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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):
Non-Member Price: C$120+tax Digital Health Canada Member Price: C$100+tax
- Jun 4 - 7, 2017
- Total Presentations: 225
OS10 - Disease and Clinical Management with Technology
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 205B
OS10.01 - The Concepts of Canadian Population Grouping Methodology and Its Application
Purpose/Objectives: CIHIs newest product a Canadian based population grouping methodology looks at an individuals experiences with the healthcare system across many sectors, including inpatient stays, day surgeries, physician visits, ED visits, hospitalizations for mental health illnesses and stays in long-term care (LTC) and complex continuing care facilities. Using data collected over an extensive time period, the grouping methodology classifies individuals, including healthy people, into cohorts with similar clinical characteristics; producing cost weights which compute the populations current and future burden of morbidity, their number of primary healthcare and ED visits, as well as the likelihood of being admitted to a LTC facility. Using these outputs, users are able to quantify the health burden of the population, identify high cost users, provide inputs into funding models, monitor population health and diseases and profile/predict future healthcare usage.
Methodology/Approach: The population grouping methodology starts with everyone who is eligible for healthcare and then looks at interactions with the healthcare system and diagnosis information over a 2-year period to describe a persons health status and predict their future morbidity and system use. This means, everyone, including individuals who havent had any interactions with the healthcare system and those with no health conditions are also included in the analysis, providing a true picture of the entire population. By using age, sex, health conditions and the most influent health condition interactions as the predictors, regression models have been applied. These models produce predictive indicators for the concurrent period as well as one year into the future. While the data is produced at the individual level, the power of the model lies in the users ability to aggregate the data by population segments and compare healthcare resource utilization by different geographic regions, health sectors, socio-economic status and health status.
Finding/Results: By comparing with other similar products in the world, CIHIs population grouping methodology has been proved to have similar or better predictive power.
Conclusion/Implication/Recommendations: CIHIs population grouping methodology is a very useful tool for profiling and predicting healthcare burden and future system use, with key applications for health policy makers, planners and funders. The presentation will focus on how these user groups can apply the outputs of the methodology to aid in their decision making and planning processes. For example, we will demonstrate how the cost weights can be used in large-scale funding models, to set physician capitation rates and identify/monitor high system and high-cost users. We will demonstrate how the clinical profiles created across the continuum of care can be used for disease surveillance and monitoring. Finally, we will demonstrate how the outputs from the models can be used to predict future system use patterns, such as visits to a family medicine physician.
140 Character Summary: A very useful tool for profiling and predicting healthcare burden and future system use, with key applications for health policy makers, planners and funders.
OS10.02 - Digital Health Based Ambient Assisted Living to Improve Medication Adherence
Purpose/Objectives: Patient-centerd healthcare involves strategies to engage and motivate patients to self-manage their health conditions in home-based settings. Medication adherence is an important aspect in disease self-management since sub-optimal medication adherence leads to ineffectiveness of the therapy and discomfort for the patient. In order to overcome the limitations of self-reported medication adherence, our objective is to use ambient assistive living (AAL) technologies in smart environments to monitor, remind and motivate patients to adhere to their therapy plans. Our intent is to exploit sensor technologies and consumer health devices to remotely monitor and collect self-management related information, infer adherence through activity recognition, and send personalized reminders and motivational messages based on the observed patients behaviour to help them improve medication adherence. We present an AAL framework that monitor activities related to medication adherence.
Methodology/Approach: We take a data analytics and AAL approach that entails: (a) data collection for activities related to medication adherence; (b) patients high-level activity model generation based on their activity data; (c) recognition of medication related activities state based on the collected patient data and high-level activity models, and (d) contextual message generation from the activity recognition results. Medication adherence is monitored from a smart pillbox (Bluetooth Low Energy) that send events (accelerometer, reed switch on pill compartments lid) to a smartphone, and from smart home sensors that include: passive infrared sensors to detect motions in specific zones, reed switches on doors and radio-frequency identification tags on objects to detect when objects (e.g. cup or glass) are used by the patient, and (c) flow meter sensors to detect when the patient uses water tap in order to get drinkable water. Smartphone and smart home services allow to obtain contextual information about the patient and medication adherences activities from the collected data: localization service (patients current location) and action recognition (e.g. opening pillbox, opening door).
Finding/Results: We implemented our AAL based medication adherence system, comprising a sensor infrastrure for data collection and a mobile health app for patients to receive messages. We evaluated system performance for three activities related to medication adherence as performed by different individuals. The Taking medication activity is carried out when the patient takes pills from the pillbox (Take pills sub-activity), then gets a cup of water (Get water sub-activity), and finally swallows the pills. The activities were validated with 780 scenarios of activity realisation with six uncertainty levels (from certain observation to complete ignorance about the observation value). Our system is able to recognize the patients activity in these scenarios with 79% accuracy. When the system is enabled to predict the most plausible patients activity then the systems accuracy is around 98%.
Conclusion/Implication/Recommendations: Ubiquitous and pervasive solutions to ensure patients adhere to their medication are challenging, yet important to improve therapy outcomes and reduce healthcare costs. We have presented an innovative digital health application to remotely monitor patients for specific activities and send them timely reminders and messages to help improve medication adherence and behaviour modification. Our framework extend to other self-manageent activities pertaining to chonic disease management
140 Character Summary: Remote patient monitoring and motivational messaging to improve medication adherence using ambient assisted livign technologies
OS10.03 - Technology Streamlines Screening Techniques and Saves Lives
Purpose/Objectives: The New Brunswick Department of Health has implemented an innovative, centralized Cancer Screening System that saves lives and reduces the cost of treating cancer. Colon cancer is New Bruswick's third most common cancer and the second deadliest cancer. Using existing information held within Department of Health databases, probabilistic algorithms identify and enable the selection of candidates for Colon cancer screening by evaluating information held in Medicare, the Client Registry, and the Cancer Registry. Where other provinces use mostly manual processes, the availability of these data sources to New Brunswick Cancer Network has enabled this system to operate with increased automation.
Methodology/Approach: The Cancer Screening program leverages investments made in the New Brunswick Electronic Health Record and data registries to support decision making while reducing effort and cost duplication. The current screening program would not be possible without the foundation of the One Patient One Record infrastructure. The provincial Client Registry is used to determine who to invite to the screening. Patients who agree to participate send their requisition sample into a provincial lab to have the test performed, and the Laboratory results are transferred via the Rhapsody Integration Engine to the Orion Clinical Data Repository. The Rhapsody messages are also transferred to another Cancer screening data repository that supports the screening processes. The EHR, Orion Clinical Portal, displays the results and nurses review with patients as they complete the pre-Colonoscopy assessment over the phone. Since results are electronic, the nurses who currently work in Fredericton can work from anywhere in the province. After the colonoscopy, the pathology report is reviewed by the nurses via the EHR. It's important to note that other health care providers have access to these results as well, through the EHR, for continuity and ongoing care of the patient. The notification of the physicians or nurse practitioners is an important factor to ensure that the patients receive appropriate follow up. Relevant information is routed to the patients care team NextGate Provider Index. Provider Index, the EHR viewer and Rhapsody messages enable the flow of information and build the foundation for the screenings highly-automated, algorithm-based cancer screening.
Finding/Results: As of July 31, 2016 there has been a 30% participation rate of solicited persons in the screening. To date, we have found 37 cancers in asymptomatic individuals. Additionally, 390 persons had polyps removed preventing cancer development. These screenings identified patients before cancer could progress, avoiding significant health risks to patients, and realizing cost savings to the province.
Conclusion/Implication/Recommendations: Before the integrated Cancer Screening's implementation there was no centralized, systematic way to identify and invite participants to be screened. By leveraging investments in existing provincial information technology systems and integrating data to build an automated algorithm to identify at-risk patients, New Brunswick has prevented cancer in many patients. The business process automation in the integrated Cancer Screening now enables proactive invitation of eligible NB citizens to engage in early detection of cancers. This technology allows for efficient delivery of the screening and ensures all providers are able to access test information.
140 Character Summary: The NB Department of Health has implemented an innovative system to support Cancer Screening that is saving lives and reducing the cost of treating cancer in NB
OS10.04 - NephroPort™: Innovative Partnership for Automation of Renal Data Reporting
Purpose/Objectives: Missing or erroneous data not only compromise patient care and quality improvement initiatives, but also lead to significant revenue lose for care providers. Increased pressure for data reporting and data accuracy to substantiate and generate contingent funding is taxing already resource-strapped healthcare organizations, and highlighting the need for access to data, and HIT interoperability. We present the joint development of NephroPort, an automatic data quality and reporting software between Grand River Hospital and the University of Waterloo. Advantages and challenges facing medium-sized community hospitals in fostering and sustaining innovation with academic partners are also discussed.
Methodology/Approach: All renal programs in Ontario are required to report patient and administrate data through the Ontario Renal Reporting System (ORRS). Manual data entry into ORRS was the only option to report data until 2015, when an interface for uploading batch files was made available. The project was established based on a strategic partnership agreement between Grand River Hospital and the University of Waterloo. Agile development methodology Scrum is used throughout the project. NephroPort software is developed as a result of this close collaboration. It is a web-based data extraction, validation and reporting system. Data completeness and accuracy were assessed at the baseline, and assessed again 6 months post implementation. <img alt="nephro - nephrport.png" annotation="" id="image://52" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=d19864cbb8dcd0577740f9035550dbcfee87af9a&id=52&width=350&height=350&download=0" title="nephro - nephrport.png" />
Finding/Results: At baseline, only 45% of required data elements were captured in the renal program's patient management system (source). Post deployment assessment shows an increase of data capture to 95% of the mandatory ORRS data in the source system and the time for data entry is reduced 70%. NephroPort enables the renal program to identify data quality issues on a daily basis and corrections can be made in the source system immediately. This project has led to new collaborative projects and research activities between the development partners.
Conclusion/Implication/Recommendations: NephroPort brings efficiency, accuracy and cost savings to the renal program. To address the demand for high quality data, medium-sized hospitals increasingly seek to automate data input and reporting. However affordable and appropriate off-the-shelf solutions for specific reporting needs, often involve high variable data extraction mechanisms and validation logic that depend on hospital business rules and source data systems. Academic-health system partnerships that provide experiential learning opportunities for students and address real-world problems are a win-win for hospitals and the system. However, the benefits of job-ready graduates must be balanced against the absence of receptor capacity for risk assessment and sustainability of software outputs.
140 Character Summary: NephroPort is an automatic renal data reporting software jointly developed via partnership between the University of Waterloo and the Grand River Hospital.
OS10.05 - Connecting Patients to the Clinic Through Community Volunteers and Technology
Purpose/Objectives: This presentation will describe the Health TAPESTRY approach as part of a randomized controlled trial in Hamilton, Ontario in a sample of older adults (N=312). The Health TAPESTRY approachis a way to proactively gather information about health goals and needs of patients in their homes through a volunteer-facilitated software application (TAP-App). This approach offers a new connection in healthcare in terms of how (and what) information comes into the family health setting to be acted upon by the healthcare team (See image below for information flow). <img alt="health tap information flow.jpg" annotation="" id="image://51" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=015b2566ca2b55d3cde303db361190568a2c5b19&id=51&width=350&height=350&download=0" title="health tap information flow.jpg" />
Methodology/Approach: A mixed-methods approach to data collection and implementation of this application of technology was used. Quantitative data tracked how information flowed from the home to the clinic (via TAP-reports) and how the clinic used the information to develop a care plan. Interviews/focus groups were conducted to gain a deeper understanding of the strengths and challenges of the application of this technology in this manner.
Finding/Results: Seventy-eight volunteers completed 393 home visits, for 174 participants. On average, the TAP-App took 80 minutes to complete over two visits. There were 173 reports auto-generated and electronically sent to the clinic. Reports included an average of 3.4 key issues for the clinic team to address. Care plans were developed for 172 reports. Qualitative findings showed that the TAP-App was generally easy to use by volunteers; however, challenges with the goal setting survey were noted, which led to changes to the script and its placement in the series of surveys on the TAP-App. Early on, clinical staff had concerns about the responsibility for, and accountability to, the information. Concerns about the quality and quantity of information were also noted, although this lessened over time. The one-way flow of information was noted by volunteers who wanted to know more about the care plan that was developed. Despite early challenges, the clinic noted the added benefits of having the health goals as a source of information to consider and thought the paperless information flow worked well.
Conclusion/Implication/Recommendations: The TAP-App successfully enabled the collection, collation, and transfer of information by trained volunteers from people living in their homes to the healthcare team. This offered a novel method of collecting and delivering health information to the clinic. Ways to facilitate the exchange of information using the volunteer, rather than the one-way flow of information, may further strengthen the Health TAPESTRY approach. This approach may extend primary care in a new way not yet fully realized.
140 Character Summary: Health TAPESTRY is a new approach to care planning; it gathers health goals & needs from patients in their homes through volunteers & tech
OS10.06 - Self eReferrals for Youth Mental Health: Canadian Research Initiative
Purpose/Objectives: The majority of mental illnesses begin in adolescence and young adulthood. In Canada, over 75% of youth with mental health concerns do not receive the services and supports they need. Barriers include geographical distances, having to navigate and rely on multiple others for referral, limited choice in terms of when and how to access services, and stigma and embarrassment. Accessing appropriate services can take weeks, months, and even years, while symptoms, distress levels, and risk for suicide can progressively increase over time. Young people are increasingly going online to seek help, creating a need for innovation in online pathways to facilitate young peoples trajectories to mental health systems of care. This presentation will describe a novel eHealth solution to facilitate rapid and direct access to youth mental health services that is currently being developed, implemented and evaluated in 6 Canadian healthcare settings. The eHealth solution is an online self-referral pathway composed of three integrated components: a youth-friendly online self-referral tool, a robust referral management system, and a secure communications platform. The ultimate objective of this innovation is to empower young people to seek help for mental health concerns, and improve the capacity of service providers to efficiently triage, manage, and monitor referral pathways and outcomes.
Methodology/Approach: The project involves multiple stakeholder collaboration and partnerships between public and private industry, youth and family consultants, service providers, decision makers, and community organizations to adapt, customize, and integrate the eHealth solution in real-world settings, and evaluate its benefits and cost-effectiveness. The evaluation is embedded within a larger, multi-site pragmatic trial evaluating a model of service transformation for youth across the country through early case identification, rapid access to services, appropriate care, youth and family participation, and continuity of care. We will also use qualitative methods to document and evaluate the process of tool development, pilot testing, implementation, and impact on referral processes, practices, and experiences from the perspectives of youth, service providers, and families. An economic evaluation will provide insights into the extent to which the eHealth solution adds value in terms of efficiency and cost-savings from a societal perspective.
Finding/Results: This is a four-year project that is currently underway. The presentation will present the prototype of the online self-referral pathway, highlight key achievements to date, and discuss lessons learned thus far in relation to public-private partnerships, context-driven implementation challenges and opportunities, and youth and family engagement.
Conclusion/Implication/Recommendations: This project can help to reduce the large unmet need gap in Canada with over 75% of youth with mental health concerns not receiving the mental health services and supports they need, at the time they need it. It can also improve efficiencies within the healthcare system. It will provide a seamless and rapid portal of entry to mental health services offered by the public healthcare system, through modalities popular with youth, ultimately improving young peoples pathways to care. This online self-referral strategy could eventually be scalable to a variety of other types of settings including adult mental health care and other health and social services-related settings.
140 Character Summary: An innovative online self-referral pathway to facilitate rapid and direct access to youth mental health services in Canada.
OS11 - Diversity in Implementation
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 205D
OS11.01 - Design and Implications of System for Shared Decision-Making via PHR
Purpose/Objectives: Engaging patients in the self-management decision-making provides opportunities for positive health outcomes. The process of shared decision-making (SDM) is touted as the pinnacle of patient-centred care, yet it has been difficult to implement in practice. Access to tools resulting from the integration of all health data and clinical evidence, and an ease of communications with care providers are needed to engage patients in self-management decision-making. Personal health record (PHR) technology is a promising approach for overcoming such barriers. To-date, few studies, and no systematic reviews, have addressed the design and implementation of SDM with the use of PHR technology. Yet, for an intervention to be effective in engaging patients and supporting SDM, the system must be designed around that purpose . This paper summarizes the design of a system for SDM via PHR, discusses the implications of the system, and suggests future work.
Methodology/Approach: A scoping review of the SDM via PHR literature was completed to map the literature in terms of system design and outcomes. A conceptual framework developed from recommendations of relationships between characteristics and elements of the SDM process and key enabling PHR functions by patient activity was used as the foundation for a functional model. Interpretive analysis and synthesis of the literature was carried out and a design of a system for SDM via PHR, including commended PHR architectural type and enabling functionality of PHR for SDM was identified.
Finding/Results: The scoping review identified a scarcity of rigorous research on SDM via PHR but with an increasing appearance in published literature. Electronic health record systems offer an enabling structure to SDM . The interconnected PHR architecture was identified as ideal, transformative, and collaborative, and likely the future of healthcare. Along with other identified, important system functions, a functional model for an integrated shared decision-makingpersonal health record (iSDM-PHR) system was revealed. Its ecosystem is defined by its core components and complemented by autonomous integrated applications whereby data is kept separate from the applications, enabling greater innovation in the applications , and built on standards for privacy and security and data exchange. To exchange data, applications use a common messaging system; an ideal structure for timely, asynchronous communication in a decoupled setting . Patients access the system anywhere, anytime using any device with internet access.
Conclusion/Implication/Recommendations: The interconnected PHRs potential to be a transformative and pervasive as a technology lies in its ability to provide quality, completeness, and accessibility of information and knowledge, synchronous and asynchronous patient-provider communications, decision making tools, and auto-population of reusable content. These capabilities shift the control of health information and care management to a shared model . Undoubtedly, the real value of a PHR lies in enabling action such as SDM . SDM is a collaborative process, whose barriers to integration into practice may be overcome with the use of intelligent, ubiquitous PHR technology. The iSDM-PHR architectural and functional model may be used as a foundation for further system design and implementation research and novel evaluation approaches of such innovations are essential next steps.
140 Character Summary: This presentation describes the design and implications of a system for shared decision-making via personal health record technology.
OS11.02 - Patient Perceptions of Health Information Exchange Privacy: A Systematic Review
Purpose/Objectives: The privacy discourse often reflects the views of healthcare providers and academic commentators, but not patients. The patient perspective on privacy is not well understood, yet patient privacy concern is often cited as a barrier to the adoption of health information technology (HIT). The purpose of this systematic review is to characterize the patient perception of health information exchange (HIE) privacy and identify the drivers and implications of patient privacy concerns.
Methodology/Approach: A systematic review was conducted on seven health sciences and interdisciplinary databases. To be included, the study must: assess the patient perception of privacy in context of HIE or interoperable health HIT; be a primary study with a quantitative approach; and be conducted after 2004. All articles were independently screened and extracted by two reviewers. The results were extracted and categorized based on the dimensions outlined in the Antecedent Privacy Concern Outcomes framework.
Finding/Results: Thirty-four of 1713 citations met the inclusion criteria. Ten articles focused specifically on privacy. Percentage concerned about privacy was the most commonly reported measure (n=11) with results ranging from 15% to 78%. A majority of participants in three studies (50%, 64%, 75%) agreed that the benefits of HIE outweigh privacy risks (i.e., privacy calculus). Privacy calculus was validated in four studies. Privacy concern was a dependent variable in 13 studies. There was inconclusive evidence on how, or if, demographics was associated with privacy concerns. There was no research on the effects of privacy experiences and privacy knowledge. One study found that experience with HIE is associated with reduced concerns, while the another found the opposite; however, the participants from the latter study wanted continued access despite the increased concerns. Awareness of provider use of HIT had no effect on concerns. Increased information control, positive attitude towards HIE, satisfaction with healthcare, and trust in healthcare providers are other antecedent factors associated with less privacy concerns. Privacy concern was an independent variable in 18 studies. Those with privacy concerns were less likely to see value in HIE, use HIT, and trust the healthcare system. Moreover, they were less willing to share their information, and more likely to engage in protective behaviours. There is inconclusive evidence on whether privacy concerns reduce an individuals intention to use HIT and support HIE as some studies reported no effect.
Conclusion/Implication/Recommendations: Patient privacy concern is not absolute as it varied depending on study and context. Despite evidence positioning privacy concerns as a barrier to HIE acceptance, these studies should be interpreted with caution as a vast majority of these studies are hypothetical and little context was provided on how knowledgeable participants were of HIE and its safegaurds. The privacy calculus highlights the importance of these factors as knowledge of benefits could offset the effects of privacy concerns. Future research should place greater emphasis on understanding the effects of these under-explored antecedents (e.g., knowledge, attitudes, trust, self-efficacy, etc) on privacy concerns. Furthermore, policy efforts should begin framing HIE as a public good and focus on raising awareness and building trust through public engagement initiatives.
140 Character Summary: Patient privacy concern is contextual. Research and policy should focus on how antecendent factors (i.e., privacy calculus) can offset effects of privacy concern.
OS11.03 - Emergency Data Management - Crossing the Borders?
Purpose/Objectives: In order to improve access to crucial patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In 2018, a law will require German physicians to create emergency datasets at the request of their patients. As a basis, the German Medical Association developed a medical emergency dataset (MED), which may store information on contact persons, prior diagnoses, medications, allergies, implants and other relevant emergency information. The MED is intended to be physically stored on the German Electronic Health Card (EHC) by authorized health professionals, and can only be decrypted with a German electronic health professional card. Consequently, access to MED will be limited to the area of Germany, and it will not be accessible by foreign health professionals when Germans are traveling abroad. Therefore, the aim of our study group is to evaluate how the MED may be used internationally. We explore this in two dimensions: is the MED content useful for non-German health professionals, and how would they prefer to access MED electronically.
Methodology/Approach: Within a project funded by the European Union and the Ministry of Health, Emancipation, Care and Aging of North-Rhine Westphalia a multi-phase study is conducted to test the possible use of the MED in different countries. The basis of this study is an evaluation, which was conducted in Germany in 2014. Within this study 13 primary care physicians developed a total of 64 emergency data sets. Afterwards the usability and potential benefit of the completed data sets were assessed by emergency care providers (14 clinicians, 14 emergency physicians and 9 paramedics) based on a semi-standardized questionnaire. Since the necessary telematic infrastructure is not yet established, the evaluation process was performed paper-based. To evaluate whether the MED may also be used in an international context, in 2016 / 2017, a second evaluation unit will be carried out in British Columbia.
Finding/Results: Within the German study, a total of 64 MEDs were completed by 13 primary care physicians. 63 MEDs were presented to clinicians, emergency physicians and paramedics for evaluation; one data set was used for training purposes. Since each emergency data set was reviewed five times, a total of 315 assessments were performed. In more than 70% of the reviewed cases, all three groups rated the completed emergency data sets as very useful or useful. The greatest benefit was attributed to the information on diagnoses and medication. The international evaluation will start in early 2017, so the results are pending at this time.
Conclusion/Implication/Recommendations: Our present study provides a scalable method not only to test and validate the MED in the German context, but also expand this validation in Canada. The findings will help us to enrich the MED in Germany, and refine it to be useful for non-German health systems. Furthermore, the findings will guide us in our next step in the development of a secure technical solution that will make it possible to access emergency data across borders.
140 Character Summary: In order to improve access to emergency data a multi-phase study is conducted to test the possible use of the German medical emergency dataset in different countries.
OS11.04 - Privacy Training and Compliance Across Multi-Regional Health Authority Staff
Purpose/Objectives: Health Information Management (HIM) services include 1,395 staff members working across 35 clinical sites at four large health authorities across British Columbia. HIM staffs access clinical information systems and patient records to accomplish job duties; therefore, privacy training around the handling of patient information is critical. An audit conducted revealed several inconsistencies in privacy training, such as: 1. There is no standard procedure across the different sites for privacy training. 2. The privacy course module and confidentiality form records were retained differently depending on the type of record. 3. There is no method of tracking staff compliance to privacy training. As a result, a critical risk identified was that HIM staff could start work within a healthcare site without completing their privacy training. Project objectives consisted of: A standardized privacy training process administered to all staff. A way to track staff compliance with privacy training.
Methodology/Approach: In June 2015, Standard Operating Procedure was circulated to HIM staff to provide clear guidelines around the administration of the privacy training. This allowed for consistencies in the type of training received by each employee. Further, the privacy training course and confidentiality form were centralized together in an online module. The module served as a single-source method to track staff compliance, and monthly reports are generated and sent directly to each HIM manager advising them of staff that has not yet completed their training.
Finding/Results: Before implementation, there was a 35% compliance rate, and since implementation, there has been a 77% compliance rate amongst all HIM staff, indicative of a 42% increase in compliance. There was an increase in compliance rate each time communication was sent to staff around the importance of the privacy training. <img alt="him privacy compliance.png" annotation="" id="image://25" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=9b7529a6e65b0a4d5685e9f5ecfaa1cfb8a92ca8&id=25&width=350&height=350&download=0" title="him privacy compliance.png" />
Conclusion/Implications/Recommendations: Challenges involved clarifying the responsibilities around privacy training between HIM and the multiple health authorities. There were several consultations with stakeholders to discuss process improvement around the administration and tracking of privacy training. There were also several iterations of the report automation from the course module due to unexpected challenges with user login IDs. Feedback has been extremely positive since this initiative launched, and PHC as an entire health organization has adopted a similar process in June 2016. Future plans involve promoting a culture of privacy through a communication strategy in November 2016. The goal of this initiative will be to reach a 100% compliance rate and further develop HIM as a leader in data stewardship and patient privacy.
140 Character Summary: The implementation and results of a compliance tool to track health authority staff to mandatory privacy training and the signing of a confidentiality agreement.
OS11.05 - Pharmacist Modifications to an EMR in Primary Care: Lessons Learned
Purpose/Objectives: Pharmacists in Primary Care increasingly rely on Electronic Medical Records (EMRs) to support patient care. EMRs are associated with increased quality of patient care, reduced healthcare errors, and enhanced appropriateness of care.1 In Canada, commercially available EMRs are physician-centric and not aligned with pharmacist logic or documentation needs for clinical and collaborative practice. The Pharmacists Clinic team at the UBC Faculty of Pharmaceutical Sciences has been working with a software specialist to design, modify or build, and pilot 3 new pharmacist-specific modules in the OSCAR EMR: the Medication module, the Disease/Indication module, and the Healthcare Team module. The purpose of this presentation is to share the clinical, administrative, and workflow lessons learned from a pharmacist perspective in a growing and innovative area of practice. 1. Canada Health Infoway from https://www.infoway-inforoute.ca/en/
Methodology/Approach: The approach to determining the clinician needs and priorities for EMR modifications were done in a comprehensive and iterative way. An analysis of pharmacist-best practices and needs in primary care was conducted, including an examination of the scope of practice and anticipated growth based on regulatory changes. Modifications to the EMR were also prioritized based on an environmental scan of other primary care practices across North America in the literature. We established a standardized ticket-based approach for communication between clinicians and software specialist. A clinic IT Lead was tasked with piloting any modifications and working directly with the software specialist. Once testing was complete, the modifications were shared with the rest of the clinician team, training sessions were scheduled, and updates to the necessary administrative documents (policy and procedures, training packages) were done. Modifications were then submitted to OSCAR Canada for review with the goal of being incorporated into future OSCAR releases.
Finding/Results: The modules have been integrated into the workflow of the Clinic for over 3800 patients. The pharmacist-specific EMR modifications were an innovative way to monitor patient clinical statuses and assess key performance indicators among others. Pharmacist logic in a comprehensive assessment required the most design changes to the Medication Module. Unexpectedly, significant modifications to other areas of the EMR were required to create a more interprofessional-friendly application rather than pharmacist-specific. The Medication module was structured in a best-possible medication history format, including prescriber and disease indication. The Disease module uses indication-based prescribing and has over 330 ICD9 disease codes translated into patient-friendly synonyms. The Healthcare Team module indicates other healthcare professionals involved in the patient's care, such as a community pharmacist or nurse. In the first year, clinicians linked 4510 medications to 905 disease indications (20%). This increased to 72% in the second year with 6334 medications linked to 4567 disease indications. In addition, over 71% of patient records have more than 1 documented healthcare team member.
Conclusion/Implication/Recommendations: There are significant changes occurring in primary care and pharmacist scope of practice that necessitate the growth of traditional EMRs. The lessons learned from the development and piloting of new EMR modifications by the UBC Pharmacists Clinic can provide invaluable lessons for any team.
140 Character Summary: The Pharmacists Clinic at the UBC Faculty of Pharmacy has designed, modified, and built 3 modules in an EMR: Medications, Disease/Indications, and Healthcare Team.
OS11.06 - A Secure e-Prescribing System Based on NFC
Purpose/Objectives: The main purpose of this proposal is to introduce a secure e-Prescribing system, which can create digital format prescriptions and transmit them to pharmacies. This system has some features including preserving the privacy of both patients and physicians, decreasing the number of medication errors occurring in traditional paper-based prescribing, checking patients allergies and reviewing adverse drug reactions before prescribing.
Methodology/Approach: The proposed e-prescribing system is using cryptographic tools such as proxy signatures, group signatures and a well-known wireless communication technology, Near Filed Technology (NFC). Using of these digital signatures is intended to hide the real identities of patients and physicians from pharmacies and drug companies to preserve their privacy. Group signature is set up by a trusted group manager to use by physicians for signing prescriptions. The group manager is able to revoke signatures of physicians in case of any future disputes. This group signature is adopted from the short group signature. Proxy signature is using by the patient in order to sign the prescription and delegate her right to other qualified parties. The proposed system is implemented as a mobile application to benefit from NFC technology as a proof of identity when collecting prescriptions at pharmacies.
Finding/Results: Results include a mobile application for the patient and a web-based application for the group manager, physicians, pharmacies and insurance companies. Each of these entities can log into the system and based on their roles they have different panels with different menu options to choose. The mobile application is used by the patient to see her prescription, verify its content, and then sign and send it to the pharmacy.
Conclusion/Implication/Recommendations: Because of several difficulties and privacy concerns for both patients and physicians in the traditional paper-based prescription, it is necessary to think about using digital technologies in prescribing to improve the old-fashioned means of prescribing. This proposal introduces one of these systems, which can prevent medication errors and preserve the privacy of the users.
140 Character Summary: This proposal introduces an e-prescribing system, which can create digital prescriptions and transmit them to pharmacies while preserving privacy of users.
OS12 - Expanding Digital Competencies Through Education
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 206B
OS12.01 - Adoption of an e-Health e-Resource via Peer Leader Educator Network
Purpose/Objectives: The Association of Faculties of Pharmacy of Canada (AFPC) and Canada Health Infoway partnered to develop a national, online, competency based, educational resource to prepare undergraduate pharmacy students in the use of Information and Communication Technologies (ICT). Drivers for development of the educational resource included an expanding scope of pharmacist practice, increased availability and reliance on information and technology for practice, and paucity of teaching resources and faculty members with expertise in informatics. The resource was intended to be flexible and modular, for use by faculty members either within their respective courses, or in its entirety.
Methodology/Approach: The first version of the Informatics for Pharmacy Students e-Resource was launched for general use December 15, 2013 (http://afpc-education.info/moodle/index.php). <img alt="logo small.png" annotation="" id="image://26" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=216d165fb1a3ecbf8a344ebe7ed3314fcd51b1e8&id=26&width=350&height=350&download=0" title="logo small.png" /> A Peer Leader Network of pharmacy educators was created to foster adoption of the e-Resource at 10 faculties of pharmacy across Canada.
Finding/Results: A formal evaluation was conducted to determine the effectiveness of the network model and drive changes for Version 2 of the e-Resource (open access, launched May 2016). Peer leaders were supportive of the network model and were enthusiastic about engagement with colleagues toward a common goal. Students were very positive about the interactive learning activities, notably Virtual Patients, Polls, Videos, Quizzes and Gamification elements. Over 4,000 students and educators have accessed the platform (October, 2016). The e-Resource has been cited as a "best practice" in informatics and e-learning by American colleagues. A Peer Review process is being undertaken for the development of Version 3, and another group of Peer Leaders has been convened (Aug 2016) to deepen the network, conduct curriculum mapping, and continue local adoption and integration projects.
Conclusion/Implication/Recommendations: This project has resulted in a viable and scalable approach for developing an accessible and valid educational e-Resource using open source educational technology and a collaborative approach to instructional design. Thousands of Canadian pharmacy students have been exposed to the emerging area of Information and Communication technologies, achieving the goal of the original funding. The integration of the e-Resource across faculties of pharmacy in Canada was largely due to a Peer Leader Educator Network, which is proving viable and sustainable through a central, coordinated approach.
140 Character Summary: The combination of a Peer Educator Network, project managment, and access to a valid e-Resource resulted in e-Health education in 10 Canadian faculties of pharmacy.
OS12.02 - Striking a Balance: Theory vs Applied Practice in HI Education
Purpose/Objectives: Theory and applied practice are polarities in health informatics education a balance of both elements is needed to prepare students for emerging health informatics job opportunities. How do students, educators and employers align on how much concept vs. practice is optimal for future professionals? Health Informatics programs seek to build foundations of sustainable theories and models for students to apply in highly-variable live settings that are replicated by practicum placements, internships and co-op work. Mixing academic and applied efforts within a graduate program, however, doesnt automatically produce cohesive health informatics professional thinking. This materializes when the learnings from both mesh effectively. The question emerges as to how to best adapt, synthesize and contextualize learnings from both polarities to suit upcoming HI professional needs. The presentation will be based on insights collected from an online survey of actual employers, students and educators related to a particular HI program. It will consider the degree to which balance can be productively reached by focusing both academic and applied opportunities on achieving competencies and skills set by organizations as COACH and AMIA. It will also note current North American dialogues on standards of professionalism. The presentation will propose a framework for consideration of opportunities and challenges in balancing educational polarities.
Methodology/Approach: The presentation will explore approaches and methods for applied placements within graduate and post-secondary settings. The placements will be compared, and differences will be highlighted to point to needs in the system. Evidence will be used from targeted employer, student and educator interviews and surveys. Specifically, practicum learning experiences of students attending a professional HI program and employers hosting these placements will be assessed. This will be done via an online questionnaire. An evaluation of career paths, practicum experiences and obtained job positions from graduates of these programs is currently underway and be drawn from, as possible. The presentation will review what elements are foundational to both academic and applied modes of study, how these areas differ and to what effect. Observations will be presented in a framework for balancing theory vs applied practice.
Finding/Results: Findings will be focused on areas of similarities and differences between academic and applied learning settings. With major evaluation efforts currently underway, the presentation will contribute, if and where possible, findings from health informatics alumni assessment at University of Toronto. An online questionnaire of stakeholders will be used as the basis of a framework to convey findings and results.
Conclusion/Implication/Recommendations: A framework for balancing polarities will be proposed based on findings and results of anylysis. The framework will serve as a tool with a recommned approach to striking a balance of theory and applied practice that will be useful for students and educators, as well as employers. . An interpretation of how this fits into the changing HI job environment will be made.
140 Character Summary: Theory vs. applied practice are polarities at the centre of graduate education in health informatics. How do we frame a balance to best enable HI careers?
OS12.03 - Using Peer Networks to Integrate Digital Health in Nursing Education
Purpose/Objectives: Information technologies are being harnessed to deliver efficient and accessible high quality healthcare, and this trend is expected to continue. Increasingly, nurses are at the intersection of these technologies and patient care. Given the growing impact of informatics on nursing practice, it is critical that nurses enter the workforce having developed entry level competence in this area. The purpose of this project is to leverage previous CASN-Infoway work to support and enable nursing faculty to integrate digital health content into undergraduate curricula with the ultimate goal of graduating nurses who are well-prepared to practice in technology enabled environments.
Methodology/Approach: The Canadian Association of Schools of Nursing (CASN) and Canada Health Infoway have partnered on a series of initiatives to prepare new nurses for technology-enabled environments; the first phase was the development and publication of entry-level nursing informatics competencies, followed by the creation of a faculty peer network to mentor nursing colleagues across Canada. This third phase of the partnership has involved reengaging the Digital Health Nursing Faculty Peer Network to further support the integration of entry-to-practice digital competencies into curricula. Over the course of a year, 12 Peer leaders from across Canada with expertise in nursing informatics were engaged to provide knowledge, educational tools and mentorship to fellow faculty through three regional workshops and three online webinars. Each webinar focused on one of CASN-Infoways previously developed entry-to-practice competencies. The purpose was to continue to build foundational knowledge of digital health among nursing faculty to increase their baseline capacity. The regional workshops provided an opportunity to go deeper and build a greater depth and breadth of understanding of digital health and included topics such as consumer health solutions and virtual care. By using a train-the-trainer approach, this project has been able to leverage efforts to support and educate faculty through strategies developed by faculty who are champions of digital health, thus increasing their perceived value and uptake.
Finding/Results: Pre and post workshop and webinar evaluations surveys are being conducted to assess the self-identified change in knowledge of, and capacity to, integrate digital health content. The results of these surveys will be presented and their implications will be discussed.
Conclusion/Implication/Recommendations: The reengaged Digital Health Faculty Peer Network has been an innovative and effective mechanism for supporting the integration of digital health content into undergraduate nursing curricula. By enlisting faculty to help disseminate the content and the support tools, this project has been able to reach a cross-country audience who respected the experience and qualifications of their peers.
140 Character Summary: Leveraging previous CASN-Infoway work to support nursing faculty to integrate digital content into curricula through a faculty peer network.
OS12.04 - Graduating in Health Informatics: Where Do We Go From Here?
Purpose/Objectives: Health informatics (HI) job prospects are expanding for candidates with graduate education credentials. This presentation will explore the value of professional and research programs in terms of achieving desired career pathways. Top of mind for HI students is securing relevant post-graduation positions that meet their HI interests and aspirations. The presentation will look at qualifying and quantifying the risk and rewards of both professional and research tracks of study to meet career goals. In so doing, the differences between research and professional pathways will be discussed. An assessment of positions acquired post-graduation from students at a particular graduate HI Professional and HI Research program will be central to the presentation. Based on responses to an online survey about what types of jobs are desired and attained, this presentation will analyze whether students are being well prepared for HI careers. There will be an assessment of whether graduate professional and research options are currently translating into achievement of immediate and near-term career goals. Consideration will be made of implications from student, academic and employer perspectives, with reference to what seems reasonable in our current Canadian job environment.
Methodology/Approach: The presentation will explore evaluation approaches and methods for tracking career success and HI pathways by using evidence from the job-market, social media data, interviews and targeted surveys. Specifically, career aspirations of students attending a professional HI program and students attending a HI research program will be determined through an online questionnaire. An evaluation of career paths and obtained job positions from graduates of these programs is currently underway. A comparison of the aspirations and realistic career opportunities will be discussed. The presentation will review what elements are foundational to both professional and research areas of study, and how these areas differ. The methods will be focused on defining the needs of students in both streams. The perspective of educators will also be captured and presented.
Finding/Results: Findings will be focused on areas of similarities and differences between research and professional stream needs. In addition to targeted survey findings, there is a larger-scale evaluation effort around career aspirations and acquired jobs currently underway. The presentation will contribute, if and where possible, findings from health informatics alumni assessment at University of Toronto.
Conclusion/Implication/Recommendations: A summary evaluation model will be proposed. Methods for for annual tracking will be also be proposed. An interpretation of the level of need to re-assess programs given the changing HI environment will be made.
140 Character Summary: Job opportunities are expanding for prospects with graduate health informatics credentials. See how professional and research programs lead to career results.
OS12.05 - Accelerating eHealth Integration in Medical Education
Purpose/Objectives: Medicine has entered the digital era. In Canada, this change is clearly reflected by 77% electronic medical record (EMR) adoption in physicians' practices, and continued growth of hospital information systems. The proliferation of patient portals, use of the Internet (and particularly social media) to search for and exchange health information by clinicians and patients alike, and the growing number of health and wellness mobile apps open new possibilities to engage patients in their own care but also introduce new challenges for professionalism. Current and future clinicians need information skills and knowledge in order to be effective in a digital technology-enabled environment. To address the challenges facing medical practice and education, the Association of Faculties of Medicine of Canada (AFMC), with support from Canada Health Infoway (Infoway), has built a peer-leader educator network across Canada that identified and published Canadas first eHealth competencies for undergraduate medical education in 2014. AFMC and Infoway also created a series of national eHealth faculty development (eHealth FD) workshops delivered in Spring 2016 targeted to medical educators and residents to raise awareness of informatics and eHealth competencies. Webinar participants asked for more resources in French as well as English, particularly in the form of teaching tools, tips, case studies and clinical examples that can bridge knowledge learned in the classroom setting with the realities of the clinical setting.
Methodology/Approach: Education is essential to better prepare our medical learners (students and residents) to practice in modern, technology-enabled, clinical environments. Yet, educational interventions that address the challenges are limited. In this phase of the project the eHealth team focused on developing the requested teaching tools (resources, case studies, and clinical examples) to address the goals and challenges of designing and introducing eHealth topics into the undergraduate medical curriculum.
Finding/Results: Members of the panel will present the learning materials developed for the eHealth resource toolkit and housed in the AFMC's Canadian Healthcare Education Commons (CHEC). We will describe the process of case development and show with an example (use of emails between clinician and patient) how this case can be introduced at the beginner level, intermediate, and advanced levels with more complex learning outcomes and competencies for advanced learners and practicing clinicians. In the panel presentation we will give an overview of the available resources and how best to search and find relevant materials, demonstrate the completed case example, describe steps taken to work with the Medical Council of Canada to include eHealth competencies in medical school examinations, and during discussion ask participants for examples from their own institutions and ideas for further incorporation and integration into the medical curriculum.
Conclusion/Implications/Recommendations: eHealth is not just another component to add into the medical curricula; rather it is the way in which medicine will be practiced in the future. The AFMC-Infoway eHealth project is an example of a national-level initiative with collaboration across medical organizations and faculties to address these issues as well as to develop learning and educational resources and promote competency and accreditation standards.
140 Character Summary: This eHealth Resources Toolkit (AFMC-Infoway) provides essential tools to prepare medical learners for practice in technology-enabled clinical environments.
OS12.06 - Strategic Integration of an Educational EHR into Health Informatics Curriculum
Purpose/Objectives: To support the effective design, development, implementation, use and optimization of electronic health records (EHR), there is a considerable need for Health Informatics (HI) students to have hands-on experience and training with using EHRs. However, many HI students in Canada have very limited exposure to EHRs in the classroom/laboratory setting. This lack of exposure results in student challenges with developing HI competencies that are pre-requisites for other courses, co-op work terms, and eventually the workplace. Consequently, HI students may feel inadequately prepared to design, develop, implement, and support EHRs as graduates. The integration of an educational EHR into HI curriculum is central to develop fully students' HI core competencies related to the health sciences. To meet this need, McMaster University procured an educational EHR for its Health Informatics and Health Information Management (HIM) diploma programs.
Methodology/Approach: To introduce the educational EHR to its HI and HIM Course Developers and Instructors, McMaster University organized a vendor-led training session with hands-on homework. The teaching team was provided the opportunity and option to use the educational EHR in their respective courses. As a part of the course redesign efforts for HTH 105: Information Systems and Technology, the educational EHR was adopted by the course developer and instructor for integration into the course curriculum. A three-hour scavenger hunt activity using the education EHR was included as a pre-requisite for the course. Relevant hands-on activities were included as weekly learning activities, providing 1-3 hours of weekly hands-on exposure to the educational EHR. Students were also provided supplementary activities to gain additional practice with using the EHR.
Finding/Results: Nearly all HTH 105 students (n=21/22, 95%) have adopted the educational EHR, completed the course pre-requisite EHR activities, and are completing the weekly hands-on EHR activities for the course. However, students have encountered a number of technical challenges with initial installation of the EHR and co-signing EHR notes (the instructor was not listed as a co-signer by the EHR vendor). The American-centric build of the EHR is also one limitation of the system. Nevertheless, the implementation challenges were presented as a learning opportunity for students to gain an understanding of the common issues faced during EHR implementation. Many students expressed the value they realized in "applying theory in practice" through use of the EHR. Evaluation and monitoring of the benefits and limitations of the educational EHR is ongoing until the end of the course (December 2016).
Conclusion/Implication/Recommendations: With the introduction of hands-on exposure to the educational EHR, HTH 105 students at McMaster University have experienced an EHR's features, learned how clinical and administrative data is inputted and retrieved, observed its workflows, evaluated its usability, and made recommendations for system improvements. These skills are foundational to the development of health sciences core competencies for HI students. Educational EHRs should be integrated strategically into other HI courses and programs across Canada to support the applied learning of HI students. Further, there is a need to develop a Canadian educational EHR to achieve this vision.
140 Character Summary: McMaster University's lessons learned will help inform the strategic integration of educational EHRs into HI curriculum across Canada.
PS01 - Architecting Jurisdictional Ecosystem
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 201CD
PS01.01 - Canada's eHealth Secret: Northwest Territories Networked Health Ecosystem
Ewan Affleck, Office of the CMIO, Northwest Territories Health & Social Services Authority; 35S/CA
Geoff Rabbie, Sierra Systems; Edmonton/CA
M. Ali, Northwest Territories Health & Social Services Authority; Yellowknife/CA
Purpose/Objectives: The objectives of the presentation are to (3 - listed to align with 3 elements of panel): o Describe the principles of Networked Health by examining the Northwest Territories enterprise interoperable eHealth system (Big-thinking). o Illustrate the approach to implementation and system governance that contributed to the success of the project (Strategy) o Illustrate the approach and benefits realization of jurisdiction-wide analytics enabled by the Networked Health Ecosystem (Analytics). These objectives are of significant relevance to jurisdictions struggling with system design, interoperability, governance and/or enterprise analytics
Methodology/Approach: Unlike most jurisdictions in Canada the Northwest Territories has quietly taken a federated patient-centric approach to the design and deployment of its eHealth system. The strategic framework, Networked Health, is based on the foundational element of a patient-centric chart shared across all outpatient services and locations. The Northwest Territories boasts 42,000 people in 33 communities in an area twice the size of France. By the end of 2016 80% of the population will be served on a single charting system shared by almost all services and locations across the spectrum of care, including the first fully digital nursing stations in Canada. By the end of 2017 it is planned to have 100% of the population on the system. The implementation of a territorial Networked Health ecosystem has been a remarkable journey that is now bearing significant benefits, specifically: · Digital remote community support · Networked Home Care support · Federated eReferral / eConsultation · Federated analytics and clinical decision support · Economies of scale in deployment and support · Accountable health governance and clinical care · Staff satisfaction
Finding/Results: Early findings demonstrate: · Improved quality of remote community support (specifically time to care, continuity of care, provider satisfaction, efficiency of service, equity of care). · Improved Home Care support (specifically continuity of care, provider satisfaction, efficiency of service, equity of care) · Improved patient outcomes with analytics and clinical decision support (safety of care, appropriate care, provider satisfaction, efficiency of service, equity of care) · Nascent means of instituting enterprise appropriate care and limiting unwarranted care. · Demonstrable economies of scale with federated solution (single solution decreases cost of application licenses, training, support, hardware). · End-user (administration and staff) approval.
Conclusion/Implications/Recommendations: The Northwest Territories enterprise patient-centric digital charting solution has proven to be a significant success, with users across disciplines and locations requesting to be implemented on the system (demand is outstripping program implementation capacity). This project has become the foundational element of the strategic plan of the Territorial Health & Social Services Authority to implement a Distributed Health Home model of service, and to drive appropriate and limit unwarranted care. Once application deployment is complete in 2017, the program will refocus on maturity of system use, leveraging early successes with interdisciplinary communication, and centrally managed but distributed remote support, enterprise analytics and clinical decision support across all communities. Further this model of eHealth design offers economies of scale in terms of application cost, operations and management (application support, technical support), analytics, ever-greening, and data management.
140 Character Summary: Canadas best kept eHealth secret is the successful deployment by the Northwest Territories of a single charting system for all health services in the jurisdiction.
PS01.02 - SPARKing a Pathway to Access Patient Health Data
Shiran Isaacksz, University Health Network; Toronto/CA
Samantha Liscio, eHealth Ontario; Toronto/CA
Shivani Goyal, 20 Dundas St. W, Suite 331, University Health Network; Toronto/CA
Joe Greenwood, MaRS; Toronto/CA
Purpose/Objectives: Over the past 10 years, Ontario has made considerable progress on the eHealth front with the development and implementation of clinically significant point-of-care systems to allow clinicians to securely access and exchange information including lab, drug, diagnostic imaging, immunization, hospital, and community care data. As well, the demand for innovative care models and technologies that facilitate access to a patients electronic health record is growing exponentially. The need for a transparent, standardized approach to connect to this data is more important than ever. Despite significant advancement in ehealth and the growing demand for access to data, there remains a number of technical, policy and regulatory challenges that need to be addressed to improve patient health outcomes through the transformation of care delivery. These challenges include non-interoperable technology solutions, limited means for patients to access their own data, and lack of open standards and access to tools/ resources for development and diffusion of technology to market.
Methodology/Approach: With funding by the Ontario Ministry of Health and Long-term Care (MOHLTC), University Health Network (UHN) and MaRS Discovery District have established a collaborative partnership through Project SPARK (SPARK). SPARK is a multi-phased initiative designed to advance healthcare delivery and improve patient care for Ontarians. Specifically, SPARK aims to stimulate digital health innovation by facilitating access to core provincial data assets and creating a pathway for innovators (researchers, software developers, entrepreneurs, private industry, etc.) to scale their digital health technologies to market. To do this, SPARK will guide innovators seeking to plug-in to the provincial EHR infrastructure by developing a transparent and standardized set of processes and tools.
Finding/Results: In alignment with the Ontario MOHLTC Patients First Strategy and the forthcoming Digital Health Strategy, SPARK will promote the health and well-being of Ontarians, improve access to healthcare services, accelerate the next generation of ehealth assets, and liberate high-value data from core ehealth assets for use by patients and innovators. By leveraging investments in provincial ehealth infrastructure and by bringing together key stakeholders across the digital health technology ecosystem, SPARK will connect the patient consumer and their provider with their health data, creating a true collaborative partnership in care delivery and management. In addition to the benefits that SPARK will create for patient/consumers, providers, and health technology innovators, it will also create several benefits for the province of Ontario. SPARK will provide an ongoing R&D pipeline for the continuous improvement of assets such as ConnectingGTA and will contribute to the ongoing sustainability of Ontarios foundational eHealth investments (e.g., through data monetization strategies). The successful adoption and diffusion of made-in-Ontario health technologies will create economic wealth and jobs for Ontarians, validating the province as a leader in healthcare innovation, demonstrating public-private collaboration that incents innovation while improving the healthcare system, and realizing a cross-jurisdictional collaboration benefits from working together with other provinces and territories.
Conclusion/Implications/Recommendations: Panelists include thought leaders from eHealth Ontario, MaRS, and UHN. In addition to providing an overview of SPARK, they will share early insights on how the patient experience is changing.
140 Character Summary: SPARK will stimulate health innovation by facilitating access to provincial data and creating a pathway for innovators to scale their digital health technologies.
PS02 - Data Sharing: Thinking Beyond Acute Care
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 201EF
PS02.01 - Data Stewardship and Primary and Community Care Transformation Partnerships
Purpose/Objectives: In Ontario as elsewhere, the drive to build digital health capacity specifically, enabling the flow of patient data through electronic medical records (EMRs) and related tools - originates from the need (at system and practice levels) to monitor its effectiveness at providing quality care for the population. In a complex health care environment, large-scale solutions sometimes require smaller scale precedents: demonstrations by key system actors on how to take responsibility for population health data.
Methodology/Approach: This proposed panel will showcase examples of data stewardship from three provincial organizations. Panel members will discuss best practices, share lessons learned from their experience, and consider future directions for data stewardship in the context of health system transformation. Discussion will centre on activities and instruments of data stewardship, addressing these areas: · *Data quality: Currently in a physician-led proof-of-concept phase, we describe a dashboard project that allows physicians to view their EMR data and benchmark against a standard set of indicators, as the foundation for practice-specific projects to improve their data quality in real time. This was created in partnership with three provincial organizations to support accountability thinking in the new provincial transformation agenda. · Quality improvement: We will describe a program that, leveraging a set of resources including hands-on support at practice sites, helps physicians identify and remedy EMR data quality issues within their practice. This converts policy thinking into action. Collaboration is key and linked to provincial domains for quality measurement in primary care. · Connectivity*: We will describe tandem applications, a health report delivery solution and electronic notifications, which are industry leaders in connectivity and enable a primary care providers EMRs to receive patient hospital discharge reports. Other projects are in development to connect family practices to specialists and to existing provincial data assets (a lab information system). We further support connectivity through delivery of provincial EMR specifications. All of these are poised to pivot physician action and behaviours in improved practice efficiency and effectiveness.
Finding/Results: This is not a research-based abstract, but rather highlights a collaborative process across multiple system level leadership agencies and associations toward a common goal of transformation and improved care.
Conclusion/Implications/Recommendations: The most tenacious challenges facing the health system require an approach that draws on deep system knowledge and collaborative approaches, like those represented in this panel. Partnerships to secure data quality and flow are the route to achieving improvements across the spectrum from practice-level patient outcomes, to regional connectivity, all the way to population health measurement. We envision that initiatives like those described in this panel could enable not only system performance accountability but also applied population health research efforts.
140 Character Summary: Panel on health data stewardship initiatives, presenting experiences with scalable projects for data quality and connectivity in Ontario.
PS02.02 - Primary Care Data Sharing Proof of Concept: Enhancing the EHR
Purpose/Objectives: Primary care data has been identified as an urgent priority in Ontario for the fulfillment of a longitudinal integrated Electronic Health Record (EHR). There is recognition amongst stakeholders that a more comprehensive patient record, that includes primary care data, will help to enhance care delivery by ensuring providers in the patients circle of care have more timely information to inform and support their care decisions. The connecting South West Ontario Program (cSWO), funded by eHealth Ontario, is one of three connecting programs across the province, working together to deliver electronic health records for every patient. The cSWO Program identified at its outset that a key component of achieving a fully integrated EHR is the inclusion of and the ability to, share primary care data. cSWOs Primary Care Data Sharing (PCDS) project is being led by the eHealth Centre of Excellence and is enabling a sub-set of clinician-identified primary care data to be shared as part of Ontarios integrated EHR. PCDS will help optimize meaningful clinical and organizational use of the integrated EHR by incorporating a new and valuable data set.
Methodology/Approach: The PCDS project involves conducting a Proof of Concept (POC) involving up to four Primary Care Teams in south west Ontario that will contribute a sub-set of their EMR data to a provincial repository at eHealth Ontario, to be securely accessed by other authorized healthcare providers within the circle of care through the cSWO Regional Clinical Viewer, ClinicalConnect. PCDS will explore the feasibility, challenges and value of sharing patient data from primary care practices. The project will help to identify the processes, integration requirements and data standards that need to be in place for primary care data sharing to demonstrate clinical and/or organizational value. The POC will also inform the broader Provincial primary care data sharing strategy.
Finding/Results: The panel discussion will focus on PCDS project approach, outcomes and key activities contributing to successful adoption: · Clinically-Driven Data Set: One that will provide value to providers and inform their care decisions. · Data Quality Improvements: Data that is relevant, available in real time and consistently collected provides more value for data sharing and primary care practice-specific analysis. · Data Set Alignment: Exploring synergies and aligning data sets across provincial projects, where clinically relevant and feasible. · Benefits Evaluation: Developing and imbedding a benefits realization strategy at the outset to ensure the clinical value of sharing primary care data can be appropriately measured and adequately assessed.
Conclusion/Implications/Recommendations: The panel will highlight the approach taken to ensure a clinically relevant data set is developed; that data quality is appropriate for sharing; and mechanisms are in place to assess the clinical value being realized by those accessing the data. The panel will also highlight the challenges to primary care data sharing and mitigation strategies applied. The multi-stakeholder initiative is a priority project for the Province of Ontario and the south west Ontario region. The panel will reflect stakeholders offering varying perspectives and insights on lessons learned, including primary care sites involved in the initiative.
140 Character Summary: The PCDS Project in Ontario is exploring the value, challenges and feasibility of sharing patient data from primary care practices as part of the EHR.
PS03 - Accelerating Information Use and Access
- Type: Panel Session
- Track: Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 202AB
Purpose/Objectives: This panel presentation will provide pan-Canadian, local/healthcare organization and vendor perspectives on reducing data collection burden for secondary use/analytics purposes. Each of the panelists will speak to projects they have undertaken to modernize data supply for secondary purposes and learnings from these. Attendees will learn how investments made in eHealth/digital technology can be leveraged to access near-real-time data for planning and management purposes and the role data standards play in this work
Methodology/Approach: Health delivery organizations and their funders need timely, quality and affordable data. eHealth systems are integral to patient care and effective planning and health system management, and can hold the key to providing the data our healthcare system needs. CIHIs 28 pan-Canadian health databases support many health system uses, including policy-making and health system management, and provide highly relevant information and indicators on acute and ambulatory care across Canada. CIHI has a strategy for modernizing and automating the way data flows to it from eHealth systems as a more cost-effective way to meet acute and ambulatory care data requirements and to have better data to support interoperable patient care. CIHI will describe this proactive data strategy and our recommendations on how to realize the potential benefits and minimize risk.
Finding/Results: CIHI will present with two organizations to provide a pan-Canadian, local (e.g. a hospital) and vendor perspective on how eHealth investments impact health system use and drive long-term benefits such as cost savings, resulting in improved access to data for patient management and planning purposes. Early findings from demonstration projects with these organizations indicate that 30% of effort can be reduced via automation because of a lesser resource draw to enter/code data (over time the proportion automated should increase with corresponding savings). In concrete terms, this translates to an estimated savings of 6.6 minutes per record and a potential savings of $10 million across the country each year, not to mention the substantial value that can be gained with access to more and near real-time data. A success story demonstrating these benefits will be showcased by each panel member.
Conclusion/Implications/Recommendations: Alternative means of sourcing data for secondary purposes is a strategy that is being examined and implemented by many countries that are reaching an advanced stage of ehealth maturity. As Canada progresses on its own ehealth journey, a number of opportunities are emerging, beyond just clinical use of digitized health data. Specifically, this data is helping to reduce data reporting burden, realize cost savings, and improve access to data that facilitates system planning and management decisions while patients are still being cared for within a hospital rather than after discharge.
140 Character Summary: A pan-Canadian, hospital and vendor perspective on how eHealth investments can lead to cost savings and improved access to data for secondary purposes.
PS03.02 - Accelerating the Scale and Spread of Connected Digital Health Solutions
Purpose/Objectives: The objective of this session is to present and discuss Canada Health Infoways digital health innovation ecosystem concept and roadmap. Our initial offering on the ecosystem roadmap is a privacy protective health information access platform. It is designed to accelerate the deployment, scaling and use of connected consumer and clinician digital health solutions by providing standardized, Canada-wide access to health information, privacy, security and consent services. The offering would be targeted at *deploying and scaling* innovative digital health solutions.
Methodology/Approach: We studied the market trends, critical success factors and taxonomy of business ecosystems across various industries. We then looked at Canadas clinical priorities and drivers along with the pain points faced when deploying and scaling digital health solutions. We then applied those observations to the definition of a Canadian digital health innovation ecosystem. The conclusions will be presented and then discussed among the panelists that represent consumer, clinician, solution developer and jurisdiction stakeholder perspectives. Panelists will provide their informed insights and frank assessment of the applicability and value proposition for the use of a health information access platform to solve some of their most pressing pain points.
Finding/Results: There is a value proposition for a platform which removes the most significant barriers faced by developers, jurisdictions and end users such as access to personal health information in a trusted and privacy protective manner. It will enable the scale and spread of innovative solutions such as e-referral, chronic disease management, predictive analytics, personalized medicine and clinical decision support. It will connect Canadians to their data so they can utilize solutions chosen by them or their clinicians. It is also a means of connecting clinicians to a persons data across the continuum of care with a *consistent and comprehensive health record. The data platform will help solve some of the systemic interoperability problems currently being faced by jurisdictions and solution developers while providing for a more connected health system* for both clinicians and consumers. The platform will be an enabler for locally driven priority areas including chronic disease management, home care, mental health services and palliative care. It can support the deployment of digital health innovations that will empower Canadians to take much greater control for their own health and well-being resulting in better patient outcomes and less pressure on the health care system.
Conclusion/Implications/Recommendations: The platform will : Harness the innovation creativity of the private sector to address Canadas healthcare priorities Improve speed to market and scaling with lower cost and risk to developers and jurisdictions Access to a consistent and comprehensive health record for Canadians in a privacy protective manner Get more value from the existing digital health investments
140 Character Summary: Digital health innovations will empower Canadians to take greater control for their own health & well-being resulting in better outcomes and lower health expenditures.
PS04 - PIA’s to Telehealth: A Journey
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 3
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 202CD
PS04.01 - Privacy Impact Assessments: Looking for a Common Understanding
Purpose/Objectives: A Privacy Impact Assessment (PIA) is a formal risk management tool that includes consideration of other risk management documents as well, assists in identifying potential privacy risks associated with a new activity, allowing for the development of risk mitigation strategies that reduce the likelihood of adverse privacy events. In Canada, some jurisdictions require a PIA in legislation, others in policy or in some cases, as a best practice. This variation and inconsistency affects the efficiency resulting in a costly PIA process. Work was conducted to examine the differences and to determine if a more consistent approach could be developed to promote consistency, enhance efficiency, and build trust in the emerging digital health environment, particularly for projects that cross jurisdictions.
Methodology/Approach: Canada Health Infoway, in collaboration with the Health Information Privacy Group (HIPG) conducted an environmental scan of the legislative requirements as well as guidance provided by Privacy Oversight offices across the country to determine the requirements for PIAs acceptable to all jurisdictions. The environmental scan was used to develop 10 Common Understandings related to PIAs. The development of Common Understandings involves considerable debate and discussion by Ministry and eHealth privacy specialists as well as input from the Oversight members from the Infoway sponsored Privacy Forum. The HIPG believe adopting the PIA Common Understandings will promote consistency across the country when completing these assessments.
Finding/Results: The Environmental Scan and the PIA Common Understandings identified that these assessments are an important component in the risk management process of an entity and are much more than a simple compliance check. A PIA is an integral part of the business activity planning process. Conducted early enough, this document can help shape the business activities development and ensure that privacy is considered from concept to deployment. A thorough PIA is used by privacy regulators to understand the implications of a business activity on an individuals privacy and is the first document requested by regulators when conducting investigations into privacy breaches.
Conclusion/Implication/Recommendations: The core principles of the HIPG PIA Common Understandings can be applied to any project or activity across a jurisdiction with impacts on the privacy of an individual. This move towards consistency could promote trust and trans-jurisdictional disclosures of personal health information across Canada.
140 Character Summary: The PIA Common Understandings outline 10 principles that promote efficiency, consistency and trust in the digital health environment.
Purpose/Objectives: OTN is one of the worlds largest telemedicine networks, serving over 300,000 patients using 1600 sites and 3,300 systems. We know that Telemedicine plays an important role in supporting health care transformation and innovation as it enables better integration and quality of care and a more sustainable health care system. We also know that Privacy must not only be a statement at the bottom of a webpage but rather a business differentiator; an integral strategic partner and component of OTNs business and technology transformational agenda in order to meet the high privacy standards expected of OTN in todays virtual health care revolution. The presentation will examine a cross-functional team approach, leveraging a case study, to adopting Privacy by design principles; building relationships, and the implementation of a holistic approach that seeks end-to-end opportunities to enhance privacy in Telemedicine. We will share how OTN has embedded privacy into the Organization at all levels, including its Project Management Officer (PMO) and the different perspectives on what that means for VPs, Chief Privacy Officer, Privacy Specialists and Project Managers.
Methodology/Approach: This presentation will describe the multi-layered/holistic & integrated business approach OTNs Privacy Team has taken with its eVisit product line to ensure Privacy is an enabler to technology innovation and not a barrier: The approach will focus on the following: Streamlined project management lifecycle & gating process that include key privacy deliverables; privacy threshold assessment (PTA) privacy requirements and safeguards and Privacy Impact Assessments (PIA) Privacy review & PIA results that are translated into a work plan which is shared with/implemented by the project team Risk registry that track and monitor PIA risks and recommendations Introduction of product privacy scorecards for assessing and monitoring results and identifying improvement opportunities
Finding/Results: The result is the assurance privacy is embedded into technology and telemedicine solutions at the onset of the project management lifecycle. This assurance inspires adoption by health care providers, organizations, and consumers.
Conclusion/Implications/Recommendations: Privacy is not a barrier. Privacy builds trust and breeds Innovation. Privacy at OTN is more than compliance with legislation. Legislation is the floor and the starting point not the ceiling. OTNs Privacy Program strives to create and sustain an environment that breeds continuous learning & innovation and champions strategies and tactics that align with and support key organizational initiatives and meet the expectations of consumers, funders, partners and the healthcare community.
140 Character Summary: Telemedicine plays an important role in supporting health care innovation as it enables better integration & quality of care & a more sustainable health care system.
PS04.03 - The Toronto Telemedicine Colaborative - Strength in Numbers
David Willis, Clinical Informatics/Telemedicine, The Hospital for Sick Children; Toronto/CA
Eva Serhal, Telepsychiatry, Centre for Addiction and Mental Health; Toronto/CA
Carol Flewelling, Telemedicine, St. Michael's Hospital; Toronto/CA
Purpose/Objectives: Telemedicine is transforming the way healthcare is delivered, by breaking down barriers that limit access to care such as geography, maldistribution of expertise, and geography. Telemedicine, has evolved significantly over the past two decades, facilitated by improvements and access to technology, increased provider and patient comfort. Toronto is the largest provider of telemedicine in Ontario, delivering care to primary care sites, such as Family Health Teams, Community Health Centres, Nurse Practitioner-Led Clinics, as well as between tertiary care centres. Throughout Ontario, it has become evident that a collective approach to access and utilization of telemedicine would be beneficial. Toronto is well-positioned to lead innovations and support best practices in telemedicine. The Toronto Telemedicine Collaborative was created with representation from academic health science centres and community level healthcare with the goal of reducing isolated programs while addressing gaps in practice protocols, evaluation, and implementation. This presentation will describe how the Toronto Telemedicine Collaborative was established, the goals and how we are able to ignite the unique experience and perspectives of individuals in breaking down barriers while increasing evidence-based models of telemedicine.
Methodology/Approach: In early 2014, informal discussions between colleagues at three large academic health centres, the University Health Network, St. Michael's Hospital and the Hospital for Sick Children, on existing barriers within their telemedicine programs illuminated the siloed nature of telemedicine To advance telemedicine in a coordinated way, a collective approach was necessary. An electronic survey was circulated in June 2014 to all the known Toronto telemedicine services. The result was significant interest in developing a collaborative with common goals and terms of reference,. Regular quarterly meetings were established and individuals were given the encouraged to contribute to the agenda of each meeting. Common concerns and opportunities were established, and eventually, government funders were invited to join ongoing meetings
Finding/Results: The participation is high with over 50 individuals from 20+ organizations. One priority is the forming of a collective voice for government and policy makers, to inform decisions and drive system change. This grassroots approach to system reform shows great promise in becoming a source of consultation by stakeholders to discuss ideas, assess feasibility, and encourage system change. We have become an advocate against decisions negatively impacting the sector, and have become a consortium with significant expertise to inform best practices and evaluation models.
Conclusion/Implication/Recommendations: Since the TTC collaborative commenced in 2014, there has been increased clarity in telemedicine practices and procedures within our region, a collective approach to addressing barriers and system challenges, an elevated interest in supporting decision/policy makers to understand system factors, and an improved ability to advocate and express concerns and opportunities to stakeholders. We sit as content experts within our sector with funders and policy makers. Future opportunities include development of validated tools, the contribution to collective research opportunities, advocacy to reduce barriers, development of best practices and protocols and a user level voice to ongoing development and expansion of telemedicine. In short, our voices in addressing systemic issues and burgeoning opportunities are stronger together than they are alone.
140 Character Summary: The Toronto Telemedicine Collaborative has created a unique and powerful voice for Telmedicine best practices, research opportunities and collaboration
PS05 - Patient Engagement Through Digital Health
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 203AB
PS05.01 - Hearing from Patients on What They Think of Digital Health
Purpose/Objectives: It has been frequently commented upon that Canadas health care system is in need of a change. Within the burgeoning pressures it faces, the patient voice has become stronger; and expectations of an active partnership in a team-based model that includes the patient as a partner, have become paramount. The purpose of this presentation is to bring the patient voice to the Conference; to hear about their experience with digital health and to get their advice about how we continue to evolve to best meet their needs.
Methodology/Approach: With a commitment to understanding and meeting the needs of Canadians is a national approach for patient/citizen engagement, centered on four pillars: listen, amplify, invest and influence. National public opinion research, education, engagement and storytelling strategies, are part of the approach used to gather the patient, caregiver and family member experience and perspective to help shape the digital health agenda directly from the voice of the citizens we serve.
Finding/Results: International research suggests that empowered patients make informed choices, have better relationships with their healthcare providers, are committed to adhering to treatment, take responsibility for their care and seek preventative measures to better manage their health (European Unions Patient Forum). Furthermore, national public opinion research suggests that over three-quarters of surveyed Canadians (77%) feel that digital health tools assist them in having improved knowledge of their health. Almost one in seven (69%) feel they have improved confidence in self-management of their health through the use of digital solutions; and nearly three in four (74%) feel more informed in their discussions with their doctor. Additionally, national survey data indicates that the use of consumer health solutions has nearly doubled in the past two years, making the impact of these emerging practices even more meaningful. At the same time, benefits studies from implementations underway corroborate this growing evidence base and also demonstrate that Canadians who use digital tools are as satisfied with their care as with traditional face-to-face models. Other studies suggest that the use of digital tools and access to information would have avoided a significant amount of in-person visits and time off work. All of these things improve outcomes for the patient; streamline processes for clinicians; and save the health system money.
Conclusion/Implications/Recommendations: With the rise of the patient engagement movement in health care, more and more patients are influencing the health care agenda in Canada and are moving from patients to partners. But the question remains: are we meeting the health care needs of Canadians? Within this panel we will hear the personal experiences of a panel of patients who will share their health care expectations and the role digital health has played. National public opinion research and evidence from existing digital health projects will also be reviewed.
140 Character Summary: A panel of patients will share their digital health experiences and perspectives on how these tools can support Canadians in partnering in their care
PS05.02 - A Box of Chocolates: Knowing What's Inside Is Key!
Purpose/Objectives: Clinicians are increasingly recognized as essential to health information systems projects, bringing their healthcare knowledge and expertise, as well as industry credibility to the project. Rarely, however, is their role well understood or maximized on projects. This presentation will address some of the underlying issues and provide effective strategies for team success while optimizing utilization of distinctive resource skills and contributions. Teams are a partnership of shared and unique skills and knowledge but are not always equipped or experienced to maximize each members contribution potential. The most effective project teams in all sectors of healthcare are both interprofessional and collaborative, which is defined by Health Canada (2010) as teams working together with one or more members of the team who each make a unique contribution to achieving a common goal, enhancing the benefit for [clients and] patients. Each individual contributes from within the limits of their scope of practice all the while emphasizing [client/] patient- centred goals and values (para 3). Success starts with understanding each team members professional knowledge and practice experience and their project related skill sets. However, the integration of clinicians into project teams is the least understood and most challenging for team dynamics. Models of clinical practice utilize process (e.g. the nursing process) in the planning, delivery and evaluation of patient care that parallel the project lifecycle. Leveraging the shared approaches supports the team maximizing each members unique abilities to advance the project goals, processes, and outcomes. This panel presentation will demonstrate the overlapping competencies between the project manager (PM), business analyst (BA), clinical informatician (CI), frame the approach to successful interprofessional team assembly and building, and share strategies for maximizing their unique contributions to the benefit of the team and client/project outcomes.
Methodology/Approach: A role and competency matrix for an interprofessional team was developed, and incorporates specific role-based competencies and responsibilities, including the roles of the PM, BA, and CI. The focus was to illustrate how the competencies both overlap and remain distinctive, and to reflect the respective contributions to the team so all roles are used effectively with recognition. It also highlights when specific skills are required and when a specific skills-based resource may need to be added to the team.
Finding/Results: The roles of team members can overlap in a significant number of areas. Working from this shared baseline, understanding team member s level of ability with each project skill, and naming their unique qualities will allow appropriate assignment and best partnerships to leverage the unique contributions through a collaborative approach.
Conclusion/Implications/Recommendations: A successful interprofessional project team can deliver and maintain a healthcare solution in a clinically relevant and responsive way with the assembly of the right professionals equipped to acknowledge the training, expertise, experience, unique abilities of each team member to collaborate on achieving the initiatives/clients goals.
140 Character Summary: Use of interprofessional teams in healthcare projects can be optimized using roles matrix paradigm, to ensuring best use of existing knowledge and skills.
PS06 - Leveraging Existing Provincial Systems
- Type: Panel Session
- Track: Clinical and Executive
- Presentations: 2
- Coordinates: 6/06/2017, 10:30 - 12:00, Room 203CD
Purpose/Objectives: Panelists will share their experiences applying eSafety in real-world projects and processes. The objective is to learn from and hear from vendors, clinicians, provinces, hospitals, privacy officers and agencies on their application of eSafety to reduce patient safety risks in designing and implementing e-health applications.
Methodology/Approach: This initiative, originally led by COACH, and now spearheaded by Ontario and Alberta eSafety Working Groups, and organizations themselves, aims to study cases for eSafety on both projects and organizational processes. The eSafety journey is underway here in Canada. Supporting a culture of patient safety, promoting e solutions for safer patient care and protecting patients against harm from unintended risks throughout the lifecycle of our e-health software, systems and solutions is our collective responsibility. Hospitals are embedding eSafety into their risk management methodology. Others are applying eSafety to products, services and integrations. Vendors are designing their solutions with eSafety and usability in mind. Provinces are expanding their understanding of eSafety and through a series of workshops to assess potential risks and develop mitigation plans, are increasing education and awareness about eSafety in their regions.
Finding/Results: Evidence has shown that asking What could go wrong? and preparing for potential risks have paid off to mitigate and avoid risks before they become real-world issues. Adopting a culture of eSafety within the organization, with openness and transparency about risks and incidents, and leadership support of eSafety has led to positive behaviour, early prediction and effective response to potential adverse events, near-misses and unsafe conditions.
Conclusion/Implications/Recommendations: Many key stakeholders are embracing and growing the eSafety culture already. Real-world applications in Ontario, Alberta and internationally have shown that applying eSafety pays off in protecting patients against the risk of harm due to unintended safety risks in the development, implementation and use e-health systems, software and solutions. Embedding eSafety does not need to be a significantly complex exercise and many organizations already have operational processes and risk management processes in place where eSafety can be tied in.
140 Character Summary: Provinces, clinicians, hospitals, agencies and vendors share their experiences applying eSafety in real-world projects and processes.
PS06.02 - Increasing Access to Specialty Care with a Provincial eConsult Service
Purpose/Objectives: The Provincial eConsult Initiative is a program initiated to support the implementation of a provincial eConsult service to enable faster and improved access to specialist care. Three provincial organizations are working together to evaluate existing eConsult services for widespread access and use by physicians and nurse practitioners. The Provincial eConsult Initiative is a complex, multi-faceted project involving technology implementation, business process design and implementation, and the establishment of the program governance framework. This panellist presentation will profile the methodologies leveraged for the provincial initiative, learnings and research from clinical champions, user experiences, and establishment of the service model.
Methodology/Approach: Utilizing a service development approach that would ensure the long-term success and sustainability of the Provincial eConsult Service was a cornerstone for the initiative. This included establishing a project governance structure and ensuring effective stakeholder engagement and change management strategy in this complex multi-stakeholder initiative. Additionally, a detailed benefits evaluation was conducted under the guidance of the provider advisory group to confirm the clinical value of eConsult. The approach included partnering with other provincial agencies and EMR vendors, leveraging existing assets and offering multiple service models is guided by the clinical leads. From the learnings of the implementation approach, the operating model for service adoption, change management, clinical governance and policies have been defined.
Finding/Results: Phase 1 was a pilot that generated a Benefits Evaluation to inform a broader provincial strategy. In response to the success of the pilot, the initiative received approval from the ministry to continue with a next phase to March 2017 so that family physicians, nurse practitioners and their patients can continue to benefit from better access to specialist advice. The key accomplishments include: Over 7,000 physicians and nurse practitioners have joined an eConsult service and have sent over 31,900 eConsults to 127 specialties (including sub-specialties and special interests) since the beginning on the initiative in January 2015. A formal benefits evaluation was conducted which found average response times are within 3 days and 99% of clinicians surveyed agree that eConsult improves patient care. Developing a single provincial service that accommodates multiple models of care. Leveraging provincial assets such as single sign on for the Proof of Concept and enabling increased adoption by complimenting clinician workflow through the EMR. Defining a tool-kit and approach to assist clinicians in the change management and adoption of eConsult within their practice.
Conclusion/Implications/Recommendations: The ongoing use of eConsult demonstrates the continued clinical value and reaffirms the results of the benefits evaluation. Critical elements for the success of a provincial initiative include establishing a robust governance structure, incorporating workflow considerations into adoption strategies, effectively managing delivery partners, and leveraging a standards-based implementation. The panel will share their successful approach and lessons learned, which offers a consideration for other jurisdictions in implementing eHealth initiatives.
140 Character Summary: Learn about the methodologies used to develop and deliver a complex, multi-faceted Provincial eConsult Initiative.
OS13 - PHR Storms Across Canada
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 201CD
OS13.01 - Mustimuhw Citizen Health Portal – Centering Patients in First Nation Healthcare
Purpose/Objectives: First Nations have built an approach to health around an empowerment philosophy where the patient is an active member in their care. However, this approach has historically not included a patients ability to electronically communicate with their providers, nor have easy access and input to their own health records. The Mustimuhw Citizen Health Portal changes that. With funding from Canada Health Infoway, a project was launched in April 2016 to evaluate consumer health models in a First Nation community where patients are interacting with on-reserve health centre clinical providers and with physicians in the local division of family practice. Typically, barriers to effective clinical information sharing have impeded interaction between health centre providers and physicians and caused challenges for effective circle-of-care models. Patients have also not had the ability to directly interact with their health records, or communicate electronically with members of their care team. As the largest First Nation in BC, Cowichan Tribes is a national leader in leveraging health information management to enable member-driven, or consumer-driven, health services and care. The Mustimuhw Citizen Health Portal, now deployed, extends the consumer-driven healthcare model further by leveraging the use of increasingly popular PHR technology and connecting patients and providers. With the project proving successful, and foundational PHR interoperability established, the Mustimuhw Citizen Health Portal can now be extended to other First Nations both in BC and in other provinces where consumer-driven healthcare models may benefit the community and enhance coordination and information sharing between providers.
Methodology/Approach: The Mustimuhw Citizen Health Portal uses an Infoway-Certified PHR Platform that enables patients to provide and access targeted personal health information. Health Centre providers and local physicians are aligned and enabled to provide this information to their shared patients and to consume patient-provided information. Patients are empowered to self-manage privacy and access across providers, and within their family, to enhance the continuity of information to their benefit. Interoperability efforts have focused on information flow between the RelayHealth PHR, the Mustimuhw cEMR, physician EMRs and a private lab while parallel efforts focused on patient and provider engagement and PHR adoption and use.
Finding/Results: To date, response and willingness to adopt has been strong by the target user groups. Efforts are currently underway to improve interoperability, increase adoption, and support ongoing use of the PHR solution by patients and providers. Activities are now underway to extend the use the Mustimuhw Citizen Portal in other locations, and extend the scope of data and functionality.
Conclusion/Implication/Recommendations: Early results indicate that a PHR solution is a viable and beneficial consumer health tool within First Nations communities. Use of a PHR can address longstanding issues and challenges that previously have impeded patient access to health services and provider access to important patient data. Given that there are many similar health care requirements across First Nations communities in Canada, and many similarities in the challenges posed to effective information sharing between First Nations and provincial providers, a recommendation can be made to extend this projects model to other First Nations within Canada.
140 Character Summary: The Strengthening the Circle of Care project brings a practical consumer health solution to First Nations through use of the Mustimuhw Citizen Health Portal.
OS13.02 - From Pilot to Provincial Roll-out – Implementing the Personal Health Record
Purpose/Objectives: A lack of connectivity and breakdowns in communication within the medical infrastructure are some of the major issues challenging the Canadian health care system. So too is a growing call from patients demanding faster access to the right services, improved outcomes and more involvement in managing their own healthcare. This presentation will show how a Canadian province is building on the success of their Personal Health Record (PHR) demonstration project and leveraging Canada Health Infoway investment to complete the implementation of a PHR solution, thereby bringing the world of e-health to all citizens within the province who want to plug in. Objectives: Learn how an easily implemented connectivity is benefiting all stakeholders Understand how the solution empowers and engages patients in their own healthcare The planning and process that was required to get providers and patients to use the solution
Methodology/Approach: The province has completed a multi-year demonstration project that introduced a Personal Health Record (PHR) solution to the provincial health care system. This project involved 30 family physicians, who invited patients in their practices to participate in the testing of this technology. Patient recruitment targets were met early in the project and enrolment numbers were much higher than anticipated. Using information learned through the demonstration phase, the project is now ready to roll out a PHR solution to the entire province. This has the potential to be a game changer for the provincial health care system, and as such, requires a thoughtful change management approach, supported by strategic communications. The change management support required to ensure smooth implementation province-wide is not only to ready the provider communities and general public to adopt the solution, but in resolving key policy issues that will be necessary to pave the way. This includes supporting the articulation of a clear vision statement by senior government leadership in support of the PHR innovation, backed by a physician compensation model for eWork. Another key enabling condition is demonstrating interoperability with practice EMRs as well as interoperability with hospital-based lab/DI information systems, and provincial assets.
Finding/Results: In this demonstration phase, the PHR solution was implemented. Provider uptake was voluntary and the project target to recruit 30 family doctors was achieved . This group largely consisted of self-described technology innovators. Physicians were tasked with recruiting their patients to the PHR demonstration project. An overall target of 3,000 patient users was achieved early in project and was well beyond its goal by the end of the project with more than 6,000 records. The provincial roll-out is based on physicians volunteering to sign up, followed by a targeted geographic deployment strategy, where physicians will be approached and asked to participate.
Conclusion/Implication/Recommendations: Based on what was learned the demonstration project, further supported by a growing body of literature, the PHR has the potential to strengthen the provincial primary health care system and make publicly funded health investments go further. Ultimately, the PHR will be a key force in transforming health care in the province into a truly patient-centred system.
140 Character Summary: Connecting the circle of care utilizing technology such as the patient portal, with the person in the middle, empowers the patient to do so much more for themselves.
OS13.03 - Exploring Patient Empowerment: The eHealth Saskatchewan Citizen Health Information Portal
Purpose/Objectives: A strong commitment to patient empowerment has been identified as a crucial element in the achievement of lasting patient-centered transformations within healthcare systems. The promise of e-health interventions in supporting patient empowerment has been widely touted, however the concept itself remains ambiguous and lacking in substantiated concrete measures. Further, very little has been done to engage with patients to ascertain their views on empowerment, especially within an e-health context. In this study, participants enrolled in a pilot deployment of the e-Health Saskatchewan Citizen Health Information Portal (CHIP) had an opportunity to engage with researchers from the University of Saskatchewan to share their views on engagement, empowerment, and their introduction to the CHIP.
Methodology/Approach: This research employed a mixed methods approach in the exploration of patient empowerment and the CHIP in Saskatchewan. Led by an extensive scoping review on patient empowerment, specifically focused on e-health interventions including portal projects, the study also incorporated qualitative data from participant interviews. Interpretive description was used to analyze the qualitative results and provide a participant driven view of empowerment in relation to the use of the citizen portal. Lastly, the research team integrated the results of the scoping review with key findings on empowerment, to develop a pilot tool to support a more focused and precise measure of empowerment in e-health initiatives.
Finding/Results: This study has produced an e-health focused review of patient empowerment and a newly proposed pilot measure that can support further examination of the influence of this vital concept. While ongoing testing and validation of the measure will need to be undertaken, this research provided a means to maximize patient voice in the instrument development process, a unique consideration in the examination of this concept within the e-health context. The results of a scoping review further guided the delivery of the proposed measure.
Conclusion/Implication/Recommendations: The promise of e-health intervention in delivering improved opportunities for patient empowerment requires more substantiation. Often the concept of patient empowerment is introduced in association with researched interventions, but reported measures focus on a host of other outcomes without specifically addressing the empowerment component. Frequent notations have been made about the complex nature of the concept seemingly to serve as an explanation for inconsistencies in how it has been measured. Patient empowerment, although extensively examined, clearly remains difficult to operationalize and evaluate. Since patients are the object of these empowerment endeavours, it seems crucial to allow patient voice to direct the definition of key aspects of empowerment in e-health intervention. This research has begun that patient-directed consideration of empowerment in the hopes that it will provide a more substantial and meaningful foundation on which to advance this measure in future study.
140 Character Summary: A scoping review and participant voice directed this study of patient empowerment in e-health and the resultant development of a new pilot measure for this concept.
OS13.04 - Perks and Pitfalls of a Patient Portal
Purpose/Objectives: To discuss the potential perks and pitfalls of using a patient portal. While it leads to improved patient care and satisfaction, physicians are incredibly reluctant to use this technology. I will discuss Grandview Medical Centre Family Health Team's three years of experience of patient portal use with our 16 family physicians and their 30,000 rostered patients.
Methodology/Approach: I will include: How we obtained physician buy-in How we decided whether or not to charge for the portal How we decided who is eligible for the patient portal How we decided who the patients could securely message in our clinic How we 'got the word out' about the patient portal and had patients sign up How we dealt with inappropriate patient use of secure messaging How we dealt with specialists concerns regarding our portal How we started patient online appointment bookings How we dealt with surprise issues surrounding online appt bookings
Finding/Results: All 16 doctors are actively using portal in some shape or form. We have had 5,200+ people have signed into portal at least once. Out of 30,000+ patients Children not signed up User Breakdown Age 65+ usage surprisingly high During the last month of data available, we have had 90 patient appointment bookings and cancellations 77 bookings 13 cancellations
Conclusion/Implication/Recommendations: Through our expercience rolling out the patient portal in a private clinic setting of 16 family physicians in a family health team setting taking care of 30,000 patients, we learned that it can take some time to set up the portal and get buy in from physicians and patients. However, once fully in place, the portal has the ability to improve patient satisfaction, decrease unnecessary visits and overall improves patient care. We strongly recommend that practices give it a try by rolling it out to clinical and non-clinical champions first and then gradually expand to the the rest of the clinic.
140 Character Summary: The patient portal is one of the most difficult technological advances to obtain buy in for but has the most potential to be a game changer in a patient care.