this information with the provincial CRIS. Trained cancer registrars will review the DIS data along with electronic patient records, hospital discharge and other sources of information already available to them to assemble a summary profile of CST treatment for the patient.

      Finding/Results: Findings of the study are currently being evaluated, but will be complete and able to be shared by June 2017.

      Conclusion/Implications/Recommendations: At the end of the pilot we hope to have achieved the following for DHW: -Creation of a standardized DIS dataset extract -Start the process of understanding impacts and opportunities on how DIS data can be used to support provincial level drug surveillance. -Developed an efficient, automated and timely process for population level collection of data -Understanding of capacity to compare drug surveillance across provinces and at a national level. -Awareness of the resource requirements for collecting drug surveillance data (in-hospital and community). The results from the pilot project will help inform the process to integrate the DIS data into the provincial data warehouse, so it can be used for purposes such as health system planning and research.

      140 Character Summary: Pilot project of NS Dept.of Health and Wellness & NS Health Authority to compare Cancer Systemic Therapy data from DIS & the Cancer Registry Information System.

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  • OS30 - Novel Education Models (ID 35)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical
    • Presentations: 6
    • Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 205B
      • Abstract
      • Slides

      Purpose/Objectives: The purpose is to present how the leadership teams at the HITS eHealth Office at Hamilton Health Sciences and Mohawk College’s Institute of Applied Health Sciences have partnered to integrate the Training environment for ClinicalConnect™, the Regional Clinical Viewer for the connecting South West Ontario Program, into the College’s nursing and health science programs.

      Methodology/Approach: The presentation will include an overview of the process the College and the HITS eHealth Office followed, based on Canada Health Infoway’s Change Management Framework, to make ClinicalConnect available to students as part of their health sciences curriculum. The presentation will highlight key elements from the project plan and describe how the HITS eHealth Office built customized, simulated test patient records in alignment with the curriculum requirements to provide maximum benefit for both faculty and students. The presentation will close with a summary of how ClinicalConnect is being used by faculty and results to date. We believe this is one of the more unique academic/healthcare partnerships, in that Mohawk College’s health sciences students learn how to gather fictitious, but clinically-accurate, patient results from disparate sources, using the Training environment of a real-life digital health tool, to develop critical thinking skills early on in their careers.

      Finding/Results: Since the introduction of ClinicalConnect into Mohawk College’s Registered Practical Nursing and the BSc.N undergraduate programs in January 2016, feedback from faculty and nursing students has been overwhelmingly positive. Victoria Labadia, a Transformational Analyst at the HITS eHealth Office who has provided education support during the first phase, says “staff and students alike are well-engaged and motivated to access electronic health information from ClinicalConnect, and immediately see how this eHealth tool can help make better informed decisions.” This presentation will explain the unique and innovative way to facilitate student nurses’ adoption and integration of technology into practice using ClinicalConnect [Training environment]. Students learn how to access their patients’ data from multiple sources from one eHealth tool, ClinicalConnect, to help complete the patient picture, while honing their critical thinking and decision-making skills to develop the most efficient and effective care plans with all the information readily available. This ability to consider patient health information from multiple sources – hospitals, CCACs, provincial data repositories – as part of care planning is key as the healthcare system moves to provide more care in community-based settings. In addition, in line with the Ontario Ministry of Health’s “Patients First” Action Plan, students learn how digital health tools can be applied to provide the best patient experience possible. Patient benefits can include avoiding duplicate testing that often results in unnecessary discomfort, potential loss of income and increased cost due to travel, as well as not having to repeat their medical history because their results are available in ClinicalConnect.

      Conclusion/Implication/Recommendations: This learning opportunity is significant; we are developing what we hope is a gold standard for technology integration into academic programs, one that we hope can be rolled out in other academic environments in the region.

      140 Character Summary: How simulated EHR is integrated into curriculum at local college to arm future nurses for real world practice using real world eHealth tool.

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    • OS30.02 - Peer-To-Peer: All About People & Process When Advancing Digital Health (ID 228)

      Anne Fazzalari, Clinical Adoption, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: A national program engaging physicians, nurses, pharmacists & clinic managers has been instrumental in advancing clinician adoption, use & optimization of digital health solutions across Canada. The panel will share how unique local initiatives are contributing to a national program that has evolved to incorporate advanced clinical eFunctions and patient eServices. Emerging evaluation results will be shared with the audience, as well as share success stories and lessons learned along the digital health optimization journey.

      Methodology/Approach: Digital health is an enabler for clinicians to provide patient/person-centered care and interprofessional practice. The panel will share details of their respective Peer-to-Peer Networks and how clinicians are supporting one another in the implementation, adoption and optimized use of digital health solutions in their clinical settings. Clinical Peer Leaders will discuss the role and value of the mentoring colleagues, available resources for clinicians along with evaluation results and project outcomes. Also, Peer Leaders will share their stories of their clinical transformation journey and how strategic digital health initiatives have benefited from the Peer-to-Peer Networks.

      Finding/Results: Program and clinician focused outcomes will be shared with participants, including the current state of local Peer Networks across Canada, their strategies and achievements for developing clinical capacity, leadership & outcomes. Results of evaluations to date will be shared, including the fact that over 90% of Peer Leaders felt they can positively support and impact colleagues to use technology effectively in a practice setting. As a result of participating in the peer-to-peer session, 84% of colleagues felt that they have improved their skills and 77% have improved their confidence when using digital health solutions. Interdisciplinary perspectives will be shared around how Peer Leaders addressed change management challenges and opportunities, providing a landscape of how clinical adoption and optimization of digital health has evolved in Canada.

      Conclusion/Implications/Recommendations: The implementation of digital health solutions is likely the most complex and powerful transformation in clinical practice and delivery of health care services this century. It requires a team based approach of all stakeholders and at all levels. Critical to success are people & process: clinician leadership, engagement and most importantly the use and integration of these systems in practice to support decision making and improve patient/client outcomes. This panel will discuss the sustainability of their projects and demonstrate successful collaboration to advance digital health initiatives.

      140 Character Summary: All about people & process when advancing digital health: panelists share success stories, lessons learned & emerging evaluation results about their P2P networks

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    • OS30.03 - A Conceptual Model for Increasing EMR Use Through End-User Support (ID 128)

      Gurprit Randhawa, Victoria/CA

      • Abstract
      • Slides

      Purpose/Objectives: The adoption and use of electronic medical records (EMR) is a priority for the Canadian health care system. Improved provider effectiveness and health outcomes require better adoption of advanced EMR features by primary care physicians (PCP). However, the majority of PCPs do not fully adopt these advanced features. The literature widely suggests that end-user support (EUS) is a critical success factor for increasing EMR use (i.e., overall use of all EMR features). EUS is any information or activity that is intended to help physicians solve problems with and better utilize their EMR. However, many PCPs must learn the true capabilities of their EMR with little effective EUS. Existing research in EUS is limited and is inconsistently described and measured, which impedes efforts to improve EUS quality and EMR use. Additional research on the relationship between EUS and EMR use is also required.

      Methodology/Approach: To explore the relationship between EUS and EMR use, the EMR End-User Support (EMR-EUS) model (Figure 1) was developed following a review of conceptual and theoretical frameworks related to technology adoption/use and EUS. <img alt="emr eus model.jpg" annotation="" id="image://20" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=ebce521215e673e27ff09ab2bcf92f383ba4fe03&id=20&width=350&height=350&download=0" title="emr eus model.jpg" /> Figure 1. EMR End-User Support (EMR-EUS) Model The EMR-EUS Model is based on Venkatesh et al.’s (2003) Unified Theory of Acceptance and Use of Technology (UTAUT) and Shachak et al.’s (2011) theoretical framework for describing and characterizing EUS for Health Information Technology (HIT). The UTAUT model is a widely-cited, comprehensive model that was developed following a meta-analysis of eight theories of technology acceptance and use. The theoretical model by Shachak et al. (2011) was developed based on a scoping review of the literature. Together, these two models were amalgamated to create the EMR-EUS model.

      Finding/Results: The EMR-EUS model contains seven EUS components that affect EMR use by PCPs (highlighted in yellow in Figure 1). These include: (a) one core construct (facilitating conditions), (b) four antecedents of facilitating conditions, and (c) two moderators. “EMR use behaviour” is the key outcome of this conceptual model. The aforementioned antecedents exert equal influence on facilitating conditions, and facilitating conditions directly impacts EMR use behaviour.

      Conclusion/Implication/Recommendations: This presentation contributes a conceptual model for exploring the relationship between EUS and EMR use that is based on existing technology adoption/use theories in the literature. This model may be applied by researchers, practitioners, or decision-makers to design EUS interventions and examine their effects on EMR use. Additional research is needed to test this conceptual model.

      140 Character Summary: Researchers, practitioners, or decision-makers can use the EMR-EUS model to explore the relationship between end-user support and EMR use.

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    • OS30.04 - Radiology Peer Review Implementation: Improving Quality and Enabling Collaboration (ID 121)

      Jisla Mathews, Joint Department of Medical Imaging, University Health Network ; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Canadian Association of Radiologists defines peer review as a process of self-regulation that aims to maintain standards, improve practice and preserve service reliability. Over the last 5 years, we have implemented the radiology peer review program at our hospital as well as several academic and community-based hospital settings across the province. The primary objective of the peer review program implementation is to enable radiologists to identify and share opportunities for collective growth in their practice, resulting in greater overall quality of care for patients. At its core, the program is enabled by an internally developed, integrated peer review and image quality evaluation tool regularly updated based on feedback from radiologist users. Additional components of the program include establishing customized peer review processes, program governance and developing a policy manual to formalize expectations of peer review with a non-punitive, educational focus.

      Methodology/Approach: The program implementation approach involved active engagement from three groups of stakeholders: a steering committee to provide strategic oversight of the project, comprised of radiologist and administrative leaders; a radiologist working group involved in the design of peer review processes customized to their environment; and an IT working group, involved in the implementation of the software itself. Based on the department’s size and case volume, peer review processes were developed and documented. This included both a process to perform peer review, using a 4-point scale (0-Great Catch, 1-Overall Agreement, 2-Minor Discrepancy, and 3- Major Discrepancy) as well as a process to translate learnings into future practice. Establishing the program’s design and governance structure involved identifying smaller groups of participating radiologists, either by division or modality, and designating a Quality Lead for each group. In developing the Learning Process, special attention was paid to designing Quality Rounds, which are forums led by Quality Leads, where anonymized peer review cases with potential educational merit are reviewed to allow for non-punitive learning and continuous improvement. A peer review policy manual was developed to serve as the reference document for the aforementioned processes. Prior to launch, all participating users were trained on using the software and familiarized with the peer review workflow. Effective transition to operations depended on facilitating communication and change management within the radiologist team.

      Finding/Results: With 100% user adoption, the program was successful in promoting education and collaborative learning among radiologist teams. The radiology peer review tool’s data analytics module has enabled radiologists to track their department’s performance, in terms of reduced discrepancies, over time. Key to the success of the peer review program is enabling users to participate in peer review processes with minimal interruption to their clinical workflows and providing a framework that enables translation of learning from peer review into future practice. This model has been successful not only within our hospital, but also at multiple academic as well as community-based hospital settings across the province.

      Conclusion/Implication/Recommendations: When implemented as part of a broader quality improvement framework, radiology peer review proves to be not just a quality assurance tool but also an enabler of collaborative learning and change.

      140 Character Summary: Peer review, within a quality improvement framework, proves to be an important quality assurance tool that enables collaborative learning among radiologist teams

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    • OS30.05 - Peer Network Collaborative Learning Enhances Health Information System Quality (ID 217)

      Rita Wilson, RNAO, RNAO; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Many healthcare organizations struggle to implement health information systems (HIS) with limited informatics knowledge and skills. Considering that approximately seventy percent of these implementations fail, it is important to explore innovative models that can be used to build organizational informatics capacity and increase the likelihood of success. Collaborative learning is one such model that is increasingly being recognized as an important contributing factor to successful HIS implementations. This presentation describes a collaborative peer network that was established to build organizational informatics capacity to facilitate the integration of advanced clinical e-Functions within four different HIS: Meditech, Procura, EPIC and PointClickCare.

      Methodology/Approach: Four organizations participated in the initiative. The collaborative peer network, which was part of a broader pan-Canadian peer-to-peer program, consisted of six nurse peer leaders (NPLs) employed within the organizations. They each received formal in-person education and training to lead and support the initiative within their organizations. The education was provided by the project sponsor and two health informatics consultants contracted for the project. The in-person sessions were supplemented by a virtual community of practice and weekly virtual meetings that afforded the NPLs multiple opportunities to acquire new knowledge, share best practices and additional resources to meet the project deliverables. At various points of the project the peer network brought together healthcare leaders, nurses, other healthcare providers, health information technology personnel and decision support staff from the four organizations to enhance their informatics knowledge, skills and abilities to effectively lead and support the integration of the advanced clinical e-Functions within their respective HIS. Three components comprised the advanced clinical e-Functions: (1) evidence-based order sets built as decision support resources; (2) standardized terminology language used to capture and retrieve clinical data for technology-enabled outcome evaluation; and (3) e-Clinical analytics to monitor structure, process and outcome indicators and evaluate the impact of using the order sets on health outcomes.

      Finding/Results: The NPLs participated collaboratively as a learning community throughout the project enabling them to share resources, knowledge and experiences with each other and with their peers within their own organizations. The NPLs also obtained help and guidance from each other to develop their project plans and the methodology used to integrate the order sets and the standardized terminology language within their HIS. Using this approach also helped them to identify solutions to potential barriers; thereby, mitigating possible risks to their implementation. All participating healthcare organizations met their implementation deadlines and achieved successful end-user adoption.

      Conclusion/Implication/Recommendations: The peer network highlighted the benefits of collaborative learning within the context of eHealth and demonstrated its potential to increase the success rate of HIS implementations. It provided opportunities to enhance the informatics knowledge, skills and abilities of clinicians and healthcare leaders and facilitated the sharing of best practices among participating organizations to optimize their adoption of advanced clinical e-Functions. Collaborative learning may be an ideal approach for organizations participating in a multi-site HIS implementation. It may also prove to be an invaluable strategy for smaller health care facilities in primary care settings and rural areas with limited resources.

      140 Character Summary: This presentation will report on a collaborative approach used by four healthcare organizations to optimize their health information system.

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    • OS30.06 - A Sum of its Parts: National Peer Network Program Evaluation (ID 229)

      Anne Fazzalari, Clinical Adoption, Canada Health Infoway; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: This interactive session will provide an overview of emerging evaluation results from a national program, building upon the success and outcomes from various local Peer-to-Peer Network initiatives focused on advanced clinical eFunctions and patient eServices. Emerging themes from various project evaluations will paint a picture of clinical engagement and optimization of digital health in Canada.

      Methodology/Approach: Canada has a national program that brings together clinicians to support the achievement of clinical value from digital health solutions. Outcomes from various partnerships across the country will be shared with conference participants – the stories of the people engaged, the interprofessional collaborative processes that ensued and the resulting outcomes, including best practices and lessons learned.

      Finding/Results: Quantitative and qualitative analysis from national program findings will be shared, including updated survey results from physicians, nurses, pharmacists and other health care providers participating in the national Peer Network program. For example, 90% of Peer Leaders felt they can positively support and impact colleagues to use technology effectively in a practice setting. As a result of participating in the peer-to-peer session, 84% of colleagues felt that they have improved their skills and 77% have improved their confidence when using digital health solutions. Key informant interviews will also be discussed, along with resources to support clinicians using advanced clinical eFunctions and patient eServices.

      Conclusion/Implication/Recommendations: A synthesis of clinician stories, leading practices & lessons will be shared from a pan-Canadian perspective. Emerging evaluation results and themes will be discussed along with implications for sustainability. The importance of clinician engagement in digital health cannot be underestimated - participants will also be invited to share their own experiences, contributing to Canada’s dialogue on digital health.

      140 Character Summary: A sum of its parts - national Peer Network program evaluation: learnings about people & process along the digital health journey

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