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  • 1. View from the North Dr. Ed Brown, CEOThe Ontario Telemedicine Network
  • 2. Overview• OTN activities and results• How does it work? - the key success factors• Telemedicine as a driver for a high performing health care system
  • 3. Ontario = California + Texas + Maryland
  • 4. Ontario: 415,000 sq mi 13 million people Virginia: 43,000 sq mi 8 million people4
  • 5. OTN: Available Everywhere• One of the world’s largest & most active TM networks.• Programs & services delivered at more than 1,200 sites using 2,100 telemedicine systems Page 5
  • 6. OTN Vision Telemedicine will be amainstream channel forhealth care delivery and education. Page 6
  • 7. OTN Service Channels1. Clinical Telemedicine – live interactive videoconferencing for patient care2. Emergency Telemedicine3. Health Care Provider Education & Administration4. Store-Forward Telemedicine – Ophthalmology, Dermatology and Wound Care5. Telehomecare – Remote monitoring and self-management coaching for patients with significant chronic disease
  • 8. 1. Clinical Telemedicine
  • 9. Participating Organizations• All Hospitals • Professional Associations• First Nations Communities • Public Health Units• Medical and Nursing • Regional Infection Control Schools Units• Cancer Centres • Ontario Agency for Health• Psychiatric Hospitals Protection & Promotion &• Family Health Teams and Public Health Labs CHCs • Community Living Centres• Community Mental Health • Addiction Treatment Centres Facilities • CCAC Offices• Specialists’ Offices and • LHIN Offices Homes • Federal and Provincial• Rural Nurse Practitioners Prisons• Long-Term Care Homes
  • 10. Active Sites by Setting2009/10
  • 11. 2010 Utilization Total Patient Encounters 125,206* Educational 11,408 Administrative 12,640 Total Events 149,254* not including telehomecare Page 11
  • 12. Clinical Specialties in Telemedicine • Bariatrics • Ophthalmology • Cardiology • Orthopedics • Dermatology • Pediatrics • Endocrinology • Physiotherapy • General Surgery • Rehabilitation Medicine • Mental Health & • Speech Pathology Addiction • Teleradiology • Nephrology & Dialysis • Telestroke • Neurology • Urology • Occupational Therapy • ENT • Oncology • And 30 others
  • 13. Top 5 Therapeutic Areas of Care(Provincial)2009/10 53%
  • 14. Patient Survey Results 2008/09 data 97% were satisfied with their telemedicine visit. 79% said that telemedicine allowed them to see their provider sooner. agreed that telemedicine allows them to have more 85% regular follow-up. 83% agreed that telemedicine helps their providers work better as a team to care for them.
  • 15. Avoided Travel in the North50,000,00045,000,000 45,912,63640,000,00035,000,000 36,494,37030,000,000 32,237,56225,000,00020,000,000 18,839,887 14,944,48915,000,000 12,051,205 12,635,18510,000,000 10,043,273 8,871,796 5,000,000 0 2007/08 2008/09 2009/10 Avoided Travel in the North (kms) Estimated NHTG Cost Avoidance($) Pollutant Load Eliminated (kgs)
  • 16. 2. Tele-Emergency Services• Acute stroke• Burn• Crisis psychiatry• Sign language servicesPilot Projects:• Critical care• Trauma• Long-term care triagePage 16
  • 17. Outcomes (2009/10)Telestroke• 405 consultations and 125 tPA deliveries• 15 lives saved and $1.43M in hospital costs avoidedMental health crisis• Hospitals avoided 395 admissions/transfers
  • 18. 3. Education & Administration
  • 19. OTN Event Calendar
  • 20. Outcomes (2009/10)Education• Accessed by 362,597 learnersTravel for meetings and training• One hospital reported saving $119,000
  • 21. 4. Store Forward Tele-Dermatology
  • 22. Tele-Ophthalmology &Retinal Screening
  • 23. Outcomes (2009/10)Tele-dermatology• Mean time from referral to consultation result was 5.9 days via store-forward vs 6 months or greater face-to-faceOphthalmologist - Retinal Specialists• Reported seeing 10 patients in 40 minutes using telemedicine vs. 10 patients in 3 hours in the officeRetinal screening for diabetics• 34% of patients had untreated pathology identified
  • 24. 5. Telehomecare for Chronic Disease Management
  • 25. Telehomecare/CDM Study Outcomes Self-reported data from 813 enrolled patients with CHF and COPD• 64 – 66 % decrease in hospital admissions• 72 – 74% reduction in emergency department visits• 16 – 33% decrease in number of primary care physician visits• 95 – 97% reduction in walk-in clinic visits• High levels of patient and provider satisfaction• More than $5 in avoided hospital costs for every $1 invested
  • 26. MoHLTC Data (courtesy of OHA)
  • 27. What Does OTN Do?1. Harmonized governance2. Technical standards3. Supporting services4. Inclusive membership model5. Service effectiveness and evolution – Policies, procedures, cost reduction28
  • 28. OTN’s Multi-Enterprise Network 29
  • 29. End-Point Eco-System
  • 30. 31
  • 31. Transactional Analysis of Declining Cost Over Time 160 140 Variable Cost of All Clinical TransactionsTransactions/Dollars 122 120 102,000 100 (thousands) 80 93 60 40 43 Variable Cost Self Service 20 28 Clinical Visits 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Years
  • 32. Marketing
  • 33. The Key Driver - Provider Innovation• Surgical Telementoring in Niagara• Regional Cancer Centres in Northern Ontario• Child & Adolescent Virtual Psychiatric Emergency Room in Central East Page 34 34
  • 34. Health System Goals
  • 35. Priorities 2011 - 2014 1. Continue to increase provider awareness and adoption in support of key health care system priorities 2. Establish population-based telehomecare to support CDM 3. Develop a provincial retinal screening program 4. Continue to evolve a simple, unified, lower cost virtual telemedicine channel to support health system transformation 36
  • 36. Telemedicine Potential 2014When we are done…Benefit Annual OutcomeHospital beds freed up 800Northern Travel Grants avoided more than $35 MMiles of travel avoided 100’s of millionsAvoided emergency department visits 120,000Reduction in wait times for specialist 50%appointments (select specialties)Avoided critical care transfers in Northern 435Ontario 37
  • 37. Telemedicine Potential 2014Benefit Annual OutcomeAvoided nursing home admissions 17%Reduction in serious visual impairment 5,574 peopleAvoided stroke mortality or severe morbidity 68 peopleIncreased productivity for select specialties Up to 30%Improved knowledge transfer and mentoringImproved collaborationEnabler for transformation of our healthsystem 38
  • 38. Follow us@OTNTelemedicine