Mental Health Engagement Network (MHEN): Connecting clients with their health team

Jeff Reiss MD, MSc, FRCPCCity-wide Site Chief, Mental Healthcare Program – LHSC; Vice Chair, Dept. of Psychiatry – UWO;

Associated Scientist - Lawson Health Research Institute

Nick Zamora BscPhm, MBA, CHE Chief Clinical Advisor TELUS Health

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Mental Health Engagement Network Canadian Innovation through Partnerships

o Canada Health Infoway: Consumer Health Innovation Programo Lawson Research Institute: Comprehensive evaluation expertise

around innovative technologieso LHSC and SJHC: Pushing transformationo TELUS Health: Investment in consumer health engagement solution

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The Health and Care Challenge

o 20% of Canadians experience mental illness, only 1/3 receive treatmento 500,000 employed Canadians are unable to work due to mental illness in

any given week (2/3 disability cases + 1/3 FT absenteeism) o Mental health is the number one cause of disability in Canada, accounting

for nearly 30% of disability claims and 70% of the total costso Current treatment cost estimates of mental illness:

• depression: $5 billion • schizophrenia: $2.7 billion • uninsured mental health services: $6.3 billion

$51B in lost productivity and healthcare costs

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Objectives

o Improve the health outcomes and quality of life for people living with schizophrenia or mood disorders

o Put novel technology in the hands of clients and their clinical team o Deploy and evaluate customized PHR application that leverages TELUS

health space®, powered by Microsoft Healthvault® , and provides:• Patient access to their own health information (through LIDB)• Interactive tools such as a mood monitor and journaling• Standardized health services • Ongoing monitoring of activities with alerts and reminders• Regular communication between clients and their care team

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Project Design

o 400 research participants recruited who have been diagnosed with a mood disorder or a psychotic disorder

o 54 care providers recruited to provide client care using new technologyo Participants recruited through staff caseloads who have volunteered at

outpatient programs in London and surrounding areas including:• London Health Sciences Centre and St. Joseph’s Health Care• Community agencies such as the Canadian Mental Health Association

(London Middlesex Branch) and WOTCH Community Mental Health Services

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Mobile Patient Interface is connected

Mental Health Clinicians & Community Care Providers

Jurisdictional, regional & local administrators

Clients

Family & Other Supporters

•400 clients provided with smartphones AND access their Smart record

•Access via web or mobile on own device (no devices provided by project)

•55 devices will be provided to community care providers by project•Remaining care providers will access using

web and/or mobile from own device

•Web access

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Mobile View

Provider Portal

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Faculty/Presenter Disclosure

• Faculty: Jeff Reiss

• Relationships with commercial interests:– Grants/Research Support: Canada Health Infoway and TELUS Health– Speakers Bureau/Honoraria: none– Consulting Fees: none– Other: none

Project Design o Delayed implementation approach

o Participants were randomized into Group 1 (early intervention) or Group 2 (later intervention)

o Participants are provided with a handheld device, a TELUS Health Space account, and a Lawson SMART record timed according to their intervention group and receive training on the handheld device and Lawson SMART record

Project Design (Cont.)

o Participants will complete a total of 4 interviews, every 6 months for a total of 18 months

o Focus groups take place at multiple points in time during the study

o Data collected includes use of devices, perception of usefulness, quality of life, empowerment, general health, and use of health and social services (including hospitalizations and emergency room visits as well as other services)

Expected Outcomes o The overall hypothesis is that the usage of smart health information

technology will improve quality of life and reduce health care system costs by providing:

• care providers can closely monitor the individuals recovery process• real-time communication with their care provider team• scheduling appointments and request medication refills• track clients in regards to medication adherence and adverse

reactions• provide earlier intervention before a crisis situation arises• provide continued support between formal face to face clinical visits

o To confirm this hypothesis we will use a standardized evaluation framework that will provide project outcomes on the basis of effectiveness, economic, policy, and ethical analyses

Design

Phase 1 Dev

2015201320122011 2014

Mental Health Engagement Network – PROJECT TIMELINE

Phase 2 – Next 200 ClientsImplementation Into Care.....

Phase 2 Dev

Phase 1 – First 200 Clients

Care Providers Wireless 18 mths I-Pads

Design

aug

mar

Descriptive statisticsn = 400

AgeMean 38.5Std. Deviation 13.8

Minimum 18Maximum 78

SexFrequency Percent

Female 155 38.7Male 245 61.3Total 400 100.0

Descriptive statisticsn = 400

Mental Health Frequency PercentDevelopmental Handicap 3 .75Anxiety Disorder 128 32Disorder of Childhood/Adolescence

20 5

Organic 3 .75Substance-Related Disorder 55 13.75

Personality Disorder 25 6.25Psychotic Disorder 233 58.25Mood Disorder 237 59.2Other 10 2.5Unknown 2 .5

Descriptive statisticsn = 400

Have you ever had a psychiatric hospitalization?

Frequency Percent

No 56 14

Yes 343 85.75

Missing 1 .25

Total 400 100

Estimated total number of psychiatric hospitalizations

Mean 7.7

Std. Deviation 10.8

Minimum 1

Maximum 100

n = 343

0

5

10

15

20

25

30

26.3

20.3

22.8

16

54

5.8

Percent

How comfortable are you with technology in general?N = 400

Accessing the Lawson SMART record

Mobile Desktop0

2000

4000

6000

8000

10000

12000

9567

3237

Hits to Homepage

Lawson SMART record Usage

Health Journal; 5654

Health Journal Notes; 995

Messaging; 1728

Scheduling; 971

Reminders ; 462

Thinking of your personal health record how do you feel about its ease of use? (n=147)

How do you feel about having your own personal health record? (n=178)

How do you feel about connecting with your health care provider using the smart phone? (n=161)

How do you feel about being able to share your health information with other health care providers? (n=160)

Summary of Focus Groups Feedback • Benefits / positive changes through the use of the Lawson SMART

record and iPhone– Care providers more accessible to their clients and vice versa– Boost clients self esteem– Clients feel more connected

• Care provider• Other community supports

– Facilitates self-awareness within clients and promotes self-reflection• Privacy and confidentiality with regards to the Lawson SMART record

– No major concerns• Workflow Impact

– Time savings– Increased productivity during client meetings

Where do we go from here?

2015

2014

2013

Approach to Maintain 400 Clients & Strengthen Solution

MHEN is a game changer!Work with System Change Agents to Scale and Sustain

1. Build on what has been done in London

2. Create Governance Sustainability and Future Development Committee

3. Link to programs and organizations with same mandate: The Sandbox Project, CIHR SPOR TRAM

Who, How and Why: Business Plan, Evaluation Engage Private Sector & Other Jurisdictions

Ontario Expansion & Establish National Sites

Eval

uatio

n , D

evel

opm

ent &

Sus

tain

abili

ty

Plan

ning

, Fun

ding

, Exe

cutin

g

National Expansion

Expand: MH Conditions & Co-Morbidities

Expand to Youth & Link with Sandbox and TRAM SPOR

Mental HealthcareSystem Redesign

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Questions?

Questions for Dr. Jeff Reiss: jreiss4@uwo.ca

Questions for Nick Zamora: nick.zamora@telus.com

MHEN: Transforming the System, Transforming LivesMAIN OBJECTIVES

• Early Intervention: Monitoring patients moods with automation of alerts to contact care providers: next of kin, substitute decision maker, family doctor, etc., so services are integrated and coordinated

• Care is Proactive and Ongoing: Through TELUS health space, clients will be able to access health tools to support them in their recovery, and beyond

• Person Driven Access to Care Plans: While this project is aimed to manage a difficult illness, the lessons learned would support future system redesign for the whole population

• Medication Management: most sought after information by community agencies. Patients can leverage their personal health record to inform care providers so better decision-making This will ensure that the new care provided is based on prior care for continuity of care

• Data Integration: To better utilize Provincial Assessment tools like the OCAN survey and RAI, which is used in hospitals, but not in community mental health Integrated Referral System

• Research Data: This project will support the future linkage with other social services, such as income support information to elevate clients from becoming homeless. Research data will inform policy-makers

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Methodology

Technology Implementation• At Phase 1 (first 3 months of project), the 200 participants in Group 1 will be provided

with a PHR through TELUS health space, as well as they will be introduced to smart phone technology to ready them for deployment of the prompts and reminders

• Two months later, they will be provided with a handheld device. A delayed implementation plan will be used (but will have no effect on the standard of care for the remaining 200 participants), so the remaining 200 participants in Group 2 will initially act as a control group, but at Phase 2 (six months later – approximately June 2012) the remaining 200 participants will be introduced to the technology in the same order (PHR -> Smart Phone)

• Group 2 will have the benefit of any enhancements made during Phase 1 of the project

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Methodology

Specifically, the study participants will receive the following: • access to TELUS health space • a PHR application account• access to an online thought diary and mood diary both linked to personalized

recovery/relapse prevention plan• access to a voice scale that assesses auditory hallucinations (for patients with

schizophrenia) • access to a medication side-effect monitoring diary, to trigger a review of medications,

as well as alerts to care providers related to prescription renewals• a handheld device and data plan which will facilitate mobile access to the applications

and interactive tools• individualized proactive prompts and cues to help them structure their days (e.g.

reminder to take medication at 8:00 am)

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Methodology

Quantitative Data Collection• Individual interviews with patient participants will be held at the baseline period and

then every 6 months for 18 months• Data collected will include use of devices, perception of usefulness, quality of life,

general health and use of health and social services (including hospitalizations and emergency room visits as well as other services)

• The knowledge learned through Group 1, over the initial 6 months, will provide baseline and comparative data to understand the client’s perceptions for designs and outcome purposes of the technology intervention

• Improvements in the technology approaches made during the initial 6 month period will enhance the tools for Group 2. We are expecting different feedback from groups, one to guide development and one to improve what is developed

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Methodology

Quantitative Data Collection

The structured interviews will involve the following seven questions:

1. Demographic Form 2. Quality of Life – Brief Version (QoL-BV)3. Health, Social, Justice Service Use4. Medical Outcomes Study 36-item Short Form Health Survey (SF-36)5. EQ-5D Health Utilities Index6. Community Integration Questionnaire 7. Perception of Smart Technology Form

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Methodology

Qualitative Data Collection

• Focus groups will take place at multiple points in time during the study• For Group 1, the focus groups will take place:

1) 2-3 months after initial implementation to discuss initial developments, usability and adoption (focus on the PHR health space solution) 2) within the next 6 months to discuss addition of phones and issues related to maintenance or loss3) a final set of meetings 6 months later to discuss the benefits and pitfalls of the technology to form base recommendations for the next phase of study

• Group 1 will have the opportunity to provide input on the initial technology design framework, supporting user-centred design (UCD) for novel tool development

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Methodology

Qualitative Data Collection

• For Group 2, the focus groups will take place: 1) prior to implementation to understand how they use technology before the new approach is introduced and starting with the PHR and health space program2) 2-3 months after initial implementation to discuss initial development, usability and adoption of phones 3) within the next 6 months to discuss maintenance or loss

• Focus groups with staff/healthcare providers will also be held so that issues can be identified and addressed quickly

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