4. Strategic Context
4
MoHLTC & Provincial eHealth Objectives
HHHS Vision,
Mission,
Strategic Plan
Community
Partners & CE
LHIN
EHR & Industry
Trends, Standards
Infrastructure
Foundation
IM/IT Strategic & Tactical Plan
6. Historic Future
Individual care providers Collaborative teams of providers
Treating individuals when sick Keeping populations healthy
Focus on volumes Focus on volumes and outcomes
Maximize resources & assets Appropriate levels of care at the right place
Care at centralized facilities Patient-convenient care sites / centres of excellence
Treating patients all the same Customize care for each patient & family (based on standards)
Challenges with chronic patients Create venues for special Chronic Care services
Responsive to those seeking service Responsive to the needs of the community
Best Efforts Highly reliable organization
Reactive to Financial / Business indicators Case based clinically integrated costs
Treatment in a Health Facility Treatment through an integrated partnership
Health provider silos throughout the community Integrated Health Hub
Provider centric (little information transfer) Patient and Family Centric, sharing, and transparent
Uninformed Patients Informed and Highly Engaged Patients (when capable)
Do it for me & treat my disease / condition Do it with me (and my coach) – holistic needs
Strategic Context - Key Trend Changes in Healthcare
6Adapted from: http://practicalanalytics.wordpress.com/2013/07/15/informatics-or-analytics-understanding-healthcare-provider-use-cases/
7. Strategic Context
7
Availability of EMRs
Patient Centric
Innovation
Accelerated Elec Recs
RM&R, cGTA, OLIS
HRM
Chronic Disease
Panorama
CCO
Improved Access to Care
Access & Wait Times
Funding Reform
System Design & Integration
Transitions, Quality & Safety
Mobility
eHealth Consumers
Integrated D.S
Information Sharing
Integration
Community Engagement
Effective People & Teams
Quality & Excellence
Sustainability
Secure Access to Information
Interoperability
Efficient & Effective
Predictive & Adaptable
Collaborative
8. Strategic Plan 2014-2017
8
Compassion • Accountability • Integrity • Respect
Health System
Integration
Leaders in
Innovative
Rural
Health Care
Community
Engagement
Sustainability
Effective
People and
Teams
Quality and Service
Excellence
9. Minden Hospital / Hyland Crest
Long-Term Care Home
Haliburton Hospital / Highland Wood
Long-Term Care Home
Community Support
Services
Supportive
Housing Offices:
Haliburton, Minden,
Wilberforce
Rural Health Hub Structure
Mental Health Services
10. IT STRATEGY & INNOVATIVE PROJECTS
Haliburton Highlands Health Services
10
11. IT Strategic Plan
11
15/16 16/17 17/18 18/19 19/20
FHT
Financial
System
CCAC CSS - Devices
Support EMS
CIS
Plan / Pilot Big Pilot Deploy
Personal Technology – Hand or Home Health
(& Monitoring)
Support CCP
testing
Support CCP Provincially
Planned Discharge
Notification to CCAC
CCD to Practice
Solutions
Lab / DI Info to
Practice Solutions
CCD: Continuity of Care
Documents
CCP: Coordinated Care
Plan
CIS: Clinical Information
System
CSS: Community Support
Services
CIS PreparationOrder Sets
12. IT Benefits
12
Patient Story
•One Chart
•Big Picture / My Picture
•Trending and
Intelligence
•Team Communication
Process Improvement
•Clear Plan of Care
•Time to Care
•Safe
•Less Waste
Performance
Intelligence
•Standardized Care
•Patient Goals Tracking
•Follow-up / Follow-thru
•Teamwork
Patient Self-
Management
•Education
•Navigation
•Direct My Care
•Contribute to My Care
Learn and Improve
•Identify Issues
•Tools to Improve
•Enable Education
•Enable Research
13. Remote Patient Monitoring
University Health Network (UHN) eHealth Global Innovation Group
• UHN project 1:
– Jointly submitted for the SPOR project, not disease specific.
• UHN project 2 option a:
– Home Remote Monitoring: Diabetes or heart
– Need a dedicated % staff. Lifestyle management.
– Health Coach – focus on preventing adverse events
• UHN project 2 option b:
– Self – Management. Phones and peripherals in less high risk, for 3-6 months.
Need teachable moments with Physician
• https://dl.dropboxusercontent.com/u/30476893/mHealth%2BRemote%2B
Patient%2BMonitoring%2BImproves%2BHeart%2BFailure%2BManagemen
t-SD%20copy.mp4
13
14. Remote Patient Monitoring
Ontario Telemedicine Network (OTN) Telehomecare Model
• Supports patients living in their own homes through health coaching and
monitoring
• Delivered by clinicians with training in self-management support and
health coaching
• Complements the care provided by the primary care provider
• Time limited secondary-prevention intervention for patients with COPD
or CHF
• Derived from evidence based guidelines, and approved by a provincial
clinical expert committee
• https://www.youtube.com/watch?v=zXtF47XC0Hg
14
15. OTN Telehomecare Model
Clinician Health Coaching:
Teaching the Patient how to self-manage
& meet their goals
Patient Empowerment:
At home; Sets Personal Goals; Submits
vitals/ health responses
Simple Technology in Home:
Tablet, BP Cuff, Scale & Pulse oximeter
Efficient MRP Engagement:
Clinician provides regular updates, consults
as required
Remote Patient Monitoring:
Weekday feeds & Alerts
16. TC -reduced ED Visits by 48% and
Hospital Admissions by 44%.
CW - reduced ED Visits by 56% and
Hospital Admissions by 58%.
Central - reduced ED Visits by 48% and
Hospital Admissions by 57%.
OTN Telehomecare Model
Consistent results across LHINs
– 48-56% reduction in ED visits
– 44-57% reduction in Hospital Admissions
17. Sustained Results, 6 months post
Sustained reduction in ER & inpatient admissions 6 months
post THC discharge
ED Visits 56% - 71% reduction
Inpatient Admissions 56 % - 76% reduction
OTN Telehomecare Model
18. Telehomecare Patient Feedback
Patient Experience (Toronto Central Results)
– 87% of the patients would definitely recommend the program to others
– 98% agreed that the THC nurses understood what was important to them
– Managing medications properly was the most important patient learning
“I can’t see why anyone wouldn’t
want to try Telehomecare. It was so
simple, so enjoyable to learn. I’d
rather do this than leave it to
chance. It’s my life I’m dealing
with…I’m looking for just a little
longevity. It’s a no brainer.”
- Ian, Telehomecare Patient
OTN Telehomecare Model
19. HHHS Benefits and Challenges
Benefits / Strengths
• Focused on patient safety and
experience
• Focused on community
engagement
• Looking for information mobility in
the community
• Deep desire for sustainability and
predictability
• Committed IS/IT partners
• Desire to link and leverage
• Desire improved integration
• Keeps the personhood of the
patient in mind
Challenges
• Small hospital with aging patient
population
• Highly dependent on IS/IT partners
• Younger staff recruited expect
electronic systems
• Physicians are looking for a clear,
integrated, and fairly rapid pathway
to electronic records
• Resources
• Need better communication
efficiency
• Desired pace of change may exceed
capacity to deliver without strong
partnerships
19
