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Breakfast w chiefs-thevirtualdoctorisin20121115


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"The Virtual Doctor is In!" Ed Brown and Will Falk, Ontario Telemedicine Network and PWC, Breakfast with the Chiefs 15 November 2012

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Breakfast w chiefs-thevirtualdoctorisin20121115

  1. 1. The Virtual Doctor is In!Ed Brown and Will FalkBreakfast with the ChiefsNovember 15, 2012
  2. 2. What is vHealth?2
  3. 3. Virtualization: The Future is Now… 3
  4. 4. Topol on Virtualization (@HealthAchieve) Consumer Demands + Game Changing Technology = The Creative Destruction of Medicine (CDoM)“The idea of going down to your doctor’s office is going to feel as foreign as going to the video store” – Sean Ahrens 4
  5. 5. Berwick on Virtualization (@HealthAchieve) AFHCAN Telemedicine Cart utilized in rural Alaska: – Travel reduced 70 % – Turnaround 24 hours – ROI > 10:1 ECHO (Extension for Community Health Outcomes): – Rural primary care physician to specialist virtual consults – Treats 6-8 x more patients than traditional telemedicine 5
  6. 6. Global Examples of Virtualization of Healthcare Who How WhatKaiser • Secure email • 26% reduction in in-personPermanente • Scheduled telephone visits visitsVeterans Affairs • Two-way messaging devices for • Reduction in diabetes-related diabetic patients hospitalizations and clinic visitsSpecialists on • 24/7/365 access to highly qualified • Increased tPA administrationCall neurologists rate for qualified stroke patients • Guaranteed 15-minute response time • 1.5 to 1.8 day reduction in ALOS for stroke victimseICU (Philips) • One intensivist and two nurses cover • 10% of U.S. ICU patients 120 ICU beds • Approximately 300 hospitals, • Supports intensive care units (ICU), 40+ health systems across 34 emergency rooms, trauma, rapid states response“Consumers ready to adopt mHealth faster than health industry ready to adapt” - PwC mHealth Global Survey 6
  7. 7. Virtualization is Broader and MoreTransformative than “m-” or “e-”Health vHealth – Virtual Health Care Delivery: any care process which is delivered remotely using information and communications technology (ICT) • mHealth – Mobile Health: use of mobile and wireless devices to improve health outcomes, healthcare services and health research • eHealth – Digitization of Health Records: Our decade long journey to move the infrastructure supporting healthcare delivery 2011 BWTC we said: “25% of care and the majority of diagnostics will be vHealth by the end of the decade” 7
  8. 8. The vHealth Transition This shift to vHealth will be as dramatic as the shift in the 1980’s and 90’s from inpatient to ambulatory care; requiring major transformation and restructuring of people, assets, and care processes 8
  9. 9. Virtualization Can Be… Virtualization connects people in a multitude of ways and both synchronously and asynchronously: Typology ExampleConsumer to • Mobile technology, web portals, social networksConsumer (C2C)Provider to Consumer • Structured email, telemedicine, video conferencing(P2C)Provider to Provider • Electronic transfers, eReferral, eConsult, care(P2P) collaboration toolsMultiple Providers to • Process of care models and case management toolsConsumer (PxP2C)Machine to Machine • Cardiac rhythm monitoring, dialysis, diabetes(M2M) management, body area networks 9
  10. 10. Virtualization Will Improve… Virtualization will improve health system access, quality, productivity, and sustainability: Access Quality Productivity Sustainability• Deliver care over • Auditability of • Automated • Avoidance of long distances decisions scheduling greenhouse gases• Reduced travel • Use of • Elimination of • Ability to substitute and wait times manufacturing, “politeness time” lower cost care• Re-distribution of QI, and QA • Asynchronous providers HHR – access to techniques consultations • Auction pricing scarce • Lower infection • Ability to mechanisms specialties rates/ Infection aggregate • Artificial control volumes Intelligence 10
  11. 11. What’s happening in Ontario and what’s next?11
  12. 12. The Ontario Telemedicine Network An independent not-for-profit corporation funded by the Government of Ontario Members include 1,000 health care and education organizations Delivery partners include: – e-Health Ontario – Keewaytinook Okamakanak Telemedicine – Canada Health Infoway Page 12 12
  13. 13. OTN Vision Telemedicine will be amainstream channel forhealth care delivery and education. 13
  14. 14. OTN “Virtual” Channels 1. Healthcare Office 2. Acute Care 3. Learning 4. Home and Community
  15. 15. 1. Virtual Health Care Office
  16. 16. Videoconferencing and ElectronicMedical Devices
  17. 17. Clinical Specialties in Telemedicine • Cardiology • Oncology • Dermatology • Ophthalmology • Endocrinology • Orthopedics • ENT • Pediatrics • General Surgery • Physiotherapy • Mental Health & • Rehabilitation Medicine Addiction • Speech Pathology • Nephrology & Dialysis • Teleradiology • Neurology • Telestroke • Occupational Therapy • Urology … And 30 others
  18. 18. 2011/12 Clinical Utilization Annual Growth Patient Events 204,058 52% Consultants 1,685 13% • Physician 1,208 • Allied 477 Regular User 1,046 22% Consultants 18
  19. 19. eConsult(AKA “Asynchronous” or “Store Forward” Consultation) Send questions, patient data and/or pictures to a specialist for advice or a full consultation Current uses: dermatology, ophthalmology, wound care 19
  20. 20. Avoided Travel in Northern Ontario 20
  21. 21. 2. Acute CareProvincial 24/7 On-call: Tele-stroke Sign language services Tele-burnRegional Programs: Crisis psychiatry Trauma Critical care Long-term carePage 21 21
  22. 22. 3. Learning and Meetings 2011/12 Events* Annual Growth Education 13,967 20% Meetings 16,529 26%*Includes videoconferences, webcasts & webconferences 22
  23. 23.
  24. 24. 4.Telehomecare for ChronicDisease Management
  25. 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 26
  26. 26. OTN’s Job1. Support a single, harmonized, collaboration model2. Catalyze adoption • Providers – Organizations – Programs3. Simplify the process of organizing and doing telemedicine 27
  27. 27. Directory – Used to find specialists andprograms
  28. 28. Directory – Used to find sites to host apatient near their home
  29. 29. 30
  30. 30. What Have We Learned?1. Telemedicine videoconferencing: • Works at scale to reduce travel and improve access • Enables new, innovative models of care2. Telehomecare technology is a powerful tool when part of a good CDM program3. eConsult has enormous potential • Provider efficiency4. We have not fully addressed patients’ virtual health care needs 31
  31. 31. World of Virtual Clinical Great Firewall of Collaboration Ontario #1Great Firewall ofOntario #2Specialty Care Primary / Community Care People + Carers
  32. 32. Patient to Provider 2013 Communication • Ask a question eConsult • Video visit • Prescription refill • Appointment request View personal health information Personal Digital Health Care (for CDM) 33
  33. 33. Provider to Provider 2013 Referring Clinician Consulting Clinician eReferral 4. eConsult (ask a question)Primary Care 3. eConsult (full assessment)Family Health TeamsCommunity Hospitals 2. Clinical VideoconferenceCancer CentresFirst Nations Communities 1.Face-to-FacePsychiatric HospitalsCCACs Specialists’ OfficesMental Health Facilities Regional HospitalsFederal and Provincial Prisons On-Call Emergency PhysiciansRural Nurse Practitioners Public Health UnitsLong-Term Care Homes 34 Mental Health and Addiction Treatment Centres
  34. 34. Predicting the future is always tricky… 35
  35. 35. Reaching the Point of Critical Mass andthe Steep Part of the “S-curve” • 200k+ visits through OTN • 50% YoY growth rate • Monthly growth rate is now > 50% 36
  36. 36. Adoption Rates Are Accelerating forvHealth as they have for othertechnological advances… technology%20adoption%20rate%20century.png 37
  37. 37. We Have Been Through Similar Shifts Before… 1992… More people leavehospital after procedure Virtual than remain overnight Care Outpatient Care 202X?… More virtual visits than Inpatient physical visits Care Each transition involved people, process, and technology changes. Major shifts in how we organize our care delivery services and assets 38
  38. 38. Where Are We Headed… Primary Care: • Increased # of virtual visits • Decreased # of Patient-Doctor Personal Video in-person visitsStructured Email/ Conferencing • Improved patient Messaging Virtual Visits experience • Enhanced patient accessHow Do We Know:• Kaiser Permanente – 26% in physical visits• Ontario’s FHTs 39
  39. 39. Provider to Provider eReferral 2013will allow very different patient andinformation flows… 1. Quick Question (e-message or phone) Depending on the specialty, between 2. e-Consult 20% and 60% of e-Referral visits can be(structured delivered remotely & secure) 3. Videoconference (mix varies by specialty) 4. Face to Face Visit 40
  40. 40. Where Are We Headed… Regional Specialist Hubs (aka Virtual Group Practices) • Increased Primary Care CapacityPrimary (e.g., Project Echo) Regional Care • Increased Access (e.g., AFCAN Specialist Hubs Cart) “Franchised” • Increased Access (e.g., using Ontario Specialists On Call) MD and OTN • Decreased Costs (e.g.,Hospitals Infrastructure Emergency Neuro Image Transfer System - ENTIS) 41
  41. 41. Technical “prescriptions” will be made along with pharmaceutical prescriptions Pharma Rx vs.Tech Rx App Formulary • UK – Cambridge Healthcare – “Europe’s Pharma Retail First Health-App Formulary Pharmacy Store” developing certification process for apps it sells. Remicade • US - Happtique –Diagnosis market-leader in health apps published set of standards to certifyCrohn’s App Virtual apps: Formulary Pharmacy • Operability • Privacy • Security myIBD • Content Reliability 42
  42. 42. “Bespoke eHealth” will involve thephysician, other care providers, thepatient and family Apps Pharmacy not Apps Store Tech Rx Take 2 Apps and Call Me in the Morning Apps Formulary AliveCor Cardiac Withings Blood Pressure bant Diabetes Pain Squad Pain Mgmt MyIBD Crohn’s Disease 43
  43. 43. Mobile Health (using “phablets”) will be a keypart of a low cost infrastructure. A variety ofapproaches exist… Ottawa Hospital • “Walled Garden”, Speed & Scale • Expensive but comprehensive Hamilton Health Sciences • “BYOD “Access to Integrated Care Record • Integrated and inexpensive University Health Network • Cultural Revolution, “Let a Thousand Flowers Bloom” • Innovative Research not operational (yet) Mount Sinai Hospital • Replacing the Clinical Interface • Intuitive but disruptive 44
  44. 44. What Now? Rx for Ontario’s Future 45
  45. 45. This is a Big Change“In times of profound change, the learners inheritthe earth, while the learned find themselvesbeautifully equipped to deal with a world that nolonger exists.” -Al Rogers 46
  46. 46. OTN Plans Continue OTN’s work to make it simpler for providers to “find each other, organize and do” virtual health care and education Work with key partners across the eHealth ecosystem to advance eConsult and eReferral Work with LHINs and other organizations to expand personal digital health care use in chronic disease management 47
  47. 47. Challenges New, collaborative way of working among providers required – Mutual commitments – New workflows Provider / physician payment New technology solutions need to be implemented – P2C – local solutions – P2P – regional or provincial solution(s) Community Leadership 48
  48. 48. What Leaders Can Do Now Get providers to sign up for OTN’s Personal Videoconferencing Portal in Q4 Bring your provider network together to plan virtual health care Hospitals and Primary Care/FHTs have special leadership roles: – Build your community of practice for eConsult and “virtual ward” – Motivate and arm primary care to deliver virtual health to their patient populations 49