HS01 - Innovations in Community Care (COACH Session) (ID 51)
Track: Not Rated
Coordinates: 6/07/2017, 08:30 AM - 10:00 AM, Room 202AB
HS01.01 - Digital Health in Home, Community, and Long-Term Care (ID 396)
T. Barbato, Revera Inc.; Toronto/CA
B. Billings, Saint Elizabeth Health Care; Cambridge/CA
Emily Seto, IHPME, University of Toronto; Toronto/CA
As clinicians and managers consider healthcare delivery options that extend beyond the four walls of the hospital, clinic, or other healthcare setting, new models are emerging for primary, home, community, and long-term care. Canadian healthcare providers face a unique set of challenges that include a rise in chronic disease and an aging, widely dispersed population. How do we merge care pathways across traditional sectors and settings while incorporating new care models and technologies? This one-hour session features a 30-minute presentation and 30 minutes of moderated open discussion with a focus on innovative solutions and emerging technologies as tools in the quest to provide a continuum of quality care, from in-person to virtual.
Trish Barbato, SVP of Innovation & Strategic Partnership, Revera Inc. Barry Billings, Intelligence Care Archi-tech, Saint Elizabeth Health Care Emily Seto, Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto
Rodney Burns, CIO, Association of Ontario Health Centres
OS03 - Realignment in Health Care (ID 2)
Track: Clinical and Executive
Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 202AB
OS03.01 - The IT Transformation Journey at Canada's Largest Healthcare Institution (ID 341)
Vicky Ramirez, University Health Network; Toronto/CA
Purpose/Objectives: In 2016, University Health Network (UHN) embarked on a transformational IT journey towards a digital future that supports our three domains of clinical practice, research and education. UHN has faced the typical technology challenges that encumber large academic research hospitals such as a distributed operating model, decentralized governance structures and a complex customer service interface. To address these challenges, UHN identified a need for greater coordination of IT expertise, a re-examination of service delivery models and an improved customer service approach to embrace the opportunities a digital world will bring. Our objectives included reorganizing 500+ IT staff into one integrated and co-ordinated digital team, implementing a new, transparent governance structure, and establishing financial accountability for nearly $100M.
Methodology/Approach: A small project team was established with authority to solicit feedback from key opinion leaders and IT experts throughout the organization. A clear understanding of the current state was developed using monthly data from each IT unit, conducting IT staff surveys on aspirations and competencies, as well as surveying the entire organization to ascertain a 'digital pulse'. The team drew upon external expertise in numerous forms: extensive literature review, an IT advisory committee of the board, consultants, hospital CIO's, and industry experts. Change management was an important aspect of the transformation; to manage this, the team employed John Kotter's 6-Step Change Model, organizing stakeholder events to co-design a solution, and pursuing a multi-faceted communications strategy. The transformation effort was given a new digital brand that served as a hallmark and a visual rallying point for the IT transformation.
Finding/Results: The IT Pulse survey showed that staff wanted their technology needs met more efficiently and desired a more personalized customer service approach. Co-design workshops with leaders from across UHN revealed the need to centralize many IT services. In addition, data collection showed needless complexity and duplication of services. The literature review and industry best practices revealed a bi-modal operating model approach with a focus on reliable and agile IT components that would respond to the needs of the organization. UHN extended this model to a third component to foster local innovation and discovery. The result was a tri-modal operating model that provided three ways for the digital team to work. The tri-modal approach will accommodate reliable, agile and exploratory modes of working.
Conclusion/Implication/Recommendations: UHN's digital transformation exemplifies a new way of thinking about IT in a healthcare organization. As technology and patient care become more integrated - running a digitally-enabled hospital is less about adopting digital technologies and more about changing the way we work in response to the nature of a digital world. Consequently, UHN embarked on an organization-wide change centered on our customers through a comprehensive operational model, strong business-IT alignment, and purposeful engagement. The IT Transformation is a necessary step forward and is a key enabler of UHN's purpose and digital strategy. Caring for our patients, teaching our students, and discovering tomorrow's treatments are critically dependent on this transformation.
140 Character Summary: UHN is implementing a new enterprise-wide integrated and synergistic IT operating model to put patients first, and bridge the care, discovery and learning domains.
OS03.02 - Hospital Information System Renewal (ID 144)
Lorelle Taylor, Health System Information Management, Ministry of Health and Long-Term Care; Toronto/CA
Purpose/Objectives: Under the Patients First: Action Plan for Health Care, Ontario has made a commitment to put people and patients at the centre of the health care system. As the Ministry of Health and Long-Term Care (ministry) develops a renewed digital health strategy, Hospital Information System (HIS) Renewal is a fundamental focus area. A critical mass of hospitals is replacing or upgrading their HIS or will do so in the near future, which provides an opportunity to examine ways to maximize the value and impact of public investments in these information systems.
Methodology/Approach: Given the current state of HIS investments, which were made independently to create hospital-specific value, the next generation of HIS investments will require a partnership model to increase value in an environment of fiscal constraint. Under the ministry's efforts to establish new digital health governance, a HIS Renewal Advisory Panel was created with the objectives of maximizing the value of current and future HIS investments, and improving patient outcomes and value for money through collaboration and innovation. The panel is comprised of ministry staff, clinicians, and executives from hospitals and local health integration networks. The panel used traditional procurement methodology to assess financial impacts and engaged in sector outreach to develop recommendations.
Finding/Results: Through rigorous analysis, broad collaboration, and consensus building, the panel finalized short-term recommendations in four strategic pillars: partnering, clinical adoption and outcomes, procurement, and financing. The panel's key recommendation was that hospitals should form HIS clusters based on previous partnerships to support patients through the use of a shared HIS, typically under a lead hospital, in order to maximize the value of current and future HIS investments. To support implementation, the panel recommended that the ministry create resources for HIS renewal, such as leveraging networks of health care professions to create a HIS Community of Practice that supports acquisition, implementation, and optimization of HIS systems and evidence-based standardization of clinical practices within hospitals. Furthermore, the panel recommended that the ministry should seek appropriate policy approvals to enable hospitals to join existing peer HIS installations, where supported by a strong clinical and financial business case. Moving forward, the Panel will develop cost standards for hospital accounting and coding to allow for more accurate projections of HIS-related expenses, and in turn support the effectiveness of ministry funding models.
Conclusion/Implication/Recommendations: In the second phase of HIS renewal, the panel will focus on defining a path for HIS clusters to coalesce into a select number of mature hubs that provide cost-effective, secure services. Ontario's 157 hospitals will begin to form approximately 15 clusters for HIS service delivery over the next five years based on value-based assessments. The Panel will develop a provincial strategy that fosters the capacity of high-performing hubs to ensure a sustainable, long-term approach to managing HIS investments. The ultimate goal is to transform the currently fragmented HIS environment into a platform for a high-performing, patient-centred health care system.
140 Character Summary: Renewing hospital information systems would maximize value and enable a high-performing patient-centred health care system
OS03.03 - Informing Health System Planning: An Integrated Performance Measurement Tool (ID 360)
Nabiel Syed, Centre for Addiction and Mental Health; Toronto/CA
Purpose/Objectives: Local Health Integration Networks (LHINs) provide strategic direction and fund health service providers (HSPs) in Ontario. To hold HSPs accountable, a number of performance indicators are being monitored but are submitted and captured in disparate locations. HSP360°, a performance management tool, was developed by the Centre for Addiction and Mental Health (CAMH) in partnership with the Toronto Central LHIN in response to feedback from HSPs and their boards about not having timely access to their information and their inability to see how their individual performance impacts the overall sector and system performance. Prior to HSP360°, each LHIN and HSP spent a significant amount of time and resources to manually consolidate health system data into reports to monitor performance. HSP360° reduces the duplication of effort and removes barriers to data by providing a centralized and consistent view of LHIN, sector and HSP data through meaningful comparative reports and dashboards. <img alt="hsp360 guiding principles.jpg" annotation="" id="image://48" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=3d84b7728ec2ae9eb535a2cb184e15beee8f18f3&id=48&width=350&height=350&download=0" title="hsp360 guiding principles.jpg" />
Methodology/Approach: To accommodate variations in performance monitoring processes, views of information, and source file formats, a pan-LHIN Advisory and Steering Committee was established to reach agreement on business requirements, prioritization, and development of a product roadmap. This approach ensures relevant, transparent, and meaningful reporting and analyses that meet the evolving needs of end users.
Finding/Results: In 2016, HSP360° expanded from a local to a pan-LHIN solution containing data for approximately 400 HSPs across 5 sectors. LHINs have found great value in automating the administrative and benchmarking process for negotiating targets and monitoring performance. On a quarterly basis, comprehensive reports are now available in weeks rather than months. In addition, HSP360° has improved decision support capacity for HSPs. In particular, HSPs have found the comparative and peer comparison reports helpful in planning for new services, looking for efficiencies and as a starting point to discuss overall sector and system performance.
Conclusion/Implications/Recommendations: The success of the HSP360° solution has been a result of a structured implementation methodology, high degree of stakeholder engagement and buy-in, and user support provided throughout the initiative. The progression of HSP360° has enabled LHINs and HSPs to set new standards in performance monitoring and a common view of performance metrics across LHIN boundaries. Future integration of new data sets and enhancing collaboration functionality will further support the performance monitoring process, and improve access to comparable information for evidence-informed decision making for all providers. The expansion of HSP360° to additional LHINs will build towards shared accountability, consistency and transparency across the province.
140 Character Summary: HSP360° builds decision support capacity and shared accountability for health service providers across data sources, sectors and regions.
OS03.04 - You Can't Do it Alone: Leveraging Partnerships in eHealth (ID 328)
Sarah Hutchison, OntarioMD; Toronto/CA
Purpose/Objectives: This panel brings together diverse health care organizations that are collaborating to reach physicians with their ehealth solutions. Hear why and how partnerships were formed, how they are governed, and how they are achieving their ehealth objectives.
Methodology/Approach: Each panel member will provide their perspective using examples of ehealth initiatives that required partnering with an organization that is the ehealth delivery partner for primary care. These examples will demonstrate how their respective sectors within health care (acute care, community care, primary care, long-term care, mental health, community support services) have come together and need to keep working together to make ehealth the interconnected system it was meant to be and work to align to provincial and regional health priorities.
Finding/Results: Every organization with ehealth initiatives needs physician participation or will soon need it. The ability to share patient information between the various health sectors and physicians is the holy grail of ehealth and is being realized through partnerships that, for example, have enabled the success of a provincial report management solution that is now of interest to other health care sectors. Critical success factors for partnership were effective agreements that allowed for "skin in the game" for the partners in addition to accountability of the delivery partner. This is demonstrated by the agreements with individual hospitals, specialty clinics, and end users of the report solution. The proven success of the initiative led to partnerships beyond acute care to deliver more reports to physicians – eNotifications, to support provincial community care initiatives; telehomecare reports with the provincial telemedicine agency to support home care. More organizations are seeing the value of a potential partnership to leverage the report solution to deliver their information to physicians – cancer care, long-term care, and mental health, to name a few. The provincial ehealth delivery partner is also collaborating with other organizations that are willing to partner for delivery services, on connecting physicians to the provincial electronic health record containing information from hospital and community organizations, the agency implementing the provincial laboratory information system, among others that require deployment to physician practices. The certified electronic medical records (EMRs) used by community-based family physicians contains a treasure trove of patient information. It is estimated that 80% of patient information is collected in primary care practices. Partnerships have also formed between a provincial ehealth delivery partner and provincial organizations responsible for health quality that need data from physicians' EMRs for health system planning and quality improvement initiatives and with regional organizations that need change management expertise with physicians to ensure the success of their initiatives.
Conclusion/Implications/Recommendations: Partnerships are crucial to the success of ehealth initiatives in the current landscape of limited financial resources, limited change management capability and the need for primary care data to effect health system transformation. Without the trusted relationship and advisory role between a provincial delivery partner and physicians, other provincial and regional bodies have no way to deploy their ehealth initiatives to a critical mass and sustain their use.
140 Character Summary: Leveraging partnerships is necessary for physician adoption and use of ehealth technologies and for getting them to provide EMR data.
OS03.05 - Towards Actionable Insights - CCO's Journey to Date (ID 88)
Angela Copeland, Analytics & Informatics, Cancer Care Ontario; Toronto/CA
Purpose/Objectives: As the Ontario government's advisor on the province's cancer and renal systems, as well as access to care for key health services, CCO drives continuous improvement in disease prevention and screening, the delivery of care and the patient experience for chronic diseases. We also encourage and support the broader improvement of Ontario's health systems by driving quality, accountability, innovation and value. To support decision-making and drive quality improvement, we acquire, collect, analyze and report on data. We are the custodian of over 75+ data holdings with 127,000+ columns that translates to over 250TB of data across production and supportive non-production environments. CCO has extensive expertise in the translation of large data sets into meaningful information that is translated into knowledge on health system performance and enables directed improvement initiatives. CCO is committed to the delivery of actionable insights to inform clinical and business decision-making around the planning, delivery, management and measurement of healthcare. To date, CCO has applied disparate approaches to the implementation and management of its data and analytics assets, practices, and technology that enable information generation and utilization. Without a solid foundation, CCO's capability to realize value from its assets and enable transformation to respond and deliver on Provincial strategies will be strained. To ensure success in the future, a defined data and analytics strategic path has been set to mitigate identified risks, exploit the value of the data, generate insights that enable informed decision-making and enable CCO's evolution as an evidence-based thought leader.
Methodology/Approach: In early 2016, a comprehensive "Discovery and Direction" phase was completed. The approach included: • The evaluation of the current state and the defining of a future state with respect to: o Data assets o Analytics & data management practices o Architecture & Technology o Analysis of requirements, risks, new opportunities, and partnerships • An Environmental Scan • Identification of key initiatives along with risks and interdependencies required to meet future state • The completion of an analytics pilot using an agile approach and big data. The phase concluded with the development of a 4 year 11.2M Data & Analytics Strategy and action plan. Phase 2 "Strengthening our Foundation" is now underway.
Finding/Results: Through all of this work, we have identified the following key learnings: • Vision needs to be business outcome driven • A collaborative enterprise approach is key to success • Data must be recognized and managed as a strategic asset. • Analytics needs to be fostered as core competency of the organization • Balanced, lean governance embedded in practice should be applied • Focus on the journey not the destination
Conclusion/Implications/Recommendations: Based on these findings, CCO has developed a Data & Analytics Strategy action plan that is now being operationalized. Our presentation will share key elements of our learnings to date, our action plan, and our priorities from a 'people, process and technology' perspective. Additionally, we will share key learnings from the analytics pilot that was conducted.
140 Character Summary: CCO is implementing a Data & Analytics Strategy to become an insights-driven organization. We will share key elements of our learnings, action plan, and priorities.
OS03.06 - Innovations to Support the Heart of Healthcare - The Patient (ID 298)
Gord Alexander, Global healthcare and lifesciences CoC, IBM; Toronto/CA
Purpose/Objectives: To demonstrate how Digital Health can improve patient outcomes, experiences and practice changes, increase real-time reporting, promote better risk management, allow for predictive and preventative care, and provide meaningful, timely data to front-line clinicians. The majority of Canadian hospitals Do not have all of the necessary information available at the point of care in an electronic format Have not implemented evidenced-based medicine and clinical analytics at an enterprise level Have process inefficiencies which compromise patient care delivery Digital Health Innovation can help address these issues through Empowerment and Engagement of Patients, Families, and Care Providers Coordination across the circle of care and collaborative innovation Integration of data and devices in a secure regulatory compliant manner
Methodology/Approach: Transformation through Digitization and mobility Visioning and priority setting to automate and optimize business processes Align enabling technologies with automated processes Design Thinking to reimagine the patient & staff experience Imbed mobile into process optimization Imbed analytics into enterprise optimization <img alt="mobility image.jpg" annotation="" id="image://39" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=cc731645e5353d25e2db65642c7269e306fc41d3&id=39&width=350&height=350&download=0" title="mobility image.jpg" />
Finding/Results: Findings/Results IBM Innovation Program Acceleration of innovation Alignment with Health System strategic priorities like Value Based Care Access to digitized health data Test IT labs for future services Focused on the healthcare ecosystem Examples Canadian examples Hamilton Health Sciences (HHC) – Collaborative Innovation Centre Global example Finland – Watson Health Centre of Excellence
Conclusion/Implications/Recommendations: IBM has created a portfolio of Digital Health services and solutions. We leverage global experiences and leading practices and bring them to the Canadian market. We can help you achieve the health system of the future: Patient Outcomes = Great! Patient Satisfaction = High Staff Satisfaction = High Virtual visits = 60% Physical visits = 40% Preventable Errors = Zero Avoidable Readmissions = Zero Hospital Acquired Infections = Zero Length of Stay = Below average Value based Care = 100%
140 Character Summary: Our approach has: an emphasis on proactive care to meet pt needs, a patient-centric focus, mobility and innovation, care that is based upon value and outcome.
OS15 - Virtual Care Trailblazers (ID 21)
OS15.01 - Design and Implementation of Tele-Pediatric Intensive Care in BC (ID 138)
Michele Fryer, Child Health BC, Suite 305, PHSA; Vancouver/CA
Purpose/Objectives: This presentation will focus on the two year process of bringing together clinical and telehealth technical experts in lockstep to design and implement pediatric Tele - PICU. This includes alignment of processes and systems between sites and health authorities for patient registration/documentation, procuring standardized equipment, developing detailed algorithms, organization of a 24/7 help desk, training, communications, testing/mock, process improvement, and establishment of the soft launch, leading to live launch.
Methodology/Approach: The design and implementation of this initiative was led by Child Health BC (CHBC) ,a provincial network of BC's health authorities and child serving ministries; in partnership with the Provincial Health Services Authority (PHSA) Telehealth Program and the regional health authorities. Sub-specialist consultation was delivered by pediatric intensivists, expert nurses, allied health, and sub-specialist from 2 PICUs at BC Children's Hospital in Vancouver, and Victoria General Hospital on Vancouver Island. The first regional site accessing Tele-PICU was Kootenay Boundary Regional Hospital in Trail. Expansion is planned as new learning is applied.
Finding/Results: Early experience reports from practitioners have been overwhelmingly positive with benefits including: subspecialist visualization of the patient; advanced understanding of the patient's pre-transfer condition, ability to monitor patient progress while providing advice, and obtaining patient history pre-transfer. Families were able to virtually meet the team who would be caring for their child after transfer, adding an extra level of connection and comfort with a new care team.
Conclusion/Implication/Recommendations: This successful pilot will now be expanded to other BC hospital emergency departments and some inpatient units with priorities linked to the Child Health BC Tiers of Service work in respect to children's emergency services. Tiers of Service is a child health service planning framework used in BC that describes the responsibilities and requirements for services from small rural communities to BC Childrens' Hospital in Vancouver. Evaluation will include a framework of quality dimensions tailored to measure the achievement level of the service goals which include: increased and timely access to quality specialized care, potential avoidance of escalation of care, and increased family satisfaction.
140 Character Summary: Canada's first 24/7 virtual Pediatric Intensive Care Unit service provides consults to remote hospitals from pediatric intensive care teams.
OS15.02 - Scaling-Up an Online STI/HIV Testing Program in British Columbia (ID 358)
Devon Haag, Clinical Prevention Services, BC Centre for Disease Control; Vancouver/CA
Purpose/Objectives: In response to increasing rates of sexually transmitted and blood-borne infections (STI/BBI) and a desire for more patient-centered health services in British Columbia (BC), the BC Centre for Disease Control (BCCDC) developed an internet-based STI/BBI testing service (GetCheckedOnline, GCO). Integrated with clinical and public health services, GCO is a "virtual clinic" of the BCCDC, developed to reduce known barriers to testing. GCO launched in Vancouver in 2014, then expanded to other regions of the province in 2016. We describe the process and early outcomes of scaling-up this intervention across a complex health care system.
Methodology/Approach: BCCDC developed an expansion plan in collaboration with regional health authority (RHA) stakeholders. We established a core team with project leads from BCCDC and two RHAs (Island Health and Interior Health), and formed a provincial expansion advisory committee with representation from BCCDC, private and public health laboratories, Ministry of Health, and all six BC health authorities. Program indicators from all sites are routinely reported and feedback on the service from clients is collected through research studies.
Finding/Results: The process took approximately 14 months from planning to implementation. Participating RHA communities were selected based on higher STI/BBI rates and limited access to testing. A high degree of collaboration between BCCDC, RHAs and local clinical services was needed to determine procedures for follow-up of positive diagnoses. Support and interest at multiple levels of RHA leadership facilitated the implementation of GCO, while challenges faced have included physician engagement and timely access to treatment in some locations. The scale-up has led to substantial increases in the uptake of GCO in Vancouver and at RHA sites. As of September 2016, RHA sites comprise 49% of new accounts, 38% of test episodes and 42% of positive STI diagnoses. Preliminary analyses suggest that GCO is reaching populations at risk; 19% of RHA clients have never previously tested for STI and 25% have never previously tested for HIV. Feedback from RHA clients has been positive, indicating acceptability and satisfaction with the service.
Conclusion/Implication/Recommendations: This represents the first time in Canada that an integrated, internet-based STI testing service has been implemented beyond a single geographic area. Through our inter-agency collaborations, we have successfully scaled-up an online STI/BBI testing service which has high acceptability, increasing uptake, and has led to new STI diagnoses in the regions where implemented. We are continuing to work towards further scale-up in BC, and our model may be relevant for other Canadian jurisdictions.
140 Character Summary: GetCheckedOnline is an online sexually transmitted infection testing service funded by public health in BC. We describe the scale-up of this program provincially.
OS15.03 - Implementation and Evaluation of a Sustained Heart Failure Telemonitoring Program (ID 312)
Purpose/Objectives: A sustained smartphone-based Heart Failure Telemonitoring Program was implemented within a large hospital Heart Function Clinic. The Program is unique compared to other telemonitoring programs due to its real time feedback to patients, low cost, minimal technical support requirements, and ability to be used without additional healthcare personnel beyond the patient's current care team. This presentation will discuss the lessons learned from the implementation process and the preliminary results from the evaluation.
Methodology/Approach: An implementation strategy and evaluation plan were developed prior to implementation of the Telemonitoring Program. Patients were recruited from a Heart Function Clinic starting August 2016, with anticipated enrolment of 200 patients within the first year. Patients receive a Bluetooth-enabled weight scale, blood pressure monitor, and smartphone installed with the Medly application. Each morning, patients are instructed to take their weight, blood pressure, and answer symptom questions on the smartphone. An algorithm uses the patient data to generate automated patient self-care messages and alerts to the healthcare provider at the earliest sign of worsening health. Evaluation data will be collected while the Program is operational for quality improvement. During the first year, the Program will undergo a particularly rigorous evaluation to determine its benefits and areas for improvement. The evaluation will include health outcomes (eg, hospitalization rates, mortality), process outcomes (eg, number of alerts), adherence, quality of life and self-care (validated questionnaires), and interview data from patients and healthcare providers.
Finding/Results: The implementation strategy included an analysis of baseline clinical workflow, as well as the effects of the Program on workflow post-implementation. Several processes were established in preparation for implementation, including for alert management, technical support, clinician and patient training, patient enrolment, and equipment management. Currently, a cardiologist receives alerts via emails and manages them in collaboration with two nurse practitioners. However, in the future the two nurse practitioners will provide the majority of management. A technical analyst (0.25FTE) who is part of the hospital's Telehealth group is managing all other support duties. Nine patients have been enrolled to date (September 2016). A slow initial rollout enabled technical and workflow issues discovered after implementation to be resolved with minimal disruption to patients and clinicians. Adherence to taking daily measurements is currently high (95% of all possible days). For this presentation, the available baseline, one month, and six month evaluation data will be summarized.
Conclusion/Implication/Recommendations: Very few implementations of sustained telemonitoring programs exist in Canada. Therefore, sharing the implementation experiences is crucial to ensure best practices, avoid repeating mistakes, and for quality improvement. In addition, evidence of the impact of such programs is important to promote the establishment of similar programs across Canada and beyond.
140 Character Summary: This presentation will discuss the implementation and evaluation of a sustained smartphone-based Heart Failure Telemonitoring Program.
OS15.04 - A Primary Healthcare Consumer Health-e' Strategy (ID 364)
Rodney Burns, Association of Ontario Health Centres; Toronto/CA
Purpose/Objectives: Present the approach, experience and Critical Success Factors for developing a sector-approved Consumer Health-'e' Strategy.
Methodology/Approach: 1. Proof of concept Connected Health and Wellness Project – a smart phone enabled health coach approach for people with diabetes from modest socio-economic communities enabled with an eHealth collaboration platform. Participants in project include Black Creek Community Health Centre, NexJ Systems Inc. Rogers Wireless, Research in Motion, McMaster and York Universities, Federal Development Program. 2. Sector-based approach The Executive Directors of Community Health Centres (CHCs) and Aboriginal Health Access Centres (AHACs), voted their approval on a requirements set for a potential solution. Various options are being piloted and implemented to inform effectiveness and critical success factors. 3. Market Assessment The ED Network, led by its Information Management Committee applied the agreed-upon requirements and assessed a number of potential vendors and their solutions, a result of a Request for Information (RFI) released by the sector in 2015.
Finding/Results: Pilots and refining requirements The Connected Health and Wellness project resulted in 7% improvement in HbA1C management vs. traditional diabetes management practices. The combination of the collaboration platform, health coaching and effective client education and communications via smart phone is attributed for the improved outcomes. Three of AOHC's member organizations (one urban and one rural CHC, as well as one AHAC) started a pilot with HQIC's miDASH PHR (Personal Health Record) in an effort to evaluate its benefits for primary healthcare clients in very different contextual settings. One CHC has started a pilot with Nightingale's MyPatientAccess PHR, relying on its integration with the Nightingale-On-Demand (NOD) EMR which is the sector-based shared EMR solution. One CHC has become part of a wider network of Health Service Providers using McKesson's Relay Health PHR. Next Steps As per the graphic below, basic analytics capabilities will be at the clients' disposal, crunching and analyzing data from various sources, including wearable devices (fitness trackers, step counters, heartrate monitors, etc.). Level 3 is where the desired solution's capabilities were acknowledged by the ED Network. Level 4 was considered more of a provincial solution approach and beyond the requirements of the AOHC members. Following this direction, AOHC, together with member organizations, is participating in the first-ever Innovation by Co-Design program, hosted by the MaRS Discovery District. The purpose is to find partners capable of producing a solution that ultimately allows member organizations to better care for their clients and help clients make better lifestyle decisions ultimately leading to improved health outcomes.
Conclusion/Implication/Recommendations: Present the innovative approach of procuring for outcomes aligned to the IHI's Triple Aim: increase client satisfaction, lower costs and improved outcomes. Solution Critical Success Factors: a. Funding: clients cannot be expected to pay for this service. Organizations must be able to make a business case for funding. b. Integration: the solution must be able to consume relevant data from provincial eHealth assets and interact transactionally with EMRs. c. Metrics: easily interpreted graphic representations of clinical information to communicate improvements to clients. d. Organizational Commitment to person- and community-centredness. e. Value for money
140 Character Summary: A culturally appropriate Consumer Health-'e' Strategy – increased client/clinician satisfaction, lower cost, improved client experience - Triple Aim.
OS26 - Creating Effective Health Care Platforms for the Future (ID 31)
Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 202AB
OS26.01 - Towards National Nursing Data Standards (ID 382)
Lynn Nagle, University of Toronto; Toronto/CA
Purpose/Objectives: This presentation will describe the strategies being utilized nationally to advance nursing data standards adoption, the benefits to be derived, and the current state of adoption.
Methodology/Approach: Monitoring health system performance and demonstrating nursing's contribution to clinical outcomes within and between sectors of care necessitates the use of data standards. This presentation will focus on the follow-up activities and outcomes of a nurse leaders' symposia held in 2016. Building upon the foundations of the action plan established in a 2016 symposium, the 2017 meeting included a broader engagement of nurse leaders and key stakeholders and continued the evolution of strategies to advance the adoption of nursing data standards across Canada. Focused in the areas of clinical practice and administration, research, education and policy, this presentation will describe the strategies being utilized to advance nursing data standards adoption, the benefits to be derived, and the current state of adoption.
Finding/Results: As clinical information systems and digital health solutions for consumers continue to evolve, the use of standardized nursing data presents an opportunity to have nursing information inform appropriate practice and use of nursing resources. Currently, the documentation of nursing practice: assessments, interventions and outcomes are not easily compared or analyzed within and between care settings because of differences in approaches to documentation, measurement and reporting. Furthermore, these data gathering inconsistencies also limit the capacity to determining the impact of: nursing care within different settings, nurse patient ratios, and staff skill mix on quality and safety outcomes. Monitoring health system performance and demonstrating nursing's contribution to clinical outcomes within and between sectors of care necessitates the use of data standards.
Conclusion/Implication/Recommendations: This presentation will be of interest to clinicians, decision-makers, and users of clinical data to evaluate care outcomes across the continuum.
140 Character Summary: Discussion of activities and outcomes of a nurse leaders' symposia held in 2016 and 2017 focused on advancing the adoption of national nursing data standards.
OS26.02 - Evaluating Canada's Innovation Agenda: Will It Meet Expectations? (ID 149)
Karim Keshavjee, InfoClin; Toronto/CA
Purpose/Objectives: Canada's health landscape is undergoing far-reaching and fundamental changes: an increasingly engaged and aging population with more complex and chronic health needs is demanding ever-greater choice, access, and integration in the provision of healthcare and related services. Innovation policies developed in the past 2-3 years to advance value-based procurement, consumer-driven innovation and enhanced use of technology do not lack vision and ambition. The question is 'can they deliver'? We developed and used a comprehensive policy evaluation framework to assess the strength of recent healthcare innovation agendas in Canada. We assess and report on the Federal, Ontario and Alberta health innovation programs.
Methodology/Approach: We developed a policy evaluation framework that assesses the ability to execute on a sophisticated and nuanced program of innovation across different settings, disease areas, patient types and funding mechanisms. We identified the following categories of best practices in program design and execution: (1) governance, (2) health system coalitions, (3) implementation approach, (4) fostering innovation, and (5) independent program evaluation. For each category, we identified 4-6 best practices that are likely to lead to excellence in execution of health innovation programs. <img alt="health innovation analysis framework.png" annotation="" id="image://27" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=0352e3d94c02fff4ad1034734a0c6f5f7ba6dbb0&id=27&width=350&height=350&download=0" title="health innovation analysis framework.png" /> The four authors assessed each program independently. One point was given if the program exhibited the best practice; half a point was given if the best practice was implemented partially. If the program did not exhibit a particular best practice, it was given a score of zero. A final overall score for each policy was achieved through consensus across all four evaluators. A program could achieve a maximum of 22 points.
Finding/Results: All Innovation Programs received poor overall scores (Federal = 8; Ontario = 7.5; Alberta = 11.5). Significant gaps in best practices in encouragement of innovation, innovation implementation and rigorous and independent evaluation were seen across all three policies. The Federal and Ontario programs also exhibited weakness in the area of encouraging multi-organizational and multi-jurisdictional coalitions to solve problems of fragmentation and cost-optimization.
Conclusion/Implication/Recommendations: This preliminary analysis shows significant room for improvement across all three Innovation programs in elements of implementation planning, fostering innovation and program evaluation. In particular, greater emphasis must be placed on stakeholder engagement, providing R&D incentives, budgetary analysis, commercialization potential and transparency to promote successful healthcare delivery transformation through disruption and innovation.
140 Character Summary: Feds and Provinces get failing mark for #HealthInnovation Agenda. Lack of Best Practices creates lost opportunities. More could be done.
OS26.03 - Structured Innovation Programs Accelerate Innovation in Healthcare (ID 308)
Robyn Berridge, Toronto/CA
May Chang, Consultant; Toronto/CA
Purpose/Objectives: Accelerating and scaling innovation is both a key strategic goal for many healthcare organizations and a difficult undertaking. Relying on the individual 'creative genius' typically results in sporadic innovations that do not scale and that are often misaligned with organizational strategic priorities. Structured innovation programs provide a much more effective method for ensuring that more innovations are created, those that are aligned with organizational priorities are nurtured successfully to realize value, and that innovation is encultured broadly across the organization. Through a case study description, participants will understand: How to define and quantify a structured innovation program Practices in healthcare innovation programs from this case study and other global best practices How to assess the maturity of the healthcare innovation programs, of which they are a part How this case study innovation program helped the organizations to achieve its goals What they can do to bring a structured innovation program approach to their organizations.
Methodology/Approach: Being a leader in healthcare innovation by combining the art of caring with the science of best practice is one of five strategic goals for Markham Stouffville Hospital (MSH). MSH envisioned an innovation initiative that was empowering to all staff and doctors and that would foster a culture where the passion and talent of the whole team would be leveraged to drive innovation MSH developed an innovation strategy and launched an Office of Innovation to lead this work. As part of a staff engagement and culture building program, MSH entered into a partnership with Colleaga, an innovation program provider, which provided its crowd-sourcing/collaboration/knowledge-management platform and methodology through which the innovation program could be structured and accelerated. MSH and Colleaga are implementing the Colleaga Innovation Program methodology and are chartering two problem-solving challenges – one aligned with the provincial Patients First strategy and one focused on workplace violence. The challenges both structure the innovation process from initial sponsorship through broad organization wide ideation and voting to evaluation and prioritization and take advantage of the open access, crowdsourced innovations, available in the Colleaga Commons knowledge repository.
Finding/Results: Evidence from idea management programs indicate that structured innovation can substantially increase innovation success. For example, a platform implemented in another healthcare organisation engaged 29% of their employees and produced 10 patents over two years. MSH and Colleaga established success metrics for the program as a whole and for each challenge, including metrics for engagement (percentage of idea submitters, the number of votes, and the number of comments) and measures of outcomes (number of ideas collected, the number of projects implemented, ROI realized). Results and trends from one challenge to the next will be presented at the conference as data collection is not complete.
Conclusion/Implication/Recommendations: Engaging staff/clinicians in finding solutions to problems through a technology-enabled, structured innovation process that leverages crowd-science and open access information, leads to better quality solutions that are more aligned with organizational objectives, greater acceptance of implemented solutions and a higher return on innovation investments. We recommend that all healthcare organizations take a more structured approach to innovation.
140 Character Summary: Structured innovation programs that use a crowd-sourcing innovation management platform empower staff to solve high priority organizational problems.
OS26.04 - Strategic Capacity Building for Clinical Informatics: A 2020 Vision (ID 180)
Gurprit Randhawa, Victoria/CA
Purpose/Objectives: To support the use and optimization of health information systems, there is a considerable need for Health Informatics (HI) professionals specialized in Clinical Informatics (i.e., Clinical Informaticists) in Canada and across the globe. However, there is currently a high shortage of Clinical Informaticists. To address this, there is a need "to broaden the skills of current clinical professionals to better support them in Clinical Informatics roles" (HI/HIM Report, 2014, p. 67). In 2014, five Canadian HI and health information management organizations identified that the upgrading of Clinical Informatics skills of clinical professionals is a priority for human resources planning until 2019 (HI/HIM Report). Although the development of Clinical Informatics skills is being introduced into clinical curricula/training, there "continues to be a significant gap in the availability of skill broadening resources for incumbent clinical professionals" (HI/HIM Report, 2014, p. 67). Capacity building in Clinical Informatics is central to addressing this gap to fully realize the quality, accessibility, and productivity benefits of health information systems. To build capacity for Clinical Informatics in Canada, there is a critical need to examine the individual and organizational levels to (a) build on the existing knowledge and skills of clinical professionals and (b) foster an environment of continuous learning and adapting to change for Clinical Informaticists.
Methodology/Approach: In 2014, Island Health created the Department of Clinical Improvements and Informatics to support clinicians and physicians with clinical change management and the integration of computing and biomedical technologies into practice to ensure system usability and adoption. The Clinical Improvements & Informatics team initially included six Clinical Informaticists. To support the implementation of an integrated electronic health record across the organization, Island Health significantly invested in the development of a strong organizational structure for Clinical Informatics, including a 2020 vision and intensive strategy for supporting the initial and continuous professional development of Clinical Informaticists.
Finding/Results: From 2014-2016, Island Health's Department of Clinical Improvements and Informatics has grown to a team of over 30 full-time Nurse Informaticists, Allied Health Informaticists, and Clinical Informatics Specialists. Currently, the majority of these Clinical Informaticists have limited education and training in Clinical Informatics. To build on the existing knowledge and skills of the Clinical Informatics team, Island Health has developed a multi-faceted strategy to meet the initial and continual learning needs of Clinical Informaticists, which includes: (a) tailored education/training sessions from COACH: Canada's Health Informatics Association and study/review sessions to prepare the Clinical Informaticists for the Certified Professional in Healthcare Information and Management Systems - Canada (CPHIMS-CA) credential, (b) monthly professional development learning sessions, and (c) Clinical Informatics practice reflection journals.
Conclusion/Implication/Recommendations: The past, present, and future work for developing capacity for Clinical Informatics at Island Health has significant implications for developing a national vision and model for Clinical Informatics capacity building to fully realize the benefits of health information systems. Island Health's barriers, facilitators, and lessons learned for developing capacity for Clinical Informatics will help inform the strategic thinking and planning of Clinical Informatics in other Canadian health care organizations.
140 Character Summary: Island Health's lessons learned will help inform the development of a national vision and model for Clinical Informatics capacity building.
OS26.05 - Global Experiences with Healthcare Innovation Ecosystems (ID 296)
Dan Gordon, Global healthcare and lifesciences CoC, IBM; Toronto/CA
Purpose/Objectives: Healthcare innovation ecosystems are interacting groups of healthcare delivery and funding organizations, capital providers, innovation accelerators and incubators and a variety of general and specialized service providers that together enable healthcare innovation to grow and flourish. In our global work, including Canada, we have assisted various countries and clients to form and assess the maturity of their innovation ecosystems. We will describe an Healthcare Innovation Ecosystem framework that helps stakeholders understand their own healthcare innovation ecosystem and will present our findings about healthcare innovation ecosystems in different parts of the world Session participants will understand: How to assess the maturity of the healthcare innovation ecosystems of which they are a part Will understand practices in healthcare innovation ecosystems from other best practice countries and jurisdictions Will understand how to interact with and leverage their healthcare innovation ecosystem to achieve their personal and organizational goals
Methodology/Approach: Using the framework illustrated below, we have evaluated healthcare innovation ecosystems in Scandinavia, Canada and United States of America and for these examples, have assessed the number of interacting parts, the extent of their connectedness and the results that they produce.<img alt="diagram1.jpg" annotation="" id="image://38" src="https://cpaper.ctimeetingtech.com/deliver_media_imagick.php?congress=ehealth2017&auth_hash=eee3f04140cfee4f271e0a1a713c3906544bc95e&id=38&width=350&height=350&download=0" title="diagram1.jpg" />
Finding/Results: In the US case, the healthcare innovation ecosystem was very well developed, with considerable effort put into innovation enculturation, resources dedicated to growing the cluster of interacting innovation programs, business support services, some support for early stage and seed stage commercialization and demonstrated financial and health system outcomes. In the Scandinavian case, the healthcare innovation ecosystem was well developed, with large sovereign support for early stage and seed stage commercialization, but had a gap in infrastructure resources to act as a catalyst for increased innovation. In both Canadian cases, healthcare innovation ecosystems are emerging and require ecosystem maturation and specific catalysts in order to achieve maturity, connectivity and outcomes
Conclusion/Implications/Recommendations: Different healthcare innovation ecosystems have different objectives, ranging from job creation to health system outcomes to tax growth. The IBM Healthcare Innovation Ecosystem Assessment Methodology has been applied in different global experiences and is proving to be a useful method for understand the baseline metrics of the ecosystem, gaps in maturity and how to prioritize efforts to grow and nurture the healthcare innovation ecosystem to achieve its goals
140 Character Summary: Learn how healthcare innovation ecosystems assess their maturity and identify gaps that, when filled, enable healthcare innovation to grow and flourish.
OS26.06 - Disrupting the EHR – Interoperability Planning (ID 317)
Sue Schneider, Architecture and Standards, eHealth Ontario; Toronto/CA
Purpose/Objectives: Interoperability planning can be daunting with the many emerging and existing standards, differing systems, and clinical and patient expectations. eHealth Ontario has embarked on a journey to advance the interoperability of the province's digital health information while considering its current state and future opportunities. This work is intended to improve the health care experience of patients and providers through the thoughtful selection, implementation, and evolution of health information standards and solutions. The early stages of adoption of the electronic health record (EHR) have increased the availability of health information, but there is more to be done to enhance the interoperability or sharing of meaningful and relevant digital health information. This presentation highlights the planning activities, practices and the plan for use in guiding Ontario's journey to semantic interoperability.
Methodology/Approach: The work originated with a paper defining interoperability, as well as further recommendations to advance its direction, and detailed planning to increase the sharing of meaningful health information. Engagement activities with stakeholders gathered insights and helped define short and long-term steps towards interoperability. Through thoughtful interoperability planning we have the opportunity to increase the quantity of health information available for sharing, including standardizing key content to improve the usefulness of digital health information for direct care as well as secondary use purposes. The effective selection of standards, the adoption of data sets, and the evolution of solutions that bring value to Ontario's digital health landscape will help us evolve the EHR to improve its use and value.
Finding/Results: Interoperability planning is a journey that will change the way we imagine and use the EHR and other digital health information in Ontario. Short- and long-term planning will help us arrive at our desired destination together and with the expected results. Shared contributions from a variety of stakeholders to this innovative planning and implementation activity will make the possible a reality. Standards alone will not achieve interoperability, and systems will evolve that require continued advancement and integration into clinical and administrative workflow. The EHR is dynamic and so is health care, and collaborative planning for digital health information is necessary to optimize the innovation, cost, and value to health and health providers.
Conclusion/Implication/Recommendations: Interoperability, in varying degrees, will continue to be advanced by the majority of Ontario health system organizations as they continue to increase the type and volume of digital health information sharing for effective support of patients and providers. The findings of this planning initiative indicate that Ontario should influence standardization across implementations, so that it is aligned with the broader selection and adoption of standards. This minimizes Ontario-specific and local customization of data sets and clinical content, and supports innovative and disruptive approaches to advanced EHR. Support for the evolution of systems and increased use of standards will improve the ability of the health system and health system consumers to measure, monitor, and bring value to the health care experience.
140 Character Summary: Interoperability with an EHR is about more than standards and data. Learn about the approach to interoperability planning and the road ahead for Ontario.
PS03 - Accelerating Information Use and Access (ID 12)
Type: Panel Session
Track: Executive
PS03.01 - Modernizing Secondary Use Data Flows in Canada (ID 184)
Greg Webster, AACIS, CIHI; Toronto/CA
Isabel Tsui, CAD, CIHI; Toronto/CA
Anne Forsyth, CAD, CIHI; Toronto/CA
S. Acharjee, NYGH; Toronto/CA
Purpose/Objectives: This panel presentation will provide pan-Canadian, local/healthcare organization and vendor perspectives on reducing data collection burden for secondary use/analytics purposes. Each of the panelists will speak to projects they have undertaken to modernize data supply for secondary purposes and learnings from these. Attendees will learn how investments made in eHealth/digital technology can be leveraged to access near-real-time data for planning and management purposes and the role data standards play in this work
Methodology/Approach: Health delivery organizations and their funders need timely, quality and affordable data. eHealth systems are integral to patient care and effective planning and health system management, and can hold the key to providing the data our healthcare system needs. CIHI's 28 pan-Canadian health databases support many health system uses, including policy-making and health system management, and provide highly relevant information and indicators on acute and ambulatory care across Canada. CIHI has a strategy for modernizing and automating the way data flows to it from eHealth systems as a more cost-effective way to meet acute and ambulatory care data requirements and to have better data to support interoperable patient care. CIHI will describe this proactive data strategy and our recommendations on how to realize the potential benefits and minimize risk.
Finding/Results: CIHI will present with two organizations to provide a pan-Canadian, local (e.g. a hospital) and vendor perspective on how eHealth investments impact health system use and drive long-term benefits such as cost savings, resulting in improved access to data for patient management and planning purposes. Early findings from demonstration projects with these organizations indicate that 30% of effort can be reduced via automation because of a lesser resource draw to enter/code data (over time the proportion automated should increase with corresponding savings). In concrete terms, this translates to an estimated savings of 6.6 minutes per record and a potential savings of $10 million across the country each year, not to mention the substantial value that can be gained with access to more and near real-time data. A success story demonstrating these benefits will be showcased by each panel member.
Conclusion/Implications/Recommendations: Alternative means of sourcing data for secondary purposes is a strategy that is being examined and implemented by many countries that are reaching an advanced stage of ehealth maturity. As Canada progresses on its own ehealth journey, a number of opportunities are emerging, beyond just clinical use of digitized health data. Specifically, this data is helping to reduce data reporting burden, realize cost savings, and improve access to data that facilitates system planning and management decisions while patients are still being cared for within a hospital rather than after discharge.
140 Character Summary: A pan-Canadian, hospital and vendor perspective on how eHealth investments can lead to cost savings and improved access to data for secondary purposes.
PS03.02 - Accelerating the Scale and Spread of Connected Digital Health Solutions (ID 221)
Mark Nenadovic, Innovation Ecosystem Group, Canada Health Infoway; Toronto/CA
Asim Masood, Innovation Ecosystem Group, Canada Health Infoway; Toronto/CA
Purpose/Objectives: The objective of this session is to present and discuss Canada Health Infoway's digital health innovation ecosystem concept and roadmap. Our initial offering on the ecosystem roadmap is a privacy protective health information access platform. It is designed to accelerate the deployment, scaling and use of connected consumer and clinician digital health solutions by providing standardized, Canada-wide access to health information, privacy, security and consent services. The offering would be targeted at *deploying and scaling* innovative digital health solutions.
Methodology/Approach: We studied the market trends, critical success factors and taxonomy of business ecosystems across various industries. We then looked at Canada's clinical priorities and drivers along with the pain points faced when deploying and scaling digital health solutions. We then applied those observations to the definition of a Canadian digital health innovation ecosystem. The conclusions will be presented and then discussed among the panelists that represent consumer, clinician, solution developer and jurisdiction stakeholder perspectives. Panelists will provide their informed insights and frank assessment of the applicability and value proposition for the use of a health information access platform to solve some of their most pressing pain points.
Finding/Results: There is a value proposition for a platform which removes the most significant barriers faced by developers, jurisdictions and end users such as access to personal health information in a trusted and privacy protective manner. It will enable the scale and spread of innovative solutions such as e-referral, chronic disease management, predictive analytics, personalized medicine and clinical decision support. It will connect Canadians to their data so they can utilize solutions chosen by them or their clinicians. It is also a means of connecting clinicians to a person's data across the continuum of care with a *consistent and comprehensive health record. The data platform will help solve some of the systemic interoperability problems currently being faced by jurisdictions and solution developers while providing for a more connected health system* for both clinicians and consumers. The platform will be an enabler for locally driven priority areas including chronic disease management, home care, mental health services and palliative care. It can support the deployment of digital health innovations that will empower Canadians to take much greater control for their own health and well-being resulting in better patient outcomes and less pressure on the health care system.
Conclusion/Implications/Recommendations: The platform will : Harness the innovation creativity of the private sector to address Canada's healthcare priorities Improve speed to market and scaling with lower cost and risk to developers and jurisdictions Access to a consistent and comprehensive health record for Canadians in a privacy protective manner Get more value from the existing digital health investments
140 Character Summary: Digital health innovations will empower Canadians to take greater control for their own health & well-being resulting in better outcomes and lower health expenditures.