The Canadian Pathway to an Integrated
System for the Delivery of Children’s
Health Care
National Healthcare Conference, Ir...
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care...
Medicare in Canada
“Canada's national health insurance program, often referred to as "Medicare", is
designed to ensure tha...
Canadian Healthcare System Funding Model
 The Federal government transfers funds to provinces and territories
 The fundi...
Agenda
5
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integr...
Vision
Mission
As innovators in child health since
1875, we lead and partner to improve
the health of children provinciall...
OUR PEOPLE
10,000Total headcount on 31 March 2013
The Hospital for Sick Children encompasses a large
number and wide varie...
 15,000 admissions
 12,000 operations
 280,000 outpatient visits
 64,000 Emergency Room visits
 Average length of sta...
Centre for Research and Learning
• Opened Sept 2013
• Corner of Bay and Elm St.
in downtown Toronto
• 21 Stories plus belo...
10
1971
2000
2001
2013
1908First Canadian milk pasteurization plant installed – 30 years before it
is mandatory
1930
1951
...
11
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated C...
Drivers for Health System Integration in Canada
Canadian
Healthcare
SystemIncreasing Costs
Increasing
Utilization of
Servi...
Value Proposition for Health System Integration
 Health Outcomes
 Patient and Family Experience
 Provider Productivity ...
Social determinants of health
Preventive health
Primary care
Advocacy Care deliveryAdvising
Few potential actors
Many pote...
 How do we define ourselves?
• What set of services do children and families need us to deliver
across these patient coho...
Provincial
National
Child &
Family
Canadian Paediatric Society
Canadian
Association of Paediatric Surgeons
Children’s Ment...
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care...
Integrated Complex Care Model
Page 18 18
Family
Lead
Clinical
Lead
Systems
Lead
Child
Family Health Teams
Primary Care Pro...
Ontario Paediatric Tertiary Hospitals
Tertiary Paediatric Sites
Community-based SickKids
Complex Care Hospital Programs
• ...
eCHN – A Made in Ontario EHR Solution
C
C C
C
C
C
C
C
C
eCHN PARTNER SITES:
• 106 Hospital sites
• 80+ Community Care Acce...
SickKids Telepsychiatry Sites
SickKids
Telepsychiatry Sites
• Connects mental health
experts with patients,
families/ care...
• Hospitals as highly concentrated
points of health care
• Medical records as a disconnected
set of snapshots of health
• ...
Looking Inward
• Where can we improve quality and
better manage resources?
• Where can we redesign systems
to be more effi...
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Cathy Seguin, Vice President, International Affairs, SickKids Toronto

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The Canadian Pathway to an integrated System for the delivery of Children's Healthcare

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Cathy Seguin, Vice President, International Affairs, SickKids Toronto

  1. 1. The Canadian Pathway to an Integrated System for the Delivery of Children’s Health Care National Healthcare Conference, Ireland April 2014
  2. 2. • Canadian Healthcare System • Introduction to SickKids • Integrated System of Health • Evolving Models of Integrated Care Agenda 2
  3. 3. Medicare in Canada “Canada's national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis.” Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage.” Source: Health Canada www.hc-sc.gc.ca 3 Canada Health Act  Public Administration  Comprehensiveness  Universality  Portability  Accessibility  (No Private Care)
  4. 4. Canadian Healthcare System Funding Model  The Federal government transfers funds to provinces and territories  The funding is a mix of public (70%) and private (30%)  Provincially, in Ontario, the Ontario Ministry of Health and Long-term Care (MoHLTC) is responsible for stewardship, setting legislation and strategy • There are 14 Local Health Integration Networks (LHINs) that plan, fund and integrate services at the local level • 14 Community Care Access Centres (CCACs) 4
  5. 5. Agenda 5 • Canadian Healthcare System • Introduction to SickKids • Integrated System of Health • Evolving Models of Integrated Care
  6. 6. Vision Mission As innovators in child health since 1875, we lead and partner to improve the health of children provincially, nationally and internationally through the integration of care, research and education. Values Excellence, Integrity, Collaboration, Innovation • Established in 1954 • Canada’s first child health RI • Established in 2007 • Advances education at SickKids • Connects and supports the many education initiatives underway across the organization and beyond • Established in 1972 • Largest non-governmental granting agency in child health in Canada • Over the past 2 years, the Foundation has provided over $200 million to the Hospital • Established in 2006 • Collaborates with international partners to improve children’s health globally through the advancement of child health education, clinical and research initiatives 6 The Hospital for Sick Children
  7. 7. OUR PEOPLE 10,000Total headcount on 31 March 2013 The Hospital for Sick Children encompasses a large number and wide variety of divisions and units 255 specializations and sub-specializations 1,102 Research Staff 7 1,486 Residents, Fellows & Students 5,195 Hospital Staff (Excluding Fellows & Students) 1,573 Volunteers 653 Physicians (Active & Associate Medical Staff) More Than a Hospital…A Community
  8. 8.  15,000 admissions  12,000 operations  280,000 outpatient visits  64,000 Emergency Room visits  Average length of stay 6.6 days 8 Annual Activity
  9. 9. Centre for Research and Learning • Opened Sept 2013 • Corner of Bay and Elm St. in downtown Toronto • 21 Stories plus below- grade parking • 750,000 square feet • $400MM project cost 9
  10. 10. 10 1971 2000 2001 2013 1908First Canadian milk pasteurization plant installed – 30 years before it is mandatory 1930 1951 Moved to current location at 555 University Avenue 1954 Research Institute is established – a first at a Canadian hospital 1919 Development of Pablum 1957 Salter’s congenital hip dislocation procedure developed 1963 Mustard’s "blue baby“ procedure developed1964 Opened paediatric intensive care units – one of the first in North America 1972SickKids Foundation was established 1989 Cystic Fibrosis gene discovered 1993Opened the Atrium, a $232M state-of-the-art patient facility 2003 2004 2006 Potential of stem cells found in adult skin Cancer stem cell for brain tumours identified Copy number variation in genome discovered 2007Opened state-of-the-art paediatric cardiac diagnostic interventional unit 2007 Key breakthrough in diabetes – discovery of link between diabetes and the nervous system Led autism genome discovery2009 Paediatric world first: transplant procedure using Interventional Lung Assist device Canadian first: baby receives heart procedure in utero Opened world’s first paediatric magnetoencephalography (MEG) facility Research & Learning Tower opens First successful separation of conjoined twins Opened world’s first Image-Guided Therapy suite 1875 SickKids is founded – the second children’s hospital in the British Empire 2008 2010Groundbreaking of The Research & Learning Tower 2010 New genetic findings linking key genetic variations to autism. SickKids’ Legacy of Innovation 10 Blood transfusion pioneered
  11. 11. 11 • Canadian Healthcare System • Introduction to SickKids • Integrated System of Health • Evolving Models of Integrated Care Agenda 1
  12. 12. Drivers for Health System Integration in Canada Canadian Healthcare SystemIncreasing Costs Increasing Utilization of Services Healthcare Provider Shortage Fragmentation and Duplication in Healthcare “system” New Funding Models Improving Health Outcomes Enhancing the Patient and Family Experience Health System Integration 12
  13. 13. Value Proposition for Health System Integration  Health Outcomes  Patient and Family Experience  Provider Productivity and Satisfaction  Costs  Inefficient Use of Scarce System Resources  Fragmentation of Care 13
  14. 14. Social determinants of health Preventive health Primary care Advocacy Care deliveryAdvising Few potential actors Many potential actors SickKids Today Research Quaternary medical care Tertiary care Emergency and secondary hospital care Increasing public spending There are Many Ways to Have Impact Across the Healthcare System 14
  15. 15.  How do we define ourselves? • What set of services do children and families need us to deliver across these patient cohorts? • How do we facilitate a coordinated system? • How can we enhance, facilitate, or otherwise impact those necessary services that we don’t directly deliver? • What partnerships do we leverage to improve the system? We Will Need to Define Our Identity in the Healthcare System 15
  16. 16. Provincial National Child & Family Canadian Paediatric Society Canadian Association of Paediatric Surgeons Children’s Mental Health Ontario Provincial Council for Maternal and Child Health Ontario Association of Children’s Rehabilitation Centres Ontario Association for Infant and Child Development electronic Child Health Network (eCHN) Local CCAC’s SickKids LHIN’s Paediatric Partnerships that Exist to Define & Execute the Strategy Canadian Association of Paediatric Health Centres
  17. 17. • Canadian Healthcare System • Introduction to SickKids • Integrated System of Health • Evolving Models of Integrated Care Agenda 1
  18. 18. Integrated Complex Care Model Page 18 18 Family Lead Clinical Lead Systems Lead Child Family Health Teams Primary Care Providers Community Health Centres Clinics Inpatient Programs Clinics Inpatient Programs Support Services Respite Day Care Schools CCAC Care Coordination CCAC Service Provider Direct Health & Support Services 0.14% of Ontario’s paediatric population uses 54% of provincial paediatric resources
  19. 19. Ontario Paediatric Tertiary Hospitals Tertiary Paediatric Sites Community-based SickKids Complex Care Hospital Programs • 3.0 M children 0-18 yrs • Inpatient distribution by tertiary centre: • SickKids 42% • Hamilton 18.5% • Ottawa 18% • London 15.3% • Kingston 6.2%
  20. 20. eCHN – A Made in Ontario EHR Solution C C C C C C C C C eCHN PARTNER SITES: • 106 Hospital sites • 80+ Community Care Access sites • 2100+ Physician offices (incl. clinics) • 30+ Children’s Treatment Sites • 2.3M+ patients C C C C C C C C C C eCHN GROWTH: • Unique users: 5,143 (+240% since 2011) • Monthly logins: 13,000 (+ 116% since 2011) • Documents viewed in 2013: 380,000 (+36% since 2011) • OLIS lab results added • Added Diabetes tracking tool 20 eCHN Hospital Partner Community Care PartnerC
  21. 21. SickKids Telepsychiatry Sites SickKids Telepsychiatry Sites • Connects mental health experts with patients, families/ caregivers and professionals • Provides clinical assessments, capacity building and education • 2000 appointments per year • External partners:  Children's Mental Health Agencies  Hospitals  Physicians  Schools  Young Offender Facilities  Nursing Stations • 35% of our work is with First Nations and Aboriginal communities • access up to 75 Child and Adolescent Psychiatrists with subspecialization
  22. 22. • Hospitals as highly concentrated points of health care • Medical records as a disconnected set of snapshots of health • Patients depend on medical system for monitoring, decision making, access • Patients responsible for integration across points of contact • Care is distributed across a number of venues depending on the necessary degree of specialization • Medical records are a continuous representation of patient state • Patients have greater ability for self- monitoring, participating decision making • System provides integration across venues 22 The Future is Systems That Transcend Time, Space and Specialty
  23. 23. Looking Inward • Where can we improve quality and better manage resources? • Where can we redesign systems to be more efficient? • How do we prepare to do more with (relatively) less?  Technology  People  Processes Looking Outward • Where else in the system can we help improve quality and resource management? • How do we share what we’ve learned about efficient and effective systems for paediatric care? • How do we anticipate changes in other parts of the system? 23 Questions to Frame Our Thinking Going Forward

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