Virtualizing Healthcare_Competing Visions KK

Copyright© Sykes Assistance Services Corporation 2014

Virtual Care

Competing Visions?

ITCH 2015Victoria, British Columbia

Jim MurphyKarim Keshavjee MD, MBADon LajoieFebruary 27, 2015

www.sykesassistance.com

http://www.sykesassistance.com/


What We Wanted to Know

• How to:– help primary care take advantage of

economies of scale (geography, time of day, peaks)

– level the playing field between large and small, rural and urban clinics

– target care to those with the greatest need– help people that have complex needs to get

care when they need it– improve the integration of telehealth services

with primary care environments


Background

• 2010 Commonwealth Fund International Health Policy Survey* – 65% of Canadians surveyed found it difficult to access

healthcare after hours– Canadians made more visits to EDs than any other

country surveyed– Most care could have been delivered in primary care

setting– Only 45% stated that they had same day / next day

access • Of the 8.5 million ED visits - 3.3 million CTAS IV

and 700 thousand CTAS V (CIHI 2012-2013)

*(Australia, Canada, France, Germany, The Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the

United States)


Collaborative Primary Care

• Very complex patient needs (multimorbidity, meds, social, legal, financial, literacy etc.)

• Most jurisdictions favour interprofessional collaborative primary care

• Most jurisdictions have implemented telehealth solutions to extend the reach of the health system – 24/7 health contact centres, remote patient monitoring,

tele-derm_psych_radiology etc, portals, PHR, mobile, Social media…

• 10%+ no show rates• 10-20% readmission rates • 1-3% impact 40-60% of resources


Creating ScaleSome Infrastructure Already Exists

HealthLink BC 811

HEALTHLink AlbertaHealthLine 811

Health Link Info Santé

Telehealth Ontario

Info Santé 811

HealthLink 811

NL HealthLine

Tele-Care 811


Stakeholder Engagement

Primary Care

Physicians

Nurses

Pharmacists

Nutritionists

Chronic Disease

Managers

Association Leaders

Executive Directors

The Problem

Acceptable Solutions

20 Structured 45 minute interviews


Key Findings - What did we discover?

• Significant focus on 1% of very complex, high use patients (e.g. Ontario Health Links)

• Limited strategy for the next 5-10%• Highly differentiated approach across primary care

settings – only 25-30% covered by FHT/FHO team-based models

• Identify, stratify and engage right patients?• Focus on the patient in front of me • Limited “population based” analytics and strategy• Incentives are somewhat ineffective


Key Findings - What they said

• Telehealth today is not ideal– 3rd parties are not part of my practice – they don’t know

my patients– Those nurse lines send everyone to ED– Remote monitoring funding restricted to certain

conditions and for a limited time– Telehealth / “Virtual Ward” not integrated with my EMR– Need technical expertise, not a part time job– Gear is expensive, site based – Telemedicine is managed and controlled by specialists


Key Findings - What might work?

• Integration of virtual providers into primary care is acceptable if– Privacy Protected– Continuity of care is

maintained– Virtual providers

document care into EMR

– Summary of progress is made available


Benefits That Drive Interest

• Patients have 24/7 access to care providers

• Peak hours admin and clinical support– Reduce abandoned calls– Appointment reminders to eliminate no shows

• Patients get support to implement recommendations between visits (Coaching)

• Monitoring of remote devices


Virtual Telehealth ~ Virtual Primary Care

• What? – Level the terrain for care teams (time and

geography) – Virtual multichannel access to allied health

professionals• Navigation, coaching, nutrition, medication review, social

services

– Post discharge follow up, coaching, monitoring and navigation

– 24/7 (nights, weekends, holidays, and when clinic is busy)


• Office hours + some after hours• Staffing based on averages• Services ƒ (need * interest)/ funding * ingenuity• Telehealth services dedicated to clinic

population

• People although scheduled have needs and arrival patterns that are randomly distributed

• People may show up, may wait, may go somewhere else or may not show up at all

Primary Care Teams


Virtually Supported Primary Care Teams

• 24/7• 80/20• Services ƒ (The Contract)• Shared and scalable Telehealth services


Virtual Telehealth ~ Virtual Primary Care

• How?– Integrate virtual coaches into care plan (nurses, lifestyle

counsellors)– Access to EMR (PIA, Data sharing agreements, HL7)– Evidence based assessments, user satisfaction surveys– Case finding and stratification tools– Access to history, discharge/care plan, scheduling– Complete database of community services, and advocacy

solutions– Shared multimorbidity care plan – Multiple care providers in an on-call telehealth supported

model – Mobile, Web, Video, Interactive Voice Recognition, Text, Social

Media


Next Steps

• Proof of concept – EMR based identification and stratification

• Canadian Primary Care Sentinel Surveillance Network (CPCSSN)

• Probability of Readmission assessment (Pra™)– Integration with 24/7 scalable telehealth

provider environment– People navigation, coaching and advocacy – Virtual provider teams

• Test model with real people (patients, families, providers, and payers)


Thank You

Questions?


Sykes Assistance Services

• Since 1955• Assistance Services Solutions Model • Surround cared for people with solutions they

value– Health care – Roadside assistance– Legal assistance– Home assistance

• Just in time• On target• Just enough

®


InfoClin

• InfoClin is a thought leader in the use of health information technology in primary care

• Pioneers of EMR subsidy model used by every province in Canada

• Architected Canada’s chronic disease surveillance network, CPCSSN

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