Purpose/Objectives: To demonstrate the effectiveness of the SickKids Pre-Anaesthesia Department’s use of telemedicine video conferencing technologies by presenting data which shows savings in internal and external costs,such as travel and time. The Hospital for Sick Children (SickKids), is a paediatric research and academic health center in Toronto, Ontario, Canada that is dedicated to using innovative technology to improve the health of children in Canada.

Methodology/Approach: The SickKids Pre-Anaesthesia department and Telemedicine departments have been collaborating to provide telemedicine services to Canadian patients for over four years. Factors that show the value of this program to the hospital and to the patients will be discussed/analysed, including travel times and costs associated with patients traveling into the hospital. Further to this, Pre Anaesthesia optimizes a GuestLink technology into the patient homes to assess their surgical factors prior to surgery at SickKids. The Ontario Telemedicine Network (OTN) facilitates the network and video conference tools which allow pre-Anaesthesia consultants to connect remotely with Ontario patients. We will demonstrate the tools which provide these services and how they have changed over time, and how equipment changes have enabled a more cost effective means to deliver this service.

Finding/Results: Families were able to reduce costs, time spent away from work and school as well as eliminate excessive travel to Toronto prior to surgery. The Hospital for Sick Children has reduced equipment expenses and benefitted from the cost savings of reducing the number of patients coming into the hospital. The pre-Anaesthesia clinic has been able to employ technologies to pre-assess sick patients at home to determine eligibility for surgery and reduce the number of Operating Room cancellations.

Conclusion/Implication/Recommendations: Pre-surgical assessments made via Telemedicine can meaningfully reduce the tangible and intangible costs of hospital visits for both patients and the hospital itself.

140 Character Summary: The use of Telemedicine Technologies in the Pre-Anaesthesia Department at SickKids allows us to serve patients better.

Purpose/Objectives: The successful transition to virtually enabled care depends on clinicians' comfort with the technology and their competency to create a safe and comfortable virtual environment for their patients and other care providers. The aim of the survey was to identify the telehealth learning requirements of BC physicians, their current telehealth usage, and their preferred instructional format. The results will allow the Telehealth Education Team to develop and refine educational materials that will meet these identified needs, as well as reflect physician competencies that impact patient care. The Telehealth Education Team includes representatives from all of the BC Health Authorities and Splatsin Nation, a project sub-committee of the BCTDC (BC Telehealth Development Committee).

Methodology/Approach: A BC Physician Education Advisory Committee provided oversight to the development of the qualitative needs assessment. The online survey was hosted by Fluid Surveys in the form of a self-administered questionnaire. It was available to all BC physicians between April 29 and July 4, 2016. A variety of methods were used to engage participants including UBC CPD (Continuing Professional Development) and social media. The survey was composed of eight multi-select questions and one open-ended text response. Questions were categorized as Clinical, Technical, Administrative, and Basic Information.

Finding/Results: Of the 126 physicians that responded, notable differences were seen depending upon geographic location, current usage, and links to First Nations communities. The majority of respondents had not yet tried telehealth, but expressed an interest in doing so. Physicians indicated a clear preference for self-paced online learning modules, the ability to use telehealth from their offices, and to utilize mobile devices. Physicians also indicated a strong need for Best Practice and Guideline training.

Conclusion/Implication/Recommendations: The survey results will inform the development of content for the physician targeted telehealth education. UBC CPD, an accredited provider of the Royal College and College of Family Physicians of Canada will accredit, promote, and host the education material. The online module(s) will be developed by the Telehealth Education Team and will be eligible for Mainpro and MOC (Maintenance of Certification) credits.

140 Character Summary: A needs assessment was completed by 120 BC Physicians to identify their telehealth learning needs and preferences. Results to be presented.

Purpose/Objectives: The Hospital for Sick Children (SickKids), is a paediatric research and academic health center in Toronto, Ontario, Canada that is dedicated to using innovative technology to improve the health of children in Canada. Through a diverse range of videoconferencing technologies, the telemedicine program at sickkids has increased access operability and choice of technology solutions while ensuring a robust network of video connections nationally and internationally.

Methodology/Approach: SickKids has been vigorously working to explore and implement the full functionality of many common network and cloud based videoconferencing solutions. THe hospital’s networking infrastructure has been optimized to allow connections through the Ontario Telemedicine Network (OTN) in an “off-net” configuration as well as allow us to make the direct connections into IP based video codecs and bridges. Our primary source of connections initiate through our Cisco VCS infrastructure which allow us to make and receive both OTN and standard H323 configured connections. Additionally through this connectivity, we are able to create Virtual Meeting rooms through a subscription to a cloud-based video conferencing solution allowing us to extend our connections to users on a PC or Mac desktop platform anywhere in the world, H323 connectivity on a virtual bridge, via webcast links or even tablet-based utilization.

Finding/Results: By extending our connection options and capabilities, we have been able to support clinical and education/administrative connections across Canada to Jordan, the Caribbean, Pakistan, Israel, US, South Africa, etc. This has resulted in a __% increase in telemedicine activity and provides a more robust platform for end users to join Sickkids events in a more efficient, easily accepted manner. By creating a user-friendly on-line meeting tool the SickKids Telemedicine department has standardized on-line video connections across the organization creating cost-saving opportunities. By eliminating the large fees associated with hiring outside bridging companies, costs are reduced further. With the resulting increase in user uptake many clinicians now manage all aspects of their educations/ research and administrative video conferences in the hospital.

Conclusion/Implication/Recommendations: To expand Telemedicine services, organizations must explore and implement a broad and often nontraditional range of video conferencing solutions. Innovative uses of Videoconferencing can dramatically improve and expand an organization’s potential for successful information sharing for both clinical and educational purposes.

140 Character Summary: Using the Hospital for Sick Children’s videoconferencing technologies to provide innovative access across Canada and Internationally.

Purpose/Objectives: 1. Attendees will learn how to use EMR tools with built in clinical decision support to facilitate chronic disease prevention and management. 2. Attendees will increase awareness of enhanced use of the EMR to identify patients with chronic conditions. 3. Attendees will learn about the impact of having change management support in place to help increase the uptake of technology, including telehealth, and other clinical process improvements.

Methodology/Approach: Since January 2016, the Centre for Family Medicine FHT eHealth Centre of Excellence has been leading project QBIC (Quality Based Improvements in Care) 2.0. As an extension of the work that was completed in the initial phase of Project QBIC, three inter-related work streams are providing eHealth coaching sessions to help support clinicians with optimizing their EMR use, adopting telehealth and improving clinical processes aimed at improving access. These sessions promote and support: · Best practice in chronic disease prevention and management through the use of standardized tools. The QBIC team has partnered with various organizations and specialists on the development of EMR tools for CHF, COPD, Chronic Kidney Disease, Chronic Pain, Diabetes and Depression. · The integration of telehealth technologies into clinical practice. · Process improvements to enhance clinic workflow and access to primary care clinicians. The eHealth coaching sessions are also an opportunity to obtain input on EMR tools, build capacity, and identify champions. Finally, the team will evaluate the benefits and report on the impact of these services on patient care.

Finding/Results: To date, the QBIC team has engaged 240 primary care clinicians from 17 primary care organizations in Waterloo Wellington. Change management and IT support was provided to clinicians and has resulted in better identification of patients in the EMR, improved office efficiencies, the elimination of unnecessary notifications, and more effective use of the EMR. Initial results from activities on telehealth and improving primary care access are expected March 2017.

Conclusion/Implication/Recommendations: After clinicians were encouraged to document chronic diseases in a structured way and with support from an eHealth coach, 240 primary care clinicians in 17 primary care organizations improved their data quality, enhanced their chronic disease prevention and management and information management.

140 Character Summary: Project QBIC is improving the quality and optimizing the value of EMRs and other technology by providing support for clinicians through eHealth coaching sessions.

Purpose/Objectives: With 50 percent of provincial budgets consumed by healthcare and, knowing that 30 percent of health system resources are consumed by 12 percent of the population, healthcare demands disruptive scalable innovations that will provide a more efficient delivery of care. Today, patients managing chronic conditions do so for about 5,800 waking hours each year while typically spending fewer than 10 hours with a healthcare professional[i]. When technology empowers citizens to actively manage their chronic conditions it allows better, more efficient and meaningful collaboration with their care team, patients are healthier and it results in significant cost savings. [i] Department of Health, Research evidence on the effectiveness of self-care support (DH, 2007), as cited in In Search of the Perfect Health System, Britnell, 2015

Methodology/Approach: We will discuss how this technology improved self-management of chronic conditions, decreased usage of acute care and delayed onset of residential care for specific populations. We will also discuss how it allowed clinicians to prepare personalized monitoring plans, monitor health indicators, adjust to meet the patient’s evolving needs and identify warning signs early on and follow-up as necessary. By way of examples, we will illustrate how home health monitoring technology provides patients additional support and comfort, in their own home, in managing health issues. We will highlight current examples that might scale to achieve this goal.

Finding/Results: In addition to significantly reducing medical travel for patients and providers, we have established that home health monitoring was capable of reducing hospital admissions by 71 percent and ER visits by 43 percent. Patients participating in comparable home health monitoring project in other jurisdictions demonstrated increased self-care capacity and improved health, and health system utilization decreased by 76 percent resulting in potential cost savings associated with inpatient, emergency and physician services and nearly 100 percent of patients reported being highly engaged in their health and had an improved quality of life.

Conclusion/Implication/Recommendations: Home health monitoring technology is having a major impact on the chronically ill. Providing better access to patient health information, particularly for patients with chronic diseases or that are located in remote areas, has the ability to reduce healthcare system costs, improve patient satisfaction and overall population health. In home health technology lies an opportunity to expand into specific demographic populations, beyond addressing aging populations and individuals with chronic illnesses, to not only empower and provide peace of mind for patients, but also opens the door to all ages and most definitely to self-care management.

140 Character Summary: Healthcare demands disruptive innovations that will engage patients and improve outcomes for all Canadians

Purpose/Objectives: Demonstrate how in-home videoconferencing is utilized for clients with significant communication impairments Share success factors and challenges to utilizing in-home videoconferencing Provide several clinical examples of how videoconferencing is used

Methodology/Approach: The University Health Network (UHN) is a multi-site health sciences centre located in Toronto, Ontario, Canada that includes the Toronto Rehabilitation Institute (TRI). UHN’s Telehealth Program uses the Ontario Telemedicine Network (OTN) to provide specialized patient care and clinical consultation via videoconferencing to patients across Ontario and Canada. Toronto Rehab’s Augmentative and Alternative Communication (AAC) Clinic provides assistive devices to patients unable to speak. The communication devices are customized based on the patient’s functional abilities. The AAC Clinic is one of only a few clinics that assess and support adults with complex communication needs in Ontario. The AAC Clinic has been successfully utilizing OTN’s regional videoconferencing sites for many years to meet the care needs of their patient population. For some AAC patients, traveling to the nearest videoconferencing site is not an option due to transportation issues or health-related limitations. Recently, OTN implemented a new in-home videoconferencing service. This service allows clinicians to directly link to the patient’s residence using secure web based technology. The AAC Clinic has been utilizing this option since September 2015 for AAC assessments, communication device dispenses, education, and troubleshooting with client and/or families.

Finding/Results: In-home videoconferencing requires specific infrastructure within the client’s home and an individual with basic computer skills Pre-session test between sites are often required to work out technical issues Having another OT and/or SLP in the home environment to assist is essential for the initial assessments and complicated equipment dispenses It is challenging to instruct individuals at patient’s residence to modify specialized AAC equipment without duplicate equipment in the AAC Clinic Observing client in home environment helps with immediate adjustments of AAC equipment to ensure a proper “fit” Less demand on AAC Clinic resources to schedule compared to booking multiple OTN sites – clinicians have ability to schedule themselves and can connect with their clients immediately The ability for clinicians to be able to set up a session almost immediately helps with troubleshooting/problem solving in a more direct manner than over the phone Early patient satisfaction results are positive.

Conclusion/Implication/Recommendations: In-home videoconferencing allows clinicians to access patients who would not be able to receive rehabilitation care. It allows patients and families to receive specialized services like AAC. Based on the initial success of this option, the AAC clinic plans to increase their use of this new type of service delivery. In-home videoconferencing is a safe and viable option improving patient access and satisfaction.

140 Character Summary: Using in-home videoconferencing to provide Augmentative and Alternative Communication services to distant or medically fragile patients improves access to care