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Background: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates' experiences as they transition to the workplace. Objective: This study aims to (1) describe newly qualified nurses' experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates' transition and practice with digital health. Methods: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. Results: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. Conclusions: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future. [ABSTRACT FROM AUTHOR]

Background: Aided by a collaborative partnership dating back to 2011, the Canadian Network for Public Health Intelligence (CNPHI) and the Canadian Paediatric Surveillance Program (CPSP) quickly undertook substantial enhancements to the CPSP's data collection instruments on the CNPHI platform to characterize the impacts of the coronavirus disease 2019 (COVID-19) on children and youth in Canada. Faced with an emerging public health threat with impacts yet unknown, the objective of the intervention was to rapidly complete enhancements to existing data collection and analytical tools to enable the CPSP's ability to characterize the impacts of COVID-19 in Canadian children and youth. Intervention: Reporting frequency from CPSP's network of paediatric practitioners was increased from monthly to weekly, and the flexibility of detailed case data collection was substantially enhanced using complex survey instruments, interactively designed using CNPHI's Web Data technology. To ensure their data collection proceeded along all required lines of surveillance, CPSP's data collection tools were enhanced to collect demographic, epidemiological, microbiological and clinical data including comorbidities of cases identified. Outcomes: Less than a month after the World Health Organization declared the COVID-19 pandemic, CPSP was able to start collecting detailed weekly case data on emerging cases of COVID-19 among Canadian children and youth. By May 2020, CPSP was able to launch a detailed study, supporting research into potential risk factors for severe COVID-19-related illness in children and youth. Conclusion: In response to a novel public health threat, CNPHI and CPSP were able to implement rapid adaptations and enhancements to existing data collection instruments while fortifying their preparedness to do the same in the future, when needed. With innovative and agile technologies at the ready, this experience helps to emphasize the importance of established collaborative partnerships across public health disciplines as a factor contributing to preparedness and agility to respond to the unforeseen. Canadian Network for Public Health Intelligence's Web Data technology showed agile adaptability and a capacity for complex and detailed data collection, supporting timely surveillance and response. [ABSTRACT FROM AUTHOR]

The inappropriate use of antipsychotic medications in older adults can reduce the quality of life and increase the risk of adverse drug interactions. To address this concern, a quality improvement study was implemented across 34 long-term care (LTC) homes in Ontario, Canada. The study aimed to reduce inappropriate antipsychotic use by implementing evidence-based deprescribing practices. The study resulted in a 40.6% reduction in inappropriate antipsychotic use. The results of this study can inform quality improvement approaches for reducing the inappropriate use of antipsychotics in LTC and beyond. [ABSTRACT FROM AUTHOR]

Background: Most electronic emergency department (ED) triage systems allow nurses to modify computer-generated triage scores. It is currently unclear how this affects triage validity.Objective: Are nurse-generated triage scores more strongly associated with rates of admission, intensive care unit (ICU) consultation, and mortality than computer-generated scores?Methods: Retrospective observational cohort study of all adult visits to a tertiary ED. An electronic implementation of the Canadian Triage Acuity Scale (CTAS) generated a CTAS score for each visit. In some cases, the triage nurse overwrote the computer-generated CTAS score with a score they felt was more appropriate. Among visits with nurse-modified triage scores, we compared the rate of acuity-related outcomes (mortality, ICU consultation, hospital admission) in each CTAS level as categorized by nurse-generated vs. computer-generated scores.Results: In a cohort of 229,744 patients, 19,566 (8.51%) had nurse-modified triage scores. Most modifications consisted of assigning a higher acuity triage score than recommended by the computer. Visits with triage scores 1-2 according to the nurse-generated scores had the same or higher rates of the acuity outcomes than visits that were CTAS 1-2 according to the computer-generated CTAS scores. Conversely, visits with triage scores 4-5 according to the nurse-generated scores had lower rates of the outcomes than visits that were CTAS 4-5 according to the computer-generated CTAS scores.Conclusions: Nursing supervision of the computer-automated CTAS triage system was associated with fewer hospital admissions, ICU consultations, and deaths in the triage score 4-5 categories, suggesting a safer triage process than the automated CTAS algorithm alone. [ABSTRACT FROM AUTHOR]

Anesthesia Information Management Systems are specialized forms of electronic medical records used by anesthesiologists to automatically and reliably collect, store, and present perioperative patient data. There are no recent academic publications that outline the names and features of AIMS in the current American and Canadian marketplace. An environmental scan was performed to first identify existing AIMS in this marketplace, and then describe and compare these AIMS. We found 13 commercially available AIMS but were able to describe in detail the features and functionalities of only 10 of these systems, as three vendors did not participate in the study. While all AIMS have certain key features, other features and functionalities are only offered by some of the AIMS. Features less commonly offered included patient portals for pre-operative questionnaires, clinical decision support systems, and voice-to-text capability for documentation. The findings of this study can inform AIMS procurement efforts by enabling anesthesia departments to compare features across AIMS and find an AIMS whose features best fit their needs and priorities. Future studies are needed to describe the features and functionalities of these AIMS at a more granular level, and also assess the usability and costs of these systems. [ABSTRACT FROM AUTHOR]

Purpose: In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics., Clinical Features: Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards., Conclusion: We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations., (© 2024. Canadian Anesthesiologists' Society.)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. [ABSTRACT FROM AUTHOR]

Purpose Expanding networks of data portals and repositories linked to electronic patient record systems, along with advances in information technology, have created both new opportunities in improving public health and new challenges in protecting patient privacy. The purpose of this paper is to review stakeholder perspectives and provide a framework for promoting implementation of current privacy protection improvement recommendations.Design/methodology/approach This paper summarizes a workshop session discussion stemming from the 2017 Information Technology and Communication in Health (ITCH) biennial international conference in Victoria, British Columbia, Canada. The perspectives within health service research, journalism, informatics and privacy protection were represented.Findings Problems underlying gaps in privacy protection in the USA and Canada, along with then-current changes recommended by public health leaders as well as Information and Privacy Commissioners, were identified in a session of the 2015 ITCH conference. During the 2017 conference, a workshop outlined the current situation, identifying ongoing challenges and a lack of significant progress. This paper summarizes that 2017 discussion identifying political climate as the major impediment to progress on this issue. It concludes with a framework to guide the path forward.Originality/value This paper provides an international perspective to problems, resources and solution pathways with links useful to readers in all countries. [ABSTRACT FROM AUTHOR]

Background: Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders.Methods: We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality.Results: The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations.Conclusions: This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality. [ABSTRACT FROM AUTHOR]

Objectives: The increasing cost of clinical laboratory testing is a challenge in our health care system. This study aims to calculate the annual clinical laboratory test costs attributed to patients in a major Canadian city and to correlate them to their sociodemographic variables.Methods: Retrospective cohort study involving patients who received clinical chemistry, hematology, and microbiology tests in 2011 in Calgary, Canada (n = 610,409). Test volumes were obtained from a laboratory informatics database. Total expenditures per patient were calculated using estimated test costs and then combined with the 2011 Canadian Census Household Survey results to infer sociodemographic correlates.Results: While more women received laboratory testing (58.4%), men had slightly higher testing costs per capita. Except for Chinese, visible minority and Aboriginal populations had higher testing costs. There was an inverse correlation between testing cost and household income, and accordingly, higher costs were found in those without postsecondary education and the unemployed. Furthermore, hotspot mapping revealed the geographical distribution of patient test costs within the city.Conclusions: There is variation in testing costs for patients among different sociodemographic variables. [ABSTRACT FROM AUTHOR]

Agent-based models (ABMs) are computer simulation models that define interactions among agents and simulate emergent behaviors that arise from the ensemble of local decisions. ABMs have been increasingly used to examine trends in infectious disease epidemiology. However, the main limitation of ABMs is the high computational cost for a large-scale simulation. To improve the computational efficiency for large-scale ABM simulations, we built a parallelizable sliding region algorithm (SRA) for ABM and compared it to a nonparallelizable ABM. We developed a complex agent network and performed two simulations to model hepatitis C epidemics based on the real demographic data from Saskatchewan, Canada. The first simulation used the SRA that processed on each postal code subregion subsequently. The second simulation processed the entire population simultaneously. It was concluded that the parallelizable SRA showed computational time saving with comparable results in a province-wide simulation. Using the same method, SRA can be generalized for performing a country-wide simulation. Thus, this parallel algorithm enables the possibility of using ABM for large-scale simulation with limited computational resources. [ABSTRACT FROM PUBLISHER]

This status report on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an emergency department-based injury and poisoning surveillance system, describes the result of migrating from a centralized data entry and coding process to a decentralized process, the web-based eCHIRPP system, in 2011. This secure system is improving the CHIRPP's overall flexibility and timeliness, which are key attributes of an effective surveillance system. The integrated eCHIRPP platform enables near real-time data entry and access, has user-friendly data management and analysis tools, and allows for easier communication and connectivity across the CHIRPP network through an online collaboration centre. Current pilot testing of automated data monitoring and trend analysis tools--designed to monitor and flag incoming data according to predefined criteria (for example, a new consumer product)--is revealing eCHIRPP's potential for providing early warnings of new hazards, issues and trends. [ABSTRACT FROM AUTHOR]

Aim A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. Background Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. Design Discussion paper. Data sources A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. Discussion The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. Implications for nursing A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. Conclusion Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models. [ABSTRACT FROM AUTHOR]

Objectives: Very little is known about the relative contributions of physician specialty groups and individual physicians to overall clinical laboratory expenditures. The objectives of this study were to determine the costs of clinical laboratory test expenditures attributable to 30 medical specialties and the associated per capita physician expenditures for an entire major Canadian city. Only chemistry, hematology, and microbiology tests were included in this study. Methods: Retrospective cohort study involving all physicians in Calgary, Canada, and surrounding areas (n = 3,499) and secondary data on laboratory test orders. Results: Data were obtained on approximately 20 million test requests. The mean clinical laboratory test expenditure, in Canadian dollars, per physician was $27,945 for all physicians combined. Total expenditures by primary care physicians (family physicians and general practitioners) accounted for 58% of total expenditures. Conclusions: There was wide variation in clinical laboratory test expenditures among specialties and on a per capita basis within medical specialties. [ABSTRACT FROM AUTHOR]

Abstract: Companion animals closely share their domestic environment with people and have the potential to, act as sources of zoonotic diseases. They also have the potential to be sentinels of infectious and noninfectious, diseases. With the exception of rabies, there has been minimal ongoing surveillance of, companion animals in Canada. We developed customized data extraction software, the University of, Calgary Data Extraction Program (UCDEP), to automatically extract and warehouse the electronic, medical records (EMR) from participating private veterinary practices to make them available for, disease surveillance and knowledge creation for evidence-based practice. It was not possible to build, generic data extraction software; the UCDEP required customization to meet the specific software, capabilities of the veterinary practices. The UCDEP, tailored to the participating veterinary practices’, management software, was capable of extracting data from the EMR with greater than 99%, completeness and accuracy. The experiences of the people developing and using the UCDEP and the, quality of the extracted data were evaluated. The electronic medical record data stored in the data, warehouse may be a valuable resource for surveillance and evidence-based medical research. [Copyright &y& Elsevier]

Background: Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. Methods: A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Results: Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. Conclusions: The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy. [ABSTRACT FROM AUTHOR]

Digital pathology is a rapidly evolving niche in the world of pathology and is likely to increase in popularity as technology improves. We performed a questionnaire for pathologists and pathology residents across Canada, in order to determine their current experiences and attitudes towards digital pathology; which modalities digital pathology is best suited for; and to assess the need for training in digital pathology amongst pathology residents and staff. An online survey consisting of 24 yes/no, multiple choice and free text questions regarding digital pathology was sent out via E-mail to all members of the Canadian Association of Pathologists and pathology residents across Canada. Survey results showed that telepathology (TP) is used in approximately 43% of institutions, primarily for teaching purposes (65%), followed by operating room consults (46%). Seventy-one percent of respondents believe there is a need for TP in their practice; 85% use digital images in their practice. The top two favored applications for digital pathology are teaching and consultation services, with the main advantage being easier access to cases. The main limitations of using digital pathology are cost and image/diagnostic quality. Sixty-two percent of respondents would attend training courses in pathology informatics and 91% think informatics should be part of residency training. The results of the survey indicate that Pathologists and residents across Canada do see a need for TP and the use of digital images in their daily practice. Integration of an informatics component into resident training programs and courses for staff Pathologists would be welcomed. [ABSTRACT FROM AUTHOR]

The increasing availability and complexity of sleep and circadian data are equally exciting and challenging. The field is in constant technological development, generating better high-resolution physiological and molecular data than ever before. Yet, the promise of large-scale studies leveraging millions of patients is limited by suboptimal approaches for data sharing and interoperability. As a result, integration of valuable clinical and basic resources is problematic, preventing knowledge discovery and rapid translation of findings into clinical care. To understand the current data landscape in the sleep and circadian domains, the Sleep Research Society (SRS) and the Sleep Research Network (now a task force of the SRS) organized a workshop on informatics and data harmonization, presented at the World Sleep Congress 2019, in Vancouver, Canada. Experts in translational informatics gathered with sleep research experts to discuss opportunities and challenges in defining strategies for data harmonization. The goal of this workshop was to fuel discussion and foster innovative approaches for data integration and development of informatics infrastructure supporting multi-site collaboration. Key recommendations included collecting and storing findable, accessible, interoperable, and reusable data; identifying existing international cohorts and resources supporting research in sleep and circadian biology; and defining the most relevant sleep data elements and associated metadata that could be supported by early integration initiatives. This report introduces foundational concepts with the goal of facilitating engagement between the sleep/circadian and informatics communities and is a call to action for the implementation and adoption of data harmonization strategies in this domain., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This poster will provide an overview of the various initiatives completed to support the development of informatics competencies among senior nurse leaders in Canada. These initiatives have included a literature review to uncover competencies of relevance to the Canadian context, and a Delphi study to achieve consensus on the competencies for Canada. Current and future plans will be discussed to translate these competencies into practice among senior nurse leaders.

Healthcare has experienced rapid transformation with the development of digital technologies which aim to make healthcare safer and more efficient. In response, health informatics has evolved, including nursing informatics, which integrates nursing, information and communication technologies (ICT) and professional knowledge to improve patient outcomes. New language has developed to describe informatics and its processes; however, this has generally been poorly understood. This paper will describe current definitions of nursing informatics from three different healthcare contexts: Australia, the United States of America and Canada, to identify the similarities and differences between these definitions and to summarise the distinct bodies of knowledge described by each country. These countries have amongst the oldest definition attempts in the literature. A pragmatic approach was taken in this narrative review, working forward from historic references and backwards from recent references extracted from published health and nursing informatics literature.

Purpose: Anesthesia information management systems (AIMS) are gradually replacing paper documentation of anesthesia care. This study sought to determine the current status of AIMS adoption and the level of health informatics expertise in Canadian academic anesthesia departments., Methods: Department heads or their designates of Canadian academic anesthesia departments were invited by e-mail to complete an online survey between September 2019 and February 2020. The survey elicited information on current AIMS or future plans for an AIMS installation, the number of department members dedicated to clinical informatics issues, the gross level of health informatics expertise at each department, perceived advantages of AIMS, and perceived disadvantages of and barriers to implementation of AIMS., Results: Of the 64 departments invited to participate, 63 (98.4%) completed the survey. Only 21 (33.3%) of the departments had AIMS. Of the 42 departments still charting on paper, 23 (54.8%) reported planning to install an AIMS within the next five years. Forty-six departments (73%) had at least one anesthesiologist tasked with dealing with AIMS or electronic health record issues. Most reported having no department members with extensive knowledge or formal training in health informatics. The top three perceived barriers and disadvantages to an AIMS installation were its initial cost, lack of funding, and a lack of technical support dedicated specifically to AIMS. The top three advantages departments wished to prioritize with AIMS were accurate clinical documentation, better data for quality improvement initiatives, and better data for research., Conclusions: A majority of Canadian academic anesthesia departments are still using paper records, but this trend is expected to reverse in the next five years as more departments install an AIMS. Health informatics expertise is lacking in most of the departments, with a minority planning to support the training of future anesthesia informaticians.

Twitter® is a popular microblogging site that allows users to disseminate information in 140 characters of text or less. A review of literature indicated that, to date, there has been little inquiry into the health based discussions conceptualized and enacted within and among Twitter® users. Methods for this qualitative study included a directed content analysis, guided by the Public Health Agency of Canada's Determinant of Health (DOH) framework was completed to explore health based discussions on Twitter®. A 24-hour cross-section of tweets (N=2400) containing the word or hashtag 'health' were collected for analysis. Findings revealed predominant themes of health services, personal health practices, and education. Many of the tweeted messages reflected existing political and social issues publicized within the global mass media. This study also considered the evolving dynamic behind the conceptualization of health and how it is co-constructed through news media, advertising, and social network technologies. Discussion of the emerging themes and implications for practice are presented. [ABSTRACT FROM AUTHOR]