This session will examine strategies, approach, challenges and lessons learned on the journey to connected care. It will also look at public/private sector relationships and how to foster innovation in a public-sector market and debate large scale province-wide implementations vs small scale implementations in a provocative and informative debate style format. The session will also be challenged by the innovation theory of small scale community implementations as trials to build and learn from.

Purpose/Objectives: Why Digital Health Needs Automated Testing Digital health is increasingly being used to capture and view clinical records, write orders electronically and track their status, view diagnostic tests, utilize clinical decision support, and many other functions. Health organizations are relying on them to improve transitions of care, chronic disease management, care coordination, and improvements to the patient experience. The digital health care ecosystem is becoming more complex and interconnected given the breadth and depth of the aforementioned elements. These systems are contributing to a better experience for patients and clinicians, better outcomes, increased productivity and lower costs associated with the delivery of high-quality health care. At the same time, like any technology and a business’ reliance on it, there are introduced risks. Each additional digital element added to the systems must be 100% reliable and interact with all of the other systems. Therefore, each application or device increases the risk to the delivery of high-quality and safe health care. Do health care organizations have the programs and tools in place to mitigate risks in the deployment and operation of this ecosystem? Automated testing is crucial in ensuring the safety of digital health applications and medical devices (also referred to as eSafety).

Methodology/Approach: The biggest inherent risks in this ecosystem are with interoperability and user interface testing. These areas are where there is the greatest configuration, customization, and systems integration. So, what is the most effective way to verify all of these system elements are functioning correctly, in other words with eSafety? One of the most effective tools we have at hand, but are underutilizing in health care, is automated testing. Test automation is the use of software, under a setting of test preconditions, to execute tests and then determine whether the actual outcomes and the predicted outcomes are the same. Automated testing can be used to validate that the messages sent and received between systems are as expected for a specific test scenario. Automated testing can be used for user interface validation. The user interface is one area that is often configured to a specific deployment. Therefore, the team deploying must validate that all of the fields are functioning as designed. Are the data captured and validated on the screen as expected? Are combinations and permutations of related data valid?

Finding/Results: Automated testing can reduce the testing and validation cycle of Health IT systems from months to hours. It offloads a high percentage of manual test scenarios freeing up staff (i.e. clinicians, business analysts, IT staff) from the time-consuming data entry validation and data presentation and help them focus on higher valued tasks and patient care instead. Presentation includes 2 case studies on results and ROI.

Conclusion/Implications/Recommendations: In summary, test automation is a practical and efficient way to ensure that the user interface and interoperability within a health care digital ecosystem are functioning as designed. It offloads mundane and repetitive tasks from staff, reduces errors, and results in better breadth and depth of test coverage at a lower cost and with reduced timelines.

140 Character Summary: Maintaining the quality and safety of digital health systems can be achieved in a cost-effective, automated and timely manner, by the use of test automation.

Purpose/Objectives: Black Creek Community Health Centre (BCCHC) provides holistic care and program services to a diverse client population in Toronto, Ontario Canada. We compared traditional paper-based data collection with an interactive mHealth platform Tickit® for the HQO Client Experience Survey and specific BCCHC questions to evaluate and implement quality improvement initiatives efficiently and in real time. Objective Compare traditional paper-based data collection with an interactive mHealth platform Tickit® for the HQO Client Experience Survey and specific BCCHC questions to evaluate and implement quality improvement initiatives more efficiently and in real time. Aim: Increase the response rates by 400% to be more equitably representation of organization population.

Methodology/Approach: Implementing change management, LEAN Six Sigma processes and continuous improvement via the Plan Do Study Act model. Staff and patients were empowered to integrate workflow in the clinic by automating processes to collect the patient’s voice in a responsive and value-added process: •Survey development •Workflow and process mapping •Review and revise survey drafts •Promotional materials •Identify staff champions •Training •Implementation •Check in and revision As an added value measure, patients completed the survey pre- and post- appointment.

Finding/Results: Results Section 1: Overall Experience Section 2: HQO Quality Dimension -Access Use of an mHealth tool on a tablet resulted in Advance Access by reducing 3rd next appointment from 30 days to 2-3 days by engaging patient population with Tickit. Section 3: HQO Quality Dimension: Client-Centred As per HQO technical specifications, the number of responses for “Always” (96) and “Often” (33) were combined, and divided by the total of responses, excluding non-respondents Average time to complete: 3 minutes A Louder Patient’s Voice 429% Survey response rate increase with Tickit Tickit n=713 vs Paper n=167

Conclusion/Implications/Recommendations: Staff was instrumental in reminding and encouraging clients to participate in the survey, and this was demonstrated by the high rate of responses within the first 5 months. Regular reporting to staff at Sheridan and Yorkgate by QIP committee members regarding the number of surveys completed, along with a “thermometer” diagram at Sheridan to track progress and report to clients also helped in encouraging clients to complete the survey. Success Factors: • Staff champions • Harness analytics power for regular monitoring and reporting • Check-ins and revisions throughout process • Reminders to staff and patients • Mobility of technology Lessons Learned: • Integration of new Client Engagement Tool • Opportunity for intersectoral collaboration and co-design process • Identify and improve on current workflows • Increase efficiencies in data monitoring, reporting and analysis

140 Character Summary: Using an mHealth tool validated quality improvement initiatives for staff satisfaction, patient-centric care and advocatng for the patient's voice.

Purpose/Objectives: To support health systems in developing processes and procedures to provide high-quality SBIRT in the context of comprehensive adolescent health screening To improve providers’ skill and comfort in addressing substance use with adolescents To provide comprehensive screening of adolescents and targeted intervention to reduce substance use through the use of technology

Methodology/Approach: Phase 1: Customize Tool and Approach to fit Community Needs.We met with leaders and stakeholders from the participating projects to conduct a needs assessment and benchmark usual care, including resources and characteristics that may affect the need for technical assistance and training. Phase 2: Implementation Planning & Training. We engaged clinic staff from each clinic to specify implementation processes for their site, including which team members will be sent Check Yourself results, protocols for follow up, and tools for documentation in the electronic medical record. Phase 3: Roll-Out of Implementation with Quality Improvement. As the implementation plan rolled out, we conducted regular meetings with healthcare staff and thought leaders for monitoring progress, evaluation and debriefing. Phase 4: Evaluation. We conducted interviews with all levels of participants from each site potentially including administrative staff, program coordinators, thought leaders, providers, and project advisory board members to understand the implementation outcomes (changes in practice thinking and practice behavior, changes in organizations/systems), implementation processes, and next steps.

Finding/Results: In total, 26 participants were recruited from the waiting area of the clinic, 5 through word of mouth, and 1 via flyer. In total, 32 interviews were conducted, though 1 interview was not analyzed as the participant provided predominantly single-word responses that were not felt to enhance understanding of the youth’s perspective. In general, participants reported that the Check Yourself tool was easy to use and that colorful images and interactive content increased their interest in the health information that was presented: All participants indicated that they would prefer the Check Yourself tool to pencil-and-paper screening. Some adolescents particularly appreciated that questions were presented one at a time such that responses to previous questions were not visible. They felt this feature would help conceal their responses from family members in a waiting area: Adolescents described distinct ways that they felt the Check Yourself tool could enhance their interactions with doctors. Many participants found it easier and less awkward to disclose health risk behaviors on the tool than face-to-face, and perceived the tool as helpful in reducing providers’ need to ask patients about sensitive topics during the appointment.

Conclusion/Implications/Recommendations: With the opportunity to create screening tools that go beyond collecting information from adolescent patients by providing education and feedback, it is useful to seek youth input in order to design content that is acceptable and effective for this population. Adolescents in this qualitative study were specific about their preferences for electronic, personalized feedback on their health behaviors. Additionally, participants valued feedback that enhances their ability for self-management by facilitating goal setting and offering ongoing technological supports. Future quantitative outcome research should test screening tools that incorporate these suggestions.

140 Character Summary: Check Yourself is a teen-friendly eHealth tool designed to promote motivational discussions between adolescents and their providers about substance use.

Purpose/Objectives: CIHI provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. The health information environment is one of proliferating data and data sources, and the capabilities and needs of CIHI’s data submitters and those who access our data have grown and are evolving. To keep pace with the industry, CIHI has initiated a multi-year program that will oversee and influence the modernization of data supply and access models across all of its data holdings. The goal of this program is to accelerate the modernization of CIHI’s data supply and access through business process re-engineering and effective use of new technologies, in order to reduce data burden and improve timeliness.

Methodology/Approach: CIHI has drafted a white paper to inform a multi-year roadmap and blueprint for its modernization efforts. This focuses on nine key themes: CIHI’s secondary use role in the health care system; what data should be collected; where this data should be sourced; how this data an flow in an automated and efficient manner; timeliness of data; adopting a one person, one record concept for secondary use; internal & external governance; vendor partnerships and data access.

Finding/Results: The near-term and long-term recommendations from each of these themes will be described during this presentation. Guiding principles that CIHI has established to steer its modernization efforts will also be discussed. These recommendations will support the development of a roadmap that will guide the major changes CIHI will be making to its supply and access chain in the coming years. These changes will impact all healthcare organizations that currently submit data to and consume data from CIHI – as such, change management and stakeholder engagement will be key to successful transformation.

Conclusion/Implications/Recommendations: Modernization of CIHI’s data supply and access flows will have system-wide impacts. A phased approach is being applied to ensure smooth change management, starting with establishing strong governance structures that will oversee and align the numerous projects that will be undertaken across the organization on this work. Additionally, key projects will be launched in high-value areas such as integrating and automating CIHI’s acute and ambulatory care systems.

140 Character Summary: Hear about CIHI's multi-year strategy to oversee and influence the modernization of data supply & access models across the country.

Purpose/Objectives: To support the effective design, development, adoption, and optimization of electronic health records (EHR), there is a considerable need for Health Informatics (HI) students to have hands-on experience and training with using EHRs. However, many HI students in Canada have very limited exposure to EHRs. This lack of exposure results in student challenges with developing HI competencies that are pre-requisites for other courses, co-op work terms, and eventually the workplace. Consequently, HI students may feel inadequately prepared to design, develop, implement, and support EHRs as graduates. The integration of an educational EHR into HI curriculum is central to developing students' digital health (HI) competencies. To meet this need, McMaster University adopted an educational EHR for its Health Informatics and Health Information Management (HIM) diploma programs in August 2016.

Methodology/Approach: As a part of the course redesign efforts for HTH 105: Information Systems and Technology, an educational EHR was adopted by the course developer and instructor. A three-hour scavenger hunt activity using the education EHR was included as a pre-requisite for the course. During the first week of the course in September 2017, HTH 105 students were asked to complete a 54-item self-assessment questionnaire based on COACH's "Health Informatics Professional Core Competencies v3.0" using a Likert scale of 1-5 (No Demonstrated Achievement to Exemplary Achievement). The course is providing students 1-2 hours of weekly hands-on exposure to the educational EHR, as well as supplementary activities to gain additional practice. To measure any changes in HI competency development at the end of the course, students will be asked to complete the same HI Competencies self-assessment questionnaire in November 2017.

Finding/Results: The response rate for the baseline HI Competencies Self-Assessment questionnaire was 67% (n=16/24). Of the respondents, almost all s have less than one year of experience in the HI field (n=14/16, 88%). The overall average across all HI competencies was 2.66/5. Although students reported a higher self-assessment average for basic clinical terminology, they reported health information systems adoption and use, EHR architecture, and systems evaluation as their weakest competency areas. Nearly all HTH 105 students (n=22/24, 92%) have adopted the educational EHR and are completing the hands-on EHR activities. Evaluation and monitoring of the benefits and limitations of the educational EHR is ongoing until the end of the course (November 2017). It is anticipated that the educational EHR will help to significantly increase students' self-assessment of COACH competencies, especially related to the EHR.

Conclusion/Implications/Recommendations: With the introduction of hands-on exposure to the educational EHR, HTH 105 students at McMaster University are experiencing an educational EHR's features, learning how clinical and administrative data is inputted and retrieved, observing its workflows, evaluating its usability, and making recommendations for improvements in EHR design and adoption. These skills are foundational to the development of COACH competencies for HI students. Educational EHRs should be integrated strategically into other HI courses and programs across Canada to support the applied learning of HI students. Further, there is a need to conduct pre and post-course evaluations of COACH competency development for HI students.

140 Character Summary: McMaster University's integration of an educational EHR in Health Informatics curriculum is helping to significantly increase students' COACH competencies.

Purpose/Objectives: Describe the development of a functional bedsheet using a non-invasive method for monitoring respiration patterns and changes in respiratory rate. The functional bedsheet captures millions of data points across a range of fabric pressure sensors, providing rich insights on individuals’ health, sleep patterns, apnea, respiratory rate, among others. In this study, we will validate the vital signs detection of the functional bed technology through a clinical study using user-centered evaluation (UCE).

Methodology/Approach: Our research team will conduct a clinical study evaluating the participants' interaction with the functional bedsheet, their movement in the bed, comfort, and the accuracy of data collection during such movement in bed. Another important aspect of this study is the validation of the functional bedsheet in parallel with other monitoring equipment, thus understanding possible interactions or interferences. The functional bedsheet consists of multiple sensors that cover a wide area that can determine pressure variation, the system is designed as an ecosystem where each sensor acts independently, yet is dependent of the neighbouring sensors. The functional bedsheet will be validated against several other clinical-grade sensors (SpO2, ECG, etc.) Our research team will use the data collected to develop a machine-learning algorithm for detection of respiration changes and apnea patterns, helping translate raw sensor data into useful and meaningful insights for patients and clinicians.

Finding/Results: The expected results are the creation of a product that requires minimal interaction by the user (zero-effort technology), which is an important characteristic for our final user-population (older adults living independently). Additionally, our research program aims to use the data collected in the study to train the system to identify breathing patterns and diagnose apnea using machine learning. The technology is being designed for rapid diagnosis, prevention of associated diseases and reduction of visits to physicians.

Conclusion/Implications/Recommendations: Finding ways to improve the care and monitoring of patients in your own home is a necessary solution to reduce costs and increase the wellness of the user through uncomplicated equipment and easy access. The functional bedsheet aims to assist in this goal by making it possible to monitor vital signs and apnea continuously in the comfort of your bed.

140 Character Summary: Vital signs detection using a functional bedsheet and use of machine learning to identify respiratory patterns and apnea.

Purpose/Objectives: Following implementation of SSO, CHRISTUS set out to assess the impact in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. A total of 65,202 logins across 6 CHRISTUS Health hospitals were sampled systematically during a 7-day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers.

Methodology/Approach: We share quantitative data on clinician time savings and recurrent computer hardware expenditure savings resulting from the implementation of SSO. We selected a 7 day observation period of SSO usage in May 2016 across 5 general community/general hospitals and 1 children’s hospital in Texas and Louisiana. There were 65,202 logins to the enterprise EHR. Potential SSO clinical users across the enterprise are 22,011. Of these, 5078 were based in the 6 hospitals evaluated, of which 2256 were active users (44.4%). Mean login durations were multiplied by the number of total first of shift and subsequent logins across all 6 hospitals for a 7 day period of evaluation and reporting in May 2016. We calculated the dollar cost savings or value in liberating time for each of 3 categories of clinicians utilizing SSO – physicians, nurses and ancillary personnel. In our SSO implementations in these 6 facilities, 28% of clinical users were physicians,54% were nurses, and 18% were from ancillary departments. For nurses, we utilized the national average wage of $34.50. We collapsed physical therapists, dieticians and respiratory therapists into a single category of ancillary users and averaged their respective average hourly wages as $32.20. We collapsed all other medical specialties into a single category and averaged the physician hourly wage rate reported in the U.S. Department of Labor occupational employment statistical database rate ($95 per hour) with that reported by Becker’s Hospital Review 2015 data ($165 per hour) for a rate of $130 per hour.

Finding/Results: *Results*: The reduction of total clinician login time over the 7-day period showed a net gain of 168.3 hours per week of clinician time – 28.1 hours (2.3 shifts) per facility per week. Annualised, more than 1461 hours of mixed physician and nursing time is liberated per facility per year. The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per year and $1,658,745 per year in the first phase implementation of 18 hospitals. The computer hardware equipment savings due to desktop virtualization increased annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO have also been realised.

Conclusion/Implications/Recommendations: Based on this evaluation of the impact of SSO implementation,SSO is delivering substantial clinical value, recurrent annual ROI and net cost savings to the first 6 facilities implemented withinour hospital system.

140 Character Summary: Attend this session to learn about the research published in the International Journal of Medical Informatics on The Clinical Impact of Workstation SSO.

Purpose/Objectives: Healthcare organizations across the globe have made large financial investments in the implementation of eHealth solutions. Many have not achieved the intended benefits. A plethora of reasons have been identified including the complexity inherent in these undertakings, sub-optimal leadership and staff with limited informatics knowledge and skills. Evidence-based resources are required to adequately prepare healthcare leaders, clinicians and others to effectively lead and support these initiatives. Yet, there is a paucity of such resources. This presentation reviews the results of one of three systematic reviews that were conducted to inform the development of a best practice guideline intended to enhance the informatics capacity of individuals involved in these types of initiatives. This systematic review identified individual and organizational factors that influence the implementation and adoption of eHealth solutions.

Methodology/Approach: Major medical databases were searched to identify relevant studies published between 2006 and 2016. A total of 178 studies met the search criteria. The data was categorized using the dimensions of the Clinical Adoption Framework and analyzed to determine the quality, consistency, generalizability and limitations of the evidence, making this the first comprehensive systematic review of its kind.

Finding/Results: A total of 173 factors were identified from the 16 articles that met the inclusion criteria. The two most commonly reported individual factors that impacted the implementation of eHealth solutions were technical competence and end-user participation. The organizational factors reported most often were training, usability and workflow integration. Fifteen individual/organizational recommendations were developed from these sources of evidence and published in the Guideline.

Conclusion/Implications/Recommendations: The individual/organizational factors and recommendations reviewed in this presentation will have relevance for healthcare leaders, clinicians and others who are involved in the implementation of an eHealth solution regardless of their role or setting. The recommendations outline evidence-based strategies that contribute to better design and adoption of eHealth solutions, enhanced clinical decision making, improved patient outcomes and health system transformation.

140 Character Summary: This presentation highlights key individual/organizational factors derived from a systematic review intended to enhance the adoption of eHealth solutions.

Purpose/Objectives: When clinicians deliver services to patients and families distant from their own clinical environment, new clinical, operational and technical systems must be designed both at the consultant site, and the patient site – a two pronged approach. For many telehealth visits, new clinical relationships between providers at BCCH and providers in community are created. In order to make the virtual clinical event as close to in-person visit as possible and meet the same health goals, there must be thoughtful and collaborative work at both patient and consultant ends. For the Children’s Virtual Care (CVC) sites across BC, the capacity and context of the system in the patient’s community must be combined with the capacity of BCCH Children’s, to meet the needs that can be unique to children and families. This presentation will describe the challenges and successes in building a system for pediatric virtual service in diverse BC communities, some of which have limited capacity and exposure to children with complex health challenges.

Methodology/Approach: Service need for pediatric subspecialty care is the primary driver for Children’s Virtual Care (CVC). With one Children’s Hospital, about 1 million square kilometers, and 1 million children, providing equitable access to pediatric subspecialty care in BC is an ongoing challenge. Analysis of access by health service delivery area and knowledge of the child health service system helped clarify the targets for virtual care, both in location and volumes. Using the Child Health BC Tiers of Service Framework for Children’s services, including the regional health authorities’ capacity for the support of children and families having telehealth visits, a feasible plan was developed for each CVC site. Children’s Virtual Care sites are those where staff at the patient site can support a number of clinical and operational requirements of a child’s virtual visit. CHBC worked in collaboration with technical, clinical and operational teams across the health authorities to develop CVC sites in regional health authorities and with the BCCH subspecialty teams to identify and meet specific requirements are needed to provide a visit as close to one at BCCH as possible.

Finding/Results: 19 Children’s Virtual Care sites in BC have been supported to gain the operational, clinical and equipment capacity to support pediatric subspecialty visits, and provide the specific requirements in 26 different subspecialty clinics. The CVC sites have child friendly environments, pediatric medical equipment, clerical support for reception and registration, processes for diagnostic testing when needed, nurses who can assist with assessment if required, and for some, pediatricians to collaborate with a pediatric subspecialist. Subspecialty BCCH teams are integrating virtual visits into their triage process, scheduling and booking , and workflows so that virtual visits are not a system separate from the system and processes that support in person visits. Rather the Virtual Care incorporates the multiple components within the health service system to increase effectiveness, efficiency and to ensure the satisfaction of children, families and their providers. 98% of families surveyed reported they agreed, or strongly agreed they would like telehealth for their child’s visit again. According to parents who participated in this survey, telehealth also prevented two parents from missing work, children from missing school and reduced the negative impacts of travel.

Conclusion/Implications/Recommendations: The two prong systematic approach to support clinical telehealth visits for sub-specialty services, systems and supports, will ensure an effective children’s virtual visit that is integrated into clinical processes, and the patient, family and provider satisfaction that leads to growth in the use of virtual services.

140 Character Summary: CHBC creates a sustainable pediatric subspecialty virtual care system for visits as close to in-person as possible, improving access care.

Purpose/Objectives: The Electronic Health Record (EHR) is central to British Columbia’s eHealth strategy to increase the quality and safety of patient care. However, the implementation of EHRs is a challenging, transformational change that involves the complex interaction between health care professionals, processes and technology. To support the successful adoption, use and optimization of EHRs for the benefits of patient quality, safety and the patient/provider experience, there is a need for a comprehensive framework/model to understand the variables that contribute to EHR adoption, use and benefits realization. Currently, such a comprehensive framework/model does not exist in the literature. However, an EHR Adoption and Use (EAU) framework/model is critical to informing evidence-based planning, implementation and evaluation of EHRs at the local, provincial, national and international levels. To inspire bold action in EHR adoption and use for benefits realization, Island Health embarked on the development of an EAU Model. The purpose of the EAU model is to guide EHR adoption and use planning, as well as to inform formative EHR evaluation at Island Health.

Methodology/Approach: A literature review of existing technology adoption/use and quality frameworks was conducted from May to June 2017. The variables/constructs and dimensions of each of these frameworks were extracted. Similar constructs and definitions were combined and an overarching framework was developed. To operationalize the model for measurement, relevant metrics related to patients, caregivers, health care providers, the health care organization and population health were extracted based on literature reviews and prior EHR evaluation knowledge for each construct. Methodologies, methods and instruments for evaluating the metrics were also identified.

Finding/Results: Ten technology-adoption-and-use frameworks/models were included in the development of the EHR Adoption and Use (EAU) Model: (1) the Unified Theory of Acceptance and Use of Technology (UTAUT); (2) Canada Health Infoway’s Benefits Evaluation Framework; (3) the UVic eHealth Observatory’s Clinical Adoption Framework; (4) Island Health’s Quality Framework; (5) the BC Health Quality Matrix; (6) The Clinical Systems Transformation (CST) Benefits Framework; (7) the Agency for Healthcare Research and Quality (AHRQ) Domains of Health Care Quality; (8) Health Quality Ontario’s Quality Attributes; (9) Accreditation Canada’s Dimensions of Quality Care; and (10) the Clinical Adoption Meta-Model. As the most cited and rigorously tested framework internationally, the Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the core framework for the EAU Model. In total, 42 constructs and sub-constructs were included, and multiple metrics at the patient, health care provider, health care organization and population health levels were developed for each construct. The EAU Model can be seen in Figure 1. The validation and testing of the metrics and evaluation methods is currently underway. Figure 1 EAU Model

Conclusion/Implications/Recommendations: The EAU model combines evidence-based variables/constructs of technology adoption and use with universal quality and experience benefits that can be measured for EHR benefits realization. The EAU model can be used by health care organizations to guide the planning, implementation and continuous evaluation of EHRs at the local, provincial, national and international levels.

140 Character Summary: The EHR Adoption and Use (EAU) Model is an evidence-based framework to guide EHR planning, implementation, continuous evaluation and benefits realization.

Purpose/Objectives: Telehealth is defined as being the virtual organisation of service networks, professional collaborations with or without patient intervention using information technology in order render at a distance professional training, patient teaching, assistance, monitoring, clinical coaching, consultation and follow-up. A new Ministerial Telehealth Framework has been proposed in the province of Quebec. The Ministry intends to review the telehealth governance in order to recognise telehealth as a service delivery model, to anticipate the clinical needs that justify telehealth services, to agree on an integrated plan for the development of telehealth services, to have an overview of the telehealth services and projects over the province, to optimise telehealth services and resources and to measure the impact and benefits of telehealth. Given this context, a telerehabilitation clinical project was developed in a Montreal-area health network. More specifically, the objective of the telerehabilitation project was to develop a model of delivery using modern technologies in order to improve the access to specialized and ultra-specialized rehabilitation services (evaluation & intervention) and to measure its effects.

Methodology/Approach: With changing demographics, increased prevalence of chronic diseases, limited health care resources and health network reforms, it is essential to consider alternative methods of rehabilitation service delivery in order to optimize recovery across the continuum of care. The telerehabilitation clinical project implemented remote services using innovative technology in three major rehabilitation centers. Using a systematic project management approach, clinical needs were assessed, appropriate technologies identified, implementation progressively undertaken, patient and clinician satisfaction was assessed and potential cost savings estimated.

Finding/Results: Close collaboration with an industry-partner was essential to develop the remote telerehabilitation applications that will be presented. An in-house evaluation process allowed us to measure several indicators such patient and client satisfaction, types of interventions and the potential cost savings with the use of the telerehabilitation modality. The factors impacting on telerehabilitation implementation and routine use are presented, with regards to the technology itself, the organisations (including clinician attitudes and beliefs), and the context within which the organisations function. The strategies to overcome barriers throughout the implementation process are also discussed.

Conclusion/Implications/Recommendations: Integrating telerehabilitation innovations into routine clinical care is a complex process. Despite the anticipated benefits of telehealth, its implementation in healthcare remains challenging. Findings from this clinical experience, as well as more long-term studies of telehealth use in different contexts will allow us to better understand the factors which impact on telehealth implementation as well as its routine use in clinical practice.

140 Character Summary: Implementation of Telehealth Services Across 3 Rehabilitation Centers in Montreal Canada

Purpose/Objectives: This presentation will focus on the successful adoption and current use of HEALTHe NL, Newfoundland and Labrador’s electronic health record (EHR). Including: ? Implementation of Orion’s EHR solution - HEALTHe NL ? Current state, in relation to Canada Health Infoway’s EHR Blueprint ? Adoption metrics ? Current usage ? Governance and future plans

Methodology/Approach: This presentation will highlight the adoption strategy for HEALTHe NL. This includes the strategic focus on target groups based in a phased approach as informational components of HEALTHe NL became available such as: ? A focus on physicians in the Eastern Regional Health Authority (RHA) when only Eastern RHA laboratory information was available ? Nurses completing medication reconciliations based on the robust medication profiles ? Clinicians in remote areas referring patients to the tertiary care centre, that would otherwise not have access to that information, for health care services including; cancer care, Janeway (children’s hospital), cardiac and vascular services.

Finding/Results: This presentation will highlight the current state of adoption for HEALTHe NL including the following information:: ? Total active use ? Top signed on user groups (eg. nurses, physicians, pharmacists) ? Top departmental users (eg. medicine, surgery, emergency room, nursing) ? Unique medication profile data

Conclusion/Implications/Recommendations: In conclusion, this presentation will provide recommendations with regards to the success of the adoption strategy employed. In addition lessons learned speaking to challenges and future areas of focus will be shared. The presentation will also highlight next steps based on stakeholder engagement and enhancement consultations with both end users and Orion, the HEALTHe NL vendor. Future plans and opportunities: With active use, comes increased requests for product enhancements and integration. We are currently working with numerous stakeholders to review and priortize opportunities for expansion of the HEALTHe NL viewer including eNotifications, eReferral, eConsult and eOrdering.

140 Character Summary: Newfoundland and Labrador's provincial electronic health record: HEALTHe NL success stories

Purpose/Objectives: Pulmonary embolism (PE) is a serious condition that can be fatal if diagnostically missed. The aim of this study is to evaluate the impact of integrating a clinical decision-support system (CDSS) on diagnosis of PE in an inpatient hospital setting.

Methodology/Approach: This is a mixed-methods study with an observational pre-post design. A CDSS for the diagnosis of PE has been designed to represent best practices in data visualization and uncertainty in presence of disease. This CDSS will be integrated into the computerized provider order entry system and set up to be triggered at key points in the PE diagnostic workflow at two hospital sites. Data will be accessed from clinical information systems and consist primarily of information about tests commonly requested for PE diagnosis and provider decision-making steps. Data will be collected for six months prior to deployment of this CDSS and again for six months after deployment. This data will be analyzed to determine pre- and post-intervention physician adherence scores. Adherence scores will be compared to determine what impact, if any, the CDSS has on physician adherence to diagnostic guidelines for PE. Similar data from a third hospital site will be collected and incorporated into the final analysis. This third hospital site will not have access to this CDSS for PE diagnosis and is designated as control site for outcome comparisons.

Finding/Results: Based on previous work, the research team expects to see increased provider adherence to diagnostic guidelines for PE in settings where the tool has been implemented.

Conclusion/Implications/Recommendations: Clinical decision-support systems have the potential to improve patient care and safety as a result of increased provider adherence to existing evidence-based guidelines. Work on PE is not the only condition for which diagnostic error is of concern, but this research may produce a template for the use of decision-support with other conditions. This pilot study is expected to launch in early 2018 with preliminary analyses available by late 2018.

140 Character Summary: Pilot clinical study of the impact of a clinical decision-support system on provider adherence to guidelines for diagnosis of pulmonary embolism.

Purpose/Objectives: The purpose of this presentation is to discuss the adoption of Telemental Health Services in a Regional Mental Health Centre. We will also discuss the high level of satisfaction our patients and providers experienced with this service.

Methodology/Approach: Background: Historically, access to mental health services for patients in the rural regions of our Eastern Ontario catchment area have been a challenge due to the long distances between our rural patients and the urban location of their mental health service providers. Objectives: To mitigate this access barrier to mental health services we created a plan to establish rural mental health clinics throughout our catchment area. Methods: We employed various strategies to ensure the clinicians and clinics we recruited adopted and retained the practice of providing Telemental Health Services from clinicians based at an urban tertiary academic health centre to patients located in 14 rural primary care clinics. Results: Our ten-fold increase in patient volumes and the high levels of patient and provider satisfaction indicate that the methods we employed to create a Regional Telemental Health Service have been successful. Conclusions: Employing the correct change management strategies can allow for the rapid adoption and development of Telemental Health Services in a catchment area where rural access to conventional specialized mental health services is a challenge.

Finding/Results: Our ten-fold increase in patient volumes and the high levels of patient and provider satisfaction indicate that the methods we employed to create a Regional Telemental Health Service have been successful.

Conclusion/Implications/Recommendations: Employing the correct change management strategies can allow for the rapid adoption and development of Telemental Health Services in a catchment area where rural access to conventional specialized mental health services is a challenge.

140 Character Summary: We will describe the adoption of and satisfaction with Telemental Health services in the context of an Ontario regional mental health centre.

Purpose/Objectives: As the healthcare industry has become more complex, the lag in the sophistication of approach in change, transition and sustainability has become more acute. The change communities in the country seek to better understand the problem, the gaps and look at how A2B Change Process can be relevant and applicable in the continuously evolving healthcare change landscape.

Methodology/Approach: This particular research is part of an informal survey, which assessed the current National Change Management Framework and its six core elements (1) Governance and Leadership (2) Communications (3) Training & Education (4) Workflow Analysis & Integration (5) Stakeholders Engagement (6) Monitoring & Evaluation using a 5-question survey. The survey was open to all Change Management Network members on both LinkedIn and InfoCentral virtual communities.

Finding/Results: Early respondents with combined practitioners’ anecdotal contribution and further literature search conducted is supportive of the A2B Change Process with solid foundations on Transitions to Operations and Sustainability Planning as part of the change journey. The results also are reflective of lessons learned as shared by the interview respondents. Oftentimes, in our attempt to manage change that we are forgetting that change and transition DO NOT 'start and stop' during 'Go-Live'. "Go-Lives' are just events in the change process, and the real change and transition management is continued well beyond 'Go-Lives'. A well-thought out 'hand-off' from project teams to the business teams is required to ensure sustained success. Note: Research is still in progress.

Conclusion/Implications/Recommendations: According to Albert Einstein it is “Insanity: doing the same thing over and over again and expecting different results.” As our environment evolves and so must we to remain relevant. As organizational leaders, we have the responsibility to manage change efforts along with the process of transition to minimize the negative impact on frontline stakeholders. It is important for practitioners to include transition components; (1) Transition to Operations (2) Sustainability into the change process or in any methodology of choice. This approach focuses the change as well as the transition. Change and Transition are not interchangeable and they must co-exist in conjunction with one another to ensure successful and sustained digital health implementations. Change is an event and Transition is a process and so as sustainability. To date, the informal survey received from 29 peer-respondents. It is expected to see an increase of 50% from current survey rate of participation. Although further numbers are expected to add to the results of the research, it is unlikely to see a change in recommendations. The story of CHANGE and TRANSITION can be summed up by 'Make a Plan, Ensure Commitment & Move on' one person at a time.

140 Character Summary: Overall, the study clearly demonstrates that a more sustained outcome results when transition components are included in the change & transition management approach.

Purpose/Objectives: The purpose of this project is to explore individual behavioral patterns, trends, and facilitate remote patient monitoring using data from IoT sensors. The focus of this study is to understand individual- and population-level behaviors based on smart thermostat data extracted from the ecobee database. This data will be used for remote patient monitoring, population-level insights, and monitoring of the progression of chronic diseases.

Methodology/Approach: ecobee, a Canadian smart home technology company, currently has the technology to collect temperature and motion data from thermostats and remote sensors. The motion data from the thermostat and remote room sensors have the capacity to capture the amount of indoor physical activity, sleep patterns, sedentary behavior, and ultimately inform on various health conditions (such as dementia and mental health). Presently, our research team has access to data collected by ecobee’s Smart WiFi Thermostats owners who consented to having their data shared in the ecobee’s Donate Your Data (DYD) program. Our sample data comes from 10,251 households with a ranging number of remote sensors, predominantly located in the US and Canada, over a two-year period. For the purpose of creating a computational environment to store, transform, and deliver the data, this study will follow a typical big data software architecture. In order to explore and analyze the data, we are going to use Python machine learning.

Finding/Results: Currently, we are in the process of analyzing ecobee’s entire DYD dataset. In phase-1, using machine learning, we will apply pattern recognition on the dataset and expect to identify variations in user behavior. Our algorithms will identify unique patterns at different levels, as for example intra- and inter-day variations. They will also be able to predict the micro- and macro-level behavior patterns, such as the time of the day or sleeping vs. awake. Ultimately, we will leverage these algorithms to identify abnormal behavior within a household to be used as an early warning for deviations health status. In the following phases, our prototype will display the statistics and summary of activity in a dashboard that public health agencies will be able to access and visualize the data in near-real time. Aggregate data will be displayed in near real-time to enable public health agencies to monitor activity across Canada’s different regions. At a later stage, deep learning will be used to identify challenging areas and forewarnings will be provided via map visualizations.

Conclusion/Implications/Recommendations: This project is pioneering improvements to public health surveillance: (1) a novel data source; (2) new indicators for physical activity, sleeping habits, and sedentary behaviour; (3) novel tools/solutions for capturing data; and (4) creating newly linked datasets combined from a variety of sources including IoT sensors. Data collection has never been achieved on such a granular level (5-minute intervals) and in virtually real-time. The Public Health Agency of Canada (PHAC) has yet to use in-home monitoring via sensors. This study will open opportunities for PHAC to go beyond traditional methods for public health surveillance.

140 Character Summary: Remote monitoring of health indicators at the population level using motion data from ecobee’s smart thermostat (IoT) and machine learning.

Purpose/Objectives: To support Fraser Health’s Integrated Plan of Care initiative at Abbottsford Regional Hospital, an electronic documentation tool has been selected. This tool enhances inter-professional care planning and collaboration. Ensuring the usability and safety of the tool has become critical.

Methodology/Approach: A framework for applying usability engineering to ensuring system usability and safety of health information technology developed by Broycki et al. (Broycki et al., 2013) has been employed in designing and building the tool. A series of multilayered user tests of the electronic documentation tool have been performed beginning with basic usability inspection and cognitive walk-through, followed by usability testing and limited clinical simulations. A framework for applying usability engineering to ensuring system usability and safety of health information technology developed by Broycki et al. (Broycki et al., 2013) has been employed in designing and building the tool. A series of multilayered user tests of the electronic documentation tool have been performed beginning with basic usability inspection and cognitive walk-through, followed by usability testing and limited clinical simulations.

Finding/Results: Usability Inspection: • Both positive and negative features of the tool were identified • Informed design and build / customization Usability Checklist: • Completed by the development team to check the compliance of the usability heuristics of the prototypes they built • Served as a guideline to form the discussion around design between the development team and stakeholders Usability Test: • 14 build packages, all of which were tested at least once (29 tests in total) • Created 5 formal Usability Test reports and 24 brief summaries Clinical Simulation Test: • 24 frontline clinical participants (Nursing: 17, Allied Health: 7) • Covered 95% of the identified workflow in Medicine, Surgery and Critical Care areas • 19 designed test cases Results informed training, highlighted anticipated questions, and mitigated issues that might occur during real patient encounters Usability Inspection: • Both positive and negative features of the tool were identified • Informed design and build / customization Usability Checklist: • Completed by the development team to check the compliance of the usability heuristics of the prototypes they built • Served as a guideline to form the discussion around design between the development team and stakeholders Usability Test: • 14 build packages, all of which were tested at least once (29 tests in total) • Created 5 formal Usability Test reports and 24 brief summaries Clinical Simulation Test: • 24 frontline clinical participants (Nursing: 17, Allied Health: 7) • Covered 95% of the identified workflow in Medicine, Surgery and Critical Care areas • 19 designed test cases • Results informed training, highlighted anticipated questions, and mitigated issues that might occur during real patient encounters

Conclusion/Implications/Recommendations: Synergistic use of usability checklist, heuristic review, “think-aloud” protocol and “near-live” clinical simulations provide a robust assessment of how the clinical documentation tool would interact in live clinical environments and allows for early redesign to increase clinician utilization. Integration of the usability checklist and the framework in the design, development and test phases buttress efforts to achieve safe technology in healthcare.

140 Character Summary: Integrating usability framework and user-centered design method in Health IT projects advances efforts to achieve safe technology in healthcare.

Purpose/Objectives: Primary Care Physicians (PCPs) manage of 80% of patients with mental health challenges. They have no systematic way to assess or monitor their patients. Currrently EMRs are not interoperable and there is no standardized digital format for insurance reports. Insurance and benefits providers pay physicians to generate medical reports. The data is handwritten, returned by fax, unsecurely, not digital, not entered in distinct fields, generally incomplete, nonspecific, replete with errors, uncodable and therefore impossible to analyze, according to a recent qualitative study: Tang KL, Lucyk K, Quan H. CMAJO August 21, 2017 vol. 5 no. 3 E617-E622. Without access to quality data, we can't answer the big questions in healthcare, like the Fentanyl crisis or teen suicide. According to the WHO, Mental Health and Addiction are the number one causes of disabiilty world-wide. The annual health cost in North America is staggering. Insurance forms are an easily accessible source of patient-level data. Consent to use patients' anonymized data for research is not implicit, but can be obtained. The objective of our project was to develop and implement a standardized, digital, mental health assessment and reporting tool that could be used interoperably in any EMR.

Methodology/Approach: We reviewed a broad sample of current insurance reports, discerned the commonly asked questions and reverse-engineered our assessment to be able to answer and score those questions in text, drop down menus and other digital fields. Our assessment included: Symptoms and their severity Functional Impact of symptoms on: cognitive tasks, work, home, relationship, social, driving and physical health. A comprehensive Co-morbidity Screen for Mood Disorders, Chronic Pain, ADHD, Substance Use Disorders and Trauma. Patient-rated measures of Current Function including: cognitive, executive, social and emotional function, as well as measures on productivity, mood, social support, motivation, readiness for change, pain, stress tolerance, quality of life and emotional stability. For simplicity and interoperability, measures were rated on a 10-point scale. Prognosis using the balance of resources (such as social support, motivation) vs. risks (such as unemployment or emotional instability) We trialed our assessment on the 150 consecutive patients.

Finding/Results: By asking the same question, the same way and putting the answer into the same field, our assessment tool simplified and standardized data capture and analysis compared to having multiple different paper-based forms. It uncovered a broad measure of relevant co-morbid psychopathology. It generated quantitative measures with face and construct validity, where previously there was unstructured, unsubstantiated opinion.

Conclusion/Implications/Recommendations: If insurance and benefits providers could agree on a standardized digital format for medical reports, using industry-standard questions, then physician-generated forms would be much more valuable as a health analysis tool. In future, machine learning, using highly segmented, anonymized, data that is disease, symptom and treatment specific, would allow us to evaluate and optimize interventions across the full cycle of care, based on patient-rated outcomes. The millions of data points created would facilitate the generation of artificial intelligence-driven algorithms that could improve care, reduce adverse events and decrease health costs. That would allow us to answer the big questions.

140 Character Summary: Mental Health is the primary cause of disability world-wide. Stakeholder collaboration on data collection would generate health benefits and cost savings.

Purpose/Objectives: Blockchain technology has shown its considerable adaptability in recent years as a variety of market sectors sought ways of incorporating its abilities into their operations. While so far most of the focus has been on the financial services industry, several projects in other service related areas such as healthcare show this is beginning to change. Numerous starting points for Blockchain technology in the healthcare industry are the focus of this presentation. With examples for public healthcare management, user-oriented medical research and drug counterfeiting in the pharmaceutical sector, this report aims to illustrate possible influences, goals and potentials connected to this disruptive technology.

Methodology/Approach: 1. Primary Research - Interviews from 50 organizations both public and private sector across Canada. 2. Secondary Research - Material from across Canada and internationally. 3. Results from Think Tanks and Focus Groups

Finding/Results: The five blockchain-based healthcare realities for healthcare 1. Clinical Health Data Exchange and Interoperability 2. Claims Adjudication and Billing Management 3. Pharma Clinical Trials and Population Health Research 4. Cyber Security and Healthcare IoT 5. Drug Supply Chain Integrity

Conclusion/Implications/Recommendations: Blockchain technology creates unique opportunities to reduce complexity, enable trustless collaboration, and create secure and immutable information. Healthcare needs to be a part of this rapidly evolving field to identify trends and leverage areas where government and/or Industry support is needed for the technology to realize its full potential in health care. To shape blockchain’s future, the industry in Canada should consider mapping and convening the blockchain ecosystem with the key stakeholders, establishing a blockchain framework to coordinate early-adopters, and supporting a consortium for dialogue and discovery in Canada.

140 Character Summary: WHERE DOES BLOCKCHAIN FIT INTO HEALTHCARE AND VICE VERSA

Purpose/Objectives: Health data is one of our most valuable assets that helps determine diagnosis and course of treatment, and expedites medical discovery. However, information silos, duplication of data, inaccurate data, and lack of interoperability remain a barrier to obtaining complete and accurate information. In addition, the growing trend of decentralized data to include personal health data as part of evolving consumer technologies contributes to the complexity of multiple and accurate data sources. Imagine a world where patients are able to take ownership and control of their own medical and personal health data; and decide what, where, and with whom they share their own health information. This session will examine blockchain technology and how it can transform health care and society, as patients gain control to improve their own health and wellness.

Methodology/Approach: Blockchain is described as “the second era of the internet” and has potential to transform health care and society as we know it. Our organization is in the early stages of examining the potential of blockchain in health care, re-inventing patient/citizen empowerment and engagement through patient control of data. Patient consent and control of primary and secondary use of data can help increase collaboration among public and private sector, and advance medical breakthroughs in a joint effort to benefit all participants, including patients, citizens, and care providers.

Finding/Results: Strategy considerations and planning range from examining and addressing identity management and authentication, trust, data governance, and legal and security implications to managing large-scale culture change as part of the transition to patient/citizen ownership and control of their own data. Considerations can be profound to impact not only each organization, but the nation. Real-life examples of blockchain in other industries will also be illustrated.

Conclusion/Implications/Recommendations: A collaborative public-private partnership between health care organizations, patients, government, and strategic partners can help advance strategic planning efforts to transform health care and society through the use of blockchain technology. By connecting the health ecosystem to a universal data infrastructure, blockchain becomes a connector to machine learning, predictive analytics and population health management. It can strengthen opportunities for collaboration between patients, providers and organizations; advance health ecosystem partnerships; accelerate innovation in medical research; and transition toward new standards for future large?scale implementation.

140 Character Summary: This session will examine blockchain technology and how it can transform health care and society, as patients gain control to improve their own health and wellness.

Purpose/Objectives: The purpose of this presentation is to provide an overview of the current state of genomics data use and to highlight the associated successes and limitations. The applications addressed will encompass the pursuit to provide effective and personalized methods of cancer prevention, diagnosis, and treatment. Furthermore, technical considerations that would allow improved data sharing and analysis will be presented.

Methodology/Approach: Current literature and clinical standards have been assessed to illustrate initiatives taken to catalogue the gene-level data pertaining to: the DNA-related factors correlated with increased rates of cancer development, the genetic fingerprints of observed cancer types, and the expected efficacy of different chemotherapy regimens. Furthermore, a comparative analysis on the efficacy of these initiatives when implemented are compared with standard treatment protocols. Lastly, the barriers inhibiting the large-scale implementation of individualized genomic data in personalized medicine will be addressed.

Finding/Results: Personalized medicine has become an appealing facet of cancer management strategies for its perceived suitability in handling a disease with a unique genetic fingerprint between individuals. However, its implementation has been piecewise and in need of improved coordination because of the vast array of technological factors and related clinical directions. Genetic markers that indicate an individual’s predisposition to cancer have been identified in many cell types but large-scale intervention by means of changes to health care standards have been slow to act on such data. Major barriers to this include the cost of genome sequencing and the immense amount of information that needs to be maintained and analyzed. In spite of this, the long-term relative savings in health care could be significant. Many oncologists currently use xenografts to gather patient-specific genomic data of cancerous cells; however, this does not always involve full genome sequencing. Although this provides a more personalized approach in designing treatment protocols, it fails to encapsulate fully many important factors at the genomic level. Full genome sequencing could provide more detailed evidence regarding prognosis and which drugs would be most effective for individual patients. Lastly, given the sheer number of different genetic presentations of cancer, a large collaborative network of researchers and clinicians would be required to provide an information library that adequately spans the disease’s genetic manifestations. Reliable data storage, access, and analysis at this scale presents concerns over the near-future feasibility of personalized genomic medicine.

Conclusion/Implications/Recommendations: While the benefits of personalized medicine have been addressed in many healthcare contexts, full-scale data at the genomic level has yet to be included from institutions outside of academic contexts. Technological concerns regarding data access and analysis across practitioners and researchers highlight the need to develop specialized data sharing methods and techniques.

140 Character Summary: There is a wealth of knowledge related to cancer available at the genomic level but means of data sharing and analysis are needed to allow the benefits to be realized.

Purpose/Objectives: Healthcare is undergoing a revolution as omics analyses have become increasingly affordable and accessible to evaluate risk of disease, diagnose disease, match treatment to disease and to enable preventive medicine. These analyses include genomics to detect genetic diseases and ascertain disease risk, and proteomic, metabolomic and exposomic to determine the environmental impact in disease development and to monitor response to treatment. Further, microbiomic analysis can give insight into the origins of immune disorders and other diseases. What is required is technology that brings together a full suite of omic tests, bioinformatics and systems biology expertise and big data analytics to deliver personalized health insights and action plans in an all-in-one online platform.

Methodology/Approach: With the use of big data analytics and artificial intelligence tools, individual data clouds of genomic, proteomic, metabolomic, microbiomic, exposomic and phenomic profiles are generated that can precisely characterize the presence and potential of disease, match treatments and monitor outcomes. The unique datasets of each individual can be formulated and referenced against curated literature to produce personalized health insights and custom action plans. Machine-learning tools can be utilized to suggest a customized action plan for individuals, assembled together with their health practitioners, that target actionable results from the molecular analysis. To provide valuable longitudinal data, tracking tools can be used to track an individual’s performance over time, capturing valuable live data insights and motivating individuals to re-test to evaluate their progress. With the live reporting of actions connected to molecular measures in the action plan, the machine-learning data centre will capture behaviors and the effects of treatment interventions.

Finding/Results: A pharmacogenomics study indicated that 97% of the population studied has a variant in their genetic code that would change the dose or medication for the most common health conditions. The value of multi-omic analyses has been demonstrated in a 108 person study applied to “healthy” individuals. The results indicated that every person in the study had an actionable possibility for better health. The power of integrating multi-omic analyses is evident when looking at complex diseases where unique bio-signatures emerge and the co-morbidities are presented even as they are emerging. Generally our health status determinants are 30% genetics, 60% behaviour and environmental and 10% health care.

Conclusion/Implications/Recommendations: Any single omic analysis is limited in its scope, making it necessary for an integration of a maximal number of omic analyses to provide information concerning diseases you have or are trending towards. Multi-omic analysis supports personalized healthcare and allows individuals to understand their body’s unique characteristics, its sensitivities and how it best responds. With this foundation of knowledge, an individual can make informed health decisions. Data analytics with artificial intelligence systems will provide novel insights not previously imagined. Benefits could include identification of novel biomarkers associated with disease and the precursors of disease. The use of multi-omic analyses will shift our current delivery of the reactive ‘sick-care’ model to a truly preventive, personalized “health care” model.

140 Character Summary: Implement advances in multi-omic methods, computational analysis, data visualization and design for personalized health solutions.

Purpose/Objectives: The purpose of this project is to evaluate the telehealth patients’ experience, to assess the quality of care we provide, and to ensure alignment with both accreditation standards and Interior Health’s five key strategies. The data gathered and analyzed from this audit is part of a strategy to support quality, safety, and standardization. The findings from this project will help to establish recommendations to improve the quality of the patient care experience, and allow for continued growth and sustainability of our Telehealth program.

Methodology/Approach: We developed a standards based auditing tool to obtain both qualitative and quantitative data to measure the current telehealth patient experience state. The auditing tool encompasses a multitude of criteria to assess current state; the criteria is categorized into themes such as quality & safety, accessibility, privacy & security, resources, efficiency, and overall workflow. The audit will encompass a review of current documentation, staff interviews, and observations of current practices. A representative from the telehealth team will audit pre-selected acute care sites to obtain data. This data will be analyzed for each site and then compared against other sites assessed. A qualitative measure of the patient’s experience will be attributed by a global score ascertained from a five-point Likert scale. A quantitative measure will be determined from observations and open-ended questions to staff members

Finding/Results: The results of the data collected from each site will be analyzed for compliance with Accreditation standards. The results from each site will act as a baseline of current practices and allow for comparison between sites and future audits. Discussion and evaluation of these results to identify deficiencies and an acceptable action plan to improve services to be implemented before the 2019 Telehealth Accreditation Survey. These results will further act as a catalyst to define IH Telehealth standards.

Conclusion/Implications/Recommendations: The analysis will be disseminated to our quality control advisory committee to implement recommendations. Once change has been implemented, a subsequent audit will be performed at the same site to confirm compliance and identify problems or issues. The auditing tool developed will be utilized as part of an ongoing audit process to measure compliance and to meet the evolving Accreditation Telehealth Standards.

140 Character Summary: Evaluate current practices against Telehealth Accreditation Standards by creating an auditing tool to identify gaps and plan for improvements.

Purpose/Objectives: Yukon government’s Home Care program supports individuals across the territory to live independently in their communities. Approximately one quarter of Yukon’s population live in rural or remote communities spread out over a large geographic area, and service delivery to these communities is an ongoing challenge. Whitehorse-based Community Liaison Coordinators (CLCs) coordinate care and provide direct service to clients via home visits to rural communities every 4 to 6 weeks. Home Care CLCs, with support from the Territorial Health Investment Fund (THIF) team, have initiated a trial where clients or Home Support Workers (HSWs) in rural and remote communities can meet with them via video. ‘Virtual visits’ are not intended to replace home visits, but evidence suggests that a combination of virtual visits with in-person visits can result in improved health outcomes. The objectives of the trial are to promote social inclusion and reduce feelings of social isolation for clients, and to explore how more regular contact with clients may support symptom management and avoid acute care interventions.

Methodology/Approach: Clients or HSWs were provided with a tablet enabled with a video conferencing app connected via the cellular network. Client selection was completed by the CLCs, from an existing caseload. Enrolment was based on client need, established functional goals, and perceived ability to benefit from increased contact. Virtual visits are available during regular working hours, and scheduled weekly. Ad hoc virtual visits are also available during regular working hours if needs arise. Clients participating in the program are asked about their comfort with technology, and are assessed using the interRAI Home Care Assessment System (RAI-HC).

Finding/Results: While the trial is still in its early stages, there have been multiple instances where client needs have been effectively addressed via virtual visits with CLCs. The technology has, in some cases, allowed rapid assessment of a client in their home, preventing a short-notice and costly face-to-face visit by a CLC. An unexpected outcome of the trial has been increased support for and involvement of HSWs in rural communities, who in some cases operate the tablets with the clients and liaise with the CLCs. Preliminary impressions of the CLCs include improved connection with their rural clients, increased support for client social interaction, and overall, a positive client experience in the use of technology. Quality of video and audio continue to be challenges for a network such as Yukon’s, where connectivity can be limited in some rural and remote areas. More positive outcomes and lessons are expected as the program continues over the following months.

Conclusion/Implications/Recommendations: Yukon Home Care and the THIF team have demonstrated how innovative use of technology can empower clients to stay at home, and improve access to health care services for rural and remote communities, while still working within existing resources. Evaluation of the virtual visits trial will continue and is expected to inform decision-makers on possible applications, outcomes, and areas for improvement.

140 Character Summary: Despite Yukon's remote landscape, virtual visits are improving access and care to rural clients who depend on the vital support of home care for health improvement.

Purpose/Objectives: The primary purpose of the presentation is to demonstrate how two Regional Health Authorities in Newfoundland and Labrador utilized an evidence-based approach to Telehealth integration for residents of Long Term Care who require healthcare access to urgent and non-urgent care and services. Objectives of this presentation are to: 1. Identify current evidence to support telehealth use in Long Term Care. 2. Identify the process and benefits realized in Eastern Health RHA for telehealth integration for non-urgent care. 3. Identify the process and benefits realized in the Western Health RHA for telehealth integration for residents requiring urgent or emergency care.

Methodology/Approach: Presentation of highlights of projects that have been developed, implemented and evaluated in the RHA associated with the integration of telehelath in the Long Term Care area for non-urgent and urgent issues that traditionally would have been provided face to face.

Finding/Results: Use of Telehealth for non-urgent appointments: Telehealth has been integrated into the Long Term Care homes in the Eastern Health region. The process included extensive collaboration with the homes involved in the integration, with associated departments (e.g. Information Managerment) and with residents who reside in the homes and their famiy members . Residents are seen by their consultants/specialists via video, from the comfort of their long term care home with the support of their regular attendantsThis has resulted in a lowered risk to residents, and with cost savings to the health care system. Use of Telehealth for urgent/emergency care: The integration of telehealth for emergency care has been completed using the eHealth Change Management Framework. Challenges and successes have been identified. The results will be tabulated within the pilot period of 6 months. The project will result in the development of criteria and algorithm for appropriate use of telehealth for residents of long term care who require urgent/emergency care.

Conclusion/Implications/Recommendations: The work completed in both RHAs supports the expansion of telehealth into other programs and sites throughout the regions. In Eastern Health, it supports preplanned appointments to improve access to services required for residents. Recommendations have been identified to improve further expansion: education/training program for future sites based on lessons learned, integration of appropriate technology. In Western Health, lessons learned will support expansion into other sites in the region and to other RHAs who are interested in expanding services in long term care for urgent and emergency care for residents.

140 Character Summary: Reducing risks and increasing access to urgent and non-urgent healthcare services for older adults residing in Long Term Care homes in Newfoundland and Labrador!

Purpose/Objectives: eConsult services in Ontario have been provided by OTN and Champlain BASE (Building Access to Specialists through eConsultation) for several years. eConsult is a service that connects referring physicians and nurse practitioners to specialists, providing the opportunity to inform clinical decision making without sending the patient to see the specialist in person. Through a private and secure web page, referring providers can get an answer to a clinical question from a specialist in less than three days on average. eConsult provides access to over 10,000 referring providers and 700 specialists, including dermatology, hematology, endocrinology, and mental health.

Methodology/Approach: In partnership, OntarioMD, OTN and Champlain BASE successfully grew eConsult from pilots to a scaled Provincial program that enables faster and improved access to specialist care. eConsult is now available in all health jurisdictions in Ontario. A comprehensive, multi-faceted project, eConsult is built on clinical modeling, business process design, technology implementation and a governance framework. This panel presentation will profile the methodologies leveraged for the provincial initiative, as well as learnings and research from clinical champions, user experiences, and details about the service model. OntarioMD has also developed a successful EMR integration with OTN eConsult which will be further enhanced to include the managed service model so that clinicians can access eConsult through both web and EMR channels.

Finding/Results: Collaboratively, a single, blended provincial service was established to accommodate multiple models of care. As of July 31, 2017, over 55,000 eConsults were submitted using OTN’s eConsult Program, Champlain Base and OTN’s Telederm program. General practitioners indicated that, with eConsult, they continued to be able to manage 72 per cent of their cases without needing to refer patients in-person or virtually to a specialist. The average response time was 2.5 days, and often as little as a few hours.

Conclusion/Implications/Recommendations: Elements critical to establishing a provincial eConsult program include effective collaboration of partners. With the support of the provincial government, Ontario continues to extend the reach of eConsult. Its commitment to accessibility is being driven by the proven benefits and patient and clinician acceptance of the approach. The goal is to deliver 40,000 eConsults in 2018 and 140,000 eConsults in 2021. The audience will: Learn how the different models of eConsult services will be combined into a provincial platform and service Gain insight into how to plan and deliver a comprehensive, multifaceted jurisdictional eConsult program Learn from research from clinical champions and users on performance metrics and evaluation of eConsult services and how they can be used to inform policy and funding decisions.

140 Character Summary: Elements critical to establishing a provincial eConsult program include effective collaboration of partners. With the support of the provincial government, Ontario continues to extend the reach of eConsult. Its commitment to accessibility is being driven by the proven benefits and patient and clinician acceptance of the approach. The goal is to deliver 40,000 eConsults in 2018 and 140,000 eConsults in 2021.

Purpose/Objectives: Hospital communication has become exceedingly complex with multiple and disparate systems. Too often, physiological monitors, beds, IV pumps, ventilators, and other systems sound alarms or send messages to clinical staff that are not actionable. As a result, care team members often suffer from alarm fatigue and become immune sounds and alerts from these systems, which can have serious consequences. In addition, hospitalized patients are also fatigued by the incessant sound of alarms, which often disrupt their sleep and makes them and their family members feel anxious. The impact this noise has on patient, family and staff well-being has accelerated the need to understand alarms, how often they occur, how they are responded to, and how to manage them safely and efficiently. Being able to connect the right people with the right information quickly is critical to delivering safe patient care in a quiet, healing environment.

Methodology/Approach: William Osler Health System implemented an intelligent alarm management solution to improve patient care, safety and experience across three sites. With the solution, alerts and alarms are automatically sent to the right care team member(s) based on workflow and escalation rules defined in the system. Clinicians can easily distinguish between alarms from multiple sources and different criticalities based on the audio and visual information sent directly to their device of choice – whether it’s a smartphone, laptop or workstation. The solution enables them to quickly prioritize alarms and respond appropriately. All alarm events and responses are date and time stamped and logged in real time, providing robust data and an audit trail to identify potential gaps in communication and processes. Analytics from the solution helps hospital leaders understand alarm trends per bed, unit, staff, alarm type, alarm density, distribution and response times. This data allows refinement of alarm filtering and escalation to reduce alarm fatigue, improve patient safety and enhance care team efficiency.

Finding/Results: Integration of the alarm management solution with clinical systems such as the EHR, nurse call system, and physiological monitors has streamlined workflows and minimized the complexity of managing multiple systems and vendors. One of the most impactful alerts set up connects the communication system to a point-of-care decision-support application. The software monitors patient data gathered from the EHR system, looking for early signs of a developing infection. When the system detects early warning signs of sepsis, it automatically sends an alarm to the appropriate nurse on his or her device of choice. With early warning, hospital staff can act immediately to accelerate treatment and improve patient outcomes. These workflow integrations and intelligent codes have helped decrease code blue events and ICU transfers. Clinicians have also noted a decrease in mortality rates.

Conclusion/Implications/Recommendations: In integrated approach to communication and alarm management is key to reducing alarm or interruption fatigue, increase staff response times, and improve the healthcare experience. Mobile healthcare technology that is fully integrated to workflows and with clinically relevant patient data can also lead to better patient outcomes.

140 Character Summary: Intelligent alarm management can reduce alarm fatigue, create a quiet, healing environment, and improve patient care, safety and experience.

Purpose/Objectives: Despite being preventable and curable, tuberculosis (TB) is one of the world’s deadliest communicable diseases. Timely and effective communication among clinicians and patients can be challenging since care is often provided “in the field”. The British Columbia Centre for Disease Control (BCCDC) TB Services provides case management and Directly Observed Therapy (DOT) within a defined geographic setting. Due to the ubiquity of mobile phone ownership and demonstrated uptake by vulnerable and isolated groups, text-messaging via WelTel, is being used to promote and enhance communication among our team of nurses, outreach workers, and active TB patients.

Methodology/Approach: WelTel is a secure, browser-based application that allows clinicians and patients to text-message with a weekly text asking “how are you?” to start the conversation. The focus of this study is to determine the acceptability of the WelTel digital platform by the nurses and outreach workers working at the BCCDC TB Clinics. Acceptability includes ease of use, usefulness, and improved communication among the team. Feasibility will be measured systematically through assessing costs, guidelines, privacy and security requirements for the Provincial Health Services Authority. Finally, aiming to align with the World Health Organization’s recommendations for universal DOT, transferability will be evaluated to expand reach and options for care through video DOT. Using qualitative research methods, baseline, midpoint, and end-of-study focus groups were conducted with the nurses and outreach workers and thematically analyzed.

Finding/Results: This project provided lessons on the convergence of health care and technology. Twenty clinicians were using the platform and there was a patient recruitment rate of 70%. Addressing concerns such as language barriers and technical issues early on encouraged confidence and interest among the clinicians. An identified challenge includes integrating digital technologies into routine clinical workflow, which was mitigated with clinical guidelines for the nursing staff. Factors contributing to success included frequent training and feedback sessions, ongoing support, local champions, and buy-in.

Conclusion/Implications/Recommendations: We are currently in the knowledge translation stage to operationalize the study within TB Services. Rapid identification of patients who require more or fewer resources aligns with practicing precision public health. Future opportunities include eventually expanding video DOT. Novel digital technology allows for undiscovered avenues to enhance patient-centered care and subsequently improve the quality of care in the BCCDC TB Services. Our team envisions the eventual use of digital technology to support routine clinical practices across the spectrum of care – from treatment delivery, to diagnostic testing, to patient appointment reminders, and beyond.

140 Character Summary: We started the conversation using text messaging at the BC Tuberculosis Services with patients and providers to promote communication and engagement

Purpose/Objectives: While almost every other industry has abandoned pagers in favor of smartphones, healthcare remains largely dependent on them as the main communication device. We completed a clinical trial designed to determine how the use of an integrated smartphone solution affects communication (and the efficiency of communication) between hospital pharmacists, physicians, switchboard operators, and ICU nurses/unit clerks compared with current state.

Methodology/Approach: The study measured how the use of the new integrated smartphone solution, which combines texts, and alerts into one secure smartphone app, affected communication. It enabled clinicians to use their personal devices or corporate devices to text and share secure, encrypted patient digital information. To quantitatively test the hypothesis that smartphones would improve efficiency of communications at Island Health, over 12 dozen clinicians participated in a first-in-Canada prospective, observational study. This project was aimed at improving clinician communication efficiency and improving patient care. The primary outcome was "page turnaround time", other outcomes were usage data and survey responses. The surveys focused on the efficiency, accuracy, satisfaction, and drawbacks of new integrated smartphone communication app.

Finding/Results: The primary outcome showed a reduction in turnaround time of pages sent from physicians to pharmacists form 5.5 minutes to 3 minutes. High priority page turnaround times from 18 minutes to 4 minutes with the new system. Physicians and switchboard operators were most receptive of the communication app, with 81% and 71.4% wishing to continue using the system. The convenience of only needing to carry one device was the most commonly reported positive aspect for physicians at 88.6%. 77% of Physicians reported that sending or receiving pages interrupts patient care “often” or “very often” before implementation, whereas only 23% responded this way after the communication application was implemented.

Conclusion/Implications/Recommendations: Formally, evaluating objective outcomes when implementing technology is essential to appreciate the impact and value of technology on clinical practice. The results of this project provides sufficient evidence to continue the implementation of the secure communication solution. The implications of this project has been the design and implementation of a large communcation project to minimize the communcation gap between acute and community care clinicians during patient transfers.

140 Character Summary: Award-winning research conducted by Island Health proved that a secure and integrated smartphone applications can improve clinical communication and workflow

Purpose/Objectives: There is an emerging need for Secure Messaging (SM) from clinicians. Unfortunately, with the prevalence and consumerization of mobile apps, finding an effective enterprise-level solution within the HA has its challenges due to prolonged timelines and rigid privacy/security requirements. Currently, clinicians are using unsecure methods of text messaging to support clinical care by sending PHI through text messaging on their personal device. At Fraser Health, an EMM platform has been implemented to enable secure access to FH data from personal or corporate smartphones. We introduced SM to enable our clinicians to communicate effectively while supporting their mobile workflows.

Methodology/Approach: The approach to implement SM was to leverage EMM to support mobile device management of personal and corporate smartphones. SM platform was identified to support the mobile workflows of the various multidisciplinary teams and more effectively communicate in support of patient care. The objective was to enable Clinical Communication and Collaboration (CC&C) and layer clinical systems integration capabilities such as, On-Call, alert notifications, MEDITECH modules and pager replacement. Without progress in this space, physicians will continue to insecurely text message colleagues to risk security of sensitive data, patient safety and fall behind in communication efficiency/effectiveness. The project focused on delivery of procurement, design, build and integration for SM in a PoC prior to expanded rollout. A clear BYOD strategy and app roadmap was created with the enterprise in mind for the acute and community sites. The complexity including smartphones and expectations around new access to clinical data impacted our security, privacy, legal and professional practice policies. A change management strategy to support a transformational app was required to support the wide range of use cases. Finally, a communication and roll-out strategy to support the pent-up demand was created to ensure effective rollout across the health authority. The challenge was managing expectations for those keenly interested while supporting those concerned with change.

Finding/Results: Secure Messaging requirements included identification of a Clinical Communication & Collaboration solution. PoC go-live included acute and community area across emergency, hospitalists, surgery, primary and mental health. The solution design supported effective communication for patient care. The implementation was successful because of ongoing support from clinical leadership to accurately identify use cases that would maximize SM utility. The implementation introduced timely communication between care providers, optimal decision making between care providers, enhanced clinical workflow to reduce unncessaary phone calls/faxing/chasing providers, and minimized user technology overload to simplify process for clinical users.

Conclusion/Implications/Recommendations: Delivering a successful mobile app at an enterprise level requires effective design, delivery, implementation and engagement, adoption and use. Many apps have the capability to create innovation and transformational change if implemented correctly. SM is a basic functionality but could be a disruptive technology if it mobilizes users, access to information and effective communication workflows. At FH, it has optimized, simplified and integrated communication for our clinicians because they have the data to support clinical decision making when required urgently. The greatest opportunity will come as we integrate systems, interoperability between other HA's and create policies to ensure professional practice are supported.

140 Character Summary: Introducing Clinical Communication & Collaboration solutions to mobilize clinicians in the Health Authority, while effectively securing PHI on personal devices

Purpose/Objectives: This presentation is to provide an overview of the changes that have occurred over time in the area of Canadian health interoperability. Presenters Diane Gutiw and Finnie Flores have each over 20 years’ experience in digital data exchange and have co-chaired the Infoway Standards Working Group and Community of Practice related to health care delivery and interoperability for over 5 years. These groups have facilitated collaboration and shared experiences among Canadian jurisdictions in the delivery of electronic health solutions. The objective of this presentation is to provide an overview of the evolution of interoperability focus and opportunities where jurisdictions have worked together to solve common challenges and outcomes with their technology standards and solutions. The presentation will review past pan-Canadian interoperability collaboration experiences, using examples of where collaboration on interoperability has been a benefit to jurisdictions and will identify how the focus has shifted from technical aspects of provincial and regional clinical data collection and sharing to addressing the clinical and business challenges of real time data exchange between health care providers.

Methodology/Approach: The material for this presentation is based on a scan of focus areas of the Infoway collaboration communities over the past 5 years. Common areas of focus will be presented with specific examples for past and current challenges; the presentation will describe how collaboration is helping to develop a common approach and solutions to common problems.

Finding/Results: While clinical data repositories are providing a benefit to health care providers, the ability to share data and information between providers related to care plans, past diagnoses and treatments remains a challenge for the day to day health care delivery. The collaborative communities have provided an avenue for sharing experiences and problem solving as jurisdictions work through common challenges in developing interoperability solutions.

Conclusion/Implications/Recommendations: The ongoing collaboration communities and working groups have provided and continue to provide opportunities for technical and clinical resources from different jurisdictions to share common challenges and solutions. The benefit of collaboration is in the development of common approaches to address these challenges including past experiences of the collaborative communities such as the development of implementable standards to meet the real need of providers, the sharing of technical solutions that have worked as well as sharing of lessons learned from jurisdictions at different stated of interoperability development.

140 Character Summary: Review of pan-Canadian interoperability collaboration, and the evolution from data collection to addressing challenges of real time clinical data exchange.

Purpose/Objectives: To demonstrate the value of incorporating interoperable clinical and functional information captured in interRAI assessments in various health care settings as part of an EHR/EMR to optimize continuity of care and potentially improve care outcomes.

Methodology/Approach: interRAI assessment instruments, administered by frontline clinicians, are used to identify the preferences, needs and strengths of vulnerable persons. The information gathered is utilized both for frontline delivery of care and for health system use to help improve the quality of life. A foundational principle of interRAI assessment instruments is that they share a common, standardized language. A key benefit of this standardization is that a person’s clinical and functional information can be tracked and used across the different settings where they receive care. Examples include, the sharing of home care information with a primary care team, and mental health information with care teams in acute and community settings. In making information accessible for use, continuity of an individual’s care is optimized. Leveraging this conceptual design feature and supported by its new Modernizing Data Supply and Access strategy, CIHI developed and launched its new Integrated inteRAI Reporting System using the FHIR standard.

Finding/Results: In launching its first-ever integrated reporting system, CIHI achieved interoperability with the suite of interRAI assessment instruments for the community health sector. The new system simplifies data flows, improves access to the data in near real-time for point of care decision support to health system use, and provides good quality and reliable data.

Conclusion/Implications/Recommendations: Achieving interoperability with the suite of interRAI assessment instruments and the FHIR standard enables clinicians to utilize the rich clinical and functional information that can be made available in an EHR/EMR. Access to and sharing of comprehensive assessment data across health care settings promotes improved continuity of care, potentially fostering improved care outcomes.

140 Character Summary: This session explores interoperable clinical and functional information optimizing continuity of care and potential for improved care outcomes.

Purpose/Objectives: Island Health’s IHealth initiative seeks to advance the region towards its vision of One Person, One Record, One Plan for Health and Care in order to provide tangible benefits to quality, safety, experience and continuity of care. Following an initial activation of advanced EHR functionality in an acute setting in 2016, the second major phase of the initiative will demonstrate a complete cross-continuum EHR in the northern part of Vancouver Island by Spring 2018.

Methodology/Approach: Leveraging a single instance of Cerner Millennium, the project utilized rapid phases of iterative design and configuration to consolidate primary care, community health services, residential care, acute and emergency services onto a single, advanced EHR. The project intentionally started with the design, configuration and activation of primary care sites, choosing to follow shortly thereafter with community, acute and residential care. Focusing on a rural area that has strong care model integration and overlapping clinical roles, provided a means to best demonstrate the value of a single record strategy.

Finding/Results: At time of writing, the project was in the midst of initial activations with primary care teams and was actively designing the community components. As such, key results are still emerging. Key findings to date suggest that: The iterative design and configuration process provided a meaningful way for end users to be engaged in the project and positively influence and own the change Leading with primary care helped orient teams to design longitudinal, whole-person workflows and support the configuration of Cerner Millennium across the continuum A single system for rural areas, where individuals often play multiple roles across multiple venues of care, provides a stronger value proposition than separate systems with interoperability Starting in a rural area helped support direct engagement with all end users and supported more active ownership of the vision and strategy

Conclusion/Implications/Recommendations: More robust recommendations will emerge as the project progresses, but early indications are that this first demonstration will provide a strong foundation for subsequent deployments of a single, cross-continuum EHR – especially in rural or highly integrated teams, complementing much of the parallel work on team-based care and interoperability. Presenters will focus on the immediate benefits of this first demonstration and provide key recommendations for other regions seeking to extend and reconfigure existing systems to broader care venues.

140 Character Summary: Demonstrating a single EHR across primary, community, acute, residential and ambulatory care to provide benefits to quality, safety, experience and continuity

Purpose/Objectives: The connecting South West Ontario Program’s Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, is enabling a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontario’s integrated electronic health record (EHR). The project is being led by the eHealth Centre of Excellence, on behalf of cSWO. The POC is being conducted with four FHTs in southwest Ontario and has two EMR vendors participating (OSCAR and Telus Health, using Practice Solutions Suite). PCDS will explore the feasibility, challenges and value of sharing patient data from primary care practices.The project will help to identify the processes, integration requirements and data standards required for primary care data sharing to demonstrate clinical and/or organizational value. The POC will inform the broader Provincial primary care data sharing strategy.

Methodology/Approach: The project involves four Family Health Teams in south west Ontario that will contribute a sub-set of their EMR data to a provincial repository at eHealth Ontario, to then be securely accessed by other authorized healthcare providers within the circle of care through the cSWO Regional Clinical Viewer, ClinicalConnect™. The data contributed by Family Health Teams will be shared with a small, targeted number of viewing sites within their respective catchment areas. These targeted organizations include local hospitals, the Home and Community Care organization (formerly CCAC) and local Health Links. The POC will run for 6 months during which lessons learned and recommendations will be developed to help inform the provincial primary care data sharing strategy. Recommendations will include the data set, data quality improvement, the respective system requirements (data capture and data access), the technology and standards (including integration requirements), implementation and adoption and benefits realization.

Finding/Results: By Spring 2018, the project will have developed recommendations to help inform the provincial primary care data sharing strategy, this will be undertaken in collaboration with key stakeholders, including the MOHTLC, eHealth Ontario and OntarioMD. The panel discussion will focus on these lessons learned and recommendations and answer key questions: - Do we have the right data set? - What are technology and standards to be used for the provincial strategy? - How can we improve data quality? How do we support primary care practices with tools/templates? - Are the required privacy and security controls in place? How do we support sites to move towards this? - What are the benefits of sharing the data? How are the clinicians using the data? - How do we move toward provincial scalability?

Conclusion/Implications/Recommendations: The PCDS POC highlights the value of, and challenges associated with primary care data sharing. Outcomes of the POC will help inform the provincial primary care data sharing strategy. The panel will highlight the lessons learned, key challenges, key benefits and key recommendations from the POC. The panel will also look at challenges for provincial scalability. This multi-stakeholder initiative is a priority project for the Province of Ontario and the south west Ontario region. The panel will reflect stakeholders offering varying perspectives and insights on lessons learned.

140 Character Summary: Outcomes from the connecting South West Ontario (cSWO) Primary Care Data Sharing Proof of Concept to help inform the provincial primary care data sharing strategy.

Purpose/Objectives: This Panel discussion will: • Provide a dialogue around opportunities and challenges of a real-time physician EMR Dashboard • Provide a quick demo of the tool by a physician user and how it helps care for their patients • Discuss technology that will transform how physicians use their EMRs to deliver patient care • Discuss how the EMR Dashboard was experienced by physician practices; highlighting formal Benefit Evaluation findings • Discuss as a panel: • Challenges around data sharing and trust for physicians • Considerations in choosing in clinical indicators for primary care physician use • Cross-collaboration and applicability to other jurisdictions

Methodology/Approach: The panel will discuss a provincial EMR dashboard that was demonstrated with 500 physician users that: • provides immediate clinical value to physicians, through real-time visual representation of EMR data using widely-recognized, primary care indicators; • provides the ability to drill down to patient-level data for each indicator enabling physicians to take immediate proactive steps to improve patient care; • helps physicians standardize their data entry to improve the quality of patient data in their EMR; • allows physicians to trend and compare their indicator metrics with other physicians using the Dashboard; • would scale provincially to all physicians using a certified EMR, and is easily expanded with new and evolving data quality, practice and clinical indicators. A discussion of stakeholder partnerships will highlight the benefits of collaborative engagements and value add to participating physicians and clinics An open discussion on the key findings, benefits, and recommendations of a provincial EMR Dashboard initiative that changes how physicians and clinics can proactively manage patient care, improve EMR data, and support clinical reporting.

Finding/Results: Collaboration with provincial indicator framework representatives, EMR vendors, and clinicians resulted in overall positive findings from the EMR Dashboard initiative. The panel will discuss these findings/results to share learnings and provide a network for similar cross-collaboration. The Dashboard resulted in the development of indicators under the categories of chronic disease, preventive care, and care bonus management. • 75% of participating physicians recognized value in the dashboard through improved patient outcomes and identifying patients of interest, supporting practice needs and data quality improvements, access to real-time data and patient lists that are actionable. • 80% of physicians used the electronic opt-in feature to share metrics with the program lead and other participating physicians to access the trend/compare functionality. Phase 2 of the Dashboard initiative will be used to build on these findings.

Conclusion/Implications/Recommendations: Using the EMR Dashboard, many participating physicians across various practice types realized the benefits in quality improvement and clinical outcomes. Partnering and collaborating with stakeholders is paramount to delivering a tool that physicians see value in using. The ability to trend and compare metrics is a key driver to quality improvement efforts. Physicians realize that change management resources would help their efforts to improve data quality and support improvements to patient care. An indicator governance structure is essential to manage the ongoing enhancement and development of provincial indicators available in the EMR Dashboard.

140 Character Summary: Dashboard indicators on chronic disease management and preventive care support clinical need and improved patient care

Purpose/Objectives: Patients, along with their caregivers and family members have been advocating for themselves in the health care space for many years. Recently, digital health has played a prominent role in their advocacy, with the recognition that having access to health information and communication tools to share information with health care providers enables patients to be engaged in their care, and bring more equality to the patient-provider relationship. More recently, a movement within health care, spurred by advocacy, has sought to create a health care system where patients and their families are not only the focus, but take a seat at the table in the design and delivery of care, including through digital health. This panel will discuss the concept of patient partnership from a variety of perspectives, most importantly from that of patients and their caregivers, who will be members of the panel

Methodology/Approach: Panellists will introduce the concept of patient partnership (sometimes also referred to as patient engagement), the conceptual frameworks that have been developed around it, its implications for organizations in the digital health sector, and describe best practices for implementation. Common myths or perceived roadblocks will also be addressed, including in the Q & A section. The panel will consist of representatives from digital health organizations that have committed to and taken action towards becoming more patient-centred, as well as patient advocates who can draw on their experience both as patients in the heath care system and as the patient partners working towards a health system that partners more effectively with patients.

Finding/Results: The panel will situate the system-wide movement toward patient partnership within the context of the digital health sector. Digital health organizations have used a variety of tools to better adhere to the concept of patient partnering, including using patient advisory panels, vision-setting workshops, co-design with patients, etc. Panellists will present the accumulated lessons learned from the use of these tools. Patients on the panel will present their point of view as agents of change in the system and as participants in the above processes, and offer their insights into where these tools are appropriate and how they can be applied more effectively.

Conclusion/Implications/Recommendations: Research has shown that partnering with patients is an enriching experience for all involved. Patients feel more empowered and in control of their health, and have greater satisfaction. Job satisfaction and morale has been shown to improve among health sector workers, and patient outcomes improve. Digital health can play a key role in achieving and accelerating these outcomes. This panel will enable attendees to better understand the concepts, tools, and value behind patient partnership.

140 Character Summary: "Nothing about me, without me". Patients and health orgs discuss, what are the implications for digital health?

Purpose/Objectives: For hospitals, laboratory test results’ reliability, turnaround time and predictive ability are critical to the performance of hospital emergency departments (ED), and to the safety and quality of care provided by emergency care physicians (ECPs) to patients. As these results are now most often obtained by ECPs through their use of IT-enabled laboratory information exchange (LIE), the purpose of this study is to answer the following research questions: What is the actual nature of ECPs’ use of LIE, and what combination of health systems (LIS, CIS, EDIS, EHR and/or other) are actually accessed by these physicians for this purpose? What is the extensiveness of this use and most importantly, what is its effectiveness, that is, what are the clinical performance outcomes of LIE use in the ED?

Methodology/Approach: In order to answer the research questions, a survey study was made of 163 ECPs practicing in hospitals in the province of Quebec, Canada, and having access to the province-wide EHR system (called DSQ) for LIE purposes. The majority of the sampled respondents were general practitioners (80%), the rest being specialists. The data were obtained through a web-based survey platform, and analyzed through descriptive and bivariate statistics as well as cluster analysis, using the SPSS statistical package.

Finding/Results: The main findings of this study are threefold. First, the majority of sampled ECPs (70 %) simultaneously access two or more health systems for LIE purposes: a) their hospital’s laboratory information “viewer” (LIV) which interfaces a CIS (clinical information system), a LIS (laboratory information system) and/or a RHIR (regional health information repository), and b) Quebec’s province-wide EHR, the Quebec Health Record (QHR). Second, three LIE user profiles emerge: i) ECPs who rely extensively on both a LIV and the QHR (n = 100), ii) ECPs who rely extensively on a LIV only (n = 40), and iii) ECPs who rely extensively on the QHR only and to a lower extent on their EDIS (n=23). Third, the clinicians reporting higher performance outcomes from their LIE usage are those within the first group, that is, the LIV/QHR-reliant ECPs whose use of their hospital’s LIV is more extensive.

Conclusion/Implications/Recommendations: The main implications of the study’s findings are threefold. First, the “laboratory” component of emergency care must be further studied in light of the growing reliance of ECPs upon information technology to enable their consultation and management of patients’ test results, that is, by explicitly incorporating effective use of LIE into ED performance models. Second, ECPS must be encouraged to make more extensive use of LIE, that is, to use their hospital-wide LIV and the province-wide EHR in combination, and to use more of the laboratory medicine functionalities available in these health systems. Third, given that the interoperability of a nation-/state-/province-wide EHR system with hospital information systems such as CIS and EDIS constitutes a necessary condition of extensive and effective laboratory information exchange in the ED, the ECPs’ requirements in this regard must be taken into account by those who design and implement these systems.

140 Character Summary: A survey of 163 emergency care physicians in Canada allowed us to study the nature, extensiveness and effectiveness of their use of laboratory information exchange.

Purpose/Objectives: A standard methodology that actively engages clinicians in telehomecare solution deployment is key to developing best practice care delivery models. In a telehomecare project, a clinician-centric methodology guided the setting of program goals, provided flexible clinician education and training, improved patient outcomes, and demonstrated measurable results including higher quality care, increased system capacity and improved operational efficiency. This methodology is successful under the guidance of a clinical advisory group comprised of patient partners and clinicians from vendor and client organizations.

Methodology/Approach: Clinicians, through the Clinical Advisory Group, are engaged in the following activities (with varying levels of engagement depending on the activity): - Clinical Strategy and Thought Leadership: - Develop clinical strategy for the project - Perform literature reviews & environmental scans - Identify innovative applications of the telehomecare solution, ensuring alignment with the client’s e-health strategic objectives - Establish program evaluation frameworks in line with the client’s objectives - Contribute industry experience and knowledge to the development of the above - Product Development: - Act as client liaisons and subject matter experts in technology solution development and configuration - Contribute to the product roadmap to ensure ongoing alignment with client priorities - Advise on product testing methodology & facilitate end-user acceptance testing - Service Delivery Model & Project Implementation: - Identify target population - Develop clinical processes - Plan operational resources, recognizing professional standards, policies and guidelines for involved roles - Plan clinician and patient education and training methodology and methods - Develop evaluation plan – evaluation methodology, methods and data collection tools - Patient Interview and Data Collection Tools: - Gather requirements for data from physicians, nurses, allied health staff and administration - Research existing and/or develop patient-facing and other data collection tools - Ensure alignment to the client’s organizational guidelines and policies, as well as national standards where they exist and are applicable - Gather input from subject matter experts, frontline staff, patient and clinician partners - Sustainment: - Provide continued thought leadership for new telehomecare solutions for additional target populations

Finding/Results: Based on a telehomecare process evaluation in 2015, we found that this methodology, guided by a Clinical Advisory Group, had the following impact: - Demonstrated strong, collaborative, client (patient)-focused teamwork among provincial and regional health organizations and the technology provider - Product improvements were identified through patient and clinician input; this input led to improved patient self-management capabilities - High clinician satisfaction: - 100% of clinicians surveyed believe that a telehomecare solution supports client self-management - There is room to further improve on clinician engagement - Patient satisfaction is high: - 98% of patients reported overall satisfaction with service - 100% of patients would recommend the service

Conclusion/Implications/Recommendations: Better patient outcomes are experienced when clinicians are directly involved in a telehomecare solution. Success can be better achieved when engagement occurs with a Clinical Advisory Group, comprised of an interdisciplinary team with expertise in nursing and medicine, who act as subject matter experts, client liaisons, and thought leaders.Through the work of the Clinical Advisory Group, patients and clinicians are embedded in the portfolio strategy, product development cycle and project delivery.This leads to positive outcomes for the project as a whole.

140 Character Summary: Patient outcomes improve when clinicians are involved in telehomecare projects. A clinical advisory group is key to project success.

Purpose/Objectives: Canada is in the midst of an extraordinary demographic transformation --1 in 4 citizens will exceed the age of 65 by 2036. Existing approaches cannot meet this challenge. Governments cannot build enough long-term care facilities, employ enough healthcare professionals or sufficiently tax the diminishing proportion of our labour force. A new approach must be taken which levers technology and partnerships to meet the real-world needs of older adults in a scalable and affordable way. The Centre for Aging and Brain Health Innovation (CABHI), led by Baycrest Health Sciences is a national solution accelerator focused on driving innovation in the aging and brain health sector. Established in 2015 with $124 million funding, CABHI is the largest investment in brain health and aging in Canadian history, and one of the largest investments of its kind in the world. CABHI brings together front-line healthcare providers, scientists, and industry to address the most pressing real-world challenges in the care of older adults. This presentation will highlight CABHI’s unique innovation strategy through case studies which detail the successes and challenges of working with seniors, their care providers, healthcare professionals and progressive companies.

Methodology/Approach: CABHI provides millions of dollars of funding, mentorship, management and knowledge mobilization services to project-teams across North America. CABHI's four, well-funded programs are overlaid along our innovation pipeline, which has a purposeful “leaky” design so that new technology and service innovations can enter and exit the pipeline as evidence is gathered and refinements are applied.

Finding/Results: After two years of operation, CABHI has supported more than 60 projects levering more than $30M. Evidence is emerging showing CABHI's impact in the following areas: - reducing unnecessary emergency department visits for older adults living with dementia - preventing falls and reducing fall-related injuries in older adults living with dementia - providing better management of complex conditions in home settings for older adults living with dementia - improving brain health and cognitive fitness in older adults Performance data also show changes in the culture of innovation in the older adult sector. Equally important, data is showing the economic impact on companies in Ontario, Canada and around the world.

Conclusion/Implications/Recommendations: There is concensus that existing elder-care service models cannot scale to meet the increasing demand. New, innovative approaches are necessary to drive solutions through technology and partnerships linking the private sector with clinicians and scientists. The unprecedented scale of investment in CABHI by Federal and Provincial Governments and by industry in CABHI is now bearing fruit -- evidence is emerging that the private, public and academic sectors are coming together to meet the challenge.

140 Character Summary: The Federal, Provincial & private sector investment of $123M in the Centre for Aging + Brain Health Innovation is creating new clinical solutions & economic impacts.

M. Chang¹, S. Isaacksz¹, S. Goyal², R. Wilson³; ¹University Health Network, M5G 2C2 - Toronto/CA, ²University Health Network, M5G2C4 - Toronto/CA, ³Ontario Telemedicine Network, M3B0A2 - Toronto/CA