Health Informatics Internship Reports

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Open Access
Integrated Quality Database
(2017-08-18) Izadi, Arman
The organization: EMC provides ground and air ambulance services to Nova Scotians in emergencies. The services range from basic to advanced life support. Telehealth (811) is also part of this company which provides medical consultation to Nova Scotians for non-emergency conditions. The internship work: Since the organization uses several different solutions that are not standard and cannot exchange data with each other, different departments should query the databases and review and approve the data, according to their reporting needs. Creating a database to integrate the data from different sources (internal and external), so that, the records could be reviewed only once (not several times by different departments) was the main purpose of the project. I was responsible for requirement assessment, planning, categorization of data, database design and implementation, as well as documentation. I created a relational database in SQL Server with about 70 tables (including the reference tables) that could meet their reporting needs, primarily for cardiac arrest cases, but I designed the structure of the database in a way that other conditions can also be added if needed. How the internship work relates to health informatics The project was related to most of the courses in the master of health informatics program, including, project management, health information flow and use, flow and standards, systems and issues, as well as networks and web. The project management course helped me develop a plan for the project, using Microsoft Project. The health information flow and use, and the flow and standards courses made it possible for me to develop a storyboard, recognize the processes, assess the work flow, and understand the indicators. The systems and issues course helped me with the data flow and systems boundaries. Finally, the networks and web helped me identify the entities, categorize the data and the tables, build a logical relationship between the tables and design the database. Querying the existing sources of data helped me in determining the data types and the possible values for each attribute and creating the reference tables. The problems in EMC that merits a health informatics solution The main problem is that the software solutions that are used in the company are neither logically related nor standard (lack of interoperability). Reporting and conducting research requires a combination of automatic integration of data from some sources and manual data entry from other sources, as well as manual editing and approval of the integrated data which is labor-intensive. In addition, there are many fields in the application where user errors could be limited but they have been ignored by the vendors. Users have to type in the textboxes in the applications and the user errors have significantly affected the validity of the stored data. The same problem is seen with health card numbers, which are manually entered and card scanners are not used. Conclusion The future solutions should see EHS companies as one system and extend the boundaries of their systems or be able to exchange data automatically within the organization. An effective system enables the company to schedule shifts according to availability of the paramedics (the administration system) and the ambulances (the fleet maintenance system), and provide a logical relationship between the computer-assisted dispatch system (CAD) and the electronic patient care record (ePCR), while facilitating transfer of data from defibrillation devices and other subsystems. The current systems are not standard and cannot exchange data with external entities. Integrating the existing solutions as well as using standard semantic codes for data exchange is one of the options. The software companies should try to limit user errors by creating reference tables from historical data or scientific resources, and by using other methods such as card scanners. Some of the current software solutions are not user-friendly and the companies should try to customize their solutions according to the type of the service
Open Access
Clinical Alarm Management Project Neonatal Intensive Care Unit (NICU) IWK Health Centre, Halifax, NS
(2017-08-18) Abouelela, Marwan
Research confirms that more than 70% of clinical alarms are unnecessary. Exposing clinicians to high volume of undesirable alarms may cause alarm fatigue associated with increasing patient risks and deaths. Alarm fatigue is mainly driven by the excess number of non-actionable alarms which are the alarms associated with self-correcting conditions that do not need clinical intervention. Alarm fatigue is considered as a common and significant healthcare problem that needs special attention. The Emergency Care and Research Institute (ECRI) recommends some strategies to eliminate the alarm fatigue and emphasizes on the importance of involving clinical staff, especially nurses, while working on those strategies. The main objective is to eradicate the alarm fatigue to pave the way for a safer and improved healthcare environment. The current open-bay NICU at IWK Health Centre was opened in 1992 and was considered as a state of the art at the time. Concerns with this setting include: lack of privacy and confidentiality, no individual control over the environment in terms of noise, light, temperature, and most unfavorable, a lack of space for families to stay with their vulnerable, critically ill infants. Recently, IWK Health Centre has decided to build a new NICU single-family room unit which is expected to solve all issues of the current open-bay model. Families will have a private room with double sleep sofa, three-piece washroom, and privacy doors which is anticipated to increase their comfort and willingness to stay for prolonged times with their baby. Based on many researches, the new model of care will provide numerous benefits for infants, families and staff. The principle purpose of the internship project was to work with clinical teams and IT teams under the umbrella and guidance of the Biomedical Engineering Department within IWK Health Centre to establish an effective clinical alarm management strategy for NICU and reduce their alarm fatigue. Then, to propose a workflow best practice for assigning care teams to the patient monitors and End User Devices (EUDs) for effective utilization in the new NICU single-family room care setting. The scope of work has been defined to the primary alarm signals produced by patient monitors (Philips) with its various locations inside NICU (please view figure 3), in addition to the primary alarm signals produced by two types of ventilators (Servo-I and VN-500). Patient monitors were desired to be fully integrated with the middleware (Connexall) to produce and escalate secondary alarm signals to the care team EUDs (iPhones). A clinical alarm steering committee was created to provide strategic directions and secure the necessary approvals. Similarly, a NICU task force was created to accomplish major tasks in a timely manner aiming at meeting the project deadline through working in a team collaborative environment. The internship road map and milestones were discussed and agreed with all key stakeholders early in the project. The internship project ended up by proposing a reasonable new clinical alarm strategy for physiological monitoring and ventilators which represent the majority and most crucial monitoring inside the NICU. The project final deliverables (please view appendix B through H) were submitted to both IT teams and Biomedical Engineering Department at the end of the project for their future work. Based on alarm data for three-real NICU case studies that have been collected during the course of the internship, non-actionable alarms represent an average of more than 60% of the total daily alarms inside NICU. Considerable delta gains of -15%, -30% and -46% are anticipated to be achieved if the non-actionable alarms inside NICU are reduced by 25%, 50% or 75% respectively for the same or similar cases. The internship project was a great learning experience and was a remarkable tool to implement what have been learnt as a clinician and as a prospective health informatician in a real-life experience. It was a concrete opportunity to implement health informatics concepts in a high-quality project that included a complicated and significant healthcare problem like alarm fatigue. Also, it was a wonderful opportunity to practice working collaboratively with other healthcare professionals in a patient centric approach to accomplish project deliverables with a challenging due time. As planned, the internship project has been completed in sixteen weeks under the supervision and mentorship of Manager, Biomedical Engineering at IWK Health Centre. The internship project was full of challenges but at the same time was interesting, meaningful, worthy and rewarding.
Open Access
Utilising Bioportal to map terms in the Canada Vigilance Adverse Reaction Online Database to various terminologies and to identify the ideal terminology to supplement MedDRA to aid in Pharmacovigilance activities.
(2017-08-18) Thandavan, Rahul
The Canada Vigilance Program is Health Canada’s post marketing surveillance program that collects and analyzes data related to the adverse events of health products that are marketed in Canada. Health Canada periodically reviews these events and releases safety profile of drugs based on the reported events. The information collected by the Canada Vigilance Program is made available publicly through an online database. This project consists of two main objectives – 1) To map the adverse reaction terms and drug names in the online database to terminologies like SNOMED-CT, MeSH, UMLS and RxNORM and to identify the best approach to map the terms. 2) To identify the best terminology which can help in grouping previously unrelated fine grained MedDRA terms for use in the analysis of adverse events. The mappings were performed through the Bioportal web service of the National Centre for Biomedical Ontology(NCBO) and then were analysed to determine the accuracy and the coverage of the mappings. The MedDRA terminology that is used for adverse event reporting is a fine-grained terminology so this project focussed on identifying an ideal terminology to group together similar MedDRA terms that are not previously related through MedDRA hierarchy. This project is highly relevant to Health Informatics as it deals in entirety with healthcare terminologies like SNOMED-CT, UMLS, MeSH, MedDRA etc. which are the basis upon which health information is stored, shared, accessed and analysed. This project was an excellent opportunity to learn a new coding language like python and to learn on using REST-API for mapping terms .It also provided exposure in using large databases. At the end of this internship, the clinical terms were mapped to the identified terminologies and an ideal process to map the terms to various terminologies has been documented. Also, groupings of related MedDRA terms that were not related previously through the MedDRA hierarchy have been identified utilising SNOMED-CT and documented. The background of the objectives, methods followed and their results, as well as problems and recommended solutions are included in this report.
Open Access
Investigating Canadian Business & System Requirements at Allscripts Canada
(2017-08-11) Miljanovic, Mara
Understanding the foundational principles upon which our healthcare organization is built, is perhaps one of the most crucial things when considering the implementation of healthcare technology within different clinical settings. While performing the internship work-term at Allscripts Canada, the author utilized various knowledge bases and sources in order to fully understand the key principles of healthcare information technology implementation. Allscripts is a multinational enterprise that equips healthcare providers with electronic health record (EHR) technology, including but not limited to, solutions for patient engagement and care coordination, as well as analytics and finance management. During their term at Allscripts, the author was involved with several multidisciplinary projects. The author contributed to the following projects and initiatives: o 2bprecise Health: a precision medicine platform using medical ontologies to store and integrate genomic data into healthcare workflows. This project was focused primarily on developing a deep understanding of the product and aligning these features, technical specifications and goals with like-minded research institutions within Canada to build new alliances. The outcome was a future plan to partner with Canadian research institutions and explore grant funding within Canada. o Follow My Health (FMH): a personal health record (PHR) platform focusing on patient engagement and collaboration with healthcare providers. This project was heavily based on privacy, security and interoperability standards within Canada. The outcome was a complete business requirements plan, projecting towards Canada Health Infoway certification of the PHR platform. o Discharge Abstract Database (DAD) & National Ambulatory Care Reporting System (NACRS): data repositories capturing information pertaining to administrative, clinical and demographic information upon discharge and for community-based ambulatory care. This project was centered on gathering information pertaining to submission requirements for CIHI. Knowledge regarding data policies, ICD-10-CA standards and health ministry infrastructure was needed to compile relevant and usable information. o InterRAI-MDS 2.0: InterRAI clinical assessment protocols are individualized assessments and care-plans for residents within long-term care facilities, used to plan and measure care outcomes in standardized and evidence-based ways. This project analyzed the business requirements needed to initiate computerization of these assessment protocols. At the end of this internship experience, the author was successfully able to identify opportune research avenues for genomic technology, to gather and analyze business requirements pertaining to privacy and security standards within Canada, to succinctly explore CIHI standards for submission to DAD and NACRS and to analyze InterRAI-MDS 2.0 assessment protocols within clinical workflow scenarios. By drawing upon several knowledge sources such as business process modelling, international health classification and coding schemas/systems, health policy standards and legal frameworks, the author was able to gain invaluable experience within the domain of Health Informatics. This internship report will introduce the background information pertaining to the workplace and the project concepts, and will then describe in full the internship duties as well as the learning outcomes, project contributions, recommendations and proposed solutions. Finally, as concluding remarks, this report will outline the value of this opportunity to a student’s professional and educational paths.
Open Access
User Growth Intern at Figure 1
(2017-08-18) Glazier, Mitch
The purpose of user growth is to acquire new users to use a product or service. In the case of the internship at Figure 1, user growth is acquiring health care professionals for medical collaboration. Figure 1 is a tech startup based in Toronto, Ontario that has created a free mobile app and web platform which allows healthcare professionals around the world to share medical cases and knowledge. During the internship period, the author performed relevant health informatics work that included network analysis, analytics, database management and SQL, and product overviews. Other areas of relevance that the author explored during the period included: verification, deidentification, and machine learning. The author was also able to identify, and analyze a problem within the current procedures of the company. Additionally, the author derived a proposed solution to this problem, using the knowledge gained during the internship as well as the courses taken in the health informatics program at Dalhousie. The solution involved automating a current manual process that would improve both the efficiency, and the overall experience within the app.
Open Access
Mapping Adverse Drug Reactions in Canadian Vigilance Adverse Reaction Database to various standardized terminologies and determining an ideal terminology to be...
(2017-08-18) Shastri, Soumya
Canada Vigilance Program is Health Canada’s post-market surveillance program that gathers and evaluates reports of suspected adverse drug reactions to various health products. This facilitates Health Canada to monitor safety profiles of these health products once they are introduced in to the market. This helps to keep track of the products that they continue to outweigh the risk associated with them. This program is supported by seven Canada Vigilance Regional Offices [1] who provide a regional point of contact for health professionals and consumers. All the collected reports and their data are then stored in the Canada Vigilance Adverse Reaction Database. The database has a total of 12 tables consisting of information regarding Drug Products, Drug product ingredients, Indications for which they are used and reactions reported for them and their severity. Adverse reactions in the database are mostly coded using MedDRA (Medical Dictionary of Regulatory Activities) which has standardized terms for symptoms, signs, diseases, syndromes and diagnoses. For the purpose of the project, only the data related to Crohn’s Disease was analyzed. One of the focus of the project was to map these adverse reactions and drug products using BioPortal REST API to various terminologies like MedDRA, SNOMED CT, MeSH, UMLS and RXNorm (mapped to respective codes, their parents and hierarchy levels) and store this data in the database using python programming language. Other focus of the project after mapping was to evaluate the results of the mappings performed and determine which is the ideal terminology which can be used as an adjunct to MedDRA. The reason for finding a terminology as a supplement to MedDRA is that MedDRA has a shallow hierarchical structure with only 4 levels. Due to lack of details in these levels of hierarchy it restricts the scope and lessens the chances of getting more fine-grained information. The results of these evaluations showed that SNOMED CT gave the best results when used along with MedDRA. SNOMED CT has a more broader scope and very detailed hierarchal structure (14 levels) which classifies the term more finely. When a particular term was searched in MedDRA the results received were based on text matching rather than concept matching. But when the same was searched using SNOMED CT hierarchal structure additional terms were returned based on related terms of the original term. This finding can be very valuable in the process of signal detection of identifying drug-patterns in Pharmacovigilance as it will enhance the matching of the terms and giving more accurate results.
Open Access
Implementation of ChekOne Task Verification Software
(2017-08-18) Kumah, Akwasi
The internship was performed at IWK Health Centre from May 10th, 2017 to September 8th 2017. The objective of the internship was to implement the ChekOne task verification software to track and monitor the daily work routines of the housekeepers at the IWK. This report provides a bird’s eye view of the overall implementation of the project and talks about some of the challenges that were faced. The ChekOne uses a hierarchy of barcodes defined for: housekeepers > building > specific locations in the building> tasks> duration of tasks. These barcodes are scanned using a handheld device that functions like a cellphone. This device synchronizes the captured scans in real-time into a database system that I am able to access. From this information, I am able to monitor and develop reports of the tasks being performed by the housekeepers. The ChekOne software was used to track and monitor daily tasks, routines and responsibilities that housekeeping staff carry out. I was mainly responsible for the roll out of the task verification software (ChekOne) at the IWK Health Center. I worked with the Housekeeping Department to teach and familiarize the staff with the software and handheld device. I also worked with the IT Department to assist and solve any problems that occurred. Lastly, I analyzed and developed current work routines to aid in workload and workflow for the housekeepers. Throughout this internship I was able to utilize the knowledge and skills that I acquired from different modules of the health informatics program. For example, from using knowledge acquired from the Business Process Model notation, I was able to track the workflow of the housekeepers in their daily task routines. This report also describes the challenges I encountered during the course of the project, and how these challenges were addressed. Finally, several recommendations are made for the future sustainability of this technology at the Health Centre.
Open Access
Health Data Analyst at DGI Clinical
(2017-08-18) Shehzad, Aaqib
This report discusses the internship undertaken by the author at DGI Clinical, a Halifax based company that provides innovative clinical metric solutions that demonstrate clinically meaningful outcomes of treatments. The author contributed towards the transformation of DGI’s SymptomGuide™ into a mobile health solution for patients suffering from Dementia. At the end of the internship, the author successfully met the objectives and deliverables of the project, which are 1. Privacy Impact Assessment and Recommendations 2. Database Design 3. Database Migration 4. User Interface Prototype for SymptomGuide™ This internship report introduces background knowledge of the mobile health application in development, details the tasks performed by the author during the internship and its outcomes.
Open Access
Certification and Requirements Writing at Allscripts Canada
(2017-08-11) Paudel, Nischal
This document is a reflection of MHI internship performed at Allscripts Healthcare Inc., Canada, from May 15 – August 11, 2017. Allscripts Healthcare Inc. is an innovative company that provides healthcare solutions and services to help organizations achieve better clinical, administrative, financial and operational results. The author was supervised by Mr. Jaimes Blunt, a very knowledgeable and experienced Senior Solution Manager at Allscripts Healthcare Inc. The report consists of background information on two key topics used in the report, introduction on Allscripts business, goals and achievements, learning opportunity and exposure during the internship, objectives and deliverables of the projects assigned, analysis of a problem that can be solved using informatics science and a conclusion and recommendation drawn at the end of internship. Within this internship period, the author contributed to two major projects and a couple of minor projects supervised by Mr. James Blunt. At the end of the internship, he successfully met the objectives and deliverables of the two assigned projects, which are: Privacy and Security Requirements Gathering for FollowMyHealth (Infoways Certification Services) and Requirements for CIHI’s RAI-MDS 2.0 Canadian Version. The end deliverables of both projects are business and system requirements documents (word, excel and Visio files) submitted to the supervisor in a timely manner throughout the internship. The internship was highly valuable to understand and use the knowledge and skills gained in MHI courses. It is a great exposure to the field of Health Informatics and is highly recommended to students on MHI internship track at Dalhousie University.
Open Access
Designing and Building an Internal Database at AGADA Biosciences
(2017-04-27) Zhuang, Xiaoqing
This report keeps track of the author’s internship at AGADA Biosciences in Halifax, Nova Scotia. AGADA Biosciences is a company who specializes in performing pre-clinical studies using murine models. They focus on facilitating orphan drug development for industry, nonprofits, and academic-based groups. During the internship period, the author was assigned a role as software developer to design and build an internal database for AGADA Biosciences with the purpose of efficiently retrieving data from the database. Tasks performed by the author were managing data, designing database models, recommending information systems, building the database, installing and implementing systems, and reporting on progress. This internship is highly related to the Health Informatics program. Knowledge learned from Health Informatics can be applied to all of the required tasks. Most of the problems, such as vague requirements,data quality issues, and time conflicts during the project can be solved with Health Informatics solutions such as drawing ERD and BPMN diagrams. Objectives were met by the end of the internship. The author also learned how to put Health Informatics knowledge into practice and present results to employers. In addition, the author experienced teamwork, working with database management systems, and data processing. Several recommendations are made for the future works.
Open Access
Informatics Student Innovator with IWK Health Centre
(2016-08-15) Stenerson, Travis
This summer I have worked with IWK Health Centre and their Informatics Department in a novel position titled ‘Student Innovator in Health Informatics’, seeking to bring a health informatics based solution of my design to reality. The position is the result of Dr Brett Taylor, a graduate of the Master of Health Informatics at Dalhousie, and hospital administrators, recognizing the growing importance of bringing technology to healthcare, hope to foster innovation and provide support to health informatics students with a vision. I was fortunate enough to be the first student in this position. This position is unique in that, while there is ample clinical and technical support, the majority of the work is selfdirected. I designed, planned, adapted, and taught myself that which was necessary for the project. With the help and feedback of my advisors, supervisor and clinical consultants, the project nears completion. The goal is to create a system that would enable diabetic patients to record, display, analyze and understand data from their lives, including blood sugar, insulin doses, carbohydrate consumption and exercise sessions. As well, to prepare this data for transfer to their care team in a clinically meaningful way. At present, this data is addressed with their care team, but it is often presented incomplete or recorded with pen and paper. The project is ongoing and will continue after the internship comes to a close, but together we have built a near complete application for iOS mobile devices that accomplishes most of these goals. Design decisions were deeply informed by clinical observation in hospital with Dr Arati Mokashi and the diabetes team at the Pediatric Endocrinology Department at IWK. Many aspects of health informatics are involved in bringing an information technology solution like this to a health care problem. Fitting seamlessly into existing clinical workflow, technical system design choices, statistical analysis, and creating a clinically meaningful tool that can also operate as a patient teaching tool are all aspects that I addressed in the design and implementation of this project. This report will detail many facets of these informatics associated topics, and will seek to justify the continuation of this substantial position for future students. Discussed herein are two specific informatics topics that were among the more complex addressed this summer. The first is a visual data representation of blood glucose, carbohydrate consumption and insulin action relative to time of day. This is a chart adapted from observations of patientcaregiver discussions about their blood sugar readings at home. The second is a novel algorithm for calculating a specific measure of glycemic variability, the mean amplitude of glycemic excursions. This is a well studied and validated measure of blood glucose swings that has been noted to be difficult to compute. (Marics et al., 2015) Both these challenges were solved using personal research, support from my advisors, knowledge taken from my course work and experimentation. The chart will visually support and improve the conversation between caregiver and patient about blood sugar at specific times of days. The algorithm demonstrates taking a clinical concept and translating it to computer understandable code. The project as a whole has been challenging as well as deeply rewarding. Entrusting a student that seeks to bring informatics solutions to healthcare, and having project success be contingent on their ability is extremely motivating. The volume of information and technical skills I have acquired to see this project through are ample evidence of how important a position like this can be. Certainly, this experience should contribute greatly to future opportunities in the health informatics field. I also have a great deal of gratitude to the institution for giving me this opportunity and intend to contribute to the continuation of the Student Innovator position as well as the Informatics Department at IWK in the future in any way I can. Beyond what I personally have taken from this position, we also have a patientcentered data recording and analysis tool prototype that compares very favorably to existing products. I feel it will improve the experience of recording blood sugar for patients and of dissecting the data for physicians The unique elements of this position allowed me to see informatics from a both a top down and bottom up perspective. Mapping clinical context to technical choices and then implementing those technical choices allowed me to apply everything I have learned in health informatics to a real world project. The position required confidence, humility, curiosity and implicit motivation to accomplish what I set out to. I sincerely hope that future students have this opportunity and that my advisors and the institution see the value that this position has had for me. Health informatics is a field that is evolving quickly. That evolution and the extent to which we can transform healthcare with technology will depend on the sort of support to bring an idea from concept to reality that I have had this summer.
Open Access
Health System Key Performance Indicators
(2016-07-15) Marriott, Carolyn
The Nova Scotia government and the Health Authorities need to ensure accountability so existing health system resources are maximized. To monitor system performance, information is needed about where dollars are spent and why, so that variations in medical practice can be detected and resources used properly. The objective of the project is to develop key performance indicators for the Nova Scotia’s two Health Authorities. The Health Authorities report their financial position during the year to the Department of Health and Wellness, however; there lacks a consistent link from the financial forecasts reported to the operational performance of the Health Authorities. The project involves scanning for existing indictors that may be in use already, and identifying indicators for strategically important programs and initiatives. The learning experience for the author included an overview of the health system and understanding of the new roles of Department of Health and Wellness and the Health Authorities. There is an existing dashboard which is created at the department annually using Canadian Institute of Health Information (CIHI) reported data from Health Authorities. There are reporting deliverables in place for some initiatives which Health Authorities report to the department. There is also Accreditation Canada practice testing and there are CIHI collected indicators. There are many performance mechanisms in place, but there is no centralized documentation of this monitoring. If regular, comprehensive and centralized reporting is established, Nova Scotia-specific data will be available to health system data users to analyze. Considerations for selection of key performance indicators include ease of calculation for the Health Authorities, easy to understand, and relevant to the users. The best solution is to evaluate existing indicators already being produced and isolate programming areas for which there are no indicators, if any exist. Implementation of the indicators should be coordinated centrally and communicated clearly.
Open Access
Evaluation of an Electronic Central Referral Intake System and the Development of a CMS User Reference Manual for Nova Scotia Hearing and Speech Centres
(2016-08-11) Clarke, Alanna
1.0 Executive Summary 1.1 Scope The CMS User Reference Manual project and the Electronic Central Referral Intake System Feasibility Report project will ultimately extend to all Nova Scotia Hearing and Speech Centers within the province of Nova Scotia. While the research will primarily be conducted within HRM with additional support and input from the NSHSC site in Sydney Mines, Cape Breton, the proposed electronic referral system (eReferral) and CMS User Reference manual will apply to all NSHSC sites within Nova Scotia. The eReferral strategy will affect incoming referrals, triage, pre-registering and the allocation of referrals within each individual NSHSC site. The CMS User Reference Manual will aid all personnel who require instructions pertaining to activities performed within Nightingale On Demand Version 8.9. 1.2 Purpose The purpose of the Database/Technology Design Student at Nova Scotia Hearing and Speech Centers was to gain valuable insight and experience in a healthcare setting while building on professional workplace skills. Throughout the internship period the author was tasked to complete two projects in order to correct various errors within the organization. These two projects were the CMS User Reference Manual and the Electronic Central Referral Intake System Feasibility Report. The CMS User Reference Manual was severely outdated and did not provide accurate guidance or instructions to personnel using Nightingale On Demand. The purpose of updating the manual was to provide staff members with an accurate guide in order to navigate Nightingale On Demand. While mainly for new staff for learning purposes, the manual is also for existing staff requiring updates on new software features or reminders on how to complete various activities within the system. Once completed, staff members can rely on an updated, accurate, and detailed description on how to complete daily clinical activities using Nightingale On Demand. The investigation into the feasibility of implementing an eReferral system for Nova Scotia Hearing and Speech Centres was conducted to reduce variance in the clinical pathway and increase patient access. Many patient referrals were becoming lost before they were pre-registered erasing any evidence of the referral from the NSHSC office. This resulted in referred patients not receiving the treatment they require. The purpose of the Electronic Central Referral Intake System Feasibility Report was to examine NSHSC and determine if an electronic referral system would benefit and function efficiently within the workflow while reducing the variance in the clinical pathway. 1.3 Findings The findings of the investigation regarding the feasibility of an electronic referral system for NSHSC resulted from extensive interviews with staff and additional research. The interviewees disclosed the flow of information regarding the referral process, more specifically, how a referral sent in by a patient moves through the system and receives services from NSHSC. Additionally, decision points and workplace practices regarding the referral process were discussed. Examining the flow of information, typical referral procedures, and decisions resulted in identifying a number of errors that contribute to misplaced referrals. Periodically pre-registering referrals, lack of standardized 5 procedures, referral storage methods, number of consultations for referrals, and the standard format of the referral which is a paper hard copy are all influences that contribute to misplaced patient referrals. In order to mitigate the volume of misplaced referrals due to these errors, a solution was developed as discussed in section 1.4 Analysis, an electronic referral system. 1.4 Analysis The investigative work regarding the referral process led to the identification of various errors contributing to misplaced referrals. The responding solution that remedied these errors was an eReferral system. Further analysis was conducted into the feasibility of NSHSC adopting such technology and whether it would function efficiently in the workplace. The investigation resulted in the eReferral system being a feasible option for NSHSC. The eReferral system requires the activation of two policies that are currently in development at NSHSC. The first policy is that the Administrative Support Professional (ASP) is trained to triage the majority of referrals without consultation. The second policy is that the ASP is to pre-register referrals within one day of receiving them. These are two vital practices that support the adoption of the eReferral system. The eReferral system can be integrated into the existing flow of information at NSHSC without causing any major disruptions to personnel. This encourages the adoption of such technology, eases the transition, and ultimately contributes to the feasibility of implementing the system. While these contributions to the feasibility are technology independent, the technology must be accessible for the system to exist. These technological requirements include an electronic referral form, an eReferral database, and an interface within Nightingale On Demand. The technological requirements have confirmed to be an option for use in the eReferral system by the developers of Nightingale On Demand and therefore contribute to the overall feasibility. With many of the barriers surpassed, the author can conclude that adopting an eReferral system is a feasible option for NSHSC and it will reduce the current variance seen in the clinical pathway resulting in reduced patient access.
Open Access
Identifying clinical workflows and Canadian requirements Allscripts Summer Internship Report 2016
(2016-07-25) Zhan, Ying Albee
This internship took place in the Allscripts Richmond Office, B.C, starting May 16, 2016, and lasting for 13 weeks. This internship report was written to report the work performed by the author in a timely manner. The author worked under the supervision of Mr. Jaimes Blunt, with help from colleagues. Within this period, two projects have been completed independently by the author, which are “Canadian Privacy and Security Standard for Electronic Medical Record (EMR)” and “Canadian Pharmacy Services”. The objectives of these projects were to identify the Canadian requirements, to capture the workflow in a clinical setting, to model the business procedure and to document the Canadian Standard. The deliverables are several business process model and notation (BPMN) diagrams and a business requirement plans for each project. Several lessons can be taken from the internship, such as gaining from the culture within Allscripts, general reporting, researching and writing skills and professional business skills. This report details the steps taken to perform the work and discusses the relevance to health informatics. A conclusion and some brief recommendations are at the end of this report.
Open Access
Medication Reconciliation Project at Allscripts Canada
(2016-08-10) Wang, Tony (Xiao)
The author performed the Master of Health Informatics Internship at Allscripts Canada, a Health IT company that delivers information technology and services to help healthcare organizations achieve better clinical, financial and operational results. The author contributed to the Medication Reconciliation Specifications and Requirement for Canada project during the internship. At the end of the internship, the author has successfully met the objectives and deliverables of this project, which are: • Clinical workflow diagrams of Medication Reconciliation best practices • Business requirements of proposed processes improvements • Presentation of the results and recommendations Also, this internship was highly related to the field of Health Informatics and provided the author invaluable experience and insights into Health Informatics. This internship report introduces the background knowledge in Medication Reconciliation, describes the internship duties, learnings, and contributions, as well as analyses a problem in the domain of work and provides the solutions as a result.
Open Access
Data Flow Diagram Project For Perinatal Follow Up Program
(2016-07-15) Alyafei, Hanan Mohsen
The author wrote this internship report to provide and describe, in detail, her duties to successfully achieve the data flow diagram project. This internship project was conducted from May 2 to July 29 2016 for the perinatal follow up program at IWK Health Centre, Halifax, Canada. The internship opportunity provided the author on-the-job training, which linked the academic health informatics knowledge with real world healthcare as IWK Health Center. The internship’s experiences comprised of a variety of responsibilities and multitasking abilities, which made it a valuable learning experience for the author. Moreover, it was a great chance to learn how to bridge the information-communication gap between the PFUP director and the PFUP team members, and to map an accurate data flow diagram that reflects a real world scenario at PFUP. The PFUP is a very busy environment dealing with complex patient health conditions, such as extremely high-risk, very high-risk, and high-risk. The author dealt with various challenges to find suitable methods to visualize the PFUP complex processes by data flow diagram. At the end of the internship the author made a presentation for the PFUP team members to explain the project work and the final product was delivered to the director of PFUP as context, Level -0, and level –1 data flow diagrams.
Open Access
Working with Customer Success (CS) Team to collaborate with customers both in the business and information systems by analyzing data, solving problems and finding creative solutions
(2016-07-15) More, Suyog
This report describes the internship work performed by author at ResMed as a Junior Business Analyst, part of Customer Success Team under Healthcare Informatics department, during April 4, 2016 to July 8, 2016. ResMed is a global manufacturer of CPAP (Continuous Positive Airway Pressure) masks, machines and other products that diagnose, treat or help manage sleep-disordered breathing (particularly sleep apnea), chronic obstructive pulmonary disease (COPD), or other respiratory conditions. They have three main products for managing sleep apnea therapy, named U-Sleep, myAir and recently launched AirView. ResMed Halifax’s flagship product, U-Sleep, is a solution that helps organizations to better monitor and manage how well their sleep therapy patients are following the recommended use of their therapy. The way U-Sleep works is by using the “Management by Exception” strategy, which allows companies to define rulesets for therapy compliance. The Customer Success (CS) Team works under global Healthcare Informatics (HI) Department and focuses on increasing customer adoption and promoting effective use of HI solutions through active monitoring and outreach. This internship was composed of different parts and tasks. Initial tasks were more focused on getting the understanding of the processes, tools and data, later tasks were focused on the actual hands-on various projects. During this internship, author get chance to work on different projects like Capacity Model, Population Results, Churn Rate, Weekly Customer Insight Report/Customer Trending Reports, Operational metrics, Biweekly Salesforce.com log reports and Salesforce.com Development. The experience gained by author during his internship at ResMed working as a Junior Business Analyst was very educational. During this internship, author get chance to implement the knowledge he learned during Master of Health Informatics into practice. Author utilize various skills and knowledge like SQL, Web Development, Statistical, Research Methods, Health Information Systems & Issues, Change Management and Organizational Management during this internship.
Open Access
Recommendations for the future version of electronic discharge summary at Nova Scotia Health Authority
(2016-04-08) Salunkhe, Arun
Continuity of care is important for quality healthcare delivery. Communication between various healthcare providers plays an important role in the continuity of care. Discharge summaries that are sent out from hospitals to primary care providers in the community tell a story of what happened to patients during the hospitalization and play a critical role in this communication to help with continuity of care. Nova Scotia Health Authority (NSHA) had handwritten and dictated discharge summaries before electronic discharge summary was introduced in the year 2014. This internship report describes the experience of assessing quality of various types of discharge summaries at NSHA in order to understand the impact of electronic discharge summary on the overall quality of discharge summaries. The project was aimed at assessing various components of quality such as content, timeliness, conciseness, and organization through patient chart audit, surveys and a clinician focus group. The project also identified challenges in using electronic discharge summary system and sought recommendations from end users to overcome those challenges. The project is expected to contribute towards improving healthcare delivery across the province of Nova Scotia.
Open Access
Furthering an Innovative Approach to Caring for the Frail Elderly
(2016-03-28) Herritt, Richard
People over the age of 65 (seniors) are the fastest growing demographic in Canada representing approximately 15% of the total national population in 2013 and expecting to grow to 24% by 2036 (Statistics Canada). The cost of caring for this seniors’ population is disproportionately high at 45% of the healthcare spending. A significant driver of this cost is frailty, the progressive physiological decline in function, cognition, and mobility accompanied by a loss of physiological reserve and increased vulnerability to disease and death (Moorhouse, 2012). The Palliative and Therapeutic Harmonization (PATH) model is an innovative approach to simplifying the process of caring for the frail elderly that is shown to produce a dramatic change in the cost of care and the quality of patient and family caregiver satisfaction with the healthcare system (Moorhouse, Mallery, 2012). The PATH model of care was developed by Drs. Mallery and Moorhouse who practice geriatric medicine at the QEII Hospital in Halifax, NS. Deloitte has been working with PATH Inc. for over two years to support the adoption of the PATH model of care across Canada and beyond. As part of this adoption effort, Deloitte was engaged by the Tideview Terrace Long-term Care facility in Digby, NS to perform a PATH Implementation readiness assessment and to identify and recommend any preparatory actions that Tideview Terrace would need to undertake prior to implementing the PATH care model. The author, along with a team of healthcare consulting professionals, planned and performed the readiness assessment and identified and presented 56 recommendations to the Tideview Terrace leadership. Through this process there were additional objectives that were addressed including the documentation of the approach, processes and tools used to complete the readiness assessment to enable repeatability of the process, as well as a detailed analysis of an identified implementation issue that has far reaching impacts beyond the current client environment. This report details the author’s work on the readiness assessment and resulting findings as well as the activities and analysis performed to support the secondary objectives of the project.
Open Access
Designing a Database to Facilitate Efficient Information Management at the Health Mentors Program Office
(2016-03-23) Alexander, Susan
This report describes the internship work performed at the Health Mentors program (HMP) office at Dalhousie University. HMP is an inter-professional education program under Dalhousie’s Faculties of Medicine, Health Professions and Dentistry. It is an experiential learning process that is compliant with the National Interprofessional Competency Framework. The students are prepared to be collaborative practitioners who keep the goals of the patients at the centre of care. The HMP director’s office is the administrative hub of the program. It holds information pertaining to the students, mentors and faculty members. The information changes each academic year when new students are enrolled, new mentors recruited and faculty members take up varying responsibilities. The internship project was to design a database that captures and stores data that is generated through an academic year in order to facilitate HMP program governance and coordination. The existing data and information was analyzed to understand stakeholder requirements, information requirements and information flow. Recommendations were made to improve data quality and prevent human errors while transcribing the data to the database. The recommendations were limited to data collection. The recommendations were, to specify required attributes, to have a standardized data collection form and to introduce measures to keep the data up to date or timely. Information models and diagrammatic representation of the information acquired will be used to guide the final implementation of the database. Designing a Database to Facilitate Efficient Information Management at the Health Mentors Program Office