International Congress on Telehealth and Telecare Healthcare reform in Quebec: Accountable care organizations and meaningful use

Transcription

1 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 Agency March 2-3, 2011

2 Province of Quebec Area: km 2 Population: Establishments: 294 Physicians/MD : Omni: Specialist: Nurses: Emergency : ADT : Imaging: Public: 7.7 million/year Private: 2 million/year Labs: (procedures)

3 Montreal region Area: 365 km2 Population: Establishments: 89 with more than 450 points of service Employees: FTE Physicians/MD: Omni: Specialist: Nurses: Emergency : ADT : Imaging: Public: 4.8 million/year Private: 1.6 million/year Labs: (procedures)

4 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

5 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

6 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

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8 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

9 Local territory Physicians (FMG, AMC, medical clinics) Social economy enterprises Community pharmacies Youth Centre Health and Social Services Centres : grouping of one or several CLSCSs, CHSLD, CHSGSs Community organizations Non institutional resources Rehabilitation centre Other sectors: education, municipal, justice, etc. Hospitals that provide specialized services

10 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

11 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

12 The Results 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

13 The Results 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

14 The Results (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

15 The Results (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

16 Healthcare IT The key to transformation TREND Challenges to: Reduce costs Improve quality of care Improve process efficiencies Telemedicine Remote patient monitoring Deployment of patient ehealth records 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

17 Technical Financial Educational Healthcare IT Famous barriers to adoption Immature technology and lack of interoperability Lack or inconsistent use of standards Perceived high acquisition and maintenance cost Lack of demonstrable ROI Dealing with existing legacy IT investments Concern on total project costs and ongoing support 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

18 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

19 Montreal Establishments Path to EMR Wave 1 Wave 3 OACIS Initiators CUSM MD: 653 FTE: MD: 619 FTE: MD: 255 FTE: MD: 147 FTE: Sacré- Cœur MD: 103 FTE: MD: 299 FTE: MD: 222 FTE: MD: 87 FTE: St. Mary s Hospital Verdun Hôpital général juif Institut de Cardiologie MD: 103 FTE: Sainte- Justine Wave 2 MD: 93 FTE: Lakeshore MD: 120 FTE: MD: 81 FTE: MD: 306 FTE: Dorval Lasalle Lachine Santa Cabrini MD: 68 FTE: Jean Talon Maisonneuve Rosemont Wave 4 Fleury MD: 68 FTE: MD: 46 FTE: 1.301

20 Montreal Application Platform

21 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

22 Objectives Improve accessibility and continuity Keep elderly at home as long as possible Develop the autonomy and empowerment (selfmanagement) of the chronically ill person Reduce the number of home visits Work as a multidisciplinary team Use common protocols for chronic care

23 Objectives USER With one or more chronic illness linked through a telephone or web connection to a group of professionals Personalized care plan Data from the patient Permanent link Professionals Multidisciplinary team collecting patient data from their computer

24 Benefits Clinical protocols Electronic data acquisition Integrated medical record OACIS Medication management

25 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

26 The East end telecare home project (Pointede-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

27 Montreal region future project 1000 stations Island wide coordination Connection to the OACIS platform

28 Just a last Message Manage the change Source: Dennis Muntslag The Art of Implementation

29 M erci! Thank You, Gracias, Grazie, Obrigado, D anke