International Congress on Telehealth and Telecare
Healthcare reform in Quebec:Accountable care organizations and
meaningful use
London
David Levine C.E.O
Montreal Health and Social Services AgencyMarch 2-3, 2011
Establishments: 294Physicians/MD : 16.062
Omni: 7.766Specialist: 8.296
Nurses: 54.896Emergency : 2.532.410ADT : 716.191Imaging:Public: 7.7 million/yearPrivate: 2 million/yearLabs: 152.591.184 (procedures)
Area: 1 542 056 km2
Population: 7 631 552
Province of Quebec
Montreal region
Area: 365 km2 Population: 1.957.345Establishments: 89
with more than 450 points of serviceEmployees: 86.068 FTEPhysicians/MD: 5.686
Omni: 1.955Specialist: 3.731
Nurses: 22.071Emergency : 834.497ADT : 155.129Imaging:
Public: 4.8 million/yearPrivate: 1.6 million/year
Labs: 49.996.604 (procedures)
The Health Reform
Objectives
• Improve the health and well being of the population (specific mandates)
• Bring services to the population• Facilitate the use of services (accessibility,
continuity)• Manage care for vulnerable clientele• Improve the quality of care• Improve the cost of care
Guiding principal
• Populational responsibility– Defined population – Responsible for the health well being of that
population– Responsible for the individuals health and well being
• Hierarchical provision of services– Regrouping primary care responsibility– Clearly refining secondary and tertiary services– Reference protocols and corridors of services
Structural changes - Integration
• A new organization: Health and Social Services Centers (HSSC)
• A new concept of integrated services through the creation of local services networks
• Mergers of hospitals, local community service center, long term care centers into a single institution
• 12 HSSC in Montreal, 95 across Quebec• 18 Regional Authorities across Quebec
The Reform of Health
Mandate of a Health and Social Service Center
• Manage and evaluate the health and well being of the population
• Manage the use of services by the population
• Manage the services offered by each HSSC
• Develop a local network of care
Local territory
Health and Social ServicesCentres :
grouping of one or severalCLSCSs, CHSLD, CHSGSs
Community pharmacies
Community organizations
Non institutional resources
Social economy enterprisesPhysicians
(FMG, AMC, medical clinics)
Youth Centre
Rehabilitation centre Other sectors: education, municipal, justice, etc. Hospitals that provide
specialized services
Montreal’s vision to achieve the objectives
• Managed care model (chronic care model, mental health model, continuum of care for the elderly, etc)
• Multidisciplinary teams for primary care with rostered population
• Unified and computerized medical health records
• Empowerment of the population and the individual to manage and direct their care and needs
Montreal’s vision to achieve the objectives
• Evaluation and measurement of clinical and administrative (eg. financial) outcomes
• A motivated, engaged and empowered work of force
• Leadership and organizational change needed to implant the vision
The Results 2005 – 2010
• Developed a successful system management strategy leading to joint management of health and social services on the Island of Montreal
• Successful implementation of 12 CSSS health and social service networks
• Implementation of 45 primary care groups, 12 local departments of primary care
The Results 2005 – 2010
• Implementation of a city wide IS platform – OASIS in all institutions as well as physician offices
• Implementation of a chronic disease management model. Pilot in each CSSS with a role out to other CSSS –eg. diabetic chronic care management, 12 programs implemented, one in each CSSS
The Results 2005 – 2010 (continued)
• Surgery wait time management by grouping high volume services together and creating new volume capacity and managing wait lists, weekly, biweekly, monthly data updates
The Results 2005-2010 (continued)
• Optimising projects• Bed management model 10% • Home care software 20% • Centralized IS servers• Centralized phone system• Centralized purchasing• Centralized transport
• 6 years balanced budget
TREND Challenges to:
Reduce costs Improve quality of care Improve process
efficiencies Telemedicine Remote patient monitoring Deployment of patient
eHealth records
Healthcare IT – The key to transformation
NEED Enhanced a health network
infrastructure Enhanced hospital
infrastructure Enhanced wireless
infrastructure Adoption of data exchange
standards EMR (Electronic Medical
Record) Enhanced security Improved backup and recovery
Technical Immature technology and lack of interoperability Lack or inconsistent use of standards Perceived high acquisition and maintenance cost
Financial Lack of demonstrable ROI Dealing with existing legacy IT investments Concern on total project costs and ongoing support
Educational Current health care culture and organizational resistance Lack of standards (clinical content and relevancy, terminology, interoperability, clinical
practice); Misalignment of incentives for IT adoption from physicians
Policy Concern over privacy, security and confidentiality Lack of incompatibility of rules about who is allowed to see information and why Clarity regarding the role of government
Healthcare IT – Famous barriers to adoption
Objectives of Montreal project Access to results
Anytime, anyplace, anywhere, but not by anyone! Quality of care
Clinicians can make informed clinical decisions about treating patients (proof based decision)
Incorporation of therapeutic advisors to support prescribing physicians
Patient safety Extensive medication history and allergy information Advanced clinical decisions support and alerts Facilitates and reduces adverse clinical events Decrease the risks of medical errors
Reduce costs Eliminate or reduces redundant tests and procedures Reduces costs associated with adverse clinical events Eliminates costs associated with transcriptions and storage of paper records
Montreal Establishments Path to EMR
OACIS
Wave 1 Wave 3
Initiators
Wave 2 Wave 4
Sacré-Cœur
Verdun
Hôpital général juif
CUSM
Sainte-Justine
Institut de Cardiologie
St. Mary’sHospital
Lakeshore
SantaCabrini
JeanTalon
DorvalLasalleLachine
Fleury
MaisonneuveRosemont
MD: 653FTE: 9.388
MD: 619FTE: 8.636
MD: 255FTE: 3.552
MD: 103FTE: 3.367
MD: 299FTE: 4.147
MD: 222FTE: 4.264
MD: 87FTE: 1.427
MD: 147FTE: 1.717
MD: 103FTE: 1.940
MD: 120FTE: 1.544
MD: 81FTE: 1.987
MD: 68FTE: 2.236
MD: 306FTE: 4.557
MD: 93FTE: 2.605
MD: 68FTE: 2.310
MD: 46FTE: 1.301
Montreal Application Platform
Telehealth and surveillance at home
• Context
– Elderly population– 30% or more chronic illness– Increased demand for home care– Poor compliance in management of chronic illness
Objectives
– Improve accessibility and continuity– Keep elderly at home as long as possible– Develop the autonomy and empowerment (self-
management) of the chronically ill person– Reduce the number of home visits– Work as a multidisciplinary team– Use common protocols for chronic care
Objectives
• USER• With one or
more chronic illness linked through a telephone or web connection to a group of professionals
• Professionals• Multidisciplinary
team collecting patient data from their computer
Personalized care plan
Data from the patient
Permanent link
Benefits
– Clinical protocols
– Electronic data acquisition
– Integrated medical record OACIS
– Medication management
Conclusions of 2009 study of Sicotte, Paré, Moreault, Morin and Potvin
1. High satisfaction of patients and professionals
2. New technology easily accepted by patient and staff
3. Allows systematic follow-up
4. Excellent learning tools
5. Increase in patient self management skills demonstrated
The East end telecare home project (Pointe-de-l’Île)
– 120 stations – Telus– 4 months length of stay– Very high satisfaction – Reduced number of home visits (12 to 2.5)– Reduced visits to emergency room– Increased self management – Long term follow-up required
Montreal region future project
– 1000 stations– Island wide coordination– Connection to the OACIS platform
Just a last Message …
Source: Dennis Muntslag – The Art of Implementation
Manage the change
Merci !Thank You, Gracias, Grazie, Obrigado, D anke