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  • e-Health 2019 Virtual Meeting

    Celebrate, Grow & Inspire Bold Action in Digital Health - Toronto, ON

    This product offers access to the e-Health 2019 Keynote / Plenary Presentation Live Webcasts, the recording of these 4 sessions and access to all PDF/Presentation Slides of each conference presentation.

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    PDF's of presentation PowerPoints are now online!

    Presentation Date(s):
    • May 26 - 29, 2019
    • Total Presentations: 240
    Non-Member Price: $95 CAD Digital Health Canada Member Price: $75 CAD
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    EP02 - Application / Implementation / Adoption and Use 1 (ID 13)

    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 8
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      EP02.01 - CPT®: A Key Step Along the Path of Digital Health (Slides Available) (ID 446)

      Dean Parisi, International Business Development, Health Solutions Group, American Medical Association; Chicago/US

      • Abstract
      • PDF

      Purpose/Objectives:
      Locally-defined physician service descriptions have several underlying challenges in Canadian provinces and territories. Attend this session to learn how and why the Current Procedural Terminology (CPT?) product suite consisting of a set of clinical terms including clinician, consumer and long descriptors along with thorough documentation and guidelines for their use (hereafter referred to as the Suite), is a strategic, innovative digital health solution for a recognized pan-Canadian problem: the lack of a physician-based universal clinical terminology to describe, record and report physician services. 1. State why a single terminology for physicians? services reporting across Canadian provinces and territories eliminates identified challenges 2. Define the characteristics of a clinical terminology for physicians? services and how CPT clinical terms addresses them 3. Explain the clinical and interoperability benefits of the Suite as a Canadian digital health solution for reporting of physicians? services 4. Identify how the CPT framework can facilitate digital health initiatives


      Methodology/Approach:
      The American Medical Association (AMA) completed a cross-Canada environmental scan in 2018. Objectives of this effort were to assess current challenges with the reporting of Canadian physicians? services as well as exploring the potential use of the Suite as the reporting solution across Canadian provinces and territories. The environmental scan execution included: ? A review of physicians? manuals and fee schedules for each of the provincial/territorial jurisdictions. ? Formal interviews across Canada including provincial/territorial governments, medical associations, clinical or performance measurement programs, national associations, and electronic medical record vendors. ? Follow-up meetings to share a summary of the environmental scan results. Next, the AMA proposed a CPT implementation framework along with the creation of resources needed to assist with CPT implementation.


      Finding/Results:
      There are a number of clinical and interoperability benefits of implementing the Suite as a Canadian digital health solution for physicians? services reporting. For example, CPT clinical terms support innovative clinical practices and technologies. Furthermore, several CPT use cases already exist in Canada. Hospitals in several provinces participate in the American College of Surgeons National Surgical Quality Improvement Program? (ACS NSQIP?). CPT clinical terms are used to monitor patient outcomes following surgery with the goal of improving the quality of services delivered and reducing adverse outcomes and complications. Five years ago, the Nova Scotia Department of Health and Wellness and Doctors Nova Scotia began the process of adopting up-to-date clinical terminologies for reporting physician diagnoses and procedures. The Suite was selected as the clinical terminology solution. Recognized as a common language utilizing a uniform methodology for representing clinically relevant physician service terms, additional uses of CPT clinical terms are possible as well.


      Conclusion/Implications/Recommendations:
      Implementation of CPT clinical terms, a physician-based clinical terminology, offers a strategic, innovative digital health solution for Canada. The Suite addresses the pan-Canadian need for a clinical terminology for physicians? services and can capture what a Canadian physician does in the current health care environment. It also has the ability to adapt to the evolving digital health environment. Resources to support implementation, such as maps and educational materials, are also accessible to those who require them.


      140 Character Summary:
      Bold Action in Digital Health: Implementing the CPT product suite as a strategic, innovative solution to describe, record and report physician services in Canada

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      EP02.02 - Innovative Realizations and Attributes of Academic Health Centers Throughout Canada (ID 82)

      Jonathan Lapointe, Montreal/CA

      • Abstract

      Purpose/Objectives:
      Implementing IT innovations that can grow beyond the pilot or research phase in healthcare have been shown to be difficult. In Canada, also known as the land of pilot projets, we want to know how the important advances in IT can be harnessed to drive positive changes in Canada?s health system. To do so, we decided to look at the 17 academic health centers (AHC) in Canada and draw a map of their main caracteristics, their partnerships and innovative projects making innovative use of patient data using next level IT tools like AI and Big Data. AHCs were chosen because of the strategic position that they occupy in the healthcare innovation landscape by their mission in clinical care, research and teaching and their role in spreading new ways of providing care. The objective of this project is to first paint the landscape of all the AHCs in Canada and then develop an analytic framework of the innovative capabilities of AHC, helping stakeholders, managers and partners to have a better understanding of what factors drive new and successful data driven innovations in Canada?s AHCs. This project is part of a greater endavour on how AHCs can sustain innovation through the creation of Learning Health Systems.


      Methodology/Approach:
      The first ongoing step of this project is to collect descriptive information on each of the 17 AHCs in Canada from their websites, research centers, patient-data related IT innovation projects they worked on and press releases. The composition of the AHC, the size and expertise of the research teams, the financing partners, the private sector collaborators and government funding are also extracted from the available documentation. After a first analysis, each AHC will be contacted to make sure that the extracted information is both correct and complete, to make sure no important information has been overlooked. The caracteristics of the AHCs and of their environment will then be compared to the number, complexity and status of the innovations A descriptive analysis of each source of information will be performed, separetely and globally according to thematics emerging from the data.


      Finding/Results:
      To our knowledge, the results of this project will present for the first time the internal context of each AHC in Canada as well as the external context and mix of private and public partnership that works with them. This alone will allow us to gain a valuable insight on the area of expertise, network and innovative characteristics of each AHC. It will also give us an understanding of how internal and external funding and partnership might promote the emergence and long term use of innovations in Canada.


      Conclusion/Implications/Recommendations:
      The results from this project will help AHCs, funding agencies and private sector partners to have a better outlook on ways to engage and promote IT innovations in the healthcare sector in Canada and lay down the foundation for learning health systems. It will also contribute to better collaboration between AHCs. We recommend that the portrait of the canadian AHC be maintained on a yearly basis.


      140 Character Summary:
      Learning health systems depend on innovative IT systems to share and analyze patient-data. Teachings from current IT projects in Canada can help us reach this goal.

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      EP02.03 - Safe Step: Falls Risk Screening Project (Slides Available) (ID 97)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      According to the Government of Ontario?s, Injury Prevention Guideline, 2018[1], ?The most common injury type associated with falls in older adults is fractures, followed by sprains or strains. These injuries can lead to significant disability including the potential for institutionalization in long-term care settings.? In Champlain, falls are a leading cause of injuries and ER visits and among older adults; with 85% of injury related hospitalizations and $55M of annual healthcare costs. Public Health prioritization of falls prevention is indicative of the fact that injuries do not occur by chance (i.e. they are not accidents), but are predictable and preventable. However, seniors are not routinely assessed for falls risk early enough to motivate preventative measures that could delay frailty. Often identification of an issue occurs when a condition has deteriorated or a fall has already occurred/ imminent. Ontario Centres of Excellence, Health Technology Funding, MOHLTC OCHIS, indicate strong support for technology driven innovations that will help fundamentally reshape prevention, care services and/or their costs. [1] http://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Injury_Prevention_Guideline_2018_en.pdf


      Methodology/Approach:
      Our objective was to determine value in an innovative broad, early screening and prevention program that increases self-awareness and motivation for falls prevention. The program, Safe Step, used evidence based sensor technology. It engaged 1500+ seniors, in more than 230 events, across 110 locations, with over 60 partners offering social, health and/ or support services. This innovative technology, QTUGTM is an electronic version of a standard mobility assessment used to screen for balance problems. It enabled preventative screening in a more cost-effective[1] way, than any other falls prevention program to-date by using trained technicians (non-professionals i.e. PSWs, therapy assistants). Sensors on shins monitored and analyzed movements during a short (approximately 10 to 15 seconds) TUG test (get up from a chair, walk three metres, turn around, walk back, sit). Combined with basic clinical questions embedded into the application, multiple data points produce personalized frailty and falls risk scores. Medium/high risk participants were provided a physician letter and information on free exercise and falls prevention programs, and told to discuss with physicians. [1] https://www.kinesis.ie/qtug-calculator/


      Finding/Results:
      Quadruple-AIM evaluation work is in-progress. Our data will provide valuable information on the participants? and technicians? experiences, the cost of operating a program, the locations/events that are the most opportunistic and the clinical value of the program. Preliminary findings showed 62% were unaware of their falls risk, 40% surprised, and 85% indicated they?ll talk to their physician. Observations indicated that participants were very engaged in this interactive screening and the falls prevention information.


      Conclusion/Implications/Recommendations:
      With 85% of high risk seniors, now indicating that they will talk to their physicians, this program has proven its value as a part of comprehensive, community based, early falls prevention programs. Based on our learnings, we are planning to implement new programs designed to engage seniors after the onset of frailty but prior to a fall. Evaluation results and learnings will design program strategies and appropriate business models across various organizations in the health system.


      140 Character Summary:
      Falls is a leading cause of injuries & health-care costs. Learn how technology has reshaped falls-prevention services, costs and effectiveness.

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      EP02.04 - Telehealth Wound Care in Nova Scotia  (Slides Available) (ID 216)

      Cathy Cruz, Nova Scotia Health Authority; Bridgewater/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Nova Scotia Health Authority (NSHA) Virtual Care recently partnered with Ambulatory Care at the Cape Breton Regional Hospital (CBRH) to develop a program that would allow inpatients requiring wound care at rural hospitals to connect virtually with a specialist located at the regional hospital using telehealth. Prior to this, patients were being transported to the regional facility to receive this care. The purpose of the virtual clinic is to provide wound assessment, prescribe treatment and follow-up in an efficient and timely manner, while maintaining the comfort of the patient. The main objectives were to: Improve the patient experience Improve outcomes due to earlier diagnosis/treatment of wounds Eliminate congestion in Ambulatory Care/Emergency Department at the Cape Breton Regional Hospital


      Methodology/Approach:
      Specialists in Sydney are connecting to wound inpatients across 6 smaller rural facilities including: New Waterford, Glace Bay, North Sydney, Cheticamp, Inverness, Neil?s Harbour, and Harbourview health centres (NSHA hospital facilities). The connection occurs using polycom telehealth equipment that is already located in each NSHA facility. The receiving site (where the patient is located) has a nurse present with an AMD camera to accurately show the wound to the clinician. Quantitative data was collected in 2018 to measure: changes in number of patients being seen, number of referrals made, and time saved for patients. Qualitative data was to collected to capture overall health care provider and patient experience.


      Finding/Results:
      After implementation of the virtual clinic, results showed that patient appointments, on average, increased from 4 in-person visits to 12 virtual visits during the weekly clinic. In 2018, between April-August, 75 patients were scheduled for virtual visits, and 70 referrals to the clinic took place between mid-May and end of June. Further data showed that on average the virtual clinic saves 3.6 hours median of 128 minutes of travel time that was taking place via ambulance transport. It was also noted that patients were waiting up to 90 minutes to return to the hospital where they were an inpatient and by starting the virtual clinic, this was completely eliminated. A patient who participated in the clinic indicated: ?[This] will be great in winter time, terrible to travel those roads and is so unpredictable?. A staff member also noted: ?This is great! Patients are seen quicker?.


      Conclusion/Implications/Recommendations:
      After the implementation of the wound care virtual clinic, there were many positive outcomes including an increase in the number of patients seen, increased referrals, reduced patient travel time, and increased patient satisfaction with their health care experience. The success of this project allows for consideration of virtual wound care clinics to other areas of the province. The development of home-based wound care has also been considered (partnering with VON or other community health services) for future expansion of this initiative. This type of initiative could also be mirrored in other service areas. Recommendations for future adoption of this type of clinic include: nurse resources at inpatient facilities, engaging health services managers early in the planning/development, and having a champion can be extremely beneficial to the success of a program.


      140 Character Summary:
      NSHA Virtual Care developed a program for inpatients at rural hospitals in Cape Breton to connect with a wound specialist at the regional hospital using telehealth.

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      EP02.05 - Data Driven Insights for the Ambulatory and Outpatient Care Sector (Slides Available) (ID 221)

      Anne Forsyth, CIHI; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Until now, little has been known about the value and outcomes of care provided in our ambulatory and outpatient sector. CIHI has expanded its National Ambulatory Care Reporting System (NACRS) to include a low-cost, low-burden reporting option that provides timely, comparative information for local planning and decision-making and for health system accountability and improvement. Its standardized data bridges information across sectors and the care continuum, providing one more piece to the overall health care picture by capturing clinical and operational patient level information on number of visits, population served and reasons for receiving health services. This presentation will provide an in-depth look at the first clinical areas that are taking advantage of CIHI?s NACRS Clinic Lite data reporting tool and the value they and the healthcare system overall are deriving from it.


      Methodology/Approach:
      CIHI is working with the Ontario Ministry of Health and Long-Term Care to support the bundled funding hip and knee program that kicked off in April 2018. Over 80 outpatient rehab sites across the province are submitting data to NACRS Clinic Lite on a variety of data points that will provide information on collaboration across care sectors, improve efficiency by reducing time spent in hospitals and encourage evidence-based care. CIHI is also working with the Canadian Association of Paediatric Health Centre?s (CAPHC?s) to support the Paediatric Rehab Reporting System (PRRS) via NACRS Clinic Lite. Paediatric rehab sites from across the country are actively submitting data for this project The data is critical for supporting improvements to outcomes for patients with autism and cerebral palsy, and incorporates patient-reported outcome measures.


      Finding/Results:
      Rapid expansion and uptake of data submission requires careful planning and well-thought out processes to navigate unforeseen circumstances. Some of the common challenges that arose during implementation, and how each was overcome, will be described during this presentation.


      Conclusion/Implications/Recommendations:
      Health care in Canada is shifting ? more care is being provided in ambulatory or outpatient settings in the hospital or community. Most jurisdictions have summary information, but there is a gap in patient-level clinical, operational, quality and utilization data that CIHI is starting to fill. This project, focusing on a priority population in Canada, showcases the benefits that access to data and information can have on understanding patient populations and improving outcomes. These will be described in detail as part of the presentation.


      140 Character Summary:
      Modernizing data collection to close secondary use data gaps in outpatient settings.

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      EP02.06 - Health Information Exchange: An Effective Use of Evaluation Study (Slides Available) (ID 244)

      Jaskaran Bains, eHealth - Health Information Exchange, Fraser Health Authority ; Surrey/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Fraser Health (FH) is continuously expanding their Health Information Exchange (HIE) system branded Unifying Clinical Information (UCI). To understand if UCI was being used to its optimum value and to ensure that the project team was working on priority initiatives for end users, an evaluation and usability study was conducted. Based on the study, initiatives were prioritised to address the three major gaps that were identified.


      Methodology/Approach:
      The study used a mixed approach of both quantitative and qualitative research methods. Qualitative research was conducted to collect data from interviews, focus group, survey and observations. The quantitative method was used to understand how frequent users accessed UCI and what the benefits were. All clinical program areas in the acute and community services areas were included in the study, and involved both clinical and administrative staff. The data collected helped the project team to identify key priority items for end users and informed the approach taken to projects. The key focus of the projects was to deliver high value to end users and resolve the major gaps that were causing a barrier to adoption. The data collected in 2016 has been kept as a baseline to be used to compare future data collections to measure the adoption of UCI within FH.


      Finding/Results:
      Clinical departments & program areas participated in the evaluation and usability study. Three major areas of improvement were identified: product, information and change management. As part of the study, users were also asked to score what the benefits of using UCI have been. These were compared to the second evaluation conducted, which found benefits in 5 categories that were realized by the majority of clinical programs. The results show that both the clinical value and user experience has improved for the UCI users. The evaluation and usability study allowed Fraser Health to better understand why there were infrequent users of the HIE, how to increase adoption (where possible) and determine where to allocate resources that will deliver the greatest value to users.


      Conclusion/Implications/Recommendations:
      Following the completion of the UCI Expansion Project, the major gaps identified through the evaluation study have been resolved. There was considerable value of conducting an evaluation and usability study as it informed which projects were initiated along with the priority of these. End users were involved throughout the project life cycle to ensure their needs continued to be met. A new change management strategy based on the PROSCI ADKAR framework was effective in developing and supporting all the changes made to UCI.


      140 Character Summary:
      An evaluation and usability study was conducted to inform the expansion of UCI at Fraser Health and optimize clinical deliverables.

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    EP03 - Application / Implementation / Benefits and Realization (ID 14)

    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 9
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      EP03.01 - Informatics Competencies for Canadian Nurse Leaders   (Slides Available) (ID 20)

      Gillian Strudwick, Centre for Addiction & Mental Health; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      There is a growing concern that a majority of nurses in leadership roles in Canada may not have the requisite informatics competencies to meaningfully participate in making strategic decisions related to the acquisition and use of ehealth systems. Core informatics competencies for Canadian nurse leaders must be identified, validated and disseminated. The aims of this study were to: 1) identify and build consensus on the informatics competencies of relevance to Canadian nurse leaders; 2) obtain the perspectives of nurse leaders on appropriate dissemination strategies for the identified informatics competencies; and 3) disseminate the informatics competencies to nurse leaders across Canada.


      Methodology/Approach:
      These objectives were met through the completion of a Delphi study of nurse leaders with informatics expertise from across Canada, interviews with a sample of nursing leaders from across Canada, and identifying knowledge translation activities, including an open-access publication, and presentations at relevant meetings and conferences attended by nurse leaders. A Delphi technique was used to achieve consensus on the informatics competencies of relevance to Canadian nurse leaders. Through a series of structured surveys and feedback reports, a panel of experts in the field was consulted to identify and prioritize informatics competency statements specific to nurse leaders. This iterative process used four rounds of data collection; further details of this process will be presented. Qualitative content analsyis will be completed from interviews being conducted with fifteen (n=15) nurse leaders using a semi-structured interview technique to determine the most appropriate dissemination strategies for the identified informatics competencies. The results of these interviews will inform the following: 1) target journal for an open-access publication; 2) target national and regional meetings/conferences/nurse leader groups for presentation of the identified competencies to be completed either face-to-face or via webinar; and, 3) additional strategies to consider for the dissemination of results (e.g., relevant websites to post competencies).


      Finding/Results:
      This study was in progress at the time of this abstract writing. The presenter will provide the outcomes of the Delphi study and the nurse leader interviews and discuss additional knowledge translation activities to be completed as per the findings of the nurse leader interviews.


      Conclusion/Implications/Recommendations:
      As a result of the study activities, it is expected that: 1) informatics competencies of relevance to Canadian nurse leaders will be identified and endorsed by national nursing organizations; 2) nurse leaders from across Canada will become aware of the informatics competencies required to be effective in their roles; and, 3) nurse leaders will actively inform strategies for the acquisition, implementation, use, and evaluation of eHealth systems in all healthcare settings. The study activities will catalyze work that will eventually result in the improved selection and use of eHealth systems that effectively support the delivery of safe, quality care that will positively impact the health system and clinical outcomes. In turn, this work will contribute to the obtainment of improved eHealth system outcomes in Canada.


      140 Character Summary:
      Discussion of validated requisite informatics competencies for Canadian nurse leaders and strategies to develop, disseminate and increase awareness of same.

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      EP03.02 - From Paper to Paperless: BORN ISCIS Integration for HBHC Screening (Slides Available) (ID 92)

      Michael Kotuba, BORN Ontario; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      BORN Ontario has partnered with the Ministry of Children, Community and Social Services (MCCSS) and Public Health Units (PHUs) to enhance the way in which key maternal child screening information moves between hospitals and public health care providers to help facilitate care and transitions from hospital to community. Enhancement of the current data collection mechanisms support its transfer to public health units and eliminates the need for manual data capture, faxing and re-keying of personal health information. Objectives: Improve outcomes for children and families in Ontario by applying innovative strategies with accurate, complete screening as well as the potential to identify populations that decline the offer of screening. Enhance knowledge of the initiative and understand the use of innovation to provide a standardized mechanisms for universal postpartum screening for more timely client follow-up in the community Illustration of the reduction in data quality issues through pre-population, data entry and data validation rules Understand how this initiative has reduced the risk of privacy breaches by eliminating non-secure transfer methods of Personal Health Information (PHI)


      Methodology/Approach:
      Current practice for the HBHC Screen involves a hard copy of the completed form being faxed or manually transported from the hospital to the PHU and then entered into the Public Health database. Faxing, often results in transcription errors, legibility issues, and transmission delays, which is especially problematic for a time-sensitive screen. The risk of a privacy breach is also inherent in the faxing process. BORN has developed an electronic version of the HBHC Screen which is housed within the BORN Information System (BIS).


      Finding/Results:
      A pilot study was performed to examine whether leveraging BIS infrastructure and existing data collection mechanisms would support increased data quality and timeliness of data transfer. The lessons learned from the pilot provided opportunities to enhance both systems and processes. Use ? There were 4,182 HBHC Screens completed in the BIS during the pilot and 3,125 Screens transmitted to ISCIS from pilot hospitals during the HBHC pilot time period User Satisfaction ? Overall participants were satisfied with the communications, training and support they received during the HBHC pilot. Quality ? During the pilot period, 88.5% of births had a completed HBHC Screen. Duplicate Screens remained an issue throughout the pilot, and has been addressed in the technical fixes for the provincial roll out. There was a significant increase in completeness of the 36 HBHC Screen questions (99.7%). Access ? 77% of respondents reported that they had the technology needed to complete the HBHC Screen in an efficient and timely manner. HBHC Screens were being received by PHUs faster, and families with risk were being contacted sooner. Productivity ? The survey and focus group noted strengthening of relationships between hospitals and PHUs.


      Conclusion/Implications/Recommendations:
      The BORN-ISCIS Integration HBHC pilot project demonstrated that data from the HBHC Screen can be transmitted from the BIS to ISCIS seamlessly while protecting PHI. This project has led to provincial roll-out of this technology to support and facilitate care to at-risk families in Ontario.


      140 Character Summary:
      Support the transfer of the HBHC Screen to PHUs by eliminating the need for manual data capture, faxing and subsequent re-keying of personal health information.

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      EP03.03 - eReferral from Acute to Home and Community Care (Slides Available) (ID 217)

      George Ibrahim, OSMH; Orillia/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Incomplete, lost or unclear referral forms resulted in rework, required follow-up, or delayed hospital discharge were identified as potential patient safety concerns within the region. In 2012, a time limited study identified that approximately 90% of a potential 12,000 referrals submitted to home and community care from acute care were missing a significant amount of the mandatory information. Each referral was estimated to take approximately 10 to 15 minutes to transcribe from the faxed original. To address these concerns, the project was initiated with the following goals: Increase patient safety by ensuring that referrals are complete, correct and timely; Reduce the risk of privacy breaches related to the faxing of referral documents; Increase system sustainability by avoiding unnecessary hospital days.


      Methodology/Approach:
      All five NSM hospitals committed to the electronic adoption of the provincially standardized Resource Management and Referral form. A collaborative project team structure was formed where a Project Manager from Orillia Soldier?s Memorial Hospital (OSMH) led the project with Royal Victoria Hospital Regional Health Centre (RVH) being the initial pilot site. The LHIN provided funding in the first year to support these efforts. Collingwood General and Marine Hospital, Georgian Bay General Hospital, Orillia Soldiers? Memorial Hospital, and Muskoka Algonquin Healthcare have also implement the solution building off the lessons learned and expertise of the preceding sites. The Information Technology teams within each of the hospitals worked with HSSO to design the bi-directional interfaces at their respective sites with support from their hospital information system (HIS) vendors as necessary for custom builds.


      Finding/Results:
      Improvements have been achieved through a standard electronic Referral Management and Referral (RM&R) form, compulsory form fields and bi-directional communication to close the loop on any outstanding referral components. Additionally, the referral is embedded at both ends: within Hospital?s Information Systems (HIS) (including Meditech and Cerner systems) and the LHIN?s CHRIS system. This integration with the existing point of care systems ensures the quick and seamless transfer of information. Efficiencies are gained as existing or previous patients in CHRIS are automatically matched to eReferral allowing some fields to be pre-populated and information to be updated.


      Conclusion/Implications/Recommendations:
      AT the time of the submission of this abstract, 3 of the 5 hospitals have gone live with the solution Results included: Patient Safety and Access Transcription errors avoided No rework leading to increased waits for the patient Bi-directional communication allowing for status updates, feedback or referral cancellations Cross Organizational Collaboration Reinforced local IT expertise and capacity within acute care facilities Cross organizational focus on common goals Partnership and positive working relationships fostered between organizations System Integration/Interoperability User convenience as hospital and LHIN staff access referral via their point of care systems Ability to close the loop on outstanding eReferrals Performance Monitoring Ability to monitor the number of referrals and wait times from referral to placement Ability to log each step of the referral with date/time and user thereby enabling reporting, performance management, and accountability System Sustainability Increased administrative efficiency in referral transcription No time needed to obtain missing information Ongoing base costs avoided


      140 Character Summary:
      Five NSM LHIN hospitals and HSS Ontario are adopting an eReferral solution to facilitate 1000s of referrals annually from acute to home and long-term care

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      EP03.04 - Modernizing Hospital Supply Chain Management: A Digital Health Case Study (ID 553)

      Alistair Forsyth, Information Services, North York General Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      NYGH has one of the busiest operating rooms in the Central LHIN and operates one of the largest cataract centres in the province. As such, its operating room (OR) relies on a large inventory of medical equipment and supplies to provide care to its patients. Due to funding constraints and other factors, the OR has developed highly manual and fragmented supply chain management processes and uses a number of disparate technology systems for inventory tracking. This has created significant challenges in maintaining appropriate inventory levels, cost control, data analysis and quality improvement. Our hospital is on a modernization journey that will transform our inventory management processes and technology for perioperative services by leveraging private and public partnerships.


      Methodology/Approach:
      This is a two year project that will be delivered in three phases: Phase 1 will represent the foundational stage and will focus on project planning, developing baseline metrics and future state workflows. Phase 2 will deliver data cleansing, space renovation, technology build/implementation and end-user training. Phase 3 will focus on outcomes evaluation against key performance indicators and knowledge translation. Through a partnership with the University of Toronto's faculty of Healthcare Engineering and Plexxus Shared Services, NYGH has established a diverse team of clinical, supply chain, technical and quality improvement experts to achieve the project's goals.


      Finding/Results:
      The expected results of this project are to: -Reduce inventory levels by 5-10% -Reduce surgical instrument waste by 10% -Improve process efficiency resulting in a 5% decrease in OR turnaround times -Enable highly accurate surgical case costing and reduce variability Key performance indicators (KPIs) will be developed to measure our success in achieving these goals and to support ongoing quality improvement.


      Conclusion/Implications/Recommendations:
      While this project will focus on improvements to the OR supply chain, the results of this project can be scaled to provide value to other areas of the hospital and to the broader health sector. Being able to transfer the technology we implement as part of this project throughout the hospital in improve efficiency and effectiveness through the standardization of processes. NYGH will work with the University of Toronto to translate the knowledge gained from this project into useful analytical tools that can be utilized by other hospitals. Additionally, our partnership with Plexxus Shared Services will provide a channel to disseminate our learnings to leadership at other Plexxus hospitals. This project represents an opportunity to produce significant cost savings for the broader health cate system through digital health technology, while enhancing patient experience and outcomes, reducing waste, enhancing the quality of data for provincial reporting and allowing clinicians to spend more time caring for their patients.


      140 Character Summary:
      Transforming inventory management processes and technologies in a community teaching hospital by leveraging public, private and academic partnerships.

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      EP03.05 - Use of Telemonitoring to Facilitate Heart Failure Medication Titration (Slides Available) (ID 513)

      Veronica Kirk, Institute of Health Policy, Management and Evaluation; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Heart failure (HF) is a common diagnosis with high prevalence, reduced life expectancy and a significant clinical and economic burden. The Heart and Stroke Foundation estimates that nearly 700,000 Canadians are living with heart failure, about 50,000 new cases are diagnosed every year, and heart failure costs the Canadian health-care system $2.8 billion annually. Large-scale randomized controlled trials have demonstrated that combination drug therapy, optimized to maximal tolerated doses, improves clinical outcomes in HF patients. However, evidence suggests that in clinical practice many patients never achieve target doses. Barriers to medication titration include provider and patient-related factors, as well as limited time and support facilities to enable regular monitoring. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support, alerting, and patient self-management. The primary objective of this study is to evaluate the efficacy and safety of the implementation of telemonitoring to facilitate HF medication titration. The secondary objective is to obtain a deeper understanding of the experience of clinicians and HF patients taking part in the remote titration program.


      Methodology/Approach:
      The study will be conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, in Toronto. It will be based on a mixed methods effectiveness-implementation hybrid design and incorporate process evaluations alongside assessment of clinical outcomes. The effectiveness research component will be assessed via a 2-arm randomized controlled trial (RCT), which will enroll 42 patients in total. The RCT will compare a predefined remote titration management strategy, which will utilize data from a smartphone-based telemonitoring system, with a standard titration management strategy consisting of regular in-office visits, and assess the efficacy and safety of the telemonitoring system in facilitating titration. The implementation research component will consist of a qualitative study based on semi-structured interviews with a purposive sample of clinicians and patients, and assess the factors that can positively impact the implementation and effectiveness of the intervention.


      Finding/Results:
      Data collection has begun and will be completed in the spring of 2019. The results of this study will be presented at the conference.


      Conclusion/Implications/Recommendations:
      Successful use of telemonitoring for the purpose of medication titration has the potential to alter the existing approach to titration and provide evidence for the development of a care delivery model that combines clinic visits with virtual follow-ups. This model could decrease the number of visits that patients make to the clinic, increase the proportion of patients who achieve optimal doses and impact the median time to dose optimization. Our study will be the first to provide evidence on the potential of telemonitoring to optimize the medication titration process, and thereby reduce healthcare resource utilization, the burden on the patient, and the cost of the process from the patient?s perspective.


      140 Character Summary:
      Use of telemonitoring to facilitate heart failure medication titration in order to reduce the amount of clinic visits made by patients.

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      EP03.06 - OpenActigraphy:  A Novel Sleep and Activity Monitoring System (Slides Available) (ID 474)

      Robyn Stremler, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Actigraphy is a method to monitor human activity such as sleep, physical activity and sedentary behaviour using an accelerometer in a wrist-worn device called an actigraph. Motion data from the actigraph are sampled and recorded, and validated algorithms are applied to the data to determine sleep-wake and other health behaviours. Current actigraphy platforms (e.g. Phillips, Ambulatory Monitoring Inc [AMI]) are expensive due to device cost ($600-$1000 per unit) and personnel hours to initialize, download, analyze data and manage device tracking. Researchers who use these systems are locked into a proprietary platform with set data analysis options. Our objectives: To develop a cloud-based platform (OpenActigraphy) which can process sensor data from consumer wrist-worn devices and inexpensive Bluetooth-enabled accelerometer devices using research validated algorithms for research and clinical purposes. To evaluate sensitivity and specificity for sleep-wake, physical activity, and sedentary behaviour determined by OpenActigraphy?s integrated, inexpensive high-quality Bluetooth accelerometer device (mBientLab Metawear [MWRG]) units).


      Methodology/Approach:
      Following REB approval and informed consent, participants (19 adults, 8 school age children, recruited in January 2018) wore the MWRG and a traditional research-grade accelerometer device (Octagonal Basic for adults, MicroMini Motionlogger for children, AMI, Yardsley NY) concurrently, on the same wrist for one day and two nights. We compared objective sleep classification via the OpenActigraphy system and MWRG to sleep classification using the AMI research-grade accelerometer system. Using two features of motion data from the MWRG device, we built a model for the OpenActigraphy system to determine activity counts comparable to those calculated by the Phillips Actical device and determined thresholds in our model that best aligned with the activity count thresholds used by Colley & Tremblay (2011).


      Finding/Results:
      Using 64,538 epochs from 27 participants across two nights and one day of recording, the ability of the MWRG device to accurately determine sleep and wake was established with 97.4% Sensitivity and 91.1% Specificity. We established good Sensitivity and Specificity for sedentary behaviour (Sensitivity 86.7%, Specificity 85.3%) and moderate-vigorous physical activity metrics (Sensitivity 93.8%, Specificity 98.3%).


      Conclusion/Implications/Recommendations:
      The OpenActigraphy platform can accurately leverage data from inexpensive consumer devices and sensors and generate sleep and physical activity health metrics as accurately as research-grade devices. OpenActigraphy offers researchers and clinicians a low-cost, accessible, higher quality system for health monitoring. With OpenActigraphy, more researchers will be able to afford inclusion of sleep as an outcome in their projects, and researchers? ability to conduct large scale, population-based, real-time examinations of sleep and health will be greatly enhanced. This work was awarded the Healthy Behaviour Data Challenge sponsored by CIHR, Public Health Agency of Canada, and MaRS Innovation.


      140 Character Summary:
      We investigated how inexpensive consumer-grade wearable devices can be leveraged to generate high quality sleep and physical activity health metrics.

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    OS06 - Innovations to Process Non Digital Data (ID 24)

    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 5
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      OS06.01 - Using Natural Language Processing for Improving Coded Data (Slides Available) (ID 269)

      Majid Sharafi, Scarborough and Rouge Hospitals; Scarborough/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Inpatient coding is a complex and tedious process that has not changed in the past thirty years. Health records departments are under constant pressure to meet tight timelines and compete for a shrinking pool of expert coders. Furthermore, the introduction of quality-based funding models increased the pressure on hospitals to improve quality of their data. Missed diagnoses are costly to hospitals. A possible solution is to leverage digital data: computational coding employs tools to ?read? clinical documents to recognize evidence and make recommendations on coding of diagnoses and procedures at a higher level of specificity. Scarborough and Rouge Hospital (SRH) embarked on a journey with 3M in 2017 to introduce Computer-Assisted Coding (CAC) to improve coding productivity and data quality. A prerequisite for CAC is availability and access to clinical documentation and other data feeds in electronic and computer readable form. Coders are trained to use the evidence and recommendations made by the computational tools to select appropriate codes. A year later, we conducted a study to understand the impact of this tool on data quality. The study?s objective was to measure the accuracy of the codes captured and whether using this tool influenced weighted cases.


      Methodology/Approach:
      The study was conducted jointly by SRH and 3M, as a before and after intervention comparison of the number of diagnoses and procedures coded by coder and their impact on weighted cases. Multi-variable regression analysis used to measure differences in weighted cases based on variables: diagnosis/procedure count and coder. Charts were randomly assigned to coders pre- and post-implementation; length of stay and weighted cases of charts coded were similar across coders, before and after CAC implementation.


      Finding/Results:
      Number of diagnoses coded post-CAC implementation was significantly higher, as was both, the Comorbidity Levels and Resource Intensity Levels of charts coded. More importantly, there was a statistically significant increase in Resource Intensity Weights (RIW) and Health Based Allocation Model Inpatient Grouper (HIG) weighted cases. Impact on inpatient data (excl. Newborns, Pediatrics and Obstetrics) 6 months post-CAC implementation within 2017/18 FY # of Diagnoses Coded 7% Increase Comorbidity Level 3% shift from Level 0 to Level 2 Resource Intensity Level 4% shift from Level 1 to Level 2 Average RIW 2% Increase (up to 9% for one coder) Average HIG Weighted Case 5% Increase (up to 13% for one coder)


      Conclusion/Implications/Recommendations:
      Results showed clear increase in weighted cases through use of CAC; increase was significant from hospital funding perspective. We anticipate further improvements in coding efficiency; the limiting factor is quality of underlying documentation. The next phase of our journey is to embark on a clinical documentation improvement (CDI) initiative to bring these tools closer to physicians and provide evidence based and data driven tools to improve accuracy and completeness of documentation. Another exciting opportunity in our CAC roadmap is the benefit from advances in natural language processing (NLP) and artificial intelligence (AI) that are incorporated in CAC.


      140 Character Summary:
      Scarborough and Rouge Hospital implemented 3M?s Computer-Assisted Coding tool using NLP engine. Results shows increase in coding quality and weighted cases.

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      OS06.02 - Realizing Patient Movement through an application adapted to your EMR (Slides Available) (ID 352)

      Jennifer Backler, Clinical Informatics, St. Joseph's Healthcare; Hamilton/CA
      Andriana Lukich, St. Joseph's Healthcare Hamilton; Hamilton/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      The purpose of this presentation will be to share our journey with patient movement within an academic health care setting located in Hamilton, ON during an EMR implementation and share creative strategies that enabled providers and front line staff to navigate the transfer within a complex environment through the developmen of an "app" that could be navigated to within the EMR. The opportunity for attendees to see the application and also understand the complexities of patient movement from the provider and front-line staff perspective. The opportunitity for developers, to consider the neeeds working wtih acute care and between multiple facilities to achieve the necessary patient movement in order to ensure that the right care provisions are available at the point of care.


      Methodology/Approach:
      The SJHH had an implementation of "Big Bang" EMR with leading practices December 2, 2017. We were aware of the complexity of patient movement having detailed patient flow with a hanbook to assist staff and providers with successfully navigating through the EMR tool. We benefited from the work of another organization who went live before us. We mapped out every patient journey with the 80:20 principle to ensure that we did not get caught up on examples which occured infrequently. It was the learnings in the post-live environment that helped us to develop an application that would ease and support the transitions of the patient through a tool that was supportive to front line users and would give them the results needed to successfully move a patient. It was born though the collaborative work on interdisciplinary team including IT professionals, clinical managers and staff and Clinical Informatics.


      Finding/Results:
      The result of this methodology was an "app" that was accessible within the journey of the patient at the time the individual provider needed to complete a discharge or transfer for the patient. This could be during a very acute episode of care and needed to be timely and accurate. The tip sheets that had been developed at go-live were extremely beneficial but were lengthy for staff to acccess. This "app" was the direct result of staff listening to provider and staff feedback about what was required to make them successful. A demo of this application will be reviewed as part of the presentation.


      Conclusion/Implications/Recommendations:
      This application development has enabled us to consider how we merge our own abiliites and developers skills with the well developed documentation and the powerful application of EMR that we have adopted. We have had the opportunity to consider this type of app for many of our clinical parameters used within the EMR.


      140 Character Summary:
      This presentation is an opportunity for industry and health care practitioners to come together to see evidence of the importance of integration.

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      OS06.03 - Automated Patient Location Identification in Pediatric Emergency Departments (Slides Available) (ID 307)

      Raza Abidi, Faculty of Computer Science, Dalhousie University; Halifax/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Pain, dehydration and anxiety in children are common paediatric Emergency Department (ED) diagnoses but are not well managed. In particular, long ED wait times are well known to increase the anxiety of the patients. We aim to mitigate the anxiety of patients, as well as their families, by providing personalized and location-specific therapeutic and educational interventions while visiting a pediatric ED. Our focus lies on customizing the content with respect to the child?s current location in the ED as well as the current healthcare task, as they move through the stages of examination, investigation and treatment. Using interactive adventure-based scenarios, we aim to proactively collect data about the child?s condition, reduce the child?s anxiety, and lead them to give more meaningful responses about their condition.


      Methodology/Approach:
      In partnership with a Canadian children?s hospital, we extended a mobile, game-based, e-therapeutic and patient education app with personalized and location-aware features. This app leads children and parents through a series of screens asking questions about the individual, their condition and other related information. Based on their responses, the app invokes a variety of therapeutic protocols (e.g., self-administration of Pedialyte for vomiting) and educational videos. The platform is made accessible to children and their parents using an iPad, to mitigate their anxiety, fear and discomfort while waiting in the hospital ED. By leveraging the child?s current location, as well as detected wait and dwell times, the platform is able to dynamically customize the educational content. We designed an intelligent indoor localization method based on (Bluetooth Low Energy) beacon signals, which detect the relative proximity between the iPad and detected beacons as (immediate, near, far, unknown). Based on these proximities, we applied machine learning methods to create an indoor localization model, which can accurately classify the child?s location by correlating multiple beacon signals.


      Finding/Results:
      Our intelligent indoor localization methods have been implemented and validated in a children hospital ED, where 14 beacons where deployed. Data from 29 locations were collected to build indoor localization models (classifiers). Using a hierarchical clustering approach, our approach supports merging multiple locations into cohesive regions to balance localization accuracy with the fine-graininess of indoor localization. Our indoor localization approach was able to recognize the current location of a child with 79% accuracy on average.


      Conclusion/Implications/Recommendations:
      With the proliferation of smart sensors and devices, this innovative project provides numerous opportunities to deliver personalized and timely location-sensitive services to patients.


      140 Character Summary:
      Indoor localization to personalize a mobile e-therapeutic platform for mitigating anxiety, fear and discomfort in children while waiting in the ED waiting room.

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      OS06.04 - Dementia Talk App - Empowering Dementia Caregivers through Technology  (Slides Available) (ID 264)

      Einat Danieli, 60 Murray St L1-012, Sinai Health System ; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Dementia Talk App: An award winning smartphone App designed to support dementia caregivers in tracking and managing challenging behaviours and in enhancing their communication with other care providers in the circle of care. Nearly 12% of Canadians are caregivers for a person with dementia. Up to 90% of people with dementia (PWD) experience significant behavioural and psychological symptoms (BPSD) that challenge and upset caregivers. Currently, there is no easy way for caregivers to manage and track behaviour-related symptoms in the care recipient, making it difficult to improve care and share information across the circle of care. OBJECTIVES: This presentation will discuss the development of a mobile application called the Dementia Talk App, designed to empower dementia caregivers to manage and track behaviours in the person with dementia as well as enhance communication among care providers. The presentation will showcase key features of the App and share highlights from beta testing results to demonstrate the importance of caregiver driven development process in creating meaningful and accessible digital solutions for clients and their caregivers.


      Methodology/Approach:
      This qualitative study involved 16 caregivers for PWD, recruited through the Reitman Centre Sinai Health System. Participants were asked to use the application for a period of 3 weeks, starting from the date that they received the link. Once the 3-week trial period is completed, a semi-structured phone interview was conducted to seek feedback from users in three main areas: 1. technology and usability 2. clarity of the content 3. The level of relevance of the App to caregivers? concerns in dealing with behaviour-related challenges. Their responses were summarized in written notes and analyzed and organized in main themes using the ?framework analysis? approach. Inclusion criteria: Age 18+; caregiver to a PWD; PWD presenting behavioural symptoms; Grade 3 literacy level; English speaking; ability to use one of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad. Exclusion criteria: Under 18 years of age; Not actively involved in caring for someone with dementia; PWD not demonstrating any behavioural symptoms; Less than Grade 3 literacy level; not English speaking; Unable to use any of the following platforms: Web, Android phone/Tablet; Apple iPhone/iPad


      Finding/Results:
      16 eligible caregivers were recruited to participate in the study, 1 participant dropped out for personal reasons. Complete data was obtained from 10/15 participants. All participants that were interviewed agreed that the content of the App was relevant to their concerns as caregivers, and most found the triggers and coping strategies to be very useful. This is a validation of the contents, as one of the most important aspects of the application for its success. Limitations: The 3-week trial period may not have been enough time to completely evaluate the usability of the app. Small sample size.


      Conclusion/Implications/Recommendations:
      Conclusions: Overall, the feedback received was overwhelmingly positive and there is great potential for the app as a meaningful tool for caregivers and other stakeholders in dementia care. Further evaluation needed to validate benefits of the application and long term impact with a larger sample size for a longer period of time.


      140 Character Summary:
      Dementia Talk App: An App designed to support dementia caregivers in tracking and managing care and enhancing communication with members of the circle of care.

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    OS07 - Spectrum of Virtual Care (ID 11)

    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 6
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      OS07.01 - Lessons in Scale and Spread in Virtual Care for Maternity (Slides Available) (ID 362)

      Mona Mattei, White Oak Ventures Ltd.; Grand Forks/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Traditional patient care planning often involves a linear model of health care access and delivery. A particular patient with a clinical concern accesses a primary care provider (GP, midwife, nurse practitioner). The primary care provider (PCP) acts as a gate keeper to direct the patient to a specialist with expertise in the area of that particular clinical problem. The patient then sees the specialist in person or via telehealth with consult notes sent at a later date. The PCP will often recall the patient to discuss the specialist?s opinion and may need to contact the specialist again if there are further questions or a change in the clinical status. The Mobile Maternity (MOM) project is changing that traditional linear model to foster a triangular and tripartite model that provides for much greater efficiency and more comprehensive care planning. Using telehealth resources (ie: tablet and desktop computers), a patient, primary care provider and specialist can in real-time, all discuss the clinical problem at the same time. This reduces the time to relay the specialist?s opinion as the PCP will hear at the time of the initial consult what the proposed plan may be. The PCP and patient can also inform the specialist of particular challenges to the provision of care related to geography or local health resources.


      Methodology/Approach:
      Initial pilot phases of the Mobile Maternity project saw 14 tablets placed with primary care providers (PCP) (family physicians, nurse practitioners and midwives) in 8 communities across the Kootenay Boundary in B.C. These units connect with two OB/GYNs to provide patient consults inclusive of the PCP, specialist and patients. Observing the value of the model of care, an opportunity to spread the model to Vancouver Island to support remote sites on the North part of the island from Campbell River was seized and 4 tablets were distributed to PCPs and OB/GYNs to provide consults. In addition desktop units in exam rooms and work stations on wheels in emergency departments were added to the mix to provide additional access.


      Finding/Results:
      Testing a pilot with a small population base provides opportunities for proof of concept, taking that concept to scale for larger volumes of patients expands the ability to gather substantial information on outcomes and impacts of new programs. Mobile Maternity is being scaled up from one OB/GYN in Nelson to include teams in Campbell River, across the Kootenay Boundary and three new sites in the next eight months. Interviews with both patients and providers demonstrate that this model of care is a resounding success for strengthening care networks, and improving patient care.


      Conclusion/Implications/Recommendations:
      This tripartite telehealth model provides enhanced mutual education for providers and patients, removes geography as a barrier to timely access, and supports the stability of primary care networks. This pilot can become the standard model of care in integrating specialist care into rural and remote primary care networks.


      140 Character Summary:
      Mobile Maternity is changing the way physicians care for patients by engaging in tripartite care planning through telehealth technologies.

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      OS07.02 - Identifying Patient and Provider Value Propositions in Virtual Primary Care (Slides Available) (ID 293)

      Lency Abraham, Mississauga/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      The Ontario Telemedicine Network is working with local health integration networks (LHINs) to implement virtual primary care visits. Patients want to engage with physicians remotely and find the quality to be equal to or better than in-person. Previous experience shows primary virtual care can be used to manage routine conditions and reduce health system costs. Yet integration of virtual primary care visits remains low, due partly to unclear physician value and payment models. The study objective is to explore how virtual visits can create value for both patients and clinicians, to facilitate uptake within Ontario primary care.


      Methodology/Approach:
      Four LHINs across Ontario, including 138 physicians, have implemented a customized virtual visits platform. The technology enables clinicians to respond to patients? clinical requests using either asynchronous secure messaging or an audio/video visit. We conducted semi-structured interviews with providers and patients to understand the perceived value of virtual visits. We then extracted themes of value propositions for both providers and patients.


      Finding/Results:
      There is demonstrated value for patients to engage with virtual visits, due primarily to the convenience that it offers over in-person visits. Clinicians and patients generally agreed that it was appropriate to use this platform for simple visits, but not for new diagnostic issues. The most often used modality was asynchronous secure messaging (94% compared to 1% video and 5% audio). We identified several value propositions for both patients and providers. Patient value propositions: *Convenience: Easier access to clinician was of priority. Rapid response is not needed; rather, patients valued not having to take time off work, seek childcare, or drive long distances. Access: Can improve care continuity and access for patients who have moved out of the area but still have the same PCP, and homebound or low-mobility patients. Urgent issues: Patients identified an interest in accessing a platform that would provide rapid responses for urgent issues, particularly after hours. Provider value propositions: Efficiency: Increases the number of patients PCPs can see per day, while not overwhelming their workflow. Revenue: Increases provider revenue by enabling them to maximize care bonuses, or paying them for previously unpaid work (e.g. phone calls). Care quality*: Enables clinicians to improve the quality of care they can deliver to their patients. Table 1 presents some ways to use virtual primary care technology that align with provider and patient value propositions. Provider value Efficiency Revenue Patient care quality 1) Delegate work to administrative assistants and nurses 2) Send reminders, prescriptions, and follow-ups for disease management Convenience Patient value 3) Provide care to homebound patients 4) Provide care to rural/remote patients Access 5) Provide virtual after-hours care Urgent issues 6) Enable easier preventative care via reminders, education 7) Pay for work previously unpaid 8) Enable time for PCP to make informed decision on complex issues (asynchronous) No motivating value


      Conclusion/Implications/Recommendations:
      When implementing virtual visits, it is important to align implementation design with patient and provider value propositions to encourage maximum adoption. The value propositions and potential use cases outlined here can guide future implementation.


      140 Character Summary:
      Integrating virtual visits in primary care faces provider resistance; aligning implementation with patient/provider value propositions may improve uptake.

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      OS07.03 - Virtual Visits: Delivering Primary Care Through Innovation (Slides Available) (ID 271)

      Danika Walden, eHealth Centre of Excellence; Waterloo/CA
      Anil Maheshwari, Grandview Medical Centre Family Health Team; Cambridge/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Virtual visits have shown promising results in supporting a patient-centered healthcare system, with the potential of moderating primary care costs over time1. The objective of this presentation is to illustrate an approach for deployment and lessons learned from implementing an innovative virtual care technology in primary care settings, as well as to highlight the outcomes and benefits of virtual visits for both patients and providers.


      Methodology/Approach:
      Virtual care technology conveniently connects patients with their primary care provider, for appropriate concerns, over a secure, online communication system via chat messaging, phone or video, providing the opportunity to create efficiencies and improve access to primary care. Providers were engaged in the clinical model design and solution development to ensure that the technology meets their needs and is user-friendly. To support integration of virtual visits into clinical workflow and reduce barriers to adoption for providers, direct feedback from providers was continuously collected to inform enhancements to the solution. A change management framework was used with a focus on working with providers as partners to support the uptake of the technology. To better understand both the provider and patient experience with using virtual visits, user surveys were provisioned which assessed the value of virtual visits related to factors such as convenience, access, efficiency and navigation.


      Finding/Results:
      Leveraging existing relationships with providers and establishing a comprehensive approach for end user engagement was a key factor in the implementation of virtual visits. Change management support was critical to the integration of virtual visits into provider workflow and contributed to them more actively promoting the service and enrolling their patients. Within 6 months of going live with the virtual visits solution, 56 primary care providers and 30 support staff registered for the solution, over 2600 patients were enrolled and over 2100 visits completed. Preliminary results of the user experience surveys indicate that virtual visits make accessing care more convenient for patients and saved them time, while providers spoke to the use of virtual visits to enhance efficiencies in their office and increase capacity to see more patients. Providers also expressed additional value in the ability to initiate the visit with their patient for reasons such as following up on test results or following up on a previous in-person appointment.


      Conclusion/Implications/Recommendations:
      Complementary to existing workflows, the integration of virtual visits in primary care settings has shown benefits to both patients and providers related to convenience and improved access to care. Using a targeted approach to user engagement and adoption, primary care providers are able to understand how a virtual visits solution integrates into their workflows and context of their practice model, as the value proposition varied depending on organizational structure. The involvement of users throughout the design and development of the technical solution ensured user buy-in, acceptance and adoption of the virtual visits innovation.


      140 Character Summary:
      Developing and implementing a virtual care solution for primary care: lessons learned and impact on patients and providers.

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      OS07.04 - Humans Behind The Machine. Telemedicine Based Shared-Care Psychiatric Services  (Slides Available) (ID 233)

      Benjamin Fortin-Langelier, Psychiatry, Royal Ottawa Health Care Group; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Background: The Royal Ottawa Health Care Group (ROHCG) has been a leader in the use of telemedicine to deliver psychiatric care. It has successfully integrated telemedicine in its regular clinical services and developed specific services based on technology. Those telemedicine-based services include correctional psychiatric care and shared-care (support to primary care) services. In psychiatry, shared-care refers to psychiatrists supporting groups of primary care providers. Typically, psychiatrists travel to family health teams and provide a blend of direct and indirect patient care. The rationale behind shared-care is to optimize the time of specialists and build capacity for primary care providers which then allows for more patients to receive the care they need in a location that is convenient. Purpose: We would like to present the case study of a shared-care partnership between a rural community health center where seven primary care providers support a community of 8000 and a tertiary care mental health center which was established in 2017 using telemedicine. Technology allows for patients to be assessed by a psychiatrist without travelling 250km and the humans behind the technology enable a lasting and successful partnership.


      Methodology/Approach:
      Approach: In this oral presentation, we will highlight the importance of the key players and their roles in creating a clinical service that benefits all stakeholders and allows harvesting the full potential of the technology. Preliminary contact with the community, training, in-person visit prior to first clinical consultation, iterative feedback loop and follow-up annual education visits have contributed to the success of the partnership and trust between partners.


      Finding/Results:
      Findings: In one year, we were able to set monthly psychiatric telemedicine consultations allowing 42 patients to receive care they would not have been able to access otherwise. This model has been demonstrated as effective and has been replicated in 14 other rural communities and translated for use in correctional institutions. At the moment, we observe two common mistakes in the design of consultation services in psychiatry. One is the over-reliance on technology at the expense of establishing strong relationships. In this mistake, there is a failure to establish consistent relationships and connections when rolling out telemedicine-based consultations. This creates a situation in which multiple remote communities are randomly connected with random providers at inconsistent times. It prevents specialists from understanding the context of the primary care providers with whom they consult and reduces trust as well as the quality and applicability of the consultations. The other mistake is the under-appreciation of technology. This is the belief that only in-person presence can lead to a solid relationship between primary care and specialists. While this is a reasonable model where geography permits, the drawback is lengthy travel time and the perceived impossibility to reach geographically distant communities.


      Conclusion/Implications/Recommendations:
      Conclusions: We believe we have found an effective balance between technology and human factor which enables trust and the development of sustainable partnerships. Appropriately implemented technology can lead to successful shared-care psychiatric services between geographically distant communities


      140 Character Summary:
      The Royal Ottawa will present a case study illustrating the implementation of shared-care psychiatric services using telemedicine in a rural community.

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    OS08 - The Road to Digital Health Adoption (ID 12)

    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 7
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      OS08.01 - Engaging Physicians for GoLive: The Role of Physician Champions (Slides Available) (ID 489)

      Melanie Buba, Department of Pediatrics, CHEO; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Physician Champions serve as department/division-specific representatives and subject-matter experts for items relating to the EMR build and operations. They liaise between the clinical operations of the hospital while engaging and supporting their colleagues. The purpose of this presentation is to provide an overview of the important role of Physician Champions as key stakeholders and drivers of change around the decisions and processes that contribute to the optimization and clinical relevance of the EMR. Specifically, the contribution of Physician Champions to decisions affecting EMR optimization will be explored.


      Methodology/Approach:
      A review of minutes from Physician Advisory Council (PAC) meetings for a two year period from October 1, 2016 to September 30, 2018 was undertaken, and the total number of decisions made was determined. Decisions were reviewed and a decision lead was identified. ?Physician-driven? initiatives were defined as having a physician as the decision lead.


      Finding/Results:
      Between October 1, 2018 and September 30, 2018, a total of 104 major clinical decisions were made. Of these, 34 (32.7%) were ?physician-driven? initiatives, of which 25 (73.5%) were made in the year after GoLive (October 21, 2017 ? September 20, 2018). Physician Champions also participated as leads in 10 identified high risk workflows. The overall attitude from physician end-users about the EHR improving quality of care was 28% prior to the start of the implementation, 50% one year post implementation and 74% two years after GoLive.


      Conclusion/Implications/Recommendations:
      Physician Champions have made a substantial contribution to decisions affecting EMR optimization. Physicians have led approximately one-third of these changes, with a large proportion of these ?physician-driven? initiatives occurring in the year post-GoLive. At the same time we have seen a significant increase in the physician perception that the EHR was improving quality of care. An EHR governance structure that supports physicians as key stakeholders is critical to enhancing the applicability and usability of the EHR system. They provide valuable clinical input into system design, implementation, optimization and training, and as experienced end-users, have help lead a large number of improvement initiatives, particularly after GoLive. Continued involvement of physicians in EHR optimization is crucial. Further research will include the impact of Physician Champions on physician end-user overall perception, satisfaction and engagement with the EHR system.


      140 Character Summary:
      Creating an EHR governance structure that includes Physician Champions has allowed physicians to make a substantial contribution to the optimization of our EHR.

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      OS08.02 - Co-Designing Digital Technology Evaluations with Service Providers, Vendors and Evaluators (Slides Available) (ID 421)

      Vess Stamenova, Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      The Office of the Chief Health Innovation Strategist (OCHIS) in Ontario supports a program called Health Technologies Fund (HTF). The program?s goal is to accelerate the evaluation, procurement, adoption and diffusion of health technologies made in Ontario. The program requires a partnership between publicly funded health service providers (HSPs), a technology vendor and a third-party evaluator. This partnership ensures that technology companies are supported in an implementation initiative within an Ontario clinical context by working closely with a clinical site that has an interest in the technology. The evaluation partner?s role is to conduct an evaluation that can support procurement decisions at the clinical site and provide evidence of effectiveness and potential cost-savings. The Women?s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) has acted as an evaluation partner for three rounds of HTF competitions. The goal of this panel will be to present key learning points from the perspective of each partner: the HSP, the technology partner and the evaluation partner. The key learnings will be presented in the context of one of our projects, the evaluation of the Cloud Dx Health Kit.


      Methodology/Approach:
      The Cloud Dx Health Kit is a web-enabled remote- and self-monitoring platform allowing Chronic Obstructive Pulmonary Disease (COPD) patients to take their vital signs (oxygen saturation, blood pressure, temperature, and weight). Data is displayed on the tablet via Bluetooth and sent to a healthcare provider via a secure cloud. To determine and ensure that all participating parties? interests are being met in the project design, we spent several months co-designing the project. The goals during this phase were to design a viable implementation plan that will have a high likelihood of adoption within the specific setting. Weekly calls between the vendor (Cloud Dx), the HSP (Markham Stouffville Hospital) and the evaluator (WIHV) were conducted. Several in-person meetings and half day co-design workshops were completed to establish viable value-proposition hypotheses and to determine each party?s interests. Qualitative interviews with patients, healthcare providers and administrators were also conducted, to test out value proposition hypotheses. The level of commitment of the vendor company and their capacity for technology modifications was also assessed at that time. Feedback received from users and administrators was directly used to make modification of the implementation plan and research study design.


      Finding/Results:
      The following key insights were gained from the above process (1) an on-site clinical lead is essential, (2) the development of relationships between all three parties facilitate progress, (3) allowing end-users to use the technology can uncover critical workflow and technology modifications that need to be well established ahead of the evaluation and (4) determining the value propositions for both users and payers is critical for adoption.


      Conclusion/Implications/Recommendations:
      In this panel discussion, we are going to provide an overview of the co-design methods we use in the planning and design of our evaluations. Representatives from each team will describe the challenges they faced in running such collaborative projects and present key learnings focused on implementation and evaluation of digital technologies.


      140 Character Summary:
      This panel will provide an overview and perspectives on a co-designing evaluations with vendors, clinical providers and evaluators.

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      OS08.03 - A Novel EMR Benefits Realization Program in the Canadian Context (Slides Available) (ID 400)

      Tammy Degiovanni, Children's Hospital of eastern Ontario; Ottawa/CA
      Ken Farion, CHEO; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Implementing an enterprise-wide, integrated EHR solution is one of the largest and most complicated investments any hospital or health system can make to transform care and achieve better outcomes. Formally quantifying these benefits requires a structured approach against pre-established targets. As a small, independent, non-case costing academic pediatric institution in Canada, we encountered some notable barriers as we set out to establish a Benefits Realization governance structure and program that would achieve targets delineated in our Board-approved Total Cost of Ownership forecast. First, quantifiable Benefit Realization has been infrequently explored internationally in publicly funded systems where no competitive advantage to build/expand business and market share exists. Financial benefits in our environment must be gained through decreasing demand for services and efficiencies resulting in decreased costs, whether FTE?s, supplies or infrastructure. Next, Benefit Realization has typically been evaluated as part of a large system initiative as opposed to at a local level. Finally, most Benefits Realization programs succeed as a fully resourced, parallel structure to the implementation and operations team; this was not possible in our environment.


      Methodology/Approach:
      Based on best practices from other organizations, but tailored to the fiscal realities of our institution, we created a Benefits Realization governance model that was clinically led yet grounded in financial and statistical rigour. This structure was embedded within existing operational committees and targeted quantifiable clinical, operational, and academic benefits that aligned with the organization?s existing strategic directions. Where relevant, benefits that aligned to specific General Ledger cost centers were tracked and tallied against our targets. A graphicly-pleasing quarterly report to the Board of Directors dually served as accountability and as a key communication and engagement tool within the organization.


      Finding/Results:
      By creating a governance structure embedded within operations, we garnered benefit ownership and buy-in to achieve the targets. Further, by driving nine targeted core benefits while also collecting and evaluating smaller incremental benefits with rigor, the organization could rally around the effort, further reinforcing the vision and mission of both the EHR implementation and the hospital strategic directions. Tools were created that fostered operational leadership and engagement and allowed Benefit Realization to fundamentally link to and drive corporate strategy. The Board report template was repurposed to support other communication channels. Through initiatives solidly linked to the General Ledger, we demonstrated efficiencies through permanent cost reductions to meet the Benefit Realization targets within our Total Cost of Ownership. Further, we linked these initiatives to improvements throughout the organization to demonstrate the power of an integrated EHR as the foundation for change.


      Conclusion/Implications/Recommendations:
      Formal Benefit Realization following an EHR implementation is often a requirement and can be seen as an academic exercise parallel to the project and operations. However, by embedding the governance structure and linking solidly to the strategic directions of the organization, large scale and smaller incremental benefits can fuel the transformation. By sharing stories, fostering buy-in, and ensuring rigour, smaller organization can meet their Benefit Realization goals across clinical, operational, academic, and financial perspectives.


      140 Character Summary:
      Benefit Realization strategy within existing governance and linked to corporate directions to identify clinical, operational, academic, and financial benefits

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      OS08.04 - Connecting for Health with the Office of Virtual Health (Slides Available) (ID 263)

      Michele Fryer, Provincial Health Services Authority; Vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      In Fall 2017, the Provincial Health Services Authority (PHSA) established the Office of Virtual Health (OVH) to leverage and enhance virtual care as part of the care continuum for patients. In order to meet this mandate, the leaders of PHSA clinical and academic programs needed a clinically led organizational strategy that would see scalable virtual health solutions integrated into their existing service models. The governance structure for virtual health is directly aligned with the clinical governance, and a strategy is now being implemented by OVH. Principles of the strategy include patient-centred and clinically led, with technology partners as enablers. Solutions are focused to improve patient outcomes that are equitable, adaptable, scalable and sustainable.


      Methodology/Approach:
      The strategy of OVH includes clinically identified priority projects and enabling foundational supports. Examples of priority projects include: virtual health visits in patient homes, online cognitive behavioural therapy, and digital messaging. Enabling foundations have been created by OVH with stakeholder involvement, and include a PHSA Virtual Health Policy, clinical guidelines, communication strategy, toolkits for clinical programs, and an evaluation framework. These carefully supported projects include: patient engagement, program and patient readiness, sound project management, patient and provider education, clinical workflow redesign and evaluation.


      Finding/Results:
      The results of a governance structure shifts the governance and priority setting from technically to clinically led to deliver one system of care. Priorities, decisions and direction about the evolution of virtual health in PHSA are now being made by leaders of clinical programs. Foundations have been created that have removed barriers and created consistent, effective strategies across the organization, including an enabling risk and consent-based policy, clinical guidelines for virtual health and many tools and processes to move our agenda forward. Clinical teams and programs no longer work in silos on similar solutions. Important supports such as privacy, procurement, and information management and technology now have an integrating team to collaborate with and are able to apply their advice in an effective manner. Advancement of virtual health including ?anywhere to anywhere? virtual health visits, text/email, remote patient monitoring and online therapy is occurring. These results are evaluated through a framework that is aligned with the evaluation structure and dimensions of other clinical services. PHSA is beginning to see and report how virtual health services impact in the context of all health services and their alignment with specific goals to achieve a system of virtual health that is acceptable to patients and providers and provides improved accessibility to the appropriate services in an equitable way, and results in organization wide scale.


      Conclusion/Implications/Recommendations:
      OVH is leading a system wide transformation that will see virtual health integrated into clinical services, not as a separate system but as an integrated, effective, and efficient patient-centred set of solutions that respond to the digital world we live in. The proposed presentation will describe the processes, principles, successes and challenges which have resulted in successful virtual health services and plans to increase patient preferred virtual health services across British Columbia.


      140 Character Summary:
      Integrating virtual health in British Columbia?s Provincial Health Services Authority clinical programs in collaboration with the Office of Virtual Health.

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    PS02 - Collaboration for Informed Patient Care (ID 9)

    • Type: Panel Session
    • Track: Executive
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 4
      • Abstract
      • PDF

      Purpose/Objectives:
      SickKids and CHEO, through the Kids Health Alliance (KHA,) have been working together for the past two years to develop a structure that has enabled them to share the same platform for their EHR. Despite different implementation timelines and organizational objectives, this goal has been met. We believe this is unique in comparison to other ?Hubs? as our partnership is based on alignment from a patient population and clinical perspective as opposed to geographical proximity. This work was done to support the strategic direction of KHA, which is to improve care for the pediatric population across Ontario. The challenge that we are now faced with is how to operationalize the structure given that we have two different application support teams and both organizations have their own unique strategic directions and stakeholder requirements. A key factor in the success of this partnership was the development of a governance structure both at the KHA leadership level as well as the application leadership level. We will continue to use and build on this governance to ensure continued success.


      Methodology/Approach:
      We will approach the discussion based on our implementation experience and lessons learned.


      Finding/Results:
      We will present our structure for shared roles including: ú A shared training manager - whose mandate is to align training across organizations to ensure a consistent training approach, with shared resources and materials ú Application analysts - we will show how the teams currently works together and how we will optimize these roles to create efficiencies that will allow for benefits to both organizations ú Technical infrastructure teams - a shared team supports the technical environments. We will share how these teams work together to support the primary site (located in Toronto) and the disaster recovery site (located in Ottawa) We will provide and discuss examples of how we will work together on upcoming projects. Specifically related to a 2018 Upgrade of the EHR, Special Updates that occur approximately every 8 weeks and shared build decisions that we need to align on for each application (e.g. ED, Inpatient, Outpatient) - We will include examples of how the need for shared build decisions has facilitated opportunities to align clinical care and best practices. Included in the discussion will be our strategy for developing a shared roadmap as we roll out more modules, features and functionality


      Conclusion/Implications/Recommendations:
      As with any endeavour of this scale there are many lessons learned which we will share and use to improve our process. Some of the key areas of challenge include: ú Change control - keeping the system safe as teams are working in it. Challenges with communication since teams are located at different organizations ú Timeliness of decisions - the need for a solid prioritization process and decisions matrix to ensure decisions are made efficiently and in a timely manner. Differences in clinical practices between the two organizations that require discussion and alignment on system build We will highlight areas where groups are working well together and use that experience to inform our approach moving forward.


      140 Character Summary:
      The session will highlight opportunities, challenges and risks as we leverage a shared EMR to support clinical care and decision making.

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      • Abstract
      • PDF

      Purpose/Objectives:
      In partnership with over 12 health service providers in 5 LHINs in Ontario, the Ontario Telemedicine Network (OTN) implemented and evaluated three models of ?digital self-care? in the area of diabetes, mental health, and chronic kidney disease through a Canada Health Infoway (CHI) funded project. To determine efficacy and potential for scale, OTN partnered with the Women?s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) to rapidly evaluate the tools and inform a provincial roll-out. One of these three solutions (Big White Wall) is now available for anyone with mild to moderate anxiety and depression in Ontario.


      Methodology/Approach:
      Instead of a traditional RCT, an innovative, non-traditional approach was applied to the evaluation, which was integrated and multi-stakeholder. The evaluation was an active piece of the implementation, in place of the typical analysis that takes place at pilot conclusion. Efforts were made to generate the data as quickly as possible using a mixed-methods approach. This practical rapid cycle evaluation as an approach was shown to offer broad utility and support effect decision making. In some cases, implementation continued according as anticipated however in some instances, data served to support a change in direction. The value of real-time evaluation was the ability to course correct in some instances or identify different value propositions altogether Also integrated was the Institute for Healthcare Improvement?s Triple Aim focusing evaluation efforts on the extent to which healthcare innovations result in 1) improved population health, 2) enhanced patient experience and 3) reduced healthcare costs -- thereby informing a sustainability model on a provincial scale.


      Finding/Results:
      Of the three pilot projects, one of the solutions was able to move to a full scale provincial rollout. Today, all Ontarians are able to access the Big White Wall - an online peersupport solution for people with mild to moderate depression and anxiety. The panel will share key outcomes from the evaluation, as well as what conclusions were drawn to inform moving from a pilot to a province-wide solution (and why some did not). There are many factors involved that are based on the findings from the initial implementation and the readiness of the healthcare sector.


      Conclusion/Implications/Recommendations:
      The evaluation underscored that the following factors contribute to the ability to scale to a provincial solution: ? A patient-centred approach to implementation focused on building and maintaining engagement is important. Many types of patient personas can benefit from technology, at all stages of their chronic disease. Provincial rollout needs to consider each persona. ? Digital Self-Care technology can be used to help patients better manage their chronic disease ? if integrated with clinical care, but sometimes without clinician intervention. Provincial rollout is significantly impacted by the level and types of clinical intervention required. ? RCT evaluations have their place, but rapid and rigorous evaluations of technology implementations are necessary not only to assess efficacy of technology, but also to know how best to optimize its utilization in practice and potential funding models. Provincial strategies need to consider payment aligned with rates of usage.


      140 Character Summary:
      Province-wide digital self-care can be achieved with pragmatic evaluation, an understanding of patient personas & aligned health system priorities.

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      • Abstract
      • PDF

      Purpose/Objectives:
      Ontarians expect that the wealth of their health information held by the province will be made available to them in the near term through the digital solution they choose. To best enable patient choice, application innovators need a clear and replicable process for connection. The current pathway to connect consumer applications to provincial digital health assets (PDHA) (e.g. labs and prescription information) lacks transparency, clarity and a defined connection process. The SPARK initiative, funded by the Ministry of Health and Long-Term Care (ministry), aims to make it easier for innovators to safely and securely flow provincial health information into the hands of patients and their health service providers. By March 2019, SPARK will make it possible for approximately 60,000 patients to digitally access their lab and prescription information stored in the PDHAs, through applications like myUHN, MedChart, and Medly. This panel will provide the opportunity for candid insights to be shared from the perspectives of the program team, innovators and patients to discuss the challenges of connecting a consumer health application to provincial digital health repositories and review what changes have been implemented to date.


      Methodology/Approach:
      The SPARK program worked with the ministry and eHealth Ontario to create an efficient, repeatable and sustainable connection process by: - Identifying policy and regulatory challenges, along with areas for potential improvement through a series of 6 workshops with our partners, 8 feedback sessions with 10 innovator groups and lessons learned from connection-related activities to create, for the first time, a comprehensive end-to-end view of the entire process. - Documenting and optimizing a transparent, clear and defined pathway innovators can follow to connect applications to PDHAs and flow health information into the hands of patients - Partnering with hospitals and pilot applications to work through the process of connection, identify areas for improvements and create efficiencies where possible


      Finding/Results:
      This panel will highlight the lessons learned, helpful tips and tools gained from the program?s pathway optimization activities by: - Developing consumer-access policies and drafting a new streamlined assessment process that is in compliance with privacy requirements, and also shortening the assessment process from 2.5 years to approximately 4 months - Drafting one set of harmonized requirements across all stakeholder groups that meets provincial security standards - Creating an Innovator?s Guide that outlines requirements for connecting a consumer application to PDHAs By enabling Phase 2 innovators to connect their applications to PDHAs in a timely manner, SPARK will make it possible for patients to digitally access their medical records.


      Conclusion/Implications/Recommendations:
      Bringing together key stakeholders across the digital health technology ecosystem, SPARK will connect patients and their providers with their health data, creating a true collaborative partnership in care delivery and management. Participants at this session will learn about the unique approach taken by the project and insights regarding early benefits and lessons learned from the initial implementation efforts, successes, and challenges. In addition to providing an overview of SPARK, this panel will share early insights on how the patient experience is changing.


      140 Character Summary:
      SPARK enables patient access to digital health information by creating an efficient, repeatable and sustainable connection pathway for consumer health apps.

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    EP04 - Application / Implementation / Adoption and Use 2 (ID 19)

    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 8
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      EP04.01 - Innovative eRehab Transforms In-Home Stroke Rehabilitation Services (Slides Available) (ID 120)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Innovative rehab technologies inspires transformations in delivery model and patient experiences for Stroke Rehabilitation Services. Champlain region has 1000+ stroke patients yearly; those living in rural areas have no access to local out-patient stroke rehabilitation services and occupy acute beds to access rehab or go without. Sub-acute capacity planning sees the value of moving patients to in-home care for stroke rehabilitation. Traditional in-home rehabilitation services combine a therapist and rehabilitation assistant for twice weekly, hands-on care with paper instructions for homework. By leveraging technology we can support the delivery of personalized stroke rehabilitation services while giving patients unparalleled access and control over their consumption of those services. By augmenting hands-on therapy via eRehab applications we improve patients? motivation; resulting in the creation of a new service experience. In-home stroke rehabilitation now offers an instructor-led, patient-centered, self-initiated, service that enables the patients? Physio/Occupational/Speech Therapy exercises to be consumed whenever they want and enhances twice weekly hands-on therapy visits. Additionally, some technologies may create a seamless treatment pathway bridging the time and service gap between hospital and in-home rehabilitation.


      Methodology/Approach:
      Simple technologies that deliver approved professional exercise applications over gaming-like devices/tvs/tablets can completely modernize and revolutionize service delivery. For example, interactive game-like technology enables patients to be guided and monitored through personalized rehabilitation programs with increasing intensity levels. Patients often describe this rehab as fun and friendly rather than exercise/work. Additionally, by leveraging personal computing devices, on-line speech rehabilitation apps offer significant opportunities to initiate services in those critical first few days post stroke. Therapists remotely monitor and update programs to deliver real-time adaptations to meet patients? ever changing needs. Quadruple AIM evaluation data defines successes in patient and therapist experiences, outcomes and cost-effectiveness and drives recommendations to sustain and spread this service.


      Finding/Results:
      Technical trials proved feasibility. Current in-home trial evaluation data will help us learn how our innovative approach to combining technology and professional health-care empowers the patient to experience and consume their rehab services when they want and as often as they want and may result in improved clinical outcomes. Participants will gain insight on population profiles appropriate for the technology, treatment needs, benefits, and impact/cost of delivery.


      Conclusion/Implications/Recommendations:
      Continued research and partnerships are essential for health-care organizations to understand how patients respond and adapt to technology-enabled care, while organizations cost-effectively operationalize, coordinate and modernize services in order to meet ever-growing demands. On-going, in-home trials indicate positive feedback; patients report feeling more motivated and indicated games are more valuable than following traditional paper instructions. By leveraging innovative eRehab technology solutions within the home-care delivery model, we are creating a patients-first experience and transforming traditional service models and delivery expectations while expanding availability of in-home post-acute rehabilitation services for stroke patients. Technology and health service partnerships between acute, sub-acute and home-care settings, can help inspire, create and celebrate an integrated stroke rehab program where patient rehab is enabled as early as possible in a seamless manner and grows across their continuum of care.


      140 Character Summary:
      Innovation combining technology & professional health-care empowers patients to experience/consume rehab services differently and improve clinical outcomes.

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      EP04.02 - Adapting Technology Through Co-Creation with Indigenous Communities to Improve Outcomes (Slides Available) (ID 390)

      Sandy Whitehouse, Medicine, UBC; Vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      To co-create patient engagement tools with three indigenous communities in Australia using the Tickit patient reported data platform. Indigenous communities in Australia face similar challenges to those in Canada with poorer health outcomes compared to the general population. Patient engagement and capturing patient reported data is challenging, but important to detect healthcare issues and direct appropriate care. Tickit Health has developed a versatile digital platform that is designed to accommodate hard to reach populations to collect patient reported data and support patient education. Over a period of 4 years, three separate remote indigenous communities, in NSW, Arnhem land and the Kimberley engaged the Tickit team to adapt the technology to suit the needs of their community. Tools developed included a smoking cessation educational tool, an intake assessment tool and a research psychosocial screen.


      Methodology/Approach:
      Each community had a designated champion, community council and local healthcare team. The community worked with the Tickit team to co-create a culturally sensitive and safe tool to meet the needs of their population. Adaptations included changing colours, text, language, images and icons as well as adding locally relevant content, while maintaining core data capture. Local workflow issues were also addressed. Multiple iterations were developed and reviewed to reach consensus on a final product.


      Finding/Results:
      Each project is at a different stage. One is completed, one has been reviewed by the Ministry of Health and will be expanding to other communities, and the third is at co-creation stage. The presentation will highlight the similarities and differences between the needs of the communities, the co-creation process and lessons learned with implementation and where possible the clinical impact of introduction of the tools. For example, the clinical assessment tool implementation resulted in a 5 fold increase in STI screening.


      Conclusion/Implications/Recommendations:
      Working with the indigenous communities can be a slow process. Relationship building, open communication and understanding community priorities, with respectful reassurances regarding privacy and inclusion are key factors for success. Technological considerations and troubleshooting for remote communities is also critical. The findings suggest these challenges are worth overcoming. With appropriate engagement, innovative technology can have a positive impact on patient care.


      140 Character Summary:
      With respectful co-creative processes, digital patient engagement tools can support indigenous to detect healthcare issues and direct appropriate care.

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      EP04.03 - Improving EMR Use through Video Tutorials (Slides Available) (ID 404)

      Andre Kushniruk, Health Information Science, University of Victoria; Victoria/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Electronic medical records (EMR) can be used by Primary Care Physicians (PCP) to support diabetes care in a proactive manner. Although the majority of Canadian PCPs have adopted an EMR, advanced use of EMRs is limited. The literature widely suggests that training, intended to help PCPs to better use their EMRs, is a critical success factor for increasing use of advanced EMR features, such as diabetes registries and recalls or reminders. However, many PCPs receive little or inadequate EMR training, especially following the implementation of an EMR. Specifically, there is a dearth of literature on the use of video tutorials to improve EMR use. Video tutorials are video demonstrations of how to accomplish tasks using software, and can support faster initial learning and reduce cognitive processing. The purpose of this study was to evaluate the potential for EMR video tutorials to improve process measures for type 1 and type 2 diabetes care for PCPs using OSCAR EMR in British Columbia


      Methodology/Approach:
      EMR video tutorials were developed based on the Chronic Care Model and evidence-based guidelines for video tutorial design. PCPs were recruited for a mixed methods(QUAN(qual) study through the Divisions of Family Practice and OSCAR BC Users' Group. Data were collected from July 2017 to May 2018 at two pre- and two post-intervention time points using a Diabetes Care questionnaire, as well as a demographic survey at baseline. Semi-structured interviews were conducted with PCPs at three and six months following the intervention.


      Finding/Results:
      In total, 18 PCPs completed the study, and 12 of them participated in 21 follow up interviews. The study results demonstrated that the intervention combined with a Hawthorne effect elicited a statistically significant increase in EMR feature use for diabetes care, with a large effect size (i.e., F(3, 51) = 6.808, p <.001, partial ?2 = .286). Multiple barriers and facilitators to applying the tutorial skills into practice were found at the physician, staff, patient, EMR, and policy levels. Three pairs of PCP characteristics had strong and positive associations, which were statistically significant: (1) age and years of practice; (2) years of experience using OSCAR EMR and number of EMRs used; and (3) computer skills and EMR skills. PCPs' years of medical practice was statistically significant in predicting their baseline use of the EMR for diabetes care. Graphical trends indicated that higher increases in mean composite EMR use (MCEU) score for diabetes care over the duration of the study were associated with PCPs with the following characteristics: (1) being female, (2) being aged 35-44, (3) being from Vancouver Island, (4), having less than four years of medical practice, (5) having 3-4 years of EMR experience, (6) having 1-2 years of OSCAR EMR experience, (7) using four EMRs, and (8) having prior post-implementation EMR training.


      Conclusion/Implications/Recommendations:
      This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalizability.


      140 Character Summary:
      This small-scale efficacy study demonstrates the potential of EMR video tutorials to improve EMR use for chronic diseases such as diabetes.

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      EP04.04 - The SCA Program: A Successful Model for eReferral Implementation (ID 419)

      Charlotte Nethercott, eHealth Centre of Excellence; Waterloo/CA

      • Abstract

      Purpose/Objectives:
      In response to the healthcare wait time challenges in the province, the System Coordinated Access (SCA) program is supporting the deployment of electronic referral (Ocean eReferral) across five LHINs in Ontario. The SCA program?s goal is to support standardization and coordination of service intake and an eReferral ecosystem that allows input from system users.


      Methodology/Approach:
      The SCA program provides the supporting infrastructure to bring together an innovative technology solution with a collaborative, systematic and local approach to deployment. By providing centralized expertise in the areas of Project Management, Technology Design & Architecture, Privacy & Security, Benefits Realization, Integrations, Communications, Change Management, Reporting and Standardization, participating LHINs can access a shared community of resources to support their local deployment and help clinicians understand how adoption of the eReferral solution can positively impact workflow processes. To achieve the level of stakeholder engagement necessary to deploy and sustain the adoption of the solution, the program applies a three-dimensional approach to change management. This approach encompasses strong communication, influential adoption efforts and hands-on-training that provide clinicians with tools, solutions, and skills to improve patient care and outcomes. The success of the program is built on its commitment to continually improve the solution by engaging clinicians, central intakes, healthcare providers and patients to better understand their needs, while feeding that input back into the solution design.


      Finding/Results:
      The success of this model is evident in the steady adoption of the SCA program eReferral solution since it went live in August 2017. The continued active use of Ocean (86% over the past 3 months), and the quantitative data collected using post-adoption end user surveys demonstrate that the SCA program is enabling the long-term sustainability of eReferral. Image 1: Total # of eReferral senders and total # of eReferrals sent in the first year of operations: SCA Program Image 2: Results from SCA Program Post-Adoption User Satisfaction Survey, Oct 2018


      Conclusion/Implications/Recommendations:
      Evidence shows that the SCA program?s multi-dimension model has the potential to stimulate a better practice flow and shape a standardized coordinated system that facilitates active communication that benefits and meets the needs of clinicians and patients.


      140 Character Summary:
      The SCA Program?s model for eReferral development, implementation and meaningful use is demonstrated by the steady adoption and user satisfaction of the solution.

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      EP04.05 - Inspiring the Next Generation – Celebrating Digital Health FACTS in Education (Slides Available) (ID 500)

      Anne Fazzalari, -/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      There has been a movement afoot in clinical education in Canada. With the ever-changing digital landscape, educators and students in the Faculties of Medicine, Nursing and Pharmacy have been engaged in the development of a national Canadian clinical informatics competency program. Commonly known as the Digital Health ?Faculty Associations Content & Training Solutions? (FACTS) program, this unique program has national organizations participating in a collaborative focused on advancing clinical informatics in medical, nursing and pharmacy education. Discipline specific knowledge assets such as medical, nursing and pharmacy informatics competencies, along with interprofessional resources will be shared that are relevant to policy, research & practicing clinicians.


      Methodology/Approach:
      The national Digital Health FACTS program has evolved to an interprofessional collaborative approach, yet still enabled a discipline specific and regional implementations. The program leveraged a national Change Management (CM) Framework as well as Peer-to-Peer Networks across Canada to facilitate educators in supporting their colleagues and preparing students to practice in a digitally enabled environment. These educators, known as ?Faculty Peer Leaders? act as change agents in medicine, nursing and pharmacy faculties, providing hands on support and guidance to their peers as well as students via face-to-face meetings, workshops and webinars. Engaging clinical faculty led to the development of pharmacy, nursing and medical resources around electronic prescribing and other real-life case studies for teaching and learning.


      Finding/Results:
      The program impacts all educators and students in the Faculties of Medicine, Nursing and Pharmacy in Canada. To date, there have been thirteen successful projects whereby over 40 Faculty Peer Leaders have engaged over 9,700 of their colleagues/educators. Each discipline-specific project within the interprofessional program conducted evaluation activities such as focus groups and in-person/online surveys were utilized when engaging Faculty Peer Leaders, their colleagues/peers and students. Interprofessional guidelines and resources that have been recently developed will be shared with the audience, along with evaluation results, emerging themes and lessons learned.


      Conclusion/Implications/Recommendations:
      A unique ?people project? has been unfolding across the country over the last number of years to engage educators and students in digital health dialogue, learning and teaching. Faculty Peer Leaders have engaged colleagues, along with their students, in an interprofessional, collaborative patient-centred care approach and momentum has been built around the development of e-Prescribing resources. This national program will continue to address the demand for digital health content by educators and students, support strategic national initiatives and better equip the next generation of clinicians in Canada to integrate technology into their clinical settings.


      140 Character Summary:
      Calling students and faculty ? do you know about the #digitalhealth FACTS movement? #medicine #nursing #pharmacy #education #faculty @AFMC_e @CASN43

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      EP04.06 - A provider documentation journey from telephone based dictation to FESR (Slides Available) (ID 556)

      Naomi Brooks, Transcription Services & Health Information Exchange, Vancouver Coastal Health; vancouver/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      FESR (Front End Speech Recognition) was approved as part of implementation of provider documentation in Cerner as part of the CST Project as a key enabler. Transcribed documents form part of the patient health record which provides the following: - A communication and decision making tool for care providers; - A historical record of a patient?s medical care; and, - The source document from which health and service quality planning, evaluation, and monitoring data is extracted The goals of the HIM VPP FESR Project are to improve patient safety and quality of care, enable high EHR adoption and reduce transcription costs by implementing the M*Modal FESR solution. The primary objectives of the project are as follows: - Reduce to zero, the TATs for the reports dictated by FESR. - Facilitate the providers? documentation in Cerner.. - Maintain or improve report quality. This includes supporting physicians with the creation of standardized report templates and content where appropriate. - Achieve annual cost savings through reduced M*Modal transcription costs. - Mitigate cost pressures and service risks associated with dictation volume growth, stat reports and the increasing demand for M*Modal transcription services.


      Methodology/Approach:
      FESR will be deployed across VPP in two phases as follows: - Phase I - Approximately 6-9 months prior to each CST site deployment, FESR using M*Modal?s Fluency Flex application. Dictating authors will review, edit and sign their documents in the Fluency Flex application. Training will occur in 1:1 sessions. -Phase II - As Cerner is activated through the CST deployments, the FESR users will be converted to dictating directly into Cerner using the M*Modal Fluency Direct application. The reason for two phases is to have FESR in use at the sites before the Cerner system becomes active so providers have more time to train and become proficient with using the new FESR tool. The Phase I conversion of telephone dictation to FESR dictation is also what generates the annual savings and addresses some of the current operational challenges


      Finding/Results:
      The introduction of FESR alongside the rollout of provider documentation in an EMR has been shown to reduce documentation times, reduce transcription costs and deliver more complete patient narratives. With Cerner, providers see minimal impact from EMR tools alone, but high impact on all three areas with the addition of FESR tools (KLAS Research, 2014). In the absence of FESR, experience has shown poor provider adoption and engagement of the implementation of electronic documentation modules within a clinical information system. (Park, Lee and Chen, 2012).


      Conclusion/Implications/Recommendations:
      Over 8000 dictating authors will be substantially impacted by the change from telephone dictation to FESR dictation and resistance by some can be anticipated. Dictating authors will be further impacted by the transition to provider documentation in Cerner. A robust and supportive change management approach will be developed to guide the dictating authors through the changes. Strong commitment and support from medical leadership in supporting and communicating the changes will also be required. At the 4 sites that have gone live with Cerner, 80% of providers use FESR.


      140 Character Summary:
      FESR is being rolled out in Lower Mainland Health Authorities as an enabler to provider documentation within Cerner.

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    EP05 - Application / Implementation / Design and Delivery (ID 20)

    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 9
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      EP05.01 - The eSafety Checklist (ID 31)

      Pritma Chattha, Calgary/CA

      • Abstract

      Purpose/Objectives:
      Background: Electronic health records (EHRs) are transforming the way healthcare is delivered. They are central to improving the quality of patient care and have been attributed to making healthcare more accessible, reliable and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Objective: To develop a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs.


      Methodology/Approach:
      Methods: A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low).


      Finding/Results:
      Results: An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist.


      Conclusion/Implications/Recommendations:
      Conclusions: Safe implementation of EHRs requires consideration of both technical and socio-technical factors through close collaboration of health IT and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.


      140 Character Summary:
      The eSafety Checklist offers 642 evidence-based user interface configuration recommendations, categorized by topic, to support safe configuration of EHRs.

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      EP05.02 - Accelerating the Adoption of Digital Health Technologies in Canada (ID 320)

      Peter Jones, ITAC Health; Mississauga/CA

      • Abstract

      Purpose/Objectives:
      To illustrate the value of digital health technologies to the Canadian healthcare system and the patients and healthcare providers it serves, the paper highlights six emerging technologies and their importance to healthcare. It also provides eight recommendations on how to successfully adopt such technologies in Canada.


      Methodology/Approach:
      The ITAC Health Advocacy Committee developed a white paper to draw attention to emerging technologies to accelerate the adoption of solutions to our current healthcare challenges. The ITAC Health Advocacy Committee focuses on promoting investment in health ICT and represent the interests of the Canadian health ICT industry to government, key decision makers and opinion leaders.


      Finding/Results:
      The six highlighted emerging technologies include virtual care, precision medicine, consumer health, the Internet of (health) things, cloud computing and blockchain. Note that these are illustrative examples only and were chosen from hundreds of emerging technologies deployed in healthcare systems already. ITAC Health recommends that industry and government: * Measurable steps to reinforce dependencies and actions between the public and private sectors, topic should have advisory panels and consultations between all stakeholders, including vendors. * Provide incentives and encourage the stakeholders to share information and commitment to sharing. * Make long term commitments to annual funding of digital health, by required reporting and tracking of commitments and expenditures * Invest in standardizing efficient and effective public procurement practices and mechanisms for engagement between the public and private sectors to manage timelines and costs of procurement. * Jointly encourage models of ICT investment, deployment and operation that bring the public and private sectors, large and small corporations, and academia together to grow the labour force and advance the skills needed to successfully implement digital health technologies. * Aggressively push solutions between and across provinces to gain experience and lessons at scale, through the use of tools and processes to safely liberate patient data enabling access to public patient data sets and solutions for use in a managed way by the private sector to fuel growth and innovation. * Invest in national privacy and security standards and practices to reduce risk and friction. * Ensure that sufficient broadband capacity exists equally in all areas of the country to support the new digital economy for all Canadians.


      Conclusion/Implications/Recommendations:
      To accelerate the adoption of emerging digital health technologies in Canada, the Canadian public and private sectors must be far more engaged together around common objectives of sustainable investment, standardized procurement practices, and taking innovation to scale across the Canadian digital health marketplace. ITAC Health calls for more structured collaboration between industry, and all provincial, territorial, and federal governments.


      140 Character Summary:
      Accelerating the adoption of emerging digital health technologies in Canada, ITAC Health calls for collaboration between industry and all levels of government.

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      EP05.03 - Improving Experience, and Staff Capacity with a Essential Clinical Dataset (ID 154)

      Amy Williams, Clinical Informatics, Island Health; Nanaimo/CA

      • Abstract

      Purpose/Objectives:
      Overdesign of a clinical information system?s (CIS) documentation tools can have a significant impact on clinical decision making, CIS adoption, data integrity, as well as a complete and meaningful patient record. Our organization set out to address these challenges head on and identify the essential clinical dataset based on an identified framework of clinically led quality improvement.


      Methodology/Approach:
      The focus of our initial activity to reduce documentation burden looked at our ?Adult Admission History? form. This document?s purpose is collecting the important historical data that can support clinical decision making and care planning as related to their acute diagnosis. This form was chosen due to the consistently voiced concerns from acute care nursing regarding the length, duplication of questions, as well as unnecessary documentation. We set out to use a methodology that supported the clinicians leading the decisions using practice informed evidence, regulatory requirements and organizational policies. In our planning phase we sought to understand current practice challenges in using the Adult Admission History form; time and motion studies as well as data audit supported this. Our current understanding identified that within just a 1-week period, 142 forms were started but never completed (approximately 142 hrs of wasted nursing time); an incomplete status meant this documentation was not visible or usable within the patient record for clinical decision making. We also identified that due to the volume of questions presented on this form, there was significant duplication of questions through the patient journey, and significant interruptions in completing the documentation leading to decrease in staff capacity. Our next efforts focused on an environmental scan to understand accreditation and organizational requirements. Our final planning phase activity was to engage with the clinical leaders of the organization to understand and support this important body of work. The development phase began with a workshop with clinical staff from a varied geographical and program background representative of the population of users. This group reviewed data around individual question usage over a one-year period. The clinicians used this information in partnership with clinical practice guidelines and policies, as well one principle motto; is the right person documenting the right information at the right time for the right reasons. This principle was used to ensure clinicians were documenting clinically relevant information that supports clinical decision making, and information that could be documented by another health care professional, at a different point in the care journey.


      Finding/Results:
      Through this methodology the Adult Admission History form was reduced from 14 sections and 150 questions, to 7 sections and 40 questions. Our preliminary evaluation of our methodology has determined the clinicians felt this is a clinically led process supporting and providing an essential clinical documentation set that values nurses time in support of patient care.


      Conclusion/Implications/Recommendations:
      In conclusion, the objective we set out to achieve by identifying an essential clinical data set for adult admission history is in the process of being realized?improved clinical decision making, CIS adoption, data integrity, increased staff capacity, and a complete and meaningful patient record.


      140 Character Summary:
      Overdesign of our EHR?s documentation tools has had significant impact on clinical practice and EHR adoption; the answer is an essential clinical dataset.

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      EP05.04 - Bridging the information gap: Access to information for community physicians (ID 291)

      Miranda Cho, Corporate & eHealth Services, Fraser Health Authority; Surrey/CA

      • Abstract

      Purpose/Objectives:
      The Ministry of Health has issued a strategic priority towards patient-centered integrated primary and community care. It has been identified systems that can enable the sharing of patient data across organizations considerably supports this strategic direction. Fraser Health (FH) has developed a health information exchange (HIE) system called Unifying Clinical Information (UCI), providing substantial benefits in communication by enabling coordinated and connected care across the continuum of care.

      Currently, there is still patient data mailed, faxed, or in some cases, available only within the system it is originally documented in. Physicians may not have access to this information; by the time they receive the information, it may no longer be of value or outdated. The FH UCI project team is driven to solve this by providing community physicians access to an integrated patient record within UCI, bridging the gap between acute and primary care to provide the best possible care to our patient population.


      Methodology/Approach:
      The project team identified the following challenges for UCI EMR Launch and a project approach was developed to take these challenges into consideration to deliver a successful outcome. 1. Privacy and Security of Data The team established a working group of representatives from privacy, security and legal, and collaborated with Doctors of BC to develop privacy and security documentation to support the initiative. 2. Authentication of users across health organizations The team designed an enrollment process to support onboarding community physicians. This process was designed and developed to accommodate credentialed and non-credentialed physicians and enable validation of user identity. 3. Usability The team recognized the importance of establishing a clinical advisory group to gather feedback throughout the design process.
      End users were involved and informed during the requirements, testing, and prototype phase. In addition, the team collaborated with all EMR vendors to design a solution that is feasible and usable.


      Finding/Results:
      *Governance*
      Early establishment of a governance model has been key for decision making, it has led to an engaged user group and increased adoption. This has also enabled the project team to develop a solution that was 90% adoptable across EMRs. *Technical Infrastructure *
      Connectivity was achieved through collaboration between EMR vendors and the technical teams. The development of an enrollment process has led to improved operational workflow for future implementations of the solution. *Privacy and Security*
      Early collaboration with privacy and security enabled the team to incorporate new agreements and guidelines in the design of the solution.


      Conclusion/Implications/Recommendations:
      Early identification of the challenges required the team to think outside of the box and consider a wide array of solutions. To address the barriers and design a usable solution, it was imperative to engage and collaborate with all stakeholders, vendors, and establish a governance group. This has enabled the team to deploy UCI EMR Launch to 20 clinics within the Fraser Health region, enabling physicians to view their patient?s journey through the healthcare system at the time of care, supporting the continuity of care and bridging the gap between the health authority and community physicians.


      140 Character Summary:
      The UCI EMR Launch project was delivered as part of Fraser Health?s Primary & Community Care Health Informatics Enablement Program.

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      EP05.05 - EMR Design - Driving Efficiency and Best Practice (Slides Available) (ID 468)

      Catherine Chater, VHA Home Healthcare; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Health professionals across disciplines and practice areas spend a significant portion of their workday charting. Even with the introduction of electronic medical records (EMRs) -- despite their significant advantages for care coordination, privacy and reporting -- an EMR per se typically does not tend to reduce a clinicians? charting time. VHA?s strategic commitment to ?leverage technology to increase productivity & uncover inefficiencies? provided impetus to comprehensively overhaul provider documenation practices, with the intent to ensure improved efficiency *and* simultaneous improvement to the adherence of regulatory/best practices standards in the course of developing a homecare rehab EMR.


      Methodology/Approach:
      The process began by developing an in-depth understanding of all the documentation and college standards required in the chart. This foundation allowed the design team to develop accurate and precise field requirements, and to differentiate between what is truly needed to achieve high quality documentation and clinical decision-making vs. items which remained in the chart without distinct purpose. An accompanying chart audit examined current paper-form fields usage, enabling user-workarounds and obsolete fields to be detected and modified to better align to real point of care practices. Alignment of data fields to workflow, and not pre-exsiting forms, helped identify significant opportunities to merge data to reduced documentation volumes. The application of tick-boxes to quickly enable documentation of required and repeated standard practices was applied to promote adherence and efficiency, and all modifications were pre-tested in paper versions prior to the sumbmission of development business requirements. The practice change these processes then effected was supported through user-led championing and change-management leadership.


      Finding/Results:
      The re-design of documentation fields and workflow has dramatically changed the structure of rehab data entry and its clinical use in day to day practice. Paper version of the form re-design alone effected a 50% reduction in the volume of documentation required for the initial assessment. Chart audit data reflects the success of building documentation standards and clinical best practices right into point care charting, enabling more consistent application and provider awareness of these required fields. Provider response to the new system has been very positive and early formal survey results strong satisfaction by users.


      Conclusion/Implications/Recommendations:
      It is important to consider documentation best practice as well as workflow and clinical best practice guidelines when developing EMR?s that impact client outcomes. Employee burnout remains a topic of high interest especially among healthcare staff. When combining this with improved client care, the effective design and implementation of EMR?s becomes paramount in the context of the limited resources we have in healthcare. In combining documentation standards with clinical best practice and provider workflow, we can positively impact both client outcome and provider well-being in community care.


      140 Character Summary:
      EMR design that is efficient and drives best practice is achievable by re-evaluating data fields requiremts that are accurate and precise.

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      EP05.06 - An EMR-Enabled Process for Release of Pediatric PHI (ID 80)

      Ellen Goldbloom, Pediatrics, Endocrinology, CHEO; Ottawa/CA
      Tammy Degiovanni, CHEO; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      Guided by the findings of an internal working group, our policy regarding the age at which competent youth control access to their personal health information (PHI) was changed from 16 to 12 years to align with current legislation and clinical practice standards. This policy applied to traditional access to medical records as well as our patient portal. Implementation required the development of a systematic, fail-safe process to ensure that youth have appropriate opportunity to control access to their PHI while at the same time for children and youth with exceptions to the age policy, that their capacity (in this context) is appropriately assessed, documented and flagged in the patient?s chart (proactively or retroactively).


      Methodology/Approach:
      A working group with membership from all stakeholders was tasked with this implementation and used our EMR as a primary tool alongside an updated patient portal activation strategy. An existing hospital form (clinician tool) was modified to include an alert for exceptions to the policy. When submitted to health records, this form triggers the creation of a flag in the EMR and requests for Release of Information or patient portal access are not compromised or delayed unnecessarily. Similarly, this flag is visible to clinicians so that they are also aware of the exception. Generally, this visibility enhances the communication and reinforces the linkages between health records and the clinical staff. Clinician resources were created to support the change and an evaluation plan was implemented to monitor impact of change and guide modifications to process. The activation strategy for the patient portal also includes two milestones where youth are required to confirm proxy access to their account. The above process for noting exceptions to the policy ensures that access is not delayed unnecessarily. Outside of these milestones, youth may adjust proxy access to their information at any time.


      Finding/Results:
      The working group met at regular intervals post go-live to review outcomes of implementation. Over the first year there were 10 concerns noted (7 from staff, 3 from families), no privacy breaches, no requests to mental health department to assess capacity and 9 requests to clinicians to complete release restriction alerts. Qualitative outcomes included smooth implementation and absence of suggested revisions/modifications. Health records staff reported some delay in time to release requests, a sense of surprise from some parents, some confusion re: crossover between consent to release of PHI and consent for medical decision making but also cited many positive examples of youth engagement in the process.


      Conclusion/Implications/Recommendations:
      A policy change at a pediatric hospital necessitated a streamlined process to ensure lawful release of PHI. A strategy including stakeholder engagement and leveraging existing EMR tools resulted in a successful implementation. A clear definition of capacity for and disclosure of PHI and how it relates to the EMR and secure patient portals in a pediatric setting, a representative working group and effective communication and education strategies were crucial in implementing workflow changes with broad impact. This general implementation model may prove useful for future hospital policy changes.


      140 Character Summary:
      We describe the development, implementation and evaluation of an EMR-enabled process for appropriate release PHI in a pediatric hospital.

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    OS09 - Internet of Things Enhances Care (ID 16)

    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 5
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      OS09.01 - Socially Assistive Robots for Children with Autism Spectrum Disorder (ID 345)

      Sabrina Tang, Dalhousie University; B3H3H5/CA

      • Abstract

      Purpose/Objectives:
      Socially assistive robotics run by machine learning algorithms are becoming exponentially powerful. This presentation explores the use of socially assistive robots for children with autism spectrum disorder and the implications of this innovation for patients, families and care providers.


      Methodology/Approach:
      520,000 individuals in Canada are estimated to have autism spectrum disorder. The waitlists for therapy are long and getting longer. in Ontario, for example, the waitlist doubled from March 2013 to 2015. As well, the cost of therapy is steep - $75K per child per year. In 2017, the Senate of Canada called on the federal government to determine the appropriate level of funding for autism spectrum disorder due to the excessive financial burden on families. Applied Behavioural Analysis therapy is the standard of practice for autism spectrum disorder to help children with communication and social skills live more productive lives. In Canada, the use of socially assistive robots Nao (by SoftBank Robotics) and Milo (by Robots4Autism) is currently being evaluated. The anticipated benefits are lower costs, higher clinical outcomes, and reduced burden of care over children's lifespan. Pilot studies show increased social behaviours, reduced repetitive behaviours, and increased spontaneous language. In addition to a review of these potential benefits, this presentation will review potential harms, possible mitigation strategies, and remaining challenges from the perspectives of patients, caregivers, providers, and provincial governments.


      Finding/Results:
      Machine learning algorithms and socially assistive robotics are improving exponentially and there is enormous potential to benefit children with autism spectrum disorder. However, concerns remain regarding trust, relationships, employment, and regulation.


      Conclusion/Implications/Recommendations:
      Socially assistive robots are a promising intervention for children with autism spectrum disorder. The government-funded health care system should fund socially assistive robots when they become evidence-based practice.


      140 Character Summary:
      Socially assistive robots can potentially improve therapy for children with autism spectrum disorder

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      OS09.02 - Telemedicine for Assessments of Essential Tremor Patients for Focused Ultrasound (Slides Available) (ID 150)

      Valerie Sutherland, Telemedicine, Sunnybrook Health Sciences Centre; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      In Canada, brain scientists at Sunnybrook Health Sciences Centre in Toronto, Ontario have pioneered the use of MR-guided focused ultrasound to successfully treat Tremor patients since 2012. Until 2015, it was the only centre in the country offering this treatment. Numerous people located in communities across Canada suffer from debilitating tremors in their arms and hands that have not responded to medication. These tremors make it difficult for people to eat, drink, write and dress themselves. Previously diagnosed tremor patients must be assessed for the severity of their arm and hand tremors before being considered for the treatment. Sunnybrook is now using telemedicine encounters as an option to assess previously diagnosed essential tremor patients from across Canada for their suitability for MR-guided focused ultrasound treatment to save them the expense, time and physical challenges (many cannot travel without assistance) of travel.


      Methodology/Approach:
      Based on the need to assess patients across Ontario and all other Provinces and, the challenges for patients to travel from far distances to Toronto, protocol creation occurred mirroring the in-person neurosurgery assessment tools that would be appropriate, and effective for the assessment of a patient via two-way videconferencing.


      Finding/Results:
      Use of the protocol for assessment of patients has been successful in identifying candidates across Canada. The use of telemedicine means the patients deemed suitable candidates to come in person for the treatment only travel to Sunnybrook for it rather than coming for the assessment and then returning for the treatment.


      Conclusion/Implications/Recommendations:
      Thanks to the provincial and national adoption of two-way video conferencing technologies as a means to deliver health care services, patients can be assessed and learn more about the treatment by interacting with one of Sunnybrook's neurosurgeons via telemedicine. As well, it is effective for post treatment appointments. Patients and their families save the time, expense and physical challenges of travelling to Toronto. To date, over 100 encounters have occurred with patients located in nine of Canada's provinces.


      140 Character Summary:
      Protocal for telemedicine assessment for MR focused ultrasound treatment of arm and hand tremors has been successfully implemented by neurosurgery at Sunnybrook.

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      OS09.03 - The Virtualists: Introducing the Next Generation of Primary Care Physicians (Slides Available) (ID 232)

      Francis Nwakire, Think Research; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      The purpose of this presentation is to share an overall picture of the virtual care landscape:, from history to present state, and to explore the ?sickcare-healthcare? dichotomy. We?ll show how virtual care technologies can help us evolve ?sickcare? silos into a more robust, preventative form of healthcare, and how the role of today?s primary care physician will evolve into that of the ?virtualist?.


      Methodology/Approach:
      By outlining the roots of virtual care and some of its current iterations, we hope to provide a foundation for audiences to understand how this critical and innovative technology will change our notion of the word ?health? and the role that community care providers play in our healthcare system.


      Finding/Results:
      During this presentation, Think Research will discuss the ways in which virtual care technology is shifting: - The role of provider vs. patient (patient-directed care) - Changing care models: from reactive and prescriptive to self-directed and preventative - Future directions: how AI and machine learning technologies will change virtual care


      Conclusion/Implications/Recommendations:
      Today?s care providers of all sectors in the continuum need to embrace virtual care technology as it will become woven into the fabric of healthcare systems around the world. By understanding how virtual care is (and will continue to) transform healthcare, clinicians, government bodies and patients alike can prepare for this new, exhilarating age.


      140 Character Summary:
      This presentation will outline the virtual care landscape, showing how virtual care technologies is evolving healthcare systems around the world.

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      OS09.04 - Mobile Health for Personalized Behavior Modification by Personalized Action Planning (Slides Available) (ID 306)

      Raza Abidi, Faculty of Computer Science, Dalhousie University; Halifax/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Chronic illness is affecting a large number of Canadians, with ca. 16% of the population having a multi-morbidity as shown by a recent report from the Canadian Chronic Disease Indicators framework (2017)1. Behavior plays a significant role, with behaviors such as physical inactivity, unhealthy diet and smoking often causing or exacerbating chronic illnesses. To realize long-term positive health behavior change, we present a personalized behavior modification framework called Engage, which computerizes key constructs from the evidence-based Social Cognitive Theory (SCT). 1https://infobase.phac-aspc.gc.ca/ccdi-imcc/


      Methodology/Approach:
      We present a knowledge-based, action-planning and community-driven approach to maximize key SCT indicators such as knowledge and self-efficacy, guided by a knowledge model computerizing SCT constructs. Our approach formulates behavior modification programs as sequences of short-term action plans, which are personalized to the patient and designed to overcome perceived barriers to long-term behavior change (mastery experience). The knowledge indicator constitutes knowledge on the risks and benefits of (un)healthy behaviors, and is influenced by frequent educational messages tailored to a patient?s current situation, personal barriers and behavioral goals. To maximize the self-efficacy indicator, which measures one?s perceived ability to perform a long-term goal, multiple SCT constructs are leveraged, such as mastery experience, social modeling and social persuasion. By performing similarity analysis and data mining on detailed patient profiles and patient feedback, our approach leverages the experiences of similar patients in the community (e.g., regarding health, social status and physical characteristics) to (1) suggest action plans with a strong likelihood of success; (2) offer motivation to patients by seeing similar patients succeed (social modeling); and (3) encourage them to connect, exchange advice and provide encouragement on barriers to be overcome (social persuasio


      Finding/Results:
      The Engage framework implements a holistic approach to behavior modification, including (a) collecting an up-to-date patient profile and assessing patient-specific SCT indicators; (b) selecting and tailoring a behavior modification program, based on individual patient profiles and collective patient experiences; (c) delivering timely educational and motivational messages; and (d) monitoring patient compliance and aggregating community-wide feedback on behavior modification programs. The framework includes a number of key components: 1) A core back-end service, which keeps the knowledge model, patient profiles and algorithms for similarity analysis and data mining. 2) A front-end web portal, allowing patients to enter their personal profile, fill out questionnaires for weekly monitoring, and selecting between different action plans to perform. 3) A tailored social network that facilitates patients to connect with other similar patients, post their progress, receive encouragement and see others, similar to their individual situation, succeed. 4) A mobile app (Android, iOS) used by patients to submit progress towards their weekly action plan, receive tailored educational and motivational messages, and serving as a portal into the social network.


      Conclusion/Implications/Recommendations:
      The Engage framework currently includes behavior change content for the long-term goal of increasing physical activity ? although other content can be easily plugged in ? and is undergoing usability tests. We are planning an extensive clinical evaluation of the system, including patients with high risk factors for chronic illness and those suffering from chronic illness.


      140 Character Summary:
      To realize long-term health behavior change, we present a knowledge-based, action-planning and community-driven system guided by the Social Cognitive Theory.

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    OS10 - Four Implementation Vignettes (ID 17)

    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 0
    • Slides Available
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 6
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      OS10.01 - e-Mental Health Demonstration Project: Implementing and evaluating Stepped Care 2.0© (Slides Available) (ID 429)

      Danielle Impey, Knowledge Exchange Centre, Mental Health Commission of Canada; Ottawa/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      In 2017, the Mental Health Commission of Canada (MHCC) launched an e-mental health (e-MH) demonstration project to improve access to mental health services in publicly funded health systems. The MHCC, the Government of Newfoundland and Labrador, and the core team at Memorial University of Newfoundland lead by Dr. Peter Cornish, are working closely together to implement and evaluate Stepped Care and e-mental health programming in 15 clinical sites across Newfoundland and Labrador. Stepped Care 2.0? is an evidence-based, rapid access system of delivering programs, including same day, flexible access to mental health resources, including face-to-face and e-MH components, while promoting client autonomy & resilience. Patients receive the least intensive treatment with the greatest likelihood of improvement. Care is stepped up or down depending on client need/preference and is continuously monitored. e-Mental Health refers to the use of the internet and other electronic communication technologies to deliver mental health information & care, and these services have been found to be an effective and complementary option. This rapid access approach aims to reduce wait times and to improve access. The objectives of the project are to: 1. Introduce innovative approaches and new technologies to mental health and addictions service delivery in the province (i.e. stepped care and e-mental health programming). 2. Reduce wait times for services. 3. Improve mental health outcomes.


      Methodology/Approach:
      Data for the evaluation component is collected from healthcare providers and site managers through training workshop and feedback surveys, usage data from pilot sites, outcome scales and interviews. Data is collected from clients via anonymous patient surveys developed by the evaluation team. A report will be produced amalgamating the feedback received during a quality improvement workshop on the project.


      Finding/Results:
      Preliminary results have shown a decrease or elimination of wait lists at some implementation sites. Feedback on the change management and training process by health care providers has been positive. We expect to show improved mental health outcomes through the introduction of stepped care and the e-mental health services offered. The final report will be released in spring 2019.


      Conclusion/Implications/Recommendations:
      The rapid access approach of the e-mental health demonstration project aims to reduce wait times and to improve access. Results from the project evaluation will inform opportunities to improve and scale-up Stepped Care 2.0? and similar mental health care approaches.


      140 Character Summary:
      The MHCC's e-mental health demonstration project seeks to improve access by implementing and evaluating Stepped Care and e-mental health rapid access approaches.

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      OS10.02 - Improving Care Transitions from Hospital to Home with Electronic Tool (Slides Available) (ID 519)

      Terence Tang, Institute for Better Health and Program of Medicine, Trillium Health Partners; Mississauga/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Care transitions from hospital to home are vulnerable times for patients and caregivers as they sometimes cope with changing physical, cognitive, and functional status, assume increasing self-care responsibilities, and experience change in care plans. As a result, adverse events and unplanned Emergency Department (ED) visits and hospital re-admissions sometimes occur. Effective communication (both among the interprofessional team, and with patients/caregivers) is essential to ensure adequate discharge planning and support safe transitions. Our objective is to evaluate the impacts of an electronic communication tool used by clinicians and patients/caregivers on patient experience, ED visits/re-admissions, and care transitions.


      Methodology/Approach:
      We augment a previously built electronic interprofessional communication and collaboration platform used by hospital clinicians to coordinate care of complex hospitalized patients with new discharge planning and patient-facing components. We facilitate care transitions by adapting the Patient-Oriented Discharge Summary (PODS, developed at University Health Network Open Lab) into the discharge planning component, incorporating its electronic completion in clinical workflow via co-design with hospital clinicians, and making PODS electronically available to patients/caregivers after discharge. To evaluate the impact, we are conducting a mixed methods study on 4 general medicine wards. The quantitative component uses an intervention-control design where the intervention will be deployed on 2 wards (intervention arm) with the remaining 2 wards providing usual care (control arm). Outcomes will be measured on both intervention and control wards at 2 time points (baseline and 3 months after the intervention has been deployed in the intervention wards). The qualitative component consists of semi-structured interviews with clinicians and patients/caregivers exposed to the electronic tool to understand the perceived impacts, reasons for success and failure, and contextual factors affecting implementation.


      Finding/Results:
      Quantitative outcome measures include patient experience using 4 selected questions about communication from the Canadian Patient Experience Survey ? Inpatient Care (CPES-IC) and 1 question related to overall hospital experience, and care transition using the 3-item Care Transitions Measure (CTM-3). These outcomes will be obtained with post-discharge telephone surveys of patients. Outcome data of ED visit and re-admission within 30 days will be obtained using routinely collected administrative data. A chart review will be used to determine process measures relating to the completion of discharge documentation including PODS. A pre-defined subgroup analysis will be performed for patients with dementia to understand the effect on this complex high-need population. Semi-structured interviews with clinicians and patients/caregivers will explore the experiences more deeply and contextualize quantitative findings. We have so far completed baseline data collection and anticipate that preliminary analysis of full results will be available for the eHealth conference.


      Conclusion/Implications/Recommendations:
      As communication technology continues to advance and its adoption are increasing in the general population, the result of this study will inform if and how such technology may be leveraged to engage patients/caregivers to impact patient experience, care transitions, and outcomes.


      140 Character Summary:
      A mixed methods study assessing the impact of an electronic tool used by clinicians and patients/caregivers on patient experience, care transitions, and outcomes.

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      OS10.03 - Streamlining Electronic Emergency Department Order Sets Between CHEO and SickKids (Slides Available) (ID 113)

      Daniel Rosenfield, Paediatric Emergency Medicine, SickKids Hospital; M5G1X8/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Tertiary paediatric care is delivered in only a few large centers in Ontario, and these centers often share patients. It is imperative that they maintain the most up to date and share similar standards when treating children, especially as they act as regional centers of excellence that often determine local practice patterns. One way to standardize care is to align order sets for commonly seen paediatric conditions. Order sets represent evidence-based treatment algorithms to promote standardization of practice amongst frontline providers. We describe the process used at Children?s Hospital of Eastern Ontario (CHEO) in Ottawa and the Hospital for Sick Children (SickKids) in Toronto capitalizing on a shared instance of our Electronic Health Record (EHR) to align Emergency Department (ED) order sets during implementation. This alignment has helped standardize care in the two largest paediatric EDs in the province. Additionally, through future expansion of the Kids Health Alliance (KHA), best implementation practices were shared between CHEO and SickKids for respective EHR rollouts.


      Methodology/Approach:
      As part of the larger KHA initiative, CHEO and SickKids are sharing one instance of Epic, the enterprise-wide EHR. As a result, there is a joint KHA Governance; however, each department is still responsible for building/maintaining its own content/order sets. Local ED subject matter experts (SMEs) reached out to one another to compare order sets, using the Epic go-live as a catalyst for collaboration. Order sets were compared in an iterative fashion, presented to local committees and integrated and modified accordingly to local preferences. The net result was an overall alignment of various order sets, as well as expansion of order sets at both institutions. This initial collaboration led to further understanding between institutions, resulting in further utility at go-live, when individuals from CHEO came to the SickKids ED to help local users navigate the system on go-live weekend.


      Finding/Results:
      Prior to collaboration, SickKids had 18 unique ED order set documents while CHEO had 37. Following review and internal consolidation of existing order sets, SickKids finalized 25 EHR-version ED order sets, including 8 order sets derived from CHEO original order sets. Similarly, CHEO developed 28 unique order sets and derived one of these from a SickKids order set. Many order sets were similar between institutions with only minor amendments introduced due to the collaboration.


      Conclusion/Implications/Recommendations:
      As large-scale EHRs and hospital alliances become more commonplace, collaboration between local divisions/department allow providers to implement local best practices and standardize care across multiple institutions. This can be achieved via the standardization of order sets, and further collaboration can be facilitated by having ?boots on the ground? from individuals from each institution help out at others during EMR implementation.


      140 Character Summary:
      Through the Kids Health Alliance and one shared EMR, several disparate ED order sets were aggregated and shared across CHEO and SickKids to promote best practices

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      OS10.04 - An Implementation Story: Public Health Digitization in Nova Scotia (Slides Available) (ID 518)

      Latifa Mnyusiwalla, Gevity Consulting Inc. ; Toronto/CA

      • Abstract
      • PDF

      Purpose/Objectives:
      Public health digitization is a silent stream in the eHealth landscape where acute care and primary care implementations dominate the conversation. Immunization registries and communicable disease management systems are key to modernizing public health practice, reporting and surveillance, and protecting and enabling a healthy population. This presentation aims to shed some light on public health system implementations in Canada, through telling the story of Nova Scotia?s journey in becoming one of the only provinces in Canada, and globally, to have a single, seamless system for the management of immunization, vaccine inventory, and communicable disease data.


      Methodology/Approach:
      In January 2017, Nova Scotia embarked on an ambitious project to configure and deploy the Inventory, Immunization and Communicable Disease/Outbreak modules of a comprehensive public health information system over a 23-month period. Each module is a distinct business area with different requirements, configuration, integration points, and users. A consulting firm partnered with the vendor of the system to serve as the implementation team. The large multi-disciplinary team to ensure that subject matter expertise for all components of the deployment was available. This included a team of business analysts, a public health subject matter expert, configuration experts, data migration and integration experts, report developers, a testing team, a change management lead, and a senior project manager. At time of abstract submission, the Inventory and Immunizations modules have been deployed, with the Communicable Disease module to follow at the end of 2018.


      Finding/Results:
      Some lessons learned that may be beneficial to other provinces/jurisdictions embarking on public health digitization projects: - Leveraging existing configuration from other provinces was not as beneficial initially thought. Though the goals of public health bodies across Canada are universal (e.g. health promotion, disease prevention etc.), how programs and services are delivered differs from province to province. - The intensity of the project scope, scale and timelines warranted a large multi-disciplinary project team to ensure that subject matter expertise for all components of the deployment was available. The cohesiveness and effective communication within the team, and between the team and the client was integral to successful deployments. - Engaging end users early in the implementation through the establishment of Working Groups that met weekly throughout the duration of the deployment, fostered ownership of the project and the configuration. Working Groups were key to driving decisions about business processes and configuration. Decision-fatigue, time-pressures to make decisions, and not being able to fully understand the implications of a decision surfaced as issues with this approach.


      Conclusion/Implications/Recommendations:
      Public health system implementation projects historically in Canada have been long and complex. Other jurisdictions have rolled out much less functionality over a longer period of time, so the Nova Scotia implementation was determined to be very aggressive with many potential points of failure. To date, this project is the fastest deployment of a provincial public health system in Canada. The project is on track within the original schedule. The project team and the province have risen to the challenge of delivering and experiencing three go-lives within an 18-month period.


      140 Character Summary:
      Nova Scotia?s journey in implementing a seamless information system for the management of immunization, vaccine inventory, and communicable disease data.

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