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e-Health 2018 Virtual Meeting
Celebrate, Grow & Inspire Bold Action in Digital Health - Vancouver, BC
This product offers access to the e-Health 2018 Keynote / Plenary Presentation Live Webcasts, the recording of these 4 sessions and access to all PDF/Presentation Slides of each conference presentation.
Group Discounts Available for 5+ Purchases. Contact us to request group pricing.
PDF's of presentation PowerPoints are now online!Presentation Date(s):
Non-Member Price: C$120+tax Digital Health Canada Member Price: C$100+tax
- May 27 - 30, 2018
- Total Presentations: 240
RF03 - Meaningful Data Use and Benefits
- Type: Rapid Fire Session
- Track: Clinical Delivery
- Presentations: 5
- Coordinates: 5/28/2018, 16:00 - 17:00, Fairview I Room, Conference Level
RF03.01 - Exploring Clinical and Organizational Value of the DHDR
Purpose/Objectives: Background/Context - Canada and the USA have the highest prescription opioid consumption in the world. Increased opioid prescribing is associated with increased opioid-related mortality; thus, better informed physician prescribing decisions are key to avoiding adverse drug events and improving patient safety. Although Canada has recently developed guidelines that recommend restricting the prescribed daily dose to less than 90mg morphine equivalents for patients with chronic noncancer pain, data from 2014 suggests that 40% of people receiving long-acting opioids are taking more than 200mg morphine equivalents. During the Fall of 2016, Ontarios Ministry of Health and Long-Term Care (MOHLTC) implemented an initiative to integrate the Digital Health Drug Repository (DHDR) through the connecting South West Ontario (cSWO) Regional Clinical Viewer, ClinicalConnectTM, to further enhance the data and information (including narcotics information) currently available in the integrated electronic health record (EHR) in south west Ontario (SWO). Purpose/Objectives The objective of this work is to understand the organizational and clinical impact of the DHDR in acute and primary care settings across the four Local Health Integration Networks (LHINs) in south west Ontario. In particular, this study sought to document if and how the DHDR influenced opioid prescribing decisions and the Best Possible Medication History (BPMH) process for clinicians working in acute and primary/community care settings.
Methodology/Approach: The study design included two data collection methods: individual interviews and online surveys. Individual interviews were conducted with clinicians and were digitally audio recorded and transcribed verbatim. Transcripts were thematically coded using a constant comparative method. Anonymous online surveys were completed by health care providers to understand the usability and functionality of the DHDR.
Finding/Results: Findings from the interviews and surveys provide insight into key clinical workflows through which the DHDR contributes to quality patient care. In particular, emergency physicians and primary care providers found the DHDR supported responsible prescribing and contributed to improved patient safety. Findings also provide examples of how the DHDR could be improved and opportunities for enhancement.
Conclusion/Implications/Recommendations: The DHDR is a reliable source of narcotic information that has the potential to improve patient safety and organizational efficiency when integrated into key clinical workflows. The DHDR can contribute to a larger strategy addressing the opioid crisis in Ontario.
140 Character Summary: Research highlights benefits of using digital tools to support clinicians to make better-informed opioid prescription decisions
RF03.02 - Big Data in Healthcare: Where to Start
Purpose/Objectives: This session will present a methodology designed to help organizations better understand how to leverage both their internal data and external data sources to make high priority data driven operational and clinical decisions quickly. The methodology includes a framework to validate any organization or departments current state of governance, data management, analytics, technology infrastructure and capabilities, as well as determining what extended data is needed to provide accurate, complete and high quality analytic analyses. The framework assesses the organizations current state against its analytic needs and future vision, resulting in a clear implementable roadmap with sequencing of initiatives that are both sustainable and adaptable to changing priorities. The resulting strategy and roadmap includes tangible and achievable objectives that leverage existing technology investments, and demonstrate short term value using highest priority analytic questions. The benefit of this incremental and iterative framework is that the organization determines its own focus areas by starting with the analytic problem that needs to be solved and considers technical, organizational and governance required to move to a big data environment and capabilities.
Methodology/Approach: The presentation will provide examples of how the methodology has been used to address clinical, operational and financial analytic needs. The presentation will walk through each stage of the methodology using a health specific example requiring data from multiple sources to result in a what-if analysis as well as comparative and drill down analytics. The presentation will also walk the group through each stage of the framework using the same example to help give context to the framework and approach being presented.
Finding/Results: The findings suggest that by starting with a specific analytic problem an organization can better understand how to build an analytic architecture, governance and capability model that is scalable for ongoing needs and priorities. The incremental approach can help an organization understand where their current strengths lie, where change is needed and what steps are needed to achieve that change.
Conclusion/Implications/Recommendations: The presentation will conclude with a recommendation on how organizations can evolve to using big data analytics for their current needs in the short term while developing a scalable roadmap to for additional analytic needs. At the end of the presentation the attendees will have seen the end to end framework in action and should have the knowledge of where to start within their own organizations to move towards big data analytics.
140 Character Summary: Demonstrates a step by step framework to help organizations understand where they can start, within their own organizations, to move towards big data analytics.
RF03.03 - Value for Money: Approach to Quantifying Digital Health Solution Benefits
Purpose/Objectives: How do you put a realistic dollar value on the good that digital health initiatives bring to the health system? This is a challenge that we in the digital health space face - one that makes it particularly difficult to implement large-scale initiatives. Quantifying the financial benefits of a digital health implementation while at the same time focusing on providing quality patient care is the ideal that few initiatives have been able to achieve. For this initiative, we measured the financial benefits and time savings accruing from a report delivery solution.
Methodology/Approach: The organization implemented a province-wide electronic patient report delivery solution to improve communications between hospitals and specialty clinics and community-based physicians and nurse practitioners for timely follow-up care. Launched in 2013, today this service connects 189 hospitals and specialty clinics to nearly 8,000 physicians and nurse practitioners. A third-party consulting firm was engaged to conduct an independent valuation of the solution. They reviewed historical clinician and hospital surveys, ongoing operational costs, and the qualitative feedback from system user groups.1. Quantitative benefits that were measured included: 1. Workflow efficiencies 2. Savings cost per page faxed/mailed 3. Administrative, legal and operational efficiencies
Finding/Results: This analysis determined the solution has helped the provinces health system avoid up to $27 million in costs over 5 years. Every report not printed, faxed or mailed adds to that figure. Every hour saved from filing patient reports, or finding misplaced reports adds to that savings. Every extra minute that a physician can use providing patient care instead of locating paper reports, adds to that figure. The independent analysis found that up to 33 extra minutes a day is saved by each clinician user. It also found $30,000 in avoided costs at an average hospital within two years of implementation.
Conclusion/Implications/Recommendations: With a quantified dollar amount to ascribe to the benefits of our digital health initiative, what can we do with this information? Firstly, we engage clinicians who have yet to adopt the service. Knowing the realized cost savings for the average user may help others understand the value of adoption. Secondly, re-engage clinicians and build their practice efficiencies by helping them realize the economics of doing so. Thirdly, use the quantified results to promote the initiatives value proposition, including expansion, new features and functionalities to further benefit users. This report delivery service demonstrates how small efficiencies (30 minutes of time saved per physician per day, ink/toner savings each month for a hospital) add up over time. Digital health initiatives bring incremental savings and efficiencies to the health system. Those benefits can easily be overlooked if not quantified early on. There is still a long way to go in fully quantifying the benefits, particularly focussing on the clinical impact of technology. There are very real benefits in increased patient-care time and the accuracy of patient report delivery that are harder to quantify and have not yet been analyzed. Determining the dollar value of patient health benefits that digital solutions bring will be the next challenge we take on.
140 Character Summary: Can you put a dollar value on the good that digital health initiatives bring to health systems? One initiative measured its value and found millions in cost savings.
RF03.04 - Heart Failure Telemonitoring: Pilot Project Findings and Full Trial Implementation
Purpose/Objectives: Patients with heart failure are vulnerable to their condition deteriorating and have high hospital readmission rates after hospital discharge. Optimal self-management and timely intervention in partnership with health professional support can reduce revisit rates as heart failure patients recover at home. The preliminary results from a 1-year feasibility study of a four-year research project studying how home telemonitoring can support the safe transition of heart failure patients from hospital to home show improved patient self-management, improved quality of life and reduced costs for acute care
Methodology/Approach: Upon discharge from hospital, heart failure patients enrolled in the program receive health monitoring equipment including a touchscreen tablet, blood pressure cuff, weight scale, and pulse oximeter. Patients submit their measurements daily for 60 days and answer questions about their heart failure signs and symptoms (e.g., coughing, dizziness). Monitoring nurses remotely track patients data for abnormalities and early interventions. Monitoring is discontinued at the end of 60 days, and patients are followed for an additional 30 days. The studys primary measure is assessing 90 day emergency department visits, hospital readmissions or mortality. Secondary measures include evaluating cost reductions as a result of hospital utilization, patients quality of life, and self-management. Primary measures are assessed via hospital administrative data, while pre and post surveys assess secondary measures. The feasibility study tested implementation and evaluation protocols. A subsequent randomized controlled trial beginning in 2018 will generate evidence from communities across the province to rigorously test the effectiveness of home telemonitoring.
Finding/Results: A feasibility study was conducted from October 2016 to November 2017 involving 3 hospital sites, with 70 patients enrolled. Preliminary findings demonstrate a reduction in 90-day ED visits and hospital admission rates of 20 to 36%, average hospital length of stay reduction of over 2 days, and approximately 20% improvement in quality of life and self-management behaviour. Full results will be presented at eHealth 2018, together with insights to optimize the home telemonitoring experience for patients and providers.
Conclusion/Implications/Recommendations: This project has received approval from the provinces health ministry and three health authorities to rollout a provincial stepped-wedge randomized control trial to 22 communities commencing in early 2018. At eHealth 2018, we will present progress to date and share the study design, which will provide comprehensive data from urban, rural and remote communities across the province, generate high quality evidence on effectiveness of home telemonitoring, and scale-up and spread home telemonitoring in the province simultaneously. This work is submitted on behalf of the TEC4Home Health Innovation Community.
140 Character Summary: Supporting patient recovery at home with home-based patient self-monitoring.
RF03.05 - Analytics: Driving Outcomes with AI and Machine Learning
Purpose/Objectives: Show outcomes of artificial intelligence (AI) initiative to leverage Microsoft Azure solutions for predictive models for patient cost and care Describe how analytics play a key role in the need for accurate risk stratification, predicting patients with rising costs, and enabling optimized care pathways for improved outcomes Explain how incorporating insights into actionable information is key to bringing value to existing data assets Demonstrate how utilizing predictive models can drive business decisions and promote adherence to current, evidence-based guidelines in chronic disease management Highlight success stories and lessons learned in the race to derive value from big data
Methodology/Approach: Followed process of capturing data, creating predictive models, applying these models and using them at point of care Selected and gathered necessary data based on analytics needs: collected from proprietary data as well as new information ?Proprietary data includes 50 million unique patients, 325 clients, linked cost data on 20 million lives Incorporated machine learning on large amounts of health data to predict health outcomes
Finding/Results: Case studies on tracking and identifying factors for chronic conditions/high resource utilization, diabetes risk, and opioid abuse risk in patient populations Use of predictive analytics enables us to identify gaps in care, optimize medical decisions, and prioritize highest risk patients into precision-medicine pathways Analytics Results in Chronic Conditions Case *US Chronic Conditions Condition Patients with Condition % Allscripts Lives National Prevalence Stats Annual Direct Cost Estimate Hypertension 11,100,000 30% 29.1% $64.5 billion Hypercholesterolemia 9,300,000 25% 31.7% $30 billion meds alone $400 billion (stroke & MI) Lower Back Pain 4,400,000 12% 12% $40 billion Allergic Rhinitis 3,800,000 10% 8.4% $18 billion GERD 4,200,000 11% 20% $10 billion Diabetes 4,500,000 12% 10% $56 billion Anxiety 3,900,000 10% 18% $42 billion Depression 3,200,000 9% 6.7% $45 billion Predictive Analytics to Identify High Resource Utilizers, based on Chronic Conditions*
Conclusion/Implications/Recommendations: To grow and develop successful predictive modeling, consider the following future opportunities and vision: Continue to leverage EHR neutrality and interoperability, promote data governance Create holistic picture of health, bridging gaps from EHR data, including integration of alternative data (socioeconomic determinants of health) Develop advanced analytics, sourced from clinical data, geo/social/environmental data, cost data, patient/consumer/social data and pharma and life science data Use large scale predictive modeling and validation to facilitate precision medicine approach to care, embed into standard EHR workflows Deliver on outbreak surveillance, risk stratification with longitudinal records, image recognition Achieve outcomes including reduced cost of care, clinical performance optimization, and recorded impact of current and future therapies
140 Character Summary: Highlights value of big data, while demonstrating how predictive models can promote adherence to evidence-based guidelines in chronic disease management.
RF04 - New Ideas for Clinical Worker Transformation
- Type: Rapid Fire Session
- Track: Clinical Delivery
- Presentations: 6
- Coordinates: 5/28/2018, 16:00 - 17:00, Fairview II Room, Conference Level
RF04.01 - Innovative Methodologies to Procure a Technology Solution for Virtual Visits
Purpose/Objectives: Less than half of Ontarians are able to see a primary care provider when they are sick1. Among patients with a family physician who visited the Emergency Department (ED), 15% went there because their doctor was unavailable. Virtual technologies that facilitate new ways of interaction between patients and providers pose an opportunity for improvement in access to primary care in Ontario. The objective of this presentation is to illustrate how health sector partners have worked together to identify and procure an innovative health care technology that can link patients with clinicians via secure messaging, clinical video-conferencing, email, and phone. 1. Health Quality Ontario. (2015). Quality in Primary Care: Setting a Foundation for Monitoring and Reporting in Ontario. Toronto: Queen's Printer for Ontario.
Methodology/Approach: The Virtual Visits initiative used an innovative procurement approach to identify a virtual solution with the potential to enhance access to primary care. Provider and patient engagement was key in designing advanced models of care such as this. An outcomes-based request for proposal (RFP) was released to vendors previously qualified under a provincial Vendor of Record (VOR). Proponents were required to participate in a Design Contest and provide their price bid for a technology solution to be developed for a Proof of Concept (POC). An interdisciplinary team was chosen to evaluate vendor capacity to provide the solution and to assess the innovation through an on-site process against pre-established criteria. The successful vendor was invited to negotiate a Statement of Work (SOW), under the terms of a Master Agreement already in place to deliver an initial Proof of Concept. A phased approach beginning with the POC to test and refine the business and clinical model will be used to support scaling of the model and provincial priorities.
Finding/Results: The Innovation Procurement process allowed for a more engaging and enriching experience for the healthcare providers involved by discussing desired outcomes rather than the traditional procurement approach of gathering technical requirements. It also provides greater insight on stakeholder needs, ensuring that the solution will address them, thereby leading to successful adoption and enhanced access. Aligning with the provinces Patients First focus, an outcomes-based procurement model also engaged patients as key stakeholders in non-technical discussions in order to understand what matters to them.
Conclusion/Implications/Recommendations: The initiative wishes to investigate whether virtually-enabled care is better for the patient, and its learnings will drive the requisite policy change to build a sustainable province-wide model. In measuring the sustainability of the initial demonstration, indicators within efficiency, integration, and appropriate resources will be targeted. Furthermore, in the interest of fostering innovation within the health care space and discouraging one model of thinking, it is anticipated that the outcomes-based procurement and VOR will provide clinicians with a choice of solutions to best meet their needs. Patients will have more convenient and timely access to their providers as this approach will inform the reform that is occurring in primary care so that patients across the province can benefit from similar virtual care technology to improve their health and experience.
140 Character Summary: Using an innovative procurement approach to identify a virtual solution with the potential to enhance access to primary care.
RF04.02 - Improving Rural and Remote Healthcare with Home Health Monitoring
Purpose/Objectives: Community paramedics (CPs) are boldly tackling one of Canadas biggest health delivery challenges: providing equitable access to health services for older people living in rural and remote communities. A home health monitoring (HHM) project for CPs (CPHHM) will demonstrate the value of introducing HHM to patients receiving care from CPs in rural and remote areas of the province. We expect the results of the project to show that HHM for CPs will: Reduce the likelihood of CP patients experiencing exacerbations resulting in ED visits or inpatient stays Empower CP patients with the assurance and confidence that their chronic illness is being monitoring on a regular basis
Methodology/Approach: The project builds on a preceding initiative to introduce CPs to more than 70 rural and remote communities in the province. The CPHHM solution for CPs launched in August 2017 and will continue through March 2018, by which time we expect approximately 80 CPs to be using HHM. CPs will install the equipment at the patients home and assist in entering their first days data. The patient will enter their metrics daily for approximately 90 days. If any of the patients entries fall outside ranges prescribed by the patients care team, the CP will see alerts which will trigger a consult with the patients doctor/care team regarding an action plan. Daily monitoring may provide the patients doctor/care team with early warning of a deteriorating condition, perhaps before a patient notices symptoms themselves. The opportunity for the doctor/care-team to course-correct may result in avoiding a more serious intervention and reduce the strain on the healthcare system. Additionally, the CP will provide continued education to the patient on how to better manage their illness. The CP will also share progress reports with the referring provider on a regular basis. Once monitoring completes, the CP will discharge the patient from the program and a member of the project team will contact the patient to capture their experience with CPHHM through a survey.
Finding/Results: Early feedback from patients and community paramedics is that patients feel more connected and safe being monitored remotely and CPs are quickly becoming proficient-with and trusting-of this new service provided to their patients. The success of CPHHM will be evaluated using data-driven outcomes that may include: reduction in the number of patient emergency department visits; reduction or avoidance of patient hospital admissions; increased patient engagement in self-management; improved coordination of care and communication between patients and care providers; and increased effectiveness and efficiency of the Community Paramedicine Initiative. Initial findings/results are expected in time to be presented at eHealth in May.
Conclusion/Implications/Recommendations: It is expected that the results of CPHHM will demonstrate a positive patient experience, increased overall health of the CP patient population and a reduction in both acute and community healthcare utilization. The primary benefit is that through HHM, CPs will provide patients with tools to better understand and manage their own illnesses.
140 Character Summary: Home health monitoring for community paramedics improves outcomes for seniors in living with chronic illness in rural and remote communities.
RF04.03 - Methods of Using Social Media Data to Monitor Physical Activity
Purpose/Objectives: Social media technology, such as Twitter, allows users to communicate with each other by sharing short messages. Users often share their thoughts, feelings, and opinions on these social media platforms and as a result, social media data could be used to provide real-time monitoring of psychological and behaviour outcomes that inform health behaviours. The growing body of social media data is becoming a central part of big data research as these data can be modeled alongside other datasets (e.g. physical activity level) and used to predict outcomes from these datasets. Research has already shown that data from social media technologies can be used for novel approaches to identifying infectious disease outbreaks such as influenza transmission and HIV outbreaks. Currently, it is unclear whether these methods used to analyze social media data for predicting infectious disease outbreaks could be applied to physical activity research. Thus, the purpose of this study seeks to establish methods of using Twitter data to monitor physical activity level by assessing 1) whether geolocated conversations about physical activity behaviors can be extracted from Twitter, 2) the feasibility of using physical activity related tweets as a method to monitor physical activity levels across the United States.
Methodology/Approach: Tweets were collected from Twitter's Advanced Programming Interface (API) between January 30, 2017 and October 15, 2017. We used Twitter's garden hose method of collecting tweets, which provided a random sample of approximately 1% of all tweets. Geo-tagged tweets were filtered. A list of physical activity keywords was compiled using the guidelines for exercise testing published by the American College of Sports Medicine. A tweet was classified as physical activity-related tweets if it contained one or more related keywords to physical activity (e.g. exercise, running). Latest data on physical activity level at each county across the United States were obtained from Center for Disease Control, Behavioral Risk Factor Surveillance System. Negative binomial regression model was used to model the association between county-level physical activity level and physical activity-related tweets while controlling for GINI index. GINI index was used as a standard measure of income inequality.
Finding/Results: There were 330,551,865 Tweets collected between January 28 to October 15, 2017. 50,844,874 contained geo-location information within the United States. Preliminary data analysis has shown that physical activity related tweets can be extracted from Twitter data and may be used to provide information about physical activity level across the United States. Detailed analysis results to use Twitter data to monitor physical activity level are forthcoming.
Conclusion/Implications/Recommendations: Using social media data to monitor physical activity level can be a valuable tool for public health organizations as it can overcome the time lag in the reporting of physical activity epidemiology data faced by traditional research methods (e.g. surveys, observational studies). Consequently, this tool could have the potential to help public health organizations better mobilize and target physical activity interventions.
140 Character Summary: This study examines the feasibility of using real-time social media data as a method to monitor physical activity levels across the United States.
RF04.04 - Efforts to Advance the Adoption of National Nursing Data Standards
Purpose/Objectives: This presentation will describe the strategies being utilized to advance nursing data standards adoption in Canada, the benefits to be derived, and the current state of adoption. Strategies to be addressed encompass activities in the areas of clinical practice, administration, nursing education and research, and health policy including concrete examples of achievements to date.
Methodology/Approach: This presentation will focus on the follow-up activities and outcomes of a nurse leaders symposia held in 2017 and highlights of the 2018 meeting. Supported by the vendor community and sponsored by the Canadian Nurses Association, Canada Health Infoway, and the Canadian Institute for Health Information, the 2017 symposium was attended by more than 85 participants representing every provincial and territorial jurisdiction across Canada. Building upon the foundations of the action plan established in a 2016 symposium, the 2017 meeting included a broader engagement of nurse leaders and key stakeholders and continued the evolution of strategies to advance the adoption of nursing data standards across Canada. The symposium included plenary sessions from key stakeholder organizations, large group discussions, and working group deliberations to identify specific objectives and activities for 2017-18.
Finding/Results: The outputs of the 2017 symposium to be described will include: 1) the identification and development of actual clinical demonstration projects to illustrate the value of adopting and using clinical data standards, 2) a strategy to delineate the competencies required by nurse leaders to advance the uptake of clinical data standards, 3) the identification of research needed to better understand the impact of using clinical data standards and continue the advancement of same, 4) strategies to advance the understanding, value and use of clinical data standards in undergraduate nursing education, and 5) the details of a policy advocacy strategy to broaden stakeholder engagement nationally. Further activities to heighten awareness, align with other initiatives (e.g., accreditation, patient safety, use of quality indicators), and extend participation to an increasing number of health care provider organizations will be described. With the 2018 symposium being held earlier in May, the attendees will also get a preview of the outputs arising from this most recent meeting.
Conclusion/Implications/Recommendations: The May 2018 Symposium will provide an opportunity to review, refine and and extend the plans and activities identified in the 2017 meeting. Hence the 2018-19 action plans arising from the 2018 meeting for the 5 working groups will be also be briefly discussed. Attendees will be invited to offer suggestions and recommendations for further development of the work.
140 Character Summary: Describing the strategies being utilized to advance nursing data standards adoption in Canada, the benefits to be derived, and the current state of adoption.
RF04.05 - Transitions in Care: iPlan
Purpose/Objectives: Humber River Hospital, in collaboration with Central LHIN Hospitals, Central Home and Community Care and Central LHIN, worked together on identifying gaps in processes related to ALC management/avoidance, and prioritized areas for improvement resulting in the development of the Discharge Planning Pathway and Discharge Planning Application iPlan.
Methodology/Approach: Our innovate approach to discharge planning combines standardized clinical workflows with a newly developed application, implemented across the Central LHIN. The Discharge Planning Pathway allows for the early identification, engagement and management of patients that require discharge planning interventions, and is supported by literature and leading practices. iPlan is a new technology that integrates with hospital electronic medical records, and brings together information from Central LHIN Hospitals, Central Home and Community Care and Resource Matching and Referral (RM&R). This application captures the flow of patients through the hospital from admission to discharge, provides real-time situational awareness, improved communication between patients/families, hospital and home and community care teams with shared accountabilities to better manage patient transitions, a platform for future community engagement, and system level data to inform decision making and future planning.
Finding/Results: Humber River Hospital implemented the pathway and observed an initial decrease in ALC numbers, and prevented some avoidable ALCs to Long-Term Care. Two months post implementation, our number of ALC cases have decreased by greater than 20%.
Conclusion/Implications/Recommendations: The discharge planning pathway and iPlan are dynamic and can be implemented at any hospital. iPlan understands where patients are in the discharge planning pathway from data received from the hospitals EMR and staff interactions with the application, and generates notifications for standardized interventions enabling consistency in practice and promoting a high reliability culture. Central LHIN Hospitals are currently implementing this solution in a phased approach.
140 Character Summary: iPlan is a smart application that understands where patients are in their hospital journey, and pushes notifications for standardized clinical interventions.
RF04.06 - Optimizing EHR End-User Support, Experience and Efficiency Through Advanced Data
Purpose/Objectives: Health care organizations across the world are seeking ways to optimize electronic health record (EHR) adoption and use for benefits realization. Specifically, there is a need for a data-informed tool that can inform the design and delivery of end-user support (e.g., EHR coaching, training, etc.) to optimize EHR adoption, use, experience and efficiency after EHR Go Live. Island Health is the first health care organization in Canada to adopt Cerner Advance, an advanced data analytics tool that provides expert analysis to inform the design and delivery of end-user support to achieve these goals. The purpose of this presentation is to share Island Healths methodology, barriers, facilitators and benefits realized in using the Cerner Advance tool.
Methodology/Approach: In May 2017, Island Health adopted Cerner Advance, a Web-based analytics tool that helps to optimize individual use of the EHR based on recognizing opportunities to create user efficiencies. The tool organizes data with multiple levels in an easy-to-use visual display that can be sorted by different views. Using stoplight coding, the tool identifies high-, medium- and low-opportunity users (i.e., opportunity to increase efficiencies in EHR use). Since June 2017, Island Health has used Cerner Advance to develop targeted EHR optimization projects to support EHR adoption/use, using five metrics: (1) Time in EHR; (2) Patients seen; (3) Computerized Provider Order Entry %; (4) Electronic Documentation %, and; (5) Adoption Score. To design an individual EHR optimization plan, the following methodology is used: (1) Review Cerner Advance data before an end-user coaching meeting; (2) Approach the targeted physician/nurse and share goals of optimization; (3) Observe the workflows of the provider/clinician using the EHR; (4) Provide suggestions that will improve EHR adoption or efficiency, and; (5) Share Cerner Advance data with the physician/nurse when appropriate.
Finding/Results: Island Health has proactively leveraged Cerner Advance to identify high-opportunity users who can be provided post-implementation end-user support and optimization coaching to improve their EHR adoption/use and efficiency. From April (baseline) to September 2017, this data-driven end-user support has resulted in increased: (1) Quick Orders Selection (45% to 51%); (2) Orders via MySearch (40% to 46%);CPOE % (94.25% to 94.65%), and; Electronic Documentation (96.8% to 98.4%) for all physicians. At the same time, physicians active time per patient in the EHR has decreased from 5:40 to 5:11. However, limitations/challenges of the tool include (1) Targeted physicians must have seen at least 40 patients to have reliable EHR usage data and (2) EHR usage data was initially unavailable for nurses.
Conclusion/Implications/Recommendations: Island Health is the first health care organization in Canada to use Cerner Advance, a proactive, data-driven approach to EHR optimization. In addition to targeting end users based on adoption, efficiency and organizational goals, this data-based approach to end-user support helps increase user satisfaction, as well as build capacity in understanding/applying data to EHR optimization conversations with end users. Canadian health care organizations can apply Island Healths methodology, barriers and facilitators to their own planning, design and delivery of EHR optimization efforts for benefits realization.
140 Character Summary: Island Health is using a proactive, data-driven approach to EHR optimization to increase EHR adoption/use and user satisfaction for EHR benefits realization.
PL03 - Tuesday Morning Plenary
- Type: Plenary Session
- Presentations: 1
- Coordinates: 5/29/2018, 08:30 - 09:30, Kitsilano Ballroom, Conference Level
Abstract not provided
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EP03 - e-Poster Session 3
- Type: e-Poster Session
- Track: Clinical Delivery
- Presentations: 8
- Coordinates: 5/29/2018, 09:30 - 11:00, e-Poster Station 1, Parq Grand Ballroom, Conference Level
EP03.01 - Home Health Monitoring Patients Use Care 76% Less Than Average
Purpose/Objectives: In Canada, chronic diseases like heart and lung disease, cancer and diabetes cause 88% of deaths and consume 67% of direct healthcare costs. Much of these costs spring from emergency visits and hospital readmissions. A Canadian Institute for Health Information study found that 21% of discharged heart failure patients are re-admitted to hospital within 30 days, while 40% are re-admitted within 90 days. The same study discovered that 18% of COPD patients are admitted to hospital once a year; 14% are admitted twice. Clearly there is an opportunity to keep chronic disease patients healthier at lower cost, especially during that critical transition from acute to self-care. Home Health Monitoring (HHM) for chronic diseases such as COPD and Heart Failure are yielding exciting results. HHM solutions in the hands of community paramedics show great promise in helping seniors with chronic conditions in rural and remote communities. HHM programs let patients measure and manage their own health metrics at home while maintaining that critical daily connection with clinicians. In one provincial pilot, heart failure patients with HHM in place used healthcare services 76% less than heart failure patients not using home monitoring.  Noncommunicable diseases country profiles: Canada, World Health Organization, 2014.  Against the Growing Burden of Disease, Kimberly Elmslie, Centre for Chronic Disease Prevention, PHAC, 2012.  All-Cause Readmission to Acute Care and Return to the Emergency Department. Canadian Institute for Health Information, 2012.
Methodology/Approach: In Home Health Monitoring (HHM) programs, patients are set up with the devices they need to measure their pulse, blood pressure and other health metrics at home. Patients send data to an HHM nurse and answer questions through an online survey about how they feel. If clinicians have any concerns, they call patients, and vice versa. This dynamic lifeline lets patients heal more safely at home, where theyre healthier. It gives clinicians the tools and insights to address issues earlier, before they worsen.
Finding/Results: Patients in a recent provincial HHM pilot were very positive about the program: 97% would recommend it to others, with many wanting to hold onto the equipment beyond the pilot period. HHM enhances patients engagement in their own health. Many felt that both the equipment and clinician contact encouraged them to be more active in self-care, like following their action plan and doing daily recovery exercises. And as studies have shown, engaged patients become healthier patients. Ongoing communication also allowed earlier interventions, resulting in better outcomes at lower cost. The pilots 76% reduction in healthcare use bears this out. As compared with average heart failure patients, patients in the program incurred half the MSP billings of patients who were not in the program, 81% less acute inpatient days and 60% less emergency visits. And 86% of clinicians reported satisfaction with their ability to deliver care.
Conclusion/Implications/Recommendations: HHM is only in its infancy. The benefits of early pilots speak for themselves. Many more pilots are running today, each accompanied with rigorous evaluations. Their lessons are creating the rich store of insight that will help us know the very best way to offer HHM for the greatest benefit to patients in Canada and around the world.
140 Character Summary: Home health monitoring programs help patients with chronic conditions in urban, rural and remote settings stay healthier at home.
EP03.02 - Managing Senior’s Health Information in Assisted/Supportive Living Communities
Purpose/Objectives: Seniors are frequent users of the health care system due to their complex care needs. Managing these needs in long-term care or community care settings requires ongoing information sharing between the seniors, their family members, and their care team. Thus, digital technologies have the potential to help those involved with the collection, management, and sharing of health information. Our study objectives are to: (1) understand the health information technology needs and readiness of seniors living in assisted or supportive living communities, as well as the needs and readiness of their family members and the site staff involved in their care; and (2) to contextualize those needs in the operational context of assisted or supportive living communities.
Methodology/Approach: Our study is currently recruiting participants from three assisted/supportive living communities managed by The Brenda Strafford Foundation and Silvera for Seniors, located in Calgary, Alberta. We aim to have a sample of approximately 36 participants including: Residents (n=~12), resident family members (n=~12), and site staff (n=~12). Participants take part in semi-structured interviews where they answer questions about how they manage, interact, collect, and share resident health care information. Participants are also asked to demonstrate how they collect, share, manage and access resident health information through a contextual inquiry approach, which is filmed and included in the analysis. By combining these two research methods, we are able to hone in on both subjective and objective information, creating a rich basis for later project phases.
Finding/Results: Results from the semi-structured interviews and contextual inquiry will allow for a deeper understanding of the roles each participant group plays in the collection, management, and sharing of resident health information. These results will also help identify gaps in current practices that will inform later project phases.
Conclusion/Implications/Recommendations: Gaining a better understanding of current health information management processes, including identification of barriers that exist within assisted/supportive living communities, will help guide the development of digital health technologies that support the management and exchange of health information in these communities.
140 Character Summary: Understanding how seniors, families and care providers collect, manage, and share health information in long-term or community care contexts.
EP03.03 - Implementing a Provider Registry FHIR Interface
Purpose/Objectives: To design and implement an HL7 FHIR interface for the Provider Registry System (PRS) used in BC, AB, SK, and NL leveraging an existing application architecture.
Methodology/Approach: The Provider Registry System (PRS) is a foundational EHR component with a significant footprint in Canada. With over 16 years of service, PRS has seen considerable turnover of health integration standards. Predating HL7v3, the solution was designed with a proprietary messaging language. Over time, multiple iterations of the HL7v3 standard were also added as interface options, including support for current pCS versions, and leveraging Infoways Message Builder API. Lately interoperability talk is all about FHIR. While those existing HL7v3 integrations will still exist, how can legacy solutions like PRS, adapt to the next generation of digital health interoperability? Building on our experience with HL7v3 integration, we leverage our core, stable, messaging technology as an internal communication mechanism, and use the HAPI FHIR API to provide an external interface to our solution. To integrate with our existing data model and internal messaging formats, we follow a proven and adaptable design pattern for mapping and translation that isolates the API libraries from core PRS functionality.
Finding/Results: By leveraging existing application architecture, and design patterns, we were able to easily add FHIR interface options to our core solution. - By adopting the HAPI FHIR API, our solution is easier to maintain and extend. - We can implement revisions and new standards releases, or multiple versions with relatively low effort. - We offload the server interface components to those provided by the API - We focus our resources on semantics, data mapping, terminology, and our core business logic, rather than formatting, validation, parsing, and communication. While our solution includes a good alignment with the core FHIR model, there are some variances, and additional data in our model that is not part of the core standard. We chose to offer a pure, core standard interface as our primary offering and support an extended interface covering features unique to PRS through FHIRs extension capabilities.
Conclusion/Implications/Recommendations: By leveraging our existing application architecture and adding a quality FHIR API solution, we were able to add FHIR interface support to our exsing Provoder Registry solution. Our developers do not need to worry about the nuances of FHIR formats, or implementing a service layer to support it. We focused effort where it matters most; on mapping, data semantics, terminology, and our core business logic.
140 Character Summary: We extend the multi-jurisdictional Provider Registry System to include the HL7 FHIR standard by leveraging a proven application architecture and the HAPI FHIR API
EP03.04 - Real-Time Risk Scoring: Algorithms for Managing Expectations
Purpose/Objectives: Many efforts have been made to develop readmission prediction models using machine learning. Few, however, have actually been implemented. Significant barriers exist relating to the data access, technology, and change management required to meaningfully utilize real-time prediction scoring in a hospital environment.
Methodology/Approach: Data from an electronic health record system, outpatient pharmacies, outpatient clinics, census data, and more were combined to train a prediction model identifying heart failure patients at highest risk of 30-day readmission. These prediction scores were made available to clinicians and administrators involved in heart failure care at multiple acute care hospitals. They were used to help prioritize patients for interventions that included admission to a specialist heart failure unit, expedited outpatient follow-up, and targeted discharge teaching. Non-specialist physician services are often challenged to evaluate heart failure risk, and some inpatient units rarely see heart failure patients.
Finding/Results: The model development process highlighted that clinician opinions of what contributes most to readmission risk dont always align with the historical data. Most of the implementation challenges were not, however, related to model accuracy. Significant care variation exists between clinical services, units, and facilities because of differing resource availability and culture. This creates disparate demands and competing interests for how risk scoring should be used. It provided an opportunity for reflection on a number of key questions: Is predicting 30-day all-cause readmission always the right outcome measure? Is a risk scoring tool best suited to help bed placement clerks assign admission units or to support physicians making readiness for discharge decisions? Or to help prioritize rounding for clinical nurse educators? Can risk scoring successfully be implemented outside of EHR workflows? What level of readmission risk constitutes high? What level of model accuracy is sufficient? What are the most effective interventions that can be applied to heart failure patients to reduce readmission risk? Can some interventions simply be applied to all patients without the need for risk stratification?
Conclusion/Implications/Recommendations: Focusing on workflow and asking the right questions early in a project are critical elements to effectively exploiting machine learning for risk prediction. And equally important, knowing when to utilize other tools. Although incredible potential exists for improving workflow and clinical outcomes, successful implementation depends on a holistic approach to quality improvement and utilizing risk scoring alongside traditional efforts to standardize care pathways.
140 Character Summary: Effective use of risk stratification and machine learning requires careful management of competing interests. Lessons from a multi-site implementation.
EP03.05 - Age and Sex Patterns of Medical Care Utilization Through OTN
Purpose/Objectives: The Ontario Telemedicine Network (OTN) provides virtual health care services to the Ontario population, with an emphasis on those patients in underserviced regions. This research seeks to determine the associations between age and sex and medical care utilization rates faciliated by OTN and to determine if these associations are modified by geographical location.
Methodology/Approach: A historical, population-based, retrospective cohort study, utilizing record-level administrative billing data and census data was employed. Utilization was determined by Ontario Health Insurance Plan (OHIP) medical billing data that has OTN listed as the service location. Patient geography was determined by matching OHIP residence codes to Ontario census subdivision (CSD) codes. Patient geography was divided into four regions: rural north/south and urban north/south. North and south classifications were determined using the geographical boundaries defined by the Local Health Integration Networks and urban and rural classifications were defined using Statistics Canada's Statistical Area Classification System. Each OTN visit creates two or more distinct OHIP codes: one telemedicine encounter premium code and at least one specified medical service code. The telemedicine premium codes were used to determine general utilization and the specified medical service codes were used to determine specialty utilization. Medical service codes were organized into therapeutic areas of care. The top utilized specialties were distinguished and reported. The remaining specialties were grouped into an other category. Crude and adjusted utilization rates were calculated and associations between the exposures, outcome, and effect modifier were analyzed using multivariate Poisson regression.
Finding/Results: There were 885,761 completed patient sessions facilitated through the OTN from 2008/2009 to 2014/2015, providing care to 185,061 unique patients throughout the province. Provincial utilization rates were highest in family and general practice, followed by addiction medicine. Addiction medicine was approximately 7-fold higher in young adults (20-44 years of age) residing in Northern Ontario compared with young adults in Southern Ontario. Utilization rates among children (0-19 year of age) residing in rural Ontario were highest in psychiatry and dermatology services, whereas children residing in urban Ontario utilized family and general practice services most frequently. Oncology, internal medicine and surgery services had the highest rates of use in male, older adults (65 years of age and older) residing in Northern Ontario.
Conclusion/Implications/Recommendations: This project provides a detailed description of telemedicine use in Ontario by sex, age, rurality, and region. While the majority of completed patient sessions through OTN are related to addiction medicine, the findings of this study highlight the variability of telemedicine usage by sex and age across the province. Results provide insight for e-health networks, such as OTN, and local health networks on what services are being utilized and by whom. Future research will investigate OTN service utilization trends, particularly in older adults, and compare OTN service rates with provincial, in-person care services.
140 Character Summary: Telemedicine services facilitated by OTN have increased access to specialized medical care for all patients, young and old, especially in Northern, rural Ontario.
EP03.06 - Breathing Easier from Home: Telehomecare Results
Purpose/Objectives: Chronic Obstructive Pulmonary Disease (COPD) has the highest rate of admissions among major chronic illnesses in Canada, as well as the highest readmission rate. 18% of people living with COPD are admitted to hospital once a year, while 14% are admitted twice . Canadian hospitals are admitting more clients with COPD flare-ups than heart attacks. COPD is the only chronic disease with an increasing mortality rate. Home health monitoring (HHM) is gaining recognition as a clinically transformative health service that supports and accelerates transitions to community-based, integrated primary care. A pilot project introduced HHM to clients to help them manage their condition from home. HHM helps clients with chronic diseases, their caregivers and families access services, enhance understanding of their condition, and reduce hospital visits. Ultimately, HHM results in high levels of client satisfaction, with 100% of clients surveyed recommending HHM to others. HHM for COPD has been operational since November 2016, and is currently in the evaluation phase. The evaluation framework has been developed and is being executed; as client data is evaluated and analyzed, results will be presented.  Canadian Institute for Health Information, All-Cause Readmission to Acute Care and Return to the Emergency Department (Ottawa, Ont.: CIHI, 2012)
Methodology/Approach: Best practice for solution design and delivery was followed for the implementation of HHM for COPD. Team members are now analyzing extensive client feedback, evaluating impact on acute care utilization by these clients, evaluating overall program utilization, and identifying potential areas of improvement. Below are the key components of the evaluation phase: Client Surveys: Telephone interviews to capture qualitative data on HHM program experience. HHM Clinician Surveys: Online survey capturing data on implementation, training and overall program deployment. Acute Care Utilization Evaluation: Data regarding emergency department visits, inpatient care admissions, and length of stay for clients before, during and after HHM will be analyzed. Only encounters specific to COPD will be included. Program Utilization (Referral) Evaluation: Look at referral data and areas for improvement.
Finding/Results: Preliminary analysis from client and clinician survey data shows that the majority of HHM clients and clinician users are highly satisfied with the HHM service. Detailed results will be shared. Analysis of the acute care utilization data by HHM COPD clients is expected to show a decrease in emergency department encounters, decreased inpatient admissions and shortened inpatient length of stay for COPD-related visits during and after HHM participation. Detailed results will be shared. Referral analysis is expected to show areas for improvement in recruiting and maintaining clients that are relevant to all telehomecare programs in Canada. The referral evaluation is also expected to show the barriers to achieving increased benefits in acute care utilization and client satisfaction. Detailed findings and recommendations for effective HHM programs will be shared.
Conclusion/Implications/Recommendations: HHM projects have shown a positive impact on clients living with COPD and their care teams. Providing better access to patient health information, particularly for patients that are located in rural and remote areas, can reduce healthcare system costs, increase patient satisfaction and improve overall population health. With the number of COPD cases on the rise in Canada, solutions such as HHM will become increasingly important.
140 Character Summary: HHM for COPD aims to increase service effectiveness, efficiency and capacity to manage high-risk clients in the community.
EP03.07 - The Importance of a Dedicated Education Team in Health Informatics.
Purpose/Objectives: The Fraser Health Authority department of Health Informatics (HI) manages the Health Care Information System (HCIS) for Acute Care. Clinical Informaticists (CIs) work to manage the Acute Care HCIS; in addition to working with stakeholders to plan, design, implement, review and evaluate HCIS processes, CIs create, conduct, evaluate, and revise HCIS education and training. In the HCIS, are eight modules; CIs are expected to be module experts for two of them. Leadership consisted of four coordinators who led two modules each; and report to a department manager. This meant CIs were reporting to two coordinators and at times this lead to uneven workload. Furthermore, this resulted in inconsistent development and delivery of education; for example, only one of the four modules education materials had identified learning objectives. In February 2017, the HI department reorganized into four teams. Three teams had two to three modules and eight CIs; and one team was a team with five CIs dedicated to creating, evaluating, and revising HCIS education. The purpose of this presentation is to highlight the benefits of a dedicated education team for HI.
Methodology/Approach: The education team was developed from employees within Health Informatics who expressed interest in education. Team members were encouraged to complete the Educator Pathway, a 4 level education model to facilitate advancement of education within BC health authorities. This allowed the incorporation of principles of adult education into the training materials. Existing training scripts were reviewed and learning objectives created in consultation with module teams responsible for content. Education team members are integrated with specific module teams, attending module meetings, anticipating and facilitating modifications to training materials ensuring currency and comprehensiveness. Formation of the education team has led to collaboration with stakeholders including Online Learning Services, Student Placement and Professional Practice.
Finding/Results: Scripts including learning objectives enable new hires within HI to grasp key content when learning to instruct courses. Computer application instruction to health authority staff is identified as the most important function of the department and staff report greater confidence in providing education with learning objectives contained within scripts. The separate education team has reduced module team burden of maintaining and updating training materials, allowing them to focus on module-specific concerns such as planning, building and testing new application functionality. A dedicated education team has also enabled creation of two computer based courses, which are so successful in providing flexible education that HI is now expanding its complement of computer based training.
Conclusion/Implications/Recommendations: Limited department resources have been effectively managed through the creation of an HI department education team. Training resources are updated concurrently with system changes to ensure accuracy of content introduced to learners. A designated education team has removed the requirement of the module teams to update training materials, allowing them to focus more attention on modules. Module teams have shown acceptance and appreciation for this support. Importantly, having a designated education team allowed the department achieve its goal of creating online learning modules, which will be expanded upon in the months and years ahead.
140 Character Summary: Dedicated education resources have reduced burdens while enhancing education materials and teaching perspectives within the Health Informatics department.
EP03.09 - Health Services Integration: The Role of Virtual Community
Purpose/Objectives: Health Services integration is a challenge in healthcare; the continuum of care extends beyond the point of care to the social services and social determinants of health (e.g. housing, income). However, the current eHealth tools target the healthcare delivery within a strict biomedical model of health that excludes the social determinants of health; the result is translated in inefficiencies and higher cost (e.g., patients that finished their episode of care but cant be discharged without organizing services that address their social needs once discharged; people whose health needs - such as mental health - are linked to the fulfillment existence of social needs). A truly patient centered healthcare need to take into account the social determinants of health. While social services exist in Canada; eHealth solutions that integrate biomedical as well as social care around the patient are still lacking. This paper argues that Health Virtual Communities enable professionals to coordinate biomedical and social care around a patient; such eHealth tools can contribute to a better healthcare delivery while overcoming some inefficiencies in the health system.
Methodology/Approach: Health Virtual Communities research published recently in a book by the author (Novel Applications of Virtual Communities in Healthcare Settings) show effectiveness and efficiency of health virtual communities in diverse areas including mental health, cancer care, pain management, personalized medicine, elderly care, and community engagement.
Finding/Results: Health Virtual Communities enable individuals with common health-related conditions to provide mutual social support, and enables healthcare providers to provide care at a distance especially in chronic disease management. Research has demonstrated effectiveness and efficiency effects linked to Health Virtual Communities for multiple health conditions (chronic kidney disease, pulmonary hypertension, cancer, pain management, elderly care), especially the virtual community members engagement. As an eHealth tool, Health Virtual Communities enable coordination of care among healthcare providers by sharing the patient's care needs and coordinating their actions. They enable providers to discover services available and book services for the individuals under their care.
Conclusion/Implications/Recommendations: Health Virtual Communities provide an opportunity to coordinate biomedical and social care in order to support a truly patient-centred care. They can support truly coordinated care across a holistic continuum of care that includes the social dimension.
140 Character Summary: Health Virtual Communities provide an opportunity to coordinate biomedical and social care in order to support a truly patient-centred care.
EP04 - e-Poster Session 4
- Type: e-Poster Session
- Track: Clinical Delivery
- Presentations: 8
- Coordinates: 5/29/2018, 09:30 - 11:00, e-Poster Station 2, Parq Grand Ballroom, Conference Level
EP04.01 - Recipe for Success: Implementation Evaluation of a Smartphone-Based Telemonitoring Program
Purpose/Objectives: Telemonitoring has a demonstrated ability to ease the burden of managing heart failure by facilitating self-care for patients and decision support for clinicians. A smartphone-based telemonitoring program was launched as part of the standard of care in a large hospital-based heart function clinic. The objective of this study was to identify the technical and contextual barriers and facilitators to implementation and to determine the success or failure of this initiative.
Methodology/Approach: A mixed method, single case study design was employed. Quantitative data included objective measures of implementation success (feasibility, cost, fidelity, and penetration). Qualitative methods included semi-structured interviews with adopting and non-adopting clinicians (N=9) and other program staff (N=4). Interview guides were developed based on the constructs of the Consolidated Framework for Implementation Research (CFIR) with the intent of eliciting responses with regard to factors known to impact implementation success. In addition to the interviews, patient and clinician-reported issues documented by telehealth staff were analyzed. Quantitative and qualitative data were collected at 4 months and 12 months to explain implementation success longitudinally over a 1-year period.
Finding/Results: By August 23rd, 2017, 98 patients had been enrolled in the program. Excluding equipment costs, the cost of implementation as measured by telehealth support time expended, was higher than initially expected. Minor problems with fidelity, which is the degree to which a program is implemented as intended, were reflected in issues documented by patients and clinicians. Penetration (i.e., integration) of the program within the clinic increased over time with an increase from 3 to 7 clinician users. Several barriers and facilitators were identified. Barriers included (1) difficulty in documentation due to lack of interoperability with the hospital EMR, (2) managing system alerts for unmotivated patients, (3) communication challenges among key stakeholders, and (4) the lack of clear implementation strategy. Facilitators included (1) characteristics of the implementation setting (i.e., a clinic that values innovation, teamwork and patient-centeredness), (2) a strong clinician champion, (3) a telemonitoring system that was easy to use, (4) pre-implementation work related to identifying a service design that minimized disruptions to clinician workflow, and (5) a general perception from clinicians that the telemonitoring program has had positive impacts on patient care. Despite increased support staff requirement and minor issues related to the system, participating stakeholders placed more weight on the facilitators and pointed to the voluntary adoption of the system by other clinicians when concluding that the implementation of the telemonitoring program was a success.
Conclusion/Implications/Recommendations: To date, no comprehensive implementation studies on smartphone-based telemonitoring programs have been conducted. By using a longitudinal and theory-based approach, our study could map barriers and facilitators experienced throughout different phases of program implementation. Findings are discussed in such a way that they are transferable to diverse settings. Understanding the factors that influence the implementation of telemonitoring systems is a necessary step toward meaningful scaling of these innovations.
140 Character Summary: This presentation will discuss results from the implementation evaluation of a smartphone-based heart failure telemonitoring program.
EP04.02 - Is FHIR the Panacea of Canadian Interoperability?
Purpose/Objectives: Fast Healthcare Interoperability Resources (FHIR), the newest standard coming out of HL7 International has been gaining a lot of traction since its early beginnings in 2012. A number of countries have already embraced it as the interoperability solution of choice for the HIT field. At the same time early implementations have found that the promised benefits can only be achieved when best practices are observed. What needs to be true for this new technology to have a chance of becoming the panacea of Canadian interoperability?
Methodology/Approach: Just like any new technology, FHIR is not immune to the hype surrounding its launch. We set out to look beyond the hype, examining how the standard is created, early adopters on the international scene, emerging trends for its use and new technologies springing up at its fringes. The challenges associated with its early adoption and the mechanisms needed to facilitate broad scaling of solutions based on its use have been investigated.
Finding/Results: FHIR is truly an international standard. Experts from around the world are contributing time and content to its continuous development. While at the surface it appears as the most user friendly standard ever to hit, the complexity associated with healthcare has never disappeared. This complexity is driving a continuous change in the very fabric of the standard as well as in the resources that are its building blocks. This change has significant repercussions on version control, large scale, long-term adoption strategies, harmonizing across international boundaries, semantic meaning and the overall project management approach those considering implementing with FHIR should consider.
Conclusion/Implications/Recommendations: There is no denying that FHIR is the path forward. Recognizing this truth does not change another one - every journey destined for successful outcomes requires the necessary due diligence. A transparent, scalable FHIR-based interoperability in Canada includes an examination of the threats, opportunities and viable strategies that does not place us at odds with the rest of the world and place us on a path to true interoperability.
140 Character Summary: FHIR will revolutionize the world of interoperability. What needs to be true for it to become the panacea of Canadian interoperability?
EP04.03 - Cognitive Apprenticeship in Clinical Informatics Practice
Purpose/Objectives: The role of Clinical Informaticists (CIs) is to bridge the gap between clinical practice and information technology to facilitate patient care. CIs work in various capacities; for example, CIs provide health care information system (HCIS) application support for clinicians; CIs develop and provide end user (clinician) education; and CIs collaborate with stakeholders to design, develop, and implement HCIS solutions. Newly hired CIs face a staggering learning curve as they transition into their new role; for example, trading in a stethoscope for a laptop and learning a new language, including numerous acronyms, which may be proprietary or organization specific. Moreover, developing CIs as mentors can prove challenging as one cannot assume all experienced CIs would make good mentors. This may be because CIs may not have formal education/training in mentorship, may not have the skills needed to be a mentor, and the mentorship process may not be clearly defined. The purpose of this project was to apply a cognitive apprenticeship model to guide the mentorship, orientation, and professional development of newly hired CIs.
Methodology/Approach: The Cognitive Apprenticeship Model (CAM) (Collins, Brown, & Newman, 1989) emphasizes the facilitation of knowledge acquisition through situated learning and discussion of cognitive processes between mentee and mentor. I utilized the CAM as a mentor to five new Clinical Informaticists hired between July and October 2017. I focused on the following CAM components: 1) Modelling (ex. user set-ups and resolving user issues), 2) Coaching (ex. observing and giving feedback to mentees teaching), 3) Scaffolding (ex. daily check-in time increased or decreased), 4) Articulation (ex. Socratic method for questions), and 5) Reflection (ex. Competency, Assessment, Planning, and Evaluation tool). As the mentees progressed with their learning and knowledge acquisition, I modelled, coached, and articulated less and gradually removed the structured support (scaffolding); for example, with user set-ups and teaching. However, because clinical informatics practice is dynamic, professional development is ongoing, and at any given time, I may be utilizing the CAM components for each mentee; there is no end to the CAM as there is no end to learning.
Finding/Results: A ten question survey and anecdotal feedback indicated mentees' satisfaction with their mentorship, using the Cognitive Apprenticeship Model (CAM). All mentees were able to achieve department expectations with defined timelines; for example, by week six, new Clinical Informaticists are expected to teach a four hour order entry class and complete user-setups independently. An unanticipated finding was an increase in staff recruitment/retention as two of the mentees were hired into temporary positions and have since been hired into permanent positions.
Conclusion/Implications/Recommendations: Mentorship in clinical informatics is often informal and may have an undefined process. Without a framework/model for mentorship, mentors may neglect to improve and/or may negatively affect the orientation and professional development of new Clinical Informaticists (CI). The application of a Cognitive Apprenticeship Model (CAM) in this project was successful to guide mentorship and ease the challenging transition from clinician to CI. Therefore, it is recommended that an approach such as the CAM is used to facilitate mentorship in CI practice.
140 Character Summary: Cognitive apprenticeship in clinical informatics practice facilitates the mentorship, orientation, and professional development of Clinical Informaticists.
EP04.04 - Evaluating the Implementation of Inpatient EMR in Outpatient Nephrology
Purpose/Objectives: Background: Since the rollout of inpatient EMR in 2013, the outpatient nephrology (off-site clinic and hospital-based dialysis unit) remained on paper. The nephrology program wanted to move away from a hybrid state to address inefficiencies with continuity of care (e.g., duplicate work efforts, transcription errors and often delays in patient care). After considering the resources in-hand, the decision was taken to leverage the existing inpatient-EMR to meet nephrology outpatient needs. The implementation included Computerized Provider Order Entry (CPOE), Bedside Medication Verification (BMV) and electronic Medication Administration Record (eMAR), integration of dialysis machines with the EMR and automation of data collection for Ontario Renal Reporting System (ORRS). The project started in October 2016 and EMR went live in April 2017. Objective: To evaluate the implementation of hospitals inpatient EMR in an outpatient nephrology by comparing pre and post go-live states.
Methodology/Approach: We proceeded with identifying and analyzing nephrology care areas that went through the transformation. We also focused on complex care processes, such as, the transfer of chronic kidney patients between care sites and related medication reconciliations. Analysis on the transformation impact on people and processes was also performed on a sample of nephrologists, nurses and renal pharmacists; in which a pre and post implementation efficiency matrix was created to evaluate expected benefits.
Finding/Results: Findings: With use of CPOE, BMV and eMAR, order processing was found more reliable, faster, accurate and auditable. Integration of dialysis machine proved to be efficient in care delivery. The process of ORRS report finalization showed better data acquisition. We also observed few inefficiencies, such as medication reconciliation between inpatient and outpatient visits, dialysis prescription reconciliation, combined trending of inpatient and outpatient labs and medications over time, tracking of outside referrals, labs and medications. We also observed occasional slowness/non-responsiveness from provincial data source (i.e., Connecting Ontario.) leading to temporary manual processes. Results: Based on the evaluation matrix, there is an overall improvement noted in the programs performance and patient care quality and safety. However, we also observed some inefficiencies due to inherent limitations in inpatient-EMR for outpatient areas.
Conclusion/Implications/Recommendations: We conclude that implementing an inpatient EMR in an outpatient setting may prove to be a better alternative to a paper-based environment; however this is heavily dependent on the flexibility of options in EMR and careful reengineering of patient care processes.
140 Character Summary: Careful implementation of an Inpatient EMR in an outpatient setting brings overall efficiency.
EP04.05 - Engaging Paramedics Key to Successful Electronic Patient Care Record Solution
Purpose/Objectives: A project to move from paper forms for documenting patient encounters in a provincial emergency health services organization to an electronic patient care record (ePCR) system prioritized frontline paramedic engagement. This approach ensured the delivery of a solution that meets end-user requirements and which is being readily adopted. This presentation will provide an overview of the projects paramedic engagement strategy.
Methodology/Approach: Paramedics have been involved in the electronic patient care record project from the beginning. Paramedics held a seat at the table during the procurement process to select a vendor. Ten paramedics participated in a usability evaluation to ensure the lead proponents solution was learnable and usable. Paramedics also completed an evaluation of the lead proponents software in parallel with a crew using paper to validate that the solution would work in a live setting. Paramedics have also been engaged throughout analysis and design. Paramedics sit on the core project team. Over 20 workshops have been held across the province, collecting feedback on the application from hundreds of paramedics, and all feedback is documented in a product backlog. Paramedics sit on a planning committee to drive prioritization and decision making on the application. All paramedics are invited to regular project demos to view the updates being made as the project progresses. During the execution phase of the project there has been twofold engagement. First, the support model involves non-paramedic project team members riding along with paramedic crews during their first shift using the system. Project team members have now spent hundreds of hours in ambulances, providing an unprecedented opportunity to observe the system being used in the field. Second, paramedics have been hired as deployment team members to provide peer support. This twofold approach has fostered a trusted partnership between IT and frontline paramedics working towards a single, shared vision.
Finding/Results: Building paramedic engagement deeply into every aspect of solution selection, training and delivery has ensured that the right decisions are being made by the right people. Paramedics helped select their new documentation tool and have driven project decisions; for example, they selected a device with a physical keyboard based on usability study findings. The workshops have identified unique regional requirements across the province. Paramedic-driven decision making in planning meetings ensures the most important updates are prioritized. By working in the field, project leads better understand the solution, and are more responsive to questions and feedback. The paramedic deployment leads add credibility to the project and deployment. As a result of engagement, paramedics have taken ownership of their solution, creating excitement around the implementation.
Conclusion/Implications/Recommendations: By making paramedic engagement core to every aspect of the project, the project has delivered on a large, complex mandate while successfully meeting end-users needs. This level of heavy engagement requires significant investment of time and a willingness to give up some decision making on product priorities, but the end result is worth the upfront effort. Regardless of the type of project, engaged frontline staff is a critical component to enabling change, adoption and successful delivery.
140 Character Summary: The project will present on the importance of paramedic engagement through all phases of a successful electronic patient care record implementation.
EP04.06 - Standardizing Care for Frequent Users to the Emergency Department
Purpose/Objectives: Fraser Health has launched a key initiative to reduce high frequency usage at their 12 Emergency Departments Familiar Faces. Utilizing the Unifying Clinical Information (UCI) solution, Familiar Faces Care Management Plan can be accessible by Acute and Community care disciplines to provide integrated care. The vision is to improve patient experience and health outcomes for high frequency users of the Emergency Department (ED) ensuring that each receives the right service, at the right place, at the right time to meet their needs.
Methodology/Approach: Frequent users or Familiar Faces of Fraser Healths ED often represent vulnerable populations who would benefit from coordinated upstream interventions that would both improve care and lower congestion. Patients/clients are identified as Familiar Faces based defined criteria. The Familiar Faces Care initiative recognized the challenges associated with coordination of care amongst health care teams, and with access to community-based health and primary health care services. These challenges were further compounding the problem of frequent ED use. If an individual is identified as Familiar Faces; the clinical team works together to develop the Familiar Faces Care Management Plan. The Care Management Plan is an integrated and shared comprehensive outline that illustrates the deliberate organization of care activities, resources and services for the Familiar Faces client when presenting to the ED. The Familiar Faces Indicator flag is used to identify patients who meet the Familiar Faces criteria. The Care Management Plan is entered in Meditech (used in acute care settings) or Paris (used in community care settings). There is only one Care Management Plan per patient/client to avoid duplication. In addition; the Indicator flag is entered in Meditech and Paris to ensure acute and community staff are aware of an active Care Management Plan available to view in UCI. Due to the lack of integration between Meditech and Paris; the UCI solution was selected to share the Care Management Plan between acute and community settings. The UCI solution provides a holistic integrated view of the patient across Fraser Health including Provincial Lab, Provincial DI and information from the Vancouver Coastal/ Providence Health/PHSA (VPP) CareConnect solution.
Finding/Results: The Familiar Faces initiative has been implemented in Meditech and Paris. Familiar Faces Care Management Plan from Meditech and Paris are both accessible in UCI for all Fraser Health users. In addition; the Paris Indicator flag for Familiar Faces is also viewable in UCI.
Conclusion/Implications/Recommendations: As a result of this key initiative, Fraser Health has achieved the following objectives: Familiar Faces alerts and care management plans developed in Meditech and Paris Consistent care and messaging for the Familiar Faces client at all points of care Emergency Departments have established links with various community services Easier access to care management plans in UCI by clinicians The following current initiatives that are currently in progress and future state: Meditech Indicator flag integration with UCI Sharing Care Management Plan with BC Ambulance Services Integration of VPP Care Management Plan with Fraser Health Implementation of Care Management Plan and Indicator flag in Profile (used in primary care settings)
140 Character Summary: The Familiar Faces initiative was introduced to reduce the high frequency users in the Emergency Departments by utilizing the UCI solution.
EP04.07 - Commercialization Landscape for mHealth and eHealth in Canada
Purpose/Objectives: The primary objective of this literature review was to understand the commercialization landscape relevant to eHealth and mHealth in Canada. In the recent few years, eHealth and mHealth focused apps have been growing at a significant rate and that has brought in a unique set of challenges in a knowledge-driven economy like Canada. This literature review will help to further identify those challenges and the kind of opportunities can come out of it from the discussion. As well as, this research will help bridge the gap between various important key stakeholders such as the academic world, clinical practitioners, and the medtech industry itself. The ultimate motivation for this discussion is to enable further collaboration among the key stakeholders pertaining eHealth and mHealth in Canada
Methodology/Approach: 1. Scoping review of eHealth and mHealth publications with the focus on commercialization of such technology within the different healthcare systems in the world. 2. Interview key stakeholders who play a key role within Canada for commercializing new eHealth and mHealth technology. 3. Use Levacs methodology to identify papers which describe barriers and opportunities to commercialization of eHealth and mHealth focused solutions in Canada
Finding/Results: The initial literature searches have identified several gaps that have limited the commercialization of mHealth technology: 1. Lack of consistent terminology defining eHealth and mHealth technology within literature and in work practices, 2. Lack of definition between go to market tools vs. wearables vs. EHRs vs. efficiency in Canadian and North American Markets, 3. Not enough multidisciplinary insight on mHealth and eHealth technology success in the long run in the current healthcare system. This literature review and discussion would be developing recommendations related to 1. How eHealth and mHealth are defined in what context, 2. What are tools, resources, and organizations in place within Canada to foster eHealth and mHealth focused innovation within the healthcare system? 3. What type of strategic initiatives need to take in order to foster longer implementation plan for new innovative eHealth and mHealth solutions to be better integrated.
Conclusion/Implications/Recommendations: eHealth and mHealth technology use in Canada, both in the research and industry domains, have been increasing significantly in the last ten years. Such use of technology has shown to help various parts of the population be better aware of their health, help the healthcare team able to remotely monitor the patients vitals, and help the overall healthcare system become more proactive. Public healthcare in Canada is a very complex system and there are various stakeholders that play key roles when it comes implementing and deploying a new form of technology on a systems level. In this project, we are finding the current barriers and opportunities that are prevalent with implementing eHealth and mHealth within the Canadian landscape by doing an initial literature review and as well as interviewing key figures within the field in order to bring together relevant information for innovators.
140 Character Summary: Understand how commercialization of mHealth and eHealth works within a public healthcare system like Canada, exploring barriers and enablers.
EP04.08 - Systematic Review of Electronic Health Record in the Canadian Healthcare
Purpose/Objectives: The Canadian health care system is a cherished institution in Canadian society. Universal access to care is viewed as a basic right for all Canadians and this historical institution is internationally recognized and envied as a model for health care delivery. In Canada, medical records can be generated and maintained in a variety of ways. Different care providers throughout the patients journey will create their own local charts and, because of the complexity this system, transference of this information between providers in the circle of care is slow, cumbersome, and often reliant on inefficient modes of communication, such as paper facsimile, or images on a CD-ROM. This can result in an increased risk to patient safety, privacy breaches, miscommunication, and costly repetitive administrative processes. This fragmented system of digital health records increases the burden on our healthcare system and patients. In terms of the experience for the individual health-seeker, the current system is disempowering because knowledge of their own personal health information is obscured through lack of access and transparency.
Methodology/Approach: Leveraging the use of systems thinking and design principles, a comprehensive current state analysis was conducted to illustrate baseline performance, and a future state ideation was generated. In order to find solutions and innovations that will translate into actual applications, a literature review was conducted with a focus on the Canadian healthcare context. For the literature review, promising components of digital health, proposed innovation, impact, and barriers were explored. Additional research included interviews that were limited to brief probes of professionals in the field to better understand context and applications.
Finding/Results: This research began by first understanding the current context of digital health records in Canada. Due to multiple types of health records, each governed by a different set of ownership, data is fragmented, out-of-date, incomplete, and cast across a network of regions and provinces. Owing to this, data can be redundant and difficult to access resulting in duplication or error that ultimately leads to unnecessary cost to Canadas healthcare system. Patients are also left at the mercy of this system, either by having to transmit their data at multiple, various touch-points or simply left disempowered; unaware of their current health status until the next care provider is available or a health crisis arises. Furthermore, the lack of comprehensive datasets negates opportunity for research to formulate disease-preventing interventions that target specific areas of Canadas population. Thus, it is clear that a need exists for reform in the area of digital health records, particularly in unifying digital health records and providing patient access.
Conclusion/Implications/Recommendations: The rise of personal data management in health care suggests patients prefer more autonomy over their personal health data. The popularity of mHealth portals and wearable devices is growing at a fast pace and presents tremendous potential. This self-generated data, in the purview of the patient, could play a role in the future alongside traditional health records to simultaneously aid in disease prevention for the patient and assist care providers in delivering improved, holistic services.
140 Character Summary: Patient data, in the form of wearables and mHealth applications, can augment a Universal Digital Health Record, made available to both patients and care providers.
OS13 - Delivering the Benefits of Digital Healthcare
- Type: Oral Session
- Track: Executive
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Fairview IV Room, Conference Level
OS13.01 - Improving Access, Navigation, and Communication About Health Services
Purpose/Objectives: Local Health Integration Networks (LHINs) provide strategic direction and fund health service providers (HSPs) in Ontario. To understand the current services available at the community level, the Toronto Central (TC) LHIN began collecting supplemental data from their HSPs in 2017. The analysis of this data set helps inform planning, and enables providers across the LHIN to collaboratively address common challenges to better serve Torontonians. Ultimately, the goal is to help improve access, navigation, and communication for patients. Some challenges faced by TC LHIN included manual and time-intensive data collection, analysis, and presentation through Excel. As HSP360 provides a centralized platform for HSPs and LHINs to access multiple data sets from various sources (for example, SRI, ALC, MLAA, Stocktake, etc.), incorporating this supplemental data set allows for greater insights through the following capabilities: - Web input form, allowing users to update their respective supplemental data at any time - Interactive dashboards, providing users with the most up-to-date information, as well as dynamic visualization, drill-throughs, and filtering capabilities (See figure 1) Figure 1: Overview of LHIN Services
Methodology/Approach: The web input form and interactive dashboards were built through close collaboration between TC LHIN and CAMH, with the scalability to expand these capabilities to other interested LHINs. First, the design and development were iterated upon through brainstorming sessions and mockup reviews. Secondly, user review and testing was incorporated to ensure that health service providers were involved in the process. Lastly, the release of the input form and dashboards were incorporated into existing SAA processes.
Finding/Results: LHINs and HSPs have found great value in using HSP360 in data collection and analysis. With HSP360s current automation of administrative and benchmarking processes, including HSP supplemental information on the same platform provides a new level of insight on community HSPs that was previously not available further building the decision support capacity for LHINs and HSPs. The Toronto Central LHIN and their HSPs have found this information helpful as a starting point in planning for new services, and looking for efficiencies to improve overall system performance and the patient experience. LHIN and HSP users are now able to identify opportunities in: coverage of service area; priority populations and conditions; and availability of services: what, when and where.
Conclusion/Implications/Recommendations: The progression of HSP360 has enabled LHINs and HSPs to set new standards in performance monitoring and a common view of performance metrics across LHIN boundaries. Including the HSP Supplemental data set on HSP360 enhances and supports the performance monitoring process, and improves access to comparable information for evidence-informed decision making.
140 Character Summary: HSP360 supports service planning for HSPs and LHINs most recently providing users with additional insights from data collected at the community level.
OS13.02 - Multilevel Interoperability: Enabling Disciplinary Autonomy within Interdisciplinary Process and Technology
Purpose/Objectives: Illustrate how a diverse healthcare environment specializing in multiple disciplines was limited in ability to share and access information across entities due to limitations of one-size-fits-all technology, but can now globally access information across diverse yet relevant areas of professional practice.
Methodology/Approach: All three levels of the HIMSS Interoperability Model are utilized to achieve the desired outcome, including: Functional Level One (basic): This lowest level includes simple criteria for sharing information between health information systems. Structural Level Two (intermediary): At the mid-level, data interpretation is possible. Semantic Level Three (advanced): In the most advanced level, disparate solutions can interpret and exchange information. *Figure A: HIMSS Multilevel Interoperability Model Prior to implementation, Readiness Assessment methodology was developed to identify at the core: current environmental status, overall level of impact on all stakeholders, and required actions for achieving the desired future state. Extended arms of the readiness assessment framework include: People & Culture, Process, Technology, Documentation Workflow, External Environment. The approach selected for implementation includes project management methodology with the following included: 1) Process improvement with workflow mapping 2) Change management 3) Agile software development 4) Post-implementation Evaluation Figure B*: Baycrest Readiness Assessment Framework:
Finding/Results: Findings, results and predicted outcomes include examples as follows: 1) Improved clinical documentation and interprofessional practice across the continuum of care. 2) Use of universal care protocols to enable regulatory compliance. 3) Quality improvement, enhanced risk mitigation and increased patient safety. 4) Business administration and financial management becomes more supportive to clinical services. 5) Integration of multi-dimensional data architecture with electronic health records, enables advanced health analitics and clinical decision making.
Conclusion/Implications/Recommendations: In conclusion, all levels of interoperability within a health information technology framework are essential for integrating the multiple specialized areas across a health services environment. It enables services to meet their unique needs related to information, workflow, care, quality, research, revenue and regulatory compliance. Interoperability not only facilitates the needs of uniquely specialized services, but it is recommended in order to achieve effective communication and ubiquitous sharing of health information when appropriate. The result is patient centric interprofessional collaboration across disciplines and throughout the continuum of care.
140 Character Summary: Disparate health services in a hospital, community, retirement or nursing home, achieve both individual and shared requirements via all interoperability levels.
Purpose/Objectives: The introduction of electronic medical record (EMR) systems is expected to provide numerous benefits; however, literature reviews often provide inconsistent evidence for the promised or expected benefits -- particularly in the home and community care sector. The lack of strong evidence in the literature for the benefits of an EMR and how to realize them undermines the business case for prospective EMR purchasers and poorly advocates for further advancement of health IT within an organization. To better understand how nurses are currently using the EMR and to identify gaps or challenges that could be addressed our organization undertook an evaluation of our EMR.
Methodology/Approach: The evaluation was conducted over a series of months and was based on an adapted version of the Canada Health Infoway Benefits Evaluation. Key domains included: System Use, System Quality, Information Quality, Training & Support as well as the Client Perspective. Information to support the evaluation was collected numerous ways including staff survey, focus groups, chart audits, client interviews, and review of system/support logs.
Finding/Results: The majority of nurses report satisfaction with the performance and reliability of using the EMR. Barriers to use were largely related to issues with network performance and connectivity in the community. When the EMR was used as intended, it improved the overall efficiency and productivity of our nurses; however the opposite was reported when the system use was described as poor. The top benefits identified were the enhanced ability to protect the privacy and security of clients health information, improved collaboration and communication to and for service delivery, and the ability to adhere to best practice standards and promote evidence based clinical practices.
Conclusion/Implications/Recommendations: The evaluation revealed several key areas of benefits allowing for a compelling business case for further investment in digital health and provided our organization with insights on areas for further enhancements. It was clear that the benefits of the EMR have had a strong, positive and measureable impact on the organization and nurses.
140 Character Summary: VHA Home Healthcare evaluates their Home & Community Based EMR for nurses using an adapted version of the Canada Health Infoway Benefits Evaluation Framework.
OS13.04 - Measuring Individual and Organizational Transformation: An eHealth Adoption Maturity Model
Purpose/Objectives: Individual and organizational transformation are important goals of large scale eHealth solution implementation projects. Yet, these goals are often not realized because these projects are inherently complex with failure rates as high as 70 percent internationally. Successful implementations require strong leadership and ongoing monitoring and evaluation of key indicators. The eHealth Adoption Maturity Model is a conceptual model developed by a panel of experts to guide this process. The Model identifies indicators for individuals with varying degrees of involvement in the implementation as well as indicators in the practice environment and the broader organizational context. This presentation provides an overview of the Model and the three levels of eHealth adoption that can be used to measure individual and organizational transformation.
Methodology/Approach: The Model emerged as a by-product of the collaborative work of a panel of international experts which was convened in January 2016 to develop a best practice guideline intended to enhance the informatics capacity of individuals involved in the implementation of an eHealth solution. The Panel included patient partners, health care executives, nurses, and other health professionals from various settings. Several panel members played key roles in eHealth solution implementations that resulted in their organizations attaining Stage 6 or higher on the HIMSS Analytics Electronic Medical Record Adoption Model. The Guideline development process included a systematic review of the peer-reviewed literature from 20062016 to identify the best available evidence to formulate recommendations. The panel developed the eHealth Adoption Maturity Model as a conceptual model comprised of key elements (and corresponding measurement indicators), each of which was aligned with one or more of the Guideline recommendations.
Finding/Results: The eHealth Adoption Maturity Model identifies several elements that are thought to impact the overall individual and organizational transformation process: management and leadership; focus on stakeholders; process and infrastructure; education; resources; and the context and environment. The Model demonstrates that as organizations and individuals progressively mature through their adoption of an eHealth solution, some elements may evolve faster than others. This lack of uniformity in the rate of maturity can persist to the end of the formalized transformation process. For each of the Model elements, generic eHealth adoption and maturity characteristics were identified and categorized along a continuum ranging from Level 0 (Beginning) to Level 2 (Advanced) to facilitate the measurement of individual and organizational transformation over time.
Conclusion/Implications/Recommendations: The eHealth Adoption Maturity Model is generic in scope with broad and practical application across all sectors. Health care leaders, nurses, and other health professionals involved in the implementation of an eHealth solution can examine the level of transformation in themselves and their organizations in light of the Model elements and associated indicators. Users of the Model can focus on the strengths and barriers that each element identifies in their specific context. Those areas in need of further transformation should be noted and a plan developed to advance the process. In this sense, the Model may be used as a driving force for sustained change.
140 Character Summary: This presentation provides an overview of an eHealth adoption maturity model, which can be used to measure individual and organizational transformation.
OS14 - Leveraging Successes and Lessons Learned
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Fairview V Room, Conference Level
OS14.01 - Ontario’s Digital Health Immunization Repository
Purpose/Objectives: To enable the vision of a provincial immunization system where individuals, healthcare providers, and public health all have real-time access to the same immunization information, Ontario is taking an innovative, coordinated approach to facilitate easier collection of and access to complete, accurate, and timely immunization information. Our goal is to improve health outcomes by making comprehensive immunization information accessible in real-time to support healthcare providers in clinical practice and to engage the public as active partners in the management of their own health.
Methodology/Approach: Employing HL7 FHIR® messaging and SNOMED-CT® terminology standards, the Ontario Ministry of Health & Long-Term Care has created a technology and policy infrastructure around the provincial Digital Health Immunization Repository (DHIR) that forms the foundation of a broader interoperable ecosystem for immunization data in Ontario.
Finding/Results: Ontarios Digital Health Immunization Repository (DHIR) is a clinical data repository containing more than 96 million immunization records for more than 6.5 million Ontarians. The DHIR is currently accessed by Ontarios 36 public health units through a web-based tool (Panorama), in support of population and public health programs. The ministry has developed a number of integrated extensions to support public health units immunization activities. We are working towards enabling the public to update and view their immunization records in the provincial DHIR through a web-based service called Immunization Connect Ontario (ICON) or the Digital Yellow Card. The ministry is trialling a number of approaches to public authentication through ICON, starting with public health unit public identity verification and credentialing, moving to use of the Health Number, and piloting the use of banking credentials. Lessons learned will inform future approaches to public authentication for access to health data online. The DHIRs corresponding secure web services will enable broader provincial Electronic Health Record (EHR) integration. The ministry is now provisioning for health care providers to submit and look up immunization records in the DHIR through a clinical version of ICON, and through direct DHIR integration with electronic medical records (EMRs) and regional clinical viewers. Expanded consumer access to immunization records beyond ICON will be accomplished through integration of the DHIR with consumer mobile applications and patient portals.
Conclusion/Implications/Recommendations: The DHIR advances Ontarios digital health goals and objectives, helping to ensure a population that is optimally protected against vaccine-preventable diseases.
140 Character Summary: An HL7 FHIR® based technology ecosystem that supports clinician, public health, and consumer access to immunization information in Ontario.
OS14.02 - Measuring the Impact of Quorum: A Healthcare Quality Improvement E-Community
Purpose/Objectives: In 2017, Health Quality Ontario launched Quorum, Ontarios new open online health care quality improvement community. The mission of this community of practice is to collaborate, share experiences, and support innovation from idea inception through to meaningful improvement. To monitor progress towards these aims, we developed a performance measurement framework that incorporates four dimensions of knowledge generation with the concept of a community life cycle (Figure 1).
Methodology/Approach: We selected performance measures across the four dimensions of knowledge generation (connection, content, collaboration, and value) and conducted an analysis to determine how to collect the data. To facilitate on-going monitoring, we used an enterprise intelligence tool (Microsoft Power BI) to create the Quorum Analytics Report (Figure 2).
Finding/Results: Since launching eight months ago, the Quorum community has grown to over 1,000 members. To assess collaboration, we monitor the number of questions, answers, and comments. To assess connection, we monitor total contributions, number of direct messages, and the number of friendships formed through the Friends feature. To assess content, we monitor the number of Lessons Learned, Projects and Posts. Finally, to assess value, we monitor weekly sessions, weekly new members, registration conversion rate, and active users. Results are summarized in Table 1. Summary of results from Quorum's measurement plan as of October 20, 2017 Dimension Measure Result Collaboration # of questions 24 Collaboration # of questions answered 21 Collaboration # of comments 108 Connection Aggregated content (Posts, Porjects, Lessons Learned, Questions, Answers, Comments, Feedback posts, and Group Messages 297 Connection # of messages 95 Connection # of friendships 801 Content # of lessons learned 7 Content # of projects 54 Content # of posts 49 Value Average weekly sessions 550 Value Average new members per week 43 Value Registration conversion rate 8.2% Value # of active users 187
Conclusion/Implications/Recommendations: Communities of practice can support quality improvement by facilitating knowledge transfer and generation. To realize these benefits for Quorum, we implemented an ongoing performance measurement plan. This approach is being used to identify opportunities for improvement and to optimize knowledge-building capacity. For other planned communities of practice, opportunities exist to implement a more robust, holistic measurement plan from launch to help achieve their potential for sustained knowledge generation.
140 Character Summary: We implemented performance measurement framework to monitor the impact of Quorum, an online community dedicated to health care quality improvement.
OS14.03 - Pandemic Preparedness in Canada: Who Has Been Vaccinated?
Purpose/Objectives: Physicians need to identify patients within their practice who have been vaccinated against influenza and those who have not been vaccinated in case of a potential influenza pandemic. In most EMR systems in Canada, a physician would initiate this search through a simple text search. The effectiveness of the search would depend on the skill of the physician and whether the EMR would allow the physician to easily separate patients who have had their vaccinations from those who have not. We have developed a Smart Algorithm that can rapidly and reliably identify records of true vaccinations.
Methodology/Approach: Our Smart Algorithm identifies those patients who received a vaccination, those who declined a vaccination and those who were not vaccinated in the clinic but received their vaccination elsewhere. We compared our Smart Algorithm, to a search that might be done by a physician in a traditional EMR system using a simple text search of flu. In the vaccination record with the ability to use the not given flag to identify those who did not receive the flu shot. The Reason for Not Given is a text field and we assume that the doctors would not be able to query it for information about why it was not given (patient refused, patient is allergic, vaccination received elsewhere).
Finding/Results: The Smart Algorithm accurately identifies a greater number of patient records which have either have or have not been administered vaccinations for influenza from a file with a total number of 20,878 vaccine records. A Simple Search misses as many as 1/3 of patients who did get an immunization and mis-identifies about 2.5% of patients as having had one when in fact they had not. Algorithm TOTAL + - Simple Search + 4,184 112 4,296 - 2,091 14,491 16,582 TOTAL 6,275 14,603 20,878 Sensitivity (Recall): 66.7% Specificity: 99.2% PPV (Precision): 97.4% NPV: 87.4% F-score: 79.1
Conclusion/Implications/Recommendations: When the simple search in the EMR finds a patient that has been vaccinated, the chances are high that the patient was indeed vaccinated (PPV=97.4%). However, a simple search performed by a physician would miss approximately 33.3% of vaccinated patients (Sensitivity of 66.7%), requiring them to spend time reviewing each record manually or contacting patients directly to confirm the patients vaccination status. When compared to a simple search in the EMR, the Smart Algorithm performs better and allows for better time management for physicians and their staff.
140 Character Summary: Pandemic Preparedness: We developed a Smart Algorithm that rapidly and reliably identifies records of vaccinations for influenza compared to a simple EMR search.
OS14.04 - Clinical Information System Integration: A Consolidated View of the Patient
Purpose/Objectives: Fraser Health has launched a key initiative to link and empower clinicians - Unifying Clinical Information (UCI). Through the creation of an interoperable connectivity solution, sharing of the most relevant and up to date information is provided to clinicians.The vision is to establish a connected health environment that enables the integration of clinical and business workflows and exchange of information to support better health across Fraser Health.
Methodology/Approach: The Unifying Clinical Information initiative provides a holistic integrated view of the patient across Fraser Health. This solution has been expanded to now include Provincial Lab, Provincial DI and information from the Vancouver Coastal/ Providence Health/PHSA (VPP) Careconnect solution. This supports optimized patient care and safety and a reduction in the provision of duplicate tests. Fraser Health has chosen AllScripts as its business partner to develop a solution that will achieve the goal of tying together information from various clinical systems. The solution provides an integrated and consolidated summary view of patient information across the Lower Mainland. The solution leverages the Provincial EMPI which provides a source for cross referencing person identity information within Fraser Health and with provincial sources.
Finding/Results: The UCI project has been expanded in a phased manner by integrating Provincial Diagnostic Imaging, VPP Encounters and Clinical Documents. Clinical information available from other Health Authorities in Careconnect will also be made available in UCI.
Conclusion/Implications/Recommendations: As a result of this key initiative, FH will have achieved the following objectives: Deployment of an Integration Service Application that aggregates patient information from multiple FH core clinical systems and information from Lower Mainland and Provincial Repositories. This allows patient data to be viewed from a number of access points without changing core applications. Providing Fraser Health with a foundation for the future development of wider electronic health information exchange, both internally and externally to FH. Improve data integrity and quality of person information to facilitate linkage of electronic health records within Fraser Health and with Provincial eHealth.
140 Character Summary: The Unifying Clinical Information solution integrates person-centered health information, across the continuum of care, in support of optimizing health care.
OS15 - Propelling Clinical Care via Standardization
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Granville I Room, Conference Level
OS15.01 - Achieving Clinical Standardization in a Regional Clinical Information System
Purpose/Objectives: Many hospitals in Ontario have been moving rather slowly in adopting clinical standards into their organizations. There seems to be a gap in the adoption of standards and best practices that can ultimately have great positive impact on the patient and on the financial stability of healthcare organizations. Since eHealth 2.0, a paradigm shift has emerged in Ontario where many organizations are collaborating and partnering in the investment of a regionalized Health Information Systems (HIS) including advanced clinical systems to support physician documentation, electronic medication administration with bedside medication verification and computerized provider order entry (CPOE). Partnerships leverages opportunities for human resource sharing, financial incentives and may even reduce costs for hardware, software and ongoing sustainability. When investing in a regionalized HIS, there is a greater necessity to support clinical standardization. Clinical standardization and the interchange of information can help facilitate early diagnosis, reduce readmissions, better manage population health, and improve the operational efficiency of patient care. Ultimately, clinical standardization will drive seamless, high-quality, and cost-effective care through cutting out extraneous costs, reducing unneeded treatment variation, and leveraging data. By using best practice guidelines and evidence in the development of standards and protocols for caregivers to follow when treating patients, it will reduce variation in treatment, improve patient care, caregiver accountability, and will increase interoperability and sharing of standardized patient information. At the end of this presentation, participants will be able to: Articulate best practices related to effective clinical engagement in a regional clinical standardization project Evaluate strategies to develop and review evidence based standardized clinical content Understand the governance model, guiding principles and decision making framework that supported the process for achieving high levels of clinical standardization in Region with 24 hospitals moving to shared clinical information system
Methodology/Approach: Our team led a large 24 hospital regional group through a six month clinical standardization project. The project began with a two day clinical standardization workshop with clinical leadership representation from the participating organizations to determine the guiding principles, decision making framework, governance model and project deliverables. With a focus on face to face engagement of clinical subject matter experts, six clinically focused Regional Working Groups were created with an emphasis on development of standards for: Medication Management, Medical Imaging, Laboratory, CPOE, Clinical and Physician Documentation and Health Information Management. The working groups meet face to face for two full days each month for six months and remotely by teleconference to complete follow up between face to face meetings.
Finding/Results: Over the six month timeframe the Regional Working Groups leveraged evidence based clinical standards to support the development of core clinical content standards that will be built into the shared regional HIS. Specifically the team developed and approved standards for: 118 Standardized Clinical Documentation Tools for Nursing and Allied Health 14 Medication Management Standards 13 Health Information Management Standards 5 Core Physician Documentation standard templates for admission, discharge, consultation, progress notes and floor procedures 2000 Medical Imaging Orders 1350 Laboratory Orders A comprehensive regional centralized process for the development of up to 400 standardized order sets
Conclusion/Implications/Recommendations: The achievement of regional clinical standardization is possible with the appropriate structure and frameworks in place to support adequate clinical engagement and consensus building. Using evidence based content as a starting point can effectively streamline and speed up the process for agreeing upon clinical content standards.
140 Character Summary: With appropriate structure and frameworks in place to support adequate clinical engagement - achieving multi-organizational clinical standards is possible.
OS15.02 - Emergency Physician Use of a Provinical Interoperable Electronic Health Record
Purpose/Objectives: Canadas hospitals are still primarily paper-based, with only 5.2% of hospitals progressing to stage five or higher on the on the seven point Electronic Medical Record Adoption Scale. Although most hospital-based care is still documented on paper, there has been systematic investment and adoption of digital ancillary systems such as laboratory, pharmacy, and diagnostic imaging, sponsored by Canada Health Infoway. One of the Canadian strategies for digitizing healthcare has been the promotion of the interoperable EHR (iEHR), which is equivalent to the concept of a Health Information Exchange (HIE) used in other jurisdictions. iEHRs are being developed by each province as part of the wider Canadian initiative to connect healthcare nationally. In 2017, over 51,000 physicians, nurses, pharmacists and other Alberta healthcare providers have role-based access to the Alberta Netcare Portal (ANP), with more than 1.9 million patient records accessed monthly. Objective: Many Canadian provinces use interoperable Electronic Health Records (iEHRs) to facilitate Health Information Exchange (HIE). Our study describes the use and utility of a provincial iEHR called the Alberta Netcare Portal (ANP) in four urban Alberta emergency departments (EDs).
Methodology/Approach: Four EDs were included in the study, two in Edmonton Zone (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and two in the Calgary Zone (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]) between October 2014 and March 2016. The UAH and FMC are comparable large, academic tertiary care facilities and the GNCH and PLC are comparable community hospitals. The average annual number of ED visits between 2012-2016 for each of these hospitals was 66,003 (UAH), 67,3007 (GNCH), 80,466 (FMC) and 79,172 (PLC). A mix of direct clinical observations, examination of system audit logs and inteviews were carried out over the study period.
Finding/Results: Over 566 hours of observation, the median percentage of observed time spent using ANP for UAH was 9.1%. This was substantially higher than the median percentage of time spent using ANP at GNCH (4.8%), FLC (5.0%), and PLC (5.3%). Audit logs were compared to the structured observations to check for correlation. Audit log access data showed that laboratory and imaging data were accessed most often. Physicians were observed spending relatively more time reviewing textual reports (4.6%, CI 4.1-5.1) than lab results (2.6%, CI 2.1-3.1) or diagnostic imaging (1.9%, CI 1.6-2.1). These patterns of access were consistent across the four sites (p = n.s.). The main themes that emerged from the analysis were: participant perceptions that ANP improved quality and continuity of care and patient safety; that there were notable barriers to use, particularly in the Edmonton Zone; and ANPs unrealized potential.
Conclusion/Implications/Recommendations: To our knowledge, there have been no prior Canadian studies describing the use and utility of an iEHR in the ED or any other clinical setting. Physicians described high utility and usability of ANP. The ANP was utilized less frequently in Calgary EDs, where they were able to access much of the ANP information in their regional CIS, and as CIS implementations increase across the country the role of separate provincial iEHRs needs further evaluation.
140 Character Summary: Using mixed methods, we describe the high use and utility of the Alberta's provincial interoperatble Electronic Health Record in four urban Emergency Departments.
OS15.03 - Policies, Guidelines, and Standards for Ambient Assisted Living Data Exchange
Purpose/Objectives: The primary objective of this study was to understand what Ambient Assisted Living (AAL) technology companies are using as policy guidelines and standards in the creation of their products and services. Ultimately, this study will highlight the gap between what is currently available for innovators in terms of data security, privacy and encryption, and what should be developed to ensure that AAL technology is designed ensuring benefits to patients and the healthcare system through safe technologies. The long-term goal of this project is the development of requirements for an infrastructure to enable IoT, mHealth, and wearable data integration, focusing on describing the design, data exchange requirements, policy and governance guidelines, and general standards for implementing this infrastructure.
Methodology/Approach: This study will explore human factors methods (user-centered design) to guide the development of standards and the data sharing infrastructure. The project is divided into the following phases: 1. Review the existing ALL technology literature and technology market in Canada. 2. Interview key policymakers, innovators, researchers, stakeholders, and leaders in the AAL landscape to support the development of policy governance guidelines, standards, and identifying the requirements of a data integration infrastructure for AAL technology. 3. Use ethnographic and UCD methods focusing on gathering key stakeholders' perspective on the issue.
Finding/Results: In this study, we will identify existing standards and guidelines that are currently used to guide the development of AAL and IoT technologies by the current technology industry. This study will lead to recommendations for standards to be created to support innovators in the development of AAL in Canada. The guidelines and standards will focus on security, privacy, and encryption around data sharing from wearable, IoT, and AAL technology. In parallel, we will initiate the development of an AAL data exchange infrastructure modelling that will identify: (1) the data sharing requirements for such platform, (2) how we could develop this platform in the upcoming years, and (3) the necessary infrastructure needed to collect and aggregate this data from IoT and wearable technology. Ultimately, we would establish a platform to centralize AAL, IoT, mHealth, and wearable data for population-level and remote patient monitoring.
Conclusion/Implications/Recommendations: IoT and AAL technologies are here to help and support the aging population in Canada. These technologies enable continuous and unobtrusive data collection at home, empowering the healthcare system to monitor patients remotely. Sharing this data will be relevant for the development of precision medicine models and aging related health research. In this project, we aim at developing a better understanding of how we can make Canada a leader in the IoT+ mHealth data integration by creating a roadmap for the development of this data-sharing infrastructure and the affiliated standards to guide the process while ensuring data encryption, security and privacy are kept in mind.
140 Character Summary: Explore how Ambient Assisted Living technologies share data generated by sensors, suggesting future policies, guidelines, and standards to support innovators.
OS15.04 - Clinical Standardization: Advancing Mental Health Care in a HIS Cluster
Purpose/Objectives: Building on the demonstrated significant clinical and financial benefit realization following the adoption of an advanced HIS, Hospital X has partnered with Hospital Y and Z, to implement an advanced integrated HIS, putting the infrastructure in place that will support creating a strategy towards clinical adoption and standardization, the streamlining and centralization of data, enable advanced decision support, data analytics capabilities, and inform quality improvement in the mental health and addictions sector. Objectives: -Drive quality improvement by reducing unnecessary variability in care across the three hospitals through the implementation of standardized clinical practices -Contribute to the provincial HIS body of knowledge through the development of a repository of standardized clinical documentation including standardized order sets; an implementation toolkit for mental health quality standards; shared governance models; and change management tools -Enable improved use of data for clinical decision-making, care coordination and monitoring patient outcomes.
Methodology/Approach: Aligned with the Ontario HIS renewal strategy, the creation of a shared vision for the partnership was established. A shared governance agreement between the three mental health hospitals was developed to drive clinical standardization and improve HIS service delivery. Standardization principles were established to help guide the clinical working groups through the standardization of clinical practice and documentation. An intense review of services and related documentation was completed in order to establish a mutually agreed upon standardized repository of assessments, order sets and other clinical documentation and evidence based best practices. This included leveraging on the work completed by Health Quality Ontario around the development of quality standards for mental health care for the behavioural symptoms of dementia, major depression, and schizophrenia. Where an agreement could not be reached, decision documents were utilized to capture non-standardized practices with a future plan to re-visit the standardization discussion.
Finding/Results: In alignment with the Auditor Generals recent report and recommendations and the Ontario HIS renewal strategy, the collaboration is standardizing the following key clinical processes: -admission process to ensure comprehensive intake assessments are completed that include the identification of risk factors through the implementation of standardized, auditable admission processes and documentation -transitions in care and discharge planning through the review and standardization of discharge related processes -care planning including the integration of quality standards and mental health clinical assessment protocols. -falls -choking -restraint and seclusion practices The aim is that the resultant work will contribute to a standardized repository of evidence based assessments and practices that can be adopted across the mental healthcare spectrum and thus contribute to a more comprehensive, integrated patient experience. This will also help to inform benchmarking across the mental health hospitals. The governance model, measuring clinical standardization process and results, and lessons learned will be shared.-
Conclusion/Implications/Recommendations: The formation of a mental health HIS cluster provides the opportunity to build capacity and capability to support an improved, integrated mental health system. Through collaboration, an evidence-based approach to standardized mental health practices that enables clinical decision support, data analytics and measureable health outcomes can be delivered. Moreover, the HIS collaboration will ensure the delivery of consistent, integrated quality mental health services that optimizes the patient experience and improves patient outcomes.
140 Character Summary: The MOHLTC has identified building a foundation to support a system transformation of mental health and addiction services and the HIS renewal strategy in Ontario as a key priority. With this objective in mind, three mental health hospitals have formed a HIS cluster to implement clinical standardization through a shared HIS. This collaboration puts the infrastructure in place to support the creation of a repository of standardized, evidence based clinical assessments, the streamlining and centralization of data to support advanced data analytics and clinical decision support capabilities, and meet data reporting requirements while informing quality improvement in the mental health sector.
OS16 - Innovation in Capacity Building
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Granville II Room, Conference Level
OS16.01 - Digital Health FACTS: Celebrating Innovation & Collaboration in Education
Purpose/Objectives: Canada has focused on building digital health infrastructure over the last 15 years and benefits are now being realized from these foundational investments. However, there was a gap in the training and education of students in the Faculties of Medicine, Nursing and Pharmacy to meet the ever-changing digital landscape. To address this need, a national Canadian clinical informatics competency program was created. Commonly known as the Digital Health Faculty Associations Content & Training Solutions (FACTS) program, this unique program has national organizations participating in a collaborative focused on advancing clinical informatics in medical, nursing and pharmacy education. Discipline specific resources such as medical, nursing and pharmacy informatics competencies will be shared, along with interprofessional lessons learned that will be relevant to policy, research & practicing clinicians.
Methodology/Approach: The Digital Health FACTS took a national program approach, yet enabled a discipline specific and regional implementation. The program leveraged a national Change Management (CM) Framework and leveraged Peer-to-Peer Networks across Canada to facilitate educators in supporting their colleagues and preparing students to practice in a digitally enabled environment. These educators, known as Faculty Peer Leaders act as change agents in medicine, nursing and pharmacy faculties, providing hands on support and guidance to their peers as well as students via face-to-face meetings, workshops and webinars. Engaging clinical faculty led to the development of pharmacy, nursing and medical clinical informatics competencies along with real life case studies for teaching and learning.
Finding/Results: The program impacts all educators and students in the Faculties of Medicine, Nursing and Pharmacy in Canada. To date, there have been nine successful projects whereby approximately 40 Faculty Peer Leaders have engaged over 9,700 of their colleagues/educators. Each discipline-specific project within the interprofessional program conducted evaluation activities such as focus groups and in-person/online surveys were utilized when engaging Faculty Peer Leaders, their colleagues/peers and students. Interprofessional evaluation results, emerging themes and lessons learned will be shared with the audience.
Conclusion/Implications/Recommendations: A people project is unfolding across Canada to engage educators and students in digital health dialogue, learning and teaching. Faculty Peer Leaders in this national program are unique as they engage faculty and students in an interprofessional, collaborative patient-centred care approach. Momentum has been built and due to the demand for digital health content by educators and students, the recommendation to continue the program has been accepted and funding as been allocated for additional project activities. Future initiatives will focus on national priorities such as e-Prescribing and telehomecare. Planning is underway for a national program evaluation to better understand the intersection of program/project management, clinical and academic expertise contributing to the advancement of digital health in the Faculties of Medicine, Nursing and Pharmacy.
140 Character Summary: Come hear about the Canadian Digital Health FACTS program: recipient of the 2017 Ted Freedman Award for Innovation in Education!
OS16.02 - Community Paramedicine Implementation: Build the Program Then the Technology
Purpose/Objectives: Community Paramedicine is a community-based model in which paramedics provide primary care services, such as patient home visits and community engagement services, within their paramedicine scope of practice. The target population served is seniors living in rural and remote British Columbia who are at risk for falls and/or living with chronic conditions such as congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and hypertension. Community Paramedicine is a new initiative for this provincial emergency health service provider, and they knew that a successful deployment would depend on an innovative approach. Based on lessons learned from similar initiatives, it was obvious the requirements for an electronic system could not be fully defined without at least prototyping the program. The team decided to pursue a simple program design that would allow them to modify quickly and at a lower cost so they could build in continuous feedback from real-world program experience. This approach created an environment that allowed for constant feedback and communication between prototype users and the project team.
Methodology/Approach: When searching for an electronic solution for the groups referral, scheduling, service delivery, and program management business processes, the nature of the program posed some challenges. Community-based paramedics serve communities dispersed over a large geographical area. In addition, there was a need to accommodate multiple technologies in the various health authorities and primary care physician offices. These factors made program design a challenge. As a result, the team decided to take a step back and focus on program design first; only then did they look to the technology. The requirements for the electronic solution were expected to change as the program matured and settled, so interim technologies, and in some case paper, were used as temporary solutions. This allowed for requirements to settle before procuring permanent, and more expensive, solutions.
Finding/Results: This approach has proven beneficial for the development of the Community Paramedicine program. As the program matured, we were able to adapt to changing needs, new discoveries, and end user feedback, working towards building definitive requirements for long-term solutions. Paper referral forms, a SharePoint scheduling application, and paper charts have all evolved and undergone several revisions through the beginning phases of the project, and the project team is now working toward transitioning these into electronic applications. This approach can also be attributed to significant cost saving as the interim solutions are far less expensive to change than large scale solutions, and we can be confident in the requirements we now have as we develop permanent solutions.
Conclusion/Implications/Recommendations: Patient-centric care is the driving force in almost every modern healthcare initiative. Sometimes, however, programs can be driven to a particular technology solution that may not be the best fit. By first building trust with patients, health authorities, and the community, the Community Paramedicine program has seen tremendous success. Focusing on the technology as one component of the overall solution has allowed for the service to flourish and provided a path forward where technology solutions can later improve established business processes.
140 Character Summary: The Community Paramedicine implementation in BC highlights a successful strategy where relationship building and program maturity come before technology.
OS16.03 - Evaluating the Effects of Post-Implementation EMR Training on EMR Use
Purpose/Objectives: To address the need for continuity, comprehensiveness, and coordination of care, primary care plays a key role in the management of chronic diseases, especially diabetes care. The electronic medical record (EMR) facilitates proactive diabetes care management through advanced features such as reminders/alerts. Although the majority of primary care physicians (PCP) in Canada have adopted an EMR, their use is generally limited to basic features, such as scheduling and billing. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features. However, training is an important type of EUS that the majority of PCPs currently lack, especially post-implementation EMR training. A recent Canadian study by Infoway also highlights the need to invest in training and education initiatives for current PCPs to improve their use of the EMR. The purpose of this research study is to evaluate the effects of an EMR training intervention for diabetes care management in primary care. Specifically, the study examines the extent to which the training affects the process measures for type 1 and type 2 diabetes care management, including: (a) use of a diabetes registry, (b) use of diabetes recalls/reminders, (c) ordering/viewing a patient's Hemoglobin A1C, and (d) recording a patient's blood pressure.
Methodology/Approach: The study is set in British Columbia (BC) and includes all PCPs who use OSCAR EMR, one of the top three EMRs used in BC. This study employs a mixed methods approach and a quasi-experimental design. The study intervention is based on the internationally-recognized and evidence-based Chronic Care Model (CCM). The study intervention is a series of four online video tutorials for diabetes care management that provide training on Level 4 (Proactive Care/Data Driven Practice) of BC's Meaningful Use Model for EMRs. From June-August 2017, the video tutorials were co-designed and developed with an OSCAR EMR Physician Super-User based on best practices in the literature. Human Research Ethics Board Approval was sought from the University of Victoria in June 2017. The study was initiated in July 2017 and study recruitment was done through BC's Divisions of Family Practice until October 2017. Data collection is currently underway and includes: (1) PCP Demographic Survey, (2) Diabetes Care Management Survey (Pre-Baseline, Baseline, 3 Months, and 6 Months), and (3) Follow-Up Interviews (3 and 6 months).
Finding/Results: In total, 23 PCPs from across BC have completed the baseline Demographic and Diabetes Care Management Surveys. Of these, 18 PCPs have received the study intervention thus far. Data collection and analysis to evaluate the effects of the EMR training are ongoing until May 2017.
Conclusion/Implications/Recommendations: Video tutorials are a cost-effective, accessible, and convenient medium for delivering post-implementation EMR training to PCPs. It is anticipated that the video tutorial series will help to significantly increase PCPs' process measures for type 1 and type 2 diabetes care management using the EMR. The study findings can be applied to the design, delivery, and evaluation of EMR video tutorials for other EMRs and chronic diseases in Canada and internationally.
140 Character Summary: Post-implementation EMR training delivered through video tutorials can significantly increase physicians' advanced use of EMRs for diabetes care management.
OS16.04 - A Novel Provincial Approach to Implementing Advanced Hospital Information Systems
Purpose/Objectives: It is well known that advanced hospital information systems (HIS) are difficult to implement successfully. Benefits to quality, safety, value and evidence-based care are possible, but not guaranteed. Risks include poor clinician adoption, inefficient workflows, unclear quality benefits, and changes to practice that introduce new types of error. Furthermore, these systems are costly. In Ontario, approximately 80% of hospitals have yet to implement advanced HIS. In the next 5 years, there will be a large investment in advanced HIS province-wide. The Ministry of Health and Long-Term Care (MOHLTC) has recognized there is a very real risk that not all hospitals will achieve the desired clinical and financial benefits from advanced HIS. However, some hospitals in the province have already been successful, with substantially improved clinical outcomes and demonstrable return on investment from advanced HIS. In a publicly-funded healthcare system, it appeared sensible to share these successes with other hospitals just beginning on their HIS journey. To meet this need, the HISBAT (HIS Benefits and Adoption Team) was created in January, 2017. The objectives of this presentation are to: a) outline the rationale, purpose, and methodology of HISBAT; b) to illustrate the outcomes achieved to date; c) to discuss future goals and directions for the Team in the provincial HIS landscape, and d) propose how a similar team could be implemented to benefit other Canadian provinces
Methodology/Approach: To comprise HISBAT, a team of HIS experts was procured from two Ontario hospitals that have demonstrated improved clinical and financial outcomes with advanced HIS: North York General Hospital (HIMSS Stage 6), and Ontario Shores Centre for Mental Health Sciences (HIMSS Stage 7). The HISBAT employs an innovative approach where a series of tactical on-site visits are provided to client organizations depending on individual identified needs. Peer-to-peer mentorship is provided on HIS implementation-related topics such as project governance and management, clinician engagement, change management, clinical content development and standardization, outcome measurement, and iterative quality improvement.
Finding/Results: In its first 10 months, the HISBAT has assisted more than 50 Ontario hospitals on a wide variety of HIS-related topics. Feedback from client organizations has been extremely positive. Survey responses indicate that clients especially appreciate the credibility and trust that a peer-to-peer hospital relationship fosters. Several organizations made note that key information points were brought forward that resulted in avoidance of potentially costly early project decisions. Having a single team that provides continutity in HIS renewal province-wide has also enabled the adoption of standards that will provide the foundation for HIS instance consolidation into more efficient clusters and provincial hubs. While exact provincial financial savings from HISBAT have yet to be quantified, the MOHLTC has already indicated that creation of this team has been a very effective use of capital.
Conclusion/Implications/Recommendations: The HISBAT is a novel approach to leveraging existing knowledge within a publicly-funded healthcare system to assist in reducing time and cost for HIS implementation, while increasing standardization and HIS-related quality outcomes across Ontario. Such an approach could be leveraged to benefit other provincial jurisdictions in Canada.
140 Character Summary: A peer-to-peer mentorship approach has been successfully undertaken in Ontario to assist hospitals in implementing advanced hospital information systems.
OS17 - Emerging Trends in mHealth: Patients' Benefits
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Cambie Room, Conference Level
OS17.01 - Driving on the Right Path Towards Mobile Patient Engagement
Purpose/Objectives: This session will provide an overview of the lessons learned during the development and implementation of a mobile technology solution in the pursuit of innovative ways to promote, measure, and advance patient engagement. It will contribute to the body of knowledge that will help guide other organizations as they embark on this journey. Objectives: -To provide a platform for collecting patient generated data that interfaces with the EHR -To increase patient engagement and activation through interactive and patient-specific actionable interventions -To provide patients with the knowledge and skills to become activate participants and agents of change within their care through access to resources within the application
Methodology/Approach: Building on the gains made with the implementation of the patient portal solution, the organization committed to continuing to drive patient engagement forward by partnering with a technology based company that offered a secure mobile and cloud technology platform that would interface to the EHR. With this solution, mobile remote-patient-monitoring that delivered interactive personalized interventions to individuals in support of their care plans would be enabled. The anticipated benefits of this solution were: -Accessibility-patients and clinicians not required to be connected on line to view, collect or generate data -Interactive platform-functionality includes more than a portal view of PHI. Interactive and actionable interventions that are personalized to the patient would be delivered through the mobile solution with the aim of helping patients to manage their care and have access to immediate and off-site support as needed. -Cross Platform Support (BYOD) the solution would support a cross platform approach for devices including the support for Android, Apple and Windows devices. This encourages and supports accessibility to e-mental healthcare through the solution regardless of the device used.
Finding/Results: The mobile patient engagement solution was implemented on 2 inpatient units and in 4 outpatient clinics. Desired outcomes around adoption and usage of the app were challenged by early issues with technological functionality including app stability, interface functionality and privacy and security concerns. Overall, these technical issues resulted in a delay in the implementation schedule, but most importantly impacted clinicians and patients perception of and their confidence in the mobile solution. Based on this experience, a number of recommendations have been developed which will guide future work in this area. -Stakeholder Engagement-early engagement of key stakeholders in the design of the interventions as well as engagement of more technically savvy patients in the education of other patient groups around the usage of the app positively impacted clinician and patient engagement. -Vendor management- clear, early communication around existing functionality required to meet scope of project -Timely communication re: planned and unplanned updates to the application is necessary to ensure good user experience -Devices- device selection should account for optimal functioning of the application and have a technical support process in place -Risk Management-clearly defined escalation process to ensure issues are addressed in a timely manner
Conclusion/Implications/Recommendations: Patient generated personal health information is a fundamental component of patient engagement and empowerment. Selecting a mobile patient engagement solution that is integrated with the EHR, reliable, easy to use, flexible, interactive and interoperable are paramount to ensuring a positive patient experience. Equally as important is securing a solution that meets the privacy requirements necessary when dealing with personal health information. Moreover, ensuring the solution is part of the clinicians workflow and co-designing patient- specific interventions with clinicians, as well as integrating outcomes-based research is essential to a the ultimate success of a new mobile technology strategy.
140 Character Summary: A mobile patient engagement solution was implemented and desired outcomes around adoption and usage of the app were challenged with many lessons learned.
OS17.02 - An App-Based Uroflowmetry System with Immediate Symptoms Feedback Recording
Purpose/Objectives: Lower urinary tract symptoms (LUTS) are bothersome and impact quality of life. It is estimated that up to one third of men aged above 65 years suffer from LUTS. There are some urodynamic tools to diagnose the cause of these symptoms. The pressure-flow study is a widely-used test to diagnose LUTS but it is invasive, expensive and time-consuming. Along the last decades, new devices and methodologies have been proposed to address its drawbacks and more recently there has been a trend towards the development of non-invasive pre-screening tools. Reports about home uroflowmetry devices have been increasing but there is an absence of a feedback symptoms platform that may bring additional information for a clinical decision making. Our goal is to develop and test an app-based uroflowmetry system that may record voiding and in which the individual may report his symptoms immediately after.
Methodology/Approach: Based on the International Prostate Symptom Score (IPSS), we are developing an Android app in which the individual may report his symptoms, such as difficult to void, straining and incomplete emptying, each time he voids. We are also developing a portable uroflowmetry device, based on a load cell, that connects to the app via Bluetooth for urine flow data recording. In a first approach, this system will be tested in a group of symptomatic individuals and, for each one, data will be collected for at least three consecutive days. The conventional uroflowmetry test and IPSS will be applied for comparison. Individuals will also be asked to answer a brief questionnaire about the use of the proposed system.
Finding/Results: We will look at the correlation between data obtained using our app-based system and the conventional IPSS and uroflowmetry test. We expect individuals to report that the app and portable uroflowmetry device are easy to use. We also expect that most of them will recommend this test to a family member or friend.
Conclusion/Implications/Recommendations: The results obtained with the app-based uroflowmetry system are expected to agree with those of stablished tools in urodynamics. This may open the possibility for home use which we would like to test in the future. The immediate symptoms feedback could be an alternative to the current version of the IPSS that requires the individual to remember his symptoms considering the past month. This may be a new approach for pre-screening the need to undergo invasive urodynamic tests.
140 Character Summary: We aim at developing and testing an app-based uroflowmetry system with immediate symptoms feedback as a pre-screening tool for urodynamic evaluation in men.
OS17.03 - Virtual Integrated Reliable Transformative User-Driven E-Health System (VIRTUES)
Purpose/Objectives: Empowering patients and caregivers to be active partners in the management of their care, requires the development of a comprehensive user-driven clinical application. The advancement of a transformed Canadian arrhythmia care system that delivers personalized, patient-driven and integrated care will be facilitated through a key technological development supported by the Cardiac Arrhythmia Network of Canada (CANet). Through the support of the Networks of Centres of Excellence, CANet is comprised of patients, researchers, clinicians, and partners. Through CANet, one of the key technological platforms that is being developed is clinical application of VIRTUES (*Virtual Integrated Reliable Transformative User-Driven E-Health S*ystem). Through the combination of wearable biosensor technology, digital multi-media interfaces and validated analytics, VIRTUES will immediately integrate symptom-driven validated physiological data into patient-specific, personalized context and trigger an appropriate care plan from a set of plans previously co-developed with the patient.
Methodology/Approach: A key innovative aspect of the development of VIRTUES is the integration of CANet researchers, clinicians, patients, technology industry partners who play an active role in the design and development of the clinical application. This is an intentional and significant diversion from the traditional inclusion of patient assessment taking place in refinement of the final product. The overall design, development and implementation of VIRTUES was guided by the discovery work completed over the course of the development of the initial VIRTUES Patient Mobile Health Applications and Clinical Portal Application prototypes. The overall development and implementation of VIRTUES involves a two-stage process. The first phase integrates the technological monitoring components into the current clinical care pathway. The second phase will pair advanced, cognitive analytics with Network data creating a personalized care platform.
Finding/Results: An initial study was completed to understand core-user needs. Using an iterative design process and engaging both patients and clinicians, workshops, interviews and focus groups were completed. Patients and clinicians were asked to discuss the integration of a mhealth platform into the arrythmia care pathway, explore past clinical experiences and interact with the initial prototypes. The information collected provided patient experience and clinical situational contexts. The exploration of pre-diagnosis, condition management, patient-clinician communications provided valuable information for the enhancement of the protoypes and user interfaces. Specifically, the identification of key journey moments linked to condition management, electrocardiography (ECG) capture and communication highlighted subsequent conversations linked to privacy, the extension of personal health information and clinician work flow.
Conclusion/Implications/Recommendations: As an mHealth platform, VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias. It is the only component that provides external touchpoints to clinicians, patients and industry partners as well as information that will be used to guide major healthcare institutions and provincial health authorities. In addition to the external flow of information, the VIRTUES interactive platform will enable the development of personalized educational material for each specific patient's medical consition and support further technology development and refinement of treatment.
140 Character Summary: VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias.
OS17.04 - Evaluation of Apps for Patients at Risk of Gestational Diabetes
Purpose/Objectives: Diabetes is one of the worlds fastest growing medical conditions that is affecting both adults and newborns. Mobile applications might be an effective way to provide education and behavior tracking tools for pregnant mothers. In this this study we evaluated mobile apps against evaluation criteria to discover their applicability for patients at risk of gestational diabetes. This study assesses how well existing mobile apps on the market meet the information and tracking needs of patients with gestational diabetes. This study also evaluated the feasibility of how to integrate these apps into patient care.
Methodology/Approach: We conducted a search of the mobile apps in the United States Apple iTunes store for mobile apps for Apple devices, and searched the Google Play store for Android devices that contained key words related to the following concepts of nutrition (diet), tracking, diabetes and pregnancy. For each of these apps we have two reviewers to look at the description of the tools to see if they include both information on nutrition relevant to diabetes in pregnant women and if they had any tools for tracking nutrition, blood sugar or exercise. Apps were included if both reviewers agreed on the inclusion or exclusion and if there was a discrepancy we used a third reviewer. Evaluation criteria was developed to assess the mobile apps on four dimensions. These dimensions were credibility and trust, education and information, interactive tools and behaviour tracking to promote patient engagement and usability and design methodology.
Finding/Results: As of August 4, 2017, there are 42008 Apps classified in the Health category and 79577 classified in the Medical Category in the iTunes store. A search of the keywords related to nutrition, diabetes, pregnancy, and tracking resulted in 103 apps that were manually reviewed per our evaluation criteria for content and features. Previous to this study, it was not known how many mobile health applications were specifically developed for diabetes in pregnancy, how well these apps meet the information needs of these patients and how much evidence-based information was available in these apps. It was also unclear how much functionality these apps had for tracking nutrition, exercise and diabetes (sugar level, insulin) and if the mobile apps implemented any behavioral strategies.
Conclusion/Implications/Recommendations: We found that there are very few apps that provided both comprehensive evidence-based educational content and tracking tools. This study demonstrates the need to develop apps that have more comprehensive content, tracking tools and ability to bidirectionally share data with the patients primary care provider.This will require both technical adaptations and policy changes to allow for data sharing. Diabetes prevention apps for women with gestational diabetes have the potential to greatly impact patient care. Future development efforts must be made to include nutrition as a core component for diabetes prevention apps.
140 Character Summary: This project provides an evaluation of Apps for Patients at Risk of Gestational Diabetes using evaluation criteria.