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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
HS03 - Improving Access for Canadians (Infoway Session)
- Type: Oral Session
- Track: Not Rated
- Presentations: 2
- Coordinates: 6/07/2017, 08:30 - 10:00, Room 203AB
HS03.01 - Connected Care – Making a Difference
A national person-centred digital health strategy provides a framework to connect Canadians with their health and information and empower them to become active partners in their care team. In this presentation, Infoway will share evidence from existing projects on the impact digital health is making for Canadians. Insights about the benefits a national strategy can deliver and the opportunities for moving forward to enable connected care for all Canadians will also be discussed.
Cassandra (Cassie) Frazer, Program Director, Consumer Health & Innovation, Canada Health Infoway
HS03.02 - Beyond the Pen and Fax – an update on the progress of PrescribeIT™
Canada’s health system is under significant pressures that increasingly threaten its ability to provide high-quality, universal care for all Canadians. Learn about the progress to date on Canada Health Infoway’s financially self-sustaining e-prescribing service, known as PrescribeIT™. By reducing the use of paper prescriptions, PrescribeIT™ will strengthen medication management, enhance patient safety, optimize existing drug information system investments and facilitate better health outcomes.
Roberta (Bobbi) Reinholdt, Division Executive, e-Prescribing, Canada Health Infoway, CA
OS22 - National First Nations eHealth Innovations in Healthcare
- Type: Oral Session
- Track: Not Rated
- Presentations: 4
- Coordinates: 6/07/2017, 08:30 - 10:00, Room 201EF
OS22.01 - A NWO First Nations’ Dream Come True...Virtual Emergency Support Services
OS22.03 - BC First Nations Panorama Implementation
OS22.04 - 5 or 50 Megs? Stop the Madness - How to Manage Bandwidth Usage at a First Nation Health Centre
OS22.05 - Mustimuhw Peer-To-Peer Network: Community-Based Best Practice Development
OS23 - Engaging Patients Through Digital Health
- Type: Oral Session
- Track: Clinical
- Presentations: 6
- Coordinates: 6/07/2017, 08:30 - 10:00, Room 203CD
OS23.01 - Mobile Diabetes/Wound Care Self-Management in a Community Care Model
Purpose/Objectives: Wound care management is a challenge for Canadas healthcare and community home care systems. Wounds are common manifestations of several chronic conditions and can cause pain, infections, hospitalizations, and decreased quality of life. With chronic condition rates increasing by 14% annually, the burden of wound care management is expected to proliferate. It is estimated that half of the care delivered by community care involves the management of wounds. Wounds cost the system ~$4 billion annually, accounting for ~3% of total healthcare expenditures. The application of eHealth from clinical settings into community care through the unification of neoteric principles of eHealth, the dogma of community self-management care, and deep-rooted best practice guidelines can curb the growing burden of wound care management from the individual level to the systemic. Through the Registered Nurses Association of Ontario (RNAO) and Canada Health Infoway, Bayshore Home Health (Bayshore), embarked on the RNAO Nurse Peer Leader Network (RNAO-PLN) project to promote the adoption of advanced clinical e-functions to support clinician and client (patient) engagement in evidence-based wound care management. Being an innovative leader, Bayshore, with QoC Health, developed: (1) the Bayshore Client Self-Management App to empower clients to build self-efficacy/confidence to manage their diabetes and wound care, improve their quality of life, and be able to effectively communicate with their healthcare team; and (2) a Clinician Decisional Support Portal for health coaches to engage and support clients.
Methodology/Approach: The project utilized co-design (think-aloud) methodology and engaged in usability testing to gain insights to improve the usability, navigation, and intuitiveness of the solutions. QoC Healths experienced co-design facilitators, conducted the sessions, engaging with expert clinicians, Clinical Practice Leaders, strategic senior leaders and Bayshore clients. Recognizing the importance of aligning eHealth technologies to organizational practices, Bayshore extensively engaged with its Clinical Practice Leaders to develop a new service delivery model that optimally and meaningfully embeds the technology into practice and in the lives of clients.
Finding/Results: The eHealth tools will be deployed in an 8-month pilot, October 2016, with clients of the Bayshore Barrie branch. The objectives of the pilot are to improve: (1) clinician and client engagement in self-management; (2) client health outcomes; (3) clinician ability to provide proactive care; (4) client ability to identify when to seek care; and (5) health system efficiencies related to wound care management.
Conclusion/Implication/Recommendations: We anticipate the RNAO-PLN project will result in improvements to wound care management in a community care setting at both the client and systemic levels; with learnings that are easily transferable to other areas of healthcare and patient populations.
140 Character Summary: Bayshore and QoC Health created a Self-Management App and Clinician Portal to engage/support clients to manage diabetes/wound care and link with the care team.
OS23.02 - Advancing Patient Engagement in Mental Health
Purpose/Objectives: At Hospital X, we believe it is essential to both the health of individuals and their communities to fully engage patients in their mental health care. To continue to drive patient engagement forward, we have employed three strategies, including the launch of an EMR-integrated patient portal; implementation of a mobile (mHealth) experience for patients to manage their care (with actionable interventions through a secure mobile cloud technology platform); and the piloting of a virtual clinic, which will utilize e-therapy.
Methodology/Approach: HealthCheck Patient Portal was launched in December 2014, and was aimed at enhancing patient access to their personal health information. The implementation of the portal also supports the paradigm shift towards patient-driven care, evolving current practices and culture from the provider as the keeper of the information to one where the provider and the patients are partners in care. Also, we are partnering with a technology based company that offers a mobile health solution that integrates with the EMR. It will enable mobile remote-patient-monitoring and empower patients to be actively engaged It will also support predictive analytics capabilities, enabling clinicians to more proactively monitor patients and respond to changes in behaviours and assist with identifying patterns and triggers that could prompt early clinical interventions. Hospital X is also implementing a virtual clinic as an adjunct to the current ambulatory Traumatic Stress Clinic following a stepped-care approach. The virtual clinic is aimed at bridging the long wait times for this clinic with the goal of maximizing patient access to care, utilizing evidence-informed virtual treatments, while more efficiently utilizing clinical resources. The virtual clinic has the potential to target improved population health, to optimize the patient experience and increase value for money.
Finding/Results: Increased patient activation 10% decrease in missed appointments for portal users 86% reduction in portal users release of information requests, and an administrative time savings of between 10.5 and 40 hours per portal user. Mobile technology solution and virtual clinic implementation are currently underway, however expected outcomes include: Improved treatment and clinician workflow efficiencies Decreased missed appointments Improved care plans Improved patient flow and access to services(currently 247) Reduced average wait time (currently 391 days) Preliminary findings presented at the conference in June 2017.
Conclusion/Implication/Recommendations: Recommendations are centered on the development of a solid change management plan focused on the following key areas: Alignment to IS/T strategic plan and corporate goals Extensive engagement of patients and clinicians throughout all phases of the project to ensure needs are well understood and being addressed Effective communications are key to supporting patients and clinicians Engage clinicians and patients to determine current state processes and establish future state processes that will benefit and support these stakeholders Create training materials with input from patients and clinicians Generate reports that will extract evaluation metrics to allow for auditing and measure impacts and benefits
140 Character Summary: Hospital X has employed to advance patient engagement, including a patient portal; an app integrated with the hospital's EMR; and a virtual clinic.
OS23.03 - Impacts of Direct Patient Access to Medical Records: Patient Portal
Purpose/Objectives: BACKGROUND The use of electronic health records (EHR) is becoming an industry standard across the hospital sector. A central major hub for patient data, EHRs provide healthcare organizations an opportunity to enhance the delivery, accessibility and relationship of patient care. In Canada, however, patient portal access remains in its infancy as hospitals strive to complete legacy EHR system upgrades. There is little context on the direct impact of patient portal deployments on patient care and potential operational efficiencies; particularly amongst ambulatory hospitals. OBJECTIVE - This presentation aims to contribute to an understanding of how direct patient access to their medical records and an expansion of services affects the patients delivery of care, experience, provider workload, and relationship. The patient portal under review is myHealthRecord at Womens College Hospital (WCH).
Methodology/Approach: METHODS Made public on August 9, 2016, a mixed methodology will be used that includes telephone interviews, quantitative and qualitative electronic surveys, provider interviews and the extraction of modular use from system data accrued over time
Finding/Results: RESULTS To date, myHealthRecord has shown a steady rate of patient interest; 68% of patients take home an activation letter and 30% of interested patients register within five days. Despite concerns of the older ambulatory patient base, 55% of active myHealthRecord users are ?50 years old. Patients have reported higher rates of service satisfaction at WCH due to the return of lab results in a timely manner as well as their ability to contact their care team regarding post-visit questions. Inspired true events have demonstrated an enhanced quality of care leading to the timely improvement of external patient diagnoses as a result of mobile access to medical records. Overall access to medical records did not increase phone volumes nor did it lead to abusive use of medical advice requests to the care team. On the contrary, 148 request have been sent since August 9th accounting for 2386 patients; averaging 0.06 a message per patient. Providers have mentioned no impact of their workload or administrative practices. In light of the patient portal, providers and administrators have shown a positive reception to automated pre/post appointment instructions and after visit summaries.
Conclusion/Implication/Recommendations: CONCLUSIONS Patient Portals are an effective and powerful tool to enhance the delivery of care and improve patient outcomes. Often being defined as a tool for the patient, patient portals offer outcomes that not only enhance the patient care experience, but also how hospitals can drive the delivery of patient care through improved services, workflows and processes. Patient enrollment only goes as far as the portals ability to satisfy gaps and needs in everyday patient care delivery model; lending ongoing value to the patient, providers and organization. Strategies to expand portal services through eCheck-In, eVisits/eConsults, eReferral and ePrescribing will deliver the tools necessary to create a self-sustaining patient portal; consequently improving patient access, enrollment and most importantly, patient care for years to come.
140 Character Summary: Andrew is a Clinical Project Coordinator for Womens College Hospital; currently leading the roll-out of their patient portal and eReferral solution.
OS23.04 - Patient Engagement Strategies for Self-Management of Wound Care: Comparative Analysis
Purpose/Objectives: Increasingly, healthcare providers understand that patients with chronic conditions derive great benefits from being actively engaged in their care. And, patients feel empowered when they have the knowledge, skills and confidence to self-manage the physical and emotional aspects of their chronic conditions. Engaging patients and assisting them to actively participate in their care is known as self-management support. While it is recognized that healthcare providers should promote patient engagement to facilitate self-management support, this has not been integrated into clinicians routine practice in Canada. This presentation will share the strategies taken across two varied healthcare settings, (i.e. community care and ambulatory care) to optimize patient engagement and self-management support for individuals with diabetes-related foot ulcers with the common objective of promoting earlier wound healing. It will also discuss the results of a comparative analysis of the findings from each setting and the lessons learned.
Methodology/Approach: Both healthcare organizations integrated evidence-based wound care order sets related to the assessment and management of people with diabetes-related foot ulcers within their health information system. In addition, they each implemented strategies to engage patients diagnosed with diabetes-related foot ulcers and provide supports to facilitate their self-management of their condition. Patients in the ambulatory care setting used a web-based tool to assess their knowledge of diabetes and foot care and to identify self-management goals in collaboration with their healthcare provider. They used an electronic goal calendar to track their progress over time. In contrast, patients in the community care setting used a wound care App to identify self-management goals in collaboration with their health coach and to track their progress. Patients were able to communicate with their health coaches through the App, as needed.
Finding/Results: There was successful adoption of the evidence-based order sets in both care settings by more than 300 clinicians. The order sets facilitated knowledge translation and evidence-based decision-making at the point-of-care resulting in reduced variation in wound care management at each site. Preliminary results from the participating organization suggest that there was a significant difference in the patient experience of the self-management support in both settings resulting from the differences in the technology and the accessibility of the health coaches. Overall, the order sets improved efficiency in wound care management and the patient engagement increased self-management support for patients with diabetes and foot ulcers.
Conclusion/Implication/Recommendations: This initiative highlights the significance of implementing evidence-based wound care order sets and the benefits of patient engagement strategies that facilitate self-management of chronic conditions across multiple healthcare sectors. The evidence-based order sets optimized wound care management while patient engagement was facilitated through technology that empowered them to self-manage their conditions.
140 Character Summary: This presentation compares technology-enabled patient engagement strategies aimed at increasing self-management in individuals with diabetes and foot ulcers.
OS23.05 - Who’s the Optimal Candidate for Remote Patient Monitoring?
Purpose/Objectives: Remote patient monitoring (RPM) is a healthcare intervention that aims to improve the management of chronic diseases where information and timely access can improve healthcare as well as reduce system costs by eliminating unnecessary 911 calls and emergency room visits. One of the greatest challenges of a remote patient monitoring (RPM) program is to identify patients who are the best candidates for the technology, patients that will respond well and enable the most benefit. Research focused on value-based approaches to care, such as the Center for Connected Health Policy and the University of Mississippi Medical Center in the United States, have recognized patient identification as an important part of RPM and are leveraging predictive analytics to identify optimal candidates but do not have an answer yet. The Community Paramedic Remote Patient Monitoring program (CPRPM) has used the aggregate data of patients to explore the impact of specific patient characteristics (e.g., age, gender) as well as aspects of RPM training and education that drive better outcomes for patients as well as savings to the health care system.  http://m.healthcareitnews.com/news/ummc-pinpoints-ideal-patients-remote-monitoring-predictive-analytics-artificial-intelligence?mkt_tok=eyJpIjoiWW1ZMU16bGxabUptWVRkaiIsInQiOiJKcnk2YmlcL3hHbTVtTWdGQ1BWMjIyM1E0YmIwKzUxZVhMXC9vZTRVbk0wbjR6VFcxelZsSXc4VWIzaGx0RkJFUUhJV0hDRnV6Z3hHR2t5YlNxdW1jWHcyajRidnl0b3hqS3B3dnR4aDVGU0Y4PSJ9
Methodology/Approach: Data for the study was gathered from three administrative datasets. First, Interdev is a private firm that provided information about the number of 911 calls made by patients on the program, and the number of patient transports to the ER. Patient enrollment forms were used to gather demographic data, namely age, gender, and community. Finally, daily readings from patients remote monitoring devices were used to measure number of alerts and compliance rates. Although the study is ongoing, Wave 1 analysis of 79 patients and over 600,000 patient device readings and alerts is complete. Transcripts from interviews with 15 paramedics across seven communities was also used to understand the impact of RPM training and education.
Finding/Results: Our research team specializes in the study of 911:Tranport conversion rates. Our conceptual approach is developed from the perspective that RPM should inform and educate patients to call 911 only when appropriate that is, when they actually need to be transported to the hospital. Our preliminary results show that overall the RPM program increased the conversion rate; however, perhaps more interesting is that patients that were 100% compliant in using the technology had significantly higher conversion rates than patients that were less compliant. As illustrated in the graphs below, compliance rates in using the devices (specifically scale and blood pressure cuff) significantly vary across communities. Our team is currently exploring results further by examining the impact of patient characteristics (e.g., age, gender etc.) as well as provider support and training on conversion rate improvements.
Conclusion/Implication/Recommendations: Our research provides evidence that the ability to select the best candidates for a RPM program will significantly improves both patient and system outcomes. Although RPM has its benefits, it is possible that this approach to care is not for everyone. Knowing what patients are most likely to generate the most value will make RPM programs more efficient.
140 Character Summary: Developing accurate selection tools that identify optimal patients charateristics is critical for a successful and sustainable remote monitoring program.
OS23.06 - Patient Collaboration to Develop a COPD Home Health Monitoring Protocol
Purpose/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission and re-admission (1) and is predicted to become the 3rd leading cause of death worldwide by 2030 (2). Home health monitoring (HHM) in Island Health has been shown to improve client self-management and decrease hospital visits and costs for the heart failure population. Island Health is expanding HHM services to the COPD patient population and set out to develop the COPD monitoring protocol to define the questions, biometrics, and educational messages that will be presented to patients in their home, through the HHM technology. Patient engagement into the design of the COPD protocol was identified as a critically important factor. Objectives for patient engagement were to: · help ensure that patient ideas and perspectives were considered and reflected in the COPD protocol · enhance the usability of the COPD protocol, and · promote a positive client experience with the HHM solution and HHM service. 1. CIHI All-Cause Readmission to Acute Care and Return to the Emergency Department, 2012 2. The Lung Association of British Columbia, Nov 2013. https://bc.lung.ca/news/media-releases/treatable-manageable-radically-under-diagnosed-%E2%80%93-what%E2%80%99s-problem
Methodology/Approach: The COPD monitoring protocol was developed as follows: 1. Project team developed a first draft HHM COPD protocol based on national and BC clinical practice guidelines. 2. Respiratory therapists and community chronic disease nurses worked with the HHM Coordinator and project team to refine the COPD protocol. 3. The Patient Voices Network and the Lung Associations Better Breathers Club helped to identify 5 patient partners to participate in usability testing. 4. Patient partners participated in an orientation telephone call to prepare them for the usability test sessions. 5. Usability tests were conducted and recorded using visual mock-ups of the draft protocol and patients were guided to think out loud as they were stepping through the COPD protocol. 6. Patient partners also participated in a two-week usability trial for the pedometer device that was being considered for use in the COPD protocol. 7. Respirologists were engaged to review and provide final approval for the HHM COPD protocol.
Finding/Results: Patient feedback, and comments were summarized and consolidated, and reviewed with the project team. Suggestions and edits to improve the wording of questions and education messages were incorporated into the final version of the COPD Protocol. Patient partners consistently reported that the protocol questions and educational messages were meaningful and important for self-management of their COPD condition.
Conclusion/Implication/Recommendations: Collaboration with these partners has been highly valued by the project team. Patient partner contributions are anticipated to promote positive COPD client experience and outcomes. Patient partners have expressed excitement about the new COPD service and their intention to promote it to friends and others in their network.
140 Character Summary: Patient partners were engaged into the development of the COPD monitoring protocol to promote optimal usability of the protocol and a positive client experience.
OS24 - Evolving Approaches to Patient Care
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 201CD
OS24.01 - Giving Patients the Power to Manager Their Health
Purpose/Objectives: A survey found that 72 percent of global leaders believe empowered patients create better value care[i] and, research tells us that patients who are less engaged cost the health system from 8 to 21 percent more than those who are engaged[ii]. With patients today playing a more active role in their own healthcare than ever before, access to personal health management tools and information are motivating people to be more proactive about their health and wellness goals. In a world where ubiquity of the Internet and powerful smartphones are transforming business models and entire industries, Personal Health Records (PHRs) can play a significant role in empowering patients to better manage their health. This presentation will illustrate how Personal Health Records empower people with the ability to access and manage their health information anywhere, anytime. [i] Impact of Home Health Monitoring on Clients with Heart Failure. Cheryl Beach, BSc(PT), MSc, PhD; Oluseyi Oyedele, BSc, MSc, PhD, MPH; Dion Bedard, BSc; Mark Lazurko, BSc(Pharm), MBA, 2014
Methodology/Approach: As the emphasis on managing chronic conditions and improving health and wellness, not just sick care, gains mainstream acceptance, its reasonable to expect that the use of digital tools and services to monitor and manage health are set to grow. This presentation will discuss how the use of Personal Health Records contributed to improving healthcare, to increasing engagement and empowered people to take greater control of their own health. We will also discuss how a patient-centred approach to healthcare delivery provided patients more control over and responsibility for their own health.
Finding/Results: Providing patients, and citizens, the ability to manage and view their health data place and proactively share this information with their healthcare providers results in better quality of care. By leveraging a pilot program, the roll-out of the PRH resulted in enhanced communication between patients and their doctors and other care providers, and empower patients to be an integral participant in the process, better managing their health conditions, and ideally, preventing illness.
Conclusion/Implication/Recommendations: By leveraging technology, and digital health tools such as a Personal Health Record, a patient-centred approach to healthcare delivery engages patients, and citizens, and ultimately, drives better health outcomes for all Canadians, for less money spent.
140 Character Summary: How access to personal health management tools and information are motivating people to be more proactive about their health
OS24.02 - The Last Clinical Mile of Precision Medicine – Challenges at POC
Purpose/Objectives: Medical history is notable for game-changing breakthroughs. Germ-destroying sterilization. Miracle drugs like penicillin. Lifesaving organ transplants. Precision medicine is equally revolutionary. It signals a significant shift from generalized medicine the traditional one-size-fits-all and trial-by-error approachto personalized medicine with testing and treatments tailored for individuals. But barriers exist. The most significant? The gap between genomic information and its timely, meaningful application at the point of care. Today, the science of genomics occurs in labs (blood, tissue testing), research facilities (omics, sequencing), pharmaceutical companies (biomarkers for specific drug efficacy) and clinical trial programs. But, its not accessible in actionable, meaningful clinical terms; nor is it structured and harmonized with the clinical context of the patient. And it is not available in the current workflow of the clinician.
Methodology/Approach: Up until now, medical knowledge and therapies were tested on broad populations and prescribed using statistical averages. And that meant they would work for some patients but not for many others. The potential result? Diagnosis and treatment delays or inaccuracies that might have catastrophic impact. Precision medicine factors genes, environment, lifestyle factors and family history into all clinical decision-making for earlier, accurate diagnoses, and more effective treatment and prevention. In other words, precision medicine overcomes the limitations of traditional health care by taking individualized factors into consideration. Clinicians are able to analyze the potential diagnosis, match and tailor the right treatment, and review the efficiency of current protocols.
Finding/Results: Here are just a few reasons why precision medicine is taking center stage in health care today: a. *Patients 9 out of 10 causes of death are influenced by genetics. b. Providers 30% reduced ED vists by applying molecular profiling treatment strategy. c. Payers - $25 billion annual spending on genetic tests by 2021. d. Pharma - $7.5 billion will be the size of the pharmacogenomics market by 2017. e. Government* - $215 million: President Obamas precision medicine initiative investment.
Conclusion/Implication/Recommendations: As physicians, we want to offer the best possible care plan for every patient, every time. When treating conditions, such as tumors or inherited diseases, we want tools that help us incorporate the many factors that affect each individual. This is where precision medicine comes in. As defined by the National Institutes of Health (NIH), precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person. The good news for patients today is that there is an increasing number of genetic diagnoses, while at the same time, the costs to sequence a human genome are dropping. We are in a better position than ever before to tailor medicine to the individual. For the first time, were seeing some alignment on the importance of precision medicine. All of these stakeholders are coming together to help realize the promise of genomic knowledge. When delivered at the point of care, precision medicine will have the greatest impact.
140 Character Summary: Precision medicine is revolutionary for healthcare and is taking center stage with patients, providers, payers, pharma, and government.
OS24.03 - Mental Health Coaching Using Cloud-Based Education and Behavioural Monitoring
Purpose/Objectives: Seventy percent of mental health problems appear before the age of 25 years. When untreated, these disorders become long-standing and significant, impairing all life domains. Although the problem is especially acute for youth from Indigenous and First Nations backgrounds, it is acute for all Canadian youth as 15-25 years is the most likely age-span for diagnosable mental health problems substance dependencies and suicide. For example, substance dependency and suicide are the 1st and 2nd most frequent causes of college and university student mortality. Cognitive behavioural therapy (CBT) is the best-validated psychotherapy, with proven effectiveness resulting in CBT being offered free-of-charge by the United Kingdom National Health Services. In recent years, CBT has been integrated with mindfulness meditation (e.g. mindfulness-based CBT), with strong evidence supporting its effectiveness. Research undertaken with student populations by our group has demonstrated psychometrically and neurophysiologically assessed benefits in web-based Randomized Controlled Trials of CBT-Mindfulness interventions. This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) with youth subjects (18 25 yrs) diagnosed with major depressive disorder.
Methodology/Approach: Two treatment groups (youth of Indigenous-First Nations background, youth of all other ethnic backgrounds) will be compared with wait list controls (50% Indigenous- First Nation, 50% other background) at baseline, 3 months (mid-intervention) & 6 months (post-intervention), using valid, standard self report outcome measures. Experimental subjects will receive additional intervention consisting of a mindfulness-based CBT online software program workbook (in collaboration with NexJ Health Inc.). Exposure to and interaction with the online workbook is combined with health coaching (duration of 24 hours) primarly delivered in phone/software interactions. Participants and health coaches will plan one face-to-face session per month. Content builds on two prior successful web-based CBT-mindfulness RCTs with students (Radhu et al., 2012 Arpin-Cribbie et al., 2012) and methods demonstrated effective in prior RCTs in other countries (Boettcher et al. 2014, Carlbring et al., 2013, Lappaleinen et al., 2014). The online workbook content consists of 24 chapters that cover multiple topics (e.g. Living By Your Truths, Overcoming Wired-ness and Tired-ness, Mindfulness and Relationships, Loss and Grief, and Resilience, Befriending Ourselves, Befriending Your Body with Exercise, Body Image and Mindfulness, Intimacy, Forgiveness, Overcoming Procrastination, Dealing with Negative Moods, Stress Resilience, Overcoming Performance Anxiety, Cultivating Inspiration) which are covered in sequence on a weekly basis with the health coach (over 24 weeks).
Finding/Results: Hypothesis: CBT-MM online intervention will be associated with statistically and clinically significant between-group differences (benefits) when treatment groups and control group are compared, using both intention-to-treat and per protocol analyses. Costs and cost-effectiveness of CBT-MM online intervention will compare favorably with office-based CBT services. Outcome Measures: Primary outcomes: Beck Depression Inventory; Secondary outcomes: Anxiety (Beck Anxiety Inventory), depression (Quick Inventory of Depressive Symptomatology) (QIDS), mindfulness (Five-Facet Mindfulness Questionnaire), pain (Brief Pain Inventory).
Conclusion/Implication/Recommendations: If significant differences are obtained, this will be a substantial advancement in our ability to offer high quality interventions without geographic restriction.
140 Character Summary: This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) for youth diagnosed with major depressive disorder.
OS24.04 - Computer Based Training for Cognitive Behavioral Therapy (CBT4CBT)
Purpose/Objectives: Created by Dr. Kathleen Carroll at the Yale School of Medicine, CBT4CBT is a revolutionary new substance abuse treatment program that is currently being rolled out in the United States. Introductory trials conducted among urban populations in major US cities have demonstrated CBT4CBTs effectiveness in providing a meaningful treatment option for challenging populations at moderately low cost and with lasting effects. A recent collaboration between Dr. Carroll and Drs. Juergen Krause and Michelle Patterson of the Centre for Health and Community Research (CHCR) at UPEI will bring this innovative treatment program to Canada for the first time. Using Prince Edward Island as a gateway, CBT4CBT is currently being implemented and evaluated in sub-populations of high-need individuals as part of a CIHR funded pilot and will subsequently be rolled out across Canada.
Methodology/Approach: The pilot program aims to determine the effectiveness and efficacy of this computer-based treatment option for addiction therapy within specific rural Canadian populations. This trial utilizes a similar methodological approach as the trials performed in urban communities of the United States, with participants at each trial site being randomly assigned to one of two groups, both including treatment as usual (standard counseling) but with one group additionally having access to the CBT4CBT tool. This simple add-on design has been shown to be effective at determining the extent to which CBT4CBT confers specific benefits over current standard practices.
Finding/Results: CBT4CBT is offered at trial sites in PEI and New Brunswick which have been selected as representative of high-needs populations who may benefit from improved addiction treatment options and support. The trial populations include First Nations, youth (age 18-24), post-secondary students, individuals maintained on methadone, and individuals transitioning out of inpatient facilities. Preliminary results from each of these populations will be discussed.
Conclusion/Implication/Recommendations: A larger-scale implementation of CBT4CBT across Canada will offer an innovative and in-demand therapeutic option for individuals struggling with substance abuse. A roll-out plan for the implementation of CBT4CBT across Canada is under development, and a list of priority revisions and enhancements for future iterations the program is being established and compiled.
140 Character Summary: CBT4CBT is currently being evaluated in sub-populations of high-need individuals as part of a CIHR funded pilot and will subsequently be rolled out across Canada.
OS24.05 - Achieving Quality in a Telemedicine Program – Engaging Referring Physicians
Purpose/Objectives: The Excellent Care for All Act formalized the quality improvement activities of all the hospitals. At St. Michaels Hospital (SMH) continuous quality improvement that focuses on patients has been an integral part of its rich history of providing excellent and compassionate care. In alignment with St. Michaels Hospitals culture of quality improvement the Telemedicine Program strives to implement at least one quality improvement initiative each quarter. This poster will demonstrate a Telemedicine Programs quality improvement initiative focusing on access to specialty care. SMH Telemedicine Program initiated the Respirology Telemedicine Clinic services in 2011 in response to referrals received from physicians in remote Ontario communities. The SMH Respirology telemedicine clinic provides consultation for a broad range of respiratory conditions such as COPD, interstitial lung disease, pulmonary nodules, and asthma. The SMH Telemedicine Program is now interested in knowing if the needs of the referring physicians are being met. The aim is to understand how the SMH Respirology telemedicine service is impacting the referring physicians daily practice. More specifically- does telemedicine affect their workflow and how they manage their patients respiratory conditions? Further, we want to assess the extent of impact of Respirology Telemedicine clinic services, which in turn will guide our efforts to provide the best possible services.
Methodology/Approach: In the past 5 years the Respirology Telemedicine Clinic has received referrals from over 30 Physicians from various communities across Ontario. To assess the efficiency and overall satisfaction with the service, the Respirology Telemedicine Clinic Referring Physician Survey was developed. All the physicians who had referred patients to the Respirology Telemedicine Clinic during the past 5 years were invited to participate in the survey.
Finding/Results: At the time of submitting this abstract the results from the surveys are still being collected. The analysis of the survey results will be available for the poster.
Conclusion/Implications/Recommendations: The SMH Telemedicine Programs initiative to engage with the referring physicians is in alignment with St. Michaels Hospitals commitment to continuous quality improvement. The Respirology Telemedicine Clinic Referring Physician survey results will provide us the referring physicians perspective and will help us to make improvements to our services. The SMH Telemedicine Program plans to roll out this quality improvement initiative in other programs like Geriatrics, Vascular Surgery etc. in the following year.
140 Character Summary: This poster presentation will describe a quality improvement initiative by a telemedicine clinic in a large academic health center.
OS24.06 - Dashboards Driving Quality: A Focused Example Using Suicide Risk Assessments
Purpose/Objectives: The Centre for Addiction and Mental Health (CAMH) is Canadas largest mental health and addictions facility. A strategic priority for CAMH is the promotion of safety, with a particular focus on the prevention of violence directed at self or others. A critical component of this strategy is focused on suicide risk prevention, with the expectation that all inpatients are screened for suicide risk within 24 hours of admission. At the time, available reporting tools were unable to communicate compliance and quality data to stakeholders, resulting in low compliance and accountability in assessing patients. Accordingly, a dashboard to monitor changes was developed as a resource to access just in time compliance data to ensure assessment completion.
Methodology/Approach: This performance management initiative involved four phases; beginning with quality assurance audits. Phase two involved working directly with stakeholders to determine what information would be clinically meaningful. Phase three focused on the development of a manual report which provided weekly data to Managers, allowing for monitoring of compliance rates over time. The final phase of the project included the development of an online dashboard with just in time completion rates, providing flexibility for comprehensive analysis.<img alt="image1 sra ehealthj.jpg" annotation="" id="image://21" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=0f336be8c9cf7736527856f012e5bf6593aa3496&id=21&width=350&height=350&download=0" title="image1 sra ehealthj.jpg" />
Finding/Results: In the second quarter of 2015/16, SRA compliance was significantly below the target of 90%, at 78% completion. The aforementioned dashboards were designed in Q3 and implemented in Q4 of 2015/16. Following dashboard launch, a increase in compliance was observed the following quarter (94%), and has remained above target since that time. <img alt="image2 sra ehealthj.jpg" annotation="" id="image://22" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=723007530ad2f64a8ba75ad354a1986a385bca8a&id=22&width=350&height=350&download=0" title="image2 sra ehealthj.jpg" />
Conclusion/Implication/Recommendations: This dashboard empoweres CAMH to set new standards in safety and meaningful reporting. By aligning strategic priorities with enterprise reporting, CAMH provides stakeholders the opportunity to push measurable improvement initiatives within their areas. Future integration of agreed best practices will expand these dashboards beyond compliance, into care planning and driving a higher quality of care for CAMH patients.
140 Character Summary: A performance management approach focused on increasing suicide risk assessment compliance rates through clinical engagement and implementation of dashboards.
OS25 - Connecting Care: Virtual Realities
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 201EF
OS25.01 - Telehealth Brings Oncology Care Closer to Home in Northern BC
Purpose/Objectives: In the fall 2012, British Columbia Cancer Agency (BCCA) opened its 6th Regional Cancer Center in Prince George to serve cancer patients in northern BC. Due to its expansive geography only one third of northern cancer patients live near the Center for the North, leaving two thirds who need to travel, at times quite a distance, for their care. Having already recognized benefits of telehealth at BCCA, the Centre was built to provide oncologic consultations and follow up care remotely, where appropriate, over videolink technology. Today the Centre connects nine Community Oncology Network clinics across the north as well as 25 other telehealth stations located in smaller community clinics. Patients are seen by videolink at one of these 34 locations, using the broad variety of clinical supports in place in each location. The purpose of this project was to examine utilization of Telehealth technology for oncology services in Northern BC over the first four years of Centers existence, including utilization trends and a qualitative assessment of the benefits and limitations of the use of this technology for our patients and our clinical team.
Methodology/Approach: Telehealth utilization data was obtained for the Centers first three years of operations. Trends over time were examined and compared to utilization in other regions of the province. A qualitative assessment of this telehealth services from the both patient and clinician perspectives is currently underway.
Finding/Results: Northern BC has experienced almost 300% growth in videolink oncology services since the Centre opened. While there has been growth in all BC Cancer Agency Centres, the north represents the fastest adoption of telehealth-enabled clinical services in the province. Telehealth offers clear advantages for patients including the ability to receive care close to home and family, avoided travel costs and increased safety by avoiding travel-related risks, particularly during winter months. Patients increasingly request this service. There are also clinical scenarios and conditions that do not lend themselves to remote care, where the best approach requires in-person assessment or aspects of physical presence. It has been recognized that optimizing multidisciplinary care for patients having Telehealth oncology assessments improves patient assessment, decision making, education, and safety.
Conclusion/Implication/Recommendations: Telehealth Oncology Care in BCs north is a rapidly growing method of service delivery with clear benefits for our patients. Ongoing assessment and development of this program is underway to optimize patient care and safety. Findings will inform the implementation of other telehealth-enabled provinical clinical programs in BC.
140 Character Summary: BCCA incorporates telehealth in day to day oncology services. We will present qualitative and quantitative insights underlying successful adoption in the North.
OS25.02 - Child and Adolescent Psychiatry Delivered to the Inuit of Nunavut
Purpose/Objectives: Participants will hear and discuss learnings on service delivery from a Physician perspective on how models of care are evolving to address unique cultural, environmental and societal factors. Participants will have a clear understanding of the clinical needs and requirements in serving Inuit populations. Understanding program management perspectives on the funding, technical and contractual requirements needed when developing agreements and launching services with remote communities, regions and governments will be discussed. The experience from the recipients perspective will be presented through presentation and discussion of the territories, the communities and individual clinician needs and requirements. Participants will leave with a better understanding of programmatic needs, clinical requirements and cultural competencies needed when creating a sustainable long term partnership for the delivery of Psychiatric care with Aboriginal and Inuit partners.
Methodology/Approach: Nunavut is Canadas newest Territory, home to the Inuit people who have inhabited Nunavut our land over 1000 years. In the last 100 years this region has seen its greatest changes. Mental health issues such as Developmental Trauma, Suicide, Isolation and Addictions are exploding in most communities. Suicide rates for Inuit are among the highest in the world at 11 times the national average, rates for young Inuit men are 28 times higher. (Mental Health Commission of Canada, 2012) Aboriginal and Inuit people have a holistic view of mental wellness, a state of balance with family, community and the larger environment. European models of treatment that remove the person from their surroundings tend not to work. (Khan, 2015) Estimates suggest 30 to 40% of children in out-of-home care are Aboriginal, yet Aboriginal children represent fewer than five per cent of children in Canada. (Mental Health Commission of Canada, 2012) Despite this, there are experiences of collaboration, creativity and empowerment that are leading to successful outcomes for patients and families.
Finding/Results: Through video conferencing technology Child and Adolescent Psychiatry was introduced to the Territory in 2013, partnering remote nursing stations, mental health teams, nurses and physicians to psychiatric expertise in southern Canada. Clinical assessments, capacity building and education are tailored to each community and clinician group to increase skill sets and support the continuum of care for patients with the goal of allowing patients and families to remain their community.
Conclusion/Implication/Recommendations: Video conferencing has opened pathways to care previously non-existent within the territory. Relationship development, capacity enhancement, knowledge translation and communities of care are being supported across the territory allowing children and youth to remain in their communities while recieving specialist services. This partnership between Sickkids and the Government of Nunavut has opened the door to further expansion of clincial services delivered through technology to communities and health care organizations. Mental health workers are connected to leading Psychiatrirst as they support families who have historically been shut out of the health care system in Canada.
140 Character Summary: Technology has enabled the delviery of specialized mental health services to the Inuit of Nunavut creating pathways to care for families, children and clinicians
OS25.03 - Home Health Monitoring Implementation in BC: Lessons from TEC4Home
Purpose/Objectives: The Telehealth for Emergency-Community Continuity of Care Connectivity via Home monitoring (TEC4Home) project aims to demonstrate that home health monitoring supports safe discharge of patients with heart failure (HF) from hospital to home and fosters high quality convalescence, thereby reducing emergency department (ED) revisits, and improving patients quality of life. This abstract focuses on the change management approach and lessons learned to date as TEC4Home is implemented within a health authority.
Methodology/Approach: TEC4Home is a four-year study funded by Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and BC Ministry of Health. It is led academically by UBC Emergency Medicine, clinically by Vancouver Coastal Health/Providence Health, with industry partner TELUS Health. Partnerships include Cardiac Services BC, HF clinics, Vancouver Division of Family Practice, and diverse clinical disciplines. Issues, emergent principles, and lessons learned have been documented from the outset of the project.
Finding/Results: We highlight *four* fundamental lessons learned: 1. Distributed Leadership. It was important to start with highest levels of leadership within organizations involved. Each organization provides necessary leadership in its domain, but individually is insufficient to advance health system change. Diffusion of leadership within each organization was necessary to link management to operations. Early engagement of leadership ensured commitment and participation in TEC4Homes governance. 2. Harmonized Language. To facilitate communication across organizations, we used three terms to organize the projects key components: a. Model of Care is the set of activities outlining clinical patient inclusion criteria, workflows, care practices, and clinical operations team engagement required to implement TEC4Home. The model of care was developed with the support of clinicians and patients. b. Model of Technology is deployed to track patients biometrics, facilitate patient education, and self-management. It includes Patient Station, Biometric Measurement Hardware, and Monitoring Nurse Station. Synchronizing components requires collaboration of technical experts, clinicians, patients and family members. c. Model of Research establishes a rigorous approach to evaluate clinical outcomes, experience, and cost factors. This requires leadership of clinical trialists and diverse evaluation expertise to ensure robust measurement of clinical, economic as well as social-behavioral outcomes and processes. 3. Realization of Shared and Individual Aspirations. Introducing innovation into the health system presents opportunities and challenges. Understanding pain-points and aspirations of each stakeholder group is vital to achieve mutual understanding and co-created goals. Using the three models was an effective foundation for dialogue to reconcile diverse perspectives. Formation of clinical, technical, steering, and evaluation subcommittees created necessary spaces to enable contributions from diverse partner organizations. 4. Patient Involvement for Clinical Innovation. Having HF patients and family caregivers involved on all committees from the outset ensured clarity, focus, and practicality. A dress rehearsal with patient representatives was instrumental in refining project workflows. Understanding the patient journey was essential in defining the model of care.
Conclusion/Implication/Recommendations: TEC4Home is a context in which cross-sectoral collaboration can be explored, documented and enabled while contributing to patient care through the services of a monitoring nurse facilitated by home health monitoring technology. This work is submitted on behalf of the TEC4Home Health Innovation Community.
140 Character Summary: Implementing home health monitoring in hospital-community transition 4 key lessons
OS25.04 - New Models of (Telehom) eCare: Diabetes, Mental Health and CKD
Purpose/Objectives: The success of Telehomecare - a self-management program for patients with CHF and COPD that includes remote patient monitoring (RPM) and health coaching - has prompted the Ontario Telemedicine Network and key healthcare sector partners to explore new innovative models of care for three new groups of patients with diabetes, mental health and chronic kidney disease (CKD). Three virtual care applications have been selected for pilot testing in Ontario based on their potential for province-wide applicability and sustainability. This panel presentation will include perspectives from researchers, clinicians and healthcare program administrators, reflecting the experience of implementing these new programs for approximately 1,400 patients. The first initiative is evaluating the impact of a mobile application (an FDA-approved mobile prescription therapy) shown to improve self-management and lower HbA1C among individuals with Type 2 diabetes across different diabetes centres located in three cities. The second initiative is evaluating the innovative use of a social media-based platform already extensively used in the UKs National Health System. With long waitlists for mental health services, this new model of care will be able to support individuals from their home on a 24/7 hour basis. The initiative is focused primarily on people with a diagnosis of anxiety and/or depression. Patients are selected from a number of mental health programs and the emergency department, from three different hospitals in Ontario. The final initiative leverages an Ontario-based mobile application to help patients stay in their home by providing RPM support for individuals with CKD receiving in-home peritoneal dialysis. Providing access to care in the home and the community for diabetes, mental health and CKD can both enhance the management of chronic illness and patient well-being and significantly bend the cost curve for these conditions. The pilots, which are funded by Canada Health Infoway and the Ontario Ministry of Health and Long-Term Care, run until June 2017.
Methodology/Approach: All three of the pilot projects are being evaluated by the Womens College Hospital Institute for Health System Solutions and Virtual Care using a mixed-methods approach, combining the rigour of a quantitative trial with in-depth qualitative assessment, aiming to answer three key questions: 1. How does it work? (Realist Evaluation) 2. How is it implemented? (Consolidated Framework for Implementation Research) 3. What is the impact? (RE-AIM Framework) Also integrated is the Institute for Healthcare Improvements Triple Aim, focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs, thereby informing a sustainability model on a provincial scale.
Finding/Results: Metrics include clinical outcomes such as improved control of risk factors, decrease in symptoms, improved person-reported health status, as well as reduction in hospital admissions and ER visits, and patient and provider satisfaction with the experience and the technology.
Conclusion/Implications/Recommendations: The process of implementing healthcare interventions is complex and context-dependent. The evaluation project results and experiences will be shared first hand. Discussion will look at how these new models of Telehomecare will lead to improved value for individual patients and the broader healthcare system.
140 Character Summary: New Models of (Telehom)eCare in Ontario: Diabetes, Mental Health and Chronic Kidney Disease
OS25.05 - PHI Sharing at the Grassroots: A Shared EMR Project
Purpose/Objectives: Efficient and effective sharing of personal health information (PHI) is recognized as a key enabler of health system integration a core principle of such initiatives such as Ontarios Patients First plan. Regional and provincial PHI-sharing initiatives are intended to support this integration, but may not accommodate the needs of every health care organization. If an organization believes that existing initiatives cannot support its specific care model, where can it turn? The Temmy Latner Centre for Palliative Care (TLCPC) and Toronto Central CCAC (TC CCAC) answered this question while looking for a PHI-sharing solution to their palliative care services - when they realized that they could use TLCPCs existing EMR solution as an information sharing platform. But what should a small, resource-constrained organization have in place to share its EMR? TLCPC and TC CCAC knew that it would take more than just creating new user accounts. For organizations working at the grassroots level, the shared use of an EMR presents clear benefits, as well as challenges around such issues as service provider responsibilities that TLCPC is still working to answer.
Methodology/Approach: TLCPC physicians provide in-home palliative care as part of a care team that includes providers from TC CCAC. TLCPC developed a collaborative care model for in-home patients with complex care needs, to enhance care team communication, and assure patients that they were receiving coordinated health care. But TLCPC and TC CCAC still saw barriers to care team collaboration, which could likely be overcome through more effective information sharing. TLCPC settled on a modest approach: its own EMR. In collaboration with TC CCAC and MD+A Health Solutions, TLCPC developed a business model and shared policies for the use of its EMR and, with substantial project support from TC CCAC, launched the pilot phase in of the Shared EMR Project in summer 2016.
Finding/Results: The pilot phase has met TLCPCs and TC CCACs expectations: care team members seamlessly exchanged high-quality patient information in a timely manner, enhancing care team integration. TLCPC and TC CCAC identified opportunities to expand the in-home care model beyond palliative care, to patients with chronic disease. The project has also presented challenges: the privacy obligations of project participants were not clear at the start of the project, and needed clarification. TLCPC also had to address its limited capacity to act as a service provider for the EMR. And there were challenges in defining the nature of a joint patient record within the EMR. Nonetheless, TLCPC managed to address these challenges, and launch the Shared EMR Project, all without the resources and direction typically available to participants of provincial-scale initiatives.
Conclusion/Implications/Recommendations: The PHI-sharing needs addressed by the Shared EMR Project are shared by many health care organizations seeking to enhance care team collaboration. The Shared EMR Project represents a resourceful, grassroots response to this need. TLCPCs next steps in for the project may therefore form the basis for an alternative PHI-sharing framework, suited to a resource-constrained context, but that still aligns with regional and provincial health system objectives.
140 Character Summary: The Shared EMR Project represents a resourceful, grassroots response to the need for effective PHI sharing at the grassroots level.
OS25.06 - Connected Care: Emerging Interprofessional Priorities
Purpose/Objectives: Connected care is defined as real-time, electronic communication between a patient and a provider, including telehealth, remote patient monitoring, and secure email communication between clinicians and their patients (Alliance for Connected Care (Alliance for Connected Care, 2014). Two key themes are influencing the emergence of connected care, including the progression of decentralized models of care and the ubiquity of technology and connectivity (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). The burden of chronic illness, shifting population demographics, escalating demand for improved results for investments in electronic health information systems, and shortages of health care professionals are driving demand for innovative models of care and communication with health care consumers (Hussey & Kennedy, 2016, Rajakulendran, MacIntosh, Salah, & Khayat, 2014). New models of care reposition the consumer at the center of healthcare (Hussey & Kennedy, 2016) and will necessitate a shift in both delivery options as well as professional practice and processes. Person centered models of care offer greater flexibility in terms of healthcare delivery options across the full spectrum in the home and community (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). Such models of care are being advanced across Europe, Asia-Pacific region, and North America. Examples can be located aross Canada, notably in Manitoba, Nova Scotia, and Ontario (Rajakulendran, MacIntosh, Salah, & Khayat, 2014). The purpose of this presentation is to discuss the interprofessional priorities emerging from the connected care movement. Clinical priorities from four specific perspectives will be discussed in this panel, including acute care reconfiguration, public and community health collaboration, pharmacy and medication management, and clinical leadership and policy.
Methodology/Approach: Not applicable.
Finding/Results: Not applicable.
Conclusion/Implications/Recommendations: Clinicians and heath care executives must go beyond awareness of connected care to the point where clinical priorities, policy, data use and analytics, program planning and funding, and practice implications are firmly on the agenda for change. This panel offers an opportunity to consider an interprofessional perspective on some of the key challenges and opportunities.
140 Character Summary: Connected care links consumers and providers across healthcare. This panel provides an interdisciplinary perspective on shared clinical priorities.
OS26 - Creating Effective Health Care Platforms for the Future
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 202AB
OS26.01 - Towards National Nursing Data Standards
Purpose/Objectives: This presentation will describe the strategies being utilized nationally to advance nursing data standards adoption, the benefits to be derived, and the current state of adoption.
Methodology/Approach: Monitoring health system performance and demonstrating nursings contribution to clinical outcomes within and between sectors of care necessitates the use of data standards. This presentation will focus on the follow-up activities and outcomes of a nurse leaders symposia held in 2016. Building upon the foundations of the action plan established in a 2016 symposium, the 2017 meeting included a broader engagement of nurse leaders and key stakeholders and continued the evolution of strategies to advance the adoption of nursing data standards across Canada. Focused in the areas of clinical practice and administration, research, education and policy, this presentation will describe the strategies being utilized to advance nursing data standards adoption, the benefits to be derived, and the current state of adoption.
Finding/Results: As clinical information systems and digital health solutions for consumers continue to evolve, the use of standardized nursing data presents an opportunity to have nursing information inform appropriate practice and use of nursing resources. Currently, the documentation of nursing practice: assessments, interventions and outcomes are not easily compared or analyzed within and between care settings because of differences in approaches to documentation, measurement and reporting. Furthermore, these data gathering inconsistencies also limit the capacity to determining the impact of: nursing care within different settings, nurse patient ratios, and staff skill mix on quality and safety outcomes. Monitoring health system performance and demonstrating nursings contribution to clinical outcomes within and between sectors of care necessitates the use of data standards.
Conclusion/Implication/Recommendations: This presentation will be of interest to clinicians, decision-makers, and users of clinical data to evaluate care outcomes across the continuum.
140 Character Summary: Discussion of activities and outcomes of a nurse leaders symposia held in 2016 and 2017 focused on advancing the adoption of national nursing data standards.
OS26.02 - Evaluating Canada's Innovation Agenda: Will It Meet Expectations?
Purpose/Objectives: Canadas health landscape is undergoing far-reaching and fundamental changes: an increasingly engaged and aging population with more complex and chronic health needs is demanding ever-greater choice, access, and integration in the provision of healthcare and related services. Innovation policies developed in the past 2-3 years to advance value-based procurement, consumer-driven innovation and enhanced use of technology do not lack vision and ambition. The question is can they deliver? We developed and used a comprehensive policy evaluation framework to assess the strength of recent healthcare innovation agendas in Canada. We assess and report on the Federal, Ontario and Alberta health innovation programs.
Methodology/Approach: We developed a policy evaluation framework that assesses the ability to execute on a sophisticated and nuanced program of innovation across different settings, disease areas, patient types and funding mechanisms. We identified the following categories of best practices in program design and execution: (1) governance, (2) health system coalitions, (3) implementation approach, (4) fostering innovation, and (5) independent program evaluation. For each category, we identified 4-6 best practices that are likely to lead to excellence in execution of health innovation programs. <img alt="health innovation analysis framework.png" annotation="" id="image://27" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=0352e3d94c02fff4ad1034734a0c6f5f7ba6dbb0&id=27&width=350&height=350&download=0" title="health innovation analysis framework.png" /> The four authors assessed each program independently. One point was given if the program exhibited the best practice; half a point was given if the best practice was implemented partially. If the program did not exhibit a particular best practice, it was given a score of zero. A final overall score for each policy was achieved through consensus across all four evaluators. A program could achieve a maximum of 22 points.
Finding/Results: All Innovation Programs received poor overall scores (Federal = 8; Ontario = 7.5; Alberta = 11.5). Significant gaps in best practices in encouragement of innovation, innovation implementation and rigorous and independent evaluation were seen across all three policies. The Federal and Ontario programs also exhibited weakness in the area of encouraging multi-organizational and multi-jurisdictional coalitions to solve problems of fragmentation and cost-optimization.
Conclusion/Implication/Recommendations: This preliminary analysis shows significant room for improvement across all three Innovation programs in elements of implementation planning, fostering innovation and program evaluation. In particular, greater emphasis must be placed on stakeholder engagement, providing R&D incentives, budgetary analysis, commercialization potential and transparency to promote successful healthcare delivery transformation through disruption and innovation.
140 Character Summary: Feds and Provinces get failing mark for #HealthInnovation Agenda. Lack of Best Practices creates lost opportunities. More could be done.
Purpose/Objectives: Accelerating and scaling innovation is both a key strategic goal for many healthcare organizations and a difficult undertaking. Relying on the individual creative genius typically results in sporadic innovations that do not scale and that are often misaligned with organizational strategic priorities. Structured innovation programs provide a much more effective method for ensuring that more innovations are created, those that are aligned with organizational priorities are nurtured successfully to realize value, and that innovation is encultured broadly across the organization. Through a case study description, participants will understand: How to define and quantify a structured innovation program Practices in healthcare innovation programs from this case study and other global best practices How to assess the maturity of the healthcare innovation programs, of which they are a part How this case study innovation program helped the organizations to achieve its goals What they can do to bring a structured innovation program approach to their organizations.
Methodology/Approach: Being a leader in healthcare innovation by combining the art of caring with the science of best practice is one of five strategic goals for Markham Stouffville Hospital (MSH). MSH envisioned an innovation initiative that was empowering to all staff and doctors and that would foster a culture where the passion and talent of the whole team would be leveraged to drive innovation MSH developed an innovation strategy and launched an Office of Innovation to lead this work. As part of a staff engagement and culture building program, MSH entered into a partnership with Colleaga, an innovation program provider, which provided its crowd-sourcing/collaboration/knowledge-management platform and methodology through which the innovation program could be structured and accelerated. MSH and Colleaga are implementing the Colleaga Innovation Program methodology and are chartering two problem-solving challenges one aligned with the provincial Patients First strategy and one focused on workplace violence. The challenges both structure the innovation process from initial sponsorship through broad organization wide ideation and voting to evaluation and prioritization and take advantage of the open access, crowdsourced innovations, available in the Colleaga Commons knowledge repository.
Finding/Results: Evidence from idea management programs indicate that structured innovation can substantially increase innovation success. For example, a platform implemented in another healthcare organisation engaged 29% of their employees and produced 10 patents over two years. MSH and Colleaga established success metrics for the program as a whole and for each challenge, including metrics for engagement (percentage of idea submitters, the number of votes, and the number of comments) and measures of outcomes (number of ideas collected, the number of projects implemented, ROI realized). Results and trends from one challenge to the next will be presented at the conference as data collection is not complete.
Conclusion/Implication/Recommendations: Engaging staff/clinicians in finding solutions to problems through a technology-enabled, structured innovation process that leverages crowd-science and open access information, leads to better quality solutions that are more aligned with organizational objectives, greater acceptance of implemented solutions and a higher return on innovation investments. We recommend that all healthcare organizations take a more structured approach to innovation.
140 Character Summary: Structured innovation programs that use a crowd-sourcing innovation management platform empower staff to solve high priority organizational problems.
OS26.04 - Strategic Capacity Building for Clinical Informatics: A 2020 Vision
Purpose/Objectives: To support the use and optimization of health information systems, there is a considerable need for Health Informatics (HI) professionals specialized in Clinical Informatics (i.e., Clinical Informaticists) in Canada and across the globe. However, there is currently a high shortage of Clinical Informaticists. To address this, there is a need "to broaden the skills of current clinical professionals to better support them in Clinical Informatics roles" (HI/HIM Report, 2014, p. 67). In 2014, five Canadian HI and health information management organizations identified that the upgrading of Clinical Informatics skills of clinical professionals is a priority for human resources planning until 2019 (HI/HIM Report). Although the development of Clinical Informatics skills is being introduced into clinical curricula/training, there "continues to be a significant gap in the availability of skill broadening resources for incumbent clinical professionals" (HI/HIM Report, 2014, p. 67). Capacity building in Clinical Informatics is central to addressing this gap to fully realize the quality, accessibility, and productivity benefits of health information systems. To build capacity for Clinical Informatics in Canada, there is a critical need to examine the individual and organizational levels to (a) build on the existing knowledge and skills of clinical professionals and (b) foster an environment of continuous learning and adapting to change for Clinical Informaticists.
Methodology/Approach: In 2014, Island Health created the Department of Clinical Improvements and Informatics to support clinicians and physicians with clinical change management and the integration of computing and biomedical technologies into practice to ensure system usability and adoption. The Clinical Improvements & Informatics team initially included six Clinical Informaticists. To support the implementation of an integrated electronic health record across the organization, Island Health significantly invested in the development of a strong organizational structure for Clinical Informatics, including a 2020 vision and intensive strategy for supporting the initial and continuous professional development of Clinical Informaticists.
Finding/Results: From 2014-2016, Island Health's Department of Clinical Improvements and Informatics has grown to a team of over 30 full-time Nurse Informaticists, Allied Health Informaticists, and Clinical Informatics Specialists. Currently, the majority of these Clinical Informaticists have limited education and training in Clinical Informatics. To build on the existing knowledge and skills of the Clinical Informatics team, Island Health has developed a multi-faceted strategy to meet the initial and continual learning needs of Clinical Informaticists, which includes: (a) tailored education/training sessions from COACH: Canada's Health Informatics Association and study/review sessions to prepare the Clinical Informaticists for the Certified Professional in Healthcare Information and Management Systems - Canada (CPHIMS-CA) credential, (b) monthly professional development learning sessions, and (c) Clinical Informatics practice reflection journals.
Conclusion/Implication/Recommendations: The past, present, and future work for developing capacity for Clinical Informatics at Island Health has significant implications for developing a national vision and model for Clinical Informatics capacity building to fully realize the benefits of health information systems. Island Health's barriers, facilitators, and lessons learned for developing capacity for Clinical Informatics will help inform the strategic thinking and planning of Clinical Informatics in other Canadian health care organizations.
140 Character Summary: Island Health's lessons learned will help inform the development of a national vision and model for Clinical Informatics capacity building.
OS26.05 - Global Experiences with Healthcare Innovation Ecosystems
Purpose/Objectives: Healthcare innovation ecosystems are interacting groups of healthcare delivery and funding organizations, capital providers, innovation accelerators and incubators and a variety of general and specialized service providers that together enable healthcare innovation to grow and flourish. In our global work, including Canada, we have assisted various countries and clients to form and assess the maturity of their innovation ecosystems. We will describe an Healthcare Innovation Ecosystem framework that helps stakeholders understand their own healthcare innovation ecosystem and will present our findings about healthcare innovation ecosystems in different parts of the world Session participants will understand: How to assess the maturity of the healthcare innovation ecosystems of which they are a part Will understand practices in healthcare innovation ecosystems from other best practice countries and jurisdictions Will understand how to interact with and leverage their healthcare innovation ecosystem to achieve their personal and organizational goals
Methodology/Approach: Using the framework illustrated below, we have evaluated healthcare innovation ecosystems in Scandinavia, Canada and United States of America and for these examples, have assessed the number of interacting parts, the extent of their connectedness and the results that they produce.<img alt="diagram1.jpg" annotation="" id="image://38" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=eee3f04140cfee4f271e0a1a713c3906544bc95e&id=38&width=350&height=350&download=0" title="diagram1.jpg" />
Finding/Results: In the US case, the healthcare innovation ecosystem was very well developed, with considerable effort put into innovation enculturation, resources dedicated to growing the cluster of interacting innovation programs, business support services, some support for early stage and seed stage commercialization and demonstrated financial and health system outcomes. In the Scandinavian case, the healthcare innovation ecosystem was well developed, with large sovereign support for early stage and seed stage commercialization, but had a gap in infrastructure resources to act as a catalyst for increased innovation. In both Canadian cases, healthcare innovation ecosystems are emerging and require ecosystem maturation and specific catalysts in order to achieve maturity, connectivity and outcomes
Conclusion/Implications/Recommendations: Different healthcare innovation ecosystems have different objectives, ranging from job creation to health system outcomes to tax growth. The IBM Healthcare Innovation Ecosystem Assessment Methodology has been applied in different global experiences and is proving to be a useful method for understand the baseline metrics of the ecosystem, gaps in maturity and how to prioritize efforts to grow and nurture the healthcare innovation ecosystem to achieve its goals
140 Character Summary: Learn how healthcare innovation ecosystems assess their maturity and identify gaps that, when filled, enable healthcare innovation to grow and flourish.
OS26.06 - Disrupting the EHR – Interoperability Planning
Purpose/Objectives: Interoperability planning can be daunting with the many emerging and existing standards, differing systems, and clinical and patient expectations. eHealth Ontario has embarked on a journey to advance the interoperability of the provinces digital health information while considering its current state and future opportunities. This work is intended to improve the health care experience of patients and providers through the thoughtful selection, implementation, and evolution of health information standards and solutions. The early stages of adoption of the electronic health record (EHR) have increased the availability of health information, but there is more to be done to enhance the interoperability or sharing of meaningful and relevant digital health information. This presentation highlights the planning activities, practices and the plan for use in guiding Ontarios journey to semantic interoperability.
Methodology/Approach: The work originated with a paper defining interoperability, as well as further recommendations to advance its direction, and detailed planning to increase the sharing of meaningful health information. Engagement activities with stakeholders gathered insights and helped define short and long-term steps towards interoperability. Through thoughtful interoperability planning we have the opportunity to increase the quantity of health information available for sharing, including standardizing key content to improve the usefulness of digital health information for direct care as well as secondary use purposes. The effective selection of standards, the adoption of data sets, and the evolution of solutions that bring value to Ontarios digital health landscape will help us evolve the EHR to improve its use and value.
Finding/Results: Interoperability planning is a journey that will change the way we imagine and use the EHR and other digital health information in Ontario. Short- and long-term planning will help us arrive at our desired destination together and with the expected results. Shared contributions from a variety of stakeholders to this innovative planning and implementation activity will make the possible a reality. Standards alone will not achieve interoperability, and systems will evolve that require continued advancement and integration into clinical and administrative workflow. The EHR is dynamic and so is health care, and collaborative planning for digital health information is necessary to optimize the innovation, cost, and value to health and health providers.
Conclusion/Implication/Recommendations: Interoperability, in varying degrees, will continue to be advanced by the majority of Ontario health system organizations as they continue to increase the type and volume of digital health information sharing for effective support of patients and providers. The findings of this planning initiative indicate that Ontario should influence standardization across implementations, so that it is aligned with the broader selection and adoption of standards. This minimizes Ontario-specific and local customization of data sets and clinical content, and supports innovative and disruptive approaches to advanced EHR. Support for the evolution of systems and increased use of standards will improve the ability of the health system and health system consumers to measure, monitor, and bring value to the health care experience.
140 Character Summary: Interoperability with an EHR is about more than standards and data. Learn about the approach to interoperability planning and the road ahead for Ontario.
OS27 - Empowering Consumers and Providers
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 202CD
OS27.01 - E-Mental Health: Effective, Efficient and Expanding
Purpose/Objectives: Access to mental health services continues to be a significant barrier to people getting the help they need. Changing Directions, Changing Lives: The Mental Health Strategy for Canada recognizes the important role that technological innovations can play in addressing mental health system problems. The Strategy recommends, using technology to foster collaboration, increase access to services, and engage people in managing their mental health problems and illnesses. Accordingly, a national effort is underway to spark action to advance e-Mental health in Canada. This presentation will present an overview of the status of e-Mental health in Canada and describe a national mental health organizations plan and recommendations to advance this area.
Methodology/Approach: Drawing on the research literature, as well as experiences from leading e-Mental health jurisdictions (i.e. Australia and New Zealand), has provided a foundation to move forward on e-Mental health. A national mental health organization has been convening e-Mental health thought leaders and stakeholders across Canada to identify recommendations to widen the adoption of e-Mental health across the country. An updated review of the research; a comprehensive scan of e-Mental health initiatives across Canada and a series of roundtables are a few key research and knowledge exchange activities taking place in 2016-17 to inform the development of a longer-term plan for e-Mental health.
Finding/Results: Research demonstrates that e-therapies can be as effective as face-to-face therapies, including the delivery of cognitive behavioural therapy for mild to moderate anxiety and depression. E-Mental health services can also address barriers of under-served areas and populations, including First Nations, Inuit and Métis communities. There are examples of e-Mental health services and interventions integrated in health systems in different parts of Canada. These services are proving to be effective and showing promise for expansion and adaptation.
Conclusion/Implication/Recommendations: Canada is still lagging behind in terms of accelerating the integration of e-Mental health into our mental health systems. By strengthening collective knowledge of the e-Mental health evidence base, facilitating knowledge exchange and engaging in strategic partnerships to support or scale up promising innovations, a national mental health organization aims to promote the uptake of e-Mental health as a way to improve access to mental health services.
140 Character Summary: A national effort is underway to spark action to advance e-Mental health in Canada as a way to improve our mental health system.
OS27.02 - Development and Testing of a Touch-Screen Tablet-Based Patient Asthma Questionnaire
Purpose/Objectives: Asthma affects 7.4% of the US adult population and carries an annual economic burden in excess of $56 billion. Guidelines indicate that primary care physicians should assess asthma control and medication adherence at each visit, however this is seldom performed. As a result, over 50% of patients with asthma are poorly controlled, resulting in significant morbidity, mortality, and health care utilization. An asthma action plan (AAP) is an individualized written plan produced by a health care professional which empowers patients to self-manage their disease, and has been shown to improve health outcomes. AAPs are rarely provided to patients due to a lack of time needed to acquire and process required information from patients. Collecting information from patients through a waiting room touch-screen tablet-based device may enable efficient data collection for assessing asthma control, adherence, and personalizing an AAP. Our objective was to design and evaluate such a questionnaire.
Methodology/Approach: We employed a qualitative focus group-based rapid-cycle design process. In focus groups (FGs), adult asthma patients completed a demographic survey, an asthma touch-screen tablet-based questionnaire, and an exit questionnaire assessing usability. Analysts independently generated lists of suggested changes to usability and content features, which were used to iteratively revise the questionnaire after each FG. FG transcripts and field notes were also independently analyzed by 2 qualitative researchers using a descriptive content analytic approach.
Finding/Results: There were 20 participants across 5 FGs [15/20 (75%) female, age 49.1 +/- 15.6 years]. Four participants (20%) had one or more emergency room visit for asthma in the last year, and 6 (30%) had previously received a written AAP. Five (25%) had never previously used a touch-screen tablet. Mean questionnaire completion time was 11.7 +/- 5.9 minutes. Eighteen participants (90%) rated the navigation structure as straightforward and easy to use. The mean System Usability Score (SUS) was 84.2 +/- 14.7. Usability themes included screen hygiene, familiarity with touch-screen technology, ease of use of the touch-screen, and questionnaire design (fonts, images, navigation). Content themes related to language used and nature of information collected. A plurality of revisions [to the questionnaire 10/29 (34%)] were made following the first FG.
Conclusion/Implication/Recommendations: The majority of participants indicated that the questionnaire was easy to understand and to use, which was supported by a high SUS, favorable Likert scale responses, and a completion time compatible with wait times seen in a majority of primary care clinics. Our study identifies key usability and content features for a touch-screen tablet-based asthma questionnaire which can be used in a clinical setting to efficiently collect information on asthma control, adherence, and data required to build an AAP. Our usability findings can also be adopted by researchers seeking to design touch-screen tablet-based questionnaires for other conditions.
140 Character Summary: Successful design process for a touch-screen tablet questionnaire for patients to provide asthma information while in the waiting room.
OS27.03 - Making EMRs Work for Physicians and Their Patients
Purpose/Objectives: Most community-based family physician practices are using certified electronic medical records (EMRs), yet there is substantial variation in how well these tools are used. Physicians are aware of the potential benefits of EMR use for practice management and patient outcomes. However, barriers - financial, technical, time, psychological, social, legal, organizational and change-related - can prevent practices from harnessing the power of EMR technology. To move beyond these barriers, our organization employs a change management strategy designed to meet physicians where they are and help them understand how their EMR can drive improvement in practice management and patient care.
Methodology/Approach: This EMR practice enhancement program deploys Practice Advisors to community-based practices to conduct current state analyses of data entry habits, raise awareness about data quality, identify gaps for improvement, and develop action plans with achievable goals. Practices can optimize their EMR use in these measures: Appointment Scheduling Practice Billing Communication & Messaging Encounter Documentation Data Quality & Nomenclature Consistency Document Management Results Management Referral & Consultation Tracking Prevention & Screening Complex Care/Chronic Disease Management The program provides insight into established workflows used to capture patient information; a practices desired future state for how they will use data entry tools and processes; necessary skills to sustain knowledge transfer; and how EMRs can be used in key areas like chronic disease prevention and management. The program focuses on discrete data to capture a current state, so that physicians have a baseline against which they can measure improvements in their EMR use. By establishing routine entry of standard quality data for practice level use, physicians can effectively leverage mechanisms such as custom forms and reminders to realize positive outcomes in patient care. The process reveals EMR functionalities to physicians and helps them achieve sustainable results in improving patient, and ultimately population, health.
Finding/Results: One-on-one coaching has been critical to success of this program. To date, working with practices has shown: *Quantitative findings: 25% improvement in cancer screening compliance within 16 weeks of baseline capture 15% increase in smoking status capture within 8 weeks of baseline capture 37% improvement in use of standard CDM data entry tools for diabetes populations within 16 weeks of baseline capture Assessed improvement in EMR use post-baseline across four physician-selected priority areas: prevention/screening, nomenclature consistency, CDM/complex care (tools), encounter documentation Qualitative findings*: Demonstrated improvement in maturity of EMR use across a number of physicians Better understanding of rostering workflow for preventive care purposes and working towards decreasing variance between EMR and ministry data Improving standard nomenclature documentation such as smoking status to inform population health Root cause analysis, e.g. categorization challenges for documenting preventive care and chronic disease management, is critical to achieving sustainable change
Conclusion/Implication/Recommendations: Physicians who have undergone an engagement in the programs early stages have already experienced marked improvements in patient care and practice efficiency. Findings reported here are based on the 250 clinicians and administrative staff across over 25 locations the program touched between April and September 2016; engagements over the coming months will increase the data on which to report.
140 Character Summary: Working with physicians on barriers to advancing EMR optimization and workflow efficiency to improve patient and practice outcomes
OS27.04 - Achieving Triple Aim Healthcare Improvement: Canada's Jumpstart
Purpose/Objectives: The purpose of this presentation is to provide an overview of the IHI Triple Aim model and how it is being addressed in the US, and to analyze where the Canadian investments in data centralization and standardization are seeing Triple Aim benefits. The presentation will wrap up with analyses of how the Canadian experience has rated in comparison with the projected benefits identified by the IHI. The Triple Aim framework was developed in 2008 by the Institute for Healthcare Improvement (IHI) to provide a holistic approach to improve the quality of care while reducing the overall cost of healthcare delivery. The model focuses on three critical objectives to improve overall healthcare delivery: 1. improving the health of a defined population; 2. enhancing the patient experience (quality, access and reliability); and 3. reducing/controlling the per capita cost of care. The presentation provides a definition of the healthcare reform model along with the need for reform and the projected benefits of each objective. The overview includes US initiatives currently being funded to help achieve the benefits. The presentation focuses on Canadas investment in jurisdictional centralization and standardization of health data, and how cross-functional analytics are leveraged in Canada to achieve both the model and its benefits. This includes a review of how analytics are used to improve targeted population health through CIHIs data content standards and population health surveillance initiatives. A review of patient access to quality care and improved accountability initiatives will also be presented. The presentation will wrap up with a comparison of the Canadian experience against the projected benefits of the IHI. The findings indicate that Canada is leveraging its existing investment to see immediate improvements in population health and quality of care.
Methodology/Approach: The approach to developing the material for this presentation included a detailed analysis of the Triple Aim model including analysis on what the intended quantitative and qualitative benefits of each of the three objectives. This analysis on the framework provides a foundation for reviewing how Canadian jurisdictions are leveraging the existing central data repositories and registries, and supporting data standards, to develop analytic frameworks that address each of the three areas. The analysis of the Canadian approach will include case study examples from multiple jurisdictions. Finally the presentation compares the Canadian experience to the IHI objectives to determine if the benefits of the investment in achieving the Triple Aim model are realistic and if the projected outcomes are achievable.
Finding/Results: Canadian investment in centralized and standardized data has provided a solid foundation for analytics that support each of the Triple Aim improvement objectives. The scope of jurisdictional data sharing increases the immediate benefits for targeted population health and the quality of patient care. The benefits of improved patient access to care and reduced cost of care have not been as quick to realize but initiatives are underway to address these.
Conclusion/Implication/Recommendations: Recommendations for continued analytics in Canada for further improvements in patient access to care and reduced cost of care will be provided.
140 Character Summary: Dr. Gutiw is a health informatics professional with CGI with a Ph.D. in heath IT. Diane has been engaged in analytic strategies in Canada and the US.
OS27.05 - Caging the Chaos: Electronic Clinical Decision Support in Mental Health
Purpose/Objectives: The diversity in mental health care can make it difficult to find consistent and reliable treatment recommendations for clients. Similar to 'chaos theory', small changes in initial conditions of a client can greatly impact their trajectory in the system of care. Where a person presents for care, what professional assess them and what the main issue the client presents with all effect a treatment plan. This presentation will describe how LOCUS, a clinical decision support tool was used to create a standard report for client care. This report includes a "level of care" recommendation that is used to match a client to a specific service menu. This allows for reliable and consistent service offerings for all clients based on their current level of need.
Methodology/Approach: The LOCUS measures six key dimensions of a clients current situation. The tool provides guidelines for scoring that produce a remarkably consistent inter rating reliability from a wide range of clinicians. The tool also provides guidelines for the types of services that should be available to the client based on their level of need. This allowed for the creation of a method in which all clinical and support services offered in an area could be 'matched' to a client based on the level of care recommendation. This matched menu of service is then used to discuss care options to clients to ensure are they are able to make informed decisions about their care. This ensures that the right client, is always offered the right service at the right time, regardless of who they are assessed by or how they enter the system.
Finding/Results: LOCUS has been applied in practice in Five Hills Health Region with findings showing that more clients in need now receive care based on their level of need. As such, improved client outcomes and reductions in hospitalizations have been measured. Based on this success, an electronic application has been developed to expand the use of the tool and the stepped care approach supported by the service matching process. This allows for a province wide approach to care.
Conclusion/Implication/Recommendations: The use of electronic clinical decision support for the LOCUS tool allows us to "cage the chaos" that can reduce the quality and reliability of services for patients. The method for service matching allows a complex and overwhelming number of options for care to be filtered down so that clinicians can engage in shared decision making with a client while discussing treatment plans.
140 Character Summary: The LOCUS tool has been used as the base for an electronic clinical decision support system that ensures the right client gets the right care at the right time.
OS27.06 - Progress in Psychiatric Informatics: From Patient Engagement to Deep Learning
Purpose/Objectives: CAMH implemented a hospital information system (HIS) in mid-2014. Amongst post-implementation projects since launch, three will be presented during the panel: 1) *Clinical optimization in behavioral health. The objective was to balance narrative documentation requirements of mental health professionals with the hospital goals of reducing variation in care, enhancing data quality, and enabling analytics capabilities. 2) Engaging mental health clients/patients in closed loop medication administration (CLMA). The purpose was to engage mental health clients/patients about their perceptions of the medication administration process. 3) Applying deep neural networks to free text notes for research recruitment of depressed youth.* Because clinical research study recruitments regularly miss up to 60% of eligible participants and the literature indicates that applying computational methods can increase participant recruitment substantially, we sought to employ such procedures.
Methodology/Approach: 1) *Optimization. The components of unmet clinician functionality needs from our issue tracker and corporate quality objectives were melded together in this project. This was accomplished by a series of foundational guiding principles that were the base on which the work was completed. 2) Engagement-CLMA. Engaging clients/patients provided valuable insights in regards to the use of technology for safe medication administration. Surveys (n=50) were distributed by a Peer Support Worker to inpatient clients/patients -- quantitative and qualitative responses were analyzed. 3) Deep learning.* REB approval was obtained. Six months free text notes from the correct age group were extracted, de-identified and annotated Brute force and deep neural network methods were applied.
Finding/Results: 1) *Optimization. Frequently used assessments were simplified including the Suicide Risk Assessment, Mental Status Examination and others. New order sets were created for Seclusion/Restraint, Addictions and Hospitalists. ECT order sets were improved. New documents were introduced for aggression, Addictions and Neurology. Physician workflow view was launched. 2) Engagement-CLMA. Themes identified innovations for the medication administration process. Clients/patients value the nurse-client relationship, being engaged as an active participant in the process, and having choice in client/patient identification methods. Concerns about the intention of personal identification, physical comfort of wristbands, and having photos taken were raised. 3) Deep learning*. Brute force methods gave inconsistent performance. Using the deep neural network of the H2O.ai package, two models resulted: a sensitive non-specific model (sensitivity 89%; specificity 53%) and a specific non-sensitive (sensitivity 45%; specificity 97%) model. Specific and sensitive models were combined and validated on an independent test set.
Conclusion/Implications/Recommendations: 1) *Optimization. A spectrum of content for documentation and ordering went live. The changes support improved client care and recovery, improve the clinician experience and align with CAMHs strategic directions and mission to transform lives. 2) Engagement-CLMA. Feedback was incorporated into education for inpatient staff, and considerations for organizational practices, policies and procedures were identified. Client/patient education material, including brochures and posters, were also developed. 3) Deep learning.* Our recommender was assembled by first training two deep neural networks, one that accurately identifies client/patients who are not suitable, and another that accurately identifies the suitable. Future work will enlargen the corpus, use discrete data, and employ other machine learning algorithm types.
140 Character Summary: Post-implementation optimization, patient engagement and deep neural networks suggest the HIS is a continually evolving entity.
OS28 - Learning to Leverage Technology
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 203AB
OS28.01 - Sparking Digital Health Innovation Through eHealth Ontario's Innovation Lab
Purpose/Objectives: eHealth Ontario helps health care stakeholders integrate the provinces electronic health record (EHR). This session introduces our Innovation Lab (www.innovation-lab.ca) and explores how it promotes innovation in Ontario. Health care is an information-intensive industry. The lab helps innovators garner support for solutions that make optimal use of health information for improved patient care. It is a free and open sandbox where participants can experiment to verify the usability of new products using the structure and composition of the EHR.
Methodology/Approach: Initially, the lab was built to help eHealth Ontario drive risk out of its own technology projects. Along the journey, we recognized the opportunity to enable innovation on a broader scale. Approaches used for developing the Innovation Lab include: Casting a wide net. Enticing talent that is potentially interested in health care, but is unfamiliar with health care-specific standards and protocols. Developing different levels of services: Lite Services are for innovators to access and illustrate proofs of concept for garnering initial clinical and financial support. These services are for getting started and are freely accessible. Secure Services are identical to our production systems, and include authentication and other privacy and security controls. Implementing a website with all relevant information, and a test harness to help familiarize newcomers to health IT messaging. Starting small and growing (as opposed to big bang).
Finding/Results: Through feedback from users, workshops with stakeholders and building on the services of our partner and host, Mohawk Colleges Mohawk eHealth Development and Innovation Centre (MEDIC), we discovered: Hamilton Health Sciences and their vendor, Influence Health, used the lab to build and validate a proof of concept integration between ClinicalConnect and the Provincial Client Registry (PCR) Lite Service (the PCR uniquely identifies individuals based on demographic information). They said: Using the Innovation Lab simplified the logistics and communication requirements associated with this very complex integration project. That other organizations want to contribute their assets to the lab. The benefits for them are: It encourages innovation with their assets They can explore further integration with other provincial assets That many organizations wish to provide support for innovation. We learned they should base their contributions on the value that their organization is uniquely positioned to provide. For eHealth Ontario, this is the provincial EHR assets; no one else can contribute this to innovation
Conclusion/Implication/Recommendations: Our start small and grow approach has allowed us to fund the lab with a modest budget. The initial services have already proven the effectiveness of the lab, and will continue to be leveraged by innovators as we add new services. Through our engagement with stakeholders from across the province, we are developing a consortium atmosphere in the lab, where all parties become part of the solution. Partnerships with other EHR service providers are key. Nobody owns innovation; it should be open, transparent and collaborative.
140 Character Summary: Ontarios Innovation Lab, our open EHR platform, fosters ehealth solution testing in a virtual EHR environment and gives innovators a space to prototype new ideas.
OS28.02 - Building a Web Based Provider Portal with Real-Time Health Information
Purpose/Objectives: This presentation will explain how ClinicalConnect, a provider portal that is now known as one of North Americas largest health information exchanges, was built from the ground up, starting at Hamilton Health Sciences in 2005. We will review a series of key milestone events, beginning in 2005 with data first being aggregated in real-time from Hamilton area hospitals, through to 2016 and beyond, where there are now more than 42,000 registered users from across south west Ontario accessing their patients data, aggregated from multiple regional and provincial data sources, consolidated into a one-stop-shop viewer.
Methodology/Approach: We will explore how innovative features and functionality, such as context-aware, evidence-based clinical information, has been integrated into this scalable digital health solution that is transforming patient care and augmenting decision-making abilities. The discussion will highlight not only what data has been successfully integrated into the portal, but how the data has been integrated. In addition, the development and deployment of ClinicalConnect on desktop computers, smartphones and tablets will be examined. Taking into account the scope of the integrations, working with diverse stakeholders, the intricacies of varying agreement frameworks, required education and communication tactics we will share success stories as well as lessons learned, and touch on the growing number of privacy considerations impacting technical integration work.
Finding/Results: To wrap up the presentation, the speaker will provide current statistics about how the portal is used, by which health information custodian types most often, and will include short testimonials from regular users about how being able to access ClinicalConnect has changed the way they can deliver healthcare. Time will be dedicated to discussing two ancillary online tools that have been developed and deployed as a result of the enormous growth ClinicalConnect has experienced in the last five years to automate the account management function and manage passwords. We believe the audience will take great interest in the complexity of the varied integration projects that have been undertaken; from connecting with local hospital information systems, to the Ontario Association Community Care Access Centres Client Health & Related Information System (CHRIS), to oncology information systems and provincial data repositories including eHealth Ontarios Ontario laboratories information system (OLIS), the Southwestern Ontario Diagnostic Imaging Network (SWODIN), and most recently, the Ontario Ministry of Healths Digital Health Drug Repository. Audiences will learn about new directions and emerging opportunities and ideas being explored to further engage both providers and patients in unique ways.
Conclusion/Implication/Recommendations: ClinicalConnect facilitates the efficient and effective sharing of patient data across the continuum, and is a catalyst for change as the eHealth landscape evolves and adapts to accommodate new data sources and privacy and security legislation. Its an excellent example of a homegrown solution that has attracted attention from regional and provincial healthcare industry professionals and grown to become a strategic asset as identified by the Province of Ontario.
140 Character Summary: How an EHR has been built, aggregating data from regional and provincial data sources, to improve patient care and provider efficiency.
OS28.03 - Partnership with the BC Services Card to Authenticate eHealth Users
Purpose/Objectives: To share the successful outcome and implementation experience of BCs first deployment of the Provincial eHealth Viewer (CareConnect) to non-Health Authority users. A key aspect of the project was integrating with the new BC Service Card as the authentication mechanism to identify Canadian Blood Services staff.
Methodology/Approach: CareConnect is actively used by all six of BCs Health Authorities (HA). User requests identified a significant interest in providing access to CareConnect to non-Health Authority users. As such, the Provincial Health Services Authority (PHSA) project team created a non-HA Access Model Framework, initially focused on organizations with establish IT infrastructures, privacy and user support departments. The Framework included approaches to address: Technical Deployment Agreements User Access Privacy Security Operational Engagement and Governance process A key issue was how to identify individuals that the Health Authorities have no direct relationship with. The solution was to integrate with the BC Services Card. The BC Services Card replaces BCs Health Card. It includes a contactless encrypted chip that is linked to identity services and supports online authentication with passcode functionality. In effect, two factor authentication. PHSA and the Ministry of Technology and Citizen Services (MTICS) completed a technical proof of concept which confirmed the technology principles. With governance approval, the project team implemented the solution which included: Integration between the HA's Active Directory Federation Services (ADFS) and the BC Service Card infrastructure Creation of a CareConnect logon process for non-HA users, which seamlessly directs the users to the BC Service Card logon service. BC Service Card confirms the correct card and passcode combination, and informs the HA ADFS of a successful authentication, which in turn grants access to CareConnect. Once authentication is complete, users are matched with the role they registered with in CareConnect, and provided with the appropriate access
Finding/Results: The partnership with the BC Service Card leverages the key strengths of both organizations: BC Services Cards role is to identify specific individuals and authenticate their online presence to a very high security standard CareConnect enforces a role-based user access model to provide the appropriate content to authenticated user With this implementation, PHSA now has an established process to provide access to Provincial eHealth data to non-HA users who work in established organizations. Canadian Blood Services' staff benefit by having faster access to the information they require to support their clinical activities. While the user experience is very streamlined, there are concerns about employees having to use their personal BC Services Card in a work environment and the initial manual process to obtain passcodes. There were two significant Lessons Learned from the project: The technical infrastructure and network connectivity was extremely complex Multiple legal, privacy and security agreements were required amongst the numerous organizations involved
Conclusion/Implication/Recommendations: In designing provincial solutions, it is important to look outside the Health sector and create partnerships across Ministries in order to create an ideal solution. While it does add complexity, the first implementation sets the foundation for future growth.
140 Character Summary: Sharing the successful integration of the new BC Services Card with the Provincial eHealth Viewer in support of providing access to Canadian Blood Services' staff.
OS28.04 - Fusing Medical Documentation and Order Entry into a Design Platform
Purpose/Objectives: While it can be said that many other professions design: an architect designs a house or an engineer designs an electrical circuit; it sadly cannot be said that health care providers design their patients care plans. The chief tools for creating and implementing patient care planning are classical medical documentation and order entry. There are two main problems with this prior art. Medical documentation is semi-structured and not rigorous enough for non-ambiguous analysis Medical documentation contains the reasoning for orders, but there is no rigorous path to align and validate these important relationships. An evolving research software prototype was constructed and is in active alpha testing in a busy inpatient environment to explore the feasibility and advantages of fusing documentation and orders while keeping their relationships explicit.
Methodology/Approach: Over the last 5 years, we have used a software modeling approach to create a formal language to represent medical documentation and orders and fuse them into singular model (PCM). Formal languages are a family of languages that are in common use in the engineering industry in the form of programming languages. The strength of these languages is that they eliminate ambiguity and allow the creation of responsive and intelligent editors that can be created to analyze and manage this code. We saw an opportunity to create a sophisticated design tool that is conceptually familiar to other technical professions (especially software engineers). We also saw an opportunity to create a programmable language that can both facilitate and constrain PCMs such that they are in compliance with best practice, local and regional policies. The result is an early generation Patient Care Design Tool (PCDT) which has been undergoing alpha testing over the last 4 years in a very busy medical inpatient environment at TBRHSC (Thunder Bay Regional Health Science Center). We have been gathering feedback in order to advance the PCDT prototype.
Finding/Results: From the live clinical field, a trained user can construct PCMs using our early generation PCDT under very high clinical workloads and gain significant advantages in speed, accuracy, automation and clarity. Large arrays of automation can be implemented during PCM design and thereafter. These include decision support, error detection, e-learning, background commentary, asynchronous communications, and metrics gathering. Isolated order entry workflows in most cases can be entirely eliminated. This allows care providers to focus entirely on the construction of optimal design of their PCMs for their patients and eliminate the recapitulation and afterthought of CPOE. Additionally, such a system can permit collaborative asynchronous drafting of PCMs to reduce the amount of overhead associated with team collaboration while still allowing maximum participation (Collaborative Patient Care Design: CPCD).
Conclusion/Implication/Recommendations: Our group is seeking to broaden the discussion and resources in order to advance PCMs as the new platform for patient care planning. We are a research group in search of likeminded academic and industry partners to advance, test and publish to trigger the rise of PCDTs to tame cost, complexity, efficiency and measurability in health care.
140 Character Summary: The rationale and demonstration of the enormous advantages of fusing medical documentation and order entry into a single model called a Patient Care Model (PCM)
OS28.05 - Cloud Computing in Healthcare – Implementation Approaches and Early Benefits
Purpose/Objectives: This oral presentation will provide a synopsis of the most recent work of Canada Health Infoway in assessing the approaches taken to the use of Cloud Computing in Healthcare across Canada.
Methodology/Approach: In 2016-17 Canada Health Infoway has embarked on a significant update to its original white paper on Cloud Computing in Healthcare. The new white-paper looks at illustrative uses of Cloud that have been deployed across the country through interviews and informal surveys. It examines the public sector business drivers for use of Cloud and the approaches taken. It also explores vendor perspectives on working with the health sector in Canada. Early benefits from Cloud implementations are identified and evaluated for applicability, extensibility, and scalability across Canada.
Finding/Results: The white paper is still in development and is expected to be published in March of 2017. Findings and results will be available at that time.
Conclusion/Implication/Recommendations: The white-paper and oral presentation will provide insights into the challenges faced by implementers and users of Cloud-based solutions as well as the benefits and positive impacts and outcomes that have been achieved.
140 Character Summary: A presentation on the findings of an Infoway white paper on the application of Cloud Computing in the Health sector in Canada.
OS28.06 - Becoming a Digital Research Hospital: UHN's Transformation Using Office365
Purpose/Objectives: An IT assessment conducted by Deloitte that highlighted areas for improvement is eliciting a multi-year organization wide IT transformation aimed at building a framework for UHN to become a digitally enabled hospital and changing the way we deliver IT. Productivity tools, such as email, instant messaging, and file sharing are currently under examination for the IT transformation because... they serve as the backbone for connecting our researchers, clinicians, and administrators with each other and to their peers as promote collaboration. This presentation will focus on UHNs transformation journey through the implementation of Microsoft Office 365 and how were disrupting status quo to enhance the way we work on a day-to-day basis.
Methodology/Approach: UHN is in the process of delivering Office 365 through a phased approach starting with Microsofts cloud platform Azure, Exchange Online, Skype-for-Business, and OneDrive-for-Business. This enterprise-wide initiative will be implemented across all four UHN campuses, affecting approximately 20,000 users including clinicians, researchers, and IT administrators. To redefine status quo, weve selected individuals from all facets of business to form working groups to challenge our way of thinking and act as project champions. To actively engage users, departmental roadshows will be held to demo the system, lunch-and-learn sessions will be offered directly on units, and e-newsletters detailing new functionality will be distributed. As this initiative has high visibility and high impact, an easy to access repository will be set up for users to access training material and project updates. As proof of concept, various end user groups will be engaged as part of a pilot to serve as checkpoints to ensure that all Office 365 features are functioning as intended prior to full rollout across the organization.
Finding/Results: At the outset of UHNs IT transformation, an organization-wide survey was conducted to assess customer satisfaction of IT services. Results from the survey highlighted certain pain points within the organization including small mailbox sizes, the need for real time collaboration tools across teams, and frustration relating to downtimes of critical communication services. Ongoing monitoring and measurements will be conducted to continuously understand the organizations receptiveness to this change, however, anticipated results are solutions to these reported pain points, fewer downtimes, increased productivity and collaboration, and ultimately a new foundation for using cloud technology.
Conclusion/Implication/Recommendations: Cloud technology is widely adopted by cross-functional industries to reduce capital expenditures of hosting equipment on premise and to allow for server scalability on demand. UHN will be one of the first early adopters of cloud technology within Ontarios healthcare sector where leveraging cloud will not only boost internal connections, but boost external connections across multiple organizations that adopt similar technology. To stimulate further adoption within healthcare, provincial incentives and encouragement are recommended. Its also recommended that provincial measures towards creating a private cloud specifically for healthcare be developed to increase security and privacy controls to encourage more healthcare organizations to join.
140 Character Summary: Through UHNs Office 365 cloud implementation, we are building the runway to becoming a digitally enabled research hospital.
OS29 - Realizing the Promise of "Big" Data
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 203CD
OS29.01 - Measuring Patient Experience Across the Cancer Journey Through Data Linkage
Purpose/Objectives: Capturing information on patient experience at the point of care gives patients a voice in driving quality improvement, aligning with Cancer Care Ontarios (CCO) goal in the Ontario Cancer Plan IV to ensure the delivery of responsive and respectful care across the cancer care continuum. Electronic Patient Reported Experience Measures (ePREMs) is an electronic platform that hosts tools for the systematic collection of cancer patient feedback in near real-time at any point in their journey. Your Voice Matters (YVM) was the first validated questionnaire launched through ePREMs in March 2016, asking patients to share their experience from their most recent visit to the hospital or Regional Cancer Centre (RCC). For the first time in Ontario, the ability to link ePREMs data to other administrative databases enables a holistic view of the cancer patient experience, thereby identifying ways to improve the cancer system.
Methodology/Approach: The ePREMs YVM Screening Rate is a measure derived by linking ePREMs data with administrative data collected on cancer activity at each RCC. This linkage allows CCO to quantify the proportion of cancer patients that completed an YVM questionnaire out of all visits to an RCC in a given month. The Screening Rate draws on three CCO data holdings: (1) ePREM; (2) Activity Level Reporting (ALR); (3) ISAAC Your Symptoms Matter (YSM). The rate numerator, count of patients with a complete YVM questionnaire in a given reporting month, is calculated using ePREMs and YSM data. Patients are considered to have completed the questionnaire if they viewed all 28 assessment questions. Any patient record lacking identifier information, including invalid health card numbers, missing facility information, or respondents with non-cancers (such as benign) are excluded from the numerator. The ALR database records each patient encounter with the cancer system, whether it be for treatment or outpatient oncology consultations/assessments (clinic visits). ALR data is used to calculate the rate denominator, the count of unique cases that had a clinic visit/treatment in a given reporting month.
Finding/Results: As of October 2016, 9 of 14 RCCs in Ontario were administering YVM. The data from the three CCO data sources were linked to derive screening rates for each of the participating centres. The linkage provided an early view on the spread of YVM throughout the province.
Conclusion/Implication/Recommendations: The YVM Screening Rate draws on three data sources that are collected independently, but together provides a more fulsome picture of the patients visit and experience across the cancer care continuum. The ePREM YVM Screening Rate highlights the potential to better understand the patient experience. The collection of linkable PREMs data will allow CCO to understand and improve on the cancer patient experience across any phase, disease site, age, gender, clinician seen, and type of treatment. This will enable CCO to map patient experiences to specific aspects within the cancer care continuum, and ultimately tailor quality improvement interventions to patient preferences.
140 Character Summary: Data linkage of Electronic Patient Reported Experience Measures data enhances the understanding and improvement of patient experience at all points of care.
OS29.02 - Pathology Laboratory Utilization Scorecards (PLUS): A Pathology Data Analytics Platform
Purpose/Objectives: Pathology laboratories provide service to both primary-care and tertiary care providers, helping with disease diagnosis and therapeutic choices. Typically, physicians request a pathology test order which may contain multiple tests; the operational question is whether these tests are relevant and useful with respect to the patients profile. As service demands on pathology laboratories is increasing, there is a realization to streamline the operations with respect to clinical guidelines and local clinical workflows in order to optimize operational costs whilst improving order relevancy and result accuracy. The optimization of pathology laboratory utilization is approached by detecting superfluous (clinically irrelevant, unnecessary, repetitive) lab orders, predicting lab utilization for specific tests, resource planning in response to test volumes, educating physicians about clinical guidelines around test ordering and result interpretation. In this project, our objectives are: (1) To develop and deploy a Pathology Laboratory Utilization Scorecards (PLUS) platform that offers end-to-end pathology big data analytics services to optimize laboratory utilization; (2) To provide primary care physicians personalized laboratory utilization scorecards to visualize their test ordering pattern and adjust their test orders accordingly; (3) To provide pathology laboratory managers a live dashboard showing the volume and type of orders to assist them with resource planning; and (4) To generate meaningful order-sets to improve test ordering patterns and guideline compliance.
Methodology/Approach: Pathology laboratories generate large volumes of clinical data that can be analyzed to monitor, manage and optimize laboratory utilization. We take a big data analytics approach to develop the PLUS platform that hosts a suite of health data analytics tools/applications to (i) standardize pathology data using SNOMED-CT; (ii) integrate pathology data from multiple health information systems (such as ADT, EDS, EMR); (iii) link non-health data sources such as geo-location data and environmental data; and (iv) visualize and interact with analytical results to gain specialized insights. We have applied machine learning and statistical methods to develop specialized physician order profile comparison models to stratify physicians with respect to their patient demographics and their conditions, thus ensuring that inter-physician comparisons are adjusted by patient population they treat as opposed to just order volumes.
Finding/Results: PLUS is web-based system that is currently deployed in Nova Scotia and is used to optimize the pathology laboratory in the central zone (Halifax) that annually performs on average 15 million laboratory tests for 200,000 patients. We provide web-accessible lab utilization scorecards for (a) primary care physicians to highlight their ordering profile in terms of volume of lab test orders with abnormal rates, repetition rates, yearly comparison and comparison to their peers; and (b) lab managers to illustrate the volume, type and location (on a map) of orders, and gross prediction of the orders for chronic patients and seasonal diseases.
Conclusion/Implication/Recommendations: We demonstrate a big pathology data analytics platform to optimize pathology lab utilization. The project involves primary care physicians as users. PLUS is expected to significantly optimize lab utilization by reducing the rate of unnecessary orders, and by offering live operational intelligence to pathology lab managers. The approach can be extended to otehr provinces.
140 Character Summary: A big health data analytics platform, using advance analytics methods, to analyze pathology lab data in order to optimize pathology lab utilization
Purpose/Objectives: Health care in Canada is shifting more care is being provided in ambulatory or outpatient settings in the hospital or community. Most jurisdictions have summary information, but there is a gap in patient-level clinical, operational, quality and utilization data that CIHI is starting to fill. CIHI's low-cost, low-burden ambulatory care data holding provides timely, comparative information for local planning and decision-making and for health system accountability and improvement. Its standardized data bridges information across sectors and the care continuum, providing one more piece to the overall health care picture by capturing clinical and operational patient level information on number of visits, population served and reasons for receiving health services. This presentation will provide information on ambulatory care activity in Canada from a system planning and management perspective based on early findings from pilot projects that are underway and taking advantage of CIHIs ambulatory care data holding.
Methodology/Approach: NACRS Clinic Lite, CIHIs ambulatory care data holding, is currently being piloted in organizations across the country, ranging from outpatient clinics at large hospitals to community-based clinics. Approximately 20 clinics providing services to various patient populations have submitted high volumes of patient visit records to date. CIHI has used this data to provide information back to the data submitters and jurisdictions such as: reasons that patients are seeking treatment in outpatient clinics, type of organizations that are referring patients to outpatient care, and number of clinicians participating in a patients episode of care.
Finding/Results: Findings from the first two projects participating in this new option, rehabilitation clinics and paediatric clinics, will be presented. Information is being provided to address key system planning and management issues, including: what are the sources of referral to outpatient rehab; and how much time is being spent with patients. The current state of technical infrastructure in ambulatory settings and conclusions on how digital solutions can efficiently be put in place to provide benefits will also be presented.
Conclusion/Implication/Recommendations: In line with the shift in care into the ambulatory care sector and high volumes of activity, advances in technology are making data collection and submission for secondary purposes possible in a streamlined and efficient manner. This provides the healthcare system with insight into a sector that has not historically been mandated to report data, which facilities improved use of resources and better patient care.
140 Character Summary: High volumes in the ambulatory care sector and advances in technology are making efficient data reporting possible. Findings from CIHI's projects will be shared.
OS29.04 - Standardizing ALC Reporting in Acute Inpatient Care
Purpose/Objectives: Alternate level of care (ALC) data in the Discharge Abstract Database (DAD) is important for understanding the needs of patients in acute care beds that are waiting for more appropriate services. Historically ALC data has not been comparable across regions due to differences in clinician criteria used for ALC designation. To standardize ALC reporting, CIHI has released new ALC Guidelines for clinicians in acute inpatient care. As part of the Emergency Department Waits and Patient Flow Initiative, Saskatchewan Health Quality Council (SK HQC) has implemented new guidelines and tools to improve ALC reporting in the province. In this presentation, CIHI and SK HQC will promote new ALC guidelines and lessons from Saskatchewans implementation, including toolkit and approach to standardization.
Methodology/Approach: In 2015, at request of the Western Canada CEO Forum and in collaboration with the Western Patient Flow Collaborative (WPFC), CIHI launched a project to standardize ALC designation practices in acute inpatient care. CIHI worked with administrative and clinical leaders to develop and pilot clinical guidelines in western regions. ALC reasons were streamlined and clarified for reporting to the DAD. Implementation across western regions is currently underway. Saskatchewans initiative was established in April 2013 to aggressively address ED wait times and by 2014, ALC emerged as a priority. A survey on regional ALC practices was completed, followed by a Rapid Process Improvement Workshop to reduce variation in ALC data collection and reporting. A Patient Flow Toolkit was released to operational leaders and point-of-care staff to increase their awareness of ALC data standardization in the context of changes in the health system. Stakeholder engagement and use of provincial implementation teams were key to successful implementation.
Finding/Results: To facilitate implementation, CIHI released the clinical guidelines, a mobile friendly clinician tool, and job aids to help interpret coding requirements. New codes were implemented in the DAD. In Saskatchewan, although ALC is a known contributor to long ED wait times, understanding of ALC population was incomplete without standardized ALC data. A standardized ALC data collection form was implemented with daily, electronic collection as of May 2016 about ALC details, such as reasons, barriers to discharge and timelines. The initiative is now starting to use the provincial ALC data for recommendations around strategic investments. The Regions are also beginning to use the data to guide some of their operational work.
Conclusion/Implication/Recommendations: Accurate and comparable ALC data is important at every level of health system for informing discharge planning at facility to measuring system gaps at regional/provincial levels and identifying access inequalities nationally. CIHI continues to work with stakeholders to broaden adoption of the guidelines across Canada. Saskatchewan expects to release a dashboard with performance indicators updated daily at hospital, regional and provincial levels. Information about ALC patients is expected to be used for health system planning at all levelsnot only in acute hospital care, but also in community care. Initiative focused on ALC data standardization but change management and working from a base of influence as opposed to authority has been the key to successful implementation.
140 Character Summary: CIHI will introduce new ALC guidelines and Saskatchewan HQC will share lessons from their implementation, including toolkit and approach to standardization.
Purpose/Objectives: Preparations for hosting the Pan Am and Parapan Am Games (PPAG) in 2015 accentuated the need for a tool to facilitate communications and coordination among a diverse group of healthcare organizations in Ontario to respond to planned and unplanned events. To address the need, the Toronto Central Local Health Integration Network (TC LHIN) initially sponsored 7 LHINs hosting the PPAG to implement a scalable and sustainable Emergency Management Communication Tool (EMCT) for health organizations within Ontario. Subsequently, EMCT was expanded to the remaining LHINs. This presentation will provide an overview of the initial implementation, expansion approach and a demonstration of EMCT.
Methodology/Approach: The project involved consulting with several emergency management experts at over 30 organizations, along with leveraging lessons learned and best practices from Vancouver BCs experience during the 2010 Olympics. As a result, the requirements for the Emergency Management Communication Tool (EMCT) have been defined. Consequently, a solution was selected through a competitive bidding process. In spring of 2015, health organizations from seven LHINs were selected to participate in the initial implementation of EMCT whereas those of the remaining seven LHINs joined the expansion phase in early 2016. UHN was the delivery partner managing the implementation of EMCT. Facilitated sessions with key emergency management experts and collaboration with the vendor ensured that the solution was customized to support business processes and best practices for any emergency events. Lessons learned from the initial implementation were transformed into strategies for success in the expansion phase to improve user adoption, including: 1) Hosting on-site roadshows to obtain leadership buy-ins 2) Onboarding organizations in rolling phases to accommodate users schedules and priorities 3) Sharing success stories and tangible real-life applications of EMCT to better educate users 4) Conducting demonstrations of EMCT with simulated scenarios for users
Finding/Results: The Emergency Management Communication Tool has grown its footprint from the initial implementation to the expansion phase with over 1400 registered users from 200 health organizations in Ontario. The user base is comprised of a diverse group of emergency planning and management organizations such as: Ministry Emergency Management Branch, Local Health Integrated Networks, hospitals, first responders, Public Health Ontario, the Public Health Agency of Canada, etc. It has proven success in both coordination and communication of large scale planned events such as the Pan AMAm games and Syrian refugee resettlement, as well as at the local level for health service providers in codes. For operational practices, seasonal influenza reports and bed availability in emergency departments were information readily available in the tool. Acting as a central hub to promote peer-to-peer collaboration and information sharing, this tool was capable to deliver pertinent situational awareness to health organizations in any large scale emergency events.
Conclusion/Implication/Recommendations: The implementation of EMCT provided the foundation to support Ontarios vision for a standardized incident management system that was interoperable across all levels of emergency management. Health organizations in Ontario can now further integrate their EMCT tool into their emergency management practices and collaborate with other organizations in the region to prepare for cross-organizational emergency responses.
140 Character Summary: The implementation of a web-based communication tool across Ontario is instrumental in emergency management during planned and unplanned events
OS29.06 - Leveraging Data to Drive Improvement: Reducing Residential Care Bed Turnaround Time
Purpose/Objectives: There is wide variation in vacancy turnaround times (TAT) for residential care (RC) beds in Vancouver Island health Authority (VIHA). This is an access and flow issue for patients awaiting RC. By combining analytic tools with process improvement methodologies TAT can be reduced resulting in smoother flow, timelier access and enhanced patient safety and experience. This project demonstrates how analytics and reporting systems can drive process improvements in healthcare.
Methodology/Approach: By using the Strata IQ reporting system and Lean Healthcare methodology the project team reviewed RC bed TAT across all owned and operated RC facilities. Two facilities (sites a and b) were selected for the pilot based on sponsor input and notable TAT variation between the sites. The regional TAT target is 4 days. Pre Improvement TAT for site (a) was 1.3 days, and site (b) was 11.1 days; a difference of 9.8 days. Quality and Patient Safety consultants engaged operational stakeholders at both sites to evaluate current state workflows and processes. The project team constructed two current state process maps from consultative sessions with management and staff. Processes, roles, responsibilities and challenges were defined, and improvement opportunities were identified. Differences in demand demographics and workflows between the pilot site and others were considered. RC facilities then reviewed improvement recommendations and worked with the pilot sites to identify revalent process measures, targets and standard work. Facility specific process measures varied due to differences in demographics, specialized care models, resources, and workplace culture. Strata IQ was used to report TAT as the primary outcome measure for the project.
Finding/Results: Overall, vacancy TAT improved by 2.1 days regionally. Site (a) reported a 0.3 day increase in TAT, and site (b) reported a 6.4 day decrease in TAT (a 58% favorable reduction). Routine performance audits and continuous improvement efforts targeting vacancy TAT are ongoing.
Conclusion/Implications/Recommendations: By leveraging data and reporting systems, variable processes in multiple RC facilities were standardized with consequent reductions in bed TAT. This resulted in improved access for patients and families and better provider experience in some instances. Results suggest that the use of analytics and reporting systems can help drive improvement in healthcare and should be a topic of future research.
140 Character Summary: This project describes how VIHA was able to reduce Residential Care bed Turn Around Time by 2.1 days using data and reporting systems to drive process.
OS30 - Novel Education Models
- Type: Oral Session
- Track: Clinical
- Presentations: 6
- Coordinates: 6/07/2017, 10:30 - 12:00, Room 205B
OS30.01 - ClinicalConnect Enhancing Mohawk College's Simulated Digital Health Learning
Purpose/Objectives: The purpose is to present how the leadership teams at the HITS eHealth Office at Hamilton Health Sciences and Mohawk Colleges Institute of Applied Health Sciences have partnered to integrate the Training environment for ClinicalConnect, the Regional Clinical Viewer for the connecting South West Ontario Program, into the Colleges nursing and health science programs.
Methodology/Approach: The presentation will include an overview of the process the College and the HITS eHealth Office followed, based on Canada Health Infoways Change Management Framework, to make ClinicalConnect available to students as part of their health sciences curriculum. The presentation will highlight key elements from the project plan and describe how the HITS eHealth Office built customized, simulated test patient records in alignment with the curriculum requirements to provide maximum benefit for both faculty and students. The presentation will close with a summary of how ClinicalConnect is being used by faculty and results to date. We believe this is one of the more unique academic/healthcare partnerships, in that Mohawk Colleges health sciences students learn how to gather fictitious, but clinically-accurate, patient results from disparate sources, using the Training environment of a real-life digital health tool, to develop critical thinking skills early on in their careers.
Finding/Results: Since the introduction of ClinicalConnect into Mohawk Colleges Registered Practical Nursing and the BSc.N undergraduate programs in January 2016, feedback from faculty and nursing students has been overwhelmingly positive. Victoria Labadia, a Transformational Analyst at the HITS eHealth Office who has provided education support during the first phase, says staff and students alike are well-engaged and motivated to access electronic health information from ClinicalConnect, and immediately see how this eHealth tool can help make better informed decisions. This presentation will explain the unique and innovative way to facilitate student nurses adoption and integration of technology into practice using ClinicalConnect [Training environment]. Students learn how to access their patients data from multiple sources from one eHealth tool, ClinicalConnect, to help complete the patient picture, while honing their critical thinking and decision-making skills to develop the most efficient and effective care plans with all the information readily available. This ability to consider patient health information from multiple sources hospitals, CCACs, provincial data repositories as part of care planning is key as the healthcare system moves to provide more care in community-based settings. In addition, in line with the Ontario Ministry of Healths Patients First Action Plan, students learn how digital health tools can be applied to provide the best patient experience possible. Patient benefits can include avoiding duplicate testing that often results in unnecessary discomfort, potential loss of income and increased cost due to travel, as well as not having to repeat their medical history because their results are available in ClinicalConnect.
Conclusion/Implication/Recommendations: This learning opportunity is significant; we are developing what we hope is a gold standard for technology integration into academic programs, one that we hope can be rolled out in other academic environments in the region.
140 Character Summary: How simulated EHR is integrated into curriculum at local college to arm future nurses for real world practice using real world eHealth tool.
OS30.02 - Peer-To-Peer: All About People & Process When Advancing Digital Health
Purpose/Objectives: A national program engaging physicians, nurses, pharmacists & clinic managers has been instrumental in advancing clinician adoption, use & optimization of digital health solutions across Canada. The panel will share how unique local initiatives are contributing to a national program that has evolved to incorporate advanced clinical eFunctions and patient eServices. Emerging evaluation results will be shared with the audience, as well as share success stories and lessons learned along the digital health optimization journey.
Methodology/Approach: Digital health is an enabler for clinicians to provide patient/person-centered care and interprofessional practice. The panel will share details of their respective Peer-to-Peer Networks and how clinicians are supporting one another in the implementation, adoption and optimized use of digital health solutions in their clinical settings. Clinical Peer Leaders will discuss the role and value of the mentoring colleagues, available resources for clinicians along with evaluation results and project outcomes. Also, Peer Leaders will share their stories of their clinical transformation journey and how strategic digital health initiatives have benefited from the Peer-to-Peer Networks.
Finding/Results: Program and clinician focused outcomes will be shared with participants, including the current state of local Peer Networks across Canada, their strategies and achievements for developing clinical capacity, leadership & outcomes. Results of evaluations to date will be shared, including the fact that over 90% of Peer Leaders felt they can positively support and impact colleagues to use technology effectively in a practice setting. As a result of participating in the peer-to-peer session, 84% of colleagues felt that they have improved their skills and 77% have improved their confidence when using digital health solutions. Interdisciplinary perspectives will be shared around how Peer Leaders addressed change management challenges and opportunities, providing a landscape of how clinical adoption and optimization of digital health has evolved in Canada.
Conclusion/Implications/Recommendations: The implementation of digital health solutions is likely the most complex and powerful transformation in clinical practice and delivery of health care services this century. It requires a team based approach of all stakeholders and at all levels. Critical to success are people & process: clinician leadership, engagement and most importantly the use and integration of these systems in practice to support decision making and improve patient/client outcomes. This panel will discuss the sustainability of their projects and demonstrate successful collaboration to advance digital health initiatives.
140 Character Summary: All about people & process when advancing digital health: panelists share success stories, lessons learned & emerging evaluation results about their P2P networks
OS30.03 - A Conceptual Model for Increasing EMR Use Through End-User Support
Purpose/Objectives: The adoption and use of electronic medical records (EMR) is a priority for the Canadian health care system. Improved provider effectiveness and health outcomes require better adoption of advanced EMR features by primary care physicians (PCP). However, the majority of PCPs do not fully adopt these advanced features. The literature widely suggests that end-user support (EUS) is a critical success factor for increasing EMR use (i.e., overall use of all EMR features). EUS is any information or activity that is intended to help physicians solve problems with and better utilize their EMR. However, many PCPs must learn the true capabilities of their EMR with little effective EUS. Existing research in EUS is limited and is inconsistently described and measured, which impedes efforts to improve EUS quality and EMR use. Additional research on the relationship between EUS and EMR use is also required.
Methodology/Approach: To explore the relationship between EUS and EMR use, the EMR End-User Support (EMR-EUS) model (Figure 1) was developed following a review of conceptual and theoretical frameworks related to technology adoption/use and EUS. <img alt="emr eus model.jpg" annotation="" id="image://20" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=ebce521215e673e27ff09ab2bcf92f383ba4fe03&id=20&width=350&height=350&download=0" title="emr eus model.jpg" /> Figure 1. EMR End-User Support (EMR-EUS) Model The EMR-EUS Model is based on Venkatesh et al.s (2003) Unified Theory of Acceptance and Use of Technology (UTAUT) and Shachak et al.s (2011) theoretical framework for describing and characterizing EUS for Health Information Technology (HIT). The UTAUT model is a widely-cited, comprehensive model that was developed following a meta-analysis of eight theories of technology acceptance and use. The theoretical model by Shachak et al. (2011) was developed based on a scoping review of the literature. Together, these two models were amalgamated to create the EMR-EUS model.
Finding/Results: The EMR-EUS model contains seven EUS components that affect EMR use by PCPs (highlighted in yellow in Figure 1). These include: (a) one core construct (facilitating conditions), (b) four antecedents of facilitating conditions, and (c) two moderators. EMR use behaviour is the key outcome of this conceptual model. The aforementioned antecedents exert equal influence on facilitating conditions, and facilitating conditions directly impacts EMR use behaviour.
Conclusion/Implication/Recommendations: This presentation contributes a conceptual model for exploring the relationship between EUS and EMR use that is based on existing technology adoption/use theories in the literature. This model may be applied by researchers, practitioners, or decision-makers to design EUS interventions and examine their effects on EMR use. Additional research is needed to test this conceptual model.
140 Character Summary: Researchers, practitioners, or decision-makers can use the EMR-EUS model to explore the relationship between end-user support and EMR use.
OS30.04 - Radiology Peer Review Implementation: Improving Quality and Enabling Collaboration
Purpose/Objectives: The Canadian Association of Radiologists defines peer review as a process of self-regulation that aims to maintain standards, improve practice and preserve service reliability. Over the last 5 years, we have implemented the radiology peer review program at our hospital as well as several academic and community-based hospital settings across the province. The primary objective of the peer review program implementation is to enable radiologists to identify and share opportunities for collective growth in their practice, resulting in greater overall quality of care for patients. At its core, the program is enabled by an internally developed, integrated peer review and image quality evaluation tool regularly updated based on feedback from radiologist users. Additional components of the program include establishing customized peer review processes, program governance and developing a policy manual to formalize expectations of peer review with a non-punitive, educational focus.
Methodology/Approach: The program implementation approach involved active engagement from three groups of stakeholders: a steering committee to provide strategic oversight of the project, comprised of radiologist and administrative leaders; a radiologist working group involved in the design of peer review processes customized to their environment; and an IT working group, involved in the implementation of the software itself. Based on the departments size and case volume, peer review processes were developed and documented. This included both a process to perform peer review, using a 4-point scale (0-Great Catch, 1-Overall Agreement, 2-Minor Discrepancy, and 3- Major Discrepancy) as well as a process to translate learnings into future practice. Establishing the programs design and governance structure involved identifying smaller groups of participating radiologists, either by division or modality, and designating a Quality Lead for each group. In developing the Learning Process, special attention was paid to designing Quality Rounds, which are forums led by Quality Leads, where anonymized peer review cases with potential educational merit are reviewed to allow for non-punitive learning and continuous improvement. A peer review policy manual was developed to serve as the reference document for the aforementioned processes. Prior to launch, all participating users were trained on using the software and familiarized with the peer review workflow. Effective transition to operations depended on facilitating communication and change management within the radiologist team.
Finding/Results: With 100% user adoption, the program was successful in promoting education and collaborative learning among radiologist teams. The radiology peer review tools data analytics module has enabled radiologists to track their departments performance, in terms of reduced discrepancies, over time. Key to the success of the peer review program is enabling users to participate in peer review processes with minimal interruption to their clinical workflows and providing a framework that enables translation of learning from peer review into future practice. This model has been successful not only within our hospital, but also at multiple academic as well as community-based hospital settings across the province.
Conclusion/Implication/Recommendations: When implemented as part of a broader quality improvement framework, radiology peer review proves to be not just a quality assurance tool but also an enabler of collaborative learning and change.
140 Character Summary: Peer review, within a quality improvement framework, proves to be an important quality assurance tool that enables collaborative learning among radiologist teams
OS30.05 - Peer Network Collaborative Learning Enhances Health Information System Quality
Purpose/Objectives: Many healthcare organizations struggle to implement health information systems (HIS) with limited informatics knowledge and skills. Considering that approximately seventy percent of these implementations fail, it is important to explore innovative models that can be used to build organizational informatics capacity and increase the likelihood of success. Collaborative learning is one such model that is increasingly being recognized as an important contributing factor to successful HIS implementations. This presentation describes a collaborative peer network that was established to build organizational informatics capacity to facilitate the integration of advanced clinical e-Functions within four different HIS: Meditech, Procura, EPIC and PointClickCare.
Methodology/Approach: Four organizations participated in the initiative. The collaborative peer network, which was part of a broader pan-Canadian peer-to-peer program, consisted of six nurse peer leaders (NPLs) employed within the organizations. They each received formal in-person education and training to lead and support the initiative within their organizations. The education was provided by the project sponsor and two health informatics consultants contracted for the project. The in-person sessions were supplemented by a virtual community of practice and weekly virtual meetings that afforded the NPLs multiple opportunities to acquire new knowledge, share best practices and additional resources to meet the project deliverables. At various points of the project the peer network brought together healthcare leaders, nurses, other healthcare providers, health information technology personnel and decision support staff from the four organizations to enhance their informatics knowledge, skills and abilities to effectively lead and support the integration of the advanced clinical e-Functions within their respective HIS. Three components comprised the advanced clinical e-Functions: (1) evidence-based order sets built as decision support resources; (2) standardized terminology language used to capture and retrieve clinical data for technology-enabled outcome evaluation; and (3) e-Clinical analytics to monitor structure, process and outcome indicators and evaluate the impact of using the order sets on health outcomes.
Finding/Results: The NPLs participated collaboratively as a learning community throughout the project enabling them to share resources, knowledge and experiences with each other and with their peers within their own organizations. The NPLs also obtained help and guidance from each other to develop their project plans and the methodology used to integrate the order sets and the standardized terminology language within their HIS. Using this approach also helped them to identify solutions to potential barriers; thereby, mitigating possible risks to their implementation. All participating healthcare organizations met their implementation deadlines and achieved successful end-user adoption.
Conclusion/Implication/Recommendations: The peer network highlighted the benefits of collaborative learning within the context of eHealth and demonstrated its potential to increase the success rate of HIS implementations. It provided opportunities to enhance the informatics knowledge, skills and abilities of clinicians and healthcare leaders and facilitated the sharing of best practices among participating organizations to optimize their adoption of advanced clinical e-Functions. Collaborative learning may be an ideal approach for organizations participating in a multi-site HIS implementation. It may also prove to be an invaluable strategy for smaller health care facilities in primary care settings and rural areas with limited resources.
140 Character Summary: This presentation will report on a collaborative approach used by four healthcare organizations to optimize their health information system.
OS30.06 - A Sum of its Parts: National Peer Network Program Evaluation
Purpose/Objectives: This interactive session will provide an overview of emerging evaluation results from a national program, building upon the success and outcomes from various local Peer-to-Peer Network initiatives focused on advanced clinical eFunctions and patient eServices. Emerging themes from various project evaluations will paint a picture of clinical engagement and optimization of digital health in Canada.
Methodology/Approach: Canada has a national program that brings together clinicians to support the achievement of clinical value from digital health solutions. Outcomes from various partnerships across the country will be shared with conference participants the stories of the people engaged, the interprofessional collaborative processes that ensued and the resulting outcomes, including best practices and lessons learned.
Finding/Results: Quantitative and qualitative analysis from national program findings will be shared, including updated survey results from physicians, nurses, pharmacists and other health care providers participating in the national Peer Network program. For example, 90% of Peer Leaders felt they can positively support and impact colleagues to use technology effectively in a practice setting. As a result of participating in the peer-to-peer session, 84% of colleagues felt that they have improved their skills and 77% have improved their confidence when using digital health solutions. Key informant interviews will also be discussed, along with resources to support clinicians using advanced clinical eFunctions and patient eServices.
Conclusion/Implication/Recommendations: A synthesis of clinician stories, leading practices & lessons will be shared from a pan-Canadian perspective. Emerging evaluation results and themes will be discussed along with implications for sustainability. The importance of clinician engagement in digital health cannot be underestimated - participants will also be invited to share their own experiences, contributing to Canadas dialogue on digital health.
140 Character Summary: A sum of its parts - national Peer Network program evaluation: learnings about people & process along the digital health journey