The Priorities of End Users of Emergency Department Electronic Health Records: Modified Delphi Study.

Background: The needs of the emergency department (ED) pose unique challenges to modern electronic health record (EHR) systems. A diverse case load of high-acuity, high-complexity presentations, and ambulatory patients, all requiring multiple transitions of care, creates a rich environment through which to critically examine EHRs.

Objective: This investigation aims to capture and analyze the perspective of end users of EHR about the strengths, limitations, and future priorities for EHR in the setting of the ED.

Interoperability: A National Person-Centred View.

We respond to Falk's (2022) recent recommendations around interoperability. Although we applaud the notion that the health data of Canadians be usable - that is, machine interpretable - and widely clinically available, Falk's (2022) recommendations must be extended. Specifically, interoperability must centre on the person and people's rights to hold and control a usable copy of their health information for their own purposes.

Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study.

Background: Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators.

Objective: We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care.

Methods: This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team.

Understanding Engagement and the Potential Impact of an Electronic Drug Repository: Multi-Methods Study.

Background: Centralized drug repositories can reduce adverse events and inappropriate prescriptions by enabling access to dispensed medication data at the point of care; however, how they achieve this goal is largely unknown.

Objective: This study aims to understand the perceived clinical value; the barriers to and enablers of adoption; and the clinician groups for which a provincial, centralized drug repository may provide the most benefit.

Methods: A mixed methods approach, including a web-based survey and semistructured interviews, was used.

Telephone, video, equity and access in virtual care.

Current public health measures catalyzed a large shift to virtual care, resulting in a great uptake in telephone and video-enabled care. While pre-pandemic public healthcare funding rarely covered the telephone as a reimbursable care delivery model, it has proven a crucial offering for many populations. As the new standard of virtual service delivery is being solidified, simple technological solutions that provide access to care must continue to be supported.

Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study.

Background: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems.

UpToDate versus DynaMed: a cross-sectional study comparing the speed and accuracy of two point-of-care information tools.

Objective: To compare the accuracy, time to answer, user confidence, and user satisfaction between UpToDate and DynaMed (formerly DynaMed Plus), which are two popular point-of-care information tools.

Methods: A crossover study was conducted with medical residents in obstetrics and gynecology and family medicine at the University of Toronto in order to compare the speed and accuracy with which they retrieved answers to clinical questions using UpToDate and DynaMed. Experiments took place between February 2017 and December 2019.

A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study.

Background: Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops.

Catalyzing Digital Health Innovation in Ontario: The Role of an Academic Medical Centre.

Overcoming barriers to health system innovation is an ongoing challenge in Canada. A total of 51 participants attended a digital health symposium in October 2017 to discuss the role of an academic medical centre (AMC) in advancing innovation. The conversation centred around (i) the current state of innovation in healthcare; (ii) the need for an innovation catalyst; and (iii) the roadmap for an AMC to drive change.

Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study.

Background: Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging.

Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study.

Background: Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province.

Objective: The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption.

Quality Gaps of Electronic Health Records in Diabetes Care.

Objectives: Electronic health records (EHRs) allow standardized data capture for robust quality and performance assessments, but data quality issues may exist. This study compared extracted structured EHR data with chart review from endocrinologists' health-care records at a large, academic ambulatory hospital in Toronto, Ontario.

Methods: Consecutive chart review for the first 10 patients with either type 1 or type 2 diabetes seen between January 1, 2015 and March 1, 2016 was sampled for each of the 10 endocrinologists within the diabetes program, and electronic data extraction was also completed for a core set of structured diabetes care elements.

Linking Quality Improvement and Health Information Technology through the QI-HIT Figure 8.

The implementation of health information technology (HIT) is complex. A method for mitigating complexity is incrementalism. Incrementalism forms the foundation of both incremental software development models, like agile, and the Plan-Do-Study-Act cycles (PDSAs) of quality improvement (QI), yet we often fail to be incremental at the union of the disciplines.

Beyond "implementation": digital health innovation and service design.

Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs), but their actual impact remains variable. In this commentary, we suggest that shifting from a perspective focused on "implementing" new digital tools in health care settings toward one focused on "service design" will help teams execute more successful digital technology adoption projects. We present value proposition design (VPD) as a service design strategy requiring that stakeholders are brutally honest in determining the value of a new digital tool for their everyday work.

Artificial Intelligence and the Implementation Challenge.

Background: Applications of artificial intelligence (AI) in health care have garnered much attention in recent years, but the implementation issues posed by AI have not been substantially addressed.

Objective: In this paper, we have focused on machine learning (ML) as a form of AI and have provided a framework for thinking about use cases of ML in health care. We have structured our discussion of challenges in the implementation of ML in comparison with other technologies using the framework of Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS).

A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial.

Background: Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support.

Objective: The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care.

Methods: A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada.

The Regulatory Challenge of Mobile Health: Lessons for Canada.

Mobile health (mHealth) is the provision of health or medical services enabled by portable devices. This field is rapidly expanding as the global market for mobile devices grows. mHealth "apps" pose benefits and risks to their users that governments have attempted to address through regulation.

Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study.

Background: Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home.

Objective: In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients' outcomes and experiences.

Extending access to a web-based mental health intervention: who wants more, what happens to use over time, and is it helpful? Results of a concealed, randomized controlled extension study.

Background: Web-based mental health applications may be beneficial, but adoption is often low leaving optimal implementation and payment models unclear. This study examined which users were interested in extended access to a web-based application beyond an initial 3-month trial period and evaluated if an additional 3 months of access was beneficial.

Methods: This study was a concealed extension of a multi-center, pragmatic randomized controlled trial that assessed the benefit of 3 months of access to the Big White Wall (BWW), an anonymous web-based moderated, multi-component mental health application offering self-directed activities and peer support.

Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial.

Background: As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A (HbA) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear.

Improving safety and efficiency in care: multi-stakeholders' perceptions associated with a peritoneal dialysis virtual care solution.

Background: Although there is a growing body of literature on the outcomes and impacts of remote home management with peritoneal dialysis (PD) patients, less is understood how this virtual care solution impacts the quality and efficiency of the healthcare system care. In this context, a study was undertaken to understand the perceptions of patients and their caregivers, healthcare providers, health system decision makers, and vendors associated with a remote monitoring and tracking solution aimed at enhancing the outcomes and experiences of chronic kidney disease (CKD) patients receiving PD at home.

Methods: A qualitative design using semi-structured interviews with 25 stakeholders was used in this study.