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
Province of Quebec Area: 1 542 056 km 2 Population: 7 631 552 Establishments: 294 Physicians/MD : 16.062 Omni: 7.766 Specialist: 8.296 Nurses: 54.896 Emergency : 2.532.410 ADT : 716.191 Imaging: Public: 7.7 million/year Private: 2 million/year Labs: 152.591.184 (procedures)
Montreal region Area: 365 km2 Population: 1.957.345 Establishments: 89 with more than 450 points of service Employees: 86.068 FTE Physicians/MD: 5.686 Omni: 1.955 Specialist: 3.731 Nurses: 22.071 Emergency : 834.497 ADT : 155.129 Imaging: Public: 4.8 million/year Private: 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 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
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
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
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
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 Wave 1 Wave 3 OACIS Initiators CUSM MD: 653 FTE: 9.388 MD: 619 FTE: 8.636 MD: 255 FTE: 3.552 MD: 147 FTE: 1.717 Sacré- Cœur MD: 103 FTE: 3.367 MD: 299 FTE: 4.147 MD: 222 FTE: 4.264 MD: 87 FTE: 1.427 St. Mary s Hospital Verdun Hôpital général juif Institut de Cardiologie MD: 103 FTE: 1.940 Sainte- Justine Wave 2 MD: 93 FTE: 2.605 Lakeshore MD: 120 FTE: 1.544 MD: 81 FTE: 1.987 MD: 306 FTE: 4.557 Dorval Lasalle Lachine Santa Cabrini MD: 68 FTE: 2.236 Jean Talon Maisonneuve Rosemont Wave 4 Fleury MD: 68 FTE: 2.310 MD: 46 FTE: 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 (selfmanagement) 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 Personalized care plan Data from the patient Permanent link Professionals Multidisciplinary team collecting patient data from their computer
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 (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
Montreal region future project 1000 stations Island wide coordination Connection to the OACIS platform
Just a last Message Manage the change Source: Dennis Muntslag The Art of Implementation
M erci! Thank You, Gracias, Grazie, Obrigado, D anke