‘More People, Healthier, Longer’ The York Region eHealth Project

Dr. Harvey Skinner, Dean Faculty of Health, York University, Toronto, Canada

Luxembourg Health Summit, May 3, 2012

local

global

How many people in India have access to mobile phones?

Amber Fort, Jaipur

Chronic conditions leading cause of death . . .

Chronic Disease and Obesity: GLOBAL HEALTH ISSUES

WHO. World Health Statistics. 2008.

Kelly T. Int J Obesity. July 8, 2008.

Global overweight

and obesity

57.8% 2030

2005 33%

By 2030, chronic conditions will cause 75% of all deaths globally

Our Lifestyle PUTS US AT RISK

• Inactivity increases insulin resistance, which is intimately linked to type 2 diabetes

• Only 49% of Canadians (aged 20+) are at least moderately active during their leisure time.

• Every 2 hours per day of television watching has been shown to be associated with a 14% increase in the risk of type 2 diabetes.

• 150 minutes of Physical Activity per week is associated with a ~60% decrease in the risk of type 2 diabetes

www.cflri.ca.

Hu FB. JAMA. 2003.

The Challenges are Large

but not Insurmountable

What if eHealth could enable game changing Health Solutions?

Overview of the Connected Wellness Platform eHealth system for delivering people-centred health

Illustrate mobile eHealth technology for care of diabetic patients and health promotion with university students

Outline research projects underway for improving patient outcomes and system transformation

The BIG Idea

‘Keeping more people healthier longer’

Building an integrated and sustainable health promoting & care system

Addressing both the Demand and Supply sides of the system

‘First Health, Then Medicine’

York Region/GTA

‘innovation ecosystem’

0ne million people, fastest

growing region in Canada,

culturally diverse

Demonstration Model projects for designing and testing integrated solutions:

• patient health outcomes

• clinician/staff workload & satisfaction

• service utilization

• system quality & safety

• savings: return on investment

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• Cloud-based software system

– Allows patients, their family, their friends and their care teams to collaboratively manage health and wellness through the use of innovative applications

– Will assist in chronic disease management for patients and health professionals who use the system

– Enables collaborative care teams by providing transparency and security among service providers while respecting privacy

The Connected Wellness Platform

$15.5 Federal Government funding for the development of the Platform. The total project size is $37 million.

Collaborative effort of York University (the applicant and administrator of the project), NexJ Systems, McMaster University and other academic, and industry partners

Delivering People-Centred Health

Provider Registry

Extensible Electronic

Health Records

Patient Registry

Health Analytics

• EMRs • EHRs • Google

Health • Health Vault • OntarioMD

External Systems

Patient Portal

• CCR • CCD • CDS

Provider Health Platform

Consumer Health Platform

Analytics Server EHR Server

Universal Health Connector

Provider Portal

Disease Surveillance

Health Insurance

Shared EHR

Credentialing

Health Coaching

HIAL

HL7

Identifies provider credentials Identifies patients & consents Stores clinical data

Integrated view of patient’s Electronic Health Record Personal Health Record

Connectivity & integration of medical device data

Connectivity & clinical data exchange

Maintain de-identified data for analysis & reporting

Patients maintain PHR & interact with care team

Consumer applications enable interactive care

Integrated Provider Portal applications extend collaborative care

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Provider Registry

Patient Registry

Electronic Medical Record

Mobile eHealth

Provider Portal

Patient Portal

Physician Credentialing

Evidence-based Best Practices

Behavior Change for Wellness

Disease Screening

Analytics on Outcomes

eHealth Deployment Strategy

eHealth Solutions Condition by Condition

Legacy Connectivity

Health Information Exchange

Health Coaching enabled by eHealth

Type 2 diabetics given free BlackBerry (& data) pre-loaded

with NexJ Health Coach

Log diet, exercise, mood and energy

Health Coach monitors, prescribes plans & motivates via mobile or a

secure portal

Daily secure communications & reminders via mobile

Culturally congruent instructional videos

Instructional Multimedia

Trusted multimedia content from health library

Context aware

delivery

Personalized 1-on-1 instructional messages

Secure Messaging

Allows patients to communicate with their care team

Built into portal Secure and auditable

Tracking “How I Feel”

Allows patients to track their wellbeing and observations

Meal Tracking

Easy-to-use logging of food intake

Allows Patients to take a photo, and comment

Tracks portion size, source and healthiness

Exercise Log

Allows users to log their exercise duration intensity and comments

Biomedical Measurements

Allows Patients to capture their readings from biomedical devices

Supports □ Blood Pressure

□ Glucose

□ Weight

□ Body Temperature

Bluetooth connectivity option enables automatic uploading of readings

Medication Adherence

Personalized medication tracking

Enables Patients to be reminded to take their medications

Allows logging of adherence and comments

Personal Health Coaching to Promote Behaviour Change

Provider Portal

Physician prescribes

personalized health

metrics for patient to

track condition.

Mobile Health Coach

Patient receives health

coaching and records

personal health metrics.

Patient Portal

Patient understands the

relationship between their

behaviour, bio-metrics, and

how they feel. The patient

becomes self managing

through sustained behaviour

change.

What is diabetes control and why should we care?

Adapted from DCCT Research Group: N Eng J Med. 1993;329(14):977-986. * AACE recommends A1c ≤6.5 (AACE Guidelines. Endocr Pract. 2007.13(Suppl):13-68.).

1

3

5

7

9

11

13

15

6 7 8 9 10 11 12

Eye disease

Kidney disease

Nerve damage

A1c (%)

Rel

ativ

e R

isk

of

Co

mp

licat

ion

s ( ‘

X’

tim

es m

ore

like

ly ‏(

7.0* CDA Target

Risk Reduction with Lowered A1c

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STRESS PHYSICAL ACTIVITY

Model Patient: North York Family Health Team Dr. Paul Ritvo and Colleagues

• Baseline HbA1C = 8.5%

• 3 month HbA1C = 7.0% - Reduction of 1.5%

• Physician decreased daily dose of Diamicron from 60mg -> 30mg in Response to lower glucose levels

Blood Glucose – Daily View June 8 – June 18, 2011

Blood Glucose – Daily View October 23 – October 30, 2011

Blood Glucose – Weekly AVG June 2011 – Oct 2011

Radical

reduction by

week 4

results in

physician

reduction of

Diamicron

dose

Regulation

then under

more

behavioural

control

Exercise & Blood Glucose – Daily View August 29 – September 26

Exercise

increases to

several

sessions/

wk.

Death in

family

results in 3-

day

exercise

gap &

glucose

spike,

followed by

resumption

& reduction

Food View October 16-19

Food pictures

reflect healthier

choices

Close up of Food October 17, 2011 – 6:24pm

*Note: absence

of simple

carbohydrates

& introduction

of salad

Healthy Eating ‘app’

• While eating choice is being made….help someone make healthier choice

• After GPS location, ‘app’ suggests proximal eating place

• With additional ‘click’, healthy options per eating place viewed

Health Coach: a New Health Profession

Core Competencies

•Uses cognitive-behaviour & motivational strategies to foster healthy behaviour

•Integrates health-behavioural programming with mobile technology

•Skilled in accessibility - working with people with a disability (eg. communication)

•Helps people navigate both the health care and health promotion systems

•Plays a key integrator role in health teams and community agencies

Training

•Basic: certificate subspecialty linked with undergraduate programs

•Advanced: professional Master’s, graduate Master’s Certificate

•Professional Development: short programs offered by the Health Leadership

and Learning Network (HLLN)

Research & Development

•Developing and evaluating (evidence based) Health Coaching initiatives at the

individual, organizational, and systems levels

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Possibilities for Luxembourg?

Lets Have An Inspired Dialogue

Harvey A. Skinner PhD, CPsych, FCAHS Dean, Faculty of Health

York University, HNES Room 443 4700 Keele Street Toronto, ON, Canada M3J 1P3 Voice: 416-736-5340 Mobile: 416-520-7615 Email: harvey.skinner@yorku.ca