This approach to chronic disease management is generally an unchartered field in Canada, still relatively new, There are some similar, smaller pilots/programs but very few provincial programs aimed at chronic disease. Telehomecare is enabled through the use of advanced communications and technology. Patients are remotely monitored and Self-management of chronic disease is reinforced through daily interactions with HCP, Outcomes include patient goal-setting, increased knowledge and self-confidence, and learned strategies about how to live healthier with one’s disease and how to manage signs and symptoms of disease exacerbation when it occurs..
In In 2007 OTN launched its first TELEHOMECARE program This is a new initiative (that was developed under the umbrella of OTN) as a solution to managing the burden of chronic disease on the acute care system Telehomecare is one strategy that literally takes care into the home. Refer to quotes on slide
The original implementation took place at 6 FHTs across the province, these sites were selected by the Ministry, there were 3 urban and 3 rural locations, 2 additional sites were engaged later in 2008. These included: TORONTO TIMMINS HAMILTON PICTON (PRINCE EDWARD COUNTY) STRATFORD OTTAWA BARRIE GUELPH Key Features: Collaboration with other service providers (home care, acute care, CCAC) Time limited intervention A Telehomecare specialist situated within a FHT conducts selection and eligibility assessment and remotely monitors patient clinical status Focus is on chronic disease management and patient self management Formal program evaluation The goal of the THC program To provide effective health care closer to home through technology-enabled patient self-management to test a Family Health Team-based model of telehomecare promote evidence-based, inter-disciplinary, integrated care and inform a province-wide roll-out Must meet the needs of patients, and providers Improve healthcare utilization
The Telehomecare strategy was developed by a multi-stakeholder group to support the deployment, sustainability and growth of telehomecare services across the province. Phase one was planned to end in Dec 08 but extension funding permitted the program to run until the end of May, 2009. Patient groups: COPD, CHF CHF: most common dx that brings a patient 65 years and older to hospital for admission COPD: 7 th most common cause of hospitalization; 3 rd leading cause of death by 2020 By the end of December 2008, there were 617 patients were enrolled Very exciting program Outcomes : 617 patients were enrolled between Dec. 07-Dec. 08 2 additional FHTs joined program to ensure adoption targets were met During the extension, an additional 196 patients have been enrolled
Telehomecare is designed to be a time-limited intervention, a 4 month program that focuses on patient education and self managment Patient referred by primary care physician to the THCS THCS meets with patient, obtains patient consent, establishes goals with the patient, installation of remote home-monitoring Patient begins daily readings that are submitted for four months. Self Management is a primary focus, where patient gains increased knowledge, skills and confidence to manage disease and make healthier lifestyle choices Education occurs at 3 levels, HR questions built into the software f/u phone calls in response to health data scheduled sessions 1:1 or group Includes goal setting, and reporting back. Patient discharged from program with ongoing support from primary care providers, caregivers and community resources
FHT selection criteria: EMR, connection to SSHA (provides the province wide IT infrastructure which connects health care providers in the province) Site readiness/Willingness to participate Role of OTN Technical support, clinical, ops and tech support – best practices Procurement process for CDMS application Undertook a PIA and TRA to ensure that the program met all privacy legislation FHTs are still fairly new – do not have the capacity in terms of IT, business processes Worked with a consultant who help to design the business process for FHTs – the goal was to build a collaborative model
Positive impacts on patient quality of life, enrolled patients were extremely satisfied with the program. Enhanced patient ability to self-manage their condition. FHT staff believed the program provided great benefits to their patients OTN successfully delivered the Phase One Program, developing processes with little leading practices to build on, which has provided significant learnings for the design and implementation of a provincial roll-out. Reductions in hospital admissions were observed, however, improvements in perceived health status have not yet translated into reductions in other health system indicators thus far. Given that the Family Health Teams are still developmental as a primary healthcare delivery model within Ontario, it is important to recognize that introducing more change into such systems will present challenges.
OTN and FHT readiness: 4 domains include technical, clinical operational, professional development Some of the challenges included: Tight project deadlines, Staggered hiring process, Varied backgrounds of THC nurses Broad range of skills required for the role (clinical and technical) New model of care delivery, self- management concepts, promoting adoption of best practice guidelines Inter-disciplinary teams of varied age, experience and skill levels Varying stages of readiness to learn, to change Site Readiness: Technical readiness, EMRs, SSHA connection Operational: Policies, work flows, Project environment, performance metrics Worked really hard to ensure proactive, prepared provider team Biweekly meetings, lunch and learns, bpg’s, etc
Ongoing communication and support was key at all levels throughout the program. OTN continues to support the FHTs with service desk support, and clinical side through biweekly meetings, Lunch & Learn events, site leadership meetings. This same support is required through out the different levels of project work.
From the perspective of health care utilizaiton, early evaluation findings have identified reduced hospitalizations and ER visits.
Patients have embraced self-management concepts and are reporting more assertively to their PCPs.
Monitoring gave them a greater sense of security – gave me and my family greater security; gave me more confidence; kept my anxiety in check; reassured my health was being monitored without being admitted to hospital Improved knowledge of condition (both patient and family): more aware of the symptoms; proper diet, medication, sleep, stress management; Enhanced family involvement: my husband has a better understanding, my wife likes to take care of me with the equiprment Greater independence: patients described their quality of life in terms of their ability to be independent. Patients also described quality of life in terms of the ability to participate in physical activities How can we make THC better: make the program transferable for vacations; keep monitoring equipment for the rest of my life; longer monitoring period; start the program right after I get out of the hospital; obtain remote monitoring units at a reduced cost.
King Smillie & Morris Telemedicine
CONNECTING PATIENTS TO CARE, ALL ACROSS ONTARIO Ontario Telemedicine Network Melody King-Smillie Kathy Morris Nov 5 2009
Objectives <ul><li>Provide an overview of the Ontario </li></ul><ul><li>Telemedicine Network (OTN) </li></ul><ul><li>Describe the components of Telehomecare Phase One Program </li></ul><ul><li>Discuss findings of THC Phase One Program </li></ul>
What is OTN? <ul><li>The Ontario Telemedicine Network (OTN) is one of the largest Telemedicine networks in world, helping to deliver clinical care and professional education among health care providers and patients. An independent, not-for-profit organization, OTN is funded by the Government of Ontario. </li></ul><ul><li>Programs and services are delivered in over 660 sites across the province </li></ul>
Our Mission and Vision <ul><li>Vision: </li></ul><ul><li>For telemedicine to become a mainstream channel for health care delivery and education </li></ul><ul><li>Mission: </li></ul><ul><li>To develop and support telemedicine solutions that enhance access and quality of health care in Ontario, and inspire adoption by health care providers, organizations, and the public </li></ul>
Utilization By Event Type 2008/09 fiscal Clinical Events 53,745 Educational Events 9,230 Administrative Events 9,794 Total Events 72,769
Utilization By Therapeutic Area of Care 2008/09 Fiscal
Telemedicine Site Locations <ul><li>Hospitals </li></ul><ul><li>First Nations Communities </li></ul><ul><li>Medical and Nursing Schools </li></ul><ul><li>Cancer Centres </li></ul><ul><li>Psychiatric Hospitals </li></ul><ul><li>Air Ambulance Program (ORNGE) </li></ul><ul><li>Cancer Care Ontario </li></ul><ul><li>Professional Associations (OMA, OHA, RNAO, CPSO) </li></ul><ul><li>CIHI, HIROC </li></ul><ul><li>Public Health Units </li></ul><ul><li>LHIN Offices </li></ul><ul><li>Long-Term Care Homes </li></ul><ul><li>Community Mental Health Facilities </li></ul><ul><li>Community Care Access Centres </li></ul><ul><li>Community Living Centres </li></ul><ul><li>Addiction Treatment Centres </li></ul><ul><li>Eating Disorder Clinics </li></ul><ul><li>Cardiac Rehab Centre </li></ul><ul><li>Family Health Teams </li></ul><ul><li>Rural Nurse Practitioners </li></ul><ul><li>Specialists’ Offices and Homes </li></ul><ul><li>MOHLTC Emergency Management Unit </li></ul>
Active Sites By Health Care Setting 2008/09 Fiscal
Telehomecare Leonard H. McCoy: The Final Frontier Starfleet Chief Medical Officer, U.S.S. Enterprise To boldly go…..
What is Telehomecare? <ul><li>Telehomecare is more than just the use of technology to link patients and practitioners. Telehomecare involves the use of health informatics, telehealth and disease management to enhance care and case management. The reason for doing this is to change the location of care and to make the right care at the right time accessible to patients in their own homes and local communities </li></ul><ul><li>(Dr. Adam Darkins, VHA). </li></ul><ul><li>Telehomecare is a service that gives the clinician the ability to monitor and measure patient health data and information over geographic, social, and cultural distances </li></ul><ul><li>(ATA). </li></ul>
New Programming: Telehomecare & Chronic Disease Management <ul><li>In 2007, OTN launched a Phase One Telehomecare Program, </li></ul><ul><li>Phase One of this program (March 2007 – Dec. 08) will be delivered to 600 patients in six Family Health Teams (FHTs) </li></ul><ul><li>Funded by Canada Health Infoway and the Ministry of Health and Long-Term Care </li></ul><ul><li>OTN is the Project Manager </li></ul><ul><li>Program evaluation </li></ul>
Education & Self-Management <ul><li>From Enrollment to Discharge: </li></ul><ul><li>Patient referral </li></ul><ul><li>THCS meets with patient </li></ul><ul><ul><li>obtains patient consent </li></ul></ul><ul><ul><li>care plan based on patient goals </li></ul></ul><ul><ul><li>installation of remote home-monitoring </li></ul></ul><ul><li>Daily readings </li></ul><ul><ul><li>teaching and coaching based on patient data, expressed goals & needs </li></ul></ul><ul><li>Patient discharged </li></ul><ul><ul><li>ongoing support from primary care providers, caregivers and community resources </li></ul></ul>
Telehomecare Architecture FHT FHT PH I FHT PH I PH I Support Center/Service Desk
Key Findings <ul><li>Positive impacts on patient quality of life… </li></ul><ul><li>Enhanced patient ability to self-manage their condition. </li></ul><ul><li>FHT staff believed the program provided great benefits to their patients </li></ul><ul><li>OTN successfully delivered the Phase One Program… </li></ul><ul><li>Reductions in hospital admissions were observed… </li></ul><ul><li>Family Health Teams are still developmental as a primary healthcare delivery model within Ontario, it is important to recognize that introducing more change into such systems will present challenges. </li></ul>
Health Care Utilization: 67.7% Average number of Emergency Department visits per patient/month DECREASE 63.6% Average number of hospital admissions per patient/month from baseline to discharge DECREASE 46.8% Hospital length of stay from baseline to discharge DECREASE
Patient Benefits <ul><li>Greater sense of security </li></ul><ul><li>Improved knowledge of condition </li></ul><ul><li>Enhanced family involvement in chronic disease management </li></ul><ul><li>Greater independence </li></ul><ul><li>More physical activity </li></ul>
Patient Survey Results Overall patient satisfaction with telehomecare 100% were satisfied with the telehomecare program 98% were satisfied with the information they received about their health condition 97% felt that the remote monitor equipment was easy to use 100% felt that their condition was well monitored with telehomecare
Next Steps <ul><li>Expand THC to those diseases that have the greatest burden on the health care system </li></ul><ul><li>Investigate different models of telehomecare </li></ul><ul><li>Offer a variety of CDMS products </li></ul><ul><li>Interoperability between the CDMS and EMRs and other applications </li></ul><ul><li>Provide a strong clinical function </li></ul><ul><li>Administrative and logistics support </li></ul>
Thank you For additional information about OTN, please visit www.otn.ca Melody King-Smillie [email_address] Kathy Morris [email_address]