Let’s Go for Gold in Health Care! Join us for this opening plenary session to learn about the transformative power of predictive analytics and why you can trust them to help you make evidence-based investment decisions. You’ll hear firsthand how Canadian Tire Bank, an expert in data analytics, is using its knowledge and expertise to help Own the Podium identify future Olympic and Paralympic athletes. This session will explore the winning formula used to predict future podium potential. It will look back on some of its predictive successes and forward with future predictions for upcoming Olympic Games in PyeongChang in 2018.

Purpose/Objectives: The purpose of the session is to provide an update St. Joseph’s Healthcare Hamilton’s (SJHH) Clinical Transformation project and their use of guiding principles in the rollout of our benefits driven implementation approach including lessons learned since our early design phase. Building on the poster presented last year, this is an opportunity to discuss where things have gone right and where we have had to course correct.

Methodology/Approach: Our poster last year described how SJHH used the Advisory Board Company presentation Best Practices for Realizing EMR Business Value from March of 2013, to embark on the development of a benefit driven implementation approach for use in the design and planning of the Clinical Transformation project. Through the use of this framework and others, SJHH has implemented the decision making process and has used the benefit realization plan and approach to focus decision making to achieve the desired clinical and business outcomes as they relate to specific target areas of improvement. A cross functional, inter-disciplinary benefits realization committee was created and is leading this work and to ensure the project maintains alignment to the principles established under the mandate of this committee.

Finding/Results: The benefits driven implementation approach to project planning has provided focus to the project ensuring that each decision made aligns with our project guiding principles and has a direct impact on a desired outcome. This link is empowering decision makers and provides a framework for making tough decisions.

Conclusion/Implications/Recommendations: We have completed design and are working through our build phase of the project towards an implementation in late 2017 and at this time have new lessons learned from using this process and how it has influenced how we use this approach in a complex, multi-year project. We recommend the exploration of this approach for use in other healthcare projects as it lends itself to ensuring continued focus on desired outcomes.

140 Character Summary: SJHH is using a benefits framework providing guiding principles to ensure project decisions align with desired outcomes for our Clinical Transformation Project.

Purpose/Objectives: Electronic medical records have the potential to transform community healthcare by improving care coordination, quality of care, patient safety and reducing inefficiencies. Despite the known benefits, the implementation of these systems has faced numerous challenges including poor workflow integration and end user adoption which suggests inadequate investment into interface design and build of the software. A study was conducted to evaluate the ease of use of a clinical documentation system as part of an iterative development cycle and acts as a case study demonstrating the value of early end-user engagement in designing quality-based systems.

Methodology/Approach: A low-fidelity testing environment mimicking a community environment was setup, where clinicians used the system by going through a series of tasks that were identified as critical elements of their current workflow. Observational techniques, retrospective audio analysis and participant surveys were used to qualitatively evaluate the system according to predetermined usability criteria and best practices.

Finding/Results: Through the usability testing process key deficiencies pertaining to ease of use, safety and quality were identified which resulted in numerous system requirements. The usability study also provided valuable information on the utilization patterns of Clinicians in the community, the process of documenting as well as identified unique nuances of the point of care environment all of which would have been undiscovered had end users not been given the opportunity to participate.

Conclusion/Implications/Recommendations: Usability represents an important yet very often overlooked factor that directly impacts the adoption and meaningful use of EMR systems across all healthcare sectors. Without usable systems, end users (eg. any member of the interprofessional team and/or client) cannot realize any of the potential benefits of features and functions of health IT systems.In conclusion, it is essential that clinicians play an active role in the selection, design, deployment and evaluation of health IT solutions and advocate for solutions that integrate with their current workflow, practices and needs at the point of care. It is vital for health leaders and adminisrators to recognize and acknowledge the unique community landscape by providing encouragement and incentives for clinican involvement in Health IT by ensuring there are opportunities for participation.

140 Character Summary: Evaluating usability of a EMR as part of an iterative design cycle while highlighting the value of early end-user engagement in developing quality systems.

Purpose/Objectives: The aim is to assess the readiness of Orillia Soldiers' Memorial Hospital (OSMH) to adopt the Electronic Medical Record (EMR) and to develop a change management plan prior to full implementation of the new system.

Methodology/Approach: The EMR Project Management team developed a survey which was sent electronically to OSMH staff and covered the following domains: Participant's characteristics, current use of paper / electronic chart, participant's expectations, engagement, and participant's computer literacy.

Finding/Results: The survey targeted 1200 participants with 304 (25.0 %) responding, of which, 214 (70.0%) reported regularly working with patients. The percentage aged 45.0 years or older was 57.0 % whereas 43.0% were below the age of 45. Participants working regularly with patients were significantly more interested in attending EMR seminars 132/194 (68.0%) as compared to remaining participants 35/74 (47.3%), P=0.003. Although 143/220 (68.0%) of Healthcare Professionals (HCPs) were interested in attending EMR seminars, only 18/32 (47.4%) of non-HCPs were interested (P=0.058). Seventy percent of physicians (12/17) and (66/100) 66.0 % of registered nurses were interested in attending seminars (P=0.811). When asked if an EMR will enhance best practice, 129/174 (74.1%) of HCPs, and 66/85 (77.6%) of non-HCPs agreed (P=0.644). Participants with previous experience in an acute EMR were much more interested in attending seminars and believed that the new system will enhance best practice as compared to those with no past experience, 102/167 (61.1%) vs. 48/102 (47.1%) P=0.031 and 127/151 (84.1%) vs. 76/116 (65.5%) P=0.0001; respectively. Sixty six out of 147 (45.0%) of participants ?45 years old believe that they need 10 hours or more of training to completely learn the new system and 23/110 (21.0%) of those younger than 45 think that they need that amount of time to learn the system (P=0.0001). Interestingly, the perception that the new system implementation was worth the time and effort, enhances work performance, makes the tasks easier and improves the quality of data did not differ between the two groups. The average of general computer and information literacy skills scores were significantly higher in the below 45 age group compared to above ?45 age group (3.5±0.62 Vs. 2.7±0.88, 3.3±0.74 Vs. 2.47±1.1, 3.4±0.6 Vs. 2.7±0.9 and 3.0±0.77 Vs. 2.2±0.97, respectively P=0.0001). The same observation was apparent in participants with previous experience in an EMR as they scored higher than those with no EMR experience in the first 3 domains and average information literacy skills score was nevertheless the

Conclusion/Implications/Recommendations: Staff without previous experience in EMR or without regular patient contact are less engaged and probably need additional, focused training. Interest among HCPs and non-HCPs is virtually the same. Regarding value of an EMR system, staff nearing retirement share the same attitude as their younger peers, but, feel a significant need for more training. The perception of the overall value of an advanced acute care EMR among HCPs and non-HCPs is similar.

140 Character Summary: Assessment of the organization readiness in the planning phase is necessary for successful implementation of the EMR projects

Purpose/Objectives: The patient perspective is a missing dimension in the reporting of health outcomes, which historically has been based on clinical and administrative data. Canada does not currently have a standardized program for the routine collection and use of patient-reported outcome measures (PROMs) data. Working collaboratively with a wide variety of stakeholders, the Canadian Institute for Health Information (CIHI) is developing a pan-Canadian PROMs program focusing on standards, data collection and reporting for different audiences in the health care system, including patients.

Methodology/Approach: In 2013-2014, CIHI performed an environmental scan of the PROMs landscape in Canada and internationally. In 2015, CIHI held a pan-Canadian PROMs Forum to advance the development of PROMs information across Canada. A series of recommendations arose from the Forum, including the identification of three clinical areas (hip arthroplasty, knee arthroplasty and renal care) for PROMs work. Demonstration projects have been launched in these areas with support by the clinical community and to illustrate the value of PROMs. Through working groups facilitated by CIHI, consensus was gained on condition-specific PROMs tools for the selected clinical areas and further work will include the development of standards for survey administration (covering timing, frequency, and survey modes) based on best practices and pragmatic considerations. An additional working group is focusing on the selection of a common generic PROMs tool that could be applied across sectors and clinical groups. In parallel, CIHI is investigating the applications of PROMs in terms of reporting for clinicians, administrators, health system policy makers, and patients.

Finding/Results: CIHI’s clinical area working groups have reached consensus on condition-specific PROMs tools: Oxford Hip Score (hip replacements), Oxford Knee Score (knee replacements) and Edmonton Symptom Assessment Scale (renal care). Working groups are focusing on survey administration standards, taking into account the varying implementation abilities across different jurisdictions and centres. CIHI is also developing a minimum data set standard for the collection of PROMs data in each of these areas. Work is underway to identify a generic PROMs tool as the national standard, with the Veterans RANDS 12-item Health Survey (VR-12) and the EuroQol Group EQ-5D as candidates. The recommended generic tool would be administered in conjunction with the condition-specific tool or on its own for broad health care sector or population surveys. Working in collaboration with stakeholders, CIHI will develop key PROMs measures that will support use of the data for varying audiences within health care systems. CIHI plans to make facility-level comparative data available to health system users in a manner that enriches current administrative and clinical outcomes reporting. PROMs data can also be used to support provider-patient discussions regarding expectations of outcomes related to care and specific patient characteristics. Development of Canadian population norms would support comparisons of individual patient results against these aggregate norms.

Conclusion/Implication/Recommendations: CIHI will continue to work with stakeholders to develop standards in PROMs tools and data collection for use in improving outcomes and the effectiveness of the health care systems.

140 Character Summary: CIHI is developing a pan-Canadian PROMs program, focusing on standards, data collection and reporting for a range of health system users, including patients

Purpose/Objectives: The purpose is to describe how the high touch high tech approach can be implemented into a mHealth app to improve quality and quantity of data collection.

Methodology/Approach: We worked closely with Carcinoid Cancer Foundation (CCF) to initiate this approach named Project Zebra. We recruited for both new users and existing registered user of the Carcinoid NETs app. We employed a “High Touch” component as a key feature to drive both acquisition and app usage (engagement). New and returning users were encouraged to fill out an online form to enroll in Project Zebra. Once complete, they were contacted by a coach. This coach helped them complete the demographic data and provided a detailed description of how to use specific health tools within the app. Peoples’ app activity was monitored and the coach followed up with them on a regular basis. On top of the high touch approach, we offered an additional incentive labelled health currency to this process. This incentive was designed to allow people to see that there is financial value to the data that they recorded.

Finding/Results: Through the recruiting efforts of both the CCF and Self Care Catalysts we report an increased number of new registrations by 150% over a 2-month period. During this time, those that were enrolled in Project Zebra had a 519% increase in the number of in app responses, whereas those that were not enrolled had a -4% change in responses. With respect to the financial incentive, despite its availability, only 35% of individuals met the requirement to receive the financial incentive.

Conclusion/Implication/Recommendations: The results described herein demonstrate that the use of high touch high tech approach compared to a standard approach yields substantially increased rate of user acquisition, and rate of engagement. The increased use was not solely dependent on the financial aspect as many users who had access to this chose not to complete the required components to receive compensation. This suggests that financial compensation alone does not account for the increase in app engagement, and that it is the human contact that is more important at driving user engagement.

140 Character Summary: High touch high tech approach for patient engament with mHealth

Purpose/Objectives: Healthcare literature is inundated with publications promoting the promise of e-health tools and interventions in delivering improved patient outcomes. Frequently, these reports feature discussion of patient engagement, empowerment, activation, or some combination therein. The issue that appears to be arising however, is the indistinct use of these terms in the science of e-health, particularly regarding how the influence of technological solutions are measured and reported. The purpose of this research was to reexamine these critical concepts and unite both academic and software development perspectives to more effectively operationalize these measures for future research and practice.

Methodology/Approach: A scoping review on patient empowerment with a particular focus on the measurement of this concept in relation to e-health intervention was conducted. During the course of this review the overlapping, and in certain instances, interchangeable use of empowerment and engagement emerged. Literature featuring patient activation, and more specifically the use of the PAM or Patient Activation Measure, completed the concept trifecta. Using the review as a foundation, an interdisciplinary team was formed with both academic research and ICT practice representation. Through this collaboration, an in-depth analysis of the concepts of patient engagement, empowerment, and activation was undertaken with the express purpose of harmonizing terminology between the domains and providing a means of distinct application and measurement of these concepts for future use.

Finding/Results: We have concluded that while empowerment, engagement, and activation are closely interrelated they describe very different aspects of patient participation in the process of healthcare self-management. Ongoing confusion of these concepts, especially in their operationalization and measurement, risks a dilution of e-health science and potentially the advancement of patient-focused intervention. The integration of academic rigour and software development best practice has resulted in a new conceptualization of these key aspects of performance measurement and a more precise framework on which to move forward.

Conclusion/Implication/Recommendations: The ongoing evolution of e-health technology will increasingly require joint undertakings between healthcare, and computer science/software development professionals. This should include the critical work of efficacy assessment and detailed performance measurement that serves the needs of both domains. By recognizing crucial differences in the concepts of patient engagement, empowerment, and activation and delivering a collaborative view on the mechanisms underlying each, we have proposed a framework for clear and concise future measure. This work can support researchers and health informatics professionals in more consistent and exact evaluation of the degrees to which patients are involved in healthcare self-management and decision making, and ultimately, the quality and success of that involvement.

140 Character Summary: ICT meets academia in a collaborative analysis and reconceptualization of patient engagement, empowerment, and activation including future use and measure.

Purpose/Objectives: HL7 Fast Healthcare Interoperability Resources (FHIR) is an emerging approach to integrating health care information systems using modern technology standards. The designers of FHIR have made ease of adoption a cornerstone of the standard for trial use. Desirable qualities include documentation that is freely accessible and easily consumable without the need for complex custom tooling, no licensing fees, and an emphasis on implementation examples for all artifacts and reference implementations for several platforms, including live test servers available over the Internet. This has contributed to FHIR’s implementation by many projects before it has achieved normative standard status. As a result, rapid proliferation can lead to local interoperability but incompatible implementations between projects. This presentation will describe eHealth Ontario’s environmental scan which sought to understand Ontario-based health care organizations’ readiness to adopt FHIR as well as the tactics that should be pursued to minimize incompatible implementations.

Methodology/Approach: The advantages of using FHIR and current adoption challenges were researched through an online literature review. Ontario stakeholder input was gathered by survey to understand perspectives on the direction of standards selection in the future, resource effort to learn new standards, and which stakeholders influence standards adoption. Over 70 stakeholders participated in a FHIR adoption readiness workshop aimed at learning perspectives on the state of FHIR adoption in Ontario, and the opportunities and cautions that should be considered in standards selection. Further input and stakeholder feedback was gathered on the subsequent FHIR Adoption Readiness - Ontario position paper. Finally, ongoing anecdotal reports indicated that organizations are implementing FHIR to solve local interoperability needs.

Finding/Results: FHIR appears to be in the early adopters phase in Ontario. Attributes from Rogers’ Diffusion of Innovations theory are applied to interpret the process of FHIR adoption within Ontario. What is less clear is whether all implementations of FHIR are using the same FHIR build and/or how significant these differences are in terms of achieving long-term interoperability.

Conclusion/Implication/Recommendations: FHIR, in some capacity, will likely continue to be adopted by the majority of Ontario health system organizations. The findings of this project indicate that Ontario should invest in efforts to influence standardization across FHIR implementations so that it is aligned with the broader North American health IT market’s use of FHIR to minimize Ontario-specific customization.

140 Character Summary: Exploring Ontario’s readiness to embrace HL7 Fast Healthcare Interoperability Resources (FHIR), as well as its benefits and pitfalls.

Purpose/Objectives: Thought Spot (http://mythoughtspot.ca/ ) is an intervention that provides post-secondary students with an all-in-one online and mobile platform where they can geo-locate mental health and wellness services in the Greater Toronto Area (GTA). The CIHR eHealth Innovations Partnership Program Grant is aimed at optimizing the Thought Spot platform to effectively meet the needs of end users. Thought Spot makes access to information easy and interactive by mobilizing students to share knowledge about services, discover wellness options in their area and build support networks. The purpose of this e-poster is to provide an overview of the innovative participatory action research methods used during the engagement phase of this project. This project is split into two phases: engagement and intervention enhancement and intervention testing (RCT). Throughout the first phase, post-secondary students shared critical information related to accessibility of services, navigating university and maintaining mental wellness. Findings from our summer workshops with post-secondary students will be presented. Issues surrounding post-secondary student’s help-seeking behaviours, including barriers and facilitators and insights on how to optimize the Thought Spot intervention will be explored further.

Methodology/Approach: Through the use of participatory action research (PAR) principles, we recruited and engaged with students across the GTA to drive the optimization of the Thought Spot platform. The participatory action research strategy encompassed different levels of involvement from passive participation to self-mobilization. Consistent with co-design approaches and PAR, seven student-led workshops, attended by 59 students, were delivered to obtain student feedback regarding the app’s usability, its potential value in a post-secondary setting, effective recruitment strategies for the evaluation and approaches to including health information in the app. The workshops were co-designed and co-facilitated by students to increase ownership and oversight by youth over the research process. A range of creative activities were delivered to provide opportunities for youth to share their views and experiences, including semi-structured focus groups, questionnaires, personas, journey mapping, user-shadowing, and a world café.

Finding/Results: Participants discussed the following issues related to help-seeking throughout the focus groups: feelings of confusion and vulnerability when accessing health services; concerns of stigma, taboo and labelling; and overall health care costs and time constraints. Innovative technological features and refinements to were also brainstormed throughout the workshops. Four key areas of improvement, within the app, were established: creating a hook that creates valuable and relevant interactions from the start; provide more social interaction within the user’s own trusted community; design more responsive discovery, search and navigation functions; and obtain better data and finesse organization within the app.

Conclusion/Implications/Recommendations: Preliminary feedback on engagement and optimization has been positive: challenges in maintaining individual engagement will be addressed by forming smaller student working groups and outlining clearer roles and responsibilities for all participants. Findings from phase two will significantly inform new technological features, within the app, that enable positive help-seeking behaviours amongst transition-aged youth. These behaviors will be further explored in the third phase: a randomized controlled trial.

140 Character Summary: Thought Spot is a mHealth/eHealth intervention providing post-secondary students with an all-in-one platform to locate mental health and wellness services.

Purpose/Objectives: Enteral Nutrition is defined as the use of dietary foods for special medical purposes, independent of the route of application. It includes tube feeding via nasogastric, nasoenteral or percutaneous tubes. In Home Enteral Nutrition (HEN), many interventions involving dietitian expertise, are needed. The communication between health professionals and caregivers must be clear and direct. Furthermore, acceptance and training of family/caregivers are critical points for the successful of tube feeding treatment. The use of technologies to support professionals and patients, become essencial to reach effectiveness of tube feeding outcomes. This project takes an innovative health knowledge translation approach, to develop the NutriMob, an e-Health system that aims to support the assessment, prescription and monitoring of tube feeding in HEN programs.

Methodology/Approach: This research project was developed in partnership between the Faculty of Comuter Sciences and the Faculty of Nursing, Nutrition and Physiotherapy (PUCRS/Brazil). To develop the NutriMob system, we used the Open Unified Process, that applies an iterative and incremental approaches to a structured a life cycle, addressing an agile and pragmatic method that focuses on collaborative nature of software development. Also, we used an Unified Modeling Language, to provide a standard way to visualize the design of a system. The content of the computational solution has been obtained by requirements gathering, evaluation and validation of system through regular meetings of the working group and health professionals.

Finding/Results: The main results were: modeling of computational solution; definition and implementation of the decision-making algorithm; Website development; Android Mobile Application Development. To address the outreach issue, NutriMob is accessible to healthcare professionals and patients through the website and mobile application. To professionals, NutriMob provides evidence-based assessment and prescription of HEN, giving them a computerized clinical decision support. Our approach is to operationalize the paper-based international guidelines about HEN in terms of computerized decision support aids, so that health professionals can easily apply the guidelines to design patient-specific HEN programs. The main features of NutriMob Website are: nutrition assessment (anthropometric and subjective data) nutrition intervention (develops the nutrition prescription, choose of enteral formula, determines the caregivers/families orientation) and nutrition monitoring and evaluation (data from patients). To patients and patient’s families/caregivers, NutriMob is accessible via mobile phones (mobile application) to provide them instructions on how to administer the prescribed HEN and also to send them timely reminders and educational material (in the local language and soon in English), so that they adhere to the treatment. More information about NutriMob is available in: http://www.nutrimob.com.br/sobre.html .

Conclusion/Implications/Recommendations: In a year of activities, the NutriMob was consolidated as a research, focusing on multidisciplinary work and cooperation between professors, students and health professionals. The system has been developed and validated internally. The next steps will be external validation through the use of the system by healthcare professionals and patients.

140 Character Summary: NutriMob is an innovative e-Health system that aims to support the assessment, prescription and monitoring of tube feeding in Home Enteral Nutrition programs.

Purpose/Objectives: The objective of MedChart is to improve overall patient care by 1) empowering patients with easy access to their official health records; and 2) improving and streamlining the interoperability of medical records between health care providers.

Methodology/Approach: MedChart is a secure, cloud-based platform that transforms patient engagement by making access to official medical records convenient and reliable for patients. We digitize all records onto our secure Patient Portal and provide tools for health management and collaborative care. Using patient consent, MedChart provides online access to all clinical medical information (EHR data, imaging, written notes, etc.) from all of a patient’s providers, and gives the patient the ability to coordinate their care with physicians, family members, and other caregivers. MedChart also provides a comprehensive online platform for medical professionals to seamlessly request and receive medical records from any healthcare provider, clinic, or hospital in Canada.

Finding/Results: The current fragmented system of paper and electronic medical records makes the process of acquiring medical records extremely time-consuming and difficult. For patients, there can also be a financial burden associated with requesting medical records, and reading the records often relies on technology that the patient may not have access to (for example, faxes machines or medical image viewing software). Results from studies have indicated that access to patient medical records can enhance patients’ perceptions of control over their health (Giardina et al., 2013), increase feelings of trust and confidence in physicians (Archer et al., 2011), improve doctor-patient communication (Ross & Lin, 2005), and identify record errors. For example, in a recent report of an online patient portal system, it was found that almost 37% of users identified a medication error in their medical record, and 40% found errors in their allergy information (Epic EHR Program, 2015). For medical providers, the fragmented access of patient health information can result in less effective medical care, including adverse drug-events, delays in patient access to care, and unnecessary laboratory tests and medical imaging (Health Infoway, 2016). In addition, clinics with seamless access to patients’ medical records experience reduced time spent managing patient records, which also results in economic benefits (Health Infoway, 2016).

Conclusion/Implication/Recommendations: Patient access to personal health information is the keystone to proactive, patient-centred healthcare, and the current process for patients to access their health information is onerous and expensive. MedChart is an innovative online platform that allows patients to safely and conveniently access their official health records, resulting in more informed, empowered patients, and a better overall health care experience. Patients with access to their own medical records require fewer medical tests, experience fewer medical errors, and enjoy faster access to medical services. For medical clinics, the ability to make simple online requests for medical records, as well as having instant access to all of a patient’s health information, not only increases the quality of care, but also reduces administrative workload and therefore reduces costs.

140 Character Summary: MedChart is a secure cloud-based platform that is improving health care by providing simple access to patient medical records to patients and healthcare providers.

Purpose/Objectives: Across the health care system data are collected daily using multiple standards, often not well aligned. People working within the system are looking for opportunities to improve alignment between standards, hoping to reduce data collection burden and improve understanding and use of data to support evidence-based decisions. This project provides an example where two organizations have collaborated with the end goal of improving the experience for stakeholders by reducing burden and in this presentation, we will share the process, and lessons learned from a pilot implementation. The Canadian Institute for Health Information (CIHI) and Canada Health Infoway (CHI) collaborated to enhance the clinical nomenclature standard used in laboratories across the country to incorporate information required to create management information that complies with the MIS Standards as a byproduct of the clinical reporting process. As such, one standard can be used to support data collection for multiple purposes. Collect once, use many! CIHI maintains the MIS Standards, which underlies the financial and statistical data reported to the provincial/territorial ministries of health. This data is used to produce financial and operational indicators of efficiency, to support funding methodologies and for comparative analysis and benchmarking. Infoway maintains the clinical nomenclature standard for the clinical laboratory. This standard is used to populate clinical data within the eHR and the jurisdictional LIS.

Methodology/Approach: Flowing from the partnership between CHI and CIHI, a working group was established with joint membership. This working group of experts developed principles for the overall alignment between the two data standards. These principles were applied to over 30,000 codes and a new attribute added to the codes within the CHI clinical nomenclature standard. Since results are generally sent to a jurisdictional lab information system using the nomenclature standard code, the approach tested by a jurisdictional LIS was to a) identify those codes with the attribute of 'laboratory test' b) count the 'laboratory tests' performed by each lab c) categorize the tests by location of patient Pilot phase - will evaluate the feasibility of broader implementation, and will support the development of a more detailed implementation plan.

Finding/Results: A pilot is currently underway and we expect to share the results and impressions from the pilot site at the eHealth conference in the spring, along with next steps.

Conclusion/Implication/Recommendations: This project demonstrates the advantages of collaboration across standards organizations to reduce duplication, improve efficiency and support stakeholders when developing standards. Aligning standards so they can be used for multiple purposes helps the end user clarify and simplify data collection. This process can serve as a model for future work, as technology and more integrated systems demand that standards allow stakeholders to "collect once, use many".

140 Character Summary: Canadian Institute for Health Information and Canada Health Infoway collaborated to align a laboratory nomenclature standard to be used for multiple purposes.

Purpose/Objectives: CCO collects and manages one of the most comprehensive healthcare data sets in Canada. The data is used to support research and inform decision-making in Ontario's health system. Data and analytics are integral to meeting the growing demand for greater health system accountability, better health outcomes and improved patient experience. One of CCO’s strategic priorities is to support evidence and knowledge generation. To support the increased demand for data to support research, CCO’s Data Disclosure Team worked to increase the capacity to support researchers both internal and external to CCO, while still meeting CCO’s privacy and legal responsibilities.

Methodology/Approach: Supporting researchers in their data needs is a resource-intensive process. Support for a typical research data request is required from coordinators, research associates, privacy specialists, as well as senior management across the organization. In order to continue supporting evidence and knowledge generation and ensure the delivery of quality service for data requests, the Data Disclosure Team focused on improvements in four areas: Engagement with stakeholders; Governance; Streamlined processes; and Pilot of a cost recovery model.

Finding/Results: The team began by focusing on quick wins by improving stakeholder communications at first contact, improving online information, and clarifying roles and responsibilities in the process. Subsequently, a multi-phased improvement plan was implemented, including: Improvement of communication tools (online; email; forms) to ensure researchers were equipped with the information necessary to request data, as well as to ensure the best quality data was disclosed; Launch of the Data Disclosure Subcommittee to oversee the decision-making and issues in a complex process; Process improvements, beginning with detailed process mapping to identify streamlining opportunities, monitored through weekly and monthly performance reports; and Launch of the pilot year of the cost recovery model to support the increasing resource requirements of data disclosure at CCO.

Conclusion/Implications/Recommendations: In the past year, CCO’s Data Disclosure Team has worked with researchers across the province to help address their research questions. The most frequent research topics include: Cancer Prevention; Cancer Diagnosis; Cancer Treatments; and Access to Care. A quarterly report to CCO’s executive team has demonstrated sustained improvements over 6 quarters. This translates to an improved experience for researchers through: Better understanding of the steps and requirements to access data for research purposes; Improved quality of data disclosed; and More timely access to data.

140 Character Summary: To meet the increased demand for data for research purposes, CCO’s Data Disclosure Team worked to streamline and improve processes to support researchers across ON.

Purpose/Objectives: Ontario is a very diverse province; while Northern Ontario contains 88% of the province’s landmass, 94% of the province’s population resides in Southern Ontario. This creates very different contexts for health care service provision. The Ontario Telemedicine Network (OTN) uses technology to connect patients and health care providers across the province. Although there has been research on women’s health, aging and health, and the implications of rurality on access to health care services, there is little research to date showing the connections between these factors and telemedicine utilization in Ontario.

Methodology/Approach: We obtained OTN medical service utilization data collected through the Ontario Health Insurance Plan (OHIP) and provided by the Ministry of Health and Long Term Care (MOHLTC). Initial investigations used data that was aggregated by census subdivision, billing code, and month and year of visit. The data did not contain information on age and sex of patients, but we were able to identify visits with gynecological, obstetrics and geriatric billing codes to infer age and gender for preliminary analyses.

Finding/Results: A total of 22% of clinical telemedicine visits occur with patients from rural Northern Ontario; an area with only 2% of Ontario’s population. For telemedicine patient visits using obstetrics or gynecology codes, this figure rises to 72%. In comparison, 14% of visits with obstetrics and gynecology codes occur with patients residing in the urban north, 10% in the urban south and 3.5% in the rural south. Similarly, at 42%, a disproportionate number of visits using geriatric codes take place with patients from rural Northern Ontario, compared with 30% from urban Southern Ontario, 16% rural Southern Ontario and 12% urban Northern Ontario.

Conclusion/Implication/Recommendations: Northern Ontario’s sparse population across a large geographic area creates unique barriers to health care services, and much of the north is medically underserved. Our data suggest that telemedicine is being used differently by men and women and by older adults in rural Northern Ontario than in the rest of the province. The findings demonstrate the potential to increase access to medical services in medically underserved areas of rural Northern Ontario for women and older adults and reduce the need for medically related travel.

140 Character Summary: This research examines selected age- and sex-specific telemedicine use in Northern and Southern Ontario by rurality.

Purpose/Objectives: A community-based hospital participated in a pilot project to demonstrate the benefits of using a standardized terminology language (International Classification for Nursing Practice (ICNP)) embedded within their electronic medical record (EMR) system to increase data quality and facilitate data extraction for e-clinical analytics to support continuous quality improvement. This presentation reviews the methodology used to build organizational capacity to facilitate the use of advanced clinical e-functions such as ICNP and e-clinical analytics to standardize data collection and employ technology-enabled data extraction for outcome evaluation.

Methodology/Approach: The hospital was required to implement ICNP-encoded nursing order sets to optimize wound care management. External consultants were contracted for the project to build organizational capacity by providing high level training, mentoring and support to: • The Project Lead who was tasked with leading the integration of ICNP-encoded nursing order sets within their MEDITECH information system to standardize and automate data collection for outcome evaluation; • The Information Technology (IT) staff to facilitate data extraction for e-clinical analytics using ICNP codes. The implementation strategy was divided into four phases: Phase I – Project Kick Off & Information Gathering Session - The project sponsor provided a project overview to all key stakeholders, validated the background information obtained and gathered more detailed information from the key informants to share with the external consultants. Phase II – Training & Technical Build Support - The consultants provided training on order set integration within the EMR. This training was divided into modules that coincided with the various stages of the technical build. This approach provided opportunities for direct application and ongoing support throughout the build facilitated by remote system access and WebEx. Phase III - Data Extraction - The consultants worked with the organization’s IT staff to extract the required data using the ICNP codes to support e-clinical analytics. Working with the site, testing and user acceptance were achieved.Phase IV – Support Migration to Production, Go Live & Post-Go Live - During this phase the consultants provided go-live and remote support to ensure adoption, data extraction and reporting functionality during the first 1 month post Go Live.

Finding/Results: The hospital successfully integrated the ICNP-encoded nursing order sets within their EMR. Data were collected seamlessly as the clinicians used the order sets to facilitate evidence-based wound care. The IT staff were successful in their efforts to extract the data required to evaluate key outcome indicators using e-clinical analytics. This methodology was welcomed by the staff who previously relied on a time-consuming manual data collection process.

Conclusion/Implication/Recommendations: This project demonstrates the benefits of technology-enabled outcome evaluation facilitated through the use of a standardized terminology language (i.e. ICNP). It greatly reduces the time required for data collection to support outcome evaluation for quality improvement. It also offers hope for others who rely on clinical data for research, benchmarking, trending and policy decisions, to name a few.

140 Character Summary: This presentation reviews an approach to build capacity to use ICNP to automate data collection and extraction for outcome evaluation.

Purpose/Objectives: Audits are important to monitor the ongoing quality and efficiency of transfusion service processes. Typically, audits combine manual observation and laboratory information system generated data to derive conclusions of how a process is performing, and suggest recommendations on its improvement. The centralization of transfusion services introduces more challenges in auditing, especially if transfusion services are distributed over significant geography and if there are limited human resources available. We describe a novel use of process mining, recently adapted for use in financial auditing, to further characterize an automated red cell unit dispensing fridge which was being suboptimally used at our institution.

Methodology/Approach: Red blood cell unit transaction data and attributes from October 1, 2013 to September 30, 2015 from the laboratory information system of a large distributed multisite transfusion service in Eastern Canada (Nova Scotia Health Authority, Central Zone) were queried, preprocessed, and process maps were created. Subject matter experts were asked to create a process map of their perception of the blood fridge process. Subsequently, blood fridge maps were displayed for real-time exploration, and comments were collected and thematically analysed.

Finding/Results: There were 2302 unique red cell units which encountered the VG-Hemosafe inventory destination. There were 1597 different variants, each representing a different unique sequence of pathway activities that a red cell unit could take from receipt to final disposition. The manually created process map at simple unidirectional flows, while the process mining derived map demonstrated complex looping, though the inventory receipt process was common between both types of maps. The process maps were relevant and valid, and comments were grounded on insight and process confirmation. The exercise also resulted in policy changes and gave us insight and impetus to re-initiate discussion with the manufacturer.

Conclusion/Implication/Recommendations: We demonstrate a novel use of process mining to enhance our transfusion services understanding of how our institution was using an automated remote blood dispensing fridge without the need for any manual auditing. We demonstrate that process mining allows for significant intelligent discussion and reflection on this process, and this technique could be applied to other processes..

140 Character Summary: Process mining can be applied to further understand the functioning of transfusion services and enhance inventory management.

Purpose/Objectives: The Canadian Institute for Health Information links data from health care organizations and health ministries across Canada to create new knowledge. The new knowledge supports system and policy-decision makers in answering questions about the health or healthcare of population groups or healthcare sectors. This presentation provides an overview of recent analytical products that incorporate a variety of approaches to linking data.

Methodology/Approach: Key success factors in data linkages are the use of standards and robust linkage methodologies. Standardized data can be linked at the individual level across hospital, long-term care, home care and community settings. Expanding knowledge about a specific sector can be achieved by linking physician billing, drug, and financial data. Linking clinical and financial data at the person and/or organization level provides insight into the cost of providing services, laying the foundation for examining efficiency and value for money. Data may also be used in non-traditional ways, for example, using payment data linked to clinical data to better understand how services are provided in various settings and to identify best practices.

Finding/Results: Results from these studies demonstrate how linked data creates new knowledge: 1) Hospital, emergency, and drug data were linked to show the number of emergency visits, hospitalizations, and the use of psychotropic medications by children and youth with mental health disorders are increasing, especially for those with mood and anxiety disorders living in urban areas. 2) Physician billing data was linked with hospital and emergency data to show that increased continuity of care with a family physician is associated with reductions in hospitalizations for people with chronic diseases and reductions in ED visits for people with conditions better managed in primary health care settings. 3) Drug data was linked with clinical assessment (InterRai) data to show that a large proportion of seniors living in long-term care exhibiting severe aggression were not being treated with antipsychotics, suggesting non-drug alternatives were often considered. 4) Financial data was linked with hospital clinical data to calculate an efficiency indicator that can be used at a system level to examine variation, and by individual managers to identify areas for further investigation and manage trends in spending.

Conclusion/Implications/Recommendations: This poster demonstrates how new knowledge created using linked data can inform decision and policy makers, and lead to action within the health system. Several examples are presented to illustrate the approach and the types of data being linked.

140 Character Summary: See how CIHI's linked data brings results and contributes to improvement of the health system, using standard data and linkage methodologies

Purpose/Objectives: How to "Walk the Talk" on Innovation To provide *practical and demonstrable* designs for implementing "innovative" organizations Innovation does not result from following a linear process - there are organization strategies and methods available to catalyze innovation An explanation on how these strategies and methods can be adopted by Healthcare organizations

Methodology/Approach: We will look at radically new leadership strategies based on the phenomena of “emergence and complexity behaviour” and how they are employed to enable self-organizing and innovative organizations. Emergence and complexity theory identifies the stimuli for self-organizing behaviour and and the methods for managing this phenomena. We will also look at organizational strategies that deliberately implement a healthy tension between result-oriented analytics and sustainable product development to drastically increase productivity. Opportunity Management is another key method for ensuring that viable innovations are rapidly progressed from ideation, through approvals and delivery while ensuring a focus on optimal value realization.

Finding/Results: Today’s most innovative analytical organizations are to be found in start-up companies unencumbered by traditional IT and project management paradigms. We will explain why large corporate organizations are grossly outmatched by the emerging data science community who were once looking for a level playing field and now have the upper hand as disrupters in the marketplace. This talk will demonstrate how large private and public corporations are radically changing their organization strategies and development methods to get back into the game as innovators and market disrupters.

Conclusion/Implication/Recommendations: Organizations in both the public and private health sectors have realized that they need to re-organize and take a deliberate approach to foster and enable innovation especially in the area of data analytics. We will look at the strategies they have implemented. Then based on our extensive knowledge of the Canadian healthcare marketplace, we will then illustrate appropriate tactics and tools Canadian Healthcare organizations can implement.

140 Character Summary: Innovation is one of the hot topics in Healthcare in recent years. This presentation introduces the concept of the Innovation Based Organization.

Purpose/Objectives: Rare inherited bleeding disorders such as platelet type von Willebrand disease (PT-VWD) exhibit considerable diagnostic challenges; however, standard guidelines for their management are as yet unavailable. Lengthy periods of misdiagnoses and subsequently inappropriate treatments resulting in significant morbidity can have serious implications on both patients and health care systems. Mysteries around the disease exist and research funding is scarce, leaving scientists with limited resources to support underprivileged patients. The purpose of this study is to propose a new interdisciplinary approach involving the primary care physician, the hematologist, and the laboratory, to improve diagnosis and management of PT-VWD.

Methodology/Approach: Extensive international work www.pt-vwd.org on this rare disease with over 10 years of experience (Othman etal., J Thromb Haemost. 2016;14(2):411-4) and established International Society of Thrombosis and Haemostasis guidelines for diagnosis of inherited platelet disorders (Gresele etal., J Thromb Haemost 2015; 13: 314–22) together with a recent case series report (Sánchez-Luceros etal., Platelets 2016; in press) have provided the foundation for this proposal. The required resources including physician awareness/education, appropriate laboratory tests and personnel training were examined. Models from other systems/countries have also been evaluated. The proposal is based on: integration of a specific education module into physicians’ (primary care and hematologists) CME program, improved recognition and referrals of abnormal bleeding conditions (thrombocytopenia and VWD) in the primary care setting and the implementation of a simple diagnostic algorithm, where essentially all patients with provisional diagnosis of type 2B VWD and undiagnosed adult or neonatal thrombocytopenia, would undergo a simpli?ed RIPA mixing assay (Favaloro Semin Thromb Hemost 2008; 34: 113–27) followed by genetic analysis for confirmation.

Finding/Results: A flow chart representing the diagnostic problem, implications of delayed diagnoses and the suggested interdisciplinary approach involving all stakeholders together with the proposed diagnostic algorithm will be presented.

Conclusion/Implications/Recommendations: It is anticipated that incorporating this approach directly into the clinical setting will enable timely and improved diagnosis of the disease, reduce health care costs resulting from unnecessary and misdirected lab testing, inappropriate treatments and most importantly minimize patients’ serious bleeding complications.

140 Character Summary: New interdisciplinary approach to improve diagnosis of PT-VWD and reduce healthcare costs resulting from misdirected lab testing and inappropriate treatments

Purpose/Objectives: eNotifications are events triggered by patient encounters within a health care setting, such as a hospital department (emergency department or in-patient) or a health care program (e.g. a Continuing Care Access Centre (CCAC)) or a patient status change in a clinical repository. Typically these brief messages are delivered to recipients (e.g. primary care physicians’ electronic medical record, hospital information system (HIS) or a CCAC) in near real-time. eNotifications aim to support better patient care and health outcomes through the timely availability of patient information (e.g. CCAC patient status, Health Link status, presenting condition) following trigger events such as hospital admit, transfer, discharge. What is the best approach for delivering eNotifications to recipients within the EHR eco-system?

Methodology/Approach: Ontario’s current eNotifications landscape: Hospitals currently send multiple HIS admission/discharge/transfer (ADT) feeds to various recipients, including the provincial client registry (PCR), the Ontario Association of CCACs (OACCAC)/CCAC’s client health and related information system (CHRIS) and clinical data repository (CDR). Each of these ADT feeds differs slightly with respect to the type and format of the information it carries. The CHRIS system transforms the ADT message to a hospital report Manager (HRM) document targeted to the specified EMR recipient. An eNotification HRM document notifies the primary care physician that their patient has been admitted or discharged from hospital. The CHRIS system also sends an eNotification message to the OACCAC patient’s care team (e.g. registered nurse, meals on wheels) to let them know that the patient is in hospital. Finally, the CHRIS system sends an eNotification message to the sending HIS system about the community care status of the patient. Other circle of care partners have also asked to be notified when patient health status is changing.

Finding/Results: Current electronic eNotification options exist as point-to-point interfaces to several solutions, creating multiple connections for health service providers to manage. This forces hospitals and clinics to maintain high IT resource levels, which is neither cost efficient nor effective. As Ontario builds centralized repositories and registries, we also need to provide eNotification capabilities for these EHR assets.

Conclusion/Implication/Recommendations: A provincial approach to eNotifications presents an opportunity to coordinate and streamline Ontario’s investments in this type of communication, and to avoid implementing multiple point-to-point solutions to deliver eNotifications. eNotifications should be sent from health providers through a central solution to regulated or unregulated practitioners (recipients) who have a time sensitive need to know about the patient’s disposition, in order to facilitate delivery of patient care. eHealth Ontario is currently building a prototype eNotification solution in its Innovation Lab to validate design, feasibility and clinical value .

140 Character Summary: eNotifications is a centralized solution to support better patient care and health outcomes through timely availability of patient information.

Purpose/Objectives: The capture and management of unsolicited Lab Test Results is needed to manage Public Health Surveillance of Communicable Diseases. Automated exchange between labs and public health agencies is not yet in place in all jurisdictions. This session will demonstrate how Public health resources led by Infoway have developed the data needed to automate management of communicable diseases.

Methodology/Approach: Identify a jurisdiction who would lead the work Establish an open, group based community platform available for clinicians, ehealth representatives, vendors, developers, and others interested in working collaboratively. Develop a model to identify the required data elements and drive the values required. Leverage previous work Adapt the approach as knowledge evolves and as resources and participants are available. Publish the content so other jurisdictions could leverage the work.

Finding/Results: Manitoba agreed to lead the development of 3 data sets based on the previously developed Communicable Disease data set. These data sets were intended to be used by those working in public health information systems to capture required data consistently and correctly to enable the management of communicable disease cases and outbreak management from both a jurisdictional perspective and a national perspective. Interested stakeholders were solicited to participate in the development including Public Health Agency of Canada, IBM, the Canadian National Microbiology Lab, and other jurisdictional lab and public health stakeholders interested in this work. Infoway established a space on InfoCentral for the stakeholders to come together to connect with experts, host meetings, and collaborate in the development of the data sets. The following data sets were developed: Causative/Etiologic agent Disease Presentation Disease Staging

Conclusion/Implication/Recommendations: During the development of the data sets it was clear that a lack of clinical practice standards made it challenging to agree on the model and the data. Public health is an area where jurisdictions have different regulations making it also challenging for Public Health Agency of Canada and others who need to use the point of care data in communicable disease surveillance do use the data for national surveillance. It was challenging to “harmonize” the data to suit most stakeholder needs. And in the end there was a very valuable outcome agreed to by all who participated. Manitoba recognized and appreciated the other stakeholder input to make the data sets as “future proofed” as possible as Panorama evolves. The data sets are being used regularly to assist surveillance clerks in interpreting complex lab results to consistently and correctly input the data in the Manitoba Panorama system. This has resulted in better management of communicable disease in Manitoba.

140 Character Summary: This session will provide an approach and lessons learned that public health and other stakeholders can leverage in their ehealth projects.

Purpose/Objectives: In Ontario, the Activity level Reporting (ALR) data is a major source of information about different aspects of cancer patient management such as consultation with medical oncologist, treatment regimen and treatment intent. The ALR data has been playing an important role in cancer patient management by providing support to funding allocation, system level performance measurement, and cancer related research. As ALR data is a unique source of information about cancer patient management, Cancer Care Ontario (CCO) has being working on improving its quality and coverage in order to promote meaningful secondary use.

Methodology/Approach: Activity level reporting data is routinely submitted to CCO by 80+ hospitals including Regional Cancer Centres (RCCs) in Ontario. Following receipt of data by CCO, data quality assessment is conducted and if data is found to be of acceptable quality its added to the repository. Formatted and aggregated data is shared with different internal and external stakeholders to facilitate various secondary uses such as funding allocation, cancer care research, clinical and regional program reporting. In order to facilitate the cancer data journey i.e. to promote its secondary use, CCO conducted multi-level review of the program to identify and address the data quality issues. Through this process, healthcare providers, policy makers and researchers were engaged to validate their information needs and to identify any information gaps.

Finding/Results: In order to facilitate the cancer data journey, identification and addressing of the existing information gap in ALR was done through engagement with internal and external stakeholders. To further promote the use of the cancer data, improvement in data quality has been implemented through development of data dictionary and data quality framework. These initiatives are expected to improve availability, usability and integrity of the data.

Conclusion/Implications/Recommendations: Addressing of information gaps and implementation of a data quality framework leads to better cancer data to support improvements in system level performance reporting, equitable funding allocation and promoting an evidence based environment for better management of cancer patients.

140 Character Summary: Improvement in ALR data quality and fulfilment of information gap will promote meaningful secondary use of data and facilitate the cancer data journey.

Purpose/Objectives: Prior to the internet, the usual and often only method of getting information on credible consumer health services was probably during an appointment with your doctor. Today, both the public and health care professionals can easily access numerous health resource directories on the internet, but are they truly reliable? The presentation will describe the Standardized Inclusion/Exclusion Criteria that were developed to provide a rigorous and reliable framework ensuring the publicly funded online directory (thehealthline.ca) remains a trustworthy site.

Methodology/Approach: Background In Ontario, each Community Care Access Centre (CCAC) is responsible for maintaining a regional directory of health and community services within its respective Local Health Integration Network (LHIN). The 14 regional directories are integrated into a provincial online directory (thehealthline.ca) with over 40,000 records, to support the delivery of information across Ontario. Providing people with high quality information is a critical component to help bridge the gap between patients and health resources in a health system that strives to deliver the best care possible. The information must be comprehensive, accurate, and up-to-date. The public and health care professionals rely on CCACs’ Information and Referral services and their respective regional online directories as a trusted source providing valuable information. In order to develop relations of trust, these regional online directories need to be hubs of certainty for those looking for accurate and reliable information. Standardized Inclusion/Exclusion Criteria were developed to provide a rigorous and reliable framework to ensure the information remains trustworthy for the health information seeker, knowing that the service profiles provided by the CCAC or viewed in the online directory may imply a “seal of approval.” The framework ensures that CCAC staff and public are aware of the scope and limitations of the CCAC online directory. Methodology/Approach Implementation of the online provincial directory allowed sharing of records between regions across the province. A service profile was identified that did not meet a particular CCAC’s inclusion/exclusion criteria, and a gap analysis was conducted to reveal inconsistent inclusion processes existed. A provincial working group was formed to explore the development of a provincial inclusion and exclusion criteria standard.

Finding/Results: An inclusion/exclusion criteria document was developed, and to ensure validity, internal and external stakeholders were surveyed to provide broader feedback. The CCAC Information and Referral Service Profile Inclusion/Exclusion Criteria received final approval in September 2016. The criteria outlined three (3) main inclusion conditions that must be passed for an agency or service to include a service profile in the I&R database; Agency eligibility, Data requirements, and Service profile category eligibility Exclusion criteria are applicable throughout the onboarding process and thereafter in each review.

Conclusion/Implication/Recommendations: The inclusion/exclusion criteria framework guides evaluation of health and community service categories and appropriate inclusion of service profiles. In addition, it provides a publically transparent criteria to support awareness of the scope and limitations of the CCAC online directory.

140 Character Summary: Using a rigorous & reliable data governance approach, CCACs’ online directory of health & community services remains trustworthy to the health information seeker

The International Perspectives panel will explore successful digital health solutions that have been implemented in other countries. The panel will look at the collaborative opportunities presented on an international level using examples of their joint projects and initiatives. Experts will also provide direction on global initiatives that will benefit Canada

Purpose/Objectives: To share the experience of two vastly different data conversion approaches - the first used vendor supplied tools not fit for the scale and the second used an Enterprise ETL (Extract Transform and Load) software.

Methodology/Approach: Review scope, approach, and technologies that were used in a two phase approach to data conversions from a legacy system (iPHIS) into BC’s Public Health Information System – Panorama. Phase 1 commenced with business requirements signed off two years prior to the implementation and with inadequate representation from the user community. Tools used were custom made and functioned in small batches, but were not designed for the volume of records. By the time the project team realized the tooling deficiency, the only viable option was to convert 45 million records in batches of 200,000 – a very onerous, labour-intensive, and error-prone process. Following Phase 1, the project re-evaluated its approach and experimented with off-the-shelf ETL (Extract, Transform and Load) software on a minor dataset. With this success, the team created a model for Phase 2 that would leverage an enterprise ETL software, change the project structure and governance, and adopt a ‘phased’ approach with seven incremental releases to users, each with a new set of data.

Finding/Results: Phase 1 Summary: Scope and Schedule: 44 million records converted over 10 full days plus workday evening conversions from 8pm until 6am for three weeks as well as effort on the weekends. Release Schedule: No opportunity to convert all data in advance of production run Defects: Two and half months required to address high priority bug fixes and missed data. Project Team: Team expanded to address challenges; exhausted team required heroic dedication. Phase 2 Summary: Scope and Schedule: 47.5 million records converted over 22 hours, including a lunch break. Release Schedule: Seven releases for the users to review, including three full production runs. This provided confidence of the quality of data and the process. Defects: Minor defects experienced; majority of team released after three weeks. Project Team: Controlled project environment requiring minimal overtime.

Conclusion/Implication/Recommendations: A significant investigation of the business signoff, process and tools is required prior to commencing any data conversion project. Use of Enterprise ETL tool was critical to success, and enabled incremental releases which built confidence in data quality and the conversion process. Incremental release did provide users with the ability to ‘see data in the application’ prior to signing off on business rules. While this was useful in many respects, it did require rework from the project team when users didn’t like what they saw.

140 Character Summary: Data conversion with the appropriate toolset and approach can be successful. For large conversions, an enterprise ETL software is critical.

Purpose/Objectives: Health Canada describes eHealth as the utilization of information and communications technologies to support a variety of functions ranging from administration to health services delivery. There is general consensus that, when properly deployed and adopted, eHealth can increase efficiency, enhance patient safety and optimize health outcomes. However, the implementation of a digital health system is a large and complex undertaking with failure rates as high as seventy percent. Factors at the macro, meso and micro levels have been identified as contributors to these failed implementations. For these reasons, successful implementations require strong leadership at all levels as well as individuals (i.e. management and staff) with the appropriate informatics knowledge, skills and abilities to lead and support the initiative. There is a scarcity of evidence-based resources to adequately prepare individuals involved in the implementation of digital health systems to realize the intended benefits for patients, staff, healthcare organizations and the broader healthcare system. The recent development and publication of an evidence-based Guideline intended to enhance the informatics capacity of healthcare executives and clinicians is therefore timely. This presentation highlights the Guideline development process and provides an overview of the recommendations it contains.

Methodology/Approach: An international panel of experts was convened in January 2016 to collaboratively develop the Guideline. The panel members included healthcare executives, nurses and other healthcare providers from a range of settings including practice, education, research and policy. There were also two patient partners on the panel. All panel members with the exception of the patient partners had previous experience with digital health system implementations. A systematic review of the grey and peer-reviewed literature from 2006 to 2016 was conducted to identify relevant articles and other resources that met the search criteria. A total of 178 peer-reviewed articles and 56 grey literature resources were deemed relevant. Draft recommendations were formulated from these sources of evidence. A Modified Delphi technique was used to achieve panel consensus on the final 26 recommendations published in the Guideline.

Finding/Results: The expert panel identified individual, organization, education and system recommendations that address known micro, meso and macro level barriers to successful digital health system implementations. The individual and organizational recommendations focus on micro and meso level factors that contribute to the implementation, adoption and optimal utilization of high quality digital health systems that realize the intended return on the investment. The education recommendations focus on the eHealth education infrastructure required to facilitate the acquisition of micro, meso and macro levels informatics competencies by healthcare executives and clinicians. And, the system recommendations address the structure, process and policy requirements at the macro level to realize the long-term goals of nation-wide electronic health information exchange and health systems transformation.

Conclusion/Implication/Recommendations: This Guideline will be an invaluable resource for healthcare executive and clinical leaders, nurses and other healthcare professionals, health information technology personnel, patients and families as well as policy makers at the organization and system levels. By adopting the recommendations provided in this Guideline, individuals, organizations and health system administrators will pave the way for successful health system transformation.

140 Character Summary: This presentation highlights a recently published evidence-based Guideline that enhances the informatics capacity of healthcare executives and clinicians.

Purpose/Objectives: Organizations throughout Canda continue to invest , design and implement electronic health systems with a focus on improving interoperability and patient outcomes. Preparing an organization for a transformation of this kind requires a comprehensive understanding of orgnaizational current state. Using standardized methodologies in the capture of current state workflows, current documentation and ordering practices will provide insight into organizational readiness. At the conclusion of this presentation, participants will be able to: Understand benefits of using standard readiness methodoligies List key components used in determining organizational readiness Identify common barriers impacting successful system implementations

Methodology/Approach: There are many initiatives in Canada which are contributing to organizational drive to move forward with advanced clinical systems. Some factors include: · Adoption and untilization of electornic medical records benchmarked against the HIMSS EMRAM scale · Ministry mandated reporting · Patient safty intitiatives · Research Providing efficient, safe and high quality clinical services is complex and requires significant organizational investment. Using an inter-professional approach when defining current state provides a comprehensive assessment of orgnaizational readiness

Finding/Results: There are certain consistent characteristics associated with the successful implementation of a new electronic system or module. Understanding organizational and staff readiness, are as important as determining current process and practice. By using a consistent approach in determining readiness, an organizations ability to achieve its desired goals, and avoid barriers is greatly increased.

Conclusion/Implication/Recommendations: The presenters, using examples from numerous readiness assessments conducted across Canada, will share useful lessons learned. The presenters will guide the attendee toward an understanding of the benefits of using a standard interprofessional approach to readiness. By the conclusion of the session the attendee will possess the knowledge and understanding of how to determine an accurate picture of organizational readiness.

140 Character Summary: Join us on the pathway to success. Learn how to prepare your organization for change by using proven methodologies to determine readiness.

Purpose/Objectives: Discuss development and implementation of a new dose range checking (DRC) solution optimized for tertiary paediatric hospital practice. Topics include creation of DRC decision rules for soft and hard alerts, approach to configuration, training and implementation, and monitoring new DRC solution for safety and efficacy.

Methodology/Approach: SickKids has had computerized physician order entry with soft DRC alerts since 2008. The standard DRC tool lacked certain functionalities for tertiary paediatric practice, resulting in “wrong-dose” incident reports. In January 2016, SickKids assembled a multidisciplinary team (Medicine, Pharmacy, Information Services) to implement a new DRC solution with the electronic medical record (EMR) vendor (Allscripts). Compared to the standard DRC tool, the new solution had these key improvements: · Mandatory override reason · Concomitant soft and hard alerts · Set alerts, individually or in combination, by o Postmenstrual age o Weight o Age o Body surface area o Frequency · DRC stratified by clinical service Key components of implementing the new solution include: · Seek DRC approaches from other centres · Develop decision rules for setting soft and hard alerts · Obtain approval to implement hard stops and decision rules from various hospital committees: o Drugs and Therapeutics o Clinical Informatics Advisory Group o Medication Advisory Committee · Develop, test and implement new DRC solution with Allscripts · Develop reports to extract o Orders and doses entered in EMR by medication name o Alerts fired and overridden in EMR · Choose medications for go-live by o Identifying high alert medications without existing DRC o Selecting two “prototype” drugs (acetaminophen, tobramycin) · Establish DRC ranges for medications using decision rules, orders report and stakeholder input · Train users during July intake, through departmental in-services and via email communications o Pharmacists received in-depth training and support for hard-alert overrides · Evaluate dose range appropriateness using DRC alerts report and incident reports

Finding/Results: Decision rules were developed: · Upper limits (percentage above usual dose) o High alert: 10% soft, 20% hard o Non-High alert: 15% soft, 30% hard · Minimum limit: 10-fold below usual low dose · Exceptions: titratable medications This was ratified at various hospital committees and helps logically set and justify DRC ranges. Soft and hard alerts were implemented for 19 medications in July 2016: · Acetaminophen · Aminophylline · Epinephrine · Epoprostenol · Esmolol · Labetalol · Magnesium sulphate · Nitroglycerin · Nitroprusside · Norepinephrine · Phentolamine · Phenylephrine · Potassium chloride · Potassium phosphate · Procainamide · Propofol · Sodium phosphate · Tobramycin · Vasopressin In the month post implementation, 1253 alerts fired for 993 items in the standard solution. Eleven alerts fired for 37 items in the new solution; 2 were hard alerts. This difference was driven by fewer nuisance alerts with the new solution. All override reasons in the new solution were reasonable.

Conclusion/Implications/Recommendations: Consultation and education to front-line users, clear decision rules and new reports facilitated a successful launch, decreased nuisance alerts and improved patient safety. Next steps include monitoring and updating DRC settings and addition of medications to the new solution.

140 Character Summary: SickKids sought to optimize its DRC tool in 6 months. Decision rules were developed & soft & hard alerts implemented, resulting in decreased nuisance alerts.

Purpose/Objectives: For years, healthcare software companies have been reluctant to fully embrace Agile development processes - the seemingly chaotic and constantly-shifting priorities of Agile seemed to fly in the face of FDA regulations that favored highly regimented, planned, and documented software releases. As more and more companies have taken on Agile, it has become abundantly clear that the Agile provides compelling competitive advantages that can be adapted for use with the Healthcare IT environment.

Methodology/Approach: Guided by the practices laid out in AAMI’s TIR45 document “Guidance on the use of AGILE practices in the development of medical device software“. we'll share how to apply Agile practices while developing FDA-compliant, “medical-grade” software.

Finding/Results: I will draw from real world experiences implementing Agile in to provide participants a candid view of our Agile story.

Conclusion/Implications/Recommendations: You'll learn how to accelerate development while delivering quality medical software, thorough testing, and comprehensive project documentation.

140 Character Summary: Five key lessons in understanding and moving towards Agile software development.

Purpose/Objectives: With a price tag of approximately four billion dollars annually, wound care is a significant financial burden to the Canadian healthcare system. This panel presentation will showcase a multi-sector wound care management strategy that targeted individuals with pressure injuries (PI) and diabetes-related foot ulcers (DFU) to optimize wound healing using evidence-based order sets. Panel members will each describe their implementation approach and lessons learned during the process. They will also discuss the net benefits derived from the project as these relate to patient safety, provider and patient/caregiver adoption, health outcomes and efficiency.

Methodology/Approach: Six nurse peer leaders (NPLs) were established in four healthcare organizations across the care continuum (i.e. ambulatory care, acute care, home care and long-term care). The NPLs received training that enabled them to provide technical expertise, leadership and mentorship to support the integration of evidence-based wound care order sets within their organization’s health information system. Two healthcare organizations in the acute care and long-term care sectors implemented interprofessional order sets that were used to guide the care of patients/clients/residents with PI and to reduce their risk of developing additional PIs. Healthcare providers in the remaining two organizations used wound care order sets in ambulatory and home care settings for the assessment and management of DFUs. Each organization also implemented a self-management order set to actively engage patients/clients/residents or families in their care. A comprehensive benefits evaluation framework was used to design the evaluation strategy. Clinical analytics enabled each organization to monitor specific structural, process and outcome indicators.

Finding/Results: Approximately 1,000 healthcare providers integrated the evidence-based order sets into their practice. The order sets facilitated knowledge translation and evidence-based decision-making at the point-of-care resulting in reduced variation in wound care management at each site. There was increased patient safety resulting from patients and residents with PI or their families conducting an initial assessment of their risk for additional PIs using a web-based tool developed for the project and keeping a PI prevention diary in which they recorded their self-management activities on a daily basis. Patients with DFUs assessed their knowledge of diabetes and foot care and used a wound care App or web-based resource and electronic goal calendar to identify SMART goals that they wished to achieve, in collaboration with their healthcare provider. Overall, the order sets improved efficiency in wound care management and patient engagement.

Conclusion/Implications/Recommendations: This multi-sector nurse peer leader project has demonstrated the value of implementing evidence-based wound care order sets across the continuum of care. These order sets support the interprofessional care team model used in this project but they may also be integrated into other service delivery models such as the nurse-led models in the primary care sector. They facilitate knowledge translation and evidence-based decision-making at the point-of-care, resulting in safe, high quality wound care and optimal health outcomes.

140 Character Summary: This presentation describes the implementation of evidence-based wound care order sets in multiple sectors: acute care, home care, ambulatory care and LTC.

Purpose/Objectives: In Canada we have built on the Canada Health Infoway Blueprint and the concept of HIAL (Health Information Access Layer) as the hub of all health information exchange within jurisdictions. The blueprint left the design and implementation of the concept to provinces, and as a result, we have seen a plethora of different and incompatible versions of HIALs in Canada. Meanwhile, the rest of the world have landed on the idea of HIE and Health Information Networks, recognizing that relevant health information exchange is not only technical issue; it requires standards, data sharing agreements, policy making, privacy controls, business incentives – and technology. Also, in the modern IM/IT architecture HIE should be seen as the Ecosystem Platform (Gartner), not only a hub that moves data between points A, B, and N. A modern platform provides data, APIs, and services to participants of the ecosystem. In Nova Scotia, we decided to pilot the HIE/HIN CMM (Capability Maturity Model) developed by Infoway in collaboration with Gartner. CMM would help us to build a roadmap to the next generation HIE that enables the “One Person, One Record” vision in Nova Scotia. This presentation describes our journey, where we have landed on, and what will (should) happen next.

Methodology/Approach: The presentation is a case study documenting and reflecting on work carried on during 2015-2016 in Nova Scotia, Canada with the help from Canada Health Infoway.

Finding/Results: After 10 years of intentional and well-funded development the health system in Nova Scotia still finds major gaps and shortcomings in their implementation of Canada Health Infoway Blueprint. CMM model helps to identify areas of strengths and weakness, and to create an ongoing process that builds towards a cohesive vision. It is important to connect all kinds of stakeholders into collaboration, and understand that technology has only a helper role, albeit an important one.

Conclusion/Implication/Recommendations: The experience using HIE/HIN CMM was very good, and it has already shaped our way of thinking and approaching the challenge. We are committed to adopt that as a strategic aid and tool for. We have already shared our experience with many jurisdictions, and there has been a certain level of excitement on the air.

140 Character Summary: Nova Scotia piloted the HIE/HIN CMM developed CHI and Gartner. That helped us to build our strategy and roadmap for the next generation Digital Health ecosystem.

Purpose/Objectives: The purpose of this presentation is to discuss the processes employed to develop a Health Sector Enterprise Architecture (HSEA) for the Philippines. The presentation will particularly focus on the ways digital health infrastructure is to be leveraged to improve universal health coverage, health equity, and population health outcomes in a lower middle income country. Aspects of the HSEA that presented challenges will be explored, including: governance; low resource care delivery settings; health human resource shortages; financial barriers to care-seeking; and mis-alignments between national and sub-national health adminstrations.

Methodology/Approach: The presentation will describe the use of a "storytelling" approach to health enterprise architecture development. This methodology is particularly well-suited to use in LMIC/developing country environments. It was developed and published by the Joint Learning Network for Universal Health Coverage and published in a 2014 eBook: Connecting Health Information Systems for Better Health -- Leveraging interoperability standards to link patient, provider, payor, and policymaker data (https://jln1.pressbooks.com/). The presenter will focus on how this "storytelling" methodology augmented other stakeholder engagement techniques and was employed to evolve, harmonize and itegrate prior enterprise architecture efforts conducted within the Philippine Department of Health (DOH) and the national health insurer, PhilHealth.

Finding/Results: Over the course of a short but intensive donor-funded engagement, existing enterprise architecture artefacts were analysed, stakeholder "stories" were gathered and rigorously processed, and a new, harmonized HSEA was developed. The presentation will review the attributes of this comprehensive health enterprise architecture and how it is being leveraged to inform the construction of durable, re-usable, standards-based digital health infrastructure within the Philippine health sector.

Conclusion/Implication/Recommendations: Digital health infrastructure is a key enabler for improving health equity and population health outcomes in low resource environments. There is a moral imperative to investing wisely. Given competing uses of funds, effectiveness and efficiency improvements must result from successfully implementing such infrastructure -- or else the money should be spent elsewhere. In a country like the Philippines, this moral imperative informs the goals of a HSEA undertaking. In wealthy countries like Canada, there is a motivation to divest efficiency improvements to "bend the cost curve" -- to try to accomplish the same degree of "health production" from a reduced expenditure of resources. In the Philippines, or any LMIC environment, the motivation is the invest the efficiency improvements -- to be able to increase the "health production" that may be realized from the scarce resources available. The presentation will compare and contrast HSEA approaches and motivations between Canada and the Philippines and draw out, for attendees, particular lessons that might be taken by each, from each other's experience.

140 Character Summary: This session describes the development of a comprehensive health enterprise architecture for the Philippines and the particular challenges LMICs face to do this.

Purpose/Objectives: Ontario’s Electronic Health Record (EHR) Connectivity Strategy was first published in July 2015 and describes how health care information will be connected to create a safe, cost-effective, provincially integrated EHR. It outlines the transition steps that will take us from where we are today to a future state where health care providers have timely and secure access to critical health care information. The strategy identifies sources of EHR information in Ontario, and describes how health care information will be connected to create an integrated EHR that provides a lifetime record of an individual's health history. Since the initial 2015 publication the eHealth landscape in Ontario has changed, provincial repositories and registries have come online, and an updated version of the strategy was required. This presentation outlines how the strategy has changed as well as lessons learned from its initial engagement and adoption.

Methodology/Approach: The initial engagement approach for the Connectivity Strategy involved several months of internal stakeholder meetings and discussions to develop a draft that could be shared with external stakeholders. Subject matter experts and technology leaders were then engaged to validate the draft. Finally, it passed through eHealth Ontario’s governance process which provided wide internal and external reviews. Over 500 comments from 28 organizations resulted in changes to the 2015 version of the document.

Finding/Results: Within and without the agency, the strategy is now recognized as an authoritative source of EHR information. Most use it as a reference, focusing only on sections that relate to their domain (labs, drugs, acute care, etc.). The strategy provides an excellent orientation into Ontario’s ehealth landscape for those entering the field. External engagements identified existing assets that were used in siloed domains, helping identify how they could integrate with provincial assets. Developing the strategy was an excellent tool for building relationships, opening a dialogue and setting a common language for discussions. The open and transparent approach built trust and fostered support. The initial release of the strategy highlighted the challenge of conveying a technical strategy to multiple audiences (e.g. both information technology professionals and clinicians). Supporting materials for the strategy, including clinical scenarios, use cases, an asset inventory, and integration requirement guides, were developed to aid communication to the broader audience.

Conclusion/Implication/Recommendations: An EHR IT strategy cannot be static. To remain relevant and maintain buy-in, it needs to reflect the landscape of the day. Engagement for version 2.0 of the Connectivity Strategy started with internal product and account management teams to ensure alignment with product roadmaps and stakeholder requirements. Only after the internal engagement were external partners engaged. As new systems come online and strategies change, current state models need to be updated. Using a UML modelling tool to document provincial systems has allowed us to continuously update key dependencies and inter-relations between systems described in the strategy. Many sections that were considered ‘Evolving Needs and Emerging Technologies’ in the 2015 version, such as HL7 FHIR, have now become core to both the current and future state of connectivity in Ontario.

140 Character Summary: Discover how changes in Ontario’s ehealth landscape and lessons learned from the 2015 publication of the EHR Connectivity Strategy have affected version 2.0.

Purpose/Objectives: Manitoba is implementing a Home Clinic model to support primary care clinics in providing their patients with comprehensive, continuous, and coordinated care. Ensuring Manitobans have a Home Clinic, which serves as the home base for the majority of their primary care needs, is a key step towards achieving a longer term vision of a robust, equitable, and accessible primary care system. Home Clinics are based on the model described in the 2011 College of Family Physicians of Canada publication, A Vision for Canada, Family Practice, The Patient's Medical Home.

Methodology/Approach: The development and implementation of the Home Clinic model in Manitoba has been a collaborative effort including Manitoba Health, Seniors and Active Living, The College of Family Physicians of Manitoba, Doctors Manitoba, Manitoba eHealth, fee-for-service clinics, and Manitoba's Regional Health Authorities. In 2015, a new Comprehensive Care Management Tariff, designed to support the adoption of the Home Clinic model, was negotiated with an implementation date of April 1, 2017, and focuses on the provision of comprehensive care to "Enrolled" patients with complex needs. The annual management tariff encourages a team based approach to care and requires that fee-for-service physicians use an EMR that can submit Manitoba's Primary Care Data Extract. This extract leverages the Primary Care Quality Indicators and includes prevention, screening, and management of chronic diseases, based on CIHI's primary care indicators. The implementation of Home Clinics has also required the development of a Home Clinic Registry, Patient Enrolment Repository, and changes to the Claims Processing System to support the new tariff. Extensive communications and change management supports have been established to help Home Clinic implementation.

Finding/Results: The Home Clinic implementation is underway at this time. By April 1, 2017, it is anticipated that the majority of eligible clinics will have registered, worked through the details of enrolling patients, and will start claiming the Comprehensive Care Management tariffs for their eligible enrolled patients. Lessons learned and the results of the early implementation will be shared at this session.

Conclusion/Implications/Recommendations: Home Clinics, Enrolment, and the Comprehensive Care Management Tariff are just the beginning of the evolution towards more comprehensive, continuous, and coordinated care for Manitobans. The Home Clinic and Enrolment Registry will serve as the foundation to allow improved information sharing and coordination between Home Clinics and episodic care providers. The next phase will focus on the ability for Home Clinics to publish a patient summary to eChart Manitoba, and to allow episodic encounter notes to be sent to the Home Clinic when a patient seeks episodic care outside of the Home Clinic. Driving policy change requires ongoing collaboration, understanding, and good faith negotiations between all parties, and a focus on ensuring that patients have access to continuous, comprehensive quality care.

140 Character Summary: Advancing Patient-Centred Medical Home in Manitoba: Aligning Continuity of Care with ICT and remuneration - a lived experience.

Purpose/Objectives: For over 15 years, multiple jurisdictions have collaborated to define, build, implement, maintain, and evolve a shared Provider Registry solution. This session will highlight this unique collaboration as an example of success. Panel members will discuss the management structure, standards process, sustainment challenges and engage in discussion with the audience on lessons learned.

Methodology/Approach: In 2001, the Western Health Information Collaborative, WHIC (Manitoba, Saskatchewan, Alberta, and British Columbia), with BC as the lead; established requirements and design for a Jurisdictional Provider Registry. In partnership with WHIC; Canada Health Infostructure Partnerships Program; and Canada Health Infoway; Sierra Systems developed the Provider Registry System (PRS) as a standards-based repository of core provider data that can be implemented by any Canadian Jurisdiction. The solution and collaboration continues today.

Finding/Results: History Founding the initial collaboration, BC Ministry of Health and the WHIC partners, through a series projects, produced a fit-for-purpose software solution including: -Provider data and communication standards; -Common business processes and rules; -A registry infrastructure (the PRS); and, -Multi-jurisdictional problem, change, and release management processes. As jurisdictions conducted their own implementations their experience fed back into the collaborative. Extensions refined core services; added new functionality; enhanced portability features; developed and adopted national standards (HL7v3); and created an implementation toolkit. Realizing the goal of implementation beyond WHIC, the PRS was also deployed in Quebec and Newfoundland. Currently, the Provider Registry System Collaborative (AB, SK, and NL) is responsible for product management. The group meets regularly to set priorities and maintain the product roadmap. Managing collaboration Multi-jurisdictional collaboration adds a significant overhead for projects and requires strong governance and stakeholder commitment, far beyond what is typical for in-jurisdiction projects. -Appropriate funding and cost sharing models are required -Significant effort is required to reach agreements on standards and core requirements -Ongoing development requires agreement on vision and re-investment -Realizing that benefits pay off over a longer term is key. Members were able to strike a balance resulting in a core solution, data standards, terminology, processes, and implementation guides that are shared by all implementations. Where jurisdictional variants are necessary, they are designed as replaceable plug-ins to facilitate customization. Standards contributions With a significant footprint in Canada, the collaborative is an active and influential participant in standards development. Early work by the WHIC team defined a data model and terminology for the Provider domain which eventually seeded the HL7v3 pan-Canadian standard. The partners continue their contributions in the HL7 community, jurisdictional implementer groups, and most recently towards Canadian FHIR profiles for Provider Registry.

Conclusion/Implications/Recommendations: Multi-jurisdictional collaboration on informatics solutions is difficult, however, the benefits are significant. The PRS is an enduring success story. -The common solution fostered a community of interest around the Provider domain. -Standardization within the group seeded the pan-Canadian message sets and terminology. -Designing for portability resulted in ease of implementation with minimal need for customization. -Ongoing costs are shared and fully re-invested into the solution. In closing, we offer this ongoing, successful, collaboration and lessons learned as precedent for new multi-jurisdictional initiatives such as PrescribeIT.

140 Character Summary: 15 years of successful multi-jurisdictional collaboration on the Provider Registry System sets a positive example for other collaborative initiatives

Purpose/Objectives: In 2016, University Health Network (UHN) embarked on a transformational IT journey towards a digital future that supports our three domains of clinical practice, research and education. UHN has faced the typical technology challenges that encumber large academic research hospitals such as a distributed operating model, decentralized governance structures and a complex customer service interface. To address these challenges, UHN identified a need for greater coordination of IT expertise, a re-examination of service delivery models and an improved customer service approach to embrace the opportunities a digital world will bring. Our objectives included reorganizing 500+ IT staff into one integrated and co-ordinated digital team, implementing a new, transparent governance structure, and establishing financial accountability for nearly $100M.

Methodology/Approach: A small project team was established with authority to solicit feedback from key opinion leaders and IT experts throughout the organization. A clear understanding of the current state was developed using monthly data from each IT unit, conducting IT staff surveys on aspirations and competencies, as well as surveying the entire organization to ascertain a ‘digital pulse’. The team drew upon external expertise in numerous forms: extensive literature review, an IT advisory committee of the board, consultants, hospital CIO’s, and industry experts. Change management was an important aspect of the transformation; to manage this, the team employed John Kotter’s 6-Step Change Model, organizing stakeholder events to co-design a solution, and pursuing a multi-faceted communications strategy. The transformation effort was given a new digital brand that served as a hallmark and a visual rallying point for the IT transformation.

Finding/Results: The IT Pulse survey showed that staff wanted their technology needs met more efficiently and desired a more personalized customer service approach. Co-design workshops with leaders from across UHN revealed the need to centralize many IT services. In addition, data collection showed needless complexity and duplication of services. The literature review and industry best practices revealed a bi-modal operating model approach with a focus on reliable and agile IT components that would respond to the needs of the organization. UHN extended this model to a third component to foster local innovation and discovery. The result was a tri-modal operating model that provided three ways for the digital team to work. The tri-modal approach will accommodate reliable, agile and exploratory modes of working.

Conclusion/Implication/Recommendations: UHN’s digital transformation exemplifies a new way of thinking about IT in a healthcare organization. As technology and patient care become more integrated - running a digitally-enabled hospital is less about adopting digital technologies and more about changing the way we work in response to the nature of a digital world. Consequently, UHN embarked on an organization-wide change centered on our customers through a comprehensive operational model, strong business-IT alignment, and purposeful engagement. The IT Transformation is a necessary step forward and is a key enabler of UHN’s purpose and digital strategy. Caring for our patients, teaching our students, and discovering tomorrow’s treatments are critically dependent on this transformation.

140 Character Summary: UHN is implementing a new enterprise-wide integrated and synergistic IT operating model to put patients first, and bridge the care, discovery and learning domains.

Purpose/Objectives: Under the Patients First: Action Plan for Health Care, Ontario has made a commitment to put people and patients at the centre of the health care system. As the Ministry of Health and Long-Term Care (ministry) develops a renewed digital health strategy, Hospital Information System (HIS) Renewal is a fundamental focus area. A critical mass of hospitals is replacing or upgrading their HIS or will do so in the near future, which provides an opportunity to examine ways to maximize the value and impact of public investments in these information systems.

Methodology/Approach: Given the current state of HIS investments, which were made independently to create hospital-specific value, the next generation of HIS investments will require a partnership model to increase value in an environment of fiscal constraint. Under the ministry’s efforts to establish new digital health governance, a HIS Renewal Advisory Panel was created with the objectives of maximizing the value of current and future HIS investments, and improving patient outcomes and value for money through collaboration and innovation. The panel is comprised of ministry staff, clinicians, and executives from hospitals and local health integration networks. The panel used traditional procurement methodology to assess financial impacts and engaged in sector outreach to develop recommendations.

Finding/Results: Through rigorous analysis, broad collaboration, and consensus building, the panel finalized short-term recommendations in four strategic pillars: partnering, clinical adoption and outcomes, procurement, and financing. The panel’s key recommendation was that hospitals should form HIS clusters based on previous partnerships to support patients through the use of a shared HIS, typically under a lead hospital, in order to maximize the value of current and future HIS investments. To support implementation, the panel recommended that the ministry create resources for HIS renewal, such as leveraging networks of health care professions to create a HIS Community of Practice that supports acquisition, implementation, and optimization of HIS systems and evidence-based standardization of clinical practices within hospitals. Furthermore, the panel recommended that the ministry should seek appropriate policy approvals to enable hospitals to join existing peer HIS installations, where supported by a strong clinical and financial business case. Moving forward, the Panel will develop cost standards for hospital accounting and coding to allow for more accurate projections of HIS-related expenses, and in turn support the effectiveness of ministry funding models.

Conclusion/Implication/Recommendations: In the second phase of HIS renewal, the panel will focus on defining a path for HIS clusters to coalesce into a select number of mature hubs that provide cost-effective, secure services. Ontario’s 157 hospitals will begin to form approximately 15 clusters for HIS service delivery over the next five years based on value-based assessments. The Panel will develop a provincial strategy that fosters the capacity of high-performing hubs to ensure a sustainable, long-term approach to managing HIS investments. The ultimate goal is to transform the currently fragmented HIS environment into a platform for a high-performing, patient-centred health care system.

140 Character Summary: Renewing hospital information systems would maximize value and enable a high-performing patient-centred health care system

Purpose/Objectives: Local Health Integration Networks (LHINs) provide strategic direction and fund health service providers (HSPs) in Ontario. To hold HSPs accountable, a number of performance indicators are being monitored but are submitted and captured in disparate locations. HSP360°, a performance management tool, was developed by the Centre for Addiction and Mental Health (CAMH) in partnership with the Toronto Central LHIN in response to feedback from HSPs and their boards about not having timely access to their information and their inability to see how their individual performance impacts the overall sector and system performance. Prior to HSP360°, each LHIN and HSP spent a significant amount of time and resources to manually consolidate health system data into reports to monitor performance. HSP360° reduces the duplication of effort and removes barriers to data by providing a centralized and consistent view of LHIN, sector and HSP data through meaningful comparative reports and dashboards. <img alt="hsp360 guiding principles.jpg" annotation="" id="image://48" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=3d84b7728ec2ae9eb535a2cb184e15beee8f18f3&id=48&width=350&height=350&download=0" title="hsp360 guiding principles.jpg" />

Methodology/Approach: To accommodate variations in performance monitoring processes, views of information, and source file formats, a pan-LHIN Advisory and Steering Committee was established to reach agreement on business requirements, prioritization, and development of a product roadmap. This approach ensures relevant, transparent, and meaningful reporting and analyses that meet the evolving needs of end users.

Finding/Results: In 2016, HSP360° expanded from a local to a pan-LHIN solution containing data for approximately 400 HSPs across 5 sectors. LHINs have found great value in automating the administrative and benchmarking process for negotiating targets and monitoring performance. On a quarterly basis, comprehensive reports are now available in weeks rather than months. In addition, HSP360° has improved decision support capacity for HSPs. In particular, HSPs have found the comparative and peer comparison reports helpful in planning for new services, looking for efficiencies and as a starting point to discuss overall sector and system performance.

Conclusion/Implications/Recommendations: The success of the HSP360° solution has been a result of a structured implementation methodology, high degree of stakeholder engagement and buy-in, and user support provided throughout the initiative. The progression of HSP360° has enabled LHINs and HSPs to set new standards in performance monitoring and a common view of performance metrics across LHIN boundaries. Future integration of new data sets and enhancing collaboration functionality will further support the performance monitoring process, and improve access to comparable information for evidence-informed decision making for all providers. The expansion of HSP360° to additional LHINs will build towards shared accountability, consistency and transparency across the province.

140 Character Summary: HSP360° builds decision support capacity and shared accountability for health service providers across data sources, sectors and regions.

Purpose/Objectives: This panel brings together diverse health care organizations that are collaborating to reach physicians with their ehealth solutions. Hear why and how partnerships were formed, how they are governed, and how they are achieving their ehealth objectives.

Methodology/Approach: Each panel member will provide their perspective using examples of ehealth initiatives that required partnering with an organization that is the ehealth delivery partner for primary care. These examples will demonstrate how their respective sectors within health care (acute care, community care, primary care, long-term care, mental health, community support services) have come together and need to keep working together to make ehealth the interconnected system it was meant to be and work to align to provincial and regional health priorities.

Finding/Results: Every organization with ehealth initiatives needs physician participation or will soon need it. The ability to share patient information between the various health sectors and physicians is the holy grail of ehealth and is being realized through partnerships that, for example, have enabled the success of a provincial report management solution that is now of interest to other health care sectors. Critical success factors for partnership were effective agreements that allowed for “skin in the game” for the partners in addition to accountability of the delivery partner. This is demonstrated by the agreements with individual hospitals, specialty clinics, and end users of the report solution. The proven success of the initiative led to partnerships beyond acute care to deliver more reports to physicians – eNotifications, to support provincial community care initiatives; telehomecare reports with the provincial telemedicine agency to support home care. More organizations are seeing the value of a potential partnership to leverage the report solution to deliver their information to physicians – cancer care, long-term care, and mental health, to name a few. The provincial ehealth delivery partner is also collaborating with other organizations that are willing to partner for delivery services, on connecting physicians to the provincial electronic health record containing information from hospital and community organizations, the agency implementing the provincial laboratory information system, among others that require deployment to physician practices. The certified electronic medical records (EMRs) used by community-based family physicians contains a treasure trove of patient information. It is estimated that 80% of patient information is collected in primary care practices. Partnerships have also formed between a provincial ehealth delivery partner and provincial organizations responsible for health quality that need data from physicians’ EMRs for health system planning and quality improvement initiatives and with regional organizations that need change management expertise with physicians to ensure the success of their initiatives.

Conclusion/Implications/Recommendations: Partnerships are crucial to the success of ehealth initiatives in the current landscape of limited financial resources, limited change management capability and the need for primary care data to effect health system transformation. Without the trusted relationship and advisory role between a provincial delivery partner and physicians, other provincial and regional bodies have no way to deploy their ehealth initiatives to a critical mass and sustain their use.

140 Character Summary: Leveraging partnerships is necessary for physician adoption and use of ehealth technologies and for getting them to provide EMR data.

Purpose/Objectives: As the Ontario government’s advisor on the province’s cancer and renal systems, as well as access to care for key health services, CCO drives continuous improvement in disease prevention and screening, the delivery of care and the patient experience for chronic diseases. We also encourage and support the broader improvement of Ontario’s health systems by driving quality, accountability, innovation and value. To support decision-making and drive quality improvement, we acquire, collect, analyze and report on data. We are the custodian of over 75+ data holdings with 127,000+ columns that translates to over 250TB of data across production and supportive non-production environments. CCO has extensive expertise in the translation of large data sets into meaningful information that is translated into knowledge on health system performance and enables directed improvement initiatives. CCO is committed to the delivery of actionable insights to inform clinical and business decision-making around the planning, delivery, management and measurement of healthcare. To date, CCO has applied disparate approaches to the implementation and management of its data and analytics assets, practices, and technology that enable information generation and utilization. Without a solid foundation, CCO’s capability to realize value from its assets and enable transformation to respond and deliver on Provincial strategies will be strained. To ensure success in the future, a defined data and analytics strategic path has been set to mitigate identified risks, exploit the value of the data, generate insights that enable informed decision-making and enable CCO’s evolution as an evidence-based thought leader.

Methodology/Approach: In early 2016, a comprehensive “Discovery and Direction” phase was completed. The approach included: • The evaluation of the current state and the defining of a future state with respect to: o Data assets o Analytics & data management practices o Architecture & Technology o Analysis of requirements, risks, new opportunities, and partnerships • An Environmental Scan • Identification of key initiatives along with risks and interdependencies required to meet future state • The completion of an analytics pilot using an agile approach and big data. The phase concluded with the development of a 4 year 11.2M Data & Analytics Strategy and action plan. Phase 2 “Strengthening our Foundation” is now underway.

Finding/Results: Through all of this work, we have identified the following key learnings: • Vision needs to be business outcome driven • A collaborative enterprise approach is key to success • Data must be recognized and managed as a strategic asset. • Analytics needs to be fostered as core competency of the organization • Balanced, lean governance embedded in practice should be applied • Focus on the journey not the destination

Conclusion/Implications/Recommendations: Based on these findings, CCO has developed a Data & Analytics Strategy action plan that is now being operationalized. Our presentation will share key elements of our learnings to date, our action plan, and our priorities from a ‘people, process and technology’ perspective. Additionally, we will share key learnings from the analytics pilot that was conducted.

140 Character Summary: CCO is implementing a Data & Analytics Strategy to become an insights-driven organization. We will share key elements of our learnings, action plan, and priorities.

Purpose/Objectives: To demonstrate how Digital Health can improve patient outcomes, experiences and practice changes, increase real-time reporting, promote better risk management, allow for predictive and preventative care, and provide meaningful, timely data to front-line clinicians. The majority of Canadian hospitals Do not have all of the necessary information available at the point of care in an electronic format Have not implemented evidenced-based medicine and clinical analytics at an enterprise level Have process inefficiencies which compromise patient care delivery Digital Health Innovation can help address these issues through Empowerment and Engagement of Patients, Families, and Care Providers Coordination across the circle of care and collaborative innovation Integration of data and devices in a secure regulatory compliant manner

Methodology/Approach: Transformation through Digitization and mobility Visioning and priority setting to automate and optimize business processes Align enabling technologies with automated processes Design Thinking to reimagine the patient & staff experience Imbed mobile into process optimization Imbed analytics into enterprise optimization <img alt="mobility image.jpg" annotation="" id="image://39" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=cc731645e5353d25e2db65642c7269e306fc41d3&id=39&width=350&height=350&download=0" title="mobility image.jpg" />

Finding/Results: Findings/Results IBM Innovation Program Acceleration of innovation Alignment with Health System strategic priorities like Value Based Care Access to digitized health data Test IT labs for future services Focused on the healthcare ecosystem Examples Canadian examples Hamilton Health Sciences (HHC) – Collaborative Innovation Centre Global example Finland – Watson Health Centre of Excellence

Conclusion/Implications/Recommendations: IBM has created a portfolio of Digital Health services and solutions. We leverage global experiences and leading practices and bring them to the Canadian market. We can help you achieve the health system of the future: Patient Outcomes = Great! Patient Satisfaction = High Staff Satisfaction = High Virtual visits = 60% Physical visits = 40% Preventable Errors = Zero Avoidable Readmissions = Zero Hospital Acquired Infections = Zero Length of Stay = Below average Value based Care = 100%

140 Character Summary: Our approach has: an emphasis on proactive care to meet pt needs, a patient-centric focus, mobility and innovation, care that is based upon value and outcome.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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