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  • e-Health 2017 Virtual Meeting

    Explore the Future of Digital Health and the People Who Benefit - Toronto, ON

    This product offers access to the e-Health 2017 Keynote Presentation Live Webcasts, the recording of these 4 sessions and access to all PDF/Presentation Slides of each conference presentation.

    Presentation Date(s):
    • Jun 4 - 7, 2017
    • Total Presentations: 225
    Non-Member Price: $120 CAD Digital Health Canada Member Price: $100 CAD
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    OS05 - Connecting Data in Meaningful Ways (ID 5)

    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 203AB
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      OS05.01 - Transforming Data into Actionable Information - Your Health System: Insight (ID 381)

      Clara Pong, /

      • Abstract
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      Purpose/Objectives: Your Health System: Insight is the beginning of CIHI’s analytical centre where information is integrated together with sophisticated, yet user friendly, business intelligence software. Its main purpose is to provide health system stakeholders a user friendly analytical tool where they can access timely, relevant and actionable information to answer key questions that matter to them. They can track their progress monthly and compare to their peers, identify factors that might contribute to their performance, and investigate potential savings.

      Methodology/Approach: YHS: Insight brings together indicator results, clinical and administrative data, and cost estimates of the acute and ambulatory care sector. In this session, we will use various user stories to demonstrate how data is transformed into meaningful information to support health system planning and quality improvement. Users of Insight can delve into emergency department and acute inpatient data to answer questions such as: what are characteristics of patients who wait the longest to see a doctor in emergency? What are the top three reasons patients are being readmitted to a hospital? Are there efficiency opportunities to discover in our operation and utilization data?

      Finding/Results: The number of users for Insight is continuing to grow, and they’re logging in to use it more-and-more. To date, feedback from Insight users has been tremendously positive and an evaluation of usability is planned. Through the demonstrations and testimonies, the audience will see how Your Health System: Insight will support the needs of facility and regional health system managers and their efforts to measure, monitor and improve performance, by offering timely, relevant, and actionable data.

      Conclusion/Implication/Recommendations: As the health system moves to more integrated care across the continuum, CIHI is working towards providing integrated reporting that supports improvement of performance and outcomes. CIHI will actively engage stakeholders to ensure that Insight is evolving in meaningful ways for the acute care sector, as well as for other health sectors as the tool is expanded into long-term care, home care, and beyond.

      140 Character Summary: Your Health System: Insight helps clients better understands their performance indicators and explores potential savings in operation and utilization.

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      OS05.02 - Improving Community Paediatric Asthma Care with EMR Algorithm and Tools (ID 327)

      Andrew Cave, Family Medicine, University of alberta; Edmonton/CA

      • Abstract
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      Purpose/Objectives: Asthma management for children in primary careis suboptimal despite guidelines. Management can be improved by point of care prompting. The Asthma Working Group (AWG) purpose was to provide and test a template for asthma management for primary care physicians (PCPs) to structure their management according to guidelines.

      Methodology/Approach: An asthma management algorithm was developed by a panel of experts in one Canadian province. Several iterations were developed of algorithms for (1) approach to first diagnostic visit (2) management of follow up visits of viral induced and (3) allergy induced phenotypes of asthma and(4) management of acute exacerbations. These paper-based algorithms were reviewed by groups of PCPs for content and presentation. Consensus was that even brief paper based formats would not be used regularly. 85% of PCPs have Electronic Medical Records (EMRs) for charting; therefore templates were developed that could be inserted into the EMR for point of care patient management. One EMR vendor provides the software for 80% of primary care practices in the province using one of three programs. The AWG consulted them to upgrade the first templates. It was soon apparent that much more was possible than the AWG had envisioned and a working partnership was developed with the EMR vendor. Through this partnership the AWG improved the template design and added a population management dashboard to enable proactive management processes and usability. To test the templates, 23 primary care practices were recruited and randomised to receive the asthma management education and the EMR tools. Clinical and process indicators for childhood asthma are captured within the dashboard for the PCP to review, analyse or act upon. Dashboard statistics can be shared by the PCP with the AWG support team, which then returns the peer average in the PCP's dashboard trends. The dashboard indicators provide insight to the AWG team to validate the asthma templates adoption, identify areas for coaching to reinforce best practices and assist with future program planning. Additional resources are accessible for template use via an integrated educational package.

      Finding/Results: Four templates have been produced and approved by clinician members of the AWG incorporating free flow algorithms and are supported by a quality improvement dashboard. These have been inserted into 11 practices that use one of two EMR systems.

      Conclusion/Implication/Recommendations: If the randomised trial outcomes show that the templates improve the management of asthma in children, the templates will be offered to all PCPs in the province who use any of the three systems (over 3000 PCPs covering over 70% of paediatric patients with asthma). Feedback from participating PCPs will enble modification of the templates before going province wide. The fact that the EMR vendor covers so many of the practices through the three systems will be a major facilitator of this roll out. Provincial working groups for Chronic Obstructive Pulmonary Disease (COPD) and for diabetes have expressed an intention to use the same approach for improving management of those conditions in primary care.

      140 Character Summary: Pediatric asthma management templates and tools were developed and inserted in primary care EMRs by a clinician/vendor partnership. Other conditions will follow.

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      OS05.03 - Diabetes Defender – Changing At-Risk Population Behaviour Using Analytics (ID 137)

      Fatima Paruk, Allscripts Analytics; Chicago/US

      • Abstract
      • PDF

      Purpose/Objectives: Studies estimate that diabetes affects 8% of the U.S. population, but confirming this in patients who are undiagnosed, and identifying those at highest risk, remains challenging. There are suboptimal levels of health literacy and a lack of engagement among asymptomatic diabetics, who go on to develop complications of the complex and costly chronic disease. This necessitates development of an innovative approach to identify and manage this population.

      Methodology/Approach: We identified pre-diabetics in the USA from more than 3000 Allscripts client sites and included de-identified longitudinal records on 40 million patients nationally using the AMA-CDC retrospective algorithm. 3.48 million patients met inclusion criteria by the algorithm.

      Finding/Results: Of the approximately 40 million patients analyzed, 3.48 million were pre-diabetic patients. Patients who met inclusion criteria demonstrated significant conversion of pre-diabetes to diabetes mellitus (near 80%) in tracked by time-series analysis of HbA1c’s over the three year period. The burden of pre-diabetes was demonstrated geographically at the national, state and county level with real-time analysis. Given the complexity of the disease, provision of tailored insights (emphasis on diet, exercise, medications, optimize geography) to empower and incentivize individual patients to assume responsibility for preventative care in the real world is needed.

      Conclusion/Implication/Recommendations: Once we have defined at-risk patients, we can begin to look at specific complex social and environmental risk factors that impact diabetes – that aren’t necessarily in the health data. For example, counseling a patient on diet modification is unlikely to help if your patient only has access to fast-food delivery because they can’t walk, or resides in a ‘food desert’ where fresh fruits and vegetables are unavailable. With targeted, informed interventions, patients can get treatment tailored to and relevant to their environments, which may include dietary advice, exercise programs or medication availability. This information must not only be delivered to the point of care for health providers, but also directly to the patient in a relevant format. We are using historical insight from 40 million records in real populations to better understand pathogenesis of disease among different groups of people. If we can show positive patient results from thousands of other diabetic patients with similar BMI, or race or age, and other sociobehavioral drivers of health, we can empower people with understanding and responsibility for their own health. Future goals are to create and refine predictive models to understand progression to DM, successfully identify at-risk populations for enrollment into DPP’s (Diabetes Prevention Programs) and other personalized treatment plans, quantify cost savings, and identify additional areas for potential intervention.

      140 Character Summary: Provision of tailored insights is needed to empower and incentivize diabetes patients to assume responsibility for preventive care in the real world.

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      OS05.04 - Answering Health Policy Questions with Open Innovation Data Challenges (ID 318)

      Simon Hagens, Canada Health Infoway; Toronto/CA

      • Abstract
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      Purpose/Objectives: Investments in digital health have led to the generation of a vast amount of health data. Traditional approaches to knowledge generation through data and analytics can be resource-intensive and not always well-positioned to support decision-makers’ needs for timely, action-oriented evidence. This has triggered interest in innovative alternatives, such as open challenges or crowd-sourcing. This presentation will share a case study of an organization using open innovation challenges to answer health-related policy questions with existing data and analytics. The effectiveness of this approach, and potential for future use, will be discussed.

      Methodology/Approach: Canada Health Infoway conducted two Data Impact Challenges in 2015 and 2016. It invited authorized users of health data from across the country to answer 20 research questions related to the health system and patient care, such as rates of duplicate testing, screening, or inappropriate prescription use. The questions were sourced from a variety of supporting health care organizations, as well as an open call to Canadians. Teams had 64 and 76 days, respectively, to submit their answers to the two challenges. A total of $167,500 in awards was made available. Submissions were judged on timeliness and quality (data quality, representativeness, and innovation). The judging panel consisted of 51 experts selected with expertise in health policy, research, data and analytics. A mixed-methods approach was used to understand the effectiveness of the Data Impact Challenges. Quantitative data were collected in the course of the registration, submission, and judging processes, and analysed. Qualitative analysis of content from semi-structured key informant interviews with participants, non-participants, and judges was also conducted.

      Finding/Results: Thirty-three individuals or teams made 51 submissions to the challenge. Nineteen of 20 research questions were answered through the challenge using data from 8 of Canada’s 13 provinces and territories. Submissions came from researchers, clinicians, and analysts based in health care organizations, government, academia and the private sector. Qualitative findings suggest that participation was driven more by non-monetary factors than by the awards. Almost all, including non-participants, indicated that they would take part in similar challenges in the future. An analysis using administrative data from British Columbia earned the highest score for the first challenge and identified opportunities for more appropriate use of screening blood tests. In the second challenge, a research organization from Ontario earned the highest score and found that 55% of patients were re-dispensed the culprit medication after an adverse drug event.

      Conclusion/Implication/Recommendations: Open innovation challenges can generate timely information in a cost-effective way that responds to novel questions that support evidence-informed decision-making while also demonstrating the value and potential of existing health data sets. Characteristics of challenge design and implementation affect both participation and the quality of submissions received.

      140 Character Summary: Open innnovation challenges are an effective way to find solutions to important health care questions.

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      OS05.05 - Beyond the Randomized Controlled Trial: Reviewing mHealth Clinical Trial Methods (ID 52)

      Quynh Pham, Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto/CA

      • Abstract
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      Purpose/Objectives: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials.

      Methodology/Approach: We conducted a review of the ClinicalTrials.gov registry to identify and examine current clinical trials involving mHealth apps and retrieved relevant trials registered between November 2014 and November 2015. Descriptive statistics were conducted on all variables to identify methodological data trends and parameters. Independent t tests, one-way ANOVAs and Pearson correlation analyses were conducted to determine whether there were differences in study duration for all methodological variables. A multiple linear regression analysis was performed with study duration as the dependent variable and all significant predictor variables from the preliminary analyses as independent variables.

      Finding/Results: Of the 137 trials identified, 71 met inclusion criteria. The majority used a randomized controlled trial design (80%, 57/71). Study designs included 36 two-group pretest-posttest control group comparisons (51%, 36/71), 16 posttest-only control group comparisons (23%, 16/71), 7 one-group pretest-posttest designs (10%, 7/71), 2 one-shot case study designs (3%, 2/71), and 2 static-group comparisons (3%, 2/71). 17 trials included a qualitative component to their methodology (24%, 17/71). Complete trial data collection required 20 months on average to complete (mean 21, SD 12). For trials with a total duration of 2 years or more (31%, 22/71), the average time from recruitment to complete data collection (mean 35 months, SD 10) was 2 years longer than the average time required to collect primary data (mean 11, SD 8). Trials had a moderate sample size of 112 participants. Two trials were conducted online (3%, 2/71) and 7 trials collected data continuously (10%, 7/68). Onsite study implementation was heavily favored (97%, 69/71). Trials with four data collection points had a longer study duration than trials with two data collection points: F4,56=3.2, P=.021, ?2=0.18. Single-blinded trials had a longer data collection period compared to open trials: F2,58=3.8, P=.028, ?2=0.12. Academic sponsorship was the most common form of trial funding (73%, 52/71). Trials with academic sponsorship had a longer study duration compared to industry sponsorship: F2,61=3.7, P=.030, ?2=0.11. Combined, data collection frequency, study masking, sample size, and study sponsorship accounted for 32.6% of the variance in study duration: F4,55=6.6, P<.01, adjusted r2=.33. Only 7 trials had been completed at the time this retrospective review was conducted (10%, 7/71).

      Conclusion/Implication/Recommendations: mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations. There is a need for clinical evaluation to keep pace with the level of innovation of mHealth if it is to have meaningful impact in informing payers, providers, policy makers, and patients.

      140 Character Summary: Our research has revealed that mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations.

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      OS05.06 - Merits of a Health Analytics Maturity Model for Canada (ID 226)

      Ron Parker, Emerging Technologies, Canada Health Infoway Inc.; Bedford/CA

      • Abstract
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      Purpose/Objectives: This panel discussion will examine and debate the use a Maturity Model for Health Analytics. The purpose of the panel will be to test and inform the audience on some of the potential uses and benefits of a maturity model and the merits of different approaches.

      Methodology/Approach: As part of developing a paper on the Considerations and Approaches to Deployment Health Analytics in Canadian Health Care, Infoway is developing a discussion paper on a proposed Health Analytics Maturity Model. The rationale for the maturity model will be presented, along with assertions about its potential use, and the panel will debate the model and relative benefits.

      Finding/Results: The Health Analytics Maturity Model is a discussion document that will be introduced in the months before the conference and the panel will discuss the merits of having such a model and of the specific approach taken.

      Conclusion/Implications/Recommendations: Implications and recommendations will be surfaced during the course of the panel discussion.

      140 Character Summary: A panel discussion on the merits and approach to establishing a maturity model for health analytics in Canada.

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    OS06 - Advancing Frameworks for Patient Engagement (ID 6)

    • Type: Oral Session
    • Track: Clinical
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 203CD
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      OS06.01 - How to Address Two Major Physician Concerns: Safety and Privacy (ID 147)

      Chris Hobson, Orion Health; Scottsdale/US

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

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

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

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

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

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      OS06.02 - How to Liberate PHI and Promote Digital Health Innovation  (ID 244)

      Jose Mussi, PwC Canada; Toronto/CA

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

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

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

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

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

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      OS06.03 - Decision Support To Design Personalized Behavior Modification Plans for Diabetes (ID 182)

      Samina Abidi, Dalhousie University; Halifax/CA

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

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

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

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

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

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      OS06.04 - Health Coaching in the Cloud: Results from Multiple Studies (ID 294)

      Noah Wayne, NexJ Health; Toronto/CA

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

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

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

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

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

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      OS06.05 - Multimorbidity, eHealth and Equity Implications: Study of Patient eHealth Perspectives (ID 62)

      Jenna Parascandalo, Family Medicine, McMaster University; Hamilton/CA

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

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

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

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

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

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      OS06.06 - A Secure, Online, Interactive, and Revocable Personal Health Record System (ID 21)

      Saeed Samet, Faculty of Medicine ( and Computer Science), Memorial University; St. John's/CA

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

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

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

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

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

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    OS07 - Virtual and Mobile Technologies in the Home (ID 7)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    OS08 - Future Priorities in Digital Health (ID 8)

    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 205CD
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      OS08.01 - Educating Nurses and Midwives Through eHealth Technologies: Potentials and Limitations  (ID 248)

      Raza Abidi, Dalhousie University; Halifax/CA

      • Abstract
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      Purpose/Objectives: Continuous education and professional development of health care professionals (HCPs) through digital media (eLearning) is now quite popular. eLearning helps overcomes the traditional barriers faced by health professionals, especially those working in challenging contexts, to access specialized training opportunities offered by subject specialists. Aga Khan Development Network has developed and implemented an eLearning based continuous clinical education program that is currently operational and offers online educational and skill development programs to HCP working in Maternal, Neonatal and Child Health (MNCH) settings of various health facilities in Afghanistan and Tajikistan. To evaluate the efficacy of the program in terms of improvement in knowledge leading to improvement in the clinical practices of HCPs, a research study is also being conducted.

      Methodology/Approach: From June to September 2016, seven online continuing education sessions were offered to the nurses and midwives at Bamyan, Faizabad and Mirwais Provincial Hospitals, and Khorog Oblast General Hospital. The topics for the session were finalized keeping in view the local needs of the HCPs. Topics for the sessions were: family planning, antenatal care, postnatal care, pre-eclampsia and eclampsia, post-partum hemorrhage, birth asphyxia and respiratory distress syndrome. The sessions were designed and offered by the Aga Khan University School of Nursing and Midwifery in Karachi. The sessions were of two hours each. In each session, participants took a pre-test and a post-test. These tests were administered through a mobile app, which was developed specifically for this purpose. The sessions were conducted in Dari. However, at each site a translator was present who translated the content in the local language. The sessions were delivered through a live video communication tool called Zoom. The support team in Karachi monitored the pre/post tests and the session using Zoom.

      Finding/Results: After seeking informed consent, fifty participants were recruited for the study. These included nurses and midwives working in MNCH clinical areas at the four research sites. With each online session, the change in level of knowledge of the participants has been assessed through pre- and post-tests which shows 20% increase in session 1, 16% increase in session 2, no change in session 3, 12% increase in session 4, 3% increase in session 5, 17% increase in session 6 and 22% increase in session 7. The retention of knowledge will be measured by administering a comprehensive delayed post-test, which is scheduled after six-weeks of the last eLearning session.

      Conclusion/Implication/Recommendations: The online education program currently being implemented is the first of its kind in Afghanistan and Tajikistan. Therefore, there are challenges associated with connectivity, language and preparedness of the local staff in each location to offer such programs. However, the initial results have indicated that online sessions have immense potential to improve the quality of care in challenging contexts such as Afghanistan and Tajikistan by enabling nurses and midwives to access up to date knowledge.

      140 Character Summary: To assess the efficacy of an online education program in improving knowledge and clinical practices of HCPs working in Afghanistan and Tajikistan

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      OS08.02 - Better, Simpler, Cheaper, Fairer: Alternative Approaches to Consumer eHealth (ID 310)

      Chris Nickerson, Gevity Consulting Inc; Dartmouth/CA

      • Abstract
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      Purpose/Objectives: The rapid growth of consumer and patient-focused eHealth systems in recent years has enabled many Canadians to manage their health more effectively and given clinicians powerful tools for engaging with their patients. In a recent evaluation, two-thirds of patients using a personal health record solution felt more connected to their physicians, and seventy-seven percent felt more involved in their own care [1]. As the popularity of these systems expands, health care delivery organizations must ensure that the solutions they deploy deliver measurable improvements in patient experience, support population health, and drive down the per-capita cost of health care. Achieving these goals in a world of limited budgets will require a creative re-consideration of how we approach consumer eHealth. This presentation will examine alternative thinking about what consumer eHealth is – or could be – by asking two simple questions: - How we can build simpler, less expensive solutions that deliver real, measurable benefits? - How we might use consumer eHealth to help address or mitigate the effects of some of the underlying social determinants of health?

      Methodology/Approach: Through an exploration of myriad consumer and patient oriented eHealth projects from around the world, attendees will gain an understanding of how popular consumer technologies can help us to answer the two key questions identified above. Some of the issues explored in this presentation will include: - How alternative approaches to consumer technologies in health can improve health literacy and equity of access for patients who may be difficult to reach with traditional consumer eHealth systems - How features of mobile devices that are often overlooked in the consumer eHealth space might be used to support patient education and engagement - How less sophisticated consumer eHealth systems can enable health care delivery organizations to provide valuable services to their communities while minimizing threats to the privacy and security of sensitive personal health information

      Finding/Results: Alternative approaches to consumer eHealth have a lot to offer. For example: - 74% of participants in a study of a simple text-messaging system for improving health literacy reported that the system informed them of medical warning signs they were unaware of [2] - Leveraging the often-overlooked audio playback functions of mobile devices for patient education, as suggested in a 2008 WHO report [3], could benefit the 48% of Canadians with inadequate literacy skills [4] who may have difficulty with the brochures and pamphets that are ubiquitous in Canadian hospitals

      Conclusion/Implication/Recommendations: As interest in, and public demand for consumer eHealth solutions increases – a 2010 survey indicated that 80% of Canadian adults wanted online access to their health information [5] – governments and health care delivery organizations will be expected to act. This presentation will help equip attendees to meet these challenges, and demonstrate that creative and innovative consumer eHealth systems need not be expensive or complicated. [1] https://www.infoway-inforoute.ca/en/component/edocman/1995-nova-scotia-personal-health-record-demonstration-project-benefits-evaluation-report/view-document; pp. 23-24 [2] http://www.csusm.edu/nlrc/documents/report_archives/Text4Baby_SanDiego_Evaluation_Overview.pdf? [3] http://www.who.int/goe/mobile_health/mHealthReview_Aug09.pdf [4] http://www.conferenceboard.ca/hcp/provincial/education/adlt-lowlit.aspx [5] http://www.longwoods.com/content/23871

      140 Character Summary: This presentation will explore alternative approaches to consumer eHealth, looking at how to build simpler, cheaper solutions that deliver measurable benefits.

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      Purpose/Objectives: As two of four stand-alone specialized mental health hospitals in Ontario, Hospital X and Hospital Y saw an opportunity to partner and leverage health IT to positively impact mental health care delivery with the establishment of a shared standardized Electronic Health Record (EHR), utilizing a shared system and a single, shared database. The collaboration’s model of a shared data and information governance, shared information technology and infrastructure is aligned with and will be a key enabler of the MOHLTC’s priority to create health hubs to aide in population health management. The MOHLTC has identified Mental Health & Addictions as a core hub service, and the establishment of the shared EHR meets the prerequisite of having an information technology infrastructure in place to support a shared EMR. Objectives: • Develop and implement evidence-based clinical standards • Establish a common technology, nomenclature and standardized processes • Create shared, standardized reporting and business intelligence • Create administrative synergies • Research opportunities

      Methodology/Approach: The creation of a shared vision for the collaboration was established in order for the collaboration to deliver the intended benefits. Guiding principles were created to help clinical working groups standardize documentation and a strong joint project governance structure was established. Decision Documents were created and escalated throughout the project structure to ensure decisions were made in a timely well-thought-out manner. In addition, Organizational Development at both organizations were engaged throughout the project to ensure the project teams continued to communicate and work collaboratively as well as to provide an open forum to address any issues related to the project. Ensuring change request and control processes are in place as well as integrating the collaboration into strategic goals at both organizations is imperative. This will not only provide a safeguard for the continued advancement of the respective organizations strategic directions but will also ensure that other concurrent projects evaluate the impact of any changes to clinical documentation in the EMR at both organizations by working within the established change request and control processes. This is paramount to ensuring that the collaboration continues to meet one of its primary objectives around clinical standardization in mental health.

      Finding/Results: • Standardized clinical documentation and physician order sets in a shared EHR • Efficiencies for implementing provincial initiatives such as Connecting Ontario and Quality Standards • Improved ability to provide coverage for Information Technology and Clinical Informatics support • A solution to deliver high-quality mental health care that also addresses the fiscal challenges of implementing an EHR • A standardized, shared EHR that provides a foundation for future provincial initiatives

      Conclusion/Implication/Recommendations: Key recommendations include: Strong governance structure with a clear change control management process Develop a methodology for standardization and provide regular status reporting Strong, coordinated project management with a clear process for escalating issues Communication and teamwork is key to a complex project such as this

      140 Character Summary: A shared HCIS/EHR provides a foundation for future collaborations and provincial initiatives; aligns with MOHTLC vision; and creates a mental health care network.

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      OS08.04 - What If You Could Do It Again? (ID 101)

      Sandy Saggar, Halton Healthcare; L6M 0L8/CA

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      Purpose/Objectives: Share our organization's journey through 3 capital redevelopment projects and how embedding technology into the design of the facility and clinical and administrative workflows improves patient care and experience. Highlight the collaboration between technology teams and clinical/support teams and the change management required for such a large transformation. This journey allowed the hospital to create a vision and provided the opportunity to ask "What if you could do it again?" Share the benefits realization of technologies implemented after moving into the new facilities.

      Methodology/Approach: Approached patients within our communities for feedback on our vision and what they wanted to see in their new hospital. Clinical and support team input before the projects and part of team during the project implementation. Governance structure key to success.

      Finding/Results: Post move into new Oakville Hospital in December 2015, improvements included: Medication management project - Medication incidents per patient day have decreased from 0.53% in Q4 2014/15 to 0.48% in Q4 2015/16, despite the influx of patients (over 30% increase in patients to the Emergency Department since the move to the new hospital) Lab automation solution - Turnaround times for lab tests from time the physician order reaches the lab to results being sent back are equivalent to before the move despite lab test volume increases from 27% to 42% Single sign on - Efficiencies include login time, persistent computing and ease of application access (save 5-10 minutes of time per staff per shift). This equates to thousands of hours of time saved per year across Halton Healthcare Follow me printing - Reduction in printer needs/costs from 678 to 350 devices. Savings of over $800K Over 500K sheets of paper saved (over 2500kg) Over 12000 litres of water saved Over 28000 KW/h of energy saved Over 7000 Kg carbon dioxide not emitted

      Conclusion/Implication/Recommendations: We have entered a new era of designing and building state-of-the-art healthcare facilities with technology embedded as part of the overall vision. These facilities bring together the best of everything to create smart hospitals that enable an environment to improve quality of care, patient safety and patient experience.

      140 Character Summary: The Health System is now building state-of-the-art healthcare facilities with technology embedded as part of the overall vision..."What if you could do it again?"

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      OS08.05 - Innovation Procurement in the Context of Health Tech Solutions (ID 91)

      Mark Fecenko, Partner & National Leader, Health Informatics Practice, Borden Ladner Gervais LLP; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: The purpose of this panel will be to cover leading edge procurement methodologies to acquire innovative health technology solutions. Attendees will have the opportunity to discuss and learn from Ontario Telemedicine Network, a global leader in telemedicine and connected care, Southlake Regional Health Centre, a community hospital providing advanced levels of healthcare to a growing population, University Health Network, Canada’s top research facility and Borden Ladner Gervais LLP, Canada’s largest law firm with specialized expertise in health informatics.

      Methodology/Approach: Survey and contrast using real-world experience (examples) of the diverse speakers on success, failures and lessons learned on innovation procurement in the healthcare context.

      Finding/Results: See "methodology/approach" focus on lessons learned and audience interaction.

      Conclusion/Implications/Recommendations: Specific best practices based on experience will be shared and open to challenge by the audience.

      140 Character Summary: This session will bring together individuals implementing leading edge best practices in respect of innovation procurement as it relates to health tech solutions.

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      OS08.06 - Using Innovation Procurement to Acquire a Multi-Stakeholder E-Referral Platform (ID 136)

      Sharon Baker, Waterloo Wellington CCAC; Waterloo/CA
      Lori Moran, eHealth Centre of Excellence; Kitchener/CA

      • Abstract
      • PDF

      Purpose/Objectives: Attendees will learn how innovation procurement can support strategy by using early market engagement and procurement tools and activities that increase the likelihood of high quality proposals that propose innovative solutions

      Methodology/Approach: In a collaborative effort, the eCE SCA program, the Waterloo Wellington Community Care Access Centre (WWCCAC) and the WWLHIN set out to secure an eReferral solution using a new approach to procurement. What did this Innovation Procurement process involve? · The pre-procurement phase included early market engagement to assess market interest and capacity to respond to a Request for Proposals (RFP), and to seek vendor input on the vision and process. These included Market Sounding in which the team used a document posted openly designed to gauge interest and seek feedback on the proposed approach, followed by in-person market engagement events. · For the RFP, the evaluation team opted not to use the traditional approach of providing a long list of functional requirements and specifications. Instead, proponents were asked to describe how their solutions would help achieve the SCA program’s outcomes and high level requirements. · The top two vendors emerging after the first five steps of evaluation were invited to participate in a design phase as the final evaluation step. During which, the vendors were asked to simulate a rapid-prototyping design exercise and develop a solution mock-up.

      Finding/Results: We learned that innovation procurement elevates procurement to strategy. Along with thinking strategically about what you what to procure, this process involved thinking strategically about how to procure it. We learned that vendors welcome the opportunity to engage in early market discussions and have valuable insights; and that time spent up front in the market engagement phase pays off – in clarity for the RFP and in the quality and nature of the proponent responses. We believe that early market engagement process has the potential to help early stage companies respond to Public Sector procurement .

      Conclusion/Implication/Recommendations: Our team concluded this method of procurement directly supports business strategy and can lead to new and different results.

      140 Character Summary: Heat how using innovative approaches to procurement creates the opportunity for new and innovative solutions for patient care.

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    OS09 - Optimizing Clinical Processes Using Telehealth (ID 9)

    • Type: Oral Session
    • Track: Clinical
    • Presentations: 6
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 206AB
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      OS09.01 - Serving Patients Better: Technologies in the SickKids Pre-Anaesthesia Department (ID 261)

      Jennifer Andrews, Telemedicine, The Hospital for Sick Children; Toronto/CA

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

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

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

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

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

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      OS09.02 - BC Physician Telehealth Education Needs Assessment (ID 155)

      Lori Einfeld, IMIT, Interior Health; Vernon/CA
      Colin Von Dohren, Interior Health Authority; Kelowna/CA

      • Abstract
      • PDF

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

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

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

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

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

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      OS09.03 - Using SickKids Videoconferencing Technologies to Provide Innovative Access (ID 264)

      Mabel Chan, Telemedicine, The Hospital for Sick Children; Toronto/CA

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

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

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

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

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

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

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

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

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

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

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      OS09.05 - Healthcare Demands Disruptive Innovations That Will Empower Patients (ID 352)

      Heather Harps, TELUS Health; Vancouver/CA

      • Abstract
      • PDF

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

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

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

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

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

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      OS09.06 - Delivery of Rehabilitation Services to Patients Using<br /> In-Home Videoconferencing (ID 171)

      Liza Culligan, University Health Network; C/CA

      • Abstract
      • PDF

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

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

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

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

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

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    PL03 - Tuesday Morning Plenary (ID 55)

    • Type: Plenary Session
    • Track: Not Rated
    • Presentations: 1
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      PL03 - From Fax Machines to 3D Printing – Digital Health at Warp Speed (ID 394)

      Julielynn Wong, 3D4MD; Toronto/CA

      • Abstract
      • Presentation

      With 3D printing, physical objects – like medical supplies – can be stored as digital files. Discover how 3D printing and crowdsourcing a digital library of quality-tested, 3D printable medical devices can save lives, time, and money for over 1 billion patients at home, abroad and in space!

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    EP05 - Innovative Technologies Today! (ID 45)

    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 6
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      EP05.01 - High Resolution Physiological Data Capture in the CCU (ID 119)

      Joe McCullagh, True Process, True Process; Glendale/US

      • Abstract
      • PDF

      Purpose/Objectives: Utilization of the continuously-generated data from physiological monitoring medical devices has been predicted to advance medical research and lead to improvements in patient care [1-3]; however, there is a lack of information documenting the acquisition of high-resolution physiological data in live clinical settings. Medical Device Integration (MDI) solutions and Clinical Information Systems (CIS) typically implemented into healthcare facilities are designed for integration into Electronic Health Records (EHRs) and provide limited numeric snapshots of complex physiological data [1, 2]. Tools claiming the ability to support high resolution data stream access often provide little or no information on in practice use; data quality, frequency limits, parameter profile, scalability, and system impact are unknown. This presentation demonstrates the acquisition of high-resolution physiological data in a live clinical setting and provides in practice information on data encountered. REFERENCES: [1] Belle, A. et al. “Big Data Analytics in Healthcare,” BioMed Research International,” vol. 2015, Article ID 370194, 16 pages, 2015. doi:10.1155/2015/370194 [2] De Georgia, M.A. et al. “Information Technology in Critical Care: Review of Monitoring and Data Acquisition Systems for Patient Care and Research,” The Scientific World Journal, vol. 2015, Article ID 727694, 9 pages, 2015. doi:10.1155/2015/727694 [3] Rumsfeld, J. et al. “Big data analytics to improve cardiovascular care: promise and challenges,” Nat Rev Cardiol. 2016 Jun; 13(6):350-9. doi: 10.1038/nrcardio.2016.42

      Methodology/Approach: We simultaneously captured high-resolution physiological data streams from 44 Phillips IntelliVue patient monitors in a Critical Care Unit (CCU) using a software-based Biomedical Device Integration tool. Patient parameters, waveform and numeric, were captured including: arterial blood pressure, respiratory impedance, plethysmography, electrocardiogram (ECG), heartrate, and peripheral oxygen saturation (Sp02). Data and parameter information was captured from high-resolution data streams encountered in a live CCU, from 44 patients monitors simultaneously, and averaged over a 24hr period.

      Finding/Results: 1) 62 distinct numeric and waveform parameters encountered; 2) 1,400 average data points per second per patient; and 3) 3.7 gigabytes of data generation per patient per 24 hour day.

      Conclusion/Implications/Recommendations: High-resolution physiological data is being captured in a live clinical environment and is providing biomedical researchers additional visibility into subjects’ physiological status. This demonstration shows the feasibility of capturing high-resolution physiological data in intensive care units using a biomedical device integration tool. High-resolution physiological data acquisition is a viable option to support biomedical investigation in live clinical environments.

      140 Character Summary: This presentation demonstrates the acquisition of high-resolution physiological data from biomedical devices in a live Clinical Care Unit.

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      EP05.02 - Re-Architecting Interoperability (ID 239)

      Karim Keshavjee, InfoClin; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: A web-based form could potentially solve several issues that currently plague electronic medical record forms: 1) Forms cannot be updated each time a new discovery is published in the literature; 2) Version control is almost impossible with current forms; 3) Every physician has to update their own forms each time an update is required; 4) Data is not easily captured for analysis and reporting; 5) Clinical decision support cannot be provided within the form, decreasing the impact of decision support; 6) A/B testing, the most powerful tool available to web designers, is not available to EMR vendors, researchers and clinicians. We sought to design an architecture that will allow web-based forms to integrate into multiple EMRs, be used seamlessly by health care providers and that will allow data captured on the web to be returned to the EMR for medico-legal purposes.

      Methodology/Approach: We used a user-centered design process to identify user needs. We then engaged in joint design sessions where mockups of the form were modified iteratively and in real-time to address user feedback. Once the mock-up was finalized, we developed a prototype of the form for further evaluation. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, a well-accepted and validated questionnaire, to assess user acceptance of the form and behavioral intent to use the form.

      Finding/Results: Users (N=12) responded to questions on a 5-point scale. We aggregated the scores by calculating the % of respondents who Strongly Agreed, Agreed or Somewhat Agreed. If the % was greater than 66%, it was colored green. If greater than 33% and less than 66%, it was colored orange. If the % was less than 33, it was colored red. See Table 1. table for utaut evaluation.png Overall, the form was considered easy to use (Effort Expectancy) and useful for completing clinical work (Performance Expectancy). More marketing and supports could enhance Social Influence and Facilitating Conditions for use of the form.

      Conclusion/Implication/Recommendations: Creating and integrating a web-based form into multiple EMRs is feasible and can be created in a way that clinicians find interesting and useful. This new tool could support capture of standardized data across multiple EMRs, allow for the return of clinical decision support to the point of care and be easily updated when new knowledge is published in the literature. The form could also be used for advanced A/B testing for forms improvement and for improving the quality of clinical decision support.

      140 Character Summary: New web-based form revolutionizes application of evidence-based medicine to electronic medical records. Time to re-evaluate our current approach to EMRs.

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      EP05.03 - A New, Unique and Innovative Design Approach for eReferral (ID 51)

      Lori Moran, eHealth Centre of Excellence; Kitchener/CA

      • Abstract
      • PDF

      Purpose/Objectives: Attendees will learn about: 1. A program that has the potential to involve a large part of Ontario and is leading strategic system improvements to support faster access to the majority of health services 2. The unique innovative design approach to develop a secure, system-wide, open electronic referral (eReferral) technology platform. 3. A patient portal and notifications system that supports patient and caregiver access to referral information and patient self-booking of appointments.

      Methodology/Approach: The eHealth Centre of Excellence (eCE) is leading the innovative System Coordinated Access Program (SCA) to: 1) improve knowledge of and access to the majority of health care services for providers and patients, 2) support organizations to coordinate access to services and, 3) support the development of an eReferral solution and patient portal. To realize these goals, SCA collaborated with the Waterloo Wellington’s Community Care Access Centre and Local Health Integration Network to secure a vendor consortium to build an open and flexible system that will evolve as both technology and healthcare systems change. This eReferral solution is starting by supporting specialist referrals, referrals to a Central Intake Program, and patient self-referrals, and will support other work-streams as time goes on. A unique benefits realization model will be utilized for the SCA evaluation, to understand the realized workflow efficiencies, clinical value for provider and patient, organizational value, and economic impact.

      Finding/Results: The Ontario-based consortium of Think Research, CognisantMD, and the Centre for Effective Practice was selected to lead the design and deployment of the ground-breaking eReferral platform. Three Proof of Concept (POC) pathways will be deployed using a rapid prototyping approach and involve input from patients, clinicians and administrators. The results from these POCs will determine if SCA will proceed with the current vendor consortium to support the future state vision of SCA. Results from the POCs and the go/no-go decision for the vendor consortium will be available for the eHealth 2017 Conference. A review of the growing body of literature on referral systems has demonstrated that access to services and patient and provider satisfaction can be improved by the implementation of an eReferral system. Parts of the benefits evaluation including some of the economic analysis will be available for the eHealth 2017 conference.

      Conclusion/Implication/Recommendations: Digital healthcare solutions should be designed as an ecosystem, where functionality can be added by many different partners and information can be integrated from different systems. Such solutions are needed to support complex processes like referral to multiple parts of the health care system. Patients and caregivers should receive faster access to services close to home and be able to find their own services. Primary care clinicians should have access to up to date information on the availability of services, referral status and their patients’ outcomes. Specialists and service providers should receive complete and appropriate referrals and have fewer patients miss appointments. SCA offers a unique approach and a critical combination of project, clinical, change management, health system, and technical expertise that will ensure the successful creation and use of an eReferral platform.

      140 Character Summary: @eHealthCE is leading the innovative @SCAprogram to design an integrated and adaptable eReferral system

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      EP05.04 - The Future of Home Dialysis Through MHealth Support (ID 63)

      Kathy Huynh, Healthcare Human Factors; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: Discuss the future of mHealth and eHealth support for patients going through Home-Hemodialysis (HHD) treatments, leveraging the experience of the world-renowned UHN Explore Home Dialysis Program. Data extracted from a global assessment of the barriers to HHD and Peritoneal Dialysis (PD) will be used to show the landscape of home dialysis programs and how mHealth and eHealth tools should be designed to support HD patients.

      Methodology/Approach: Dialysis is an artificial process used to eliminate harmful metabolic waste, salts, and excess water from the blood of patients with kidney failure. There are two types of dialysis, peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the inside lining of the patient’s abdominal cavity to filter the patient’s blood; while hemodialysis utilizes an artificial filter (dialyzer) that cleans the patient’s blood on an external machine (dialysis machine) outside the body, before returning the filtered blood back into the patient’s bloodstream. Unlike traditional hemodialysis that is performed by nurses in hospital settings, home dialysis treatments (HHD and PD) allow patients to perform their own dialysis independently in their homes, promoting better quality of life as it allows greater flexibility and convenience in the treatment and daily living.

      Finding/Results: Barriers – Despite the benefits of home hemodialysis, several barriers still limit the successful implementation of this type of treatment for large patient populations. The most important barriers to self-care from a patient’s standpoint include patient education, remote patient support, and access to information about their treatment and equipment. Although systemic barriers also impact the deployment of HD, patient-perceived barriers are one of the main constraints to the wider deployment of HD. Needs – To successfully self-manage their care, patients need tools that will allow them to understand and take control over their treatment on a daily basis, as access to nurses and clinicians is limited. The utilization of eHealth and informatics can help by providing patients with easy access to information that will give them the ability to manage the common issues and maintenance of the machines on their own. Most of the patient-perceived barriers could be addressed if a combination of telehealth and educational platform was available to them. Potential tools – mHealth platform delivering access to training and FAQ about their treatment, remote technical support and training for their equipment, the ability to communicate with and seek medical advice from healthcare professionals remotely, and gaining access to their health information to monitor the changes and effectiveness of their treatment overtime. Examples of how these tools have been used to support patients with other chronic diseases will be explored.

      Conclusion/Implication/Recommendations: Home dialysis has a strong positive effect on patients’ quality of life, but the perception that HD is risky and that patients and caregivers may not have the direct support of nurses can be a barrier to the wide deployment of the technology. mHealth and eHealth systems with the features outlined in this proposal could be used to support patients at home and ensure that they have the right level of oversight while getting accustomed to the technology.

      140 Character Summary: Discuss some of the user-perceived barriers towards the deployment of home dialysis technology and how mHealth tools can be designed to support these patients.

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      EP05.05 - NQuIRE®: Leveraging Technology for Evidence-Based Nursing-Care to Improve Health Outcomes (ID 288)

      Yaw Owusu, Registered Nurses' Association ON, Registered Nurses' Association ON; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: To meet accountability demands, health-care organizations are expected to invest in quality improvement initiatives and demonstrate their performance through various health-related indicators, which are predominately based on outcome indicator measurement. Such measures include minimal focus on the human resource (HR) related structures and evidence-based nursing practice interventions that greatly impact health outcomes. Therefore, this presentation will describe how the web-based innovative Nursing Quality Indicators for Reporting and Evaluation® (NQuIRE®) data system facilitates the evaluation of HR structure indicators, and best practice guideline-based process and outcome indicators, and how this interrelationship effects quality health care. The main learning objective of this session is to facilitate the understanding of leaders across the health-care continuum related to leveraging technology applications to generate and utilize evaluation indicator data to optimize evidence-based, safe, quality health care.

      Methodology/Approach: RNAO's Best Practice Spotlight Organization® (BPSO®) designation is a globally recognized knowledge translation strategy that engages health-care organizations in a formal partnership to implement and evaluate the use of RNAO’s Best Practice Guidelines (BPG). The program promotes the spread of evidence-based nursing practice and quality patient care and to date encompasses over 500 health care organizations world-wide. To evaluate the guideline implementation efforts of BPSOs, RNAO has developed NQuIRE, a unique international data system of quality web-based indicators that collects, compares, and reports data on HR structure and guideline-based nursing-sensitive process and outcome indicators. Because of the inclusion of structure, process and outcome indicators, BPSOs can meet their targets on quality improvement initiatives, and demonstrate their performance on various health-related indicators focusing not only on outcome indicators, but also on the evidence-based process indicators and the human resources context. This unique and innovative international data system to *advance the evaluation* of the effects of human resources structures within health-care organizations, and evidence-based nursing care on patient outcomes and organizational and health system performance, provides sound information about the impact of evidence-based guidelines on practice and outcomes and the necessary human resources required. The growth and expansion of the NQuIRE data system participation globally in health-care sectors in Canada, Spain, Chile, Columbia, Australia, Italy, South Africa, and China will lead to cross country comparisons of: client outcomes, use of evidence-based practices and nursing's contribution.

      Finding/Results: NQuIRE is a unique approach to quality improvement in that it includes performance measurement and helps to foster a culture of evidence-based practice within BPSOs. Its technology enabled features such as the auto-generated single and overlay indicator run charts with annotations, as well as the dashboards enable BPSOs to conduct within-BPSO comparisons of units/wards/programs. These features have greatly enhanced monitoring of performance indicators that are aligned with BPG implementation in local, national and international BPSOs across the care continuum and have shown to improve health outcomes

      Conclusion/Implication/Recommendations: Health-care leaders in BPSOS globally are able to utilize their NQuIRE data to: a) determine the extent of evidence-based intervention uptake (b) identify how process indicators (nursing interventions) impact clinical outcomes and (c) demonstrate the impact of human resources on quality evidence-based practice and client outcomes.

      140 Character Summary: This presentation describes how the innovative NQuIRE data system facilitates the evaluation of structure, process and outcomes indicators on health outcomes.

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      EP05.06 - Creating Smart Cities Through IoT Devices Enabled Seamless Healthcare (ID 374)

      Chandana Unnithan, Charles Darwin University; Melbourne/AU

      • Abstract
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      Purpose/Objectives: Smart cities is an endevour to assimilate technologies and and IoT (Internet of Things), securely and efficiently to manage assets in a city, including hospitals, care centres, waste management, community services, schools - to name a few. In the past decade, density of urban population has risen, so has the longevity due to healthy ageing population in the cities. Subsequently, there is growing demand to enhance the quality of life, such that the ageing population can live longer independantly in their homes rather than care facilities. The objective of this research is to explore IoT solutions that faciitate the above mentioned evolving needs of citizens, while engaging them in the process, leading to the development and growth of smart cities.

      Methodology/Approach: This research has taken an exploratory approach, leading from empirical findings relating to an RFID implementation project within hospitals. Specifically, the use of wearable devices has been explored in the hospital context, extending to home care, seamlessly, in the Australian context. Furthermore, using the theories of participation and engagement, an investigation is presented on extending hospital care to homes, engaging citizens and using IoT devices. Recommendations are presented through Living Labs approach used by the Space and Global Health Expert Group (Committee on Peaceful Uses of Outerspace Affairs - COUPOUS) within the umbrella of the United Nations initiative of building sustainable communities.

      Finding/Results: The findings elaborate on real-time potential of IoT in the context of bringing long term sustainable care, within homes, enabling the ageing population in cities to live independant lives for a longer term. By engaging citizens in the process of assimilating IoT devices assist in the diffusion into communities, thereby leading to smart communities and smart cities.

      Conclusion/Implication/Recommendations: IoT devices present a sustainable, smart future for communities around the globe, as illustrated in the findings. Assimilation of IoT devices into the assets of a city (such as hospitals, care centres, schools, rehabilitation centres etc) facilitates improvement of quality of life in a sustained manner, leading to smart cities. Citizen engagement through the Living Labs approach is recommended for increased participation of citizens in the translation of IoTs into smart cities, at a faster pace.

      140 Character Summary: IoT solutions that faciitate seamless healthcare for smart cities, considering the needs of ageing populations, through Living Labs approach of UN Expert group.

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    EP06 - Adoption and Use Across the Care Continuum (ID 46)

    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 5
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      EP06.01 - From Adoption to Integration – Success Story in a Telemedicine Program (ID 329)

      Frank Yu, St. Michael's Hospital; Toronto/CA
      Rashmi Bhide, St. Michael's Hospital; Toronto/CA

      • Abstract
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      Purpose/Objectives: The Telemedicine Program at St. Michael’s Hospital (SMH) functions on the mandate: To increase access to healthcare services and resources by supporting the adoption of telemedicine technologies. During initial years of its existence, telemedicine was somewhat of a novelty, appealing to ‘early adopters’ who were open to use of technology in order to help increase access to their patients, who lived at a distance. In 2011, the Telemedicine Program at SMH employed specific adoption and integration strategies based on needs assessment and customization, with an ultimate aim to integrate and embed telemedicine in routine patient care practice. The Telemedicine Program at SMH is viewed as a strategic enabler that can support improved access to care while making delivery of health care efficient and cost effective. The telemedicine adoption and integration strategies, support our hospital’s quality agenda in the areas of access, efficiency and patient experience as outlined in the Hospital’s strategic plan.

      Methodology/Approach: Recognizing the fact that introduction of telemedicine in a clinic environment means significant changes in otherwise well-established routines and processes, the adoption strategies focused mainly on clinician’s readiness assessment, change management and ensuring simple and easy-to-follow new processes, to minimize disruption of routines. Detailed telemedicine clinical protocols are developed in collaboration with the providers to ensure an efficient and smooth telemedicine clinic, providing a seamless experience for clinical providers. Depending on need, new users are also given a trial run through a simulated clinic to address any concerns and to familiarize the users to technology. These initiatives were initially implemented in departments of General Surgery, Respirology, Mental Health, Geriatrics and Trauma. The increased clinical activity in these areas reinforced our standard approach to drive adoption in other clinical services. In a study conducted by a medical student at SMH, location of the telemedicine studios; disruption in the daily routine were identified as limiting factors for uptake of telemedicine. As a way of addressing the limiting factors, SMH Telemedicine Program implemented desktop videoconferencing solution PCVC (Personal Computer VideoConferencing) in physicians’ offices. Again, the introduction and integration of PCVC in clinicians’ offices followed the same philosophical approach for adoption.

      Finding/Results: The impact is measured qualitatively by surveying users (clinicians & support staff), and quantitatively by number of providers using telemedicine to provide care for their patients and by telemedicine clinical activity numbers. The overall clinical activity numbers and number of clinical providers have doubled in years since the adoption and introduction strategies were introduced. Both qualitative and quantitative results will be shown on the poster for the conference.

      Conclusion/Implications/Recommendations: These early results indicate that the SMH Telemedicine Program’s adoption and integration strategies have enabled the program to demonstrate its potential as an enabler to address the issue of access, efficiency and sustainability. The adoption and integration strategies developed and implemented, with a focus on ease of use, by SMH Telemedicine Program, can help create a framework for approach to promote clinician acceptance and integration of telemedicine in delivery of healthcare.

      140 Character Summary: This poster presentation will describe adoption and integration strategies implemented at a large academic health center.

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      EP06.02 - Workflow Analysis to Inform a Remote Patient Monitoring System Implementation (ID 104)

      Martin Lam, Centre for Global eHealth Innovation, University Health Network; Toronto/CA
      Peter Rossos, University Health Network; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: This summer student project created a workflow and implementation plan for a remote patient monitoring (RPM) system in a complex chronic disease management clinic. Baseline observations and analysis were performed in order to understand care pathways and identify how to introduce the technology and contextually train patients and providers involved in care. We avoided interruption of care while designing optimal methods for training and support. The goal was to improve patient outcomes through earlier detection and treatment modification to avoid complications and unnecessary hospital admissions. Based on favorable pilot study data the intent was to scale and offer RPM as standard care.

      Methodology/Approach: Analysis of current workflow. The complete ambulatory process from patient check-in, waiting time, exam room, clinical care, and check out were carefully observed and documented. New workflow creation. UML diagrams modeled the training and deployment of the RPM technology in the clinic setting. This allowed clinic staff to easily and visually follow the steps on how to handle patients, reports, and notifications. The staff training was customized to roles and responsibilities and individualized on the basis of skills and requirements. Unique job creation. In order to provide ongoing support and sustainability, the analysis highlighted the need for unique roles and responsibilities to train and onboard patients and staff, advise them of system updates, gather ongoing feedback for quality improvement, and provide technical assistance. In addition, based on our observations and interviews we created print and online learning tools including videos tailored to the needs of patients and staff. Assembled kits were intuitive for a wide range of patients including the visually and physically impaired.

      Finding/Results: Systematic and detailed workflow and process analysis was very effective in determining the implementation, training and support requirements for deployment of an RPM system in a large congestive heart failure clinic providing care to patients with advanced complex chronic illness. The UML diagram summarizes some of our key observations and proposed interventions.proposed rpm system no logo.jpg

      Conclusion/Implications/Recommendations: Scaling an RPM system requires a clear understanding of the needs of both patients and the care team in order to implement, support and optimize the value of the deployed technology. There is sufficient data to support the use of RPM in order to improve patient outcomes in a variety of clinical conditions. The approach and learnings from this project will be applied to other patients in our organization and hopefully elsewhere in order to provide safer, more effective and affordable care.

      140 Character Summary: Implementing a large scale RPM system requires the efforts of new workflows, electronic teaching materials, and unique staff.

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      EP06.03 - The Impact of Electronic Medical Records in Clinical Teaching Environments (ID 114)

      Alexander Singer, Family Medicine, University of Manitoba; Winnipeg/CA

      • Abstract
      • PDF

      Purpose/Objectives: Limited research has investigated the implication of Electronic Medical Records (EMRs) on physician education and training and what tools and functionality medical educators need to effectively supervise and teach residents.

      Methodology/Approach: A quantitative survey was developed to assess respondents experience related to EMR use and their impact in clinical teaching environments. Participants across Canada were invited to complete the survey online with an email invitation. The themes and topics were identified in a previous qualitative study conducted by our research group.

      Finding/Results: There were 147 surveys completed representing respondents using all of the most common EMR products in Canada. Most respondents were family physicians (67%) with a smaller proportion of interdisciplinary (24%) and specialist providers (12%). Responses demonstrated that 50% of learners received no formal EMR training. A majority of respondents (51%) felt that EMRs improved the learning environment compared to paper charts. For most of the specific features related to teaching and supervision between 15-30% felt that their EMR performed sub-optimally, poor or horribly. Seventy five percent felt that reviewing encounter notes was the most important feature, with 62% of users reporting their workflow to be good, very good, or excellent.

      Conclusion/Implication/Recommendations: Our findings suggest that EMR use in Canadian teaching environments has had an overall positive impact. Several EMR features related to teaching had sub-optimal use and there is much room for improvement in workflows across Canada. Many areas requiring improvement were identified and could be used to advocate for improved functionality from EMR vendors. Clinician teachers who use EMRs, professional organizations that accredit training programs as well as provincial licensing authorities should be aware of the advantages and limitations of EMR functionality related to teaching and supervision of learners. Further research is needed to identify the impact of improvements in EMR design on training environments.

      140 Character Summary: Study suggests clinicians felt EMRs improve their clinical teaching but more work still needs to be done to improve teaching functionality

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      EP06.04 - Scheduling/Registration Workload Assessment after Cerner Implementation: Lesson Learned (ID 165)

      Daniel Meraw, IT, PMO, Orillia Soldiers' Memorial Hospital; Orillia/CA

      • Abstract
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      Purpose/Objectives: Orillia Soldiers’ Memorial Hospital (OSMH) is a community based hospital in North Simcoe Muskoka. The hospital recently implemented a Cerner Electronic Medical Record (EMR). The new system replaced paper charting as well as a home grown application used for Scheduling and Registration. In addition, some areas within the hospital had previously been using a manual booking procedure. The Project Management Office (PMO) and the Health Records Department developed a staff survey 4 months after implementation of the system, in order to assess the impact of the new EMR on clerks’ workload across various service areas in the hospital.

      Methodology/Approach: The survey was circulated to 123 clerks with 75 (61.0%) responding Participants were from the following areas; ambulatory care 34 (45.3%), admission/preadmission clinic 11 (14.7%), cardiorespiratory service 9 (12.0%), diagnostic Imaging (DI) 7(9.3%), Day Surgery/OR 6 (8.0%), Emergency Department 5 (6.7%) and Dialysis 3(4.0%).

      Finding/Results: Scheduling time was significantly higher in the new system compared to the previous one (7.9 ± 2.9) versus (3.3 ± 1.9) minutes P=0.001; respectively. A similar observation was found in registration (7.8 ± 3.7) versus (3.0 ± 1.8) minutes P=0.001; respectively. Ten users were using the new system for billing. The average workload duration of billing was significantly higher in the new system compared to the old one; (5.0 ± 4.3) versus (2.4 ± 1.8) minutes (P=0.017). 37 out of 75 (49.3%) users acquired new task(s). The average number of additional tasks was found to be 1.4 ± 0.64; range (1-3). Scanning documents was the most frequently added task at 15.0, with billing at 10.0 and the Wait Time Information System (WTIS) activity in OR and in Diagnostic Imaging at 5. Additional tasks were related to booking for more than one service areas or helping other end users. Time needed to scan documents varied considerably from 10 seconds to 15 minutes, based on the number of documents and the complexity of the task. No significant difference in the time needed to schedule or register cases between the different service areas had been observed (P>0.05).

      Conclusion/Implication/Recommendations: The transformation resulted in an increase in OSMH’s EMR Adoption Model (EMRAM) hospital score from 2.065 to 3.17 (OSMH). Increases in workload is believed to be related to: (1) complexity of the new system, the previous system was more streamlined in terms of data entry efficiency; (2) none of the service areas has implemented CPOE yet (HIMSS level 4); therefore, additional scanning of requisitions was now required; (3) additional tasks related to billing and WTIS could be contributing factor(s); (4) The time needed for users to master the new system (study was conducted 4 months post go live). It is anticipated that the numbers would be slightly reduced if this survey were repeated in 6 months. Senior executives and managers may use the information in this study to set up effective strategies prior to go live such as conducting time studies with their current health information system to determine if they need to adjust the resourcing during the interim/ongoing operation.

      140 Character Summary: Workload impact on clerical staff is a significant issue following a hospital wide EMR adoption. Planning prior to go live is critical to ensure seamless transition.

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      EP06.06 - Launching Electronic Documentation for Community Nursing (ID 99)

      Kartini Mistry, Best Practice, Research & Education, VHA Home Healthcare; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: It is well known and documented that electronic medical record systems offer substantial opportunities to organize clinical data in ways that can improve the coordination of care and services provided. As part of our organization's strategic direction to create more spectacular care, an initiative to introduce electronic documentation among nurses was undertaken. Objectives included streamlining documentation processes through collaboration in system design and improving client outcomes.

      Methodology/Approach: The project methodology included a two-stage release, first to a small group of nurses and later to the community with planned roll-out across multiple regions in Ontario. Throughout the project cycle, an iterative approach to design was undertaken where nurses participated in development of new features.

      Finding/Results: Several critical success factors were identified including early user engagement, strong technology vendor relationships, champion support and the ability to recognize the opportunity to redesign practices. Other success factors included ensuring frequent monitoring and feedback mechanisms during initial stages to ensure proper usage.

      Conclusion/Implications/Recommendations: While much success has been obtained thus far, future work efforts will be focused on interface upgrades, specialized assessment tools to support specialty populations and the development of a client-facing interface which would further strengthen organization’s commitment to client and family centered care.

      140 Character Summary: Transforming the way community nurses provide care through the use of electronic documentation system.

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    EP07 - TeleHealth Models with Big Data Flavour (ID 47)

    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 6
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      EP07.01 - Moving Knowledge Between Providers using the ECHO Chronic Pain Model  (ID 53)

      Naima Salemohamed, University of Toronto & Toronto Rehabilitation Institute ; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives: One in five Canadians suffer from chronic pain, and given the long wait time for specialty pain programs, many are cared for by their family doctor. However, family doctors only receive a limited amount of pain training during medical school. Project ECHO (Extension for Community Healthcare Outcomes) is a telemedicine initiative that teaches primary health care providers (HCPs) how better to manage their patients’ chronic medical conditions using a hub (experts) and spoke (learners) model involving case-based discussions and didactics. Project ECHO Ontario Chronic Pain teaches HCPs best practices in the management of chronic pain, and responsible opioid stewardship. Research Questions: A) Do ECHO’s HCPs increase their skills and competence levels (in pain management and opioid stewardship) after attending Project ECHO? B) How is the knowledge diffusing within or outside the online community created by ECHO and is it leading to improved care for patients whose HCP attended Project ECHO? C) In what ways, if any,have HCPs gained insights into their own motivations, confidence levels and processes for managing their chronic pain patients after attending Project ECHO?

      Methodology/Approach: This study is based on in-depth interviews conducted with HCPs who are either participating in Project ECHO or have completed their training with ECHO. Interviews will be conducted with 12-15 HCPs to evaluate their experience with ECHO, the impact of ECHO on their own clinical practice, how ECHO spreads to other HCPs, and how technology facilitates medical education. Maximum Variation sampling is being used to select the participants to ensure a representative provider population. The HCPs will include a mix of: a) those from rural and urban Ontario, b) presenters or non-presenters of ECHO cases, and c) a variety of HCP disciplines (e.g., physicians, nurse practitioners, physical therapists, occupational therapists, and social workers). Data analysis will use thematic analysis, which includes inductive and deductive coding strategies. The Diffusion of Innovations framework will guide inductive coding, while deductive coding will create codes and themes that fall outside of the framework. The codes will be generated on an ongoing basis with regular feedback from members of the research team. Multiple coders will take part in checking and interpreting the data.

      Finding/Results: We have interviewed three HCPs to date. Preliminary results suggest that participation in Project ECHO increases HCPs’ a) confidence in managing patients, b) knowledge of specific pain resources, and c) skills for managing chronic pain in the community using a multi-modal approach. In addition, video-conferencing has been a successful continuing education method for HCPs to share their knowledge in a no-shame community and this online learning platform has increased the interactions of HCPs.

      Conclusion/Implication/Recommendations: Preliminary results suggest that ECHO is increasing HCP knowledge, skill and confidence in caring for chronic pain patients in the community, and that this teleconferencing modality is a viable approach to educating primary care HCPs in managing chronic pain patients. This research can be used to guide further evaluations of ECHO programs and help researchers understand how knowledge can be shared innovatively through the use of online communities.

      140 Character Summary: Understanding how Project ECHO is an innovative method to learn and share knowledge about chronic pain management with healthcare providers in online communities.

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      EP07.02 - Caring for the Homebound: Technology and the Patient's Medical Home (ID 159)

      Amanda Condon, ACCESS River East; Winnipeg/CA

      • Abstract
      • PDF

      Purpose/Objectives: Increasingly, traditional models of in-office, appointment based care are being questioned as optimal to provide care for homebound and complex patients in our community. The pillars of a patient's medical home include timely access to care, coordination, team based approach to care and continuity of care for a population of patients. Achieving these goals can be difficult for patients who are homebound; use of various digital health technologies, interoperability of clinical systems and remote communication can optimize care delivery and experience of care for this population of patients and their caregivers. Further, use of data from exisiting electronic systems allows for measurement of patient outcomes and use of data for population identification. This presentation will describe a model of care that addresses the needs of this population, the role of technology in improving care and experience for these patients and where the gaps remain for seamless integration of electronic systems for home based primary care. Objectives: (1) Describe a model of care for complex and homebound patients, in keeping with the goals of the patient's medical home. (2) Identify opportunities for use of exisiting electronic systems for measurement of care delivery and improvements in clinical outcomes (3) Describe use of exisiting electronic systems for communication, care coordination and interprofessional team based care for homebound and complex patients. (4) Spark innovative thinking and problem solving to address existing barriers to communication and outcome measurement.

      Methodology/Approach: Review of exisiting care model will be described and how various exisiting clinical systems (i.e. clinic electronic medical record, home care MDS and hospital EDIS) are used for data collection, patient identification and measurement of outcomes. Further, use of these systems for communication and information sharing amongst team members will be detailed. The role of the provincial electronic health record in care delivery for homebound and complex patients will be explored with examples given. Gaps within exisiting systems and opportunities for improvement will be described.

      Finding/Results: Home based primary care, provided by an interprofessional team with intensive case management, to a population of high risk patients or patients who are high system users, has demonstrated a reduction in emergency room use and hospital bed days for this population.

      Conclusion/Implication/Recommendations: Recognizing those in our community who are at high risk and in need of intensive primary care, requires us to look outside the walls of the clinic and change our approach to care delivery. Measurement of these innovative models of care is imperative to demonstrate success but also for appropriate identification of populations in need. Existing electronic systems can provide opportunites for communication, information sharing and data collection to improve care for this population. Ongoing barriers exisit to further optimization of care delivery for this population of patients and their care givers.

      140 Character Summary: Care for homebound patients requires optimal and innovative use of exisiting electronic sytems to improve their health and healthcare experience.

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      EP07.03 - Community Based Virtual Care (ID 164)

      Margarita Loyola, Telehealth, Island Health; Nanaimo/CA

      • Abstract
      • PDF

      Purpose/Objectives: To provide "virtual consultations" in the community facilitated by a "community health worker". This will enable clients and providers to make timely and accessible health care connections, conducive to producing better health outcomes.

      Methodology/Approach: Virtual care technology and processes will be implemented in a community care setting. Community Health Workers (CHW) will be connecting to primary care and/or specialized care providers from the patient's home. This is in support of Primary Care Home initiative to increase continuity, and improve care and coordination between clients and clinicians. Initially the technology will be tested to ensure technical, security, and privacy needs are met. Because this is a community setting, broadband connectivity is not a given, thus hotspots will be used. Virtual models supporting primary care home is anticipated to have the following benefits: increase access to primary care services for remote communities, enhance continuity and coordinated care particularly for outreach services, patient-centered care, support patients with chronic diseases, patients requiring mental health and substance use services; access to specialists; and acute care services in remote service areas, enable the primary care home to provide continuity of care to community’s patients and, achieve the triple aim (e.g., improve provider and patient experience – decrease provider isolation; improve population health; and improve sustainable cost).

      Finding/Results: Expected results will include: New virtual model to support “Primary Care Homes” linkages to patient/families/communities and family physicians, specialist and community health services. Strengthen community health services into local virtual teams. Change Island Health processes and staff models to provide people with better access to these services, especially when it is remote urgent (Rapid Response, 7 days a week). Educate staff to support patients in setting their own health goals in a proactive care plan. Support people to live at home as long as possible by promoting a ‘Home is Best’ approach. Develop methods for finding and monitoring people at risk of deteriorating health. Build and expand upon partnerships with community health providers, such as First Nations Health Authority, Divisions of Family Practice, local government and not for profit agencies.

      Conclusion/Implication/Recommendations: Virtual care is one of the identified elements of the Primary Care home and provides a seamless approach for Community Health and Care to link frail and elderly and complex care clients to their physicians and clinicians directly from home, contributing to rapid response and early intervention goals. Virtual care through home support is a strong fit that will enable a shift in the point of care directly to the home, furthering Island Health's goal of 'right care, right time, right place'.

      140 Character Summary: Harnessing existing home support capacity, virtual care accessed in the home represents a proactive paradigm shift in healthcare.

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      EP07.04 - Adult Children Caregivers’ Experiences with Online and In-Person Peer Support (ID 122)

      Marina Wasilewski, University of Toronto; Toronto/CA

      • Abstract
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      Purpose/Objectives: To explore adult children caregivers' (ACCs) experiences with online and in-person peer support exchange while caring for an elderly parent. Specifically, we aimed to answer two questions: 1) How do ACCs use online and in-person modalities to obtain support? 2) What type of support is exchanged within each modality?

      Methodology/Approach: *Design: We employed a qualitative descriptive approach. Qualitative description entails a concise and descriptively rich analysis that remains true to the data. Recruitment: Brochures distributed through several in-person support groups and the social media channels of national organizations. The first author also used her Twitter account to tweet the study link. Procedure: Participants accessed the online survey where they were first asked about their eligibility. Consent was then sought. At the end of the survey, participants could volunteer for an in-depth qualitative interview. Data Collection: Each caregiver participated in an in-depth semi-structured interview that was conducted over the phone. Each interview was transcribed verbatim by a professional transcriptionist. The authors then checked for accuracy by cross-referencing the transcripts with the original audio files. Data Analysis:* Thematic analysis was performed to identify themes from the caregivers’ narratives. Line-by-line coding informed the development of a coding framework which was applied to all transcripts. NVivo version 10 qualitative data analysis software was used. Analyses included comparing and contrasting the coded data and categorizing similar ideas. All authors participated in the final phase of the thematic analysis which entailed constant comparison until categories could be grouped into ‘themes’ that were distinct from one another.

      Finding/Results: In total, 15 adult children caregivers (ACCs) participated in an interview. The average age of ACCs was 51 years old (Range: 41-65 years old). The majority of ACCs (80%) indicated that their peer was a family member, long-time friend or co-worker– suggesting that this population mobilizes their existing network for peer support. Theme 1: ACCs take a pragmatic approach to peer support exchange. This was characterized by ACCs' blended use of communication modalities and mention of telpehone calls and tetxing as supplementary modes of communication. ACCs interacted online with peers to meet their practical needs (e.g. efficient and fast communication). Conversely, they interacted in-person to meet relational needs (e.g. desire for high quality relationships). Theme 2: The nature of peer support that ACCs received transcended the interaction modality. Regardless of whether the ACCs interacted with peers online or in person, they consistently received emotional, informational and appraisal suppport across modalities.

      Conclusion/Implication/Recommendations: Dichotomizing support as either ‘online’ or ‘in-person’ may detract from our ability to understand how ACCs use multiple modalities to achieve their support goals. ACCs’ approach to peer support was complex. This highlights the need for future interventions to emulate their naturally pragmatic and flexible support-seeking style.

      140 Character Summary: Adult children #caregivers use a blend of communication modalities to obtain #support from #peers. Type of support received transcends online/in-person modality

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      EP07.05 - Drinking from the Data Fire Hose, Integrating Medical Device Data (ID 319)

      Doug Frede, True Process; Milwaukee/US

      • Abstract
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      Purpose/Objectives: We are still in the early days of a clinical data revolution. While medical devices generate an enormous amount of clinical data, most of this data goes unused, siloed in proprietary device formats and systems that are nearly impossible to access. However, this data is essential to realizing the promise of improved healthcare by the emerging advances in predictive analytics and retroactive data analysis systems. Exactly what does it take to get this data and then what can you do with it? What does it take to get a data acquisition project rolling and how can you empower your clinicians, researchers, and innovators to make breakthrough discoveries?

      Methodology/Approach: Using a variety of systems and methods, we have developed techniques and methods for collecting large amounts of data for customers such as Sick Kids in Toronto. In addition, we have 12 years of experience connecting medical devices for companies such as Hospira, Baxter, and Smiths Medical. This data is sometimes placed in the medical record, but is now being placed into systems from IBM, Google, Hitachi, GE, and others to perform real time predictive analytics.

      Finding/Results: Having implemented/integrated and developed software for device integration at hospitals across the US and Canada, we have taken years of expertise and put it into our own products and solutions for data acquisition and storage. This has resulted in some of the most reliable, high quality data that researchers have been able to use from devices that generate huge amounts of data such as patient monitoring systems. Medical record systems are not device data warehouses. Data is generated at a high rate from some devices, both numeric and waveform data, that cannot be stored at the resolution necessary for research, or simply not at all.

      Conclusion/Implications/Recommendations: Although standards exist and are being further developed, there are still a large number of devices that need connectivity that will be around for years and don't utilize standards. We have helped customers sort through these systems to provide data that can be used for more than just the medical record, it is stored and can be used for research for as long as is needed. When most people think of "big data" in healthcare, they think of the analysis of the data and systems that perform it (such as IBM Watson). What they miss is that the most difficult part is still the link from the device to those systems.

      140 Character Summary: We will bring our expertise of the task of connecting medical devices and device data for hospitals, researchers, and technologists alike.

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      EP07.06 - Integrating Medical Device Product Information into CIHI’s Hospitalization Database (ID 350)

      Nicole De Guia, Canadian Institute for Health Information; Toronto/CA

      • Abstract
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      Purpose/Objectives: The medical device industry is an innovative health care marketplace that is regulated less stringently than drugs under federal legislation in Canada and internationally. Currently there is a large information gap in terms of which devices provide the best outcomes with good value in terms of device pricing as well as the need to perform longer-term surveillance of medical device safety. The Canadian Institute for Health Information (CIHI) is expanding the capability of its primary hospitalization database, the Discharge Abstract Database (DAD), to capture medical device product information, beginning with hip and knee replacements, in order to support these patient safety and procurement agendas.

      Methodology/Approach: CIHI has managed the Canadian Joint Replacement Registry (CJRR), Canada’s only national medical device registry, since 2001. This Registry captures hip and knee replacement product (barcode) information to support the monitoring of device performance and related outcomes. CIHI is working to integrate the capture of the CJRR information via the DAD, which will directly associate the product information with the associated medical-device related hospitalization. Activities undertaken as part of this initiative included an assessment of the CJRR data elements vis-à-vis the DAD, comparisons with international arthroplasty registries, and consultations with clinical and classifications experts, as part of a multi-disciplinary team that also included IT business analyst, architecture, and developer staff.

      Finding/Results: As of April 2018, the DAD will include additional data elements to capture detailed manufacturer and product number information associated with each hip and knee replacement device. The DAD will also have the enhanced ability to received scanned barcode information and parse out requisite information, a key functionality given that the current lack of standard barcode formats in the industry. These additions lay the groundwork for future medical device product capture. Several provinces in Canada have mandated CJRR collection and it is expected that this integration will increase the reporting to support device surveillance and procurement decisions. For instance, product characteristics, such as bearing surface, are known to influence the revision rates of joint replacement surgeries. Early revisions need to be reduced, as such surgeries are significant procedures for the patient, take longer for recovery, and are costly to the health care system. These medical device products have varying costs negotiated through private procurement contracts; under the current pressures to reduce health care costs, it is important that their relative outcomes be considered during purchasing arrangements.

      Conclusion/Implications/Recommendations: An estimated half a million medical-device related hospitalizations and procedures occur in Canada annually, incurring significant costs in the health care system. By building in the capability for medical product device capture directly linked with the patient hospitalization record, CIHI is enhancing its ability to provide outcomes data in a manner that supports the work of regulatory and supply chain/procurement agencies.

      140 Character Summary: CIHI will be capturing medical device product information in its primary hospitalization database to support improvements in outcomes data.

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    EP08 - Novel Canadian Delivery Projects (ID 48)

    • Type: e-Poster
    • Track: Clinical and Executive
    • Presentations: 6
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      EP08.01 - The Value of Patient Generated Data (PGD) (ID 47)

      Reshma Prashad, Toronto/CA

      • Abstract
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      Purpose/Objectives: The objective of this presentation is to discuss the value of patient-generated data. A summary of the dialogue in the industry and academia on the potential benefits of capturing, analyzing and utilizing patient-generated data will be covered. The forecasted benefits and the current progress towards achieving these benefits will be discussed.

      Methodology/Approach: An environmental scan of gray literature and an academic literature review were utilized to gather the facts for this presentation. This information was synthesized to derive the findings and arrive at the conclusions that will be presented.

      Finding/Results: The findings from the environmental scan and academic literature review revealed that both clinical and financial benefits can be gained (results of both international and national projects will be discussed) from capturing, analyzing and utilizing patient-generated data. However, despite the many benefits, the progress has been slow in the collection and utilization of patient-generated data in Canada. Currently, care is provided based on data collected from episodic interactions with care providers; this data does not accurately represent the patients’ health status. In many cases, it was shown that several interactions with care providers were required before a patient received the appropriate care. This is both costly to the healthcare system and results in unnecessary complications that affect a patient’s quality of life.

      Conclusion/Implication/Recommendations: Implications The implications of not utilizing patient-generated data have a significant impact on both clinical and financial outcomes. In terms of clinical outcomes, patients are not benefitting from the proactive collection of data that provides clinicians a better picture of their health status. The collection of patient’s data over a longer period is shown to help providers gain a better understanding of the patients’ health status and facilitates proactive care which results in a better quality of life for patients. In terms of financial outcomes, healthcare organizations are not benefitting from the collection and utilization of patient-generated data. Proactive data collection can facilitate care in the community versus costly care in acute care organizations that results when patients’ health status deteriorate significantly (due to a lack of proactive care) and cannot be handled in the community. There is potential for significant cost savings as a result of proactive management of patients; this is particularly the case for patients with multiple chronic conditions. In 2005-2008 the cost of caring for patients with multiple chronic diseases was $192.8 billion, many of these patients can benefit significantly from proactive management of their conditions which can result in reductions in acute care readmissions. Chronic diseases have a profound impact on society, both in terms of health outcomes and economic burden. Conclusions/Recommendations By discussing the results of the environmental scan and academic literature review, the goal is to create awareness and a call to action for healthcare organizations to leverage patients’ increased use of technology to enable a better quality of care and create a sustainable healthcare system through significant cost savings.

      140 Character Summary: The results of an environmental scan and an academic literature review on the value of patient-generated data will be shared with attendees.

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      EP08.02 - Students Mental Health Virtual Community: Results of a Focus Group (ID 222)

      Christo El Morr, York University; Toronto/CA

      • Abstract
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      Purpose/Objectives: Anxiety, stress and depression are on the rise among post-secondary student. Yet, support for mental health concerns available on campuses are limited and may not address the vast needs for students on campus. A recent survey of 25,000 students by the Ontario University and College Health Association reported a rise in anxiety, depression and suicide attempts rates in Ontario: 65% reported experiencing anxiety; 46% reported feeling depressed, 13% had suicidal thoughts. Further, campus based counsellors report that they are overwhelmed with the mental health needs. Indeed, innovation is needed to address growing mental health needs on campuses. Given that mindfulness is a proven technique that decreases levels of stress, anxiety and depression when delivered online, our team aimed to develop a student centered, Mindfulness Virtual Community (MVC) that could be scalable at a reasonable cost once found effective. Our research team has received a Canadian Institutes of Health Research (CIHR), eHealth Innovation Partnership Program grant to develop the MVC and conduct a randomized control trial to test its effectiveness (lower depression, anxiety and Stress) and efficiency (cost reduction).

      Methodology/Approach: In order to achieve this goal, we have conducted eight focus groups with students at York University, between April to May 2016, in order to elicit their mental health challenges, their online a behavior, and their perspectives about the development of an online MVC to address stress, anxiety and depression. In total, 72 students participated in the focus groups. The discussions were audio recorded and later on transcribed. All qualitative data was analyzed thematically using technique of constant comparison.

      Finding/Results: Participating students' mean age was 23.38 (SD 5.82) years, 55.6% identified as females,58.3% were working for varying hours. The focus group qualitative data analyses uncovered two themes related to the design of the Mindfulness Virtual Community: (1) the need for a dedicated mental health Virtual Community (VC), and (2) its desired content and features. Students perceived that the campus mental health resources were either limited and not known to students. They perceived value in having a student VC for mental health. The main advantages that the student found in an MVC were anonymity, flexibility and sense of connectedness. Student have seen anonymity as a way to overcome stigma associated with mental health and cultural barriers. Besides, they have expressed that online access to mental health resources allow flexibility in terms of commute and comfort (e.g. anytime, anywhere) and to be connected with peers having similar experiences. The main potential challenge of an MVC was cyber bullying, and thus students have seen the presence of a moderator as an essential requirement.

      Conclusion/Implication/Recommendations: A Mindfulness Virtual Community presents definitive advantages from the point of view of students, such as, anonymity, flexibility and connectedness. A moderation of the online forums is a must to guarantee a safe environment.

      140 Character Summary: Mental health challenges among students can be addressed by a moderated Mindfulness Virtual Community providing Anonymity, Flexibility, Connectedness.

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      EP08.03 - Critical Success Factors and Engagement Methodology for Successful Project Delivery (ID 313)

      Kathy Steegstra, Telemedicine, Trauma Services BC, Mobile Medical Unit (MMU), PHSA; Vancouver/CA

      • Abstract
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      Purpose/Objectives: The BC Patient Transfer Network (BCPTN) initiated the Patient Transfer Management System (PTMS) project to replace its existing application. PTMS will set the foundation for a standardized, integrated system with enhanced reporting functionality to drive improved outcomes. BCPTN engaged with TELUS Health to provide project management consulting services to bring the project to completion. The presenters will provide insight into how TELUS Health partnered with BCPTN to successfully deliver the project.

      Methodology/Approach: The TELUS Health delivery methodology contained four key phases. Planning and Analysis The TELUS Health team conducted a current state assessment of the PTMS project, to understand challenges being faced and strategies for addressing them. Stabilization TELUS Health reviewed the project structure and governance and provided recommendations. The TELUS Health project manager established a detailed project plan with defined resources and deliverables, and core project management processes. Transformation Working collaboratively with the project team, TELUS Health adapted an agile methodology to design the software to meet end-user requirements. A product owner from the business was empowered to make decisions about system functionality. Issue management and testing processes were put in place to bring the software to go-live readiness. Sustainment TELUS Health developed and executed a go-live plan, supported go-live, and managed the transition to operational support for the project.

      Finding/Results: A number of key lessons and critical success factors were identified during the delivery. Establishing Governance For TELUS Health, the first priority when engaging on a project is to validate and establish clear governance, with engaged sponsors and a steering committee. This enables the project manager to raise and resolve risks and issues, gain support on high priority asks and enable key decisions to be made. Delivering a Team-based Approach TELUS Health established a multidisciplinary consulting team, and leveraged each individual’s strengths to focus on driving process improvements in areas of the project with the highest business value. Maintaining Objectivity As an objective third party, TELUS Health conducted a fact-based current state analysis of the project. They created an action plan to appropriately address any challenges or barriers being faced. Driving Engagement The project team promoted transparent, regular communication between teams, and through governance to executive leadership to foster the trust required to move the project forward. Developing a Transparent Plan with Clear Deadlines The project team created a credible deployment schedule with a high likelihood of delivery. The scheduled was designed to be flexible and adaptable to meet business needs while maintaining the overall scheduling objectives. Managing Scope The project team collaboratively set about de-scoping items that were not critical for the project’s success in order to keep the schedule on track.

      Conclusion/Implication/Recommendations: By applying an adaptable methodology, TELUS Health was able to bring together a diverse project team with a strong focus on delivery, successfully meeting the client’s needs. The outcome was a successful deployment, allowing the PTMS project to realize its business objectives and ensuring that the patients of British Columbia will continue to receive the best possible care from BCPTN.

      140 Character Summary: TELUS Health will share its critical success factors and engagement methodology to successfully deliver a project on time, while meeting the client’s vision.

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      EP08.04 - Telegerontology: A Novel Approach to Rural Dementia Care (ID 183)

      Elizabeth Wallack, Medicine, Memorial University of Newfoundland; St. John's/CA

      • Abstract
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      Purpose/Objectives: Telegerontology is a type of home Gerontology support that takes advantage of Information and Communications Technologies to facilitate remote medical care. The goal of this project is to test Telegerontology as a way to assist people with dementia and their caregivers to stay safe and age in place in rural and remote regions of eastern Newfoundland. We intend to enhance the caregiver/patient/physician triad using the remotely delivered expertise of a dementia care team and specialized remote assessment tools, thereby improving care for people with dementia in rural and remote areas.

      Methodology/Approach: Participants (n=19) were recruited through primary care physicians in four geographical regions within the Eastern Health Authority of Newfoundland. Primary care physicians identified potential participants from their practices and participated in interviews prior to the intervention phase of the study. Blocks of patients, grouped by primary care physician practice were randomized into intervention and control groups. All participants receive an initial home visit, an iPad with study-designed remote assessment apps, a case report with recommendations sent to family physician (implementation at the discretion of Dr.), occupational therapy recommendations, and post, 6 month and 12 month follow up. The intervention group received weekly Skype™ or telephone calls from a representative of the dementia care team.

      Finding/Results: Ten participants were assigned to the intervention group and 9 were assigned to the control group. The average age in the intervention group was 76 (SD±8.0), who had on average 8 comorbid conditions (SD±4) and who were prescribed an average of 8 (SD±5) medications. The control group (n=9) had a mean age of 77 (SD±7), with 9 (SD±4) comorbid conditions and were prescribed on average 8 (SD±4) medications. Caregivers in both groups reported similar levels of stress (Caregiver Hassle Scale) at baseline with 19.89 (SD±14.98) in the intervention and 19.44 (SD±19.99) in the control group. There were no significant differences found between the groups with respect to level of disability (Barthel Index) t(17)=2.076, p=0.053 or stage of dementia (Reisberg Scale) t(17)=0.992, p=0.580. At this time there have been an equal number of falls in the treatment and control groups (1:1); and fewer reported emergency room visits (2:4), hospital stays (1:2), primary care physician visits (18:22) and admissions to long term care (1:3) in the intervention group versus the control. Primary care physicians (n=11) noted the importance of anticipatory care, system navigation and caregiver validation in successfully managing dementia patients at home. With respect rural practice a lack of resources (dementia specific supports), unclear circles of care, and lack of communication between physicians and families were seen as barriers to effect service delivery. Twelve month follow up is complete for the first group (n=9). At this time we are completing 6 month follow up on group 2 (n=10). 12 month assessment will be complete in April 2017. Full results will follow.

      Conclusion/Implications/Recommendations: Preliminary findings provide evidence of the benefits of Telegerontology for the remote management of people with dementia living at home.

      140 Character Summary: The utility of Telegerontology was assessed as a way to assist people with dementia and their caregivers to stay safe and age in place in rural/remote Newfoundland.

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      EP08.05 - Innovative Model of Ambulatory Care Within an Academic Hospital Center (ID 240)

      Jacqueline Barrett, Women's & Infants, St. Joseph's Healthcare; Hamilton/CA

      • Abstract
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      Purpose/Objectives: St. Joseph’s Healthcare Hamilton is the busiest birthing centre in the region, delivering 3,600 babies per year, which accounts for 51% of all the babies born in Hamilton. The Obstetrics and Gynecology Clinic provides care for obstetrics (pre and post-natal), as well as gynecology patients. While the 2013 goal was a volume cap at 12,000 patients, the clinic received 13,747 ambulatory patient visits in 2014-15 and 14,013 ambulatory patient visits in 2015-16. Continued increasing patient volume in 2016 and cost containment pressures prompted an optimization review of services and an innovative model to emerge. Increasing access to care and efficiencies as well as acting upon pressures to reduce per patient care costs led to restructuring the ambulatory care model for Obstetrics and Gynecology.

      Methodology/Approach: This will be a phased implementation, both from a care delivery perspective as well as a physical location within the hospital buildings. The expected outcome will be to establish a new 11-physician group practice model situated on site with physical space including several in-kind hospital support services, but funded and managed independently by the physician group. The redesign includes recommendations for staffing, physical space and an operating business model. The methodology included a review of background information, an environmental scan to identify hospital-based clinics with a physician-funded and managed model, analysis of reports and clinic data, a review of all EMRs currently certified in Ontario as considerations to increase efficiencies for the new model.

      Finding/Results: For medical groups with 3 or more physicians, hiring a professional practice administrator may bring additional value and efficiency. The new structure ensures minimum overhead costs to the practitioners (?10%) including staffing and supplies and shows various options for revenue sharing between the practitioners depending on previous year revenues of patient volumes or equal revenue sharing distribution. Job descriptions were developed for the various positions at the Ambulatory OB-GYN clinic and use as appropriate in recruiting staff for this new clinic. Taking into account physician roles in teaching and research as well, the respective Women’s & Infant Program at St Joseph HealthCare Hamilton and the Ambulatory OB-GYN Clinic Physician group have endorsed a plan for physicians practicing within the hospital setting to integrate their independent offices and processes at an operational level, while ensuring the independence and autonomy of each medical staff at a strategic level.

      Conclusion/Implication/Recommendations: Recommendations included measurement metrics to know and track how the practice is performing clinically, financially, and in delivering services. Financial and operational considerations included tracking indicators of operational efficiency such as deliveries, diagnostic tests, surgeries by type, and outpatient visits. Tracking relative value units and revenue per doctor is also useful as indicator of practice performance. Managing change proactively was key to maintaining excellence in working relationship between physicians. Finally, looking at budgeted versus actual expenses and evaluating the service mix each month will ensure continued sustainability of the practice.

      140 Character Summary: St Joseph Healthcare Hamilton Hospital developed an innovative operating business model to restructure its ambulatory care model for OB/Gyn Ambulatory care.

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      EP08.06 - Stop Complaining About Healthcare Procurement: The Fix Is In (ID 373)

      Graeme Foster, GEF CONSULTING INC.; TORONTO/CA

      • Abstract
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      Purpose/Objectives: Identity the pain points, common solutions and roadmap for change for traditional procurement organizations looking to adapt to the changing marketplace and Government policy agenda Introduce innovation procurement and provide real-world evidence of adoption

      Methodology/Approach: Provide a level set on traditional procurement models, functions and organizations Itemize the systematic issues with the tradititional procurement function Identity the pain points, common solutions and roadmap for change Introduce innovation procurement Provide real-world evidence of adoption of innovation procurement methods

      Finding/Results: Solutions to issues are rooted in process Strategic Sourcing / Strategic Procurement is an oxymoron in Healthcare - it doesn't have to be this way however Organizations have not evolved with the times - procurement of complex IT solutions or Solution-as-a-Service offerings require a higher level of sophisication and alternate engagement model from the procurement organization Fairness monitoring is analagous to a referee in a hockey game. The procurement officers are the players. So why is there often no coach?

      Conclusion/Implication/Recommendations: Innovation procurement is not the only solution to procurement challenges, nor is it the solution for all - we must crawl before we walk before we run However for those further along the maturity cycle, innovation procurement offers some truly powerful tools

      140 Character Summary: Healthcare Procurement has gotten a bad rap. And not entirely undeservedly. However there are solutions for Healthcare organizations of all shapes and sizes.

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