Topic / Title: Week

Keywords / Questions: Notes:

● Complexity in relation to the adopter means taking up new identities
● ORganizational complexity has to do with scope, scale, pace,
resource requirements and logistical uncertainties and
interdependencies of delivering the innovation
● It’s all about interdependence of different influences. One problem
cannot be addressed without generating other problems elsewhere
in the system
● MRC guideline on design and evaluation of complex interventions
● The guide has taken a view of complexity in health interventions
● Non adoption or abadondemenet of technolyg by indiviauls
diffiuclties achieving scale up, spread and sustainability
● Seven domains

Condition domain
● nature of illness that digital health targets. How complex is it, are
there comorbidities involved, are there other factors involved
● Deep vein thrombosis is considered simple or complicated. Even
though its a life threatening disease.
Knowledge
● Knowledge needed to use it, knowledge generated from it, who
owns the IP, the supply model
● Certain data can be contensatable.
Value proposition
● supply side means you have a strong business case and this
product can generate revenue
● there is demand on the client side, whether its effective and
afforable.
Adopter
● involves evryone using th esystem
● change in identity is the complexity involved in this domain
● i.e. when staff have to wear a new hat. Clinicians take on data entry
/ IT role.
Organization
● Capacity to innovate
● Whether there is strong leadership involved
● whether they are ready for the change
● whether technology is involved in multiple layers
● The work needed to support or implement the change
The wider system
● outside of the technology
● political, financial, regulatories,
● everything you need to consider
Embedding and adaptation overtime
● organization is resilient and wants to take on this change
● technology can start as being great but it needs to adapt over time
How to use the framework
● NASSS framework takes the opposite lens of a lot of frameworks.
● this is about avoiding failures
● a checklist about htinking about hte problem before you start
● what to think through
 ● A way to frame the evalauation
● the other framework iwas not a technology framework when it was
developed. It was a knowledge translation frameworks
● Re-aim framework.
● You dont have to use all of it
● Buffet, pick and choose what you think is relevant
Benefits evaluation framework
● THERE IS SYSTEM QUALITY, INFORMation qulaity, service
quality
● They are each linked with use and user satisfaction
● the net benefits are quality, access and productivity
● self perception. Am I techy or not? Having a message for both
CIO of CAMH
● CAMH intro
● Brain science is theri research area focus
Project background
● started seven years ago
● was supposed to change how care is delivered
● clinician led project
● issue: lots of different systems that didnt talk to each other
● No one knew what they were doing
● Supposed to be one integrated system
● goal was to reduce medication error
● EHRs were brought in to reduce medication errors
● 30% of medication errors upon administration. 30% of medication
errors are about how
● 1000 a month now being prevented and logged
● standardizing process is the big other goal
● goal was to use it to document ALL CARE in camh
● Scanning will be eliminated, except when required
Areas of prework
● Clinical documentation standardization, medication management.
order sets development, benefits measurements, data governance,
data quality assessment and quality, workload and reporting,
centralized intake and registry, change management initiation
● They went with cerner. They didnt even have a mental health
module
● There were 8 accountability principles for the steering committee.
No system customization without steering approval.
● design decision on excel spreadsheets
● Big bang approach. This was the practice in the state. Piece meal
is painful but it’ll be done.
● People were assigned to different units
● How big was the clinical implementation team? 50 people.
● When optimization happened? 90 people.
● There will be real optimization phase afterwards. Optimization
phase
Support post implementation
● On site 24,7 support for 6 weeks post go live
● CIS project team, CAMH resources, CERNER, students, hospital
peers
Education
● Length of training physicians
 ● 2 days -> 4 hours
● Physicians need someone to sit beside them, one on one to walk
them through it.
● level of accountability goes up
Benefits realization:
● improved quality of clinical documentation, reduced medication
errors, reduced redundant testing and streamlined process,
● Call volumes dropped overtime as people used the system
● Alerts optimization?
iManage - Data driven care
● Set up a data warehouse and business intelligence
● Talk to iCare team, once a month
● You can tell clinicians why you’ve done it.
● You can now unpack what’s happening at the organization
● Hits people’s efficiencies and productivity
● here is something useful
● Key priority dashboard. Look into this. Looks nice.
● Suicide risk assessement completition dashboards
● Which nurse hasn’t completed her SRA on whihch patient? you can
● nurses read this disclaimer. They were provided with cards.
● 100% electronic order sets
● HIMS 7 excludes order sets
● You need to let it settle for a year before optimizing. Other than
obvious safety things.
● Sinai compute resources. Krembil centre for neuroinformatics.
● Moving to a vanderbilt model for consent.
Summary: