Telemedicine in Central East LHIN

Status Report

May 28, 2014

Jeanne Thomas, Lead System Design

Shelley Morris, Regional Coordinator, OTN

What is OTN Telemedicine?

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• OTN is one of the largest Telemedicine networks in world, helping to deliver clinical care and professional education among health care providers and patients.

• An independent, not-for-profit organization, OTN is funded by the Government of Ontario.

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1. Clinical Videoconferencing

6. Education 5. Telehomecare

3. Acute Care 2. eConsult

4. Store Forward

OTN’s Virtual Suite of Services

OTN Enabled Organizations:

Central East LHIN Accountable

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• All Hospitals – multiple sites

• CMHA HKPR, Durham, Toronto

• CCAC – 7 sites

• All 7 Community Health Centres

• LTC Homes (9)

• Ontario Shores and various Community Clinics

• Hong Fook, Pinewood, FourCast

• Diabetes Education Providers (e.g. Hospital, CHC, Charles H. Best)

**Equipment investments by Central East LHIN and MOHLTC = $640K

121 OTN Enabled Organizations in Central East:

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Including:

• CMHA Toronto Branch

• Bellwood Hospital

• Primary Care Sites: 5/9 FHTs (Kawartha North, HHFHT, SAFHT, EGTAFHT, Peterborough), Apsley Medical Centre

• First Nations (Curve Lake, Alderville, Mississaugas of Scugog)

• Various MCYS/MCSS Sites

• Warkworth Penitentiary & Central East Correctional Centre

CLINICAL TELEMEDICINE

Investing in

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How does Telemedicine Work for Patients and Clinicians?

• OTN Homepage video http://www.youtube.com/watch?feature=player_embedded&v=VE0kmEqNnfo (1.11min)

• Jennifer’s Story – How Telemedicine works http://www.youtube.com/watch?v=y02nSCYl2ZE (2.13 min)

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Provincial Telemedicine Nursing Investment

Column1

LHIN FTE

Funded

# of FTE

Hired

1 Erie St. Clair 15.0 14.00

2 South West 12.0 8.00

3 Waterloo Wellington

12.0 12.00

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Hamilton Niagara Haldimand Brant

8.0 8.00

5 Central West 8.0 8.00

6 Mississauga Halton

3.0 3.00

7 Toronto Central 11.0 11.00

8 Central 5.0 5.00

9 Central East 20.0 18.75

10 South East 14.0 14.00

11 Champlain 15.0 14.00

12 North Simcoe Muskoka

10.0 10.00

13 North East 29.6 29.60

14 North West 28.0 28.00

TOTAL 190.60 183.35

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• All 14 LHINs = 190 FTE

• Central East – third largest investment (20 FTE)

• 7.25 FTE vacancies province wide (2013-14)

• Currently 1.5 FTE vacancy in CE LHIN (93% hired)

• Brock CHC

• Yee Hong

Telemedicine Nursing Investment

• Barrier to access: Optimal use of existing OTN systems for clinical interventions (patient-provider) is often challenged because of an absence of dedicated and trained health human resources to support these clinical consultations

• MOHLTC Central East LHIN Telemedicine Nursing Investment (June 2011):

– $1.48M

– 20 FTE RN or RPN

– 24 Telemedicine Nurse Sites across LHIN

– Hospitals, Primary Care/Community Health Centres, Mental Health Providers, LTC Homes

• Central East LHIN Community of Practice (COP) – all nursing sites plus other OTN partners (e.g. Four Cast, Fairhaven LTCH)

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Telemedicine Nursing Investment

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Health Service Provider FTE

Ross Memorial Hospital 1.00

Peterborough Regional Health Centre 1.00

Haliburton Highlands Health Services 0.75

Extendicare Haliburton 0.25

Lakeridge Health 1.00

Rouge Valley Health System 1.00

Campbellford Memorial Hospital 1.00

Northumberland Hills Hospital 0.75

Ontario Shores Centre for Mental Health Services 2.50

Port Hope CHC 2.00

City of Kwartha Lakes CHC 0.50

The Youth Centre 0.50

Oshawa CHC 0.50

Brock CHC 1.00

TAIBU Community Health Centre 0.50

CMHA Durham 1.00

CMHA Peterborough 1.00

Yee Hong Centre for Geriatric Care 0.50

Hong Fook 0.25

Scarborough Academic FHT 0.50

Haliburton Highland FHT 0.50

North Kawartha FHT 1.00

Charles H. Best Diabetes Centre 0.25

Carefirst Seniors and Community Services Association 0.75

TOTAL CE LHIN 20.00

PERFORMANCE

2011-2014

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Clinical Events

• Central East LHIN Target of 10 056 events/year was exceed each year since implementation (2013-14 = 16, 332)

• 20/24 sites increased in use between 2012-13 and 2013-14

• Four sites experienced decrease clinical visits factors influencing drop in use included:

– short-term nursing vacancies,

– difficulty in accessing specialists (psychiatry)

– Programming changes and

– Re-distribution of visits amongst new sites

• Five organizations are contributing significantly (approx. 75%) to achieving target:

– Northumberland Hills, Ontario Shores, LHC, RMH, PRHC

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100.00%

93.33%

89.38%

85.71%

85.42%

80.44%

79.06%

64.96%

63.11%

62.13%

59.68%

58.23%

57.98%

56.47%

53.60%

50.40%

50.03%

50.00%

54.18%

0.00%

6.67%

10.62%

14.29%

14.58%

19.56%

20.94%

35.04%

36.89%

37.87%

40.32%

41.77%

42.02%

43.53%

46.40%

49.60%

49.97%

50.00%

45.82%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

Carefirst Family Health Team

Hong Fook Mental Health Association

Community Care City of Kawartha Lakes

Brock Community Health Centre

Barbara Black Centre for Youth Resources

Rouge Valley Health System

Canadian Mental Health Association - Haliburton Kawartha Pine Ridge

Charles H. Best Diabetes Centre (The)

Kawartha North Family Health Team

Lakeridge Health

Port Hope Community Health Centre

Ross Memorial Hospital

Haliburton Highlands Health Services

Canadian Mental Health Association - Durham

Northumberland Hills Hospital

TAIBU Community Health Centre

Peterborough Regional Health Centre

Extendicare Haliburton

Total

OTN Clinical Events at Telemedicine Nurse Sites by Fiscal Year by Organization (Increasing Use)

2012-2013 Events (%) 2013-2014 Events (%)

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23.47%

32.90%

40.05%

45.67%

76.53%

67.10%

59.95%

54.33%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

Oshawa Community Health Centre

Ontario Shores Centre for Mental Health Sciences

Haliburton Highlands Family Health Team

Campbellford Memorial Hospital

OTN Clinical Events at Telemedicine Nursing Sites by Organization by Fiscal Year (Decreasing Usage)

2012-2013 Events (%) 2013-2014 Events (%)

HSP SURVEY RESULTS

Identifying Opportunities and Challenges

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Purpose of Survey – Gain Insight!

• How is OTN currently supporting patient care in telemedicine nursing sites?

• How can we build capacity across the system?

• How can site level performance be improved?

• How can we expand access to new patients, specialist consultants, primary care providers and communities?

• How is the system is performing for patients and how well it is supporting clinicians and provider agencies?

• Support Strategic Planning by Central East LHIN, Telemedicine Community of Practice and OTN.

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IHSP Strategic Aims & Priority Populations

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• 89% of responding (16/18) use OTN to support people with Mental Health or Addictions Needs Frequently or Almost Always

– This includes hospital, primary care and mental health providers

• 44% (8/18) use OTN to support Seniors Frequently or Almost Always

• 40% use OTN to support people with Vascular or Diabetes needs Frequently or Almost Always

• Lowest use of OTN is in supporting Palliative Care (10%)

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0

1

2

3

4

5

6

Hosp MHP PHC LTCH

1 =Never 2= Hardly Ever 3=Occasionally 4=Frequently

5=Almost Always

OTN Use Supporting Strategic Aims

Palliative and End ofLife Care

Vascular Health andDiabetes

Mental Health andAddictions

Seniors

Opportunities for Expand Care

Over 50% of sites identified many opportunities to expand the use of OTN to support the care of:

• Seniors and Frail Elderly

• People with Mental Health and Addictions needs

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20

0

1

2

3

4

5

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Hosp MHP PHC LTC

1 =None 2= Few

3= No Opinion or Uncertain 4= Some 5=Many

Opportunities to Improve Patient Care Using Telemedicine

Mental Health

Addictions

Seniors

Frail Elderly

Opportunities to Support LHIN Priorities:

Vascular Health/Diabetes Aim & Seniors Care

• OTN is being used by most organizations (73%) to support client/patient self management training

• The majority of sites are seeing clients/patients who would be well-suited for Telehome monitoring if available

Vision Care Strategy

• Teleoptholmology would be complementary to hospital sites performing cataract surgery, supporting Diabetes care (Retinal Screening) and other vision care procedures

Aboriginal Services

• Opportunity to explore partnerships between CE LHIN First Nations and OTN enabled Aboriginal Health Access Centres across the province

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Access to Specialist Consultants

• The OTN Service Directory is the central tool used by all OTN sites to identify Specialist Consultants

• Supply does not meet demand from Central East clients/providers:

– Orthopedics Pre and Post Operations

– Rheumatology

– Neurology

– Psychiatry

– Psychotherapy

– Cardiology

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Central East LHIN Consultant Directory

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Wait Times & Access (Performance Metrics)

• Very few organizations are focusing OTN to improve performance on their Service Accountability or Ministry-LHIN Performance indicators:

• Examples include:

– Knee Replacement wait times (Hospital)

– Emergency department wait time and ALC for MH patients

– Inter-professional Diabetes Care rate in CHCs

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Opportunities to Expand: Quality Based Procedures

• Agencies see opportunities to expand the use of OTN to support the care of patients/clients related to various QBP clinical areas or procedures.

• Areas of particular opportunity include Orthopedic procedures, Stroke, COPD and CHF

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0

1

1

2

2

3

3

4

4

5

Hosp PHC

1=None 2=Few

3= Uncertain 4=Some 5=Many

Opportunity: QBPs Orthopedic Procedures

Hip replacement surgery

Knee replacement surgery

Knee Arthroscopy

Hip Fracture

Upper/Lower Limb Fractures

Improvement Initiatives Underway

Many active improvement initiatives:

• Streamlining of administrative processes

• Partnerships with Primary Care

• Scheduling of appointments

• Patient Awareness and Experience

Less focus on Clinical Area improvements:

• Protocols

• Training of Clinicians

• Specialist Access

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OPPORTUNITIES TO STRENGTHEN SYSTEM

Moving Forward

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Emerging Opportunities

Objective Focus Responsibility Timeframe

Align nursing capacity to expansion opportunities Ensure resources are deployed effectively

• Mental Health and Addictions

• Seniors and Frail Elderly

• Orthopedics (Pre and Post Op)

• All FTEs deployed

LHIN CE Community of Practice OTN Sites

June - December

Identify and Spread Best/Promising Practices

• Mental Health and Addictions

• Patient Self Management Training and Skill-building

• Seniors and Frail Elderly Care

CE Community of Practice OTN Sites OTN organization

June - September

Explore new opportunities for OTN Clinical Care

• Teleoptholmology

• Telehomecare

• Specialist Consultant identification/ expansion

• QBP (Stroke, CHF, COPD, others)

LHIN OTN organization OTN Sites

September – April 2015

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Immediate Next Steps

• Engage Central East LHIN Community of Practice:

– Strategic Planning Session (June 11th)

• Partner with OTN Business Support Unit:

• Develop of Improvement Strategies

• Improvement Facilitator support for sites

– Review key administrative processes that are creating challenge and develop strategies to address

• Initiate Performance Analysis

– Site specific review for slow to deploy/hard to employ sites and those where utilization has decreased

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THANK YOU

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