Purpose/Objectives: Engaging patients in the self-management decision-making provides opportunities for positive health outcomes. The process of shared decision-making (SDM) is touted as the pinnacle of patient-centred care, yet it has been difficult to implement in practice. Access to tools resulting from the integration of all health data and clinical evidence, and an ease of communications with care providers are needed to engage patients in self-management decision-making. Personal health record (PHR) technology is a promising approach for overcoming such barriers. To-date, few studies, and no systematic reviews, have addressed the design and implementation of SDM with the use of PHR technology. Yet, for an intervention to be effective in engaging patients and supporting SDM, the system must be designed around that purpose [1]. This paper summarizes the design of a system for SDM via PHR, discusses the implications of the system, and suggests future work.

Methodology/Approach: A scoping review of the SDM via PHR literature was completed to map the literature in terms of system design and outcomes. A conceptual framework developed from recommendations of relationships between characteristics and elements of the SDM process and key enabling PHR functions by patient activity was used as the foundation for a functional model. Interpretive analysis and synthesis of the literature was carried out and a design of a system for SDM via PHR, including commended PHR architectural type and enabling functionality of PHR for SDM was identified.

Finding/Results: The scoping review identified a scarcity of rigorous research on SDM via PHR but with an increasing appearance in published literature. Electronic health record systems offer an enabling structure to SDM [2][3]. The interconnected PHR architecture was identified as ideal, transformative, and collaborative, and likely the future of healthcare. Along with other identified, important system functions, a functional model for an integrated shared decision-making–personal health record (iSDM-PHR) system was revealed. Its ecosystem is defined by its core components and complemented by autonomous integrated applications whereby data is kept separate from the applications, enabling greater innovation in the applications [4], and built on standards for privacy and security and data exchange. To exchange data, applications use a common messaging system; an ideal structure for timely, asynchronous communication in a decoupled setting [5]. Patients access the system anywhere, anytime using any device with internet access.

Conclusion/Implication/Recommendations: The interconnected PHR’s potential to be a transformative and pervasive as a technology lies in its ability to provide quality, completeness, and accessibility of information and knowledge, synchronous and asynchronous patient-provider communications, decision making tools, and auto-population of reusable content. These capabilities shift the control of health information and care management to a shared model [6]. Undoubtedly, the real value of a PHR lies in enabling action such as SDM [7]. SDM is a collaborative process, whose barriers to integration into practice may be overcome with the use of intelligent, ubiquitous PHR technology. The iSDM-PHR architectural and functional model may be used as a foundation for further system design and implementation research and novel evaluation approaches of such innovations are essential next steps.

140 Character Summary: This presentation describes the design and implications of a system for shared decision-making via personal health record technology.

Purpose/Objectives: The privacy discourse often reflects the views of healthcare providers and academic commentators, but not patients. The patient perspective on privacy is not well understood, yet patient privacy concern is often cited as a barrier to the adoption of health information technology (HIT). The purpose of this systematic review is to characterize the patient perception of health information exchange (HIE) privacy and identify the drivers and implications of patient privacy concerns.

Methodology/Approach: A systematic review was conducted on seven health sciences and interdisciplinary databases. To be included, the study must: assess the patient perception of privacy in context of HIE or interoperable health HIT; be a primary study with a quantitative approach; and be conducted after 2004. All articles were independently screened and extracted by two reviewers. The results were extracted and categorized based on the dimensions outlined in the Antecedent Privacy Concern Outcomes framework.

Finding/Results: Thirty-four of 1713 citations met the inclusion criteria. Ten articles focused specifically on privacy. Percentage concerned about privacy was the most commonly reported measure (n=11) with results ranging from 15% to 78%. A majority of participants in three studies (50%, 64%, 75%) agreed that the benefits of HIE outweigh privacy risks (i.e., privacy calculus). Privacy calculus was validated in four studies. Privacy concern was a dependent variable in 13 studies. There was inconclusive evidence on how, or if, demographics was associated with privacy concerns. There was no research on the effects of privacy experiences and privacy knowledge. One study found that experience with HIE is associated with reduced concerns, while the another found the opposite; however, the participants from the latter study wanted continued access despite the increased concerns. Awareness of provider use of HIT had no effect on concerns. Increased information control, positive attitude towards HIE, satisfaction with healthcare, and trust in healthcare providers are other antecedent factors associated with less privacy concerns. Privacy concern was an independent variable in 18 studies. Those with privacy concerns were less likely to see value in HIE, use HIT, and trust the healthcare system. Moreover, they were less willing to share their information, and more likely to engage in protective behaviours. There is inconclusive evidence on whether privacy concerns reduce an individual’s intention to use HIT and support HIE as some studies reported no effect.

Conclusion/Implication/Recommendations: Patient privacy concern is not absolute as it varied depending on study and context. Despite evidence positioning privacy concerns as a barrier to HIE acceptance, these studies should be interpreted with caution as a vast majority of these studies are hypothetical and little context was provided on how knowledgeable participants were of HIE and its safegaurds. The privacy calculus highlights the importance of these factors as knowledge of benefits could offset the effects of privacy concerns. Future research should place greater emphasis on understanding the effects of these under-explored antecedents (e.g., knowledge, attitudes, trust, self-efficacy, etc) on privacy concerns. Furthermore, policy efforts should begin framing HIE as a public good and focus on raising awareness and building trust through public engagement initiatives.

140 Character Summary: Patient privacy concern is contextual. Research and policy should focus on how antecendent factors (i.e., privacy calculus) can offset effects of privacy concern.

Purpose/Objectives: In order to improve access to crucial patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In 2018, a law will require German physicians to create emergency datasets at the request of their patients. As a basis, the German Medical Association developed a medical emergency dataset (MED), which may store information on contact persons, prior diagnoses, medications, allergies, implants and other relevant emergency information. The MED is intended to be physically stored on the German Electronic Health Card (EHC) by authorized health professionals, and can only be decrypted with a German electronic health professional card. Consequently, access to MED will be limited to the area of Germany, and it will not be accessible by foreign health professionals when Germans are traveling abroad. Therefore, the aim of our study group is to evaluate how the MED may be used internationally. We explore this in two dimensions: is the MED content useful for non-German health professionals, and how would they prefer to access MED electronically.

Methodology/Approach: Within a project funded by the European Union and the Ministry of Health, Emancipation, Care and Aging of North-Rhine Westphalia a multi-phase study is conducted to test the possible use of the MED in different countries. The basis of this study is an evaluation, which was conducted in Germany in 2014. Within this study 13 primary care physicians developed a total of 64 emergency data sets. Afterwards the usability and potential benefit of the completed data sets were assessed by emergency care providers (14 clinicians, 14 emergency physicians and 9 paramedics) based on a semi-standardized questionnaire. Since the necessary telematic infrastructure is not yet established, the evaluation process was performed paper-based. To evaluate whether the MED may also be used in an international context, in 2016 / 2017, a second evaluation unit will be carried out in British Columbia.

Finding/Results: Within the German study, a total of 64 MEDs were completed by 13 primary care physicians. 63 MEDs were presented to clinicians, emergency physicians and paramedics for evaluation; one data set was used for training purposes. Since each emergency data set was reviewed five times, a total of 315 assessments were performed. In more than 70% of the reviewed cases, all three groups rated the completed emergency data sets as very useful or useful. The greatest benefit was attributed to the information on diagnoses and medication. The international evaluation will start in early 2017, so the results are pending at this time.

Conclusion/Implication/Recommendations: Our present study provides a scalable method not only to test and validate the MED in the German context, but also expand this validation in Canada. The findings will help us to enrich the MED in Germany, and refine it to be useful for non-German health systems. Furthermore, the findings will guide us in our next step in the development of a secure technical solution that will make it possible to access emergency data across borders.

140 Character Summary: In order to improve access to emergency data a multi-phase study is conducted to test the possible use of the German medical emergency dataset in different countries.

Purpose/Objectives: Health Information Management (HIM) services include 1,395 staff members working across 35 clinical sites at four large health authorities across British Columbia. HIM staffs access clinical information systems and patient records to accomplish job duties; therefore, privacy training around the handling of patient information is critical. An audit conducted revealed several inconsistencies in privacy training, such as: 1. There is no standard procedure across the different sites for privacy training. 2. The privacy course module and confidentiality form records were retained differently depending on the type of record. 3. There is no method of tracking staff compliance to privacy training. As a result, a critical risk identified was that HIM staff could start work within a healthcare site without completing their privacy training. Project objectives consisted of: • A standardized privacy training process administered to all staff. • A way to track staff compliance with privacy training.

Methodology/Approach: In June 2015, Standard Operating Procedure was circulated to HIM staff to provide clear guidelines around the administration of the privacy training. This allowed for consistencies in the type of training received by each employee. Further, the privacy training course and confidentiality form were centralized together in an online module. The module served as a single-source method to track staff compliance, and monthly reports are generated and sent directly to each HIM manager advising them of staff that has not yet completed their training.

Finding/Results: Before implementation, there was a 35% compliance rate, and since implementation, there has been a 77% compliance rate amongst all HIM staff, indicative of a 42% increase in compliance. There was an increase in compliance rate each time communication was sent to staff around the importance of the privacy training. <img alt="him privacy compliance.png" annotation="" id="image://25" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=9b7529a6e65b0a4d5685e9f5ecfaa1cfb8a92ca8&id=25&width=350&height=350&download=0" title="him privacy compliance.png" />

Conclusion/Implications/Recommendations: Challenges involved clarifying the responsibilities around privacy training between HIM and the multiple health authorities. There were several consultations with stakeholders to discuss process improvement around the administration and tracking of privacy training. There were also several iterations of the report automation from the course module due to unexpected challenges with user login IDs. Feedback has been extremely positive since this initiative launched, and PHC as an entire health organization has adopted a similar process in June 2016. Future plans involve promoting a culture of privacy through a communication strategy in November 2016. The goal of this initiative will be to reach a 100% compliance rate and further develop HIM as a leader in data stewardship and patient privacy.

140 Character Summary: The implementation and results of a compliance tool to track health authority staff to mandatory privacy training and the signing of a confidentiality agreement.

Purpose/Objectives: Pharmacists in Primary Care increasingly rely on Electronic Medical Records (EMRs) to support patient care. EMRs are associated with increased quality of patient care, reduced healthcare errors, and enhanced appropriateness of care.1 In Canada, commercially available EMRs are physician-centric and not aligned with pharmacist logic or documentation needs for clinical and collaborative practice. The Pharmacists Clinic team at the UBC Faculty of Pharmaceutical Sciences has been working with a software specialist to design, modify or build, and pilot 3 new pharmacist-specific modules in the OSCAR EMR: the Medication module, the Disease/Indication module, and the Healthcare Team module. The purpose of this presentation is to share the clinical, administrative, and workflow lessons learned from a pharmacist perspective in a growing and innovative area of practice. 1. Canada Health Infoway from https://www.infoway-inforoute.ca/en/

Methodology/Approach: The approach to determining the clinician needs and priorities for EMR modifications were done in a comprehensive and iterative way. An analysis of pharmacist-best practices and needs in primary care was conducted, including an examination of the scope of practice and anticipated growth based on regulatory changes. Modifications to the EMR were also prioritized based on an environmental scan of other primary care practices across North America in the literature. We established a standardized ticket-based approach for communication between clinicians and software specialist. A clinic IT Lead was tasked with piloting any modifications and working directly with the software specialist. Once testing was complete, the modifications were shared with the rest of the clinician team, training sessions were scheduled, and updates to the necessary administrative documents (policy and procedures, training packages) were done. Modifications were then submitted to OSCAR Canada for review with the goal of being incorporated into future OSCAR releases.

Finding/Results: The modules have been integrated into the workflow of the Clinic for over 3800 patients. The pharmacist-specific EMR modifications were an innovative way to monitor patient clinical statuses and assess key performance indicators among others. Pharmacist logic in a comprehensive assessment required the most design changes to the Medication Module. Unexpectedly, significant modifications to other areas of the EMR were required to create a more “interprofessional-friendly” application rather than pharmacist-specific. The Medication module was structured in a best-possible medication history format, including prescriber and disease indication. The Disease module uses indication-based prescribing and has over 330 ICD9 disease codes translated into patient-friendly synonyms. The Healthcare Team module indicates other healthcare professionals involved in the patient's care, such as a community pharmacist or nurse. In the first year, clinicians linked 4510 medications to 905 disease indications (20%). This increased to 72% in the second year with 6334 medications linked to 4567 disease indications. In addition, over 71% of patient records have more than 1 documented healthcare team member.

Conclusion/Implication/Recommendations: There are significant changes occurring in primary care and pharmacist scope of practice that necessitate the growth of traditional EMRs. The lessons learned from the development and piloting of new EMR modifications by the UBC Pharmacists Clinic can provide invaluable lessons for any team.

140 Character Summary: The Pharmacists Clinic at the UBC Faculty of Pharmacy has designed, modified, and built 3 modules in an EMR: Medications, Disease/Indications, and Healthcare Team.

Purpose/Objectives: The main purpose of this proposal is to introduce a secure e-Prescribing system, which can create digital format prescriptions and transmit them to pharmacies. This system has some features including preserving the privacy of both patients and physicians, decreasing the number of medication errors occurring in traditional paper-based prescribing, checking patients’ allergies and reviewing adverse drug reactions before prescribing.

Methodology/Approach: The proposed e-prescribing system is using cryptographic tools such as proxy signatures, group signatures and a well-known wireless communication technology, Near Filed Technology (NFC). Using of these digital signatures is intended to hide the real identities of patients and physicians from pharmacies and drug companies to preserve their privacy. Group signature is set up by a trusted group manager to use by physicians for signing prescriptions. The group manager is able to revoke signatures of physicians in case of any future disputes. This group signature is adopted from the short group signature. Proxy signature is using by the patient in order to sign the prescription and delegate her right to other qualified parties. The proposed system is implemented as a mobile application to benefit from NFC technology as a proof of identity when collecting prescriptions at pharmacies.

Finding/Results: Results include a mobile application for the patient and a web-based application for the group manager, physicians, pharmacies and insurance companies. Each of these entities can log into the system and based on their roles they have different panels with different menu options to choose. The mobile application is used by the patient to see her prescription, verify its content, and then sign and send it to the pharmacy.

Conclusion/Implication/Recommendations: Because of several difficulties and privacy concerns for both patients and physicians in the traditional paper-based prescription, it is necessary to think about using digital technologies in prescribing to improve the old-fashioned means of prescribing. This proposal introduces one of these systems, which can prevent medication errors and preserve the privacy of the users.

140 Character Summary: This proposal introduces an e-prescribing system, which can create digital prescriptions and transmit them to pharmacies while preserving privacy of users.

Purpose/Objectives: Chronic diseases such as cardiovascular disease, chronic respiratory disease, diabetes, and cancers are the leading causes of morbidity and mortality in the world. Also, the high prevalence of chronic diseases has led to a rise in number of people with multiple chronic disease (comorbidities), which is the co-existence of two or more diseases. The risk factors of chronic diseases are well known and established, whereby most chronic diseases share a common set of modifiable and non-modifiable risk factors. Therefore, chronic diseases are largely preventable by means of early and effective interventions that target the modifiable risk factors, such as unhealthy diet, physical inactivity, and smoking. Chronic disease risk prediction algorithms are becoming more common in healthcare and can assist individuals in evaluating their risk of developing a chronic disease. In this research, we investigate a digital health-based framework for citizens to monitor their risk for chronic conditions. Our idea is to model and computerize a range of validated chronic risk assessment algorithms and questionnaires. With personal health data as input, the model will assess the citizen’s risk of the common chronic diseases and accordingly categorize them into different risk categories of chronic diseases for subsequent treatment options. An important aspect of the research is to investigate the integration of multiple risk scores (for multiple chronic diseases) into a single risk scale to provide an assessment of the individual’s overall health status and risk of comorbidities. We propose to develop a health-based dashboard that can provide an individual with an up-to- date account of their health status with respect to the common chronic diseases. The objective of this research is to provide individuals with the necessary tools and resources to evaluate their risk of chronic disease, risk of comorbidities, overall health status and informing them how to manage their health and modify risky behaviours to prevent the occurrence of chronic diseases.

Methodology/Approach: The process of developing the health-based web tool is based on an iterative approach and informed by evidence-based research, clinical practice guidelines, and patient-centered care models. We use a knowledge management approach to model, computerize, and integrate a number of validated chronic disease risk assessment algorithms to generate personalized health risk profiles.

Finding/Results: The result was the development of Know Your Risk health dashboard – a health-based web tool for citizens to monitor and evaluate their overall health status and risk of the common chronic diseases. We plan to conduct a usability study by testing Know Your Risk dashboard with representative users to determine how they will interact with the dashboard. We will collect and analyze qualitative and quantitative data throughout the study to identify any issues of usability from a user’s perspective.

Conclusion/Implications/Recommendations: The overall aim of this research is to develop a digital health-based framework to support the lifetime healthcare of citizens and engaging them in proactive care to prevent the occurrence of chronic diseases. By providing the necessary tools and resources across the continuum of care, we intend to empower citizens in monitoring and managing their health.

140 Character Summary: Know Your Risk health dashboard provides individuals with the necessary tools and resources to monitor and evaluate their health status and risk of chronic diseases

Purpose/Objectives: The purpose of this presentation is to describe the design of eHealth breastfeeding resources for mothers and co-parents, addressing the needs of target populations with lower breastfeeding rates, young and single mothers and Indigenous families.

Methodology/Approach: A participatory model was used in this two phase study. The first phase included creating an eHealth resource for mothers and fathers/partners. A needs assessment was conducted and the resource was created based on the feedback provided by the target population. The second phase of the study included designing two additional versions of the resource. Members of the target populations and health providers who work with these populations were consulted regarding their suggestions for adaptations to the original course to meet the needs of young and Indigenous families. Once the resources were completed they were piloted with members of the target populations and health professionals.

Finding/Results: In Phase 1, the resource was piloted with mothers, fathers and health professionals. The users' feedback indicated they liked the inclusion of information specifically for fathers/partners as well as the content, design and usability. In Phase 2 the modified resources were piloted with young, single and Indigenous mothers who indicated the eHealth resources were culturally relevant, interactive and provided information in a variety of formats.

Conclusion/Implications/Recommendations: <img alt="indigenous png.jpg" annotation="" id="image://12" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=add672a184bca9d47055a503712e0dbb4a688d69&id=12&width=350&height=350&download=0" title="indigenous png.jpg" /><img alt="young mothers.png" annotation="" id="image://13" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=16b526b4ac0a11558a84742b9bfc3a7bccbf2996&id=13&width=350&height=350&download=0" title="young mothers.png" />Including the target populations in all phases of the design and development of eHealth educational resources ensured they were meeting the needs of the target populations. eHealth resources provide parents with the ability to access information based on their individual needs, at a time and location of their choosing. Interactive components such as games, quizzes, narration, videos, illustrations and text accommodates parents with a variety of learning styles. Ongoing evaluation of the resources will ensure they are continuing to meet the breastfeeding and co-parenting educational needs of the target populations.

140 Character Summary: eHealth resources were designed and created based on input from members of the target populations, fathers/partners, young mothers and Indigenous families.

Purpose/Objectives: To evaluate the efficacy, usability, and accuracy of public reporting of immunization histories using a web application.

Methodology/Approach: A mixed methods approach including qualitative and quantitative evaluation tools including: · Repeated longitudinal usability studies during the development of the web application have been completed using a sampling of members of the target demographic (parents of school-aged children) using scripted use-case scenarios. · Pre and post exposure questionnaires administered to the same population sample to capture technical competency, vaccine attitudes, and impressions of the web application prototypes. · Quantitative evaluation of accuracy and completeness of submitted data from the public using synthetic personal health information from the usability scenarios. · Semi-structured interviews with different stakeholder groups including public health personnel, primary care clinicians, and parents of school-aged children.

Finding/Results: While final results are still pending, preliminary results from the ongoing usability studies indicate that many members of the target demographic are willing and able to accurately and completely report immunization histories for themselves and their school-aged dependents. Continuous testing of successive iterations of the web application have produced evidence of stepwise improvements to user satisfaction and quality of captured data. Qualitative feedback indicates a strong interest in the target demographic in such a tool and a high intent-to-use has been shown. Preliminary evaluations of submitted data show reasons for concern as some users have demonstrated difficulty interpreting and accurately transcribing technical-medical information such as immunization agents. Indicators show evidence that continuous improvement of the user interface has resulted in improved user comprehension and improved quality of captured data has followed.

Conclusion/Implication/Recommendations: The web application evaluated here shows promise to meet its objectives of providing a simple and structured tool for parents to submit immunization histories. An ongoing challenge for this project is the iterative improvements to the user interface that will help guide users to enter accurate and complete immunization histories and thus minimize administrative overhead by public health personnel who must vet submitted data before submission to the provincial database.

140 Character Summary: Can the public accurately report immunization histories using the web? We evaluate a new web application that has been developed to facilitate this in Ontario.

Purpose/Objectives: Digitial health interventions have tremendous potential to help patients with chronic health conditions manage their symptoms and stay on their medication regimens. For asthma patients, adherence to controller medications is a significant problem. In addition to increasing the risk of asthma attacks, lower controller adherence also increases the use of rescue inhalers resulting a series of unwanted side effects. To help patients better manage their medications, MEMOTEXT, in conjunction with PerformRX and AmerihealthDC, developed HealthNHand, a pilot digital personalized adherence and support program for asthma patients with the goal of improving adherence to daily controller medication while decreasing the need for rescue inhalers.

Methodology/Approach: Using real time data from patient self-report (inc. mood, quality of life, perceptual barriers to adherence) and objective data sources (e.g prescription claims data, real-time blood glucose levels), HealthNHand provided patients with personalized and targeted support as well as daily air quality forecasts delivered via text (SMS) message.

Finding/Results: Using this data-oriented personalization approach, controller medication adherence improved in more than 50% of patients who entered HealthNHand as poor adherers. Even more encouraging, over 80% of patients who were high rescue inhaler users prior to enrollment reduced their use while participating in HealthNHand. The program had a strong retention rate of 87.5%.

Conclusion/Implications/Recommendations: This pilot program showcases the power of digital health interventions to improve the lives of patients with chronic illnesses. The use of similar interventions,which tap into the power of patient data, in other chronic conditions should be explored as scalable, efficient ways to improve patient outcomes.

140 Character Summary: Data-centric, personlized digital health program helps asthma patients improve use of controller medications