Breakfast w chiefs-thevirtualdoctorisin20121115

Breakfast w chiefs-thevirtualdoctorisin20121115

• 1.
  The Virtual Doctoris In! Ed Brown and Will Falk Breakfast with the Chiefs November 15, 2012
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  What is vHealth? 2
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  Virtualization: The Futureis Now… 3
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  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
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  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
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  Global Examples ofVirtualization of Healthcare Who How What Kaiser • Secure email • 26% reduction in in-person Permanente • Scheduled telephone visits visits Veterans Affairs • Two-way messaging devices for • Reduction in diabetes-related diabetic patients hospitalizations and clinic visits Specialists on • 24/7/365 access to highly qualified • Increased tPA administration Call neurologists rate for qualified stroke patients • Guaranteed 15-minute response time • 1.5 to 1.8 day reduction in ALOS for stroke victims eICU (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
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  Virtualization is Broaderand More Transformative 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
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  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
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  Virtualization Can Be… Virtualization connects people in a multitude of ways and both synchronously and asynchronously: Typology Example Consumer to • Mobile technology, web portals, social networks Consumer (C2C) Provider to Consumer • Structured email, telemedicine, video conferencing (P2C) Provider to Provider • Electronic transfers, eReferral, eConsult, care (P2P) collaboration tools Multiple Providers to • Process of care models and case management tools Consumer (PxP2C) Machine to Machine • Cardiac rhythm monitoring, dialysis, diabetes (M2M) management, body area networks 9
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  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
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  What’s happening inOntario and what’s next? 11
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  The Ontario TelemedicineNetwork 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
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  OTN Vision Telemedicinewill be a mainstream channel for health care delivery and education. 13
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  OTN “Virtual” Channels 1. Healthcare Office 2. Acute Care 3. Learning 4. Home and Community
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  1. Virtual HealthCare Office
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  Videoconferencing and Electronic MedicalDevices
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  Clinical Specialties inTelemedicine • 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
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  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
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  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
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  Avoided Travel inNorthern Ontario 20
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  2. Acute Care Provincial24/7 On-call: Tele-stroke Sign language services Tele-burn Regional Programs: Crisis psychiatry Trauma Critical care Long-term care Page 21 21
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  3. Learning andMeetings 2011/12 Events* Annual Growth Education 13,967 20% Meetings 16,529 26% *Includes videoconferences, webcasts & webconferences 22
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  http://learning.otn.ca/
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  4.Telehomecare for Chronic DiseaseManagement
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  Telehomecare/ CDM StudyOutcomes 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
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  OTN’s Job 1. Support a single, harmonized, collaboration model 2. Catalyze adoption • Providers – Organizations – Programs 3. Simplify the process of organizing and doing telemedicine 27
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  Directory – Usedto find specialists and programs
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  Directory – Usedto find sites to host a patient near their home
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  What Have WeLearned? 1. Telemedicine videoconferencing: • Works at scale to reduce travel and improve access • Enables new, innovative models of care 2. Telehomecare technology is a powerful tool when part of a good CDM program 3. eConsult has enormous potential • Provider efficiency 4. We have not fully addressed patients’ virtual health care needs 31
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  World of VirtualClinical Great Firewall of Collaboration Ontario #1 Great Firewall of Ontario #2 Specialty Care Primary / Community Care People + Carers
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  Patient to Provider2013 Communication • Ask a question eConsult • Video visit • Prescription refill • Appointment request View personal health information Personal Digital Health Care (for CDM) 33
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  Provider to Provider2013 Referring Clinician Consulting Clinician eReferral 4. eConsult (ask a question) Primary Care 3. eConsult (full assessment) Family Health Teams Community Hospitals 2. Clinical Videoconference Cancer Centres First Nations Communities 1.Face-to-Face Psychiatric Hospitals CCACs Specialists’ Offices Mental Health Facilities Regional Hospitals Federal and Provincial Prisons On-Call Emergency Physicians Rural Nurse Practitioners Public Health Units Long-Term Care Homes 34 Mental Health and Addiction Treatment Centres
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  Predicting the futureis always tricky… 35
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  Reaching the Pointof Critical Mass and the Steep Part of the “S-curve” • 200k+ visits through OTN • 50% YoY growth rate • Monthly growth rate is now > 50% 36
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  Adoption Rates AreAccelerating for vHealth as they have for other technological advances… http://cdn.theatlantic.com/static/mt/assets/business/ technology%20adoption%20rate%20century.png 37
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  We Have BeenThrough Similar Shifts Before… 1992… More people leave hospital 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
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  Where Are WeHeaded… Primary Care: • Increased # of virtual visits • Decreased # of Patient-Doctor Personal Video in-person visits Structured Email/ Conferencing • Improved patient Messaging Virtual Visits experience • Enhanced patient access How Do We Know: • Kaiser Permanente – 26% in physical visits • Ontario’s FHTs 39
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  Provider to ProvidereReferral 2013 will allow very different patient and information 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
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  Where Are WeHeaded… Regional Specialist Hubs (aka Virtual Group Practices) • Increased Primary Care Capacity Primary (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
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  Technical “prescriptions” willbe 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 certify Crohn’s App Virtual apps: Formulary Pharmacy • Operability • Privacy • Security myIBD • Content Reliability 42
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  “Bespoke eHealth” willinvolve the physician, other care providers, the patient 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
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  Mobile Health (using“phablets”) will be a key part of a low cost infrastructure. A variety of approaches 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
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  What Now? Rxfor Ontario’s Future 45
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  This is aBig Change “In times of profound change, the learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” -Al Rogers 46
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  OTN Plans ContinueOTN’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
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  Challenges New, collaborativeway 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
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  What Leaders CanDo 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
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  THANKS! @OTNTELEMEDICINE AND @WILLFALK