eHealth2014 – June 4th

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CS37: Looking Forward

CS37.1: A Blueprint for e-Health – Beyond the EHR

Speaker: Ron Parker Canada Health Infoway With 28 years of experience with IT in health and social services sectors, Ron is part of a team at Infoway identifying, assessing, and elaborating on the implications of emergent ICTs for the healthcare sector. He is also responsible for the maintenance and extension of Infoway’s e-Health Blueprint, an enterprise architecture for e-Health in Canada. Session’s Details: To introduce the next iteration of the Infoway Blueprint and elaborate on the implications for e-Health in Canada. Methodology/Approach The Infoway Emerging Technologies Group has been evolving the EHRS Blueprint to address current and emerging needs of health care in the context of the “2018 Opportunities for Action” published by Infoway in June of 2013. The new Blueprint provides guidance and considerations for e-Health IT strategies, architectures, and deployment approaches that support collaborative and coordinated health service delivery while improving the patient and provider experience. This presentation provides an overview of that work. Coordinated and collaborative care is an imperative for health consumers and health service providers. It must be enabled by health information technologies to support healthy living, access to health services, person-centered continuity of care, and quality and efficiency improvements necessary for a sustainable health system. Findings/Results The rapid evolution and use of emerging technologies by consumers and providers in their personal and professional lives has created both a compelling need and an opportunity for health care to innovate using technology to achieve its the goals. The new Blueprint describes options and considerations for all stakeholders. It illustrates how reusable technology building blocks can be dynamically configured to orchestrate and manage clinical processes. It also focuses on the provision of e-Health for the consumer. Conclusions/Implications/Recommendations The new Blueprint provides guidance on the planning, integration, and deployment of practical yet sustainable computing environments. It includes considerations for building a road-map to evolve current systems to the new vision and speaks to the roles of people, process, and e-Health services in the delivery of a sustainable health care system. My notes on the presentation. Presentation’s PowerPoint from e-Health Conference. This was early morning session at 8:30 am and there were not enough seats. There were too many delegates in a small room. We had at least 11 delegate including me stand. It was a bit shock to me to hear that EHR implementation is done and it is time to move forward. We still have a lot of problem with linking silos and EMR to provincial EHR systems. I don’t see how this is the point in time that the infrastructure is ready to go beyond the EHR. Ron Parker did not speak of interoperability issues that provinces are dealing with. This shows a lack of communication and weak leadership in Canada Health Infoway.

CS37.2: Coming to you: Your Genomic Health Record

Speaker: Aditya Pai BSc, MSc, MSc, MS, CGC, MBA Senior Managing Consultant Strategy and Transformation, Healthcare Practice IBM Global Business Services Aditya Pai is a Senior Managing Consultant and Healthcare SME with IBM Global Business Services. Aditya has a background in medical, molecular genetics and is a certified genetic counselor. He works in areas of IT strategy, business strategy, Clinical information systems, e-health, life sciences and pharmaceutical innovation and governance. Session’s Details: To provide ehealth leaders, stakeholders with vital information about genomic medicine and its disruptive technologies that are already revolutionizing the practice of medicine and ehealth. –> Of note, the past two opening key note speakers for ehealth each quoted genomic medicine as key technology enablers in their talks. This presentation provides practical information for ehealth leaders that can influence their ehealth agendas Methodology/Approach Use case description; patient care related examples of application of genomic medicine in a clinical scenario, literature review of genome based statistics Findings/Results Coming to you shortly: Your Genomic Health Record Genomic Medicine has reached a unique inflection point owing to the rapid decrease in cost of gene sequencing as well as the increased processing of such information. Coupled with the number of genome based tests available through publicly funded laboratories or through private consumer based genomics companies, genome based information is fast becoming a vital part of a patients health record. The healthcare system is already experiencing the outputs of three key pillars of genomic medicine: Gene sequencing, translational medicine and personalized healthcare. Each of these will continue to impact healthcare and ehealth in significant ways ranging from storage and processing of such data to applying advanced analytics and personalization. Such data will be uniquely tied to a person’s electronic health record in the form of a Genomic Health Record. With the explosion of information in genomics, every individual who has an interaction with the healthcare system will have some form of a genomic health record; whether it be to manage a disease with precision medicine (a targetted therapy for a known gene alteration), or to prevent disease state through earlier predictive testing, or to dose medications based on a pharmacogenomic profile. Such a genomic health record will add unique value to the traditional electronic health record by offering “molecular personalization”. This presentation examines key use cases for the development of the genomic health record and links these to patient scenarios where this is already a reality. Conclusions/Implications/Recommendations Genomic Medicine is here As EMR maturity increases, a new aspect to the traditional health record will become reality: Your Genomic Health Record The Genomic Health Record will add a degree of molecular personalization that will revolutionze how healthcare is practiced. Genomic Medicine in Healthcare (IBM) Presentation’s PowerPoint from e-Health Conference. my notes on the presentation. It was very informative presentation and I enjoyed listening to Aditya Pai.

CS37.3: Increasing Value by Thinking Outside the Box – Contrarian Views

Speakers: Dr. Alan Brookstone Dr. Alan Brookstone Inc. Dr. Alan Brookstone is a family physician and internationally recognized expert on Electronic Medical Records and health information technology. He also works as an addiction physician in an EMR-based 6 physician practice in Surrey, British Columbia. Michael Martineau VP Sales and Marketing B Sharp Technologies Session’s Details: The Digitization agenda in Canada has been moving through three fundamental phases; amassing data, exchanging data and analyzing data. Good progress has been made on the first phase but the latter two have seen far less success. There has not been a good debate on what needs to happen in Canada to bring more success to the other phases defined as value. This panel would highlight other ideas, some that will be considered contrarian, about how to make more progress by considering other approaches to achieving more value Methodology/Approach The panel will be comprised of some members from the main stakeholder groups but also others from non health care sectors groups that have been considering and exploring alternative ways to achieve value from the digitization agenda. The intent is for participants to comment on the current drivers for changes in the health care sector and link them to the opportunities that a digitization agenda can introduce. A roundtable is being organized in February/March to explore potential areas and approaches that could have applicability to the health care sector with a cross section of thinkers from the broader based digitization community. The outcome from these deliberations will form the basis for the debate. Findings/Results The ideas that will be shared will build off current research on digitization that focuses on; business processes, customer engagement, introducing more value, maximizing core competencies, changing roles of participants and analytics Conclusions/Implications/Recommendations The discussion will be thought provoking, challenge the thinking currently driving the eHealth agenda today and hopefully lead to a more robust and innovative agenda going forward. PowerPoint Source: (eHealth-2014) my notes on the session.

CS52: Business Intelligence

CS52.1: Toronto Central LHIN’s Community Business Intelligence Initiative

Speakers: Mohamed Badsha Reconnect Mental Health Mohamed Badsha is Chief Operating Officer at Reconnect Mental Health Services and is responsible for Clinical Programs, Finance, Planning, Development, Information Systems, Human Resources, Corporate Performance, and Projects (Business Intelligence, Shared Services, Infrastructure, IT/IM). As Chief Operating Officer, Mohamed is responsible for the strategic and operational management of the organization. Mohamed provides leadership in all aspects of planning, operations and evaluation of health service programs. Mohamed has extensive experience in strategic planning, senior IM/IT management, and clinical change management. Since commencing with projects on behalf of the Toronto Central Local Health Integration Network (TCLHIN), Mohamed and his team have established the foundation for the implementation of a community based business intelligence tool coupled with several initiatives to boost IT/IM infrastructure and shared services in the community health care space. An experienced healthcare executive with 12 years of progressive leadership experience, Mohamed’s previous roles included Director of Community Support Services and Director of Program Development and Community Integration. He has extensive leadership experience as a senior executive in complex environments. Mohamed’s educational background is in community development and healthcare leadership. Nathan Frias Toronto Central Local Health Integration Network Nathan Frias is a Senior Consultant and Business Intelligence Lead for the Toronto Central Local Health Integration Network (TC LHIN). In this role, Nathan facilitates the identification, planning and implementation of cross-sector BI initiatives. Some of these initiatives include the TC LHIN implementation of the Integrated Decision Support (IDS) tool and the Community Business Intelligence and Information Infrastructure projects. Mr. Frias received his B. Sc. (Honours) in Human Biology from the University of Toronto and his MBA from the Schulich School of Business (York University). Session’s Details: The Community Business Intelligence (CBI) Project was undertaken in early 2012 to take the TC LHIN to an enhanced level of data quality and reporting by Community Sector services as a foundation for organizational, sector and system planning, and performance monitoring. In the current state, community health service providers (HSPs) often access multiple resources to provide aggregate level data to funders, HSPs are not provided access to their own data after submission, and the aggregated data provided to organizations allows little flexibility for analysis and insight into sub-sectors. The CBI project will address these issues by providing both HSPs and the TC LHIN, a single resource in which to access standard reports and enable ad hoc querying of select data elements. Uploading of the most currently available data to a single repository will allow the TC LHIN and funded providers to understand who is receiving what service, after what waiting time, and how much they are receiving (visits and length of service). Methodology/Approach The CBI project has limited impact on HSPs as data will be pulled directly from the HSP client management system and submitted to an existing electronic service provider (DATIS, Drug and Alcohol Treatment Information System) held by the Ministry. CBI is being implemented in phases, beginning with a data set (client demographic and service utilization data) which is consistently captured across the three sub-sectors. Subsequent tiers will aim to link these data elements with hospital utilization records and community assessment data as well as add additional data sets such as referral and access hubs. The project team has embraced a “made in community” approach and has ensured that engagement with the sector and stakeholders is a primary component of the initiative. A number of working groups, and open information sessions for the sector and vendors have been organized. Findings/Results There are significant gaps in the information available to community HSPs about the populations they serve, especially with respect to patient journeys across the different community sub-sectors. As a result, HSPs have a high degree of interest in accessing and using data, as well as, fairly well developed ideas and requirements for system functionality and reports. Conclusions/Implications/Recommendations The success of the project to date has been a result of a high degree of stakeholder engagement throughout the initiative. The project team leads weekly calls with both HSPs and vendors to ensure project process and issues are effectively communicated. Similarly, the next phase of the CBI project will include investments in change management and training for HSPs to ensure the technology will be used effectively. The limited availability of community health sector data has hindered the ability of health system planners to provide a comprehensive analysis of health system use. Upon enabling community sector data collection, integration with other health sector data will eventually yield a view of the patient journey that extends across all sectors and inform a holistic view of health system use. PowerPoint Is not Available. Here is my notes for this session. This was really good session focusing on the the architecture and the system development and data analysis.

CS52.2: A Tale of Two (Plus) Teams: How CAPHC and CIHI are Working Together to Improve Paediatric Practice in Canada

Speakers: Janine Kaye Canada Institute for Health Information (CIHI) Janine is manager of the Portal Services department at the Canadian Institute for Health Information (CIHI). In this role she is responsible for the development and expansion of the CIHI Portal so that clients can continue to efficiently access CIHI data and meet their information needs. Before joining CIHI, Janine at University Health Network where she helped build and support the organizations data warehouse and hospital indicator development. Scott McRae Clinical Consultant BC Women & Children’s Hospital and Health Centre (PHSA) Chair, CAPHC-CPDSN Session’s Details: The Canadian Institute for Health Information (CIHI) and the Canadian Association of Paediatric Health Centres (CAPHC) partnered in 2005 to create a paediatric community of practice (CoP) centred-around the CIHI Portal business intelligence tool. The CoP provides a vehicle for paediatric clinical experts to obtain easy access to information they need to make informed decisions. We will walk participants through two initiatives (paediatric sepsis and surgical wait times) that have leveraged this relationship to drive positive changes in Canadian paediatric practice. Methodology/Approach CAPHC has taken the following approach: • identify priority areas • use data to identify the national situation • bring together clinical experts to provide best-practice guidelines • monitor the impact of changes For paediatric sepsis, CAPHC established a Paediatric Practice Guideline Collaborative in 2011 with the objective to improve healthcare practice quality, safety and efficiency through the creation of paediatric practice guidelines. Sepsis was one of four priority areas identified for investigation. For paediatric surgical wait times, in 2011 the Canadian Paediatric Surgical Wait Times Project in collaboration with CAPHC approached CIHI to use their established administrative databases to measure, monitor and manage paediatric surgical wait times in Canada. Starting in April 2013 project participants were able to use customizable project fields in these databases to collect paediatric wait-time data on the actual surgical record. This data is fed through to the CIHI Portal tool on a monthly basis and can be accessed by authorized users across the country. Findings/Results For paediatric sepsis, the immediate value is a common understanding of national practices and the identification of issues and challenges. Going forward, the Collaborative is working to facilitate the adoption of best practices. Data extracted from the CIHI Portal tool will serve as the basis for evaluating the extent of these infections and will allow the Collaborative to monitor the impact of new guidelines on patient care. For paediatric surgical wait times, the data collected in 2010 shows that 28% of paediatric patients received surgery past acceptable wait times*. At a local level, participating hospitals have reduced this percentage by prioritizing cases by acuity and redistributing resources among surgical departments to address their specific requirements. Providing the wait-time information in conjunction with the clinical administrative data provides richer detail of patient outcomes in a single, national report. Examples of questions that can now be answered within the same tool include: [su_list]
  • What is the correlation between surgical wait-times and post-surgical complications?
  • What is the correlation between surgical wait times and lengths of hospital stays?
  • What are the local and national areas of greatest concern with respect to paediatric surgical wait times?
[/su_list] *Wright JG, Menaker RJ. Canadian Paediatric Surgical Wait Times Project Study Group. Waiting for children’s surgery in Canada. CMAJ. 2011. Conclusions/Implications/Recommendations Going forward CIHI and CAPHC will continue to leverage their long-standing relationship to provide paediatric experts from across Canada with the information they need to shape paediatric practice in other emerging areas of focus, while continuing to monitor the impact of previous changes. PowerPoint Is not Available. My notes on the session. This session was very informative, but as one of the delegates told me, he did not see any business intelligence aspects that he was looking forward to in this session. CIHI Portal

 CS52.3: Small data in your face, right time, right place – synchronicity at the point of care

Speakers: Susan Grills Southlake Regional Health Centre Susan Grills, MRT(R), PMP, PMI-RMPProject Manager, Southlake Regional Health Centre Susan started her career at Southlake over 20 years ago as an MRT in the Diagnostic Imaging Department and has been managing clinical & IT projects since 1999. Most notable implementations include Ontario Breast Screening Program, multi-site Picture Archiving Communication System (PACS), multi-site pharmacy information system, and an enterprise electronic tracking board system. Helena Hutton Southlake Regional Health Centre Helena J. Hutton Chief Operating Officer and VP RelationshipsSouthlake Regional Health Centre Newmarket, Ontario Helena Hutton is currently the Chief Operating Officer and Vice President Quality and Relationships at Southlake Regional Health Centre. A nurse by profession, Helena has worked at Large Academic Teaching Hospitals, Regional Community Hospitals and has also managed her own private healthcare consulting practice. Throughout her career Helena has lead several teams which became nationally recognized with awards including the Johnson and Johnson Best Practices Award, the National 3M Health Care Quality Team Award, and Canada’s Health Informatics 2012 award for Innovation in the Adoption of Health Informatics. Recently, Southlake Regional Health Centre has also been recognized in 2013 by winning the Canada’s Passion Capitalists Award and the Canada’s Top 10 Most Admired Corporate Cultures Award . Helena is passionate about quality and patient safety. Helena’s career has been focused on best and emerging practices, the development and implementation of process solutions and performance indicators to measure sustained excellence. Session’s Details: Small data is the information needed at the point of care to make the right decisions at the right time, and to predict and prevent challenges – before they occur. Useful information is often cumbersome to obtain at the point of care. Logging into hospital systems, making phone calls, tracking people down – these are all impediments to accessing the important information that positively influence patient care outcomes. Lean management principles tell us to “Use visual controls so no problems are hidden”. This presentation describes how SRHC deployed a simple lean-based mechanism to mine data from disparate sources, streamline data, and “push” the data to the right place, at the right times and to the right people. Methodology/Approach SRHC deployed a tool to broadcast “small data” visual controls throughout the enterprise including the ER, patient care units, bed management, and even executive offices. This endeavor proved to be an enterprise-wide catalyst for significant process and communications improvements that, together with multiple other strategies, resulted in reduced Emergency Room( ED) wait times, improved quality outcomes and all while treating more patients within existing acute care beds. Real-time information for discharge planning, admissions, infection control, patient safety, process compliance, patient location and bed cleaning was made available at a glance, and throughout the enterprise; all without jeopardizing patient confidentiality or requiring additional data entry. Findings/Results Information availability not only improves communication but also exposes opportunities for improvements: stakeholder-driven advancements that are consistently executed with results the entire corporation can see right before their eyes. The deployment of this simple concept has changed the paradigm for information access, where and when you need it. The tool creates transparency and synchronicity across patient care teams. Every team now knows that others track progress through visualization of all process steps. Potential delays in entering / sharing information are avoided through visibility of all process steps across the corporation. Transparency has created a self-correcting mechanism that has enhanced the timeliness of data entry in sources systems. Broadcasting information across the enterprise eliminated hundreds of phone conversations and system logins. Delays in processes and compliance violations are easily identified and corrected. Results included faster bed placement and a significant drop in patient falls. Conclusions/Implications/Recommendations Useful information is often cumbersome to obtain at the point of care. Information is often spread across multiple hospital systems and restrained by interdepartmental silos. The challenge is to find a simple mechanism to break down these silos and put actionable data at the point of care in an efficient format. A simple solution allowed SRHC to retrieve that information from disparate sources and push it out to the point of care in real time. The result has been significant enterprise-wide synergistic improvements to process flow and communications. Remember – “Point of Care” includes the executive office and even remote access! PowerPoint Is not Available. My notes on the session. The presenters were able to showcase their bed management system which uses only visual features and their outcome was very good. Many of the delegates wanted to see their infrastructure and system architecture.

Saving Lives and Healthcare Dollars: Pharmacy’s Action Plan for Better Health Care

Speaker: Domenic Pilla President & Chief Executive Officer Shoppers Drug Mart Session’s Details: Canadians are aging. We are living longer, dealing with complex chronic illnesses and taking more costly therapies, all of which are putting an unprecedented strain on our healthcare system. There is an urgent need for practical solutions to ensure the sustainability of our healthcare system for our children and generations to come. Pharmacists have the expertise to help meet the evolving healthcare needs of Canadians, and the pharmacy community is committed to working with government and the other healthcare providers to implement change. Domenic Pilla, President and Chief Executive Officer, Shoppers Drug Mart Corporation will discuss how Canada’s community pharmacies can drive savings while contributing to improved patient care and health outcomes. He will share insights from 9,000 Point of Care: Improving Access to Affordable Healthcare, a pharmacy industry report that identifies five creative initiatives to improve healthcare system outcomes. In addition, he will provide an overview of the Company’s strategy to evolve to a more patient-centric approach including the use of new technology, like electronic records, to further evolve the patient experience. PowerPoint Is not Available.