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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: $120 CAD Digital Health Canada Member Price: $100 CAD
- May 27 - 30, 2018
- Total Presentations: 240
PS03 - Driving Governance and Mobile Health (ID 23)
- Type: Panel Session
- Track: Clinical Delivery
- Presentations: 2
- Coordinates: 5/29/2018, 11:00 - 12:00, Fairview III Room, Conference Level
PS03.01 - A National Approach to Information Governance (ID 336)
G. Webster, Director, Acute & Ambulatory Care Information Services, CIHI; Toronto/CA
K. Addison, Health Information Management, Alberta Health Services; Calgary/CA
Y. Robens-Paradise, Digital Health Informatics, Providence Health Care; Vancouver/CA
Purpose/Objectives: There is a growing consensus that a consistent and comprehensive approach to information governance (IG) is required to support Canadas health systems successfully implement digital health solutions capable of supporting both primary and secondary use priorities. This need is felt at local, jurisdictional and national levels. As such, it can be best addressed through joint development of a common IG framework that incorporates and clarifies roles for various stakeholder groups (ministries of health, regional health authorities, clinical/business/IT teams, care levels and sectors, vendors, etc.). Leadership on national coordination can make the local IG efforts more efficient by providing a common foundation to build from and guiding vendors to develop nationally aligned and locally relevant digital product and services. A national approach to IG is proposed as an essential support to achieving digital health goals across Canada.
Methodology/Approach: This panel presentation, led by CIHI, will bring together digital health leaders from across the country to share their insights and expertise on the value of a comprehensive and aligned information governance strategy and on approaches being taken in various provinces. Specifically, each representative on the panel will highlight the approaches, challenges and progress being made in their respective jurisdictions (panel members will include Greg Webster, CIHI; Kathleen Addison, Alberta Health Services/CHIMA Board; Yoel Robens-Paradise, Providence Health Care). In response to the need for stronger national IG and consistent with CIHIs role as a trusted source of standards and quality data, CIHI will describe how we can work with digital health leaders from across the country to develop a common approach to IG.
Finding/Results: The combination of a robust information governance program and strong standards are foundational to achieving Canadas digital health goals. In the absence of effective IG, digital health solutions typically incur higher costs and slower implementation due to the need for locally customized solutions. Establishing an effective and common approach to IG for broad use leverages broad expertise and resources to develop IG and makes it more efficient for all stakeholders to align with an effective approach, while still allowing some room for local customization. Information Governance is the combination of roles, responsibilities, and processes for the clear ownership, accountability and direction of data assets. Views from CIHI and provincial leaders on IG will be discussed and audience input encouraged.
Conclusion/Implications/Recommendations: A successful national information governance program is needed to support digital health implementations across Canada. It should be: -Supported by a range of digital health leaders from across Canada -Sustainable like any other change management initiative sustainable information governance needs ongoing organizational commitment -Embedded information governance should not be treated as something extra that needs to be done any time data is being managed. It needs to be thoughtfully incorporated into existing processes (e.g. the architectural gating process) -Measured you need to know what the measures of success are for your information governance program to be a success.
140 Character Summary: Leaders from across the country discuss insights and expertise on the value of a comprehensive and aligned information governance strategy.
PS03.02 - Mobile Health Solutions: Evaluation at the Speed of Implementation (ID 260)
Purpose/Objectives: The Ontario Telemedicine Network (OTN) pilot tested three new models of care supported by virtual applications in the area of diabetes, mental health, and chronic kidney disease. To determine efficacy and potential for scale, OTN partnered with the Womens College Hospital Institute for Health System Solutions and Virtual Care (WIHV) to rapidly evaluate the tools and inform a provincial roll-out. The tools included: - a mobile application designed to improve self-management and lower HbA1C among individuals with type 2 diabetes - an online mental health support to help with anxiety and depression - a mobile application providing remote monitoring support for individuals receiving in-home peritoneal dialysis
Methodology/Approach: WIHV used a mixed-methods approach, combining the rigour of a quantitative trial with in-depth qualitative assessment. The approach aimed to address: 1. How does it work? (Realist Evaluation) 2. How is it implemented? (Consolidated Framework for Implementation Research) 3. What is the impact? (RE-AIM Framework) Also integrated was the Institute for Healthcare Improvements Triple Aim focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs, thereby informing a sustainability model on a provincial scale.
Finding/Results: An innovative, non-traditional approach was applied to the evaluation, which was integrated and multi-stakeholder. Both the evaluation and implementation teams met regularly to ensure that the goals of all stakeholders, from partners to funders, were met. The evaluation was an active piece of the implementation, in place of the typical analysis that takes place at pilot conclusion. Efforts were made to generate the data as quickly as possible. Learnings and data sharing also occurred across the pilots. The panel will share key clinical outcomes, as well as what conclusions were drawn to inform next steps. Practical rapid cycle evaluation as an approach was shown to offer broad utility and support effect decision making. In some cases, implementation continued according as anticipated however in some instances, data served to support a change in direction. The value of real-time evaluation was the potential to course correct in some instances or identify different value propositions altogether.
Conclusion/Implications/Recommendations: The evaluation underscored the following: - Health technology that is used to help patients better manage their chronic disease should integrate with clinical care. - A patient-centred approach to implementation focused on building and maintaining engagement is important. - Rapid and rigorous evaluations of technology implementations are necessary not only to assess efficacy of technology, but also to know how best to optimize its utilization in practice and potential funding models. - Implementation strategies should have a strong focus on clinical engagement and change management. - Both the implementation strategy and its execution influence the effectiveness of new models of care
140 Character Summary: Bigger than research: Real-time evaluation strategies for mobile app implementation
RF05 - Consumer Digital Health Partnership (ID 27)
- Type: Rapid Fire Session
- Track: Clinical Delivery
- Presentations: 5
- Coordinates: 5/29/2018, 11:00 - 12:00, Fairview I Room, Conference Level
RF05.01 - eHealth Interventions to Manage Perinatal Anxiety: A Systematic Review (ID 431)
Purpose/Objectives: Anxiety is the most common mental health problem during the perinatal period, affecting one fifth of women. Addressing mental health needs in maternity care settings has been challenging due to various barriers such as treatment cost and access. Recently, more research has been focused on eHealth interventions as more accessible and cost-effective approaches to manage maternal mental health issues. Few reviews have been conducted to examine the impact of these interventions in improving perinatal depression. No review to our knowledge has specifically focused on anxiety. The aim of this systematic review is to examine the effectiveness of eHealth interventions in management of perinatal anxiety.
Methodology/Approach: To identify the relevant evidence, the following databases were searched, beginning with the date that the electronic databases were available through August 2017: MEDLINE, CINAHL, EMBASE, and PsycINFO. Studies that examined the impact of an eHealth intervention on anxiety symptoms or disorders, as a primary or secondary outcome, during pregnancy or postpartum period and provided data to assess anxiety levels pre and post intervention were included.
Finding/Results: Eight studies met the inclusion criteria and were included in this review. The interventions in seven studies included cognitive behavioural therapy (CBT) (online/computer-based) and one study used an internet-based cognitive behavioural stress management (IB-CBSM) therapy. Only in one study anxiety was examined as a primary outcome. Five studies reported interventions among pregnant women and three studies were conducted during the postpartum period. None of the included studies determined anxiety using a clinical diagnostic interview. Various scales were used to measure symptoms of anxiety or generalized anxiety disorders. Six studies reported reduced levels of anxiety symptoms/disorders post interventions.
Conclusion/Implications/Recommendations: The evidence is amounting that eHealth interventions might be promising approaches for management of perinatal anxiety. More studies are needed to examine the effectiveness of eHealth interventions on reducing clinical anxiety during the perinatal period.
140 Character Summary: Findings of this systematic review suggest that eHealth interventions might be promising approaches for management of perinatal anxiety.
RF05.02 - Is There an App for That? Health Apps and Law (ID 240)
Purpose/Objectives: Outline the legal considerations in designing and implementing an application which collects, uses, analyzes or transmits personal health information. Review of the privacy and regulatory issues in the US, Canada and EU. Key information for app developers as well as health care institutions looking to use emerging devices and apps.
Methodology/Approach: See previous. Look at the issues from both sides: developer and health care instutution. Panelists will include: developer, health care institutional leader, legal expert.
Finding/Results: See previous.
Conclusion/Implications/Recommendations: A developer can navigate the patchwork of legal and regulatory issues in designing a health application. Health care institutions can ensure they are compliant with legal and regulatory when engaging a provider or using a new application.
140 Character Summary: Is there an app for that? What developers and health care institutions should consider in new applicatons.
RF05.03 - Managing Chronic Disease with Digital Health – A National Update (ID 211)
Purpose/Objectives: The Canadian healthcare system faces a number of pressures that increasingly threaten its ability to provide high quality, universal care for all Canadians. Among these is the fact that Canadians are living longer than ever before and with increasing prevalence rates of chronic disease. Evidence suggests that digital health solutions have the power to enable the necessary transformations to ensure the sustainability of Canadas healthcare system. A key aspect of understanding the potential benefits to be realized lies in understanding how these digital health tools are being used in todays current environment to help Canadians manage their chronic conditions, and in identifying opportunities to scale what is working well.
Methodology/Approach: An environmental scan was commissioned to examine what digital health solutions are currently available and in use by Canadians diagnosed with chronic disease. The scan, which will complete in January 2018, includes a focus on identifying what chronic diseases are covered by the solution(s); who is offering the solution (e.g. provider, agency, institution); any partnerships that may exist alongside the solution offering; a listing of information and/or services offered through the solution; and a description of how users (e.g. patients, providers, organizations/associations etc.) interact / engage with the solution. An overall assessment of the environmental scan findings will identify commonalities in approach and service offerings, with an aim to understand aspects that are best meeting Canadians needs and that could be scaled nationally.
Finding/Results: More than one in five Canadian adults live with one of four major chronic diseases and nearly seven percent have been diagnosed with at least two of the top five major chronic diseases. There are varieties of ways in which Canadians use digital health solutions to help self-manage chronic conditions, and these are not necessarily connected or coordinated across an individuals care continuum. The results of the environmental scan will help to identify opportunities to synthesize a common approach for chronic disease management in Canada.
Conclusion/Implications/Recommendations: Results from an environmental scan of adopted digital chronic disease management solutions indicate that these solutions can improve health, enhance quality, increase access to care and reduce health systems costs. A coordinated, common approach will remove duplicity of effort while providing a consistent look and feel to enhance the user experience for those Canadians managing one or more chronic diseases. It will also facilitate improved sharing of information between patients, providers and caregivers, and support improved ability to self-manage health conditions. These findings will be shared in an energetic, rapid-fire style format and will identify opportunities for a common, national approach for chronic disease management.
140 Character Summary: This presentation will share results from a national environmental scan of adopted digital chronic disease management solutions.
RF05.04 - Older Adults use of Medical Services Facilitated by the OTN (ID 216)
Purpose/Objectives: As the population ages in Canada, telemedicine may help meet the challenge of providing care and services to older adults. There are medically underserved regions within Canada that may benefit from increased access to medical services facilitated by telemedicine. The purpose of this study was to determine what medical services, facilitated by the Ontario Telemedicine Network (OTN), were most utilized by older adults between April 2008 to March 2015, and determine if patient sex, and geography influenced utilization.
Methodology/Approach: A secondary data analyses was performed on data from the Ministry of Health and Long-Term Care. Utilization was determined by Ontario Health Insurance Plan (OHIP) medical billing data that had OTN listed as the service location. All patients who were 65 years of age and older at time of service were included. Patient geography was determined by matching OHIP residence codes to Ontario census subdivision codes. Patient geography was divided into four regions: rural north/south and urban north/south. North and south boundaries were defined by the Local Health Integration Networks and urban and rural boundaries 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 age, sex, and patient geography were analyzed using multivariate Poisson regression.
Finding/Results: There were 102,968 completed older adult patient sessions facilitated through the OTN from 2008/2009 to 2014/2015 fiscal year, representing approximately 11% of all recorded OTN sessions. At the population level, 39% (n=40,194) of all patients utilizing medical care through OTN were 65 years of age and older. Family/general practice services had the highest utilization rate in urban, Southern Ontario (20.4/1000). Dermatology services had the highest utilization rate in rural, Southern Ontario (16.1/1000). Oncology services were the highest utilized service in urban (35.6/1000) and rural (22.7/1000) Northern Ontario. Utilization varied by sex, region and age group, but overall, older male patients had higher rates of utilization when compared with female patients, especially in oncology, and urology/nephrology services. Although not consistent throughout all age groups, female utilization rates were higher in dermatology, and psychiatry/mental health services, particularly within the Southern, 65-74 and 75-84 year age groups.
Conclusion/Implications/Recommendations: This research provides a detailed description of telemedicine use by older adults in Ontario, which has implications for medical service use in aging populations in Ontario and across Canada. Future research should compare OTN medical service utilization rates with in-person care services to determine what OTN facilitated medical services should be made more readily available or more frequently promoted. Increasing such services, would help make health care more accessible to older adults residing in northern, rural communities.
140 Character Summary: Because of the OTN, older adults in Northern Ontario have increased access to specialized medical care- specifically oncology, internal medicine, and surgery.
RF05.05 - Breathr: Supporting Youth Mental Health Through an Innovative App (ID 396)
Purpose/Objectives: The practice of mindfulness has recently received significant attention in the media for its usefulness in promoting social and emotional well-being and contributing to the ability to manage difficult or stressful situations. Mindfulness is all about encouraging awareness of oneself in the present moment, without judgment. While initial studies on mindfulness focused primarily on adults, practicing mindfulness has benefits for children and youth too. Youth are increasingly using the internet and mobile devices when seeking mental health information and resources. The rising trend of digitizing health care, and the desire to increase health care accessibility to tech-savvy youth, inspired the Health Literacy team at BC Children's Hospital to develop Breathr a new app to help introduce the concept of mindfulness and create an easy access point for those who are new to this practice. Breathr provides opportunities for users to try out a variety of mindfulness practices, while also teaching them interesting facts about the brain science behind those practices. The aim is to show youth that mindfulness can be fun, easy to try, and that it can have very real benefits for their overall health and well-being. The app is also a tool that can help prevent mental health challenges such as depression and anxiety from developing or escalating. Breathr was developed in collaboration with BC Childrens Hospital medical professionals, mindfulness experts and youth, making it an informed and evidence-based resource. This rapid-fire presentation will be a live demonstration of the Breathr app, highlighting its engaging components and features.
Methodology/Approach: The Breathr app is an example of one of the many youth-focused eHealth resources the Health Literacy Team has developed, in collaboration with youth and other key stakeholders, to address the mental health literacy needs of youth and emerging adults through evidence-informed approaches. The Team engages youth in a variety of ways when creating new resources; for example, youth are involved in content development and design to ensure that resources are appealing and relevant to the target audience.
Finding/Results: The Health Literacy Teams youth-focused initiatives have become widely recognized and utilized throughout British Columbia. The creation of websites and mobile apps, and province-wide dissemination through social media channels has increased accessibility of mental health information and supports for youth. Breathr has been downloaded over 5072 since its launch in May 2017 and feedback has been very positive. A youth who struggled with anxiety and depression and was involved in the development of the Breathr app commented: I found mindfulness to be one of the most valuable tools to maintain my personal wellness and cope with the symptoms of anxiety and depression when they would come up. I believe that making mindfulness easy and accessible to youth through platforms such as Breathr will allow more young people to discover the benefits mindfulness can have in their day-to-day lives like I have.
Conclusion/Implications/Recommendations: Through the development of innovative and evidence-informed eHealth tools and resources, such as the Breathr App, the Health Literacy Team is supporting the mental health literacy of youth in British Columbia and helping to reduce stigma associated with mental health challenges.
140 Character Summary: An overview of Breathr, an app designed in collaboration with youth and professionals, to help youth tackle stresses in their lives through practicing mindfulness.
RF06 - Getting It Done: Bringing It All Together (ID 51)
- Type: Rapid Fire Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 11:00 - 12:00, Fairview II Room, Conference Level
RF06.01 - Provider Experience – the Fourth Aim of Innovation in Healthcare Technology (ID 333)
Purpose/Objectives: Champlain BASE eConsultation service, established in 2009, connects primary care providers (PCPs) to specialists through a secure webbased platform. Approximately 80% of all PCPs in our region and over 170 specialists from 105 different specialty services participate. Objective: New healthcare technologies often fail due to poor provider experience. Understanding key drivers of provider experience and how to measure will enable health service delivery partners to successfully launch new health technologies. We will discuss three areas of focus: 1. Successful primary care engagement strategies used in BASE eConsultation 2.Specialist motivation to participate in BASE eConsultation 3.How eConsultation services can enhancing provider relationships and continuing professional development
Methodology/Approach: The panel will discuss their extensive experience in implementing and sustaining provider engagement in an eConsultation service. We have obtained provider experience in several ways: Who uses eConsultation services? We linked usage data from our eConsult data to physician characteristics retrieved from the CPSO database and determined characteristics associated with usage A survey of specialists participating in two eConsult services (OTN and BASE) was conducted A qualitative analysis of free text comments made by primary care providers when closing an eConsult was done.
Finding/Results: We have engaged over 1300 PCPs submit 1000 eConsults per month. Neither sex, being an international graduate documented predictors of EMR adoption- nor proximity to specialists were found to explain usage. Only length of time in practice was found to be predictive. Lower use by veteran physicians may reflect their lower need for services like eConsult given their well-established specialist networks, or their greater confidence in practicing medicine. Of the 175 specialists who completed the survey, there was strong agreement that participation in eConsult services was driven by the goal of improved communication with primary care providers, desire to provide innovative care and need to reduce wait times. (figure 1) PCP's included comments related to educational value and collegial value in 223 cases which highlighted the impact of eConsult services in improving the primary care and specialist relationship. (see figure 2)
Conclusion/Implications/Recommendations: Health care providers highly value eConsult services as an opportunity to improve patient care and reconnect primary care to specialty care.
140 Character Summary: Health care providers highly value eConsult services as an opportunity to improve patient care and reconnect primary care to specialty care.
RF06.02 - One Stop Shop for Digital Health Solutions in Primary Care (ID 538)
Purpose/Objectives: Attendees will learn about challenges and rewards of the eHealth Centre of Excellence (eCE) approach to supporting primary care providers (PCPs) with the adoption and use of digital health technologies. The approach merges organizational engagement strategies and change management methods to support PCPs in their strategic selection of tools that support care delivery.
Methodology/Approach: The eCE has grown their efforts to enhance the quality of patient care across several digital health programs. Current programs include System Coordinated Access (SCA) eReferral, Quality Based Improvements in Care (QBIC) which develops best practice electronic medical record (EMR) based tools, eConsult, virtual visits and more. The eCE is also Delivery Partner for the connecting South West Ontario (cSWO) Program offering the cSWO Regional Clinical Viewer, ClinicalConnect, and Health Report Manager (HRM), deployed in collaboration with OntarioMD. Within this varied work the eCE provides a collaborative process, a one-stop shop, to PCPs. Clinicians are supported to make decisions and customize their adoption of solutions. The central idea at the eCE is to work with clinicians to understand challenging elements in their practice and to enable best fit solutions to produce clinical value for patients. To get to agreement the eCE uses a set of strategies that includes: 1. Engaging in deep relationships with primary care providers developed over time to learn about delivery model requirements and clinical workflow; 2. A change management framework designed to support the unique requirements of the primary care environment, developed iteratively with input from PCPs across the region; 3. Development and communication of benefits realization cases providing evidence of the clinical and system value created during adoption; and 4. Internal use of client relationship tools to track and optimize stakeholder engagement activities as well as developing adoption targets based on the knowledge of practice.
Finding/Results: Even though the eCE has a refined method and strategy, the key finding in our work lies in the dedication to working through tensions and complexities. Our focus on enabling PCPs and pursuit of their informed choice of a solution that best enables their work requires acknowledgement that engagements change directions and our people need to adjust and avoid collisions.
Conclusion/Implications/Recommendations: Managing within a regional, centralized service organization that supports the PCP adoption and meaningful use of digital health solutions involves patience, communication and skill. The rewards for remaining focused on enabling clinicians to produce value are: appropriate information accessed by PCPs to produce clinical value for patients and improved efficiencies for the system as a whole.
140 Character Summary: The eHealth Centre of Excellence provides a one-stop shop of digital health tool solutions and supports for PCPs across the Waterloo Wellington LHIN.
RF06.03 - TIDES Rehab - Using Technology for Rural & Remote Rehab Services (ID 255)
Purpose/Objectives: The BC Ministry of Health Rural policy paper calls for improved access to health care services in rural communities, a reduction in travel for clients/patients in these communities and the use of technology to assist in service delivery. At present patients/clients face considerable expense and hardship travelling to the city for rehab services or go without the benefit of these programs. Telehealth units are present in each rural community but are not well utilized. There are very limited Rehab resources available in the Coastal Rural & Remote communities due to a shortage of skilled Rehab staff, the challenges of recruiting to rural/remote communities (other employment, housing, isolation, few services), and underutilization of technology and virtual care. The TIDES (Telehealth Innovation Deployment Education & Sustainment) Rehab team is a Rural & Remote Rehab service located in Sechelt BC. The TIDES team services the Sunshine Coast, Powell River, Bella Bella, Bella Coola and Sea to Sky communities with the goal of providing early discharge service to patients coming from hospital/rehab centers to home for local rural rehab. The mandate is to fully utilize the potential of Telehealth as a platform for Rehab service delivery
Methodology/Approach: The OT/PT/SLP provide therapy to patients in person at their local hospital Rehab area, and virtually via Telehealth. Therapists will work closely with the Rehab Assistants to carry out treatment. Rehab is short term and goal directed with an emphasis on building connections with community resources and programs. Ipads are used as a tool in all therapeutic work with clients. Clinical sessions are held via Telehealth with the Therapists, Rehab Assistants and clients. Remote communities are accessed via Telehealth for client sessions in First Nations Health Centers in cooperation with First Nations Health Authority Telehealth Services.
Finding/Results: *Population Health: ·Strengthened chronic disease management programs ·Lower mortality rates ·Heightened feelings of cultural safety ·Improved collaboration with partners in care delivery (FNHA, First Nations Health Centers) ·Stronger understanding of patient needs and community complexities Experience of Care: ·Improved access to healthcare services within the community ·Reduction in travel outside of the community ·Improved continuity of care due to consistency of providers ·Quicker repatriation of patients back to their communities ·Consistent quality of care delivered across the CoC Per Capita Cost:* ·Reduced patient travel costs ·Faster discharge of rural patients from acute settings ·Reduced ED visits and acute care utilization ·Greater flexibility to address shifts in demand/volume ·Less reliance on in-community FTE via the virtual healthcare delivery model
Conclusion/Implications/Recommendations: *Quantitative:* -Client journey -Service Delivery model based within home communities in rural/remote settings -Reduced travel to the city- patients/clients seen in their home communities -Reduced expenses for patients/clients and VCH -Recruit skilled professionals to go into rural/remote communities -Meet the needs of the community to provide rehab services closer to home. -Better health for communities, innovate for sustainability in health care
140 Character Summary: Virtual Rehab delivery through the TIDES Rehab proram allows us to leverage and promote the use of technology to care for clients in rural and remote communiteis.
RF06.04 - Standardize Electronic Medical Record Tools and Templates (ID 399)
Purpose/Objectives: Background: Improving the quality of the electronic medical record (EMR) and reducing medical errors are critical factors in the provision of successful patient care. Embracing the use of information technology and EMR to provide evidence-based medicine readily available at the point of care has had a major impact on achieving these goals. Incorporating evidence-based information into patient care requires making the right information available at the right time. EMR documentation using templates can play a key role in improving the efficiency of data collection, and ensuring all relevant elements are collected in a structured format. In addition, consistent and standardized clinical data play a key role in measuring and monitoring the quality of healthcare delivery. Context: The North York Family Health Team (NYFHT) is one of the largest in Ontario serving 92,533 active patients. NYFHT comprises of 84 family physicians, 52 Interdisciplinary healthcare professionals, 20 physical sites, two different EMR systems operating on seven in-house servers. Purpose: We identified the need to create a centralized process to review and update all existing EMR forms and templates, particularly the chronic disease management forms and templates across our multisided organization.
Methodology/Approach: Approach: To improve consistency of patient care, data sharing and quality of reports, the NYFHT has formed a data standardization committee responsible to promote and support standardization of EMR data entry. Terms of reference were developed to define the goals and objectives, responsibilities and the scope of work. The committee meets every other month and reports to the Information Management/ Information Technology Committee at the FHT.
Finding/Results: Findings: The committee has identified the following priorities to work on: periodic health review templates, diabetes flowsheet, asthma action plan, UTI encounter form, EMR reminder installation in patient charts, and renewal of existing vaccination lists within the EMR systems. Once these forms are reviewed and revised, they are trailed to evaluate their accuracy by volunteer physicians and nurses prior to releasing to the entire FHT. Currently, the committee has accomplished the task of reviewing and updating several forms against current best practice guidelines. These forms have also been standardized and released for use among FHT physicians across the two EMR systems. In 2016-2017, 7 EMR forms and templates reviewed against most recent clinical guidelines and revised, 4 EMR system reminders and alerts were developed to prompt providers to provide care needed, 62% of NYFHT providers adopted the newly developed Periodic Health Review templates.
Conclusion/Implications/Recommendations: Implications: EMR documentation and data optimization are the cornerstone of effective patient care. The quality of healthcare data impacts every decision made along the patient care continuum. The demand for accurate and reliable data has never been more important. Involving the right team members and ensuring effective implementation and adoption across the team is the foundation for building an effective and successful process that will help improve patient care through meaningful use of EMR systems.
140 Character Summary: EMR standardization, involving the right peple and ensuring effective implementation and adoption across the team play a key role in improving patient care.
OS18 - Minding the Gap in Our Healthcare Policies (ID 34)
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 4
- Coordinates: 5/29/2018, 13:00 - 14:00, Fairview IV Room, Conference Level
OS18.01 - Developing a Data Quality Assessment Framework for Primary Care (ID 385)
Purpose/Objectives: The connecting South West Ontario Programs Primary Care Data Sharing Proof of Concept (PCDS POC) project, funded by eHealth Ontario, is enabling a sub-set of primary care electronic medical record (EMR) data to be shared as part of Ontarios integrated electronic health record (EHR). The POC is being conducted across four Family Health Teams in southwest Ontario. A key objective is to improve data quality to enhance data sharing; ensuring the data being shared is accurate, complete and timely and can be used to inform clinical care. The purpose of this presentation is to explain the framework, including tools and templates that was developed by the project team to assess and monitor data quality improvements.
Methodology/Approach: To create the framework, existing data quality frameworks were assessed and customized to meet project needs. The tools focused on three dimensions: a) completeness: how well the data in the EMR reflects the actual medical state of the patient; b) correctness: how up-to-date the data is in the EMR; and 3) comparability: how much of the data in the EMR is comparable (e.g. coded and easily analyzed). The framework enables the evaluation of these dimensions across several elements of EMR data including: problem list, past medical and surgical history, medications, immunizations, allergies, and risk factors. The framework consists of two data quality assessment tools (an objective and a subjective tool). An online survey to assess the clinicians perception of their level of confidence of their EMR data and a checklist used to validate data quality by completing a mini chart review. For both tools, a percentage of completeness, correctness and comparability is calculated, and averaged to calculate an overall data quality score.
Finding/Results: Our analysis resulted in a number of key findings. First, clinicians recognized the necessity of data standardization, but also recognized the need for resources (human and time) to achieve desired outcomes. In addition, continued reinforcement is needed to remind clinicians to motivate change including showing them what their data looks like. Some sites addressed their interest for reinforcement by creating a data quality scorecard that showed data quality status by physician and site. An additional consideration for future work included data capture inconsistencies across clinicians and vendor variation in terms of completion of data queries to support data quality plans. In terms of benefits, standardizing EMR data was shown to enable more accurate identification of patients with complex care needs; allowing clinicians to better focus on providing preventative care. This finding, of course, is vital to consider when the POC is put into the larger system goals of improving patient outcomes and ensuring appropriate use of health system resources.
Conclusion/Implications/Recommendations: The PCDS POC has designed a framework to assess and monitor data quality improvements over time. The framework includes a number of tools that can be utilized by primary care sites. The tools and templates reveal important potential being developed during a POC centred on Primary Care Data Sharing and offer considerable potential for decision-makers considering scaling and spreading of such an initiative.
140 Character Summary: Development and validation of a data quality assessment framework to support primary care sites in assessing and monitoring data quality improvement activities.
OS18.02 - Electronic Consultation Services Worldwide: An Environmental Scan (ID 458)
Purpose/Objectives: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many healthcare systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists via a secure platform to facilitate discussion of patients care. In this presentation, we examine the different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different healthcare contexts worldwide.
Methodology/Approach: We conducted an environmental scan comprised of three stages: a literature review, a grey literature search, and targeted, semi-structured key informant interviews. A team member searched Medline and EMBASE (literature review) and Google (grey literature search) using an established keyword matrix. Upon completing the searches, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, care providers, and decision-makers. Maximum variation sampling was employed to ensure sufficient breadth of participant experience. We conducted semi-structured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach.
Finding/Results: A total of 53 services emerged from the published and grey literature. Services spanned 16 countries, with the majority (53%) located in the United States. Hospitals/clinics comprised the most common provider type (34%), while the most common technology platforms utilized were web-based (38%) and electronic medical records (28%). Interviews have been conducted with respondents from various countries and represented a mix of service types (e.g. public versus private, electronic medical record versus web-based). Preliminary analysis has revealed a variety of service structures, payment models, and technologies. Recurring themes include need for physician engagement, importance of maintaining workflow, and value of improving access. Further analysis will be shared during the presentation.
Conclusion/Implications/Recommendations: eConsult services have emerged in a variety of countries and health system contexts worldwide. Structure, platform, and delivery model varies, but the services consistently demonstrate improved access and high levels of satisfaction.
140 Character Summary: We conducted an environmental scan of eConsult services available worldwide and compared the strategies, barriers, and successes of their implementation
OS18.03 - Psychometric Evaluation of the Canadian Nurse Informatics Competency Assessment Scale (ID 194)
Purpose/Objectives: Purpose: While the Canadian Association of Schools of Nursing (CASN) has defined entry-to-practice informatics competencies for Registered Nurses, there has been no research-based tool developed to date for the assessment of these competencies. The purpose of this study was to integrate these competencies into a measurement scale and evaluate its psychometric properties. Such a tool would serve to evaluate nurses informatics readiness for practice, their learning and continuing education needs related to same, and assist in the planning of targeted informatics education in the workplace.
Methodology/Approach: Methods: The researchers developed the Canadian Nurse Informatics Competency Assessment Scale (C-NICAS)a 21-item comprehensive measure and applied it into a cross-sectional survey; 2844 nurses from practice settings in Alberta completed the survey. An exploratory principal component analysis with oblique promax rotation was applied to examine the factor structure and internal consistency reliability of the (C-NICAS).
Finding/Results: Results: Results revealed a four-component/factor structure of the C-NICAS, explaining 61.04% of the variance. Items loading per each component reflected the original Canadian Association of Schools of Nursings grouping of nursing informatics competency indicators, as per three key domains of competency: information and knowledge management (? = 0.85); professional and regulatory accountability (? = 0.81); and ICT use in the delivery of patient care (? = 0.87) with the exception of one item (Indicator 3), which loaded into the category of foundational information and communication technology (ICT) skills (? = 0.81).
Conclusion/Implications/Recommendations: Conclusion: This study provided a preliminary evidence for the construct validity of the entry-to-practice competency domains, and the factor structure and reliability of the C-NICAS among practising nurses. Further testing among nurses in other settings and among nursing students is recommended.
140 Character Summary: A principal component analysis supported the validity and reliability of the new Canadian Nurse Informatics Competency Assessment Scale.
OS18.04 - Patient Privacy Perceptions in a Digital Mental Healthcare Environment (ID 388)
Purpose/Objectives: The concepts of privacy and trust are critical for patients with mental health conditions or addictions as effective therapeutic relationships are grounded in the assurance that disclosed information will be held in confidence by the healthcare provider. Without this assurance, individuals may avoid seeking mental health care due to fears of stigmatization if their health records are inappropriately disclosed. Privacy concerns about the appropriate use of mental health records have often overshadowed the valuable characteristics of interoperable health information technology (HIT) the potential to improve the integration and continuity of care, support clinical and health service research, and empower patients through consumer-based applications. The purpose of this study is to explore the privacy perspective of mental health patients and understand how they feel about the electronic sharing of their records.
Methodology/Approach: Semi-structured interviews were conducted with outpatients receiving care for mood and anxiety disorders or substance addictions at an Ontario mental health hospital. Participants were recruited using a maximum variation sampling strategy on the following characteristics: perceived health status, disposition to trust, and tech savviness. The interview questions were developed based on the eHealth Trust Model (eHTM), a theory-grounded conceptual framework, to understand the patient views on privacy and trust, the factors that contribute to those views, and the impact of those views. Using Braun and Clarkes framework for thematic analysis, qualitative themes were identified through iterative rounds of coding using a schema based on the eHTM.
Finding/Results: Interviews were conducted with 14 patients. Privacy was defined by some as the self-controlled release of information while others equated it to confidentiality. Participants were concerned about their privacy for fears of stigmatization, particularly from employers, insurance companies, and healthcare providers. The term privacy was often used interchangeably with security and linked to a fatalistic belief that there is nothing that can be done about hackers. The concept of trust was grounded in the following themes: competency, credentials, familiarity, and past experiences. Key themes on building trust include: greater accountability, more transparency on how data is used, and more education on patient rights to their information. While patients were not always comfortable with the idea, they were willing to electronically share their records because they saw the individual benefits of providers having complete information and of having online access to their own health records. They were also supportive of sharing their records for clinical and health service research because of the societal benefits.
Conclusion/Implications/Recommendations: The preliminary analysis of the interviews found that patients were unaware of their health privacy rights and the permitted uses of their health records; however, they supported interoperable HIT because the perceived benefits outweighed privacy risks. With a body of literature mainly comprised of commentary from academics and healthcare providers, this research makes a contribution by gathering first-hand accounts from a vulnerable patient population on how trust can be developed to support Canadian efforts in building interoperable HIT.
140 Character Summary: This study found that patients with mental health conditions and addictions supported interoperable HIT because the potential benefits outweigh privacy risks.
OS19 - Expanding EMR Use in Communities (ID 29)
- Type: Oral Session
- Track: Technical/Interoperability
- Presentations: 4
- Coordinates: 5/29/2018, 13:00 - 14:00, Fairview V Room, Conference Level
OS19.01 - Increasing Access to Care with Patient Preferred Secure Communication (ID 312)
Purpose/Objectives: Coordinating patient care using phone, fax, and mail requires a large amount of staff time and resources and fails to centre care around the patient. Clinicians, patients, and staff express frustration over conducting office visits for simple issues when that time could be saved for more critical cases. Crowfoot Village Family Practice (CVFP) and Brightsquid conducted a trial to augment clinic-to-patient communications using Secure Health Exchange, a compliant email service. The goal was to increase access to care while also creating clinic efficiency using secure asynchronous communication.
Methodology/Approach: Secure Health Exchange was used by the clinic to: Follow up with treatment plan reminders or notify patients of changes Check in on the effectiveness of treatment Send patients test results Respond to questions as appropriate Deliver educational materials Secure Health Exchange was used by patients to: Ask follow-up questions Request non-urgent medical advice Consolidate your healthcare records Request prescription refills
Finding/Results: Following the trial, patients revealed a preference for secure-email over phone communication and office visits in 3 out of 6 common scenarios for an aggregate first choice ranking. When describing their experience with Secure Health Exchange: 84% of patients said it was convenient; 83% said it was easy; 71% said it was time saving; 8% labeled the service impersonal; and 6% said it was tedious. (Survey respondents: 104, 50% 50-69 yrs) With 25% of patients registered on Secure Health Exchange, the number of phone calls handled by clinic staff dropped by 17%. Average call length reduced by 45 seconds, equivalent to saving 5 hours of phone time each week. Now patients that do need to call the clinic get through more easily because phone lines are less congested and often issues can be resolved with a single communication instead of trying to coordinate over voicemail. Staff are more focused and experience fewer interruptions. Physicians can manage 10 appropriate patient concerns remotely in the time it takes to conduct three office visits, opening 7 appointments for patients that require a clinic visit sooner. By receiving visit notes and treatment plans to patients through Secure Health Exchange patients are better informed, more compliant to treatment plans, and can be more active in their own care.
Conclusion/Implications/Recommendations: The clinic has increased capacity to care. The inclusion of secure messaging in clinic-to-patient communications improves patient access while boosting attachment and satisfaction. Simple issues are handled via secure email, creating more clinic time for complex or urgent issues. Clinic staff and physicians are more productive because they can deliver all required information in a single secure message and work with fewer interruptions.
140 Character Summary: Clinics using patient preferred secure electronic communication can increase access to care even for patients not using the service.
OS19.02 - Electronic Medical Records: Information Aggregators or Gateway Systems? (ID 39)
Purpose/Objectives: Is an Electronic Medical Record (EMR) a machine for aggregating information? Is it a launchpad for accessing broader digital health solutions and national repositories? Is it both? Early EMRs were effectively electronic versions of paper charts isolated silos of manually entered information. The advent of integrating systems such report manager solutions and laboratory information systems helped the EMR become less isolated and more interconnected with broader sources of information; however, the EMR continued to rely on its own database for supporting patient care. Now, integration efforts with systems such as eConsult and digital health immunization repositories are changing the EMR paradigm. No longer are EMRs standalone systems wherein community-based physicians work, they have become one piece of an interconnected web of independent databases, comprehensive decision-support logic, and tools for legislative compliance. This panel presentation will explore the effect of this evolving role of EMRs on: 1. Physician practices, including their ability to deliver patient care and meet legislative requirements; 2. EMR product vendors, that need to adapt to the changing needs and opportunities for physicians; and 3. The ability for the system to deliver high-quality patient care.
Methodology/Approach: With a growing number of EMR users and interconnecting systems, it is increasingly difficult for digital health vendors and stakeholders, as well as their physician customers, to continue building tightly-integrated solutions in the EMR forms and pages developed within the EMR that integrate with external solutions. Increasingly complex decision-support tools and greater quantities of stored data further stress EMR infrastructure as these systems are expected to deliver mass scope on minimal scale. This challenging trend is encouraging loosely-integrated solutions in the EMR where the EMR passes user and patient context to a partner system, and presents that other systems pages within the frame of the EMR. Loosely-integrated solutions reduce the burden on the EMR to adapt to ever-changing requirements while still delivering needed functionality to physicians.
Finding/Results: Loosely-integrated EMR solutions are easier for the product vendors and the evolving system; however, they introduce new challenges for practising physicians: 1. EMR users are faced with an inconsistent and unfamiliar look and feel to their EMRs, as each loosely-integrated solution introduces system-specific layout and features; and 2. Information in support of clinical decision-making that used to be stored within the EMR exists across an array of digital health solutions, complicating a physicians ability to reflect the best information available at a given time. On the other hand, tightly-integrated EMR models may lead to higher EMR prices and system costs as solution vendors accommodate multiple specifications and system-specific needs. Further, EMR users face the burden of more frequent upgrades and updates to deliver changing functionality to their systems.
Conclusion/Implications/Recommendations: This panel presentation will bring together voices representing community-based physicians, digital health product vendors, and digital health system stakeholders to consider the best path forward for EMRs, the community-based physicians who use them, and the patients who benefit from their care.
140 Character Summary: Listen to a panel of users and system stakeholders discuss the future of EMRs as either tightly-integrated systems or loosely integrated with external solutions.
OS19.03 - Standardizing Free Text in EMRs: Automating Data Coding in Primarycare (ID 361)
Purpose/Objectives: To automate the standardization of clinical data in electronic medical record systems (EMRs). Data collected in EMRs do not always accurately and consistently map to medical concepts that physicians need to identify individuals at high risk of specific health conditions and their complications. Asking physicians to enter structured data puts too great a burden on already busy clinicians. Addressing data quality problems through new advanced artificial intelligence and machine learning techniques holds the promise of saving doctors hundreds of hours of coding time while increasing data quality in their EMRs.
Methodology/Approach: We developed several advanced text mining Smart Algorithms to identify patients with a range of chronic diseases that can lead to severe complications such as blindness, cancer, stroke, kidney failure, heart attacks and death. We compared our Smart algorithms (SA) to a simple search (SS) that a reasonable physician might conduct in their EMR for the same disease.
Finding/Results: Disease: GERD Breast Ca Prostate Ca Lung Ca Schizophrenia Depression Diabetes Polycystic Ovarian Disease % Identified by SS 67% 63% 58% 68% 88% 81% 90% 46% % Missed by SS 33% 37% 42% 32% 12% 19% 10% 54% % False Positive by SS 3% 13% 13% 24% 7% 3% 5% 7% % Accuracy of SS 80% 73% 68% 72% 90% 88% 92% 62% % Identified = patients identified by SS compared to SA.Table. Comparison of Physician Search in EMR against a Smart Algorithm % Missed = percent patients with disease but not identified by SS. % False positive = percent of patients that SS detects who actually dont have the disease. % Accuracy = how well SS compares to SA in terms of not making any errors in detection. Simple searches in EMRs can find as many as 90% of patients with a disease and as few as 46% (Table). Although the false positive rate is quite low (3-13% for the most part), it can be as high as 24% in some cases (Lung ca). The accuracy of SS in EMR can be as high as 92% (e.g., diabetes), but is usually lower than that and can get as low as 62%.
Conclusion/Implications/Recommendations: Smart data cleaning approaches are required to overcome problems raised by heath data inconsistency and to help physicians accurately identify high risk and targeted groups. These data standardization algorithms are also important for more advanced uses such as predictive analytics, patient engagement, health system management reports and machine learning applications.
140 Character Summary: New advanced Smart data cleaning Algorithms standardize data in EMRs more consistently than doctors.. Smart Algorithms help doctors provide better patient care.
OS19.04 - Optimizing your EMR: Tools and Processes for Understanding Patient Panels (ID 430)
Purpose/Objectives: Within the context of the patient medical home model of primary care, having accurate patient registries within EMRs was highlighted by the GPSC as an essential component for proactive and quality patient care. In order to facilitate this process, the Practice Support Program (PSP) partnered with BC EMR vendors to build EMR based tools to provide more intuitive reporting functions for understanding your patient panel. PSP regional support teams (RSTs) were trained and deployed to assist physician in optimizing their EMR functionality.
Methodology/Approach: The initial tools were built with three of the major EMRs in BC (Telus MedAccess/Wolf, and Intrahealth Profile), allowing both RSTs and physicians to easily view panel counts, using either a simple dashboard or reporting interface. This reduced the need to run multiple reports within the EMR. The EMR reporting tools were designed to query standardized disease codes pulled from patient charts to identify prevalence of patients with active status, polypharmacy use, and diagnostic codes for 15 disease indicators. RSTs were trained to provide in-practice support to physicians and their teams in using the tools and improve patient coding methods. We hypothesized that active patient status and polypharmacy prevalence would decrease, and disease registry prevalences would increase. These changes would indicate improved patient data quality and allow for comprehensive problem summaries. Physicians were asked to choose 3-5 indicators to manage and provide their baseline and post clean-up scores to the provincial office, along with an evaluation to assess the functionality of the tools and skill set of the RSTs. Additionally, focus groups were conducted at the end of the initial pilot with RSTs and physicians to evaluate the success of the pilot phase, and to inform improvement opportunities. Questions were designed to assess motivators, barriers, and facilitators of action.
Finding/Results: Over 400 general practitioners (GPs) have now enrolled to use the EMR based tools across BC. The average physician rated somewhat satisfied with the functionality of the EMR panel clean-up tools, and very satisfied with the coaching support. The findings were in line with our hypothesis; based on the subset of physicians who reported their scores, the average active patient status went down by 22% and each of the disease prevalence averages increased. Polypharmacy also showed an average decrease of 54% of patients on 5+ medications and 52% on 10+ medications. Focus groups revealed that participation was influenced by perceived benefits, normative beliefs, and perceived control. Perceived benefits included themes like preparing for retirement, normative beliefs included themes around peer support and community initiatives, and perceived control themes included EMR skill level, tool usability, and availability of resources. Specific barriers included lack of time, lack of strong RST relationships within some clinics, and technical problems with the tools.
Conclusion/Implications/Recommendations: Overall, the initiative continues to be successful in meeting its objectives. The EMR tools facilitated the process of panel management, are a helpful for RST coordinators to engage the physicians in good data entry practices, and act as a stepping off point for other PSP support services.
140 Character Summary: The Practice Support Program has helped over 400 General Practitioners to better understand their patient panels with innovative EMR tools, and coaching support.
OS20 - Patient Connectivity Goes Mainstream (ID 32)
- Type: Oral Session
- Track: Health Business Process
- Presentations: 4
- Coordinates: 5/29/2018, 13:00 - 14:00, Granville I Room, Conference Level
OS20.01 - The Secret is Out: Achieving High Patient Portal Adoption (ID 177)
Purpose/Objectives: New patient portal implementations aimed to give patients access to their own electronic health record, along with added functions, achieve average adoption rates of 5-10%. This session will reveal secrets of our success in achieving and sustaining high adoption rates of 49%.
Methodology/Approach: Our Patient Portal is a Web-based solution that enables patients with real-time access to their personal health record so they can be informed partners in their care. Patients are able to see their appointments and receive appointment reminders; see lab results with links to patient education; see clinical documentation, such as assessments, discharge summaries, clinic notes, and reports (including sensitive information such as mental health notes and pathology reports); share their health information with others; and find programs, clinic information and patient education resources. Our Patient Portal was first made available to early adopter clinics in May 2015, and expanded to the rest of the organization in January 2017. Approaches to achieving and sustaining high adoption rates will be discussed. This includes meeting the needs and priorities of patients and their caregivers; strategic alignment; organizational change management; patient and staff engagement; and gaining public support.
Finding/Results: Patients told us that they want and need access to their online medical records and health data to become informed partners in care. Patient sign-ups soared from 3,100 to 30,000+ within nine months of portal expansion. Adoption rates of 49% have been sustained for over two years. 84% of monthly log-ins are returning visitors. 53% of unique visitors log in 2-10 times per month.
Conclusion/Implications/Recommendations: Despite initial clinician reluctance to give patients real-time access to their personal health record, our organization put needs and priorities of patients and their caregivers first! A solid patient and staff engagement framework are necessary when planning, designing and delivering an enterprise Patient Portal in order to achieve and sustain high adoption rates. This includes meeting patient, caregiver and staff needs; and addressing challenges and concerns. As part of large-scale organizational culture change, processes need to be well-integrated into clinical care and at point-of-care. This includes administrative staff engagement with patients as part of patient check-in, admitting and registration; along with education and support for the multi-disciplinary team of physicians and health professions.
140 Character Summary: This session will reveal secrets of our success in achieving and sustaining high adoption rates of 49% for a new patient portal implementation.
OS20.02 - BC Cancer Agency: Online Art Therapy Groups (ID 329)
Purpose/Objectives: Art therapy allows patients the opportunity to express themselves in a new way. It is also an intervention that patients find relaxing and empowering, and it may even alleviate symptoms that cancer patients experience. Working in a busy cancer centre, finding space to host art therapy sessions is a challenge. Cancer patients may not be able to attend support groups as they may live in rural areas, lack energy, or not want to access support from a cancer centre. CancerChatCanada.ca provides an online platform for hosting art therapy groups. These groups bring participants from across the country together to receive emotional support.
Methodology/Approach: In 2012, BC Cancer Agency (BCCA) began collaborating with art therapists with expertise in digital art therapy across Canada. Together they began experimenting with different methods for creating art and meeting online. BCCA created an online platform for online groups called CancerChatCanada, which provided a forum for groups to meet online in a secure chat room, where participants would discuss the art that they had created. In 2013, a pilot group of international art therapists and health care professionals piloted BCCAs first online art therapy group for young adults with cancer. From there, BCCA began hosting art therapy groups on CancerChatCanada (now CancerChatCanada at de Souza Institute.) Each group consists of 10 weekly sessions with an art assignment given each week. Participants create their art work with whatever tools they have available (including online art-making programs), then submit photographs of their work. Photos are compiled and sent in a document to the group members and the art therapist facilitates a discussion of the art while in the chat room.
Finding/Results: From 2015-2017, five art therapy groups took place on CancerChatCanada, and plans are to continue running two 10-week groups per year. The presentation at e-health will also review findings of patient satisfaction surveys and program evaluation data. Participants in the online art therapy group bond quickly. Many have shared how grateful they are for the opportunity to participate in an art therapy group (since they live in a rural area) and meet others who share this experience. One participant stated, While art therapy was outside of the box for me, it was successful in creating an important connection to other people with cancer. The discussions generated by the projects helped to address real fears, frustrations and questions that were common to all of us. The resulting moral support was invaluable.
Conclusion/Implications/Recommendations: Art therapy is an effective form of support for people with cancer. However, art therapists are challenged to find spaces to work in health care centres, and many cancer patients have difficulty accessing face-to-face support services. CancerChatCanada is an innovative and effective way to provide art therapy services to cancer patients across the country.
140 Character Summary: Art therapy groups for cancer patients hosted in chatrooms
OS20.03 - New Buildings and New Beginnings for a Children's Treatment Centre (ID 78)
Purpose/Objectives: When Ontarios largest Childrens Treatment Centre was faced with the unprecedented opportunity to create three new purpose build facilities, they were enfranchised simultaneously with a new horizon of both possibilities and challenges. The ambit of technology in these buildings far exceeded anything the organization previously had access to, and the opportunities for transforming service delivery were staggering. However, equally humbling was the requisite level of change for staff, and workflow re-engineering, in order to harness the full potential of these advancements.
Methodology/Approach: Of the design and implementation approaches that were familiar to the organization, many were simply impossible given the interdependence between the new technology and the design of the physical spaces. The seamless integration of technology within the yet-to-be built facilities, meant that small scale experiments were often impossible to recreate in existing spaces for the purpose of running small tests of change or pilot studies that could inform broad scale process change. For the same reasons, it was not feasible to introduce the changes to a select group of staff who could act as early adopters, providing support to their colleagues when organization-wide change was later implemented. Additionally, a phased approach to the implementation of technology was also unworkable given the move to the new facilities had a remarkably short transition time for staff. Operational requirements for client service necessitated that the existing 10 sites would remain fully functional until they simultaneously closed on the same day, and the 3 new buildings were all fully occupied by staff 3 days later. This condensed transition period did not allow for an approach where both old and new processes could run in parallel, with groups of staff gradually transitioning over to the new way of functioning; each group benefitting from the experiences of the previously transitioned group. Forced to consider new and different approaches, the organization undertook a journey within the constraints of the physical move to successfully transition to the new technologies and accompanying workflows.
Finding/Results: The approaches employed were rooted in LEAN principles, with a particular emphasis on leveraging the knowledge and expertise of front line staff. Collaboration between the staff who had experience with our client population and the vendors introducing the technology were able to collectively design systems that would meet the needs of both our staff, and their clients and families. Testing and validation of these systems was of course a challenge for the reasons described above, so once again innovative approaches, based on LEAN methodology were relied upon to develop low-tech simulations to help prepare staff in the existing environments. Underpinning the focus on clients, staff, and workflow was a leadership approach that fully engaged the entire executive team for the 4 year venture of operational readiness planning.
Conclusion/Implications/Recommendations: This presentation describes the learnings that were acquired throughout this project and the synergistic elements that supported this success.
140 Character Summary: The move into fully accessible, technologically advanced facilities has brought a new horizon of possibilities to Ontario's largest Children's Treatment Centre.
OS20.04 - Engaged Patients Are Driving Healthcare Innovation and Efficiency (ID 453)
Purpose/Objectives: Almost 50 percent of provincial budgets are now consumed by healthcare, with 30 percent of health system resources going to 12 percent of the population. How can healthcare respond to spiraling costs, especially high for a small number of chronically ill patients? The answer lies in patients themselves and their demand for the digital health technologies that will deliver dramatically more efficient care for all Canadians. Global leaders believe empowered patients create better value care. In fact, research tells us that patients who are less engaged cost the health system between 8 and 21 percent more than those who are engaged. Fortunately, patients today are playing a more active role in their own healthcare than ever before. Access to personal health management tools and information are motivating people to be more proactive about their health and wellness goals. In a world where the ubiquity of the Internet and powerful smart phones are transforming business models and entire industries, personal health technologies can empower people to access and manage their health information anywhere, anytime. This presentation will illustrate how the demand for personal health technologies is driving better health management and better health.
Methodology/Approach: Citizens are looking at ways to be part of the healthcare decision-making process, communicate electronically with their care provider and access their results anytime from any location. As a result, personal health technologies such as patient portals, Personal Health Records, virtual care tools and health monitoring solutions are now widely available. Patient self-management and engagement are having remarkable effects on health outcomes and costs. This presentation will present stories and results from personal health technology implementations across Canada.
Finding/Results: Better access to patient health information, particularly for patients with chronic diseases or those located in remote areas, is proving to reduce healthcare system costs, increase patient satisfaction and improve overall population health. In addition to significantly reducing medical travel for patients and providers, weve seen that personal health technologies are reducing hospital admissions by 71 percent and ER visits by 43 percent, resulting in a significant cost savings per patient. We will provide results from a range of patient engagement implementations across Canada.
Conclusion/Implications/Recommendations: Providing digital health tools that engage patients to play a central role in their own health ultimately drives better health outcomes at lower cost for all Canadians.
140 Character Summary: Patient demand for personal health technologies is driving better health management and better health.
OS21 - Advancing Telehealth: The Next Wave of Opportunities (ID 33)
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 3
- Coordinates: 5/29/2018, 13:00 - 14:00, Granville II Room, Conference Level
OS21.02 - Mixed Method Exploration of Telehealth for Autism Intervention Services (ID 299)
Purpose/Objectives: Western Health serves a catchment area of approximately 70,000 residents across a large geographic area of Newfoundland and Labrador (NL). Children who are diagnosed with autism spectrum disorder (ASD) within the jurisdiction of Western Health are eligible to receive early intervention services in the form of Applied Behavioral Analysis (ABA) therapy. Traditionally, orientation and ongoing follow-up for these services have been provided in face-to-face format, requiring travel by family members and healthcare providers (HCP). This modality has many limitations for families as well as for involved HCPs, primarily due to the rural nature of the area as well as needs of families who care for vulnerable children. Telehealth has been implemented to ensure adequate access for families as well as maximal efficiency for all involved at three distinct phases of the Western Health ABA delivery process, including the three-day ABA training, mentorship and support for healthcare providers, and to facilitate ongoing evaluation/communication with the family and home therapist in the childs home. The research team leading this mixed methods study have followed a patient-engagement framework perspective. Quantitative data provided insight into registration information and family/healthcare provider participant satisfaction with using telehealth. Qualitative data from focus groups and interviews provided more extensive exploration of the processes and experiences of families and HCPs involved in the program. The program and evaluation framework are based on the Patient Provider Expectations Model. The final evaluation of the various phases of the project have informed changes required to transform the program to one that is truly home based. Based on study results, the researchers conclude that telehealth is a viable method of delivery for the three phases of the ABA program delivery, with the results having implications for improving efficiency of additional programs. The aim of this study is to build upon the existing use of telehealth for the ABA programs three-day training and then expand into a telehomecare component for the mentoring phase. The objectives of the study include: 1. Implementation of telehomecare in the delivery of ABA parent/caregiver training 2. Explore the experiences of healthcare professionals and clients in the implementation of telehomecare 3. Summative and formative evaluation of health professional and client satisfaction with use of telehomecare for delivery of ABA orientation and ongoing mentoring 4. Review of cost and clinical effectiveness of telehomecare implementation to determine clinical efficacy of this mode of program delivery 5. Provide recommendations for further implementation of telehomecare initiatives
Methodology/Approach: Mixed method methodology
Finding/Results: Surverys received from over 60 participants of the three day ABA training. Results include: 87% satisfaction rate among participants; significant cost savings of participants (up to $2000 per participant); emotional benefits (avoidance of travel and separation from children for training). Individual interviews and focus groups provide insight into the challenges and solutions to identified issues.
Conclusion/Implications/Recommendations: The first phase of this project included a one year pilot of telehealth use for the three day ABA sessions. Based on the results and feedback received from this review, the program has been adapted by the facilitators to be telehealth-friendly. Based on the successful results and subsequent change to the program, Telehealth is now used to assist in the delivery of all sessions of the three-day ABA training. Recommendations have been made based on the surveys and other feedback from participants and facilitators, including the recommendation that all staff who will be involved in facilitating the sessions via Telehealth participate in comprehensive telehealth orientation.
140 Character Summary: Celebrating successes in telehealth -- bridging the gap for families of children with ASD and healthcare providers involved in ABA program delivery!
OS21.03 - Rural-Urban Comparison of Telehomecare for Patients with Heart Failure (ID 529)
Purpose/Objectives: To assess the differential benefits of telehomecare for patients living in rural versus urban environments and suffering from chronic heart failure.
Methodology/Approach: A cross-sectional design was used to examine the differences in process and outcomes care measures between rural and urban patients enrolled at a major specialized hospital. Chart review of all patients enrolled in the program in 2014 was conducted to extract data on relevant indicators. Rural status indicated a patients home residence in a geographic area with < 30,000 habitants. Descriptive analysis provided an overview of the sample; bivariate analyses examined the relationship between rural/urban status (R/U) and patient characteristics, and process/outcomes measures. Multivariate analysis was conducted with the variables that demonstrated significant relationships at the bivariate level.
Finding/Results: Table 1 presents an overview of the sample that included 240 patients (137 urban and 103 rural). Analysis of differences in their characteristics revealed a significantly higher proportion of rural patients living with someone and diagnosed with diastolic heart failure. In addition, a significantly higher number of emergency room visits was observed for male patients and when living alone. Patients who were seen by a specialist and a regular GP had the longest telehomecare duration, and the highest number of diuretic adjustments, nurse calls and emergency visits. A preliminary examination of the relationship between R/U and process/outcomes measures did not reveal any significant association, although more rural patients had undocumented reason for emergency visits compared to urban patients (Table 2a). The multivariate analysis controlling for significant patients characteristics further confirmed the absence of any significant differences between rural and urban patients on process/outcomes measures related to telehomecare. Interestingly, a posthoc analysis of correlation between process of care (e.g., frequency of changes of diuretic doses, calls) and outcomes measures (e.g., emergency visits, admissions) demonstrated significant positive relationships (Table 2b).
Conclusion/Implications/Recommendations: Telehomecare is equally beneficial for urban and rural patients with chronic heart failure. The improved process of care attributed to this patient management approach was associated with more emergency visits and hospital admissions. This is an indication that timely interventions are done, when needed, especially that the emergency visits appear to be correlated with hospital admissions.
140 Character Summary: There are no differential benefits associated with the use of telehomecare for rural versus urban patients with chronic heart failure.
OS21.04 - Supporting COPD Patients with Home Telemonitoring: Insights from TEC4Home (ID 479)
Purpose/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality that decreases patient quality-of-life and increases health system utilization due to frequent emergency department (ED) visits and hospitalizations. Supporting patients either before or after an exacerbation can optimize health outcomes. TEC4Home COPD is an evaluation to determine how home health monitoring (HHM) technology can better support patients with COPD at home, after leaving the hospital or clinic. The aim of TEC4Home COPD is to improve patient outcomes and quality-of-life, while also reducing ED readmissions and hospitalizations.
Methodology/Approach: In TEC4Home COPD patients, either in acute exacerbation or in stable condition, are provided with home telemonitoring. Participants are recruited from emergency departments, in-patient units, and out-patient clinics. Once enrolled, the HHM equipment a tablet, BP monitor, pulse oximeter, weight scale, and pedometer is delivered to the participants home. Participants are asked to submit their measurements every weekday, for 60 days. A monitoring nurse reviews the data and follows up with the patient and/or primary care provider when necessary. After 60 days, the patient is discharged from the service, and equipment is retrieved. To assess impact and outcomes, participants are asked to complete an enrollment (pre-) and completion (post-) survey. The surveys are comprised of various validated scales including the Veterans Rand 12 Item Health Survey; the Clinical COPD Questionnaire; the COPD Self-Efficacy Scale; a healthcare utilization survey; and the System and Use Survey. Surveys assess overall health and disease-specific quality of life, self-efficacy, healthcare utilization, and comfort with technology. Patient biometric data from the 60-day monitoring period is also analyzed to assess changes to the patients health outcomes (e.g., change in symptom severity). Follow-up surveys with the monitoring nurses are conducted to assess provider experience and feedback on the monitoring process, communication with patients and other healthcare providers, and to collect recommendations for improvements to the technology and service. Other providers a part of a patient participants circle of care (e.g., family doctor, respirologist, etc.) are invited to provide insight into the impact of home telemonitoring on their patient care. Hospital administrative data is used to assess utilization and cost outcomes.
Finding/Results: Enrollment is open until February 2018. Results and recommendations from the benefits evaluation will be shared at the eHealth conference. This study will contribute unique insights into home telemonitoring by: 1. Determining the efficacy of monitoring to help patients in exacerbations recover and to help stable patients avoid deterioration; 2. Comparing those in stable condition versus those recovering from exacerbations to identify similarities and differences in the use of home telemonitoring for COPD management; 3. Applying the triple aim framework to understand how home telemonitoring impacts patient experience, health outcomes, and costs in both groups of COPD patients.
Conclusion/Implications/Recommendations: This evaluation of home telemonitoring for the care of both COPD patients recovering from exacerbations and those in stable condition will generate insights into how best to deploy home telemonitoring in accordance with patients specific needs. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.
140 Character Summary: Better COPD outcomes: The benefits of home monitoring for enhanced patient quality-of-life, self-management & reduced healthcare utilization.
OS22 - Digital Health Big Data: Promises and Possibilities (ID 30)
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 3
- Coordinates: 5/29/2018, 13:00 - 14:00, Cambie Room, Conference Level
OS22.02 - Barriers to Testing Mitigated by an Online STI Testing Service (ID 311)
Purpose/Objectives: While rates of sexually transmitted infections (STI) continue to increase nationally, many people face known barriers to accessing testing for STI and HIV (e.g., clinic access, wait times, stigma, fear of judgement). Online STI testing programs are thought to reduce barriers associated with traditional in-clinic testing, though uptake could reflect social or technology gradients. In 2014, the BC Centre for Disease Control implemented a digital health intervention called GetCheckedOnline (GetCheckedOnline.com; GCO), which allows individuals to test for STI and HIV without the need to visit a clinic. To understand the types of barriers that may be mitigated by online STI testing, we compared clients of a large STI clinic in Vancouver, British Columbia, to clients of GCO.
Methodology/Approach: Our study was initiated one year after GCO was launched, during which time the service was promoted to STI clinic clients and men who have sex with men (MSM) in Vancouver. Clinic and GCO clients were invited to take an online survey two weeks after receiving their test results. Survey questions included barriers/facilitators of testing at individual, health care provider, clinic and societal levels.
Finding/Results: GCO clients were older than clinic clients and a higher proportion were MSM. More GCO clients reported their reason for testing as routine and fewer reported symptoms or being a contact to STI. More GCO clients considered accessing online health resources important, but otherwise did not differ from clinic clients on technology use or skills. GCO clients were more likely to report having delayed testing in the past year due to clinic distance, less likely to agree that clinic hours were convenient or that making appointments was easy, and more likely to report long wait times to see a health care provider. GCO clients were more likely to be uncomfortable discussing their sexual history with clinicians in general and where they usually went for health care, as well as more likely to fear being judged by clinicians. Table 1: Characteristics of STI clinic and GetCheckedOnline clients
Conclusion/Implications/Recommendations: Our study in a large urban setting suggests that online testing services may effectively engage individuals with barriers to testing, leading to increased uptake and frequency of testing and more timely diagnoses. Further evaluation to verify these findings in different geographic locations (e.g., suburban and rural settings) and populations is underway.
140 Character Summary: GetCheckedOnline, an online STI testing service in BC, mitigates the barriers that people face when accessing testing in traditional clinic-based environments.
OS22.03 - Health Data Integration to Enable System-Wide Palliative Care Analytics (ID 506)
Purpose/Objectives: In 2016, a provincial partnership, was formed to provide oversight on improving palliative care across the system. As this program establishes and matures, its data and analytics needs are evolving rapidly. Building a responsive analytics and informatics solution that can grow with the program is paramount. We wish to showcase our innovative approach to building a patient-centred data repository.
Methodology/Approach: Patients at the end-of-life receive care in many settings within the provincial health care system. We developed a data repository that links routinely collected health administrative data to better understand the patient throughout this journey. The complexity and diversity of this population presents a unique opportunity to design a patient-oriented data integration solution capable of linking patients at all stages in this journey. Our approach leverages learnings from the big data revolution, specifically around the concept of data lakes We implemented a multi-layered analytical data repository (figure 1), that enables analytics across the health system. Population-level data is imported from 13 health administrative data sources and individually cleansed and standardized. Next, concepts on health system utilization, disease identification algorithms, significant health events, treatments/interventions, assessment surveys results, co-morbidity scores and other important health information is defined and collated. Cohorts, such as the decedent and palliative cohorts, are easily derived from pre-implemented algorithms and are easily linked to the derived patient information to define analytical base tables (ABTs). ABTs are the primary data product used to support all measurement. For example, the Decedent Last Year of Life ABT supports regional reporting, scorecard development and predictive modeling.
Finding/Results: This data repository design has many benefits: ? Cohorts can be quickly derived from concepts. ? Concepts are persistent, validated and centrally governed. ? Data is housed in one environment, expediting data access and manipulation tasks. ? Centralized data and analytics workflows enables better collaboration between groups ? Data Quality and Metadata is centrally maintained. ? ABTs are the single source of truth; improving consistency, accuracy, time-to-results and encourages exploratory analysis. Leveraging the data repository has enabled: ? Rapid development of the decedent and palliative cohorts. ? Release of current state assessment within 5 months of initial request. ? A tool to provide regional profiles to the regions. ? Ongoing development and implementation of risk-prognostication tools. ? Insights through exploratory analytics and data science.
Conclusion/Implications/Recommendations: As part of a larger health system organization, we are leveraging many of the ideas developed in this proof-of-concept to modernize our information and analytics systems. The innovation and learnings are being adapted throughout our organizations information strategy with the goal of becoming more insights-driven.
140 Character Summary: Data driven decision making How an innovative new data repository is providing valuable insights into the palliative care needs of a provincial health system
OS22.04 - C<sup>3</sup> - Collaboration and Connection with eCASE<sup></sup> (ID 352)
Purpose/Objectives: eCASE supports patients in the community and streamlines the patient journey by connecting primary and specialty care through technology. As a complementary service to the successful RACE telephone advice line, eCASE allows primary care providers (PCPs) such as family physicians and nurse practitioners to submit non-urgent questions to participating specialty areas. Through the dr2dr website and mobile app, questions can include patient documentation such as a lab test or ECG to aid the specialist in providing informed advice, within a one week timeframe. The intention is for this advice to expand PCPs scope of practice, avoiding unnecessary specialist visits, and ensuring appropriate tests are ordered in advance of specialist visits when theyre needed.
Methodology/Approach: A phased implementation approach was taken, given the novelty of this care model and limited nature of this prototype. Expanding from a single specialty area, we leveraged the relationships formed through RACETM to include 6 additional specialties over the first 4 months. Similarly, access to the system was expanded across Vancouver Coastal and to Nurse Practitioners and Medical Residents over the course of the prototype. We worked closely with stakeholders from the Champlain BASE eConsultation service in Ottawa, through a collaborative delivered by the Canadian Foundation for Healthcare Improvement, to tailor our implementation approach.
Finding/Results: Data has been gathered through the dr2dr platform, as well as through surveys sent to the referring provider and consulting specialist after every conversation. 56% of conversations avoided a face-to-face referral, while 20% resulted in a previously unconsidered referral. eCASE was viewed positively by both primary care providers and specialists; when asked whether they would recommend eCASE to their colleagues, primary care providers averaged 4.4 on a 5-point scale from Strongly Disagree to Strongly Agree, while specialists averaged 4.1 on this same scale. Challenges related to fee codes for remuneration, and a sustainable technology to facilitate the conversations, are key to sustainability and are currently being addressed.
Conclusion/Implications/Recommendations: eCASE has proven effective at streamlining the patient journey by connecting providers through technology. Our metrics closely mirror those attained by the Champlain BASE service over their 7 years of operations, demonstrating the potential of this model in our local BC context. The eCASE team will resume the recruitment of additional specialty areas to provide greater value to primary care, and continue to socialize this model to community providers through further expansion. Specific change ideas will be generated through evaluation interviews with both primary care providers and specialists, and these will be implemented to the greatest degree possible over the next Phase of this project. Specifically, direct integration into provider EMRs would eliminate the need for these conversations to take place in a separate system, resulting in fewer necessary steps to ask a question or provide a response. We believe that this efficiency would serve to direct primary care providers away from referrals, and hence away from unnecessary patient transfers. The team is currently investigating ways to influence the implementation of fees, and embedding this process within providers existing systems.
140 Character Summary: eCASE is a non-urgent email advice service connecting primary care providers with specialists, which is effective at streamlining the patient journey.
PS04 - Health Information Systems: Making Gains (ID 31)
- Type: Panel Session
- Track: Executive
- Presentations: 3
- Coordinates: 5/29/2018, 13:00 - 14:00, Fairview III Room, Conference Level
PS04.01 - Successful HIMSS Stage 6 Clinical Transformation Enterprise Implementation – The Journey (ID 74)
Purpose/Objectives: Follow the journey of a successful HIMSS Stage 6 implementation in a large community hospital within the province of Ontario. From the initial vendor selection process guided by clinician input and engagement to the rapid 15-month implementation, the new electronic medical record (EMR) provided the opportunity for the organization to be transformative and innovative to further its smart hospital vision. Crucial to the process was establishing solid governance and guiding principles, as well as reinforcing that this was not an Information Technology (IT) project, but rather a clinical transformation project. This approach inspired members across the organization to believe in the project and contribute to its success.
Methodology/Approach: A rigorous project management framework was established to guide the work of the Project Team, which included subject matter experts, operational leadership and a skilled clinical informatics team. Together, they built a foundational system, based on demonstrated evidence, that allowed the hospital to build the first EMR of its kind in Canada and transform the way care is delivered in its community by adopting best practice functionality to improve the care of the patient. A state-of-the-art system, the EMR makes it possible for the care team to spend more time with patients, provides physicians with exactly what they need to make important health care decisions quicker and empowers patients with easy access to their health records. Although the project was challenging and presented a number of obstacles, the Project Team, with the exceptional support of the Executive Sponsor and Senior Leadership Team, maintained its clear focus throughout the journey. Engaging stakeholders both from within and outside the organization was paramount to the rapid success of adoption, fostering an all-hands-on-deck approach. A solid training and support plan was established. Help/Assistance for end users included Super Users, as well as At-The-Elbow Student Support, which provided staff and clinicians with the peace of mind and comfort that they were indeed supported through the whole process.
Finding/Results: One of the most rewarding benefits of the implementation was watching the project evolve from an IT project to a clinical transformation project fully supported by the hospital operations team. The adoption and acceptance of the new system by clinicians to the new system was swift, with the system becoming the new normal within weeks of it being launched. We have been able to achieve successful adoption rates including 87% CPOM, 92% BCMA (patients), 89% BCMA (medication) and 84% for Discharge Medication Reconciliation. Testament to the successful implementation is also the fact that the hospital received the EMR Adoption Model (EMRAM) Stage 6 designation from HIMSS Analytics within 32 days of Go-Live and life returned to the new normal very quickly. Following the successful implementation, planning has begun for the enhancement and optimization stage. This will help to ensure that the system continues to evolve and improve patient care, as well as contribute to the hospitals vision to create a world-class health experience.
140 Character Summary: Follow the journey of a successful Clinical Transformative HIMSS Stage 6 implementation in a large community hospital within the province of Ontario.
PS04.02 - Becoming a Data-Driven Organization: The Journey to HIMSS Stage 7 (ID 327)
Purpose/Objectives: Over the last five years, a leading Canadian mental health organization has transformed itself into a data-driven organization. The purpose of this presentation is to provide an overview of the strategic and tactical elements used for this transformation and the results of these endeavors. This presentation will be given in the context of a Journey to HIMSS EMRAM Stage 7, which was achieved in June 2017.
Methodology/Approach: The transformation to a data-driven organization began with the implementation of its clinical information system (CIS). The implementation of dashboards and a revitalized data analytics model has allowed information generated within the CIS to be used in research and quality improvement initiatives. Many other approaches were also used. Specifically, the implementation of computerized provider order entry (CPOE) has provided data to support research, quality improvement, and patient care initiatives. Closed loop medication administration was implemented in an effort to reduce preventable medication errors and improve patient outcomes. A Suicide Risk Dashboard was created that allows clinicians to view information about care plans and assessments for each patient. Care plan tasking ensured that automatic tasks were suggested for patients with a high or moderate risk for suicidality. Physician alerts / risk flags implemented include drug-drug interactions, drug-allergy interactions, cumulative dosage, and others. Clozapine-induced myocarditis monitoring and prevention protocols were deployed for all patients initiated on clozapine to reduce the risk of serious complications associated with Clozapine administration.
Finding/Results: New incidence rates of Clozapine-induced myocarditis were determined. Eighteen patients were removed from Clozapine due to early warning signs of myocarditis. Orders data has supported research activities and provides accountability for providers. CPOE rates have been over 90% since December 2016. Medication errors are decreased as providers have discrete order options. Over 90% of patients have a suicide risk assessment completed within 24 hours of admission. Over 85% of patients showing a high or moderate risk for suicidality have a care plan created compared to 20% prior to interventions. Alerts are reviewed by an interprofessional team when overridden by an ordering provider. Drug-allergy and care planning alerts have changed practice by providing additional information. Medication scanning rates have been above 95% since December 2016. The number of scanning-related medication administration alerts has increased while self-reported preventable medication errors have decreased. High quality data for research studies and quality improvement initiatives is readily available to researchers, clinicians, and quality improvement professionals. This information can be used to track the performance of quality improvement initiatives. A capstone outcome has been the achievement of HIMSS EMRAM Stage 7, an environment where paper charts are no longer used.
Conclusion/Implications/Recommendations: Implementation of a CIS must be clinician-driven to drive effective care practices and adoption. A value-driven approach to data collection and use is necessary to ensure that improvements and practice changes are realized. It is important to initiate an organizational culture shift prior to initiatives when shifting into a data-driven model. The organization has positioned itself with the complete vision to lead this paradigm shift into the future where there will be a true integration of care, research, and education.
140 Character Summary: A leading mental health hospital has transformed into a data-driven organization. Strategic and tactical elements driving the transformation will be discussed.
PS04.03 - Varying Perspectives - Rapid HIS Implementation an Academic Teaching Hospital (ID 238)
Purpose/Objectives: In October 2016 SJHH formally kicked off project Dovetale - the movement of the hospital from a primarily paper based environment (HIMSS EMRAM 1.29) to a fully electronic environment. During this panel presentation, members of the SJHH implementation team will review - A litte goes a long way - Opportunities for Standardization and other pre-initiation activities that pay off in dividends during a rapid install - Who moved my paper? - Reaching the masses and tailoring change management approaches for all system users. - Keeping up with the Intakes - Implementation approaches for teaching hospitals - what worked, what would we change. - A Focus on Bench to Bedside - Designing a system for an Academic Research Environment - Its Time for Results! - A Benefits Driven implementation was our matra - we will return to present our outcomes achieved (our approach with a benefits driven install was previously presented at EHealth 2016 and 2017)
Methodology/Approach: The change initiative at St. Joe's was rapid and big bang requiring a different approach to project planning and change management. We began this journey by clearly defining our project scope and objectives which lead to the creation of our project governance structure and establishment of our project and decicion making guiding principles. Both of these were invaluable in achieving our identified level of standardization, guided our system configuration, supported our research driven data rich focus and change management benefits driven implementation approach. Leveraging the Epic lessons learned and standardized templates, St. Joe's customized processes to our organization's specific needs and pushed the boundaries of typical project processes with creative ways of engaging all levels of the organization. Our cross functional interdisciplinary teams, benefits focused approach and strong executive leadership lead us to a successful go-live in a mere 13 months.
Finding/Results: St. Joe's is 44 days to go-live at the time of this submission. Our governance structure and decision making guiding principles have been used to ensure our system has been standardized where possible to best practices, developed to ensure rich data collection for use by research and aligns with our organizational best practice and priorities specifically excellence in patient care using data and research driven approaches to quality of care. Our change management strategy has empowered our front line staff to become change leaders and has pushed us as an organization to learn new ways of engaging our staff and leveraging their expertise and passion. At the time of presentation, we will be able to confirm our successful implementation and will be working towards our HIMSS level 7 designation.
Conclusion/Implications/Recommendations: At the time of presentation we will have successfully implemented across all inpatient areas, our urgent care and emergency departments. We will be part way through our project's post-live optimization phase and working towards our HIMSS level 7 designation. We will share real lessons learned and strategies for succussful implementations using a big bang approach in an academic and research focused teaching hospital and join one of the few fully digital healthcare organizations in Canada.
140 Character Summary: Focus of our panel discussion is to provide the perspectives of our project leadership team on how were were able to achieve project success from varying perspectives
RF07 - Techniques to Accelerate Innovation (ID 28)
- Type: Rapid Fire Session
- Track: Health Business Process
- Presentations: 6
- Coordinates: 5/29/2018, 13:00 - 14:00, Fairview I Room, Conference Level
RF07.01 - Staying Agile in HCIS Development (ID 511)
Purpose/Objectives: To describe the creation and development of electronic documentation for clinicians following an agile philosophy that was adapted for use for a large organization with multiple stakeholders. We will review the process, outcomes, successes and lessons learned. In November 2016, the Fraser Health Authority (FHA) implemented electronic documentation at Abbotsford Regional Hospital and Cancer Centre. This was part of a large-scale project called the Integrated Plan of Care (IPOC) and began in 2015. The IPOC project involved multiple stakeholders and the utilization of many resources.
Methodology/Approach: The IPOC project required iterative development with frequent inspection and adaptation, so an agile approach was needed. This philosophy also promotes a leadership style that fosters teamwork and accountability. Agile principles were applied to the IPOC project, with a breakdown of work into sprints and scrums. A sprint is a set period of time during which a defined package of work needs to be completed. A scrum is a short meeting that includes the design and build team to review progress and identify obstacles. In the IPOC, a sprint was the development of each clinical departments documentation with the following phases: an opening day, daily or every second day scrums until complete, and a closing day. Each phase followed a pre-determined script for consistency from one sprint to another. Each sprint consisted of the preliminary build, quality assurance review, final build, stakeholder testing, e-safety and data integrity review.
Finding/Results: Utilizing an agile philosophy for the IPOC project allowed us to identify a large percentage of documentation requirements early in the build, provided a platform for rapid development and accommodated unexpected changes. This also facilitated the detailed tracking of the build progress, and created opportunities for team members to connect on a regular basis with their clinical counterparts. Findings/Results include, but are not limited to: - Resourcing the build with part time staff or staff that had additional duties were a detriment as the project could not maintain the philosophy of an agile process. - Stakeholders reviewing the electronic documentation build need to be engaged as delayed response time slowed down the development cycles. - Unclear role definitions and expectations lead to assumptions around task responsibility and lack of communication. - Lack of predetermined build practices and not following naming convention guidelines and processes lead to inconsistency in product and frequent rebuilds.
Conclusion/Implications/Recommendations: Using an agile philosophy in the IPOC project to implement electronic documentation contributed to the success of the project. Our recommendations include: use of an agile philosophy for informatics projects; ensure staff are dedicated solely to the project during the build, ensure roles and expectations are clearly defined, clearly define build practices and naming conventions and to guarantee stakeholders are engaged with defined timelines for feedback in order to keep the development cycles on track.
140 Character Summary: To describe the creation and development of electronic documentation for clinicians following an agile philosophy that was adapted for use for a large organization with multiple stakeholders. We will review the process, outcomes, successes and lessons learned.
RF07.02 - Designing and Embedding Telemonitoring in an Integrated Care Model (ID 148)
Purpose/Objectives: Chronic care continues to be focused on single conditions treated individually, often without consideration of greater complex multi-morbidity needs. In-between appointments, patients are left to provide self-care, as well as manage and monitor their health. An opportunity has arisen to address the challenges that patients with multiple chronic conditions (MCCs) face by combining the two innovations: telemonitoring and an integrated complex medicine clinic (CMC). The objective of this novel team-based clinic is to integrate care and stabilize ailing patients with MCCs by bringing together clinicians to create a comprehensive care plan. William Osler Health System (WOHS) is in the process of creating this integrated CMC model. In terms of the telemonitoring, patients will be able to monitor their chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patients ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. Furthermore, health professionals can track patient status through physiological readings in-between appointment visits. The aim of this study is to conduct a needs assessment to inform the design and implementation of telemonitoring into an integrated care setting for patients with MCCs.
Methodology/Approach: A qualitative case study was undertaken to determine how to design and integrate telemonitoring into the development of an integrated CMC model at William Osler. Semi-structured interviews were conducted to determine the specific needs and requirements, desired workflow, and anticipated challenges of implementing telemonitoring in this model. Patients and healthcare professionals were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their work, clinical pathways, perspectives and challenges around managing MCCs, as well as their needs and preferences for development of the CMC model and telemonitoring system.
Finding/Results: Six patients and ten care team members (including administrators, clinicians, and allied health staff) were interviewed to reach saturation at WOHS. Preliminary analysis indicates interviewees are positive about the opportunities for telemonitoring in this new clinic model but have common concerns related to affordability and digital literacy. Patient interviewees are particularly interested in how telemonitoring could improve their health and symptoms under more consistent monitoring by multiple health care professionals in one place, communicating seamlessly. Interestingly, most respondents view this integrated model as a bridge from hospital to family medicine in order to stabilize complex care needs effectively. Finally, interviewees indicated the nurse or the nurse practitioner should be responsible for monitoring alerts generated by the telemonitoring application. A preliminary workflow map for the CMC has been distributed for stakeholder-review. Once the workflow map is approved and operationalized in the model, the telemonitoring system will be embedded within this novel workflow design.
Conclusion/Implications/Recommendations: Based on this research, a six-month mix methods pilot study will be undertaken to determine the feasibility of implementing the telemonitoring system into the CMC model. The potential impact of this research includes a sustained program combining telemonitoring within the integrated model that improves health outcomes, reduces healthcare utilization costs and is scalable to other healthcare institutions.
140 Character Summary: Telemonitoring in an integrated care clinic presents an opportunity to design and develop a novel care delivery model for patients with complex chronic conditions.
RF07.03 - Spread of HIT Innovations: Social Franchising Applied to eConsultation Services (ID 450)
Purpose/Objectives: The Canadian healthcare system has witnessed extensive innovation activity in recent years, but the system has been caught in a perpetual cycle of pilot projects, which precluded spreading and scaling up of potentially relevant and important innovations. Social franchising represents a governance and operating model that has been widely used to support the quick and successful scaling up of certain types of social initiatives. This project presents an overview of social franchising in general, and in the context of health care, discusses its applicability to health IT innovations, and proposes a governance and operational framework based on this model for the Champlain BASE eConsultation program.
Methodology/Approach: A literature review on social franchising was performed to evaluate this model in non-healthcare and healthcare realms. A general search was performed in electronic databases (e.g. Medline (Ovid), ProQuest, Scopus) to identify relevant peer-reviewed articles on social franchising and gauge the scope of research. The initial search of the term social franchising yielded 438 hits, after which the yields were narrowed using more specific search terms (e.g., social franchising and health). Three systematic reviews on social franchising were identified in the process. Grey literature was used to supplement the use of social franchising in healthcare and non-health industries by filtering through organizations websites and news articles.
Finding/Results: Social franchising has been enthusiastically embraced internationally in healthcare and non-healthcare industries. Peer-reviewed articles related to social franchising and healthcare generally presented low quality evidence and concentrated around patient outcomes in family planning and reproductive health programs implemented in low- and middle-income countries. Articles related to social franchising in high-income countries were largely absent. Overall, the lack of high quality peer-reviewed articles is due to the recent advent of this model. While the evidence is still scarce on the effectiveness of this model, there were strengths consistent across the articles. When used appropriately, social franchising has shown to increase patient satisfaction and program accessibility with the most impressive strength being its proven ability to rapidly spread programs in the healthcare sector without sacrificing quality. A National BASETM governance model is proposed for the Champlain BASETM program, using social franchising as the key linkage mechanism between the governing National BASETM Committee (franchisor) and the provincial franchisees.
Conclusion/Implications/Recommendations: Social franchising is now the fastest growing approach of healthcare in low- and middle-income countries. Healthcare systems in high-income countries, such as the UK, Germany, Australia, and Denmark are taking notice and are beginning to experiment with the model as well. HIT innovation in Canada cannot be unleashed until the barrier of fragmentation is overcome. Social franchising has not been diversely tested within the healthcare industry, but with the strengths this model has shown in the healthcare systems of low- and middle-income countries and in non-health industries, this model appears to present opportunities that may benefit the healthcare system in Canada. The Champlain BASETM team and the Canadian healthcare system should consider the model as a viable governance and operating framework to scale and spread innovative health IT programs.
140 Character Summary: Social franchising can overcome healthcare fragmentation and scale and spread HIT innovation. An application to the Champlain BASE project is conceptualized.
RF07.04 - The Future State of Technology in Home and Community Care (ID 19)
Purpose/Objectives: This research and resulting report was focused on the current state, gaps and the optimal state of the use of health IT to access patient records and provide care to the home and community sector. The perspective that the research tool was on the end user consumer. The research was conducted nationwide with providers from National Home Care Agencies, Hospitals, Health Regions, LHINs, CCACs, and other speciality organizations including Ministry
Methodology/Approach: This session explored the current state, gaps & the optimal state of health IT to access patient records and provide care to the home and community sector. Respondents provided advice on key considerations to success in this sector/ The Think Tank Series brought together leaders in the Home and Community sector and represented organizations including LHINs, CCACs, hospitals, home care agencies and speciality care organizations.
Finding/Results: The Tectonic Think Tank found many pockets of excellence in home and community care, technologies created within the system out of necessity, led by organizations committed to providing quality care to the families they serve. These technologies are implemented on such a small scale that they cannot contribute in a meaningful way to the system-wide culture shift needed to ensure a high-performing system that is truly client and family-centered. 6 Key recommendations were made that focused on the role such as Mobile, Telehealth, Virtual Care, Cloud, Blockchain and Leveraging current assets provided by multiple stakeholders Implementation of all of the recommendations can begin immediately, and most can be fully implemented within the medium term.
Conclusion/Implications/Recommendations: The following themes emerged from the research Theme 1: Client and Family-Centered Care as well as Personal Care Theme 2: Support for Family Caregivers Theme 3: A Basket of Services Theme 4: Capacity Planning & Bundled Payments Theme 5: Primary Care Theme 6: Increased Accountability for Performance The Tectonic Think Tank found many pockets of excellence in home and community care in Ontario, technologies created within the system out of necessity, led by many individuals and organizations committed to providing quality care to the families they serve. However, these technologies are often implemented on such a small scale that they cannot contribute in a meaningful way to the system-wide culture shift needed to ensure a high-performing system that is truly client and family-centered. These technologies need to be scaled and aligned. The challenge is to fully define family-centered care and how the system can best support clients and families in the community. There is a need to ensure accountability for delivering a high-performing home and community care sector in Ontario as a pre-requisite. Leverage current assets to support family-centered care and the circle of care in that role and introduce thought funding and innovation technology such as Mobile, Telehealth, and Virtual Care solutions. LHIN Reform lets hope it works! Debate - Should technology be paid for by the public sectors or be positioned as a differentiator for homecare provider agencies competing for LHIN contracts. Fix the procurement problem in Ontario and in the rest of Canada!
140 Character Summary: Tectonic found pockets of excellence, technologies created out of necessity, assessing the current state vs future state, where scale & spread was identified.
RF07.05 - Hamilton Health's Ecosphere Pipeline for Digital Technology: Calling All Innovators (ID 138)
Purpose/Objectives: One of the biggest challenges that health care startups face is gaining access to the health care environment while they are developing their products, in order to gain insight and feedback from end-users. How does a hospital build an innovation pipeline for health technology start ups? How can hospitals help accelerate commercialization, and create a market for the adoption, procurement and diffusion of these solutions? In the fall of 2017, Hamilton Health Sciences embarked on the Health Ecosphere project to create a launchpad for technology solutions that have the potential to transform the health care system. Hear the story of how the Hamilton Health Ecosphere curated innovative solutions directly related to our enterprise needs, and embedded them within our hospitals so that we could play a role in shaping the technology to best benefit our patients and the health care sector.
Methodology/Approach: Our Health Ecosphere projects were grounded in mutually beneficial partnerships to health care providers, patients, and families. A common thread ran through these partnerships: a positive patient experience through technology. To begin, the Hamilton Health Ecosphere defined our requirements, and then put out a call to entrepreneurs for expressions of interest. We requested that they outline their solution, and provide an overview of themselves, their business, and their innovation. Selected entrepreneurs presented their innovative technology at a Health Ecosphere event, where we had the opportunity to listen to each company's pitch. After the event, we selected entrepreneurs to introduce to our clinical teams at Hamilton Health Sciences. Companies selected include Cloud DX, who have developed a connected health solution that provides a better way of collecting vital signs remotely, unifying the clinical and home monitoring experience, and shortening the patient length of stay. mHealth Solutions utilizes a holster to more consistently monitor post-operative patients, while also allowing suitable patients to be discharged from the hospital within 24 hours. GeneBlueprint empowers users with the ability to access, understand, and benefit from knowledge of their personal genetics so they can live healthier lives through personalized fitness and nutrition plans, while HealthQR simplifies medication management by connecting the patient, and their medical records, directly to nearby pharmacies through a mobile application. Each company's solution addressed a component of the patient journey, and leveraged technology to enhance and elevate the patient experience and overall patient outcome.
Finding/Results: Our project is still underway. We anticipate that bringing researchers together with businesses to develop technologies that can help coordinate care across systems that previously operated in silos will be of benefit to both patients and the health care system.
Conclusion/Implications/Recommendations: We are using leading practice to evaluate the benefits of the project, referencing Canada Health Infoway's Benefits Realization Framework. We have integrated a benefits evaluation plan into our project plan to ensure alignment. Given current fiscal pressures, hospitals face a strategic imperative to consider fundamental changes to their operating model. Leveraging technology to enhance and elevate the patient experience and overall patient outcomes will be a component of this transformation.
140 Character Summary: Hear the story of how the Hamilton Health Ecosphere curated innovative technology solutions related to our enterprise needs and embedded them within our hospitals.
RF07.06 - Delivering Digital Solutions, Leveraging Expertise and Existing Solutions Across Ontario (ID 436)
Purpose/Objectives: The delivery of the Specialists and Community Services Directory empowers primary care providers (PCPs) in Central Toronto region to access up-to-date information on specialty and community support resources, so patients are directed to the right care in a timely fashion. This project involved working with local primary care providers and five organizations a delivery partner, regional health authority sponsor and three provincial solution providers. The success of the project depended on the ability of stakeholders to form an effective partnership and work towards a common goal of delivering an online Directory to PCPs across the Toronto region. For this presentation, the project delivery partner will demonstrate the unique engagement approach that facilitated collaborative design, development and implementation of the Specialists and Community Services Directory.
Methodology/Approach: To construct the delivery partnership, the project team created an environment conducive to collaboration. Stakeholder engagement took place in a variety of formats and at three levels. Local At the local level, engagement objectives included understanding PCP needs to inform requirements and enlisting volunteers for co-design and development of the solution. To secure time in PCPs busy schedules, various methods were applied to encourage active participation of local providers across Toronto. These methods included in-person meeting presentations and interviews, as well as electronic engagements. Regional At the regional level, working collaboratively with the regional health authority and primary care physician leads proved crucial to project decision-making. This group was kept informed to help understand and respond to project developments as they unfolded. A governance model was established to enable the project team to leverage existing regional committees and forums to provide updates, garner advice and/or obtain approval on recommendations. Provincial At the provincial level, working with three provincial solution providers required clearly defined roles, understanding of each partners needs and capabilities, and shared goals. Delivering a solution aligned with PCP needs was at the core of the partnership. Consultation with solution providers in the early planning stages, involvement in decision-making processes and ongoing engagement throughout the project were instrumental to project success.
Finding/Results: By forming strategic partnerships at all levels, establishing a common goal and converging expertise of partners, we were able to meet project objectives. Local PCPs contributed to developing business requirements and actively participated in the solution design process. The regional decision-making body was instrumental in providing project oversight including the selection of solution providers. As a result, partners worked together in harmony to develop and implement the Directory for PCPs.
Conclusion/Implications/Recommendations: Participants at this session will learn about the engagement approach to facilitate collaborative design, development and implementation of the Specialists and Community Services Directory. In addition, insights will be shared regarding early benefits and lessons learned from the initial implementation efforts.
140 Character Summary: Robust engagement efforts at local, regional and provincial levels contributed to the success of implementing the Specialists and Community Services Directory