Telemedicine in Central East LHIN Status Report May 28, 2014 Jeanne Thomas, Lead System Design Shelley Morris, Regional Coordinator, OTN
What is OTN Telemedicine? 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-forprofit organization, OTN is funded by the Government of Ontario. 2
OTN s Virtual Suite of Services 1. Clinical Videoconferencing 2. econsult 3. Acute Care 4. Store Forward 5. Telehomecare 6. Education 3
OTN Enabled Organizations: Central East LHIN Accountable 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 4
121 OTN Enabled Organizations in Central East: 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 5
Investing in CLINICAL TELEMEDICINE 6
How does Telemedicine Work for Patients and Clinicians? OTN Homepage video http://www.youtube.com/watch?feature=player_embedded&v=ve0k meqnnfo (1.11min) Jennifer s Story How Telemedicine works http://www.youtube.com/watch?v=y02nscyl2ze (2.13 min) 7
Provincial Telemedicine Nursing Investment 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 LHIN FTE # of FTE Column1 Funded Hired 1 Erie St. Clair 15.0 14.00 2 South West 12.0 8.00 Waterloo 12.0 12.00 3 Wellington 4 Hamilton Niagara Haldimand 8.0 8.00 Brant 5 Central West 8.0 8.00 Mississauga 3.0 3.00 6 Halton 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 North Simcoe 10.0 10.00 12 Muskoka 13 North East 29.6 29.60 14 North West 28.0 28.00 TOTAL 190.60 183.35 8
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) 9
Telemedicine Nursing Investment 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 10
2011-2014 PERFORMANCE 11
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 12
Canadian Mental Health Association - Haliburton Kawartha Pine Ridge OTN Clinical Events at Telemedicine Nurse Sites by Fiscal Year by Organization (Increasing Use) Total Extendicare Haliburton Peterborough Regional Health Centre TAIBU Community Health Centre Northumberland Hills Hospital Canadian Mental Health Association - Durham Haliburton Highlands Health Services Ross Memorial Hospital Port Hope Community Health Centre Lakeridge Health Kawartha North Family Health Team Charles H. Best Diabetes Centre (The) Rouge Valley Health System Barbara Black Centre for Youth Resources Brock Community Health Centre Community Care City of Kawartha Lakes Hong Fook Mental Health Association Carefirst Family Health Team 0.00% 6.67% 14.58% 14.29% 10.62% 20.94% 19.56% 45.82% 54.18% 50.00% 50.00% 49.97% 50.03% 49.60% 50.40% 46.40% 53.60% 43.53% 56.47% 42.02% 57.98% 41.77% 58.23% 40.32% 59.68% 37.87% 62.13% 36.89% 63.11% 35.04% 64.96% 79.06% 80.44% 85.42% 85.71% 89.38% 93.33% 100.00% 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% 2012-2013 Events (%) 2013-2014 Events (%) 13
OTN Clinical Events at Telemedicine Nursing Sites by Organization by Fiscal Year (Decreasing Usage) Campbellford Memorial Hospital 45.67% 54.33% Haliburton Highlands Family Health Team 40.05% 59.95% Ontario Shores Centre for Mental Health Sciences 32.90% 67.10% Oshawa Community Health Centre 23.47% 76.53% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 2012-2013 Events (%) 2013-2014 Events (%) 14
Identifying Opportunities and Challenges HSP SURVEY RESULTS 15
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. 16
IHSP Strategic Aims & Priority Populations 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%) 17
6 OTN Use Supporting Strategic Aims 1 =Never 2= Hardly Ever 3=Occasionally 4=Frequently 5=Almost Always 5 4 3 2 Palliative and End of Life Care Vascular Health and Diabetes Mental Health and Addictions Seniors 1 0 Hosp MHP PHC LTCH 18
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 19
Opportunities to Improve Patient Care Using Telemedicine 6 5 1 =None 2= Few 3= No Opinion or Uncertain 4= Some 5=Many 4 3 2 Mental Health Addictions Seniors Frail Elderly 1 0 Hosp MHP PHC LTC 20
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 wellsuited 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 21
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 22
Central East LHIN Consultant Directory 23
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 24
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 25
5 Opportunity: QBPs Orthopedic Procedures 4 4 1=None 2=Few 3= Uncertain 4=Some 5=Many 3 3 2 2 1 Hip replacement surgery Knee replacement surgery Knee Arthroscopy Hip Fracture Upper/Lower Limb Fractures 1 0 Hosp PHC 26
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 27
Moving Forward OPPORTUNITIES TO STRENGTHEN SYSTEM 28
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 LHIN OTN organization OTN Sites September April 2015 QBP (Stroke, CHF, COPD, others) 29
Immediate Next Steps Engage Central East LHIN Community of Practice: Strategic Planning Session (June 11 th ) 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 30
THANK YOU 31