Tentatively, the day of May 4th will run from 9:00 AM to 3:00 PM. Below is the tentative schedule for May 4th.

**(p) denotes speaker attending in-person at e-Health conference site
**(v) denotes speaker attending virtually using Breeze software from another location

0910-0945
Sisira De Silva (v)
Dalhousie University
An ontology to model time in Clinical Practice Guidelines

Abstract: Clinical practice guidelines (CPGs) are developed to reduce inappropriate variations in clinical practice, to improve health care quality, and to help control costs of patient management. In order to provide patient specific treatment, the collection and processing of temporal data are vitally important in many clinical settings, especially those pertaining to chronic disease such as diabetes. Representation of temporal data using clinical practice guidelines is a critical issue for computer-based guideline development, implementation and evaluation. Our objective is to represent practice oriented temporal knowledge from the collection of clinical practice guidelines for Diabetes domain in a temporal ontological model. We employed an evolving prototyping life cycle methodology to develop our ontology. This methodology is comprised of five steps: 1) identifying the purpose, scope, and users of ontological model; 2) domain analysis and knowledge acquisition; 3) building a conceptual (informal) ontology model; 4) formalization; and 5) ontology evaluation using a sample of clinical practice guidelines and patient cases. One of the potential applications of our temporal ontology for Diabetes is the integration with electronic patient management applications.

0945-1020
Preetpal Singh (p)
Laurentian University
An e-Health Model for Rural Communities in Northern Ontario

Abstract: An e-Health Model for Rural Communities in Northern Ontario: The aboriginal communities look at the concept of health holistically ‘Good health is a balance of physical, mental, emotional, and spiritual elements. All four interact together to form a strong, healthy person. If we neglect one of these elements, we get out of balance and our health suffers in all areas’. The community strongly believes that nature has provided them with; natural foods, fresh water and air, medicines, and the laws and teachings to use these elements wisely-ingredients to good health. However, there is a strong need to educate these communities about active lifestyle, proper nutrition and simple means to detect and prevent health issues on time. The demographical distribution of the aboriginal population in the north together with the shortage of physicians poses a serious challenge to timely and effective delivery of quality medical-care. Compared to the general Canadian population, the aboriginal communities are more prone to Infant Mortality Rate, Infectious Diseases, Diabetes, and Alcohol & Drug Abuse. The degree of ill health in Aboriginal populations is unacceptable; with a forward thinking vision we propose a healthcare service-oriented architecture (SOA) to build a HealthCare Grid that would greatly improve healthcare system in northern Ontario. Much of patient care involves getting patient information, conducting tests and obtaining results, and monitoring patient’s progress. The Grid enables participation across various levels in the healthcare ecosystem-from patients to health care providers, to physicians and social workers. Nursing and other healthcare staff insights can significantly improve clinical decision making and reduce the stress on physicians. By setting up computers with web cameras in community centers of rural north, patients will be encouraged to get in touch with counselors or physicians to share their health concerns and learn about various forms of illnesses and disease. The data collected is then shared by the Grid for research to draw statistical inferences about spread of disease across particular communities, thus providing timely intervention. User friendly interfaces help inform patients about conditions like depression and diabetes, this improves patient cooperation and they take on an important role in the delivery of their own care. The Grid could be based at the Northern Ontario School of Medicine which in return could make student placements in these rural communities mandatory. Students can share information back with the Grid using devices like PDAs. Not to forget, the members of this system including physicians, nurses, community healers and administrators will need to be trained on the Grid. This will promote team comprehension and understanding through debates, discussions and team critique and hopefully bring about the motivation of change, a change in people’s attitude... the biggest challenge to this project.

1035-1110
Mihail Cocosila (v)
McMaster University
User Acceptance of Wireless Text Messaging in Telehealth: A Case for Adherence

Abstract: This work is an investigation of user acceptance of a prototype solution utilizing wireless text messaging (or SMS - i.e., short messaging service) to improve people’s adherence. Insufficient adherence, also known as medical non-compliance, is a major cause of failure in self-management programs, causing significant losses to all healthcare stakeholders. Innovative mobile healthcare solutions, based on portable devices like cell phones, may address some non-adherence aspects by helping outpatients to follow treatments agreed with their health providers. Although this seems a win-win situation, a verdict on the overall usefulness of such an approach cannot be formulated before exploring outpatient acceptance, as this is a novel technology that targets a new area of implementation. Accordingly, this research investigates key factors that may influence the acceptance of a mobile healthcare solution based on SMS to support improved adherence to healthy behaviour, with special attention to motivation (the ‘pro’ factors) and perceived risk (the ‘con’ factors). As a means of investigation, a one-month longitudinal experiment with two groups of subjects (an intervention group and a control group) was utilized. Data were analyzed with quantitative and qualitative techniques: descriptive statistics, partial least squares modelling, and content analysis. Findings show that users are aware of the potential usefulness of such a pioneering application. However, enjoyment is the unique reason for adopting, and perceived financial and psychological risks the main obstacles against adopting, an SMS-based solution for improving adherence to healthy behaviour. Furthermore, a business analysis shows that users are concerned about usefulness features, even when asked about financial aspects. These results, together with encouraging findings about the effectiveness of the application, open the way for medical-led research to investigate if long-term mobile healthcare initiatives customized to patient needs are also beneficial for outpatient adherence and health outcomes.

1115-1150
Betanya Tefera (p)
York University
Electronic Discharge Summaries: Physician Views and Perceptions

Abstract: An electronic discharge summary (eDS) has the potential to improve the efficiency of patient information flow, enhance interdisciplinary communication, and prevent unnecessary treatment/tests [1,2]. This study aims to provide a preliminary understanding of the current use of discharge summaries (DS) provided by acute care or rehabilitation centers to the General Practitioners (GPs). The aim of the study is to determine the informational needs of GPs by eliciting responses regarding their (a) perceptions of the content and format of the DS and (b) their views regarding the benefits and drawbacks to eDS. A self-administered survey was mailed to 250 GPs in the Greater Toronto Area. Respondents had a choice of either completing the mail-in form or completing the survey online. The survey included questions related to demographics such as age, gender, and years of practice as well as questions regarding current use of DS. The attitude towards eDS was captured by inquiring about preferences and needs, current use of technologies, and potential barriers to eDS use. The response rate for the survey is currently 12% and we expect to increase it by following up with the GPs included in the study. Our initial analyses suggest that the majority of physicians (67%) experience frequent problems with the DS they currently receive. The most frequent problems are: illegibility, timeliness, completeness and some hospitals do not send DS without patient’s request. Although most of the GPs (83%) agree that there is great value in utilizing eDS, there is still a preference for mailed or faxed DS (over 75%). The findings of this project will potentially inform the development of an eDS system prototype. References [1] Dougherty, G.E. (1999). Conventional dictated versus database-generated discharge summaries: Timeliness, quality and completeness. CMAJ, 160 (3). [2] Sumi, M., et.al. (2001). Improving the quality of discharge summaries. CMAJ, 165(1).

1320-1355
Josephine McMurray (p)
University of Waterloo
Hospital capita investment decisions in information and communication technology: ration choice or rock, paper scissors?

Abstract: Hospital capita investment decisions in information and communication technology: ration choice or rock, paper scissors?: According to Canada Health Infoway (the agency charged with accelerating the implementation of electronic health information systems in Canada), the average Canadian healthcare information and communication technology (ICT) spending is between 1.5% and 2.0% of total revenues. Infoway believes that Canada will “struggle to meet the increasing demands of its stakeholders” unless average healthcare ICT spending increases to over 4% of total revenues. In current dollars this represents an annual incremental investment of approximately $10-$12 billion in additional capital and $1.5-$1.7 billion in annual operating costs, double what is currently being spent (Infoway, 2007). If capital investment decisions are based on a process of evaluation and prioritization conditional on strategic organizational objectives, it follows that healthcare organizations with higher ICT investments are doing so with rational intent. Making rational, well informed spending decisions of this magnitude will require a disciplined, consistent allocation process (Clarke, 2003) driven by strategic priorities (Reiter, 2000). Published research on healthcare organization’s capital allocation methodologies is sparse, but suggests that political rather than rational decision making processes may govern many resource allocation decisions. This paper will present an overview of ex ante ICT evaluation methods used in hospital capital allocation processes and investigate the inputs and processes (i.e. practices or approaches) to their decision making in order to develop an explanatory theoretical framework.

1400-1435
Julia Yinxin Zhu (p)
University of Victoria
National Health Information Management/Information Technology Strategies in Hong Kong, Taiwan and Singapore

Abstract: The main purpose behind national health information management/information technology (IM/IT) strategies is to ensure that health information is accurate and available to those who need it, thereby improving the nationwide patient health services and outcomes. However, little comparative research has been performed in this area, especially in Asian countries. This paper reviews, assesses and compares the healthcare systems, as well as the national health IM/IT initiatives and strategies in three leading Asian jurisdictions: Hong Kong, Taiwan and Singapore. Although the proportion of public and private health services, IT infrastructure development and government involvement in these three jurisdictions are different, they experience similar challenges in terms of changing population structures and lifestyles, and meeting increasing demands with limited resources. Hong Kong has taken unique approaches to build their territory-wide Electronic Health Record system, and it achieved its initial goals on sharing accurate patient information among multiple points of care. Similarly, Singapore has adopted inforcomm technology in their healthcare sector to enhance data exchange, patient-oriented service and e-Health. Taiwan was the first jurisdiction to introduce a territory-wide card-enabled e-health network. Their Smart Card system replaced the old paper-based medical certificate system, and achieved significant savings. There is no single correct national health IM/IT solution for all countries. However, by learning what other jurisdictions are prioritizing, a country can use that knowledge to help focus their own national health IM/IT priorities. By outlining the approaches being taken in the three Asian jurisdictions, this paper provides comparison, evaluation and ideas that may be useful to other jurisdictions.