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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
OS14 - Successes in Quality and Efficiency
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 201EF
OS14.01 - Transcription Services Project - Improving Quality, Efficiency and Accessibility
Purpose/Objectives: The Transcription Services Project (TSP) was a successful large scale initiative led by Health Information Management a department of Providence Health Care focused on getting patient reports to clinicians and patients quicker and more securely. The project was designed to improve service levels, reduce costs, keep up with growing dictation volumes, standardize processes and systems, leverage new speech recognition technology, address patient safety and privacy concerns, and improve report distribution, including a patient-centered solution.
Methodology/Approach: This initiative implemented a ground-breaking business and technology Application Service Provider model where both the transcription labour and technology was outsourced to a third party provider (M*Modal Canada). The project used an agile iterative development approach, at a high level, was similar to most large technology enabled transformation initiatives. One of the projects biggest achievements and a first in BC, was the piloting of my ehealth via Excelleris Technologies, a secure online report distribution portal that provides patient access to their transcribed reports.
Finding/Results: As a result of the project, over 65% of transcribed reports are now delivered directly to physician electronic medical records as compared to fax or mail, eliminating significant internal manual printing and mailing efforts as well as improved data, security and privacy controls. Patient reports are reaching clinicians and patients within 1-2 days (as compared to 7-25 days turnaround previously) across four of British Columbias health organizations. The new system has definitely led to much faster transcription of dictated reports, thereby considerably improving patient care. Endocrinologist, St. Pauls Hospital Close to 10,000 clinicians now use a standardized dictation system with 1.4 million reports processed in 2015 leveraging new speech recognition technology. The pilot evaluation found that my ehealth met its objectives and that patients are benefiting and highly satisfied with the service (93% satisfaction rate). Transcription Services is now looking to expand my ehealth to better meet the needs of patients that will include further consultation with patients, families and clinicians. Prior to my ehealth, for every appointment, I drove to the Cancer Agency, go to Health Records and get them to print off a copy of my report. Now its so easy! I only wish other sites had this service.
Conclusion/Implication/Recommendations: Through eight multi-site deployments at 242 sites over 25 months, the TSP achieved its objectives, was completed under budget and generated almost three times the expected savings target. These savings ($7.9 million annually) are now being put back into the health care system for spending on direct patient care while also providing clinicians and patients easier and timelier access to their health information. The TSP has been instrumental to BCs health care system in the continuous improvement journey of health information getting to the right person at the right place at the right time. The project scope has impacted more than 60% of the BC population. Since the project close, eleven sites have implemented the solution with four additional sites/clinics joining in the next few months. Discussions are underway to onboard another two hospitals on BCs central coast.
140 Character Summary: The Transcription Project resulted in patients and clinicians receiving reports < 2 days across four of BCs health organizations with $7.9 million annual savings.
OS14.02 - Leveraging Chartmaxx for Tracking Radiology Reviews
Purpose/Objectives: The objective was to find a way to implement a system of tracking when and if a Radiology report has been reviewed within the Emergency department. Additionally, this new system must be easily adoptable by the users and inexpensive to implement.
Methodology/Approach: Our approach was to leverage an existing Hospital application: Chartmaxx - the hospital's electronic patient record. Using Chartmaxx we were able to design workflows that: - Flag Radiology reports arriving from the Radiology system into Chartmaxx that pertain to an Emergency Department (ED) visit. - Using built-in worklist capabilities, assign the report to the original requesting physician in order to be reviewed. - Provide the flexibility of allowing one physician to review another's report through built-in delegation tools; - Supervise physician response through the tracking tools within Chartmaxx; - Regularly notify physicians as to their personal number of pending reports to review. Furthermore, from the Chartmaxx database we could: - Create customised reports to assist ED management in monitoring progress. - Have a full audit trail of interactions with the reports. In order to make this a reality, a full cooperative effort between the Emergency Department, Medical Records Department, IT, IM and the application vendor Quest Diagnostics.
Finding/Results: Our experience in this project was, as hoped for, that the use of existing software allowed for a quick adoption and acceptance of the new workflow. Users did not have to learn a new application or remember another password. Additionally, we found that with the new process in place there was an easy way to see any pending Radiology reports from other shifts that are waiting to be reviewed. That is day shift personnel could easily see what reports have not been reviewed by their evening shift colleagues and vice-versa. A clear audit trail was created to allow for analysis of when any Radiology report arriving in the ED was seen and by whom.
Conclusion/Implication/Recommendations: The approach of leveraging in-house software to manage the review process of Radiology reports was successful in allowing for a speedy acceptance of the new workflow and provided for immediate reporting feedback on performance. Its success means we can use a similar approach to solving similar problems within the Hospital.
140 Character Summary: Leveraging existing in-house software, (Chartmaxx), made a quick and cheap solution possible for live tracking of the report review process within our ED.
Purpose/Objectives: To share lessons learned and opportunities realized as a result of the implementation of an Ontario Ministry of Health & Long-Term Care (MOHLTC) application in BC to consume student data from the BC Ministry of Education to share with BCs Health Authorities in support of Public Health Mass Immunizations programs.
Methodology/Approach: In 2013, the Ontario MOHTLC developed a tool to support public health school immunization assessment and administration programs. The Student Information Exchange (STIX) tool automates the uploading and matching of student demographic records with the correct records in the provincial immunization repository. BC and Ontario entered into an agreement to share the application code Approval of the minimum data set required to support client matching and public health program requirements Customization of code to meet BC requirements Relationship with the BC Ministry of Education, who worked on behalf of BCs School Districts, to develop a single extract of student data from their provincial student information system and facilitate collection of the necessary agreements Utilization of a BC Ministry of Health sFTP service to securely transfer data between the BC Ministry of Education and Provincial Health Services Authority Signing of a Provincial Privacy Impact Assessment to allow for the new process Configuration of BCs Public Health system, Panorama, to accept data Implementation of solution at two Health Authorities, as a pre-curser to wider adoption
Finding/Results: Hugely successful implementation, laying the foundation for the use of Mass Immunizations functionality in Panorama BCs project metrics included: 80% return rate of agreements from targeted School Districts within two weeks 84% match rate of data from the Ministry of Educations system and Panorama 85% reduction in work effort to reconcile student data and 60% reduction in work effort to support Mass Immunization event Clinical and business benefits included: Improved data quality for surveillance and clinical care Mass Imms and Personalized Consent Adoption advancing clinical best practice and use of immunization decision support Per clinic vaccine and supply management preventing wastage Coverage and catch up at school level advancing disease prevention Management of school outbreaks Readiness for legislative change requiring immunization status reporting for all students Presentation will also compare and contrast an assorted challenges each party faced and approaches we took to be successful (e.g., legislative changes required to enable use of the Ontario Education Number; privacy challenges requiring an independent security assessment)
Conclusion/Implications/Recommendations: BCs public health system benefited significantly from Ontario MOHLTs investments Workflow improvements were significant enough to enable use of functionality previously deemed too resource intensive Relationships are key to bring project to success Patience is required when dealing with multi-dimensional implementations
140 Character Summary: Share opportunities realized from the implementation of the Ontario-developed application in BC in support of public health immunization programs.
OS14.04 - HDC: A Physician-Led Information System for Practice Reflection
Purpose/Objectives: Canadian provinces and international jurisdictions are initiating a powerful push in the direction of a Health Quality Agenda. Established to enable quality improvement in primary care and support a learning health system, the Health Data Coalition (HDC) was formed with the support of BCs General Practices Services Committee and the Doctors of BC. An independent not-for-profit organization, the HDC is governed by physicians, for physicians and their medical care partners across British Columbia. The adoption of the Privacy by Design framework and certification program allows the HDC to protect patient and health care provider privacy, while increasing trust, knowledge sharing, and collaboration.
Methodology/Approach: Our technology is designed to aggregate patient level data from individual physician practices, across disparate EMR systems, to support self-reflective practice and facilitate system change using coaching support and small learning groups. Building on the work of its founding organizations (AMCARE and the Physicians Data Collaborative), the HDC is unifying the technical assets of the two entities to create a robust, reliable, flexible solution to enable clinician data contributors and their clinical support staff to engage in quality improvement, continuous learning and collaborative research. The technology is open source licensed, reflecting the community-building spirit of the HDC. The HDCs relationships create a culture of continuous improvement by inspiring curiosity and professionalism among individual physicians and creating a positive, collegial and supportive culture among physician peers.
Finding/Results: Learning from the experience of its founding partners, we developed a governance framework inclusive of our health care and technology partners, while maintaining a physician-led approach for the measures used, the context of information reported, and who sees the aggregated practice information. Physician engagement amongst early adopters has shown that the HDC approach to the use of clinical data has tremendous power to change physician behaviour and build a collaborative culture between providers and health system planners by asking and answering questions together. Establishing trust is essential. The HDC distributed data model in combination with the adoption of the Privacy by Design framework and certification program ensures that the HDC can build and maintain the trust of its members by proactively embedding privacy into the design specifications of information technologies, the networked infrastructure, and business practices of the organization.
Conclusion/Implications/Recommendations: Canada can play a leadership role in this innovative approach to the use of healthcare information for performance management in primary care. Improving the quality of care requires a continuous learning process which in turn needs to include the ability to reflect on ones work. The basis for this reflection is a need to document what is done and monitor changes over time. The HDC supports this learning culture by providing secure access to comparative data in a cost effective, transparent and inclusive approach that could spread across Canada. Engaging physicians in both the governance and development of the toolset encourages an ownership perspective and helps ensure the work of the HDC maintains its relevance to the practising physician and the patient receiving care.
140 Character Summary: A physician-led practice reflection IT solution using a Privacy by Design approach enables a positive and trustworthy continuous learning process for physicians.
OS15 - Virtual Care Trailblazers
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 202AB
OS15.01 - Design and Implementation of Tele-Pediatric Intensive Care in BC
Purpose/Objectives: This presentation will focus on the two year process of bringing together clinical and telehealth technical experts in lockstep to design and implement pediatric Tele - PICU. This includes alignment of processes and systems between sites and health authorities for patient registration/documentation, procuring standardized equipment, developing detailed algorithms, organization of a 24/7 help desk, training, communications, testing/mock, process improvement, and establishment of the soft launch, leading to live launch.
Methodology/Approach: The design and implementation of this initiative was led by Child Health BC (CHBC) ,a provincial network of BCs health authorities and child serving ministries; in partnership with the Provincial Health Services Authority (PHSA) Telehealth Program and the regional health authorities. Sub-specialist consultation was delivered by pediatric intensivists, expert nurses, allied health, and sub-specialist from 2 PICUs at BC Childrens Hospital in Vancouver, and Victoria General Hospital on Vancouver Island. The first regional site accessing Tele-PICU was Kootenay Boundary Regional Hospital in Trail. Expansion is planned as new learning is applied.
Finding/Results: Early experience reports from practitioners have been overwhelmingly positive with benefits including: subspecialist visualization of the patient; advanced understanding of the patients pre-transfer condition, ability to monitor patient progress while providing advice, and obtaining patient history pre-transfer. Families were able to virtually meet the team who would be caring for their child after transfer, adding an extra level of connection and comfort with a new care team.
Conclusion/Implication/Recommendations: This successful pilot will now be expanded to other BC hospital emergency departments and some inpatient units with priorities linked to the Child Health BC Tiers of Service work in respect to childrens emergency services. Tiers of Service is a child health service planning framework used in BC that describes the responsibilities and requirements for services from small rural communities to BC Childrens' Hospital in Vancouver. Evaluation will include a framework of quality dimensions tailored to measure the achievement level of the service goals which include: increased and timely access to quality specialized care, potential avoidance of escalation of care, and increased family satisfaction.
140 Character Summary: Canadas first 24/7 virtual Pediatric Intensive Care Unit service provides consults to remote hospitals from pediatric intensive care teams.
OS15.02 - Scaling-Up an Online STI/HIV Testing Program in British Columbia
Purpose/Objectives: In response to increasing rates of sexually transmitted and blood-borne infections (STI/BBI) and a desire for more patient-centered health services in British Columbia (BC), the BC Centre for Disease Control (BCCDC) developed an internet-based STI/BBI testing service (GetCheckedOnline, GCO). Integrated with clinical and public health services, GCO is a virtual clinic of the BCCDC, developed to reduce known barriers to testing. GCO launched in Vancouver in 2014, then expanded to other regions of the province in 2016. We describe the process and early outcomes of scaling-up this intervention across a complex health care system.
Methodology/Approach: BCCDC developed an expansion plan in collaboration with regional health authority (RHA) stakeholders. We established a core team with project leads from BCCDC and two RHAs (Island Health and Interior Health), and formed a provincial expansion advisory committee with representation from BCCDC, private and public health laboratories, Ministry of Health, and all six BC health authorities. Program indicators from all sites are routinely reported and feedback on the service from clients is collected through research studies.
Finding/Results: The process took approximately 14 months from planning to implementation. Participating RHA communities were selected based on higher STI/BBI rates and limited access to testing. A high degree of collaboration between BCCDC, RHAs and local clinical services was needed to determine procedures for follow-up of positive diagnoses. Support and interest at multiple levels of RHA leadership facilitated the implementation of GCO, while challenges faced have included physician engagement and timely access to treatment in some locations. The scale-up has led to substantial increases in the uptake of GCO in Vancouver and at RHA sites. As of September 2016, RHA sites comprise 49% of new accounts, 38% of test episodes and 42% of positive STI diagnoses. Preliminary analyses suggest that GCO is reaching populations at risk; 19% of RHA clients have never previously tested for STI and 25% have never previously tested for HIV. Feedback from RHA clients has been positive, indicating acceptability and satisfaction with the service.
Conclusion/Implication/Recommendations: This represents the first time in Canada that an integrated, internet-based STI testing service has been implemented beyond a single geographic area. Through our inter-agency collaborations, we have successfully scaled-up an online STI/BBI testing service which has high acceptability, increasing uptake, and has led to new STI diagnoses in the regions where implemented. We are continuing to work towards further scale-up in BC, and our model may be relevant for other Canadian jurisdictions.
140 Character Summary: GetCheckedOnline is an online sexually transmitted infection testing service funded by public health in BC. We describe the scale-up of this program provincially.
OS15.03 - Implementation and Evaluation of a Sustained Heart Failure Telemonitoring Program
Purpose/Objectives: A sustained smartphone-based Heart Failure Telemonitoring Program was implemented within a large hospital Heart Function Clinic. The Program is unique compared to other telemonitoring programs due to its real time feedback to patients, low cost, minimal technical support requirements, and ability to be used without additional healthcare personnel beyond the patients current care team. This presentation will discuss the lessons learned from the implementation process and the preliminary results from the evaluation.
Methodology/Approach: An implementation strategy and evaluation plan were developed prior to implementation of the Telemonitoring Program. Patients were recruited from a Heart Function Clinic starting August 2016, with anticipated enrolment of 200 patients within the first year. Patients receive a Bluetooth-enabled weight scale, blood pressure monitor, and smartphone installed with the Medly application. Each morning, patients are instructed to take their weight, blood pressure, and answer symptom questions on the smartphone. An algorithm uses the patient data to generate automated patient self-care messages and alerts to the healthcare provider at the earliest sign of worsening health. Evaluation data will be collected while the Program is operational for quality improvement. During the first year, the Program will undergo a particularly rigorous evaluation to determine its benefits and areas for improvement. The evaluation will include health outcomes (eg, hospitalization rates, mortality), process outcomes (eg, number of alerts), adherence, quality of life and self-care (validated questionnaires), and interview data from patients and healthcare providers.
Finding/Results: The implementation strategy included an analysis of baseline clinical workflow, as well as the effects of the Program on workflow post-implementation. Several processes were established in preparation for implementation, including for alert management, technical support, clinician and patient training, patient enrolment, and equipment management. Currently, a cardiologist receives alerts via emails and manages them in collaboration with two nurse practitioners. However, in the future the two nurse practitioners will provide the majority of management. A technical analyst (0.25FTE) who is part of the hospitals Telehealth group is managing all other support duties. Nine patients have been enrolled to date (September 2016). A slow initial rollout enabled technical and workflow issues discovered after implementation to be resolved with minimal disruption to patients and clinicians. Adherence to taking daily measurements is currently high (95% of all possible days). For this presentation, the available baseline, one month, and six month evaluation data will be summarized.
Conclusion/Implication/Recommendations: Very few implementations of sustained telemonitoring programs exist in Canada. Therefore, sharing the implementation experiences is crucial to ensure best practices, avoid repeating mistakes, and for quality improvement. In addition, evidence of the impact of such programs is important to promote the establishment of similar programs across Canada and beyond.
140 Character Summary: This presentation will discuss the implementation and evaluation of a sustained smartphone-based Heart Failure Telemonitoring Program.
OS15.04 - A Primary Healthcare Consumer Health-e' Strategy
Purpose/Objectives: Present the approach, experience and Critical Success Factors for developing a sector-approved Consumer Health-'e' Strategy.
Methodology/Approach: 1. Proof of concept Connected Health and Wellness Project a smart phone enabled health coach approach for people with diabetes from modest socio-economic communities enabled with an eHealth collaboration platform. Participants in project include Black Creek Community Health Centre, NexJ Systems Inc. Rogers Wireless, Research in Motion, McMaster and York Universities, Federal Development Program. 2. Sector-based approach The Executive Directors of Community Health Centres (CHCs) and Aboriginal Health Access Centres (AHACs), voted their approval on a requirements set for a potential solution. Various options are being piloted and implemented to inform effectiveness and critical success factors. 3. Market Assessment The ED Network, led by its Information Management Committee applied the agreed-upon requirements and assessed a number of potential vendors and their solutions, a result of a Request for Information (RFI) released by the sector in 2015.
Finding/Results: Pilots and refining requirements The Connected Health and Wellness project resulted in 7% improvement in HbA1C management vs. traditional diabetes management practices. The combination of the collaboration platform, health coaching and effective client education and communications via smart phone is attributed for the improved outcomes. Three of AOHCs member organizations (one urban and one rural CHC, as well as one AHAC) started a pilot with HQICs miDASH PHR (Personal Health Record) in an effort to evaluate its benefits for primary healthcare clients in very different contextual settings. One CHC has started a pilot with Nightingales MyPatientAccess PHR, relying on its integration with the Nightingale-On-Demand (NOD) EMR which is the sector-based shared EMR solution. One CHC has become part of a wider network of Health Service Providers using McKessons Relay Health PHR. Next Steps As per the graphic below, basic analytics capabilities will be at the clients disposal, crunching and analyzing data from various sources, including wearable devices (fitness trackers, step counters, heartrate monitors, etc.). Level 3 is where the desired solutions capabilities were acknowledged by the ED Network. Level 4 was considered more of a provincial solution approach and beyond the requirements of the AOHC members. Following this direction, AOHC, together with member organizations, is participating in the first-ever Innovation by Co-Design program, hosted by the MaRS Discovery District. The purpose is to find partners capable of producing a solution that ultimately allows member organizations to better care for their clients and help clients make better lifestyle decisions ultimately leading to improved health outcomes.
Conclusion/Implication/Recommendations: Present the innovative approach of procuring for outcomes aligned to the IHI's Triple Aim: increase client satisfaction, lower costs and improved outcomes. Solution Critical Success Factors: a. Funding: clients cannot be expected to pay for this service. Organizations must be able to make a business case for funding. b. Integration: the solution must be able to consume relevant data from provincial eHealth assets and interact transactionally with EMRs. c. Metrics: easily interpreted graphic representations of clinical information to communicate improvements to clients. d. Organizational Commitment to person- and community-centredness. e. Value for money
140 Character Summary: A culturally appropriate Consumer Health-e Strategy increased client/clinician satisfaction, lower cost, improved client experience - Triple Aim.
OS16 - Evolving Access for Remote Communities
- Type: Oral Session
- Track: Clinical
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 202CD
OS16.01 - Cedar Project: MHealth Among Young Indigenous People Who Use Drugs
Purpose/Objectives: Indigenous leaders and scholars continue to be concerned about high rates of HIV and barriers to HIV treatment among Indigenous young people who use drugs. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. The Cedar Project is a cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, British Columbia. In response to the paucity of evidence of mobile phone use among among young Indigenous people who use illicit drugs living with and vulnerable to HIV, we: (1) examine patterns of mobile phone ownership and use; and (2) explore acceptability of an mHealth program to support access to healthcare.
Methodology/Approach: This multi-method exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth intervention. At enrollment, participants completed a questionnaire which included quantitative and qualitative questions related to mobile phone use and interest in mHealth. This data was linked to the main Cedar Project questionnaires and serodata. We present comparative statistics and results of a rapid thematic analysis related to mobile phone patterns and interest in receiving an mHealth intervention among young Indigenous people who use drugs.
Finding/Results: Slightly less than half of participants (59; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smart phone (46; 78%). Most participants with a phone reported having an unlimited texting plan (39; 70.9%); using Internet on their phone (44; 74.6%); and texting daily (51; 67.1%). Participants were asked whether they felt using a mobile phone would be helpful for healthcare, and if they had any concerns using text messaging for their health. A majority reported that using a mobile phone for health would be invaluable (120; 92.3%). There were no differences in mHealth acceptance between participants who already owned a phone and those who did not. All participants living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (10; 12.5%). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits falling into six themes: (1) access to healthcare and emergency services; (2) convenience, privacy, and safety; (3) connection for emotional, mental and spiritual support; (4) connection to family; (5) staying in touch/being reachable; and (6) overcoming current barriers to phone use.
Conclusion/Implication/Recommendations: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who use drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and wellbeing among the young Indigenous people in this study. These findings may be useful for health providers preparing to scale up mHealth programs to support HIV prevention and treatment with this population.
140 Character Summary: Mobile phone use and mHealth to support access to healthcare are highly acceptable among young Indigenous people who use illicit drugs living with/vulnerable to HIV
OS16.02 - Clinical Decision Making Applications
Purpose/Objectives: Clinical decision making technologies assist doctors in diagnosing and treating patients in both acute and community care settings. Doctors are faced with making complex decisions, requiring them to take into account multiple inputs in a short time frame. Everything from lab results, clinical observations and patient history needs to be factored into decisions. Doctors are often stretched for time as they go through all the patient details. Additionally, When it comes to complex diseases with multi-step treatments there is a lot of new data and evidence that is being updated on an ongoing basis. Doctors arent always able to keep up with all the new data. Our applications house complex decision trees combined with machine learning algorithms to help doctors improve efficiencies in treating their patients and assist with their decision making process. The platform and algorithms incorporates data from new studies to provide doctors with tools that reflect the latest in evidence based medicine. Doctors that engage with the application have seen an improvement in patient outcomes, as well as quicker times to process patients.
Methodology/Approach: The platform harnesses the decision making process of leading KOLs in each disease state. It incorporates input from doctors specializing in multiple diseases including Virology, Oncology and Immunology. Lab integrations, patient questionnaires and clinical observation flowcharts are used to capture data points during diagnosis. These data points are analyzed and a proprietary algorithm runs through millions of possible permutation and combinations to recommend possible diagnosis and course of action. As new data is fed into the system (ex. updated lab work), the algorithm re-computes the results and makes recommendations on staying course of treatment or adjusting the therapy
Finding/Results: With our existing platforms we have been able to expand the population of patients that receive care for some complex diseases. In addition to high utilization by specialists, there have been two primary use cases for the platforms: The platforms have provided family physicians in rural areas the ability to diagnose, triage and start treatment on patients that would otherwise be left undiagnosed or underdiagnosed There has been a significant uptick in First Nation populations on reserves receiving treatment for chronic conditions by doctors who use our platforms
Conclusion/Implications/Recommendations: Clinical decision making applications are ideal for hospitals and large clinics that are front-line in dealing with patients. The platforms assist doctors in diagnosing patients and automates the results from labs, clinical observations and patient history into the decision. The investment doctors make in learning to use the platform is quickly paid-off by allowing them to manage each patient more efficiently. Further, doctors are able to make better decisions with the most up to date data and evidence.
140 Character Summary: Clinical Decision Making tools assists doctors in performing better diagnosis and implement improved treatment plans on patients suffering from complex diseases
OS16.03 - First Nations in Ontario – New Focus on Practical eHealth Pathways
Purpose/Objectives: In another abstract an updated approach for the First Nations Panorama Deployment in Ontario (FNPDiO) project was explained. This presentation provides examples of project success/challenges at the level of the individual First Nation Health Service Organizations (FNHSOs) the project works with. Overall, the FNPDiO project has a goal to support FNHSOs in Ontario to identify and develop practical health information management processes. Our scope began with access to provincial immunizations tools and data, but has grown to incorporate broader requirements. Analysis makes a few things clear. First, FNHSO access to provincial eHealth tools is necessary to support effective circle of care for First Nations. Second, many challenges impede access to provincial eHealth tools. Third, provincial eHealth tools on their own are not complete solutions for FNHSOs as they are not designed to support specific First Nation requirements, and as a result local eHealth tools and solutions are also required. Given this clarity, the project developed a suite of eHealth pathways that are meaningful and relevant to FNHSOs. The term pathway describes an identified health information management priority, plus the methodology, templates, etc. that enable access to relevant systems/tools. By focusing our discussion on three FNHSOs working through the various FNPDiO pathways we will describe how progress is being made, how challenges are being resolved and how the overall model is validated/refined for possible expansion to other FNHSOs. Our examples will highlight access to provincial immunization data and systems (DHIR), implementation and use of community electronic medical records (cEMR), access to provincial clinical viewers (ConnectingOntario), and use of Personal Health Records in conjunction with other local health care providers. Multiple pathways may be applicable to a specific FNHSO, and local capacities for enabling and sustaining these pathways may vary between FNHSOs. However, the underlying requirements that must be met to enable any pathway are similar (e.g. network connectivity, P&S frameworks, etc.) and these will also be discussed.
Methodology/Approach: With advice from our Advisory Group, the project team developed a set of detailed processes to enable the pathways that address priority FNHSO health information management needs. Our presentation will describe the pathways process from the perspective of three of our Initial Subscriber FNHSOs. We will identify and discuss the commonalities across pathways, describe the necessary collaboration with provincial partners, and share our experiences on FNHSO-level change management efforts and strategies.
Finding/Results: The pathways developed through the project are proving successful with the projects Initial Subscriber FNHSOs. Through our work with them and their provincial partners, the pathways approach is being refined and communicated to other FNHSOs in hope that the outputs of the project can be beneficial more broadly to First Nations in Ontario and support meaningful advances in First Nations eHealth.
Conclusion/Implication/Recommendations: The project has been successful in using a systematic methodology to identify and support FNHSO health information management priorities. This approach can improve workflow and circle of care coordination with provincial partners. Other FNHSOs in Ontario should be supported to benefit from the projects success.
140 Character Summary: A pathways approach is being used in Ontario to bring practical and meaningful solutions to First Nation health centre information management priorities.
OS16.04 - First Nation Health Information Management – Aligning with Ontario eHealth Strategies
Purpose/Objectives: In 2008, the First Nation Panorama Deployment in Ontario (FNPDiO) project began between Chiefs of Ontario, First Nations and Inuit Health Branch Ontario Region and the Ontario Ministry of Health and Long-Term Care with a goal to support First Nations use of the Panorama Public Health Surveillance System. Time has passed and eHealth strategies have changed, including how Panorama is used in Ontario. However, the pressing need for on-reserve health information management tools and processes, including interoperability with provincial providers, remains largely unfulfilled. In response, the project restructured with expanded scope, emphasis on aligning First Nations requirements with evolving provincial eHealth strategies, and with a practical circle-of-care focus that includes significant collaboration with First Nations, Public Health Units and Local Health Integration Network staff. Immunization information management is still a priority interest, but its become clear that a more holistic view of health centre information management is needed. To this end, the project team is now supporting First Nations Health Organizations to assess their need for information management across their range of clinical program management and then match identified needs to eHealth systems available in the environment from ConnectingOntario clinical viewers, to interaction with the Ontario Digital Health Immunization Repository (DHIR), to use of community EMRs, to Personal Health Records. Properly enabled, this broader range of systems can address long-standing challenges that have impeded First Nation from taking advantage of eHealth advances.
Methodology/Approach: The FNPDiO project follows a needs assessment, provincial integration, and implementation toolkit methodology proven successful in similar First Nations eHealth projects. Guided by a First Nations-led Advisory Group, the project team developed tools to identify discreet health centre information management requirements and priorities and match these to available systems. The approach also supports facilitating system access/implementation. The methodology is flexible and accommodates varying requirements and priorities across health centres, plus it aligns strongly where necessary to the evolving and expanding set of eHealth tools and services being introduced by the province of Ontario (e.g. DHIR, ConnectingOntario, PHIX, ICON, etc.). At its core, the project methodology also takes into consideration the many non-system enablers of eHealth system access/use (e.g. P&S, information governance, ongoing support, etc.) and establishes a foundation that builds eHealth capacity within First Nations Health Organizations.
Finding/Results: First Nations Health Organizations in Ontario have begun to access and use required eHealth systems through the project. We are now working to extend the successful methodology to others while continuing to work with partners to identify and support new system access/use models in an ever-evolving eHealth world.
Conclusion/Implication/Recommendations: The First Nation eHealth environment is complicated. However, experience has demonstrated that with patience and a focus on practical clinical requirements, progress can be made. The methodology used to support First Nations in Ontario to improve their eHealth capacity should be made available to all who have a demonstrated need. This methodology and its outcomes likely have relevance in other provinces as well. Success on the FNPDiO project should be shared wherever possible.
140 Character Summary: The FNPDiO project has developed an approach to support First Nation health info mgmt. priorities in alignment with provincial strategies. It is working.
OS17 - Sharing Clinical Information: Successes and Challenges
- Type: Oral Session
- Track: Clinical
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 203AB
OS17.01 - Solving the Drug Terminology Challenges to Enable e-Prescribing in Canada
Purpose/Objectives: This session will describe the current challenges with the lack of a common terminology in Canada to meet the e-prescribing business needs and identify how Infoway and Health Canada have partnered to begin to solve these challenges. Currently all systems do not speak the same language as demonstrated in the diagram below. <img alt="erx.png" annotation="" id="image://43" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=e190fc98c647450f198e43f9644c333104fd158c&id=43&width=350&height=350&download=0" title="erx.png" />
Methodology/Approach: In the session I will provide the details of the approach which included: Exploration of options to find a pragmatic solution that would work in Canada within tight timelines. An expert panel was convened to develop editorial guidelines The development and testing of the Non-Proprietary Therapeutic Product Data set (NTP-CA Data set) co-led by Health Canada and Canada Health Infoway The NTP-CA Data set will be machine generated then subject to a curation review prior to being published Public comment and review periods to allow broader input and feedback
Finding/Results: Infoway has initiated a work plan with Health Canada to develop and publish the NTP-CA Data set This will include new codes and descriptions with a mapping to the associated DINs This work is necessary to move forward with safe electronic prescribing and other medication e-services Early findings/results are only available at abstract time however we anticipate completion of the first publication of the NTP-CA Data set by April 2017.
Conclusion/Implication/Recommendations: While socializing this work we learn that stakeholder interest is very high. This work contributes to the benefits for e-prescribing by: Allowing prescribers to unambiguously identify the drug they wish to prescribe in an e-prescription Making it easier for dispensing systems to provide safe product selection Other benefits include Medication Profile / Medication Reconciliation Hospitals using multiple systems that need to exchange drug information (e.g. supporting Medication Reconciliation modules) Medication Surveillance / Healthcare Analytics
140 Character Summary: Canadians will finally have easy access to drug terminology that solves their e-prescribing needs and beyond, and all published by one authoritative source.
OS17.02 - FHIR - Sparking Innovation in Health Information Sharing
Purpose/Objectives: Care providers need pertinent patient information, at the point of care and not locked into silos of collection. Theres a need for rapid, secure healthcare interoperability. In response, there is a new standard from HL7 called FHIR or Fast Healthcare Interoperability Resources, which is now at a level of maturity where clinicians and healthcare executives can begin to fully benefit from. The presentation will cover: -What is FHIR? -Evolution of this new healthcare standard -How profiling can customize FHIR for your organization -Security and how SMART will ensure this -How FHIR will benefit clinicians, executives, implementers and patients -How FHIR APIs will future-proof your organization
Methodology/Approach: FHIR represents a major standards upgrade that will boost access to health information in Canada. FHIR aims to speed application development and interoperability, plus boost information sharing in healthcare, especially on mobile platforms. FHIR is both a model and an API and promises to make health information easily and securely accessed from any device, anywhere helping to break down information silos existing in healthcare. For example, a lack of readily available patient health history often forces doctors in emergency departments to make guesses about appropriate medication, when there is no one to speak for the patient. It will support the creation of an app store of independently developed mobile applications, because it supports the collection of data via APIs. To secure these applications, the standard SMART has been developed to assist with this. SMART defines the use of the widely used OAuth2 authentication standard along with FHIR as the model and API layer to encourage the development of a secure ecosystem of data sources, services and applications. It also defines the app launch mechanism to allow an EHR to securely launch an external application.
Finding/Results: FHIR aims to support the following groups: -Clinicians: FHIR provides access to a more complete, higher quality electronic health care record, by being able to include data from traditional sources like laboratory results, as well as evolving sources like genomic information. -Patients: With more applications being targeted at patient engagement, FHIR removes the technical barriers for data from patient engagement apps to be included in clinical systems. -Developers: Familiar tooling and technologies are used. Predefined resources, and APIs allow implementers to focus on the core application functionality. -Healthcare providers: Vendors are committed to FHIR, which increases the range of applications able to be deployed. This should lead to faster deployments, and lower cost interoperability. It supports the ability to develop applications specific to their needs, yet integrate with the clinical information already available.
Conclusion/Implication/Recommendations: FHIR has captured interest around the world and promises to revolutionize sharing of healthcare information. David has been involved with the formulation of the new FHIR standard from the beginning and is active in the international standards community as the chair of HL7 New Zealand and co-chair of the FHIR Management Group. FHIR represents a major standards upgrade that will boost access to health information and healthcare delivery in Canada.
140 Character Summary: Learn how the new standard HL7 FHIR will future-proof your organization and enable improved healthcare interoperability with Dr. David Hay.
OS17.03 - Sharing Immunization Data Between Family Doctors and Public Health Units
Purpose/Objectives: Better Outcomes Registry and Network (BORN) Ontario is developing a common Digital Health Exchange Service (DHEX) in partnership with the Digital Health Solutions and Innovation (DHSI) Branch and the eHealth Strategy and Investment Branch (HSIB) of the Ministry of Health and Long-Term Care (MOHLTC). DHEX has three primary objectives: 1. Design, plan and implement a proof of concept with Electronic Medical Record (EMR) vendors to allow submission and retrieval of immunization records with Public Health Units (PHUs) via the Ontario Digital Health Immunization Repository (DHIR). 2. Implement a general exchange mechanism, based on HL7-FHIR, between the BORN Information System (BIS) and the DHIR to synchronize immunization and demographic data. 3. Support current EMR integration initiatives at BORN.
Methodology/Approach: Provide Ontario PHUs more complete immunization records by delivering immunization information from EMRs for children up to 18 years of age. Develop an updated and simple EMR submission (DHEX) approach using HL7-FHIR to enable providers to easily and securely submit and retrieve immunization administrations to PHUs via the DHIR. Develop a working proof of approach/technology to finalize the HL7-FHIR specifications and reference implementations that will allow EMRs to submit and query the DHIR, providing EMR primary care providers with a mechanism to both submit and view an immunization record (at the record level), encouraging the adoption of the DHIR immunization dataset by EMR vendors. Develop a proof of concept for an enhanced HL7-FHIR based mechanism for BIS integration with EMRs and upgrade the security integration with the current eHealth Ontario ONE ID Single Sign On project. Equip health care providers with enhanced information, tools and support
Finding/Results: The project will provide the MOHLTC with: Timely access to the largest EMR vendors in the province in support of Immunization 2020 goals Further refinement and endorsement of the IHR (Immunization Health Record) specification A single EMR transmission solution in support of provincial expansion for initiatives supported by BORN This project will provide EMR Vendors with: A simplified and unified approach to interoperability HL7-FHIR Simplified development and technology tools, lowering barrier to entry Input to the specifications and development of the proposed solution Input to create broader auxiliary data services that can be leveraged for other initiatives This project will provide health care providers with: EMR access to patient level immunization records, including forecaster data, which will alert to upcoming or improperly administered vaccinations Ability to provide PHUs with up to date immunization records, seamlessly embedded within the EMR, in support of proposed immunization reporting legislation and improved clinic workflow
Conclusion/Implication/Recommendations: This project supports the goals and objectives of Immunize 2020, the MOHLTCs strategic framework to modernize Ontarios publicly funded immunization program (MOHLTC, 2015). It also supports the development of a common provider solution that allows for immunization data from EMRs to be transmitted to PHUs via the DHIR. This would occur seamlessly, in near real-time, avoiding the need for clinicians to implement new clinic workflows or processes to support proposed legislative requirements.
140 Character Summary: Development of a common provider solution that allows for immunization data from EMRs to be transmitted to PHUs via the Digital Health Immunization Repository.
OS17.04 - LTC eConnect: Advancing Clinical Interoperability in Ontario’s LTC Sector
Purpose/Objectives: The purpose of the Long Term Care (LTC) eConnect Project is to enable clinical interoperability between LTC clinical information systems and Ontarios Electronic Health Record (EHR). 20,000 clinical users will have seamless access to EHR data so they can improve the quality and timeliness of care for some of the provinces most vulnerable residents. Ontarios Long Term Care sector includes 630 Long Term Care homes providing care for approximately 100,000 residents with approximately 60,000 clinical and non-clinical staff at a cost of almost $4B per year. Specific objectives include: · Connecting up to 520 of the 630 LTC Homes to at least one of the two provincial EHR clinical viewers (ClinicalConnect in the Southwest Region, ConnectingOntario ClinicalViewer in the Northern and Eastern Region (NER) and Greater Toronto Area (GTA)); · Enabling at least 20,000 clinical users in these homes to have seamless (i.e., single sign on and patient context), privacy-enhanced access to resident EHR information: laboratory results, diagnostic imaging reports, discharge summaries, and hospital and community care reports; · Ensuring appropriate legal agreements, including privacy and security due diligence are completed, support integration and user authorization; and · Undertaking a detailed Benefits Evaluation to support the sector-wide expansion and on-going sustainability for the solution.
Methodology/Approach: The project sponsor is the Ontario Long Term Care Association (OLTCA) working in collaboration with the Ontario Association of Homes and Services for Seniors (OANHSS), Ontario Long Term Care Clinicians (OLTCC), eHealth Ontario, and many delivery partners. The project integrates long term care homes with EHR assets managed by eHealth Ontario, using PointClickCares Electronic Medical Record (EMR) using ThoughtWires Ambient integration technology. There are two main phases: 1) View Integration within PointClickCare to ClinicalConnect 2) View Integration within PointClickCare to ConnectingOntario Clinical Viewer Both phases follow an agile development process over five, two-week sprint cycles, guided by a Clinical Advisory Committee of front-line users who ensure that the solution is easy to use and meets their clinical requirements as well as legislative and business requirements. Clinical users require a ONE ID credential the provincial standard for accessing provincial EHR Services. The project team works closely with eHealth Ontario and other partners to streamline and manage the legal agreement processes and implementation activities needed to authorize, train, and support clinical users. Following each development phase, a rolling wave deployment process used to on-board LTC homes to ensure staff are trained to effectively use the EHR services.
Finding/Results: At time of submission the project is in the Phase 1 development stage. Rollout in February 2017 and by June 2017 preliminary results: design, development and deployment results for the first group of Long Term Care homes and clinical users in the Southwest Region.
Conclusion/Implication/Recommendations: The project presents an innovative approach to integrating clinical users with provincial EHR services using middleware integration technology to streamline the integration approach, enhance privacy and security controls, improve quality and timeliness of care, and provide an efficient user experience. This is an approach that others can leverage to accelerate EHR interoperability and deployment efforts elsewhere.
140 Character Summary: An innovative LTC sector based approach using single sign on and context management to support advanced clinical workflows and future value-added capabilities.
OS18 - Evolving Standards
- Type: Oral Session
- Track: Not Rated
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 203CD
OS18.01 - Healthcare Information System Interoperability - Leveraging Standards Case Study
Purpose/Objectives: The Image Capture system serves as a case study of how leveraging DICOM and HL7 as interoperability standards can provide an extremely low cost strategy to communicate and archive visible light medical images through a centralized PACS (Picture Archiving and Communication System). Leveraging this approach could allow for regional/provincial management of endoscopic, surgical, retinal, dermatologic, and other medical images for clinical care and quality management purposes.
Methodology/Approach: Our system was originally developed in 1995 to run on commodity hardware and capture medical images generically from medical video processors. It has been in production at a large multi-site health sciences center since then with very little cost, training and support requirements. The capture system consists of a Microsoft Windows software program written to interface with a USB NTSC video capture device and a HD-SDI capture card. Still bitmap images are captured and converted to DICOM and then routes to PACS. Digital mpeg video is archived and available through a web review application. Other features include a custom developed hardware interface to the endoscopy image processors for endoscope hand switch capture control, as well as an HL7 patient work list interface to the hospital ADT information system. Upgrades have included privacy and data security controls and secure wireless network transmission for emergency cases performed on mobile procedure carts in areas such as the ICUs and emergency departments. The system is currently being adapted for newer generation HD image processors.
Finding/Results: This systems simplistic yet functional features have served the needs for electronic documentation of patient procedures for the past two decades with average usage statistics of 800 cases per month and 10 images per case. The usage areas include Endoscopy, Cystoscopy, Neurosurgery, Orthopedic surgery. In leveraging the existing PACS system, operating costs are negligible and clinicians access the images through their preferred review application along with traditional medical images without the need for additional applications and training.
Conclusion/Implication/Recommendations: Medical data interoperability requires different information systems to communicate and exchange meaningful data across all medical facilities. DICOM and HL7 are two medical data standards that contribute to the eventual plug and play interoperable model. Ongoing work to achieve interoperability is being done by IHE (Integrating the Healthcare Enterprise), a worldwide organization that supports interoperable healthcare to improve quality, ensure patient safety and reduce cost through the adoption of standards for healthcare by publishing guides for how to use those standards. Our case study serves as an excellent example of an affordable scalable approach to medical interoperability. Within Canada, this approach to interoperability could affordably support provincial initiatives for cancer screening and endoscopy quality improvement programs.
140 Character Summary: Health Information data interoperability: a case study leveraging DICOM and HL7 standards to improve management of medical images and clinical care quality.
OS18.02 - Manitoba EMR Certification: Responding to Physician Call-Out for Choice
Purpose/Objectives: In 2009 Manitoba was involved in the pan-Canadian EMR Adoption Program in partnership with Canada Health Infoway. After a competitive RFQ process, 4 Manitoba-Approved Vendors were selected. Over the next several years, and for a variety of reasons including acquisitions, the list decreased to one Approved Vendor. Though the concept of one provincial vendor can be appealing, the Manitoba primary care physician community raised a call-out for more choice in the EMR marketplace. Join our session to learn about the steps taken in Manitoba to respond to the physician community through the development and implementation of a new EMR Certification process. The objective of this session is to share Manitobas new EMR Certification process, including how the framework was developed, how requirements were gathered, inclusion of physicians as key stakeholders during the consultation process, the implementation strategy, and the end results.
Methodology/Approach: Through key stakeholder consultation and a pan-Canadian jurisdictional scan and analysis, Manitoba developed a new framework and approach to evaluate EMR products against provincial standards. Provincial standards were developed to support the core administrative, clinical and privacy needs of primary care clinics in Manitoba while aligning with provincial primary care strategy. A non-competitive open certification approach was selected as part of the new framework, providing flexibility for vendors to enter the marketplace at a level appropriate for their business goals while meeting the needs of Manitoba primary care clinics. In this session we will share Manitobas new EMR Certification process including how the framework was developed, how requirements were gathered, and how primary care clinics and physicians were part of the consultation process as key stakeholders. Learn about the final results of the Certification journey and the next steps for primary care clinics and EMRs in Manitoba.
Finding/Results: The Certification process is underway at this time. Final results are expected by the end of 2016 and will be shared at this session including details on adoption, implementation and ensuring provincial EMR standards have been met.
Conclusion/Implication/Recommendations: Lessons learned from the development of the new Certification process will be shared. This will include the benefits and challenges of including physicians and primary care clinics in the consultation process, as well as feedback from EMR vendors on our Certification approach and comments on the scope of Manitoba provincial EMR requirements.
140 Character Summary: Learn how Manitoba responded to call-outs for more choice in the EMR marketplace through the development and implementation of a new EMR Certification process.
OS18.03 - Data Standardization in Canada's Acute and Ambulatory Care Settings
Purpose/Objectives: The poster will explain how data standards can improve patient care and health system planning if implemented/adopted at the outset of an eHealth system implementation project. CIHI will provide an overview of the activities it has undertaken since launching the data standard and some upcoming opportunities will be addressed with the support of various partners, including vendors and data submitters, across Canadas health care system.
Methodology/Approach: As part of CIHIs efforts to operationalize the principle of collecting data once and using it for multiple purposes, an Acute and Ambulatory Care Data Content Standard has been launched. The intention of this document is move Canada towards standardizing data collection at the point-of-care, so data can flow seamlessly throughout the system including to CIHI for secondary use purposes.
Finding/Results: To realize health system use benefits from eHealth solutions, it is essential to incorporate CIHIs data standards at the planning and implementation stage for essential downstream health system use. These data standards also support key aspects of interoperable patient care. After launching the data standard, CIHI has completed a number of activities to promote its adoption amongst the vendor community, hospitals and ministries of health. An overview of these activities, including key learnings, will be presented.
Conclusion/Implications/Recommendations: 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. In order to build a truly interoperable system across the continuum of care, including health system use, data standards need to be considered at the outset. Adoption of data standards in eHealth systems is essential for access to better data for both patient management and planning purposes.
140 Character Summary: Data standards can improve patient care and health system planning if implemented/adopted at the outset of an eHealth system implementation project.
OS18.04 - Filling the Terminology Expertise Gap in Canada
Purpose/Objectives: A business need exists in the Canadian health care sector to address the current gap of trained and experienced human resources in the use of clinical terminologies, including SNOMED CT and LOINC, to support the implementation and maintenance of e-health solutions. CHIMA and assistance from Infoway will identify how this gap will be addressed by a Canadian Terminology Standards Certification process.
Methodology/Approach: Human resource sector studies, survey data, and a Canadian advisory group were used to confirm the business need. A business case to create the Terminology Standards Certification was developed. A multi-stakeholder committee led by CHIMA and Infoway representatives identified key components required.
Finding/Results: Human resource sector studies, survey data, and a Canadian advisory group validated that a business need exists in the Canadian health care sector to address the current gap of trained and experienced human resources in the use of clinical terminologies, including SNOMED CT and LOINC, to support the implementation and maintenance of e-health solutions. The use of clinical terminology across the country has been growing as part of the increased investments in health information technologies. In the context of this increased use of e-health solutions using clinical terminology, new and evolving human resource role requirements to support eHealth are emerging. Key stakeholders identified the development of a clinical terminology professional certification in Canada as a priority to help address this resource gap. A business case to create a Terminology Standards Certification was approved by senior representatives from Canada Health Infoway and the CHIMA Board of Directors. Regenstrief Institute and the International Health Terminology Standards Development Organization confirmed support in working towards launching a clinical terminology professional certification in Canada. Support and commitment from the Canadian academic community was also received. A multi-stakeholder committee led by CHIMA and Infoway representatives completed the following work: Development of three (3) Terminology standards (TS) role descriptions (e.g., the development of key TS roles that are required in the current eHealth workplace) Development of a Canadian TS competency framework Creation of learning content items to support curriculum development
Conclusion/Implication/Recommendations: Stakeholder input to the certification process has not yet been completed. Based on significant international interest, this work has been brought to ISO TC 215 to ultimately make this become an international product. Further input and feedback and a process to keep the material relevant is required and currently underway.
140 Character Summary: The role descriptions and Canadian competency framework will be introduced and a discussion on the learning content items will take place in this session.
OS19 - Experiences in Adoption & Use
- Type: Oral Session
- Track: Clinical
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 205B
OS19.01 - Addressing Complex Clinical Documentation Through Human-Factors & Human-Computer Interaction Principles
Purpose/Objectives: Upper gastrointestinal (GI) endoscopy and colonoscopy are common procedures with complex documentation requirements. Research indicates there is significant variability in the clinical reporting quality of these procedures. Although documentation solutions are currently available, adoption remains poor due to challenges with workflow, functionality and ease of use. With support from Canada Health Infoway and Canadian Partnership Against Cancer, national data models for reporting colonoscopy and upper GI endoscopy procedures were created to provide a framework for standardized reporting and improve procedure documentation, data quality and patient care. The data models were designed to incorporate standard terminologies and classifications with endorsement from the Canadian Association of Gastroenterology (CAG). At a large multi-site academic health sciences centre, the existing electronic clinical documentation application was updated to incorporate the national data models for colonoscopy and upper GI endoscopy. To accommodate the complexity of the documentation required and the variability in patient population and clinical practice we released a working prototype as part of an iterative design approach based on human-factors and human-computer interaction principles. The purpose of this presentation is to share the lessons learned in the design, implementation, and adoption of complex electronic clinical documentation applications. These principles may be broadly applied to a wide variety of clinical documentation environments.
Methodology/Approach: Semi-structured interviews and observational studies were conducted to evaluate the content, workflow, and usability of the application. Completed electronic procedural notes were quantitatively analyzed to examine adoption and performance. Human-factors and Human-computer interaction principles were applied to the application in the production environment.
Finding/Results: Common themes emerged from the interviews. Despite motivation to adopt the data models, clinicians found that it did not meet their workflow or usability requirements and took longer to complete than a dictated clinical note. In some circumstances, the application did not support Human-factors and Human-computer interaction principles such as consistent user commands and informative field labels. Users also had misconceptions regarding the purpose of the application; some thought it was solely for research. Many users found the generated synoptic report failed to capture sufficient patient narrative and context. Engaging with users is essential; their feedback combined with the results of the quantitative analysis guided the iterative re-design of key components of the application. Concurrently, the Human-factors evaluation of the application helped to identify areas of improvement in terms of usability, readability, and speed.
Conclusion/Implication/Recommendations: Currently, the feedback and results of our analysis are being integrated into the application. Upon the next release, feedback and usability testing will be conducted to continue the process of iteratively designing the application to fit the needs of the clinicians. The national data models contain best practices and guidelines that are important for improving patient care and clinical documentation. Clinicians must be aware of the intent and share in the benefits of changing their workflows and practices. Iterative engagement, feedback and use of the application at the point of care are important for supporting implementation, training, adoption and benefit realization of complex clinical documentation.
140 Character Summary: Adoption of complex clinical documentation systems is limited. Human-factors principles and clinician feedback can aid in the adoption and use of these systems.
OS19.02 - Use of Digital Health: How Does Canada Compare?
Purpose/Objectives: In Canada and internationally, there have been significant investments made in health information technology. This presentation will examine the use of digital health by primary care physicians and patients in Canada and how it compares to peer countries. Provincial electronic medical record (EMR) adoption rates, use patterns and impact on patient care will be discussed.
Methodology/Approach: Findings are based on responses from the Commonwealth Funds International Health Policy (IHP) Survey of Primary Care Physicians in 2015 and the IHP Survey of the General Population in 2016. A total of 11,547 Physicians from 10 countries participated in the 2015 survey (Canada, n=2,284 ). The survey included topics such as access to care, coordination of patient care, organization of practice, use of information technology and performance measurement. Comparable data from previous surveys of primary care physicians (2006 and 2009) are used to analyze trends. Data for each of the countries are weighted to reflect the local physician population. The 2016 survey of the general population targeted adults (18 and older) in 11 countries including Canada (n=4,712) and focused on patient experiences with the health care system.
Finding/Results: The adoption of EMRs among Canadian primary care physicians has tripled over the past nine year (23% to 73%). Provincial adoption of EMRs ranges from 36% to 85%.Canada shows room for improvement in EMR adoption to reach levels seen in peer countries (Fig 1). Canadian physicians with EMRs report the ability to better manage their patients care. For example, 79% of physicians with EMRs report that they are able to generate a computerized list of patients by diagnosis compared to 20 % without an EMR. Canadian physicians use of advanced EMR functions that support patient care varies and shows room for improvement. Canadian physicians are more likely to use some functionalities (reminders for guideline based care, review data on preventive care) and less likely to use others (alerts related to medications, tracking results, patient reminders) when compared to the 10 country average from the Commonwealth Fund survey. Canada lags behind in allowing patients to access their digital health records or communicate electronically with their doctors. All countries show room to improve in offering patients access to health information.
Conclusion/Implication/Recommendations: EMR adoption and use has nearly tripled in Canada over the last decade, equipping doctors with an important tool to better manage patient care. The survey findings show that Canada and its international counterparts have room to improve in the use of advanced EMR functionalities that could positively impact patient safety, prevention and chronic disease management. The surveys also highlight room for improvement in electronic information exchange and online services for patients.
140 Character Summary: Canada is catching up but still lags behind in use of digital health in primary care; who can we learn from internationally and where can improvements be made?
OS19.03 - Usage Patterns of a Health Information Exchange Network in Quebec
Purpose/Objectives: The objective of this study is to describe the usage patterns of a medication health information exchange (HIE)1 network in Quebec 2 years after its full implementation. (1This system is also described as a Drug Information System and an Electronic Health Record by Canada Health Infoway)
Methodology/Approach: Longitudinal analysis of usage data of the HIE network between January 1st 2015 and July 30th 2016 was performed to describe the number of users, number of accesses and tools used to access the data. Usage data were obtained from the Health Ministry of Québec.
Finding/Results: During the 18 month study period, a total number of 30 996 unique users accessed the medication data of the HIE. Access was possible using a Viewer application, an electronic medical record (EMR) application, or a Pharmacy application. In 2015, only 5% of users accessed the medication data through an EMR, while this proportion increased to 19% in the first 6 months of 2016. This suggests that a greater number of clinicians were using the advanced features of an EMR to access the data. Figure 1 shows the mean and median number of accesses to the medication data per month, and per tool used. The level of use was higher when clinicians accessed the data through an EMR (mean number of accesses per month in 2016 was between 101 and 264 per user) compared to the Viewer (between 42 and 90). Table 1 presents a detailed description of the number of users per year, the tool used to access the data, and the number of accesses for all users. <img alt="table1.jpg" annotation="" id="image://18" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=bbd43344205533a2c762e94b594350bcdc2afb71&id=18&width=350&height=350&download=0" title="table1.jpg" /><img alt="figure1.jpg" annotation="" id="image://19" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=68f2ff60e95f4b90e839036b9a75772ce52c6d3f&id=19&width=350&height=350&download=0" title="figure1.jpg" />
Conclusion/Implication/Recommendations: These results suggest that using an EMR application facilitates the integration of medication data from an HIE network into clinical activities. Further research should explore the heterogeneity between commercial EMRs in terms of integrating data from HIE networks.
140 Character Summary: The level of medication data usage from the HIE network was higher when clinicians used an EMR versus a Viewer application
OS19.04 - Secondary Use of DIS Data-RediLink Project
Purpose/Objectives: The focus of ReDiLink is to investigate the standardized collection and transfer of Cancer Systemic Therapy (CST) data from provincial Drug Information Systems (DIS) into the provincial Cancer Registry Information System (CRIS). From a Department of Health and Wellness perspective this represents the first use of the DIS for linkage to other data sets and will start the process of understanding impacts and opportunities for how this system can be used to support provincial level drug surveillance, both from a technical and clinical perspective.
Methodology/Approach: The purpose of ReDiLink is to explore the use of provincial DIS data to identify CST drugs dispensed at community based pharmacies and to link this information with the provincial CRIS. Trained cancer registrars will review the DIS data along with electronic patient records, hospital discharge and other sources of information already available to them to assemble a summary profile of CST treatment for the patient.
Finding/Results: Findings of the study are currently being evaluated, but will be complete and able to be shared by June 2017.
Conclusion/Implications/Recommendations: At the end of the pilot we hope to have achieved the following for DHW: -Creation of a standardized DIS dataset extract -Start the process of understanding impacts and opportunities on how DIS data can be used to support provincial level drug surveillance. -Developed an efficient, automated and timely process for population level collection of data -Understanding of capacity to compare drug surveillance across provinces and at a national level. -Awareness of the resource requirements for collecting drug surveillance data (in-hospital and community). The results from the pilot project will help inform the process to integrate the DIS data into the provincial data warehouse, so it can be used for purposes such as health system planning and research.
140 Character Summary: Pilot project of NS Dept.of Health and Wellness & NS Health Authority to compare Cancer Systemic Therapy data from DIS & the Cancer Registry Information System.
OS20 - Consumer Health Advances
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 205D
OS20.01 - A Personalized Risk Investigation, Stratification and Mitigation (PRISM) Health Platform
Purpose/Objectives: Chronic diseases such as cardiovascular disease, chronic respiratory disease, diabetes, and cancers are the leading causes of morbidity and mortality in the world. Also, the high prevalence of chronic diseases has led to a rise in number of people with multiple chronic disease (comorbidities), which is the co-existence of two or more diseases. The risk factors of chronic diseases are well known and established, whereby most chronic diseases share a common set of modifiable and non-modifiable risk factors. Therefore, chronic diseases are largely preventable by means of early and effective interventions that target the modifiable risk factors, such as unhealthy diet, physical inactivity, and smoking. Chronic disease risk prediction algorithms are becoming more common in healthcare and can assist individuals in evaluating their risk of developing a chronic disease. In this research, we investigate a digital health-based framework for citizens to monitor their risk for chronic conditions. Our idea is to model and computerize a range of validated chronic risk assessment algorithms and questionnaires. With personal health data as input, the model will assess the citizens risk of the common chronic diseases and accordingly categorize them into different risk categories of chronic diseases for subsequent treatment options. An important aspect of the research is to investigate the integration of multiple risk scores (for multiple chronic diseases) into a single risk scale to provide an assessment of the individuals overall health status and risk of comorbidities. We propose to develop a health-based dashboard that can provide an individual with an up-to- date account of their health status with respect to the common chronic diseases. The objective of this research is to provide individuals with the necessary tools and resources to evaluate their risk of chronic disease, risk of comorbidities, overall health status and informing them how to manage their health and modify risky behaviours to prevent the occurrence of chronic diseases.
Methodology/Approach: The process of developing the health-based web tool is based on an iterative approach and informed by evidence-based research, clinical practice guidelines, and patient-centered care models. We use a knowledge management approach to model, computerize, and integrate a number of validated chronic disease risk assessment algorithms to generate personalized health risk profiles.
Finding/Results: The result was the development of Know Your Risk health dashboard a health-based web tool for citizens to monitor and evaluate their overall health status and risk of the common chronic diseases. We plan to conduct a usability study by testing Know Your Risk dashboard with representative users to determine how they will interact with the dashboard. We will collect and analyze qualitative and quantitative data throughout the study to identify any issues of usability from a users perspective.
Conclusion/Implications/Recommendations: The overall aim of this research is to develop a digital health-based framework to support the lifetime healthcare of citizens and engaging them in proactive care to prevent the occurrence of chronic diseases. By providing the necessary tools and resources across the continuum of care, we intend to empower citizens in monitoring and managing their health.
140 Character Summary: Know Your Risk health dashboard provides individuals with the necessary tools and resources to monitor and evaluate their health status and risk of chronic diseases
OS20.02 - Design and Evaluation of an eHealth Intervention: Breastfeeding Resources
Purpose/Objectives: The purpose of this presentation is to describe the design of eHealth breastfeeding resources for mothers and co-parents, addressing the needs of target populations with lower breastfeeding rates, young and single mothers and Indigenous families.
Methodology/Approach: A participatory model was used in this two phase study. The first phase included creating an eHealth resource for mothers and fathers/partners. A needs assessment was conducted and the resource was created based on the feedback provided by the target population. The second phase of the study included designing two additional versions of the resource. Members of the target populations and health providers who work with these populations were consulted regarding their suggestions for adaptations to the original course to meet the needs of young and Indigenous families. Once the resources were completed they were piloted with members of the target populations and health professionals.
Finding/Results: In Phase 1, the resource was piloted with mothers, fathers and health professionals. The users' feedback indicated they liked the inclusion of information specifically for fathers/partners as well as the content, design and usability. In Phase 2 the modified resources were piloted with young, single and Indigenous mothers who indicated the eHealth resources were culturally relevant, interactive and provided information in a variety of formats.
Conclusion/Implications/Recommendations: <img alt="indigenous png.jpg" annotation="" id="image://12" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=add672a184bca9d47055a503712e0dbb4a688d69&id=12&width=350&height=350&download=0" title="indigenous png.jpg" /><img alt="young mothers.png" annotation="" id="image://13" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=16b526b4ac0a11558a84742b9bfc3a7bccbf2996&id=13&width=350&height=350&download=0" title="young mothers.png" />Including the target populations in all phases of the design and development of eHealth educational resources ensured they were meeting the needs of the target populations. eHealth resources provide parents with the ability to access information based on their individual needs, at a time and location of their choosing. Interactive components such as games, quizzes, narration, videos, illustrations and text accommodates parents with a variety of learning styles. Ongoing evaluation of the resources will ensure they are continuing to meet the breastfeeding and co-parenting educational needs of the target populations.
140 Character Summary: eHealth resources were designed and created based on input from members of the target populations, fathers/partners, young mothers and Indigenous families.
OS20.03 - Public Self-Reporting of Immunization Histories Using a Web Application
Purpose/Objectives: To evaluate the efficacy, usability, and accuracy of public reporting of immunization histories using a web application.
Methodology/Approach: A mixed methods approach including qualitative and quantitative evaluation tools including: · Repeated longitudinal usability studies during the development of the web application have been completed using a sampling of members of the target demographic (parents of school-aged children) using scripted use-case scenarios. · Pre and post exposure questionnaires administered to the same population sample to capture technical competency, vaccine attitudes, and impressions of the web application prototypes. · Quantitative evaluation of accuracy and completeness of submitted data from the public using synthetic personal health information from the usability scenarios. · Semi-structured interviews with different stakeholder groups including public health personnel, primary care clinicians, and parents of school-aged children.
Finding/Results: While final results are still pending, preliminary results from the ongoing usability studies indicate that many members of the target demographic are willing and able to accurately and completely report immunization histories for themselves and their school-aged dependents. Continuous testing of successive iterations of the web application have produced evidence of stepwise improvements to user satisfaction and quality of captured data. Qualitative feedback indicates a strong interest in the target demographic in such a tool and a high intent-to-use has been shown. Preliminary evaluations of submitted data show reasons for concern as some users have demonstrated difficulty interpreting and accurately transcribing technical-medical information such as immunization agents. Indicators show evidence that continuous improvement of the user interface has resulted in improved user comprehension and improved quality of captured data has followed.
Conclusion/Implication/Recommendations: The web application evaluated here shows promise to meet its objectives of providing a simple and structured tool for parents to submit immunization histories. An ongoing challenge for this project is the iterative improvements to the user interface that will help guide users to enter accurate and complete immunization histories and thus minimize administrative overhead by public health personnel who must vet submitted data before submission to the provincial database.
140 Character Summary: Can the public accurately report immunization histories using the web? We evaluate a new web application that has been developed to facilitate this in Ontario.
OS20.04 - Using Personalized Digital Health Behaviour Change to Manage Asthma
Purpose/Objectives: Digitial health interventions have tremendous potential to help patients with chronic health conditions manage their symptoms and stay on their medication regimens. For asthma patients, adherence to controller medications is a significant problem. In addition to increasing the risk of asthma attacks, lower controller adherence also increases the use of rescue inhalers resulting a series of unwanted side effects. To help patients better manage their medications, MEMOTEXT, in conjunction with PerformRX and AmerihealthDC, developed HealthNHand, a pilot digital personalized adherence and support program for asthma patients with the goal of improving adherence to daily controller medication while decreasing the need for rescue inhalers.
Methodology/Approach: Using real time data from patient self-report (inc. mood, quality of life, perceptual barriers to adherence) and objective data sources (e.g prescription claims data, real-time blood glucose levels), HealthNHand provided patients with personalized and targeted support as well as daily air quality forecasts delivered via text (SMS) message.
Finding/Results: Using this data-oriented personalization approach, controller medication adherence improved in more than 50% of patients who entered HealthNHand as poor adherers. Even more encouraging, over 80% of patients who were high rescue inhaler users prior to enrollment reduced their use while participating in HealthNHand. The program had a strong retention rate of 87.5%.
Conclusion/Implications/Recommendations: This pilot program showcases the power of digital health interventions to improve the lives of patients with chronic illnesses. The use of similar interventions,which tap into the power of patient data, in other chronic conditions should be explored as scalable, efficient ways to improve patient outcomes.
140 Character Summary: Data-centric, personlized digital health program helps asthma patients improve use of controller medications
OS21 - Adoption & Engagement
- Type: Oral Session
- Track: Clinical
- Presentations: 4
- Coordinates: 6/06/2017, 13:00 - 14:00, Room 206B
OS21.01 - Engaging Mental Health Clients/Patients in Closed Loop Medication Administration
Purpose/Objectives: Closed Loop Medication Administration (CLMA) supports client/patient safety by ensuring that they receive the right medication at the right time by scanning client/patient identification, as well as the medication to be given, prior to administration. In order to achieve a 95% scanning compliance rate as a mental health organization, feedback from all stakeholders involved in this process must be elicited. The purpose of this initiative was to implement an engagement strategy to solicit feedback from mental health clients/patients on their perceptions of the medication administration process using technology intended to promote safety.
Methodology/Approach: Engaging clients/patients provides invaluable information and insights into their experience of the use of technology for safe medication administration. To gain a genuine perspective from client/patients, a survey of 50 inpatient clients/patients was conducted by a mental health peer support worker.
Finding/Results: Quantitative and qualitative data was analyzed and then summarized by an Advanced Practice Clinician and a masters student. Themes were used to identify recommendations for improvements and innovative solutions to support the medication administration process. Preliminary findings indicate that mental health clients/patients value the nurse-client relationship, being engaged as an active participant in the process, and having choice in the client/patient identification methods. In addition, concerns about the intention of personal identification, physical comfort of wristbands, and having photos taken were raised.
Conclusion/Implication/Recommendations: Feedback was incorporated into educational initiatives for inter-professional inpatient staff, and considerations for organizational practices, policies and procedures were identified. Client/patient education material, including brochures and posters, were also developed as a means for communicating medication administration process and expectations.
140 Character Summary: An innovative client/patient engagement strategy regarding the use of technology for safe medication administration in a mental health inpatient setting.
OS21.02 - Telehealth and Medical Assistance in Dying - Enabling Equitable Access
Purpose/Objectives: In June 2016, federal legislation governing Medical Assistance in Dying (MAiD) was passed by Parliament. Patients experiencing intolerable suffering due to a grievous and irremediable medical condition may now end their life with the assistance of a qualified medical professional. However, MAiD is not immediately available in every community and not all doctors/nurse practitioners are willing or able to provide the service. The Island Health Authority has turned to Telehealth to help bridge this gap by connecting patients to appropriately qualified clinicians in other communities.
Methodology/Approach: Patients requesting MAiD need to have access to the highest standard of compassionate and respectful care, and healthcare professionals must be fully informed and supported. Every person requesting MAiD must be assessed to see if they are eligible for this service. A written and signed request must be witnessed by two independent individuals. In addition to the primary physician, a second independent physician or NP must also provide an assessment and written second opinion. Access to a secondary physician/nurse practitioner to complete the necessary documentation and assessment can be difficult in smaller communities. It may be easier for clinicians in larger urban facilities to access resources related to MAiD requests and develop proficiency in the associated processes. Given this reality, Telehealth was identified as a way to connect these providers to patients requesting MAiD in smaller centres such as Campbell River. Regardless of location, regulated Island Health healthcare professionals can act as a witness for a telehealth assessment to comply with the requirements of the process. Telehealth staff members have connected community hospital in-patients by video both at the bedside and in standard telemedicine rooms to clinicians in Victoria, across Vancouver Island, and to surrounding islands to complete MAiD assessments.
Finding/Results: Telehealth removes a significant barrier to MAiD for individuals facing end of life in rural and remote locations, or where no providers are available to support their application. Although Telehealth is accepted as part of an integrated approach to care, using it in this new, time sensitive and emotionally delicate service demonstrates the degree to which that integration has occurred. Challenges remain in terms of reliable quality video over wireless hospital networks; however, through the combined efforts of the clinical teams and the telehealth staff, those hurdles can be overcome and patients provided the same level of access to MAiD regardless of their location.
Conclusion/Implication/Recommendations: Telehealth, through the use of live video conferencing, can be used effectively to enable access for patients to MAiD where the necessary qualified health care providers may not be available in person.
140 Character Summary: Telehealth enables equitable access for Island Health patients to MAiD when qualified health care providers are not locally available.
OS21.03 - Innovative Change Management Approach to Implementing an Electronic Health Record
Purpose/Objectives: Purpose: The purpose of this proposed oral presentation is to share an innovative change management approach used to successfully support the implementation of an electronic health record in a 300 bed mental health care centre. The model is unique, based on formal stakeholder feedback and recommendations from an organizational EHR change readiness survey conducted in January 2015. The following actions were recommended to ensure effective transition to EHR Develop a robust change management strategy Creating a climate of influence and championship with leaders with particular emphasis on frontline clinical management Ongoing and innovative communication and clinical staff engagement initiatives with multiple opportunities for input from a wide variety of hospital staff Utilizing strategies to manage resistance and engage dissenters Ongoing stakeholder analysis regarding change and responding with customized interventions to build awareness and support staff Strong project structure and work plan(s) specific to the EHR change project Standardization leveraging the EHR change project as an opportunity to embed standardized change management practice in the organization The presentation will address the development and success of the change management strategies implemented by the organization in response to these recommendations.
Methodology/Approach: This innovates change support project successfully employed a unique methodology which integrated a diverse range of approaches and tools. It is intended as a pilot program which will serve as the organizational model for future change projects. This integrated approach included: Targeted application of the ADKAR model for successful change implementation Application of William Bridges model for transition as a theoretical foundation Sustained engagement with frontline clinical managers to develop their roles as transition leaders Collaborating with clinical mangers to develop and implement program specific change plans using customized tools and templates Establishing a long term change support committee, structured in sub groups to address the key components of the change project including: communication, clinical informatics, clinical manager engagement, advisory group liaison, organizational development, professional practice Establishing a large multi-disciplinary change advisory group to disseminate key information hospital-wide and support committee initiatives Integrating structured project management methodologies as a foundational element of the initiative. Integrating organizational leadership competency model adoption and training and with the change initiative Note: Because of its complexity, training coordination was considered as a separate function; independent of the change initiative.
Finding/Results: Currently, in house evaluation methods reveal a high degree of success in the EHR change process, including: 100% percent of milestones complete in the overarching committee change plan, a 100% compliance rate for program change plan development, and 25% (to date) of clinical staff being engaged in a structured change planning workshop. The formal post-survey results are expected in November, 2016. Positive indicators and opportunities for improvement will be explored more extensively in the final presentation.
Conclusion/Implications/Recommendations: The change survey recommendations provided an effective framework for an innovative EHR change plan which engaged the organization, supported staff, and project implementation. The plan will act as an effective vehicle to embed a standardized change management approach to support future initiatives.
140 Character Summary: Embedding an innovative change management approach in a health care setting using best practices developed from implementing an electronical health record.
OS21.04 - Speech Recognition Versus Traditional Transcription Model for Documentation in EMR
Purpose/Objectives: Speech recognition (SR) is a valid new technology that provides an alternative to back-end transcription services. SR facilitates dictation and editing of clinical notes in real time. Front-end dictation using SR was proposed as a quality initiative in our organization in which physician documentation is done mostly through back-end dictation. Manual transcription not only is expensive but also results in delays of hours and days that substantially affect the continuity and quality of care provided. Our objectives were to evaluate the quality of documentation and the cost effectiveness of speech recognition versus back-end dictation. In using speech recognition, we aim to align with our digital vision for better integration and interoperability of care via: Ensuring accurate, timely completion of reports by utilizing a dictation tool that has speech to text capability and integrates with our EHR. Reducing annual dictation costs. Optimizing physician productivity and satisfaction through providing physicians with a tool that easily integrates with their workflow.
Methodology/Approach: We proceeded with a 1-year pilot project which involved 115 physicians, implementing a cloud-based SR for documentation in EMR. Analysis of the quality of documentation was performed on a sample of physicians (n=38); in which 2 files per physician were reviewed pre, mid and post implementation of front-end SR using a physician documentation quality instrument (PDQI) tool to evaluate the quality of clinical notes. Physician education and one-on-one training was followed by post-live support throughout implementation. We addressed change management and adoption delivery challenges, and monitored the KPI of the software system by soliciting physician feedback and undergoing post live surveys of project success from the physician perspective. Furthermore, we addressed, documented and analyzed troubleshooting issues.
Finding/Results: Based on our initial findings there is an overall benefit in relation to documentation speed when using SR which resulted in elimination of time lag to report availability. The accuracy and completion of clinical notes improved. With the use of SR, the quality and timeliness of documentation were evident, however, the main drawback reported by physicians was the time spent on editing documents. The software performance in regard to accuracy, response time and author accent or speech impediment were favorable. Preliminary findings show a reduction in cost as a result of adoption of front-end dictation versus back-end dictation. Barriers to adoption included; prior experience with other dictation software version that had slower response time and higher error rate; fear of increase in the workload and lack of familiarity with the new process.
Conclusion/Implication/Recommendations: We conclude that SR is a potentially valuable and effective tool that improved the quality of clinical documentation and reduced the cost incurred through manual transcription. The implementation of SR in clinical practice significantly changed the clinical processes undertaken by our organization and these changes along with their follow-on effects may need to be further analyzed. The advantage to adoption of this technology must be weighted in regard to the efficiency, timeliness and the impact it has on patient safety as well as the added value it gives to the quality and continuity of care.
140 Character Summary: Speech recognition software versus back-end dictation improves quality, timeliness and the utilization of resources.
HS01 - Innovations in Community Care (COACH Session)
- Type: Oral Session
- Track: Not Rated
- Presentations: 1
- Coordinates: 6/07/2017, 08:30 - 10:00, Room 202AB
HS01.01 - Digital Health in Home, Community, and Long-Term Care
As clinicians and managers consider healthcare delivery options that extend beyond the four walls of the hospital, clinic, or other healthcare setting, new models are emerging for primary, home, community, and long-term care. Canadian healthcare providers face a unique set of challenges that include a rise in chronic disease and an aging, widely dispersed population. How do we merge care pathways across traditional sectors and settings while incorporating new care models and technologies? This one-hour session features a 30-minute presentation and 30 minutes of moderated open discussion with a focus on innovative solutions and emerging technologies as tools in the quest to provide a continuum of quality care, from in-person to virtual.
Trish Barbato, SVP of Innovation & Strategic Partnership, Revera Inc. Barry Billings, Intelligence Care Archi-tech, Saint Elizabeth Health Care Emily Seto, Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto
Rodney Burns, CIO, Association of Ontario Health Centres
HS02 - Modernizing CIHI’s Data Flow: Starting in the Community (CIHI Session)
- Type: Oral Session
- Track: Not Rated
- Presentations: 1
- Coordinates: 6/07/2017, 08:30 - 10:00, Room 202CD
HS02.01 - Modernizing CIHI’s Data Flow: Starting in the Community
This interactive panel session will highlight the work CIHI is doing to transform the way it collects data. It will provide specific examples of what is being done to change the way data flows to CIHI in our community sectors including home care, long-term care and child and youth mental health agencies.
Overall, this transformation will:
• Modernize data flow using interoperable standards such as FHIR;
• Reduce data submission burden for CIHI’s data submitters and clients;
• Increase the standardization of data across the health system;
• Ensure business processes and technologies are sustainable and efficient; and,
• Improve the ability to collect once and use many!
Greg Webster, Director, Acute and Ambulatory Care Information Services Christine Proietti, Manager, ITS Product Development Paulo Domingues, Manager, Architecture and Standards Adrian Dalloo, Manager, Home and Continuing Care, Standards and Support
Lynn McNeely, Special Projects Lead, Home and Continuing Care