eHealth Innovations in the Haliburton Highlands

June 10, 2015

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Agenda

• Strategic Context• Organizational Strategy• IT Strategy• Remote Patient Monitoring Projects

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Strategic Context

MoHLTC & Provincial eHealth Objectives

HHHS Vision, Mission,

Strategic Plan

Community Partners & CE

LHIN

EHR & Industry Trends, Standards

Infra

stru

ctur

eFo

unda

tionIM/IT Strategic & Tactical Plan

Patient Transfers 2013/14

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Historic Future

Individual care providers Collaborative teams of providers

Treating individuals when sick Keeping populations healthyFocus on volumes Focus on volumes and outcomes

Maximize resources & assets Appropriate levels of care at the right placeCare 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 communityBest 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 HubProvider centric (little information transfer) Patient and Family Centric, sharing, and transparentUninformed 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

Adapted from: http://practicalanalytics.wordpress.com/2013/07/15/informatics-or-analytics-understanding-healthcare-provider-use-cases/

Heal

thca

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rend

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Strategic ContextAvailability of EMRsPatient CentricInnovationAccelerated Elec Recs

RM&R, cGTA, OLISHRMChronic DiseasePanoramaCCO

Improved Access to CareAccess & Wait TimesFunding ReformSystem Design & IntegrationTransitions, Quality & Safety

MobilityeHealth ConsumersIntegrated D.SInformation Sharing

IntegrationCommunity EngagementEffective People & TeamsQuality & ExcellenceSustainability

Secure Access to InformationInteroperabilityEfficient & EffectivePredictive & AdaptableCollaborative

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Strategic Plan 2014-2017

Compassion • Accountability • Integrity • Respect

Health SystemIntegration

Leaders in Innovative

Rural Health Care

CommunityEngagement

Sustainability

EffectivePeople and

Teams

Quality and Service

Excellence

Minden Hospital / Hyland Crest Long-Term Care Home

Haliburton Hospital / Highland Wood Long-Term Care Home

Community Support Services

SupportiveHousing Offices:

Haliburton, Minden, Wilberforce

Rural Health Hub Structure

Mental Health Services

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IT STRATEGY & INNOVATIVE PROJECTS Haliburton Highlands Health Services

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IT Strategic Plan

15/16 16/17 17/18 18/19 19/20

FHT

Financial System

CCAC CSS - Devices

Support EMSCIS

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 DocumentsCCP: Coordinated Care PlanCIS: Clinical Information SystemCSS: Community Support Services

CIS PreparationOrder Sets

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IT BenefitsPatient 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

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Remote Patient MonitoringUniversity 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%2

BPatient%2BMonitoring%2BImproves%2BHeart%2BFailure%2BManagement-SD%20copy.mp4

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Remote Patient MonitoringOntario 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

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

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 ModelConsistent results across LHINs

– 48-56% reduction in ED visits– 44-57% reduction in Hospital Admissions

Sustained Results, 6 months postSustained reduction in ER & inpatient admissions 6 months

post THC discharge

ED Visits 56% - 71% reduction

Inpatient Admissions 56 % - 76% reduction

OTN Telehomecare Model

Telehomecare Patient FeedbackPatient 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

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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

Leaders in Innovative Rural Health Care

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QUESTIONS?