Purpose/Objectives:
Timothy Caulfield wrote a powerful critique of ill informed celebrities reshaping public opinion on health and health care. He titled his book Gwyneth Paltrow is Wrong About Everything. Professor Caulfield has 30,991 twitter followers. Gwyneth Paltrow’s has 2.9 million twitter followers.

In a social media age where the American President with 20 million twitter followers makes public policy by tweet, how can health and healthcare be based on evidence and knowledge.

How can dangerous ideas such as the anti-vaccine movement be counted and repelled?

As technology is ramping up its disruption of healthcare, artificial intelligence (AI) can play a huge role in solving many high cost healthcare problems. The FDA recently set up a new division with AI expertise. and permitted the marketing of an AI based medical device. At first, most of the approvals will likely be analytics that assist doctors but in certain cases the AI will be allowed to provide diagnostics. Radiology is seen as ripe for disruption by AI.

The role of eHealth is essential. If health care providers are to make evidence based decisions as well as combatting fake health news they need real time access to both evidence and to patient level information. Canada has made a large investment in eHealth and evidence at all levels of the healthcare system. The next few years will be a time of delivering the results to providers and most importantly to patients. As the Boomer generation increases its contact with the health services system due to chronic disease they will be seeking a much more informed journey. Boomers also come equipped with Iphones and an addiction to the eWorld. They are surprised when a physician or pharmacist in Canada faxes their prescription. Will we be able to deliver that informed journey and supported patient journey that they expect?

Michael Decter will base his presentation on his three decades of experience as Ontario Deputy Minster of Health, Chair of CIHI and the Health Council of Canada as well as Chair of Saint Elizabeth Healthcare. His recent experience as Chair of Patients Canada, Medavie Blue Cross and Ontario SPOR-OSSU will also be drawn upon.

He will explore this challenge with humour, wit and optimism. Yes there are reasons for hope- yes the Internet is not all false news and yes we as a species are getting healthier on a global basis due to better evidence and better communication. And there is much to be done by the eHealth community to support our progress.

Purpose/Objectives:
With digital health journey advanced, number of new applications and computing devices increases dramatically and so does support demand. Hospital IT support team is facing a number of challenges in maintaining the SLA (Service Level Agreement) and struggles to do more with the same level of resources on hand. At North York General Hospital (NYGH) Information Services Helpdesk (IS Helpdesk), compliance rate of SLA drops below 60% and the team requires 25% more FTE to keep up the demand at its peak time. Hospital users waited much longer in receiving the support or getting their working devices back. Patient care is suffering and directly impacted ? delayed or sometimes cancelled. Will be sharing with audiences on what methodology/innovated solutions were developed and implemented; how the team went from 25% under-resourced to giving back 6600 hours to patient care; and how they turned IT support from largely reactive mode to more consistent proactive actions.


Methodology/Approach:
NYGH IS Helpdesk has implemented many innovated solutions, highlighted solutions in last 18 months below. 1. Shift Left Methodology: Shift-left for the IT Helpdesk is the movement of IT support closer to the operational frontline and the end user/customer. 2. Walk-in Support Centre: A community focal point that bridges the gap between hospital personnel and traditional IT support (level 0 and level 1). 3. Preventive Maintenance (PM): Time spending on Preventive Maintenance is much less than the time spending on recovering a system after an incident. 4. Scan to reset password: an in-house tool was developed and equipped at the Walk-in support centre aiming to cut down the password reset process from minutes to seconds. By scanning a hospital badge, staff can obtain a new password and come back to their normal duty in 30 seconds.


Finding/Results:
- System incidents has dropped more than 550 tickets every month (23%) from its peak time. - IS Helpdesk team shifts its workforce from Incident Resolution (drop from 58% to 37.5%) to Proactive Maintenance (increase from 0% to 20.8%). - Phone support is among the top performers comparing to other professional support centres: Item Professional Support Centre NYGH IS Helpdesk Average Speed to Answer 28 secs 14 secs Abandon Rate 8% 7% Call Duration 4 mins 3.05 mins Percentage of Password Reset Calls 33% 4%


Conclusion/Implications/Recommendations:
This presentation provides quick tips, pros & cons, and lessons learned from NYGH?s experiences. Audience takes away a solution of improving employee productivity, increasing efficiency and enabling innovation & value creation in the healthcare environment.


140 Character Summary:
Technology is the backbone of digital health. IT teams can get from this session on how to keep innovating solutions and show the values to the senior leadership team.

Purpose/Objectives:
CHRISTUS implemented computer workstation single sign-on (SSO) in 19 community hospitals. SSO technology utilizes a badge reader placed at each workstation where clinicians ?tap? their identification badges for expedited access to the EHR and related software. Executive management at CHRISTUS had expressed concerns about the costs and value of SSO implementation, thus a team assessed how much impact, if any, SSO was having on clinician workflow, efficiency, and value.


Methodology/Approach:
Following implementation of SSO, login time duration was sampled systematically in 128 logins during a 7 day period across 8 hospitals selected randomly from 19 facilities, one from each of the 8 regions within the CHRISTUS enterprise. Mean first of shift login duration and mean reconnect login duration was compared to durations pre-SSO implementation. Dollar values of time saved were assigned to 3 groups of clinical end users: physicians, nurses and ancillary service providers. Total per facility and enterprise-wide clinician time liberated from keyboard are reported in hours and dollars saved per week and per annum.


Finding/Results:
Following SSO implementation, first of shift login was reduced by 5.3 seconds and reconnect login duration in the balance of the shift was reduced 20.4 seconds. Total weekly time savings enabled by SSO was 943.4 hours across 19 hospitals, a mean of 49.7 per facility. Annually, 49,056.8 hours of mixed clinician time was liberated from keyboard, a mean of 2584.4 hours per facility per year. The annual dollar value of clinician time liberated from keyboard was $3,201,001 and $168,474 per hospital per annum.


Conclusion/Implications/Recommendations:
A critical implementation lesson learned was the recognition that in order to achieve the best performance of SSO technology, migration to the cloud and a virtual desktop with a thin client should be considered before implementation. In these 19 hospitals, SSO is an effective and highly cost-effective method to liberate clinician time from repetitive, time consuming logins, and delivered real, meaningful liberation of clinicians from keyboard. The recurrent, ongoing annual dollar value of this time liberated by SSO for clinicians to focus on providing patient care exceeded the one time initial implementation costs of SSO, and far exceeded its recurrent annual cost to the system.


140 Character Summary:
CHRISTUS Health?s new computer workstation single sign-on (SSO) platform reduced clinician log-in time, improved workflow, and delivered bottom-line savings.

Purpose/Objectives:
The goal is to make working rounds efficient, to share relevant data with the team more effectively, to process the data and arrive at diagnostic and therapeutic considerations for each patient every day in a more timely manner than presently implemented.


Methodology/Approach:
Clinical (?work?) rounds, can take anywhere from 3-4hrs in length depending upon the complexity and the number of patients being managed by the medical team. The primary goal is for the central core of providers to use distribution or sharing of cognition to create and follow a plan for each patient while giving effective continuity of care. Multiple levels of staff will have obtained data from: a) sign-out from covering house staff, b) review of paper and EMR; and, c) direct questioning and examination of the patient. We propose to increase efficiency and effectiveness of walking rounds, through a simple modification of existing hardware tools used during rounds, i.e. the mobile battery powered EMR computer carts, found in most hospitals today. Modifications include; the addition of a digital projector for projecting onto existing walls or curtains and/or by adding dual 30? monitors to the cart. In addition to the hardware modifications, the creation and use of a web application will be designed to navigate the EMR by creating a simple face-sheet in an easy to read user interface (UI) with all pertinent information laid out using the space available intelligently.


Finding/Results:
Working memory has limitations, EMR tools will assist in the process. One of the tools most commonly utilized during rounds is a battery powered mobile computer cart for EMR access. There are several restrictions and limitations with this approach including; a) suboptimal computer arrangement ? with screen size limitations and; b) requirement to have most meaningful data held in working memory, c) fragmented nature of rounds, with multiple distractions and interruptions, and, d) lack of closure relating to patient plans. These changes will accomplish multiple goals; increasing actual image size allows for easier reading and sharing of information in a group setting; visual representation of relevant information cuts redundant and inappropriate information from the EMR during rounds, and including visual memory tools and cues i.e. a picture of the patient and other types relevant infographics make for better working memory utilization.


Conclusion/Implications/Recommendations:
Ultimately, we predict these changes will ease the cognitive burdens on the clinical team, reduce medical error and improve the quality of patient care. Multiple problems may arise in this type of public sharing of information including possible HIPAA concerns and social ramifications and will be addressed in the poster.


140 Character Summary:
Shared cognition tool to increase efficiency, share relevant data effectively, diagnose & arrive at therapeutic considerations in the most timely manner.

Purpose/Objectives:
Canada?s health sector is increasingly relying on the adoption and successful use of information and communication technologies (ICT) in all care settings. Therefore, care providers, such as registered nurses, must possess the required knowledge and skills to effectively utilize digital health tools in the provision of safe, quality patient care in today?s technology intensive clinical settings. As the largest group of care providers in Canada, the development of core digital health competencies among practicing and future registered nurses is of the utmost priority. The purposes of this study were to: (1) describe the current state of Canadian nurse educator integration of digital health in nursing education and the current state of digital health content integration into nursing curricula, (2) to understand needs of nurse educators in promoting their capacity and future development of digital health integration, (3) to identify teaching and learning exemplars of digital health integration in nursing curricula, and (4) to identify recommendations for advancing the development of informatics and digital health in nursing education.


Methodology/Approach:
Research questions were addressed using multiple methods including surveys, telephone interviews, and a focus group; target participants included nursing educators and administrators within Canadian schools of nursing.


Finding/Results:
The results depict the current state of digital health content integration in nursing curricula in Canada and identify nurse educators? capacity to integrate and utilize this content, and the impact of efforts to increase nurse educators? capacity in informatics to date. The qualitative and quantitative findings from this study indicate that a number of schools of nursing have incorporated informatics content within their basic curricula, while others offer elective courses at the graduate and undergraduate level, and the remainder provide little to no content in any of their nursing programs. These discrepancies exist even though Canadian core nursing informatics competencies for new graduates have been available since 2012.


Conclusion/Implications/Recommendations:
Recommendations for next steps in faculty and pedagogical development needed to further advance the curricular integration of digital health will be discussed. This study was made possible through the support of Canada Health Infoway and the Canadian Association of Schools of Nursing.


140 Character Summary:
Findings from a national study of digital health curricular content and faculty capacity in Canadian schools of nursing will be discussed.

Purpose/Objectives:
eHealth Ontario helps health care stakeholders integrate with provincial digital health solutions. This session introduces eHealth Ontario?s Innovation Lab, discussing how the lab has grown since inception, its promotion of innovation in Ontario what we have learned and our vision for the future.


Methodology/Approach:
The lab was built to help eHealth Ontario drive risk out of our own technology projects. Along our journey, we recognized the opportunity to enable innovation on a broader scale. The approaches used for growing the Innovation lab include: Cast a wide net. Attract talent that is interested in health care, but is unfamiliar with health care-specific standards and protocols. Offer various services which enable knowledge transfer: Lite Services are designed for anyone to access high value interactions for proof of concept, garnering initial clinical and financial support. These are for ?getting started? and freely accessible. Specs and Standards documentation which provides pertinent information to innovators in a central location Code Sharing allows innovators to repurpose work which has been successfully tested, it is also a platform for near-real-time feedback from the development community Discussion board empowers innovators to have conversations with their peers enabling support, shared lessons learned, and a gathering point for innovators. Keeping in step with Healthcare technology trends Introduction of the FHIR (Fast Healthcare Interoperability Resource) standard for a number of our assets Introduction of Innovation Lab 2.0 in support of eHealth Ontario?s new technology modernization priorities (Cloud, API Management, web viewlets, containerization, modernized data holdings) to expedite development, prototyping, and conformance testing.


Finding/Results:
There are currently over 800 registered users from the vendor community, academic institutions, small incubators, and teaching hospitals using the Innovation Lab Through feedback from Innovation Lab users, and building on the services of Mohawk College?s Mohawk eHealth Development and Innovation Centre (MEDIC) and workshops with stakeholders, we discovered the following: - Numerous organizations across Canada (from individuals to large academic institutions) have used the various Innovation Lab services to familiarize themselves with the healthcare space, interact with fellow developers, use code that has already been complied, as well as build and validate Proof of Concept - 1500 site visits per month - 11 code project shared with 3600 combined views


Conclusion/Implications/Recommendations:
Our ?start small and grow? approach has allowed us to fund the lab with a modest budget and experience success from our initial services. Moving forward, the Lab will evolve to keep pace with modern services and upgraded technology to empower innovators. The Lab will take advantage of cloud services to consistency benefit from new technologies and seamless hosting. APIs, common elements, containerization, Kafka solutions will be employed to keep pace with IT developments. Most importantly, we will continue to engage stakeholders from across the province to develop a consortium community for the Lab, where all parties feel part of the solution. Partnerships with other EHR service providers are key. Nobody owns technology innovation; much like the Lab it should be open, transparent and collaborative.


140 Character Summary:
eHealth Ontario?s Innovation Lab our open digital health sandbox, enables ehealth solution testing in a virtual environment to prototype new ideas.

Purpose/Objectives:
Patients requiring specialist care in Canada often face poor access and excessive wait times which can lead to patient stress, missed appointments, and ultimately, poorer health outcomes. The implementation of innovative e-Health technology such as electronic consultation (eConsult) and referral (eReferral) systems has aimed to improve access and reduce wait times for specialist care. Electronic consultation allows the specialist to give advice to the primary care physician through an electronic platform, often without the need for a face-to-face visit. Electronic referral is the automation of the referral process allowing for the secure exchange of patient information. In this presentation, we examine what private and publically funded services are available in Canada and compare their operations in the context of the Canadian healthcare system.


Methodology/Approach:
An environmental scan consisting of 2 stages was conducted in Fall 2018. First, a grey literature search was performed using four different search engines (Google, Duckduckgo, iOS App Store, Google Play Store) using an established keyword matrix. The next stage of the environmental scan is a key informant interview. From the stakeholders that the grey literature search generated, a list of potential interview candidates was created and contacts were emailed. Maximum variation sampling was employed to ensure sufficient breadth of participant experience. Semi-structured interviews are currently being conducted over the phone using a guide based off of the RE-AIM framework. We will then conduct a qualitative review of interview transcripts using a thematic synthesis approach.


Finding/Results:
The grey literature search yielded 24 systems offering eConsult services and 15 systems offering eReferral in Canada. Ontario had the most eConsult (29%) and eReferral (67%) services followed by Alberta (25% and 20%, respectively). Private vendors comprised 42% of eConsult systems and 60% of eReferral systems. The most common technology platform utilized was web-based for both eConsult (78%) and eReferral (60%). There were 4 service providers (11%) who offered both eConsult and eReferral services. Interviews are currently underway. Full analysis of recurring themes will be completed prior to the presentation.


Conclusion/Implications/Recommendations:
The potential of eConsult and eReferral systems to improve access and patient satisfaction have been recognized across Canada with the emergence of new and innovative services. The Canadian healthcare climate has the capacity to support both public and private systems. Further analysis into the state of eConsult and eReferral services is needed to guide decisions around integration of the two services and appropriate spread and scale.


140 Character Summary:
An environmental scan of the public and private eConsult and eReferral systems available within the Canadian healthcare system.

Purpose/Objectives:
Provide an overview of the people and processes involved in the implementation of a patient portal in a paediatric setting. Outline the benefits and challenges of sharing the same portal across two paediatric organizations who went live on the same system at different times. Detail the strategies necessary to achieve engagement and adoption from both patient populations. Inform audience of lessons learned and provide a glimpse at the future-state roadmap planned for both hospitals.


Methodology/Approach:
Each organization had unique implementation approaches given they went live with varying project scope and in different years (2015 and 2018). Extensive collaboration was required between the two hospitals to review shared system settings including those impacting consent requirements, release of information (e.g., results) to portal and communication between patients and providers. Both organizations chose to implement outpatient areas in a pilot phase with a subset of clinics and form official working groups to facilitate decision making. There was heavy engagement from representative stakeholders including communications and privacy. Each organization engaged patient and family representatives or existing family advisory councils to obtain valuable feedback prior to, during and post-implementation.


Finding/Results:
The sequential implementation of patient portals in two organizations allowed for enhanced planning and decision making for the latter organization and facilitated re-analysis of important issues for the former organization. The pilot areas informed broader rollout strategies, both with patients/families and clinic staff. Adoption of portal differed in varying specialties (and by organization) due to patient populations and provider/clinic engagement and likely perceived portal utility. Patient portal implementation in a paediatric setting sparked interesting discussions surrounding policies around adolescent vs. parental/guardian access to personal health information. As clinic activation spread, new questions arose given the unique specialty-specific patient populations impacted. The working group membership - clinicians, patients/families, communications and privacy staff - proved to be a great resource for decision-making and facilitation of larger discussions required at an organizational level. The working group was an ideal venue to vet communication and training materials for the portal to establish consistent messaging across the organizations. Once live, the project teams had to balance resolving go-live issues with appetite from clinical and patient/family communities for advanced portal features and functionality. The working groups for both organizations continue to play an important role in defining priorities and establishing expectations beyond the initial implementation.


Conclusion/Implications/Recommendations:
Involving key stakeholders early on in the process was a success factor for each organization. Having working group members weigh in from the planning stage through implementation and beyond was critical to drive communication, implementation and post-live strategies. Strongly encouraging clinic champions or ?hype? staff proved to contribute to a clinic?s success in increased patient/family activations and engagement. Creating and providing ample communication and training material from the onset helped to facilitate each clinic activation and reduce the burden on the project team. There are benefits and challenges with sharing the same portal across two organizations. Building a solid relationship between the organizations to reach consensus on shared system settings and share lessons learned proved valuable for each hospital.


140 Character Summary:
Two organizations effectively implemented a shared paediatric patient portal. Keys to success were engaged, representative working groups at each organization.

Purpose/Objectives:
The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to enhance support to nurses and clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner. VES has been implemented in eight First Nations Nursing Stations in Sioux Lookout Zone. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.The objective of the final evaluation is to determine if the VES service model is an effective means for enhancing urgent and emergent care in isolated nursing stations.


Methodology/Approach:
The evaluation is based on a limited production roll-out in the Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations and reflects service-level data and provider feedback collected between 16 March and 31 December 2017. VES Data Sources and Collection Approach: A. Nursing Feedback ú Nurses summarized VES encounters by filling out a record of event ú KOeHealth staff conducted short interviews with Nurses-in-Charge (NICs) on a weekly basis. ú Face-to-face interviews with NICs B. Physician feedback ú Eight physicians were interviewed or provided written responses about their experiences with the VES. ú Three ORNGE Transport Medicine Physicians (TMPs) provided feedback about their experiences. ú ORNGE shared results of post-VES surveys C. Service-level data ú Nursing records of event ú Logging files from OTN?s videoconferencing application for Emergency Medicine ú Provincial air ambulance transport logs ú Monthly VES Implementation Team meetings ú Promising Practices Workshop ? 4 October 2017, Thunder Bay. D. Direct engagement and observation: ú Site visits to four First Nations communities.


Finding/Results:
Between mid-March and end of December 2017, VES resources were mobilized to manage 10.4% of the 666 medical evacuations that originated from one of the four VES First Nations. Feedback by nurses, ORNGE TMPs and Regional Critical Response Program (RCCR) confirm that VES is an effective means for enhancing urgent and emergent care in isolated nursing stations. With VES, patients living in Ontario?s most remote communities have access to the same level of clinical expertise as any other resident in the North West LHIN


Conclusion/Implications/Recommendations:
VES is an advanced, integrated and scalable urgent/emergent service model that is effectively supporting nurses and patient care in isolated First Nations nursing stations. Provider feedback and service-level data show promising results. Nearly three-quarters of the ORNGE TMP workforce (17 of 23) have used VES one or more times to support nurses and MDs in isolated nursing stations. Regional Critical Care Response teams have used VES multiple times to stabilize critically ill patients prior to transport, coach nurses in the optimal use of life-saving equipment, and counsel family members about the imminent death of a loved one. Service-level data and provider feedback signal successful completion of the VES pilot project and anticipate its expansion to additional isolated First Nations in the Sioux Lookout Zone.


140 Character Summary:
VES is urgent/emergent service model that support nurses and patient care in remote and isolated First Nations nursing stations in Sioux Lookout Zone.

Purpose/Objectives:
Patient-reported outcome measures (PROMs) are essential to patient-centred health care delivery. Hip and knee replacements are procedures aimed at improving patients? pain, functioning and overall quality of life. To support the delivery of patient-centred, evidence-based care, the Ontario Ministry of Health and Long-Term Care (MOHLTC) approached the Canadian Institute for Health Information (CIHI) and CCO to help execute a new PROMs project for hip and knee replacement patients. The PROMs project is being implemented in alignment with the bundled hip and knee replacement surgery Quality Based Procedure (QBP) program. Goals of the project included: ? Piloting collection of PROMs, with intent to scale-up to province-wide. ? Leveraging technology to support implementation and real-time reporting back to providers. ? Developing initial comparative reports for health system monitoring. ? Improving communications between providers and patients, informing treatment decisions and patient expectations. ? Complementing traditional, clinical outcomes, cost, and patient experience data for a more comprehensive understanding of their relationships. ? Supporting the evaluation of performance and effectiveness of care.


Methodology/Approach:
The MOHLTC oversees the governance structure for the project and provides leadership to ensure project alignment with the bundled hip and knee QBP project. The MOHLTC, CIHI and CCO have complementary roles in the execution of the PROMs project. CIHI is responsible for confirming data collection standards including instruments, minimum data set, and collection time points. After receiving PROMs data collected by CCO, CIHI will provide a range of comparative reports to support Ontario health system performance monitoring and evaluation (e.g., comparative reports to facilities and others, and data files to the MOHLTC). CCO has over a decade of experience overseeing the systematic collection of oncology PROMs in Ontario. Electronic PROMs collection is currently available at more than 80 oncology centres across the province and more than 30,000 oncology patient screens are completed via CCO?s e-PROMs platform each month. CCO has been commissioned to leverage and apply this expertise to the collection of hip and knee PROMs. CCO is responsible for implementing electronic PROMs collection across the province and for hospital-level data collection. CCO will regularly submit datasets to CIHI for use in comparative reporting. Based on the needs of the MOHLTC, the planned approach is a three-year pilot project which started September 1, 2017, with data collection commencing April 2018.


Finding/Results:
The objectives of the project are to demonstrate the value of collecting PROMs data, test the platform/mechanism for collecting PROMs data in Ontario, and initiate technological and business processes for a cost-effective scale-up to provincial implementation. Other benefits include measures of access and appropriateness, and the potential to support patient and surgeon decision-making prior to surgery. The goal of the pilot is to determine the most effective, user-friendly, and cost-effective method for collecting PROMs over the long-term.


Conclusion/Implications/Recommendations:
Ontario is the first province in Canada to implement the national PROMs hip and knee arthroplasty standards and electronic collection. Early learnings from an implementation, data and reporting perspective will be presented at the conference.


140 Character Summary:
To support patient-centred, evidence based care, a new patient-reported outcome measures project for hip and knee replacements has launched in Ontario.

Purpose/Objectives:
While sex work itself is not illegal, the criminalization of certain aspects of sex work in Canada increases Occupational Health and Safety (OHS) risks, including violence, stigma and discrimination. The use of Information and Communication Technology (ICT) such as web pages, Twitter, and WhatsApp as a tool for the sex worker communities to access OHS strategies is largely unexplored. The objective of this qualitative study is to explore the question: What are the needs and preferences of Toronto-based sex workers (SWs) regarding ICTs as a strategy to communicate knowledge and education about OHS risks in the workplace?


Methodology/Approach:
This qualitative study consists of two components, both using a community-based research approach. The first is a thematic analysis of three focus groups and three individual interviews (unpublished data from a previous research project) to provide preliminary insights into how sex workers might like to utilize ICTs for OHS. The second component will delve deeply into the needs and barriers of sex workers in terms of OHS, and their preferences in ICT use through focus groups. The findings from the first component will be used to inform the categories of inquiry for the focus groups. The second component will be conducted with Maggie's: The Toronto Sex Workers Action Project (Maggie's). Focus groups of 6 to 8 participants will be convened until data saturation is reached. Leaders from the sex worker community will facilitate the discussions. After each interview, the researcher will practice reflexivity by documenting her own observations on what took place during the interviews. Using thematic content analysis, the focus group transcripts will be analyzed by three people; this group will be composed of the researcher, a research assistant and a member of the sex worker community trained in qualitative analysis.


Finding/Results:
The first component revealed that sex workers would like the following OHS strategies to be available via an ICT tool: condom negotiation techniques; anonymous reporting of assault; reducing a sense of isolation; reduction in HIV vulnerability; job satisfaction; client does not attempt removal of condom; prevention of stalking, exploitation, being outed. The interviews did not provide insights into the privacy and security concerns when using ICTs and will be explored in the focus groups in the second component. The research will be completed by March 2019; results from the completed study will be presented at the conference.


Conclusion/Implications/Recommendations:
The research into ICT tools will support sex workers in their access to OHS strategies. As most SWs in Toronto, Canada, own a smartphone, the provision of an ICT tool for SWs to exchange OHS strategies endeavours to reduce their OHS risks, strengthen their social network, enhance their social cohesion and social capital. The findings from this research will inform a future study ?What are the core components of potential ICT intervention strategies to exchange OHS information in the workplace?? Once the chosen ICT intervention has been established, another phase of research, exploring the feasibility of SWs using an ICT intervention to exchange OHS strategies in the workplace, is proposed as the next step.


140 Character Summary:
Community-based research with Toronto sex workers in exploring the potential of exchanging occupational health and safety strategies via an ICT tool

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


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


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


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


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

Purpose/Objectives:
TAPMI is an innovative program that brings together 5 unique Toronto-based pain management services under one umbrella. The multi-institutional partnership needed help rethinking the design of the existing processes in order to provide improved access for both chronic pain patients and their PCP?s. The goal was to take a service design approach to understand chronic pain patients, their PCP?s, the existing chronic pain specialty clinics and their unique processes, and the current patient experience across all touch-points. With these learnings, we created a virtual hub where their services could be virtually accessed, intake and triage procedures could be standardized, and ensure a more efficient and accurate referral process for patients and their providers.


Methodology/Approach:
As part of our user-centered design process, user/stakeholder interviews were conducted to better understand how key users navigate the health system and current model of care for chronic pain patients, as well as the mental, emotional, and physical impact along the way. We researched international programs innovating in the treatment and triage of chronic pain, and identified areas of opportunity for improvement. Our findings were compiled into a document/presentation with the star finding being a Patient Experience Map. The research and Experience Map further informed the content strategy and design of the website, which we rolled out in phases as the program continued to develop.


Finding/Results:
The Experience Map clarified where the team should focus their efforts: seeing the patient journey mapped out visually and sequentially revealed that during the patient?s longest wait times, the system was doing nothing for them. This informed strategic planning of the website and the program itself to develop pain education and self-management tools for patients, as well as resources and educational tools for primary care providers to build capacity and provider chronic pain patients with better, easier access to care. The website provides TAPMI with a virtual home, establishing who they are and the services they provide, as well as accomplishing their primary objectives. They are now able to provide a centralized referral process with one referral form into all of the 5 pain services, and both patients and primary care providers can easily access information about chronic pain, treatment options, and how to access the TAPMI program.


Conclusion/Implications/Recommendations:
TAPMI is providing an accessible space where patients can create their own self-management pathway. Space where they can educate themselves on chronic pain and holistic treatment methods, experiment with different techniques, set and work towards their goals ? both small and large ? and access support services at their own pace and from the comfort of their home. This allows for TAPMI to extend these services to chronic pain patients who live far away or may not have time to attend regular sessions in person. The efforts put forth in this project are placing patients on a successful path to begin their journey to a better quality of life. TAPMI is not only a catalyst for better self-care, but care at the primary, specialist, and system level.


140 Character Summary:
A Service Design approach to understanding the chronic pain patient and provider experience and inform the design of an innovative, accessible hub for virtual care.

Purpose/Objectives:
The literature indicates that during pregnancy and the postpartum period, women have a very high incidence of new onset mood and anxiety disorders and high relapse rates for pre-existing psychiatric disorders. However, only 33-50% of women receive services provided by existing community groups, which do not always identify, monitor or treat the mental illness. These women often end up going to emergency departments or do not access services at all. The objectives of the program are the following: 1) Increase accessibility to specialized perinatal mental health services in the community 2) Develop and promote an appropriate interdisciplinary care pathway to serve women with perinatal mental health concerns 3) Promote perinatal mental health knowledge and skills translation to community care providers through various educational activities including telemedicine 4) Strengthen collaboration of hospital and community service providers in providing community-based services 5) Improve patient and family and provider satisfaction with the delivery of an improved consultative experience using telemedicine technology


Methodology/Approach:
With the use of Ontario Telemedicine Network (OTN) technology, the Perinatal Mental Health Telemedicine Program has been able to provide ongoing follow-up and support for patients in their own homes. Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. It is an efficient and cost effective way for patients to access specialized perinatal mental health care without the associated costs of travel from their home environment.


Finding/Results:
Performance indicators include the number of unique patients who engage in the program as well the total number of telemedicine events. By the end of fiscal year 2017-2018, the total number of telemedicine events was 1326. This exceeded the telemedicine numbers during the previous year, which were 1245 events. In terms of new unique patients who were seen via telemedicine, the final count was 198. In addition to this, the program has also obtained other metrics including patient satisfaction with telemedicine. For fiscal year 2016-2017, 399 surveys have been sent out with a total of 133 responses (33.3% response rate). Based on the responses, there is a high level of satisfaction. Some of the positive feedback from telemedicine patients include: ?It's very simple to use. I really like it and feel very grateful for this service. It has allowed me to receive a closer psychiatric monitoring of my health condition without adding additional stress and without spending time and money on transportation." and ?An absolutely fantastic program that enables people like me who live in smaller cities to access the resources traditionally afforded to only those in large cities (without the hassle of travel)."


Conclusion/Implications/Recommendations:
Through the implementation of telemedicine, the Perinatal Mental Health program has been able to reach deeper into the community to evaluate, diagnose and treat patients both within the TC-LHIN and in remote locations across the province. In terms of spread, the central focus of the telemedicine program include further outreach to various community partners, including family health teams and community health centers in order to provide consultations, education and case conferences leveraging telemedicine technology.


140 Character Summary:
The Perinatal Mental Health Program aims to improve access to perinatal mental health services and promote capacity building by leveraging the use of telemedicine.

Purpose/Objectives:
There has been great excitement and growth in the mobile health field; however, due to a lack of oversight, it is likely that many of these apps are of poor quality posing potential risks to patients. Previous attempts, including efforts at the National Health Service, had significant limitations or were not sufficiently rigorous to inform health system decision makers. The objective of the Practical Apps project is to leverage a comprehensive framework to develop set of credible reviews that identify high quality, patient-facing health apps that have the potential to impact chronic disease outcomes across the health system.


Methodology/Approach:
The first phase of this project involved the development of a methodology to review mobile health apps for chronic disease management. The research team reviewed relevant academic literature and regulatory guidelines. No current evaluation criteria were comprehensively addressed all factors relevant to real-world clinical use. Therefore, a new framework was created incorporating previously identified quality criteria from multiple resources, listed and grouped into six common themes. A group of primary care physicians were trained in using the resulting framework to review 4-5 apps related to a single common chronic condition. Reviews were posted on the site practicalapps.ca with the ability for clinicians to subscribe to receive alerts of new reviews.


Finding/Results:
The resulting framework integrates quality heuristics related to both clinical and regulatory needs to support the rapid evaluation of app quality, thus enabling further decisions around clinical use and scale (see Table 1). Table 1: Mobile Health App Quality Framework Dimension Details Features overall purpose, user engagement, clinical integration, data integration Clinical Effectiveness creator credibility, evidence-based information, empirical evidence, clinically comprehensive Usability learnability, memorability, efficiency, satisfaction, visual appeal, clarity Privacy/Security privacy policy, secure data storage, data sharing, permission management, password use Safety/Reliability technical performance, technical support, ongoing updates, error handling, company profile Accessibility cost, available languages, health literacy level, compatible devices, accommodates disabilities Overall 1/5=no clinical use, 3/5=potential for clinical use with limitations, 5/5= appropriate for widespread clinical use and scale The framework was utilized to review 70 apps relating to 17 different health topics. Of the apps that were evaluated, the average overall rating was 3/5 with 39% receiving a rating of 3.5 or higher. However, there was significant variation on key indicators and between topics, especially with regards to clinical effectiveness and privacy/security. Overall, the apps rated well for accessibility and usability but poorly for privacy/security and clinical effectiveness. Over one year, over 3000 people, mostly clinicians, have registered for an online subscription to the site.


Conclusion/Implications/Recommendations:
The Practical Apps project and framework provides an effective tool to rapidly identify and inform use and scale of high quality mobile health apps for chronic disease management. The Practical Apps website has received significant amount of unique visitors and subscribers who read the reviews. Currently, our research team is working on a scoping review to inform a more comprehensive updated version of this framework. The results of the Practical Apps can support both clinicians and health systems decisions makers in identifying and supporting high quality apps for patient use.


140 Character Summary:
Practical Apps is a project aimed to assess the quality of patient-facing mobile health applications for chronic disease management.

Purpose/Objectives:
Delivering patient-centered care requires an ability to collaborate and communicate across care settings and organizational boundaries, including hospitals and community care settings. Without a secure system available, care providers (including family physicians, specialists, hospitalists, nurses and pharmacists) resort to using their personal Smartphones and non-secure applications to communicate about patient care. The SMaCCS project involved an application that was installed on a participant?s own Smartphone. The app had a user directory that included user specialty area, enabling participants to connect with other health care providers in a secure environment. The purpose of this first-in-Canada project was to determine if the introduction of a SMaCCS for use by community and hospital-based health care providers would improve clinical communication, thereby increasing efficiency and enhancing patient care.


Methodology/Approach:
This study used a mixed methods approach, which has been found to be useful in other examinations of secure mobile communications. A before-and-after evaluation approach was used to compare providers? work experiences and proportion of successful contacts using existing communications methods to those achieved using the SMaCCS. The study evaluated the impacts of introducing the SMaCCS on switchboard operators, pharmacists, and physicians using a quality of experience framework to examine; the degree and nature of adoption of the SMaCCS; Effects on user workflow and experience; Effects on care provision


Finding/Results:
In total, 2,806 messages were sent in 636 conversations. Of these, 582 conversations occurred between care providers. According to the tracked data, 25% of provider-provider conversations that were initiated were not responded to. Overall, 53% of participants surveyed (59 of 111) reported being satisfied with the SMaCCS app. 75% of survey respondents (85 of 114) were satisfied or very satisfied with the security of the app. Interviewees (n=11) noted that the security was the biggest benefit over using a regular texting application, since it allowed them to send patient information, including PHNs and images, which supported valuable clinical conversations. Six interviewees specified that having the app allowed them to communicate when it was most convenient for them. Only a small percentage of participants (4% of survey respondents; 4 of 113) indicated that the messages interrupted their work day. When the SMaCCS app successfully connected care providers, it allowed them to share secure information to support better clinical care. Furthermore, 51% (57 of 111) agreed or strongly agreed that having the app made it easier to send or receive information that was important for patient care. 80% felt more comfortable sharing patient information using the secure communication tool, which will enable further collaboration for patient care.


Conclusion/Implications/Recommendations:
The SMaCCS pilot project provided valuable learnings regarding use of secure messaging between community and hospital-based care providers, and within-hospital communication. Having a secure mobile communication solution was identified as a key component of safe, connected health care system in the future. [results of a FOLLOW-UP PROJECT: *Investigation into the Cleaning Methods of Smartphones and Wearables from Infectious Contamination in a Patient Care E*nvironment (I-SWIPE) may also be presented for the first time at EHealth19 if selected]


140 Character Summary:
First-in-Canada research identifies how a common secure communication solution between hospital and community practice improves patient care

Purpose/Objectives:
Care coordination requires effective communication and the proper communication tools and channels help providers communicate, collaborate and deliver care across the care continuum. There is an emerging need for Secure Messaging (SM) from care providers. Currently, clinicians are using unsecure methods of text messaging to support clinical care by sending personal health information through text messaging on their personal devices. At Fraser Health (FH), Secure Messaging solution has been implemented to allow personnel to securely communicate confidential clinical and corporate information on their corporate and personal devices. The objective was to enable Clinical Communication and Collaboration (CC&C) and layer clinical systems integration capabilities such as, On-Call, alert notifications, MEDITECH modules and pager replacement. Without progress in this space, physicians will continue to insecurely text message colleagues to risk security of sensitive data, patient safety and fall behind in communication efficiency/effectiveness.


Methodology/Approach:
The approach to implement SM was to leverage Enterprise Mobile Management (EMM) platform to support mobile device management of personal and corporate smartphones. Formal project management methodology has been applied. The project first focused on the delivery of procurement, design, build and integration for SM solution in a Proof of Concept (PoC) fashion prior to expanded rollouts. With the successful completion of PoC at one of FH sites, our workflow-based phased rollout approach has been confirmed and supported by a clear Bring-Your-Own-Device (BYOD) strategy. A change management strategy to support a transformational app has been defined to support the wide range of use cases and to manage user expectations. An initial top-down communication and engagement strategy was created and executed to ensure effective rollouts across the health authority, followed by a targeted site-focused engagement so as to bolster the sense of ownership thus increase the adoption.


Finding/Results:
The SM solution provides a simplified process for clinical users; supports the enhanced and timely communication between care providers, the coordination of care via optimal & timely decision making between care providers and the enhanced clinical workflow by reducing the need for phone calls/faxing/chasing providers. As part of the completion of PoC, we have conducted lessons learnt and post implementation review. One of the key learnings is to ensure all stakeholders who communicate with one another need to be enrolled. Also, the complexity around supporting various smartphones and BYOD challenge has been identified. Providing SM access to non-privileged physicians presents new questions to our security, privacy, legal and professional practice policies as well as funding model. The challenge of managing expectations for those keenly interested while supporting those concerned with change needs to be balanced and well addressed, top-level executive leaderships' support is crucial and effective.


Conclusion/Implications/Recommendations:
Delivering a successful mobile app at an enterprise level requires effective design, implementation, engagement, adoption and use. SM is a basic functionality but could be a disruptive technology if it immobilizes users' access to information and effective communication workflows. The greatest opportunity will come as we integrate systems, interoperability between other Health Authorities and create policies to ensure professional practice are supported.


140 Character Summary:
Introducing Clinical Communication & Collaboration solutions to support clinicians? mobile workflow, while effectively securing PHI on personal devices.

Purpose/Objectives:
Horizon Health Network is New Brunswick?s (NB) largest Regional Health Authority and is a recognized leader in implementing and sustaining innovative telehealth solutions across all levels of the healthcare system. Horizon?s Stan Cassidy Center for Rehabilitation (SCCR) has recently celebrated 60 years as a North American leader in neurological rehabilitation. SCCR?s newest initiative is another example of empowerment of patients and clinicians to facilitate timely access to scarce clinical resources via telehealth. The purpose for the development of this application was to provide secure capture, delivery and storage of videos taken of those pediatric patients referred to SCCR with significant neurological impairments. These videos obtained by families, as well as established community partners, in various non clinical settings, are critical tools through which rehab professionals at this tertiary center can now provide more timely access, recommendations, treatment and follow-up.


Methodology/Approach:
Horizon embraces the philosophy that technology is an enabler. The key to success is to ensure the design and selection of technology to be used is driven by clinical needs. Two clinical needs were identified by SCCR when asked to formally outline the challenges they regularly encounter while providing care to patients throughout rural NB. The first, that situational behavior cannot be appropriately assessed for treatment recommendations unless witnessed by the attending MD or therapist. Secondly, ensuring that assistive/supportive equipment prescribed is safely and correctly applied. Up to this point any attempt to send pictures or videos to the clinicians demonstrating either of these, had been fraught with barriers regarding privacy, security, size and storage. In frustration, many families found their own work around and posted them on u-tube to provide clinicians access. Using Horizon?s established telehealth browser based portal, a mobile app was developed specifically to address SCCR?s need. Patients now use their own devices to download the app from Google Play or Apple store to record and upload videos to their individual patient folder. Clinicians are immediately notified via text and / or email that something new has been added for review and can then communicate their treatment recommendations. Innovative clinical processes and technical architecture are imperative to success in any sustainable telehealth initiative and will be shared specific to this application during the presentation.


Finding/Results:
Early intervention by way of increased accessibility permits clinicians to be proactive versus reactive in the detection of safety and treatment requirements for this vulnerable patient population; positively impacting quality of life and overall clinical outcomes.


Conclusion/Implications/Recommendations:
Improved access to services that would otherwise not be available in rural or remote communities continues to be seen as the primary contribution of telehealth. However, there is evidence that telehealth can enhance quality of care by better supporting application of best practices, improvement of knowledge and skill development in local care providers, and improvement of care coordination, with decreased costs for payers. Furthermore, telehealth can improve patient/caregiver engagement and enable them to become more active participants in their own care and well-being often from the convenience of their own home, wherever that may be.


140 Character Summary:
Provision of a collaborative approach to patient centric rehabilitative care via the use of a Health Authority custom designed mobile app on patients own devices.

Purpose/Objectives:
Patients, caregivers, and care teams are challenged with the fragmented health system which prevents easy movement and sharing of patient health records. This results in barriers for patients in managing and partnering in their health, and timely decision-making to determine best treatment options. Now imagine an opportunity where patients can securely control, share and monitor the use of their data! A consortium of Blockchain Accelerator Program founders representing healthcare, government and private industry is in the early stages of co-design with patient, caregiver, clinician, research and privacy representatives to deliver a minimal viable product (MVP) that will start to break down fragmented health systems. The MVP will demonstrate how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The long-term goal will be to enable patients to become more active participants in managing their health; contribute to data-driven insights to improve communication, safety and health outcomes; and support research to find effective treatments and cures.


Methodology/Approach:
Co-design with patient, caregiver, clinician, research and privacy representatives ensures that varied perspectives are considered to inform the design and delivery of the MVP. An architecture solution framework has been established to enable patient consent, control and access of their own health data from government, healthcare and private sector sources. This MVP demonstrates how a patient can control, share and monitor the use of aspects of their health data to (i) healthcare providers, (ii) caregivers, including family and (iii) research institutions. The project will undergo frequent Stage Gate Reviews to assess and evaluate performance, lessons learned and risks to ensure ongoing delivery of value for patients and the health system.


Finding/Results:
Findings and results are three-fold: 1. Delivery of a working MVP and prototype through co-design with patient, caregiver, clinician, research and privacy representatives. This ensures the creation of a usable and value-driven product, taking into account privacy and consent considerations as part of patient control of their own health data; 2. Findings, learnings and value of the project are transparent and shared with key stakeholders and the general public as the project progresses. They have opportunities to dialogue and inform future investment decisions; and 3. Future strategy and planning considerations are well-documented and range from examining and addressing identity management and authentication, to ensuring data governance and trust in a future business network. This MVP informs the next stage of the project to establish a formal Patient Control Blockchain Consortium that oversees data governance, and ensures that a future business network is transparent, trusted and secure. Grounds for further investment can then be substantiated to pilot the Patient Control Blockchain in a real-life setting and address movement of data.


Conclusion/Implications/Recommendations:
Through patient control of their own data, a collaborative partnership made up of health care organizations, government, and private industry can be established in order to advance health ecosystem partnerships, accelerate innovation in medical research and inform efforts to deliver value for patients and the health system.


140 Character Summary:
This session will share results of a Patient Control of Data Blockchain project that enables patients to securely consent, share and monitor use of their health data.

Purpose/Objectives:
Patient outcomes are reliant on ensuring communications between the right person at the right time. Easy right? Not always in a complex team setting across acute care sites, into community and allied health and across widely dispersed geography. When Interior Health was faced with the loss of pager supports at Kelowna General Hospital, they had to look for a new solution. Exploring beyond the needs of a pager replacement, IHIT opted for a system that addressed a broader variety of communications supports including: immediate access to the callboard for all departments, access to patient information for ADT notifications, secure messaging with upload capability. All the right information in one convenient place for all users.


Methodology/Approach:
Key for their selection process was: compliance with FIPAA, the integration into Meditech EMR, vendor flexibility and securing the system on IH servers. Two pilots at KGH in 2015 led to the adoption of the MicrobloggingMD messaging system at IH. Further implementations of the system proceeded in collaboration with hospital teams, Divisions of Family Practice, and Facility Engagement associations.


Finding/Results:
Detailed data has been collected to evaluate the uptake and engagement of the system with physicians, nurse practitioners, nursing teams. Initial super user survey feedback indicates: 57% feel the communications informs their care planning, 62.5% agree it is improving care for patients and communications between physicians.


Conclusion/Implications/Recommendations:
IHIT will provide an overview of the system, data on use of the system, and share their experience in implementing a new technology for teams including: - Finding and communicating with the right person, at the right time and according to their preferences, to engage in patient care. - Using secure messaging as a medium to reduce telephone tag and provide detailed patient information that will ultimately lead to well informed and improved patient outcomes. - Providing a reliable tool which means maintaining when and how a provider wishes to be paged/notified to engage in patient care. - The challenges in rolling out enterprise wide, and how they were overcome.


140 Character Summary:
Implementing secure messaging enterprise wide in Interior Health Authority is a leading edge project ready to share lessons and challenges learned on the journey.

Purpose/Objectives:
Experience gleaned from a 2017 rapid review shows that the process of integrating e-mental health as a routine health care tool faces many challenges, is very complex, and requires significant time in most cases. When defining e-mental health, the Mental Health Commission of Canada (MHCC) borrows from the Centre for Mental Health Research in Australia: ?Mental health services and information delivered or enhanced through the Internet and related technologies?. To support the uptake, use and evaluation of e-mental health in a clinical setting, the MHCC undertook the development of an implementation toolkit. The purpose of the toolkit was to collect, synthesize and present best and promising resources on how to successfully implement e-mental health into clinical practice. It synthesises evidence-informed tools (e.g. templates, fact sheets, worksheets, assessment tools, etc.) and packaged them in a clear and comprehensive way. The goal is to provide practitioners working at the point of care with guidance and support around integrating e-Mental health with their existing client populations.


Methodology/Approach:
The MHCC partnered with Dr. Lori Wozney and the IWK Health Centre in Halifax, NS to undertake the development of the toolkit. Building upon the findings of a 2017 environmental scan and literature review, Dr. Wozney and team undertook a scan and content audit of current e-mental health implementation resources to identify key topics, current gaps in resources and evidence-based tools relevant for the target audience. Where necessary, content was either developed or adapted for inclusion in the toolkit.


Finding/Results:
Although there are tools that exist which are applicable to the Canadian mental healthcare system, there continues to be gaps in tools and resources that are specific to clinical needs. Since technology is evolving at such a rapid pace, it is important to stay abreast of changing needs of clinicians. Effort was made to contextualize itself within the larger e-mental health/e-health environment to avoid duplication of tools/resources, though work to enhance the toolkit will continue through 2018, into 2019. The toolkit is available in English and French (where French tools existed) on the MHCC website.


Conclusion/Implications/Recommendations:
More implementation tools for clinicians are needed. By providing evidence-based and evidence-informed implementation tools, clinicians may be better-equipped to assess things like organizational readiness, change management, and workflow management as it pertains to e-mental health.


140 Character Summary:
Building the Toolkit for e-Mental Health Implementation, an MHCC resource for mental health professionals to implement e-mental health innovations.

Purpose/Objectives:
BACKGROUND: The use of kiosks for patient check-in will help reduce costs, reduce patient waiting time and less errors. The kiosk encourages patients to take control of their care information demographics to complete basic workflow on their own by checking in appointments, updating demographics and verify coverage (ie. OHIP), wayfinding, questionnaire and myHealthRecord (patient portal sign-up). The kiosk will help reduce the line at the front desk registration which will help reduce the wait times. OBJECTIVE: This presentation aims to contribute to an understanding of how direct patient engagement to their registration workflow affects the patients? delivery of care, experience and reduction of admin workload


Methodology/Approach:
A mixed methodology to search patients? identities will be used that include to scan patients unique barcode (generated by patient portal) received by email, swipe OHIP card, search by entering first name, last name and medical record number. The check-in rate and percentage will be determined by using Ambulatory Electronic Patient Record (aEPR) reports.


Finding/Results:
Simulation Results: Pilot phase for the Kiosks went live in November 2018 at Women?s College Hospital (WCH) for patient use. The proposed solution Kiosk like structure, where the information regarding patient demographics verification/patient portal sign-up/wayfinding/appointment check-ins can be easily performed by patients. Long queues to check-in with the receptionists can be avoided by using the kiosks. Aim is to have 30% patients to use kiosks during the first quarter of the year. The report generated by Ambulatory Electronic Medical Record will show the patient, the date and time of the appointment, and the appointment status, along with other information about the appointment. The Kiosk Check-In Statistics tab shows the total number of appointments by department and a graph of the percentage of appointments by status. Kiosk Session Exit Reason Breakdown Report:


Conclusion/Implications/Recommendations:
The quality of the healthcare delivery will be increased, since the kiosk workflow brings together patients in front of the clinical workplace to verify patients' demographics. Strategies to expand services through wayfinding and fill out questionnaires according to the clinic visit types will deliver the tools necessary to create self-sufficient full check-in workflow for patients; consequently improving.


140 Character Summary:
Using kiosks to check-in patients for their appointments will improve patient engagement. This will enhance delivery of care and reduce administrative workload.

Purpose/Objectives:
The purpose of this panel is to share learnings from ?big bang? Epic HIS implementation at a tertiary care children's hospital ? SickKids Hospital, Toronto - using a Blood products case study, including: - Interprofessional team formation to deal with high risk issues - Urgent issues management - The role of process improvement in HIS implementation - End user engagement and education Following this session, participants will leave with an understanding of critical success factors and lessons learned related to ?big bang? HIS implementation.


Methodology/Approach:
The Blood products SWAT Team was formed in the first week following the implementation of Epic to address urgent issues related to blood products impacting patient safety. Specifically, issues with the blood products ordering and preparation processes were causing significant delays in blood products administration and impacting patient care. The SWAT team included a broad range of stakeholders, including representatives from Epic project team, process improvement, laboratory and clinical staff and organization leadership. In the 4 months following go-live, the Blood products SWAT team became the first point of contact for problem solving and issues management. Through the Blood products SWAT group following activities were performed to identify root causes of issues and to develop resolutions: Ongoing monitoring of relevant safety reports Comprehensive tracking of blood products issues Shadowing of Transfusion Medicine Department and clinical staff Addressing technical and build issues in Epic and HCLL (Transfusion Medicine System) using iterative system design Obtaining feedback from Subject Matter Experts (SMEs) Providing regular touchpoints for troubleshooting issues Establishing and management of key work groups to review specific issues Establishing SWAT Oversight Committee Establishing new processes and practices to align with new workflows resulting from Epic implementation Co-designing processes with inter-disciplinary teams Ongoing communication across the organization related to blood productss in Epic ? web site, presentations, email, meetings Re-education of clinical and Transfusion Medicine staff based on key issues Developing education materials The Blood products SWAT team took interdisciplinary approach to problem solving. This resulted in many departments across the organization being involved throughout the work of the BC SWAT Team, including: Blood Bank Epic Teams: Orders, Beaker, Beacon, Clin Doc, Op Time, Anaesthesia, Ambulatory Dialysis/Apheresis Haematology/Oncology ICUs Perioperative Services Inpatient Units Medical Day Care Provider Advisory Committee


Finding/Results:
Results are below:


Conclusion/Implications/Recommendations:
Despite being prepared, anticipate issues at go live. Importance of interprofessional engagement to identify and resolve issues post ?big bang? HIS implementation. Need for additional education post HIS training. Don?t underestimate the role of processes in HIS implementation and importance of interprofessional pre- work prior to go live.


140 Character Summary:
Learn how we managed blood product ordering, issuing and administration issues, following implementation of a new Epic HIS and Transfusion Medicine System.

Purpose/Objectives:
This presentation demonstrates a practical framework for strategically improving scanning compliance in the closed loop medication administration process for the organizational and unit level. In June 2018, SickKids went live with a new information system and shortly there after achieved HIMSS EMRAM level 6. A criteria for achieving this level is the implementation of closed loop medication administration process (or also referred to as Barcoded Medication Administration, BCMA). BCMA is a proven process that helps to reduce medication and patient identification errors. A key factor for BCMA's success to improve patient safety is contingent on scanning compliance by front line staff. There currently is a lack of a conceptual framework to practically guide healthcare institutions to improve BCMA compliance after implementation of the technology.


Methodology/Approach:
A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses? perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


Finding/Results:
A thematic analysis of a literature review identified four domains of strategies effective in improving BCMA compliance rates: organize, monitor, improvement, and education. These domains form the four core concepts of a conceptual framework: OMIE Framework. The OMIE Framework serves to guide the improvement of BCMA compliance at both the organizational and unit level. Utilizing the OMIE Framework, practical BCMA improvement strategies were developed for use at the unit-level. The Model for Improvement was then utilized to initiate a BCMA compliance quality improvement project on an in-patient unit. This quality improvement project helped to evaluate the usability of the OMIE Framework as a guide to improve BCMA compliance and assess the effectiveness of the corresponding BCMA improvement strategies. Further, to explore clinical leadership and bedside nurses? perception of the OMIE Framework and unit-level BCMA improvement strategies, open-ended questions were used during informal sessions to gather feedback.


Conclusion/Implications/Recommendations:
The OMIE Framework is an effective and useful conceptual framework to practically guide hospital initiatives in improving BCMA compliance rates. Utilizing the OMIE Framework to derive unit-level BCMA improvement strategies demonstrated effectiveness in increasing BCMA compliance rates at both the organization and unit level. Healthcare facilities can consider the use of the OMIE Framework as a conceptual framework to improve BCMA compliance rates on their journey to enhancing patient safety. Further exploration of contextual factors that hinder or enable implementation of BCMA improvement strategies is needed.


140 Character Summary:
A practical framework for improving scanning compliance in the closed loop medication administration process for the organizational and unit level.

Purpose/Objectives:
Artificial Intelligence in healthcare is, arguably, a solution in search of a problem. It is rife with potential in the domain of improving patient care and outcomes, yet who is leading the vanguard to make this actually happen? Despite our healthcare community valuation of collaboration, we see a proliferation of silos emerging to lead the challenges of integrating AI into the field. This presentation will consider whether such fragmentation in pursuit of AI excellence risks HI history repeating itself with cycles of missed opportunity, or whether more cohesive models for enhancing the ecosystem can emerge. The presentation will take the perspective that health informatics professionals are well positioned to make AI happen in healthcare?s complex system of systems. We have learned (the hard way via compromised projects and implementations) the critical importance of management and evaluation to prepare for change and ensure viability through adoption. As such, we are uniquely positioned to navigate ?upstream? challenges at organizational and systemic levels, where accountability and accrual of benefits are concentrated, to ensure the ?downstream? move into actual use of AI technologies to maximum advantage.


Methodology/Approach:
The presentation will investigate the current landscape of AI advancement in healthcare. It will build perspective from capstone and executive-stream projects underway within the Master of Health Informatics (MHI) at University of Toronto, under the leadership of presenter Julia Zarb. Content may be drawn from alumni contribution of a machine-learning algorithm to evaluate such activities, and will be developed with input from the MHI Modernization Committee. The presenter will draw on work underway as the Director of the MHI program, and in collaboration with Emily Seto, health informatics lead for the Institute of Health Policy, Management and Evaluation.


Finding/Results:
The presentation will deliver a comparison of current Canadian models for upstream AI leadership in healthcare, with specific references to viable cases for collaborative activity. The findings will reflect work underway within University of Toronto and within the local community, with extension into the province and nation with possible reference to international cases. The presentation will suggest critical considerations and viable models for building next generations of AI-competent professionals to manage upstream to maximize downstream viability of new technologies.


Conclusion/Implications/Recommendations:
Attendees will emerge with an understanding of the current state of AI upstream leadership in Canadian healthcare, and a sense of potential models for collaborative advancement. The presentation will contain recommendations on how to realistically move forward in planning for a full scope of AI integration, using lessons-learned in health informatics.


140 Character Summary:
AI in healthcare is a topic filled with hope and hype. HI professionals can use lessons learned about managing upstream to ensure downstream AI success.

Purpose/Objectives:
Police recognize that Early Intervention Solutions (EIS) can be invaluable tools for improving the effectiveness of supervisors, identifying at risk officers, and building public trust, but what impact would an EIS have on detecting warning signs of PTSD in first responders and front-line hospital workers, who are frequently exposed to traumatic, life-altering events? This presentation explores how combining data about at-risk events (e.g. complaints and critical incidents) with operational data allows agencies and health employers to provide early intervention for at-risk front-line staff, manage corresponding follow-up activities, and ultimately preserve careers and support mental health. Sierra Systems? Justice and Public Safety and Health Leads will explore how lessons learned from Police can help to support mental health for front-line healthcare workers.


Methodology/Approach:
With intense public scrutiny of relations between police officers and the communities, departments were looking for new ways to mitigate problems before they escalate. Police departments already have a lot of data available that could be helpful: use of force incidents, citizen complaints, praise of officers from other officers or the community. Even the number of calls they respond to, the type of call, the condition of victims and perpetrators, the shifts or locations, high-speed pursuits, canine use, and how relative peer groups compare can all impact the analysis. To sort through the data and draw the right conclusions, departments are turning to early intervention systems for predictive analytics. Analyzing the data allows for monitoring of early indicators of potentially risky behaviours, exemplary behaviours, and even indicators of officer wellness. The EIS gathers data from a dozen or so operational sources and maintains it in an EIS data warehouse. Configurable, standard deviation-based threshold criteria are established, examining simple event counts, ratios, presence of multiple of events, etc. Personnel are grouped into peer groups, with trends and optimal warning levels made available to supervisors. Notifications are automatically routed to supervisors, with links to additional information made available to support interventions. The solution also records findings, interventions, and employee responses. Staff have access to their own summaries, as well as comparisons to their peers, organization to organization, and trends.


Finding/Results:
Law enforcement agencies both large and small have seen improvements in proactive risk mitigation, transparent evidence-based staffing decisions, and public trust and communication. Agencies are now expanding use of the same operational metrics to flag early detection of potential PTSD-related work behaviours by comparing an officer to their own personal historical metrics and looking for material changes such as: -Increase in risky high-speed pursuits or acting before backup arrives. -Decrease in productivity, e.g. missed court appearances, or dropped charges due to incomplete investigations. -Changes to sick-time patterns. -Conflicts with other officers detected through scheduling requests. -Scheduling requests that suggest avoidance of certain neighbourhoods.


Conclusion/Implications/Recommendations:
EIS monitoring of first responder health worker performance, including exemplary, risky, and potential PTSD workplace behaviours, is something that should be pursued. While it is not a panacea and does not replace a professional diagnosis, it can help agencies get a better handle on the metrics and identify outliers.


140 Character Summary:
Exploring the impact of an Early Intervention Solution on detecting warning signs of PTSD in first responders and front-line hospital workers.

Purpose/Objectives:
Emergency department (ED) data is a crucial component of understanding the effectiveness and efficiency of Canada?s overall healthcare system. CIHI currently has data related to 85% of ED visits that take place across Canada. CIHI?s ED data coverage has provided our health system with valuable information on ED wait time trends at the facility, regional, provincial, peer and pan-Canadian level, as well as highly needed information to manage the opioid crisis and insights into the use/overuse of ED services. Closing the data gap on the remaining 15% of ED visits that is currently not being reported to CIHI?s National Ambulatory Care Reporting System (NACRS) will provide a fulsome picture of the valuable indicators described above, and will be an effective predictor of demand for hospital inpatient services, availability of primary and mental health services, and insights into the care being delivered in other sectors such as long-term care. This presentation will provide an in-depth look at the strategies being put in place to accomplish 100% data coverage from EDs across Canada.


Methodology/Approach:
CIHI is actively working with each province and territory not currently submitting 100% of their ED visit data to NACRS to design a solution for data capture that minimizes burden and leverages technologies that have been put in place within EDs or jurisdictions. This includes innovative web-based data capture tools as well as leveraging hospital and/or health authority/provincial data warehouses with modern data extraction and transformation methods.


Finding/Results:
Rapid expansion and uptake of data submission requires careful planning and well-thought out processes to navigate unforeseen circumstances. The learnings from successes CIHI has had in bringing in ED data from Quebec and other provinces/territories will be described during this presentation.


Conclusion/Implications/Recommendations:
CIHI has been focusing on designing solutions that meet the needs of data submitters and minimize submission burden to get at the last 15% of ED visits not currently being reported, and expand on the data that is currently submitted to gain more clinical insights, notably the clinical diagnoses and procedures taking place in EDs. Key areas of focus from CIHI?s strategy to expand ED coverage and success stories will be described during this presentation.


140 Character Summary:
Flexible strategies and solutions to gather valuable emergency department data across Canada

Purpose/Objectives:
The Wander Detection and Diversion (WDD) system is designed to assist caregivers and persons with dementia (PWD) that are at risk of wandering at night. Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the system detects when the PWD gets out of bed and automatically provides cue lighting to guide them safely to the washroom and back. It will also guide them back to bed through audio prompts if they near an exit ? all without disturbing the caregiver in any way. The caregiver is only woken if the PWD opens an exit door. The system has a flexible design allowing it to be adapted to meet the needs of diverse residences and users such as protection for multiple exit doors or coverage for higher risk areas of the residence such as a kitchen or stairs. The message to the PWD is also customized both in the content and the voice. The goal of the system is to improve the caregiver?s sleep and reduce their stress while supporting the safety of the PWD.


Methodology/Approach:
Our team of researchers installs the smart technology devices into participants houses for a 12 week trial period. Before the installation the caregiver is asked a series of questions regarding their stress, depression and anxiety levels, as well as questions regarding how many hours of sleep in a night they are getting and how often their PWD exits the bed during the night. During the 12 weeks the participants are contacted every 2 weeks to ensure satisfaction with the technology. At the end of the 12 weeks the caregiver is asked the same questions as the date of the install, comparing their stress, depression and anxiety levels after having the system in their home for 12 weeks.


Finding/Results:
3 male and 1 female participant, age range from 59 years old to 98 years old, had this system installed in their houses for a 12 week trial period. There was an average depression rate of 6.5 and an average anxiety rate of 8 at the beginning of the trial, at the end of the trial the average depression decreased to 4.5 and the average anxiety rate decreased to 6.7. The only issues caregivers have had thus far in the research is that there were a few technical issues and that at the end of the 12 weeks the system had to be uninstalled.


Conclusion/Implications/Recommendations:
The study is not completed, however thus far, all participants have been satisfied and said that they felt less stressed, depressed and anxious. All participants were able to get more hours of sleep in a given night, and those who did not had reasons unrelated to the system and their PWD. Next steps include testing other types of sensors and looking for a private sector partner.


140 Character Summary:
An off-the-shelf smart home technology solution is installed in participants? homes for a 12 week trial to detect and redirect nighttime wandering in PWD.

Purpose/Objectives:
This panel will examine ways to inspire greater innovation in healthcare by discussing the existing innovation landscape in Canadian Healthcare and the barriers standing in the way of innovations that can improve the efficiency and effectiveness of care delivery. These experts will explore potential solutions based on decades of experience working within health technology innovation and studying the system.


Methodology/Approach:
These four experts will explore potential solutions to the problem of low rates of health-tech commercialization based on decades of experience working within health technology innovation and studying the system. Rohit Joshi - Heath tech CEO and lawyer with experience on both sides of the border who has lectured on compliance and patient privacy across North America Feisal Keshavjee - National Chairperson of the Canadian College of Health Leaders, Managing Director KWC Consulting (a boutique health strategy consulting firm), former head of Health strategy for Ernst & Young Consulting Dr. Deepak Kaura - Chairman of the Board of Directors at Joule, Chief Medical Officer at 1QBit, Founder at Imagine Innovation Framework Dr. Ewan Affleck - Family physician, Board of Directors at Canadian Medical Association, Former Chief Medical Information Officer in Northwest Territories where he was awarded the Order of Canada for his work to bring all patients and providers onto a single EMR.


Finding/Results:
Canada ranks 9 out of 11 top developed nations when looking at Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Canadians spent the equivalent of 10% of GDP on healthcare in 2014 while many higher-ranked countries spent less (https://globalnews.ca/news/3599458/canadas-health-care-system-lower-performing-compared-to-its-peers-study/). Commercialization of health technology innovations can create cost efficiencies and improve health outcomes. These speakers have experienced what works first hand,


Conclusion/Implications/Recommendations:
Examining the Canadian health innovation landscape will provide insight into what?s holding us back, and provide guidance for a strong path forward.


140 Character Summary:
Canadian healthcare innovation suffers from barriers in ideation, pilots, commercialization and procurement. What?s working in Canada?

Purpose/Objectives:
In 2018, NS Department of Health and Wellness (DHW) initiated an enterprise architecture project to define a Digital Health Architecture Blueprint for the Province of Nova Scotia. Core objectives for this project are as follows: - Establish a shared vision of architecture across programs - Define a target state architecture that leverages existing investments; offers flexibility in deployable solutions, and accommodates evolutionary change - Provide guidance for developing program and solution roadmaps. - Support Nova Scotia?s Digital Health Strategy


Methodology/Approach:
For this project we focused our effort on seven major programs operated by DHW. We worked with each program to accurately document the current state architectural capabilities, dependencies, challenges, and opportunities. We then assessed the overall adherence to the Canada Health Infoway EHRS blueprint and highlighted key foundational services that are still essential today. We developed and communicated a high-level view of the target digital health architecture. Using this view as guide, we are working collaboratively with programs to support planning and road mapping.


Finding/Results:
The current state of Digital Health in Nova Scotia evolved through a continuing series of initiatives addressing specific program needs. Solutions in production cover both clinical and administrative functions and are in varying stages of solution lifecycles. Many initiatives used the EHRS Blueprint for architectural guidance. This blueprint introduced the concept of interoperable electronic health records. While the EHRS blueprint is still relevant for the core, foundational components it defined, there are new realities that architecture strategy needs to consider: - New models of care including virtual care - Consumer Health Solutions - Ways to leverage and derive value out of the data through analytics Program administrators are also facing the realities of solution lifecycles: - Some solutions are nearing end of life, so alternatives must be explored. - Some solutions are evolving in pace with innovation, so we might leverage solutions in new ways. - New initiatives introduce solutions which must align with both the existing foundation and strategic direction. Key findings: - Adherence to the original EHRS Blueprint varies across programs. Many solutions keep a separate copy of data rather than reading a central repository. Registry integration does not extend to some important solutions like EMRs. Registries and repositories are not easy to interface with. Many point-to-point integrations. - Programs maintain lists of desirable future enhancements however: Alignment across programs on objectives is limited. The lack of a digital health architecture makes it difficult to plan/roadmap. - Attention to critical core services like registries, repositories, standards, and common services has diminished. - Having up-to-date architectural views is critical for leaders to communicate complex ideas, and support decisions.


Conclusion/Implications/Recommendations:
The resulting Digital Health Architecture Blueprint helps align initiatives with key building blocks in a flexible architecture, that facilitates design choice, leverages emerging technology, and supports strategic planning. The blueprint provides senor leadership with an updated backdrop to support cross program planning and coordination in support of the province's Digital Health Strategy.


140 Character Summary:
Developing a modern, flexible Digital Health Architecture for Nova Scotia to facilitate program planning and support of the provincial Digital Health Strategy

Purpose/Objectives:
Cancer Care Ontario (CCO) is respected for its analysis and reporting of data to inform decision-making in the cancer and renal systems, as well as Ontario?s Wait Time Strategy. Over the years, the number of data assets collected and stored by CCO have increased substantially, and analytics is used across the organization. What didn?t occur was the establishment of standardized practices to support data & analytics usage. Each lines of business developed their own data management processes and analytics practices to meet their requirements. In 2016, CCO recognized an enterprise approach to data management, analysis and reporting of data was required to ensure on-going sustainability, continued growth and innovation within the data & analytics space.


Methodology/Approach:
Data & Analytics (D&A) Governance is a multidisciplinary approach that applies business management principals to the life-cycle of our data & analytic information assets. To support this philosophy, CCO embarked on a journey to create an Enterprise D&A Governance department with the key responsibility to set authorities, accountabilities and controls to formalize and consistently guide the management of enterprise data & analytics assets. A D&A governance framework has been developed that includes policies supported by guideline and procedural manual. An overarching D&A management guideline is drafted for key governance domains: Architecture, Data Quality, Metadata, Master Data, Concept/Methodology management, Security & Privacy, Lifecycle Management that describes principles and practices to be consistently performed on CCO?s data and analytics assets. The guideline describes the processes and stewardship model to effectively collect, process, provision, evaluate and archive CCO?s data assets and to effectively manage the information and analytics assets produced by internal analytics teams. Procedural manuals are data asset specific controls that provide step by step instructions to assist staff in implementing the various policies, standards and guidelines. A D&A governance structure is in place to approve guidelines, policies and standards; review consistently for changes in enterprise D&A artifacts; bring forward enterprise-wide data & analytics issues and act as a champion to formalize the practice within their business areas. The advisory forum ensures D&A priorities align with CCO?s strategy and are accountable to management committee. The community of practice (tactical groups) contribute to the development and maintenance of guidelines and help identify continuous improvement opportunities but are not part of the formal governance structure.


Finding/Results:
CCO?s data & analytics governance provides a coordinated approach to manage data and analytics assets in the most efficient way. Standard data governance and business processes reduce duplicate data management efforts and improve data understanding among analytics teams. Defining consistent analytics methodologies will standardize analytics concepts used across the organization which will lead to consistent analytical reporting at enterprise level. Integrated Data & Information stewardship model helped establish clear and consistent enterprise accountabilities and practice expectations for data management and analytics teams across CCO.


Conclusion/Implications/Recommendations:
Robust Data & Analytics governance will ensure CCO has reliable, high quality and trustworthy data available that will enable business users generate actionable insights.


140 Character Summary:
Provides an overview of CCO?s Data & Analytics Governance implemented enterprise-wide to manage, control and have oversight over CCO?s data and analytics assets

Purpose/Objectives:
Highlight how the Canadian Drug Dictionary (CCDD) is being used identify drug products in digital health solutions such as e-prescribing, and how it can be used for medication profiles and secondary use such as adverse drug monitoring.


Methodology/Approach:
Identified use cases for the CCDD partnered with Health Products and Food Branch of Health Canada (who agreed to own the CCDD) to leverage the Drug Product Database to develop the CCDD content Establish a governance framework to manage content and issues Influence knowledge base vendors to integrate the CCDD within their commercial product Market and communicate the value of the CCDD Improve consistency of drug information within EMR, pharmacy and hospital systems


Finding/Results:
The CCDD has been published monthly for over a year. The CCDD content will be complete by March 2019 and include all medicinal products with a Health Canada drug identifier that are being used in Canada. The CCDD has been integrated into at least 3 knowledge base vendor commercial products by January 2019. The CCDD is being used in interoperability projects.


Conclusion/Implications/Recommendations:
The CCDD was launched in September 2017 to bridge the gap between systems that don?t speak the same language. For example, electronic medical record (EMR) systems are typically supported by knowledge base vendor databases that provide proprietary coded content that cannot be understood by pharmacy systems that use different knowledge base vendors. When these vendors map their proprietary content to the CCDD, the data can be understood, enabling the sharing of medicinal product data. Doctors can use their EMR to identify the product they wish to prescribe (at the level of detail they wish to use) and the pharmacy can receive, understand and determine the product to dispense. The Canadian Clinical Drug Data Set (CCDD), is receiving tremendous interest from knowledge base vendors who want to integrate it with their commercial products. This will enable more prescribers and pharmacists in Canada to use PrescribeIT?, Canada?s national e-prescribing service and enable other interoperability projects share vital drug information safely and reliably.


140 Character Summary:
The CCDD will support more efficient workflows and improved safety in medication management, the national opioid strategy and improve care for individuals.

Purpose/Objectives:
To enable Cancer Care Ontario?s (CCO) mandate supporting Ontario government on cancer and kidney care systems, and key health priorities such as wait times on health services, CCO collaborates with healthcare partners to improve the performance of our health systems by driving quality, accountability, innovation, and value. Metadata documentations were inconsistent, incomplete, and scattered across muiltiple artifacts, thus has been identified as a foundational pillar of enterprise data governance practice to deliver CCO?s mandate using data and analytics capabilities. Implementing Enterprise Metadata Management (EMM) ensures data users can access consistent supplemental documentation across clinical domains, understand the underlying meaning of the data they use or may want to use, leading to better trusted information for decision making.


Methodology/Approach:
EMM approach has been developed by defining and implementing a policy, guideline, procedural manuals, processes, and identification of roles and responsibilities (R&Rs) that center around a work cycle. To enable EMM practice adoption, CCO has introduced technology to support the implementation and maintenance activities to keep metadata current, complete, and correct at all times. Guideline establishes enterprise R&Rs, standardized repeatable and scalable process steps, and standardize templates to gather metadata, resulting in robust and maintainable EMM repository. Procedural manuals are established to ensure data asset specifics are captured. Customized sessions are conducted to ensure data stewards and users understand benefits of this work and how it can positively impact their work. Data Stewards receives close mentorship to ensure metadata content gathered reflect EMM standards. Technical teams standardizes the approach to link between technical and business metadata across data assets, a single scalable data model is used to capture business metadata across all data assets, and the technology supports organization wide access to the metadata.


Finding/Results:
EMM implementation improves CCO data users? understanding of the underlying meaning of CCO data, reducing unnecessary time to determine information accuracy, enable identification and resolution of conflicting information, thus increasing users? trust and confident use of the data. People, process, and technology are all required to ensure the EMM practice is sustainable. Having commitment from all levels of organization (from executive team to junior analysts) to undertake this initiative is critical. By ensuring stakeholders are included in the process development and refinement, they feel they are part of this journey. The technologies meet current needs while also scalable to meet future requirements. This initiative may change how users interact with information to understand data; ongoing change management support is recommended to assist users through this transformation.


Conclusion/Implications/Recommendations:
Enterprise metadata management is required for organizations looking to realize value by leveraging its data and analytics assets


140 Character Summary:
CCO?s Journey to Enterprise Metadata Management is essential to transforming CCO to an insight driven organization.

Purpose/Objectives:
Concerns about protecting patient privacy and growing risks related to cybersecurity are dominating the digital health agenda. There was an increasing need for comprehensive, up-to-date, convenient privacy and security training with attestation that addressed important topics such as legal obligations around PHI, best practices for protecting PHI, and dealing with privacy breaches. Training needed to be practical, accessible 24/7 and recognized by all digital health partners. Learn how we delivered this scalable, cost-effective solution for clinicians and their staff.


Methodology/Approach:
Previous attempts at providing a robust privacy and security training solution did not fulfill the objectives for the health care system because they were either not comprehensive, not updated, could not be audited to ensure completion and often involved a cost to the end-user?s organization. Our organization took a unique, transformative and strategic approach to providing privacy and security training. Our strategy was to work with key health care partners to develop a practical solution to privacy and security training recognized by all organizations and scalable to thousands of clinicians, allied health professionals, administrative and IT staff who may come into contact with PHI. An online solution was the most cost-effective for the partners and the health care system. Partners included organizations responsible for digital health infrastructure, regulatory bodies, and associations representing physicians and liability protection, and risk-management education for physicians. The strategy incentivized users of the Privacy and Security Training Module by making the training mandatory for access to EHR systems, providing a printable certificate of attestation, and providing CME credits for physicians. The strategy provided flexibility so the training could be ?white-labeled? for any health care organization or other jurisdictions to spread the benefits of the training to more clinicians and prevent more cybersecurity incidents.


Finding/Results:
In less than 9 months, almost 1,000 users have completed the Privacy and Security Training Module. In October, a French version of the Module became available. The reviews are very positive. After completing the Privacy and Security Training Module: - 91% of users understand PHI and ownership of medical records - 90% of users indicated that they were able to identify and appropriately respond to privacy breaches and security incidents - 89% understand ways to safeguard PHI. This comprehensive training is helping to instill privacy and security best practices at the practice level, avoid breaches and ensure EHR systems are used appropriately.


Conclusion/Implications/Recommendations:
At a time when health information is shifting to digital platforms, security and privacy training is critical for all clinicians and partners. The Privacy and Security Training Module is convenient, accessible and accredited training that clinicians want and need. It is an innovative learning solution that encompasses change management principles that include the people and process sides of change. Users can access the free training from any Internet-enabled mobile device and complete it at their own pace. As privacy legislation and technology evolves, the module will be updated. It is recommended that users take the training once a year to keep current on best practices and protocols.


140 Character Summary:
The Privacy & Security Training Module with attestation provides comprehensive, 24/7 training accessible from any Internet-enabled device.

Purpose/Objectives:
With the increasingly active virtual primary care visit landscape both in Canada and internationally, many across health systems have accepted that virtual visits are here, and they’re here to stay. But what do we know about virtual primary care visits and their impact on continuity of care? One of the central tenets of primary care in Canada is that it stands as practice grounded in relationships and relationship building. Indeed, provincial governments historically endeavoured to set targets to attach their populations to a primary care physician in recognition of the benefits that the continuity of a single relationship can have on health outcomes and experience for patients. So how do we reconcile this historic approach with the incumbent technologies that stand to disrupt the way we deliver primary care by making available, ‘physicians on demand’? What should we be mindful of as these technologies enter the primary care space and what are the arguments for or against continuity when we have such a dire access situation nationally?