Expression of Interest for Wound Care Project

Expression of Interest for Wound Care Project November 11, 2016 Telewound Care EOI Page 1 of 12

Contents 1 Introduction... 3 2 Telewound Care Project Background... 4 2.1 Background... 4 2.2 Purpose... 5 2.2.1 Proposed Approach... 5 2.2.2 Role of OTN... 6 2.2.3 Role of Partners... 6 3 EOI Submission requirements... 7 3.1 Collaboration (15%)... 7 3.1.1 Lead Organization and Project Partners... 7 3.1.2 Description of partners... 7 3.1.3 Partner experience... 7 3.2 Clinical Process Flows (10%)... 7 3.2.1 Project impact... 7 3.2.2 Current care delivery model... 7 3.3 Patient, Caregiver, and Clinician Engagement (25 %)... 8 3.3.1 Target patient population... 8 3.3.2 Patient and caregiver engagement... 8 3.3.3 Change management... 8 3.4 Evaluation (20%)... 8 4 Timelines... 9 4.1 Project Plan (5%)... 9 5 Funding and In- kind contributions... 9 5.1 Funding (5%)... 9 5.2 In Kind Contributions... 10 6 Sustainability and spread... 10 6.1 Sustainability and Spread (20%)... 10 7 Appendix A: Evaluation of Responses... 11 Telewound Care EOI Page 2 of 12

1 INTRODUCTION As a world leader in telemedicine solutions, including remote patient monitoring, Ontario Telemedicine Network (OTN) has the experience and leadership to implement innovative care models to benefit patients throughout their care journey. In partnership with 10 of 14 LHINs, more than 10,000 patients have been enrolled in Telehomecare to help patients manage their congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). The subsequent successful trial implementations of Telehomecare in diabetes, post-acute monitoring, chronic kidney disease and mental health, as well as congregate living, reinforces OTN s strong capabilities to leverage opportunities to further mature into new models of care. OTN has received funding from Canada Health Infoway and MOHLTC to plan, implement and evaluate a Telewound care project. The identification of expert project partners is an essential component of the project. To ensure that OTN engages in a fair and transparent process, the OTN project team is releasing an Expression of Interest (EOI) to engage partners and organizations across the province. Submissions from interested partners/organizations will be evaluated and scored on a set criteria outlined below. EOI applicants will be contacted for a readiness assessment to determine the engagement of their team partners and leadership, review of patient data for target populations and review the proposed care model. Up to 3 EOI applicants will be selected. Concurrently, OTN will be procuring a Telewound care technology solution. It is intended that there will be multiple solutions that a Partner/Organization team may select, although this well depend on the outcome of the procurement process. Innovative procurement processes will be used and already demonstrated with the initial Market Sounding session that was held for Telewound care technology solution providers. In responding to this EOI, OTN welcomes partnerships between Local Health Integration Networks, their CCACs and health service providers as the majority of wound care management occurs in the community. Funding up to $100,000 will be available from January 2017 to June 2018 for up to 3 successful EOI applicants. Timelines for the EOI submission are as follows: 1. EOI release: Week of November 7, 2016 2. Applicant questions regarding EOI submission: OTN will accept questions regarding EOI submission up to November 25, 2016. To receive OTN s response to EOI questions, interested applicants are asked to submit an email to Sandra Mierdel smierdel@otn.ca indicating their interest in submitting an EOI. 3. EOI Due: December 9, 2016 by 5pm. 4. EOI evaluation: week of December 12 th 5. Readiness assessment for short listed EOI applicants: week of December 12 th 6. Final selection of Wound Care project partners: week of December 19 th Telewound Care EOI Page 3 of 12

2 TELEWOUND CARE PROJECT BACKGROUND 2.1 Background Wounds often take months to heal, from 8 to up to 45 weeks, 1 or have the potential to not heal at all. Patients typically have more than one wound, experience wound recurrences, and have comorbidities such as congestive heart failure, hypertension and/or diabetes. Having an unresolved or poorly managed wound can often cause, trigger or worsen other health issues and impact the patient s ability to carry out the activities of daily living. It has been shown that identifying the most appropriate wound care plan early has a positive impact on the trajectory and outcome of the wound. However a number of factors limit access to quality wound care, including: Barriers to patient travel, be it distance or type of residence (home, long term care, community hospital, etc.) Inadequate number of wound care nurses to meet demand 1 The limited scope of wound care nurses; physician involvement may be required to order medication, diagnostic interventions, etc. Inconsistent care pathways and adherence to best practices Inadequate number of physicians specializing in wound care to meet demand; wait lists can be greater than a month, jeopardizing the ideal 8-12-week wound-healing timeline 2 Expedited access to wound specialty services avoids unnecessary emergency department visits, hospitalizations and/or delayed hospital discharges, but most importantly avoids pain and, in some cases, premature death. There is consensus that wound care could be made more effective and less costly. The estimated total cost of wounds in Ontario is over $1 billion and improved practices could save at least $100 million, according to the Ontario Hospital Association 3 The Ontario Home Care Association suggests that the adoption of best practices could reduce home care wound costs by 40-50% 4 An Ontario study of over 100,000 diabetic foot ulcer and leg ulcer clients estimated the annual cost of standard community care at $511 million. The same study estimated $338 million in cost savings for these clients by adopting best practices, including $24 million in savings from reduced hospitalizations due to fewer infections and amputations 5 1 Ontario Association of Community Care Access Centres. Outcome-Based Pathways to Quality and Value in Home Care. Presentation. 9 June 2014. Accessed at http://oaccac.com/who/conference/documents/june%209%2c%202014/ma02-obp.pdf 2 Toronto Health Economics and Technology Assessment Collaborative (THETA). Specialized Multidisciplinary Community-Based Care for Chronic Wounds: A Field Evaluation. August 2011. http://lgdata.s3-website-useast-1.amazonaws.com/docs/3744/740114/iwc_26sep2011_final.pdf 3 Ontario Hospital Association. (2010). Ideas and Opportunities for Bending the Healthcare Cost Curve. 4 Ontario Home Care Association et. Al (2014) Outcome-based Pathways to promote Quality and Value in Home Care 9 June 2014. PowerPoint presentation, citing Wound Care best practices and outcomes: ICCP Literature Review, 2009. 5 Shannon, RJ A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer in the Ontario Community. Wound Care Canada, Vol. 5.Suppl. 1. http://cawc.net/images/uploads/wcc/5-1-costutility_evaluation.pdf Telewound Care EOI Page 4 of 12

Insufficient access to health care increases amputation rates. One study suggests that timely care for diabetic foot ulcers could reduce high-level amputation by 65-80%, while another suggests that an interdisciplinary strategy that includes education, prevention and close monitoring can decrease amputation rates by 49-85% 6 The potential cost savings (or increase in system capacity) from the implementation of best practice wound care would be significant, given that wound care accounts for half of all CCAC nursing visits. Cumulatively CCACs provide care to 33,000 patients with wounds annually, at a total cost of $240M/year or approximately $7,272/patient/year. 7 Based on the above data, 6 the potential cost savings for CCACs could be up to $5,818/patient/year, depending on wound type, patient co-morbidities, type and cost of bandages, frequency of nursing visits, etc. 2.2 Purpose The objectives of the project include: 1) Improve patient and family caregiver experience with their care. 2) Improve patient outcomes (i.e. Average time to heal, best practice pathways for wound healing) 3) Reduce costs for wound care management (i.e. Average costs for wound care management) 2.2.1 Proposed Approach This project targets patients suffering from complex chronic and acute wounds and who rely on treatment from community care service providers to maintain a regular quality of life. Patients would be referred to participating CCACs for wound care management. Target patients would be placed on a best practice outcome-based or service pathway that is supported by a wound care technology solution to enhance assessment, management and selection of appropriate wound care supplies. The wound care digital technology will track progression/delays in wound healing; thereby supporting timely consultation with expert wound care teams/specialists. OTN is seeking a collaborative approach between LHINs and their CCACs and Service Provider Organizations. OTN will work with up to 3 LHINs and their CCACs and Service Provider Organizations to implement the Telewound care project for a minimum of 400 patients. Participating CCACs will be required to formally engage their Service Provider Organizations and Wound Care specialists as required using their preferred model of care i.e. outcome-based or service pathways. Telewound care project will include a wound care digital technology to help clinical staff keep detailed medical records including photographs of healing wounds and statistical trends. Clinical staff will be able to easily share information, photos, and videos regarding a patient s care with 6 Moxey, P.W., Gogalniceanu, P., Hincliff, J. Loftus, I.M., Jones, K.J., Thompson, M., and Holt, P.J. (2011). Lower extremity amputation a review of global variability in incidence. Diabetic Medicine, 28(10), 1144-1153. 7 Ontario Association of Community Care Access Centres. Outcome-Based Pathways to Quality and Value in Home Care. Presentation. 9 June 2014. Accessed at http://oaccac.com/who/conference/documents/june%209%2c%202014/ma02-obp.pdf Telewound Care EOI Page 5 of 12

other specialized wound care professionals, thereby facilitating response time care plan adjustments. In addition to the psychological assurance for patients and family care givers that healing is progressing, the technology will support identification of a problem early in the healing process to decrease medical costs and prevent further complications if left untreated. The additional burden on delayed treatment due to lack of clinical providers, as well as the cost of having to travel for follow-up care is being eliminated with the use of Telewound care. 2.2.2 Role of OTN OTN will work collaboratively with project partners to design, plan, implement and evaluate the Telewound care project. OTN will lead the following project components: I. Project governance II. Partner selection and engagement III. Contracts and agreements IV. Project management (including reporting of deliverables to Infoway) V. Budget and funding allocations VI. Support for clinical model, site training, adoption and change management VII. Technology solution procurement, privacy and security VIII. Project communication IX. Evaluation framework X. Sustainability planning and lessons learned 2.2.3 Role of Partners Project partners will be engaged in the project planning, be responsible for the site implementation and participate in project evaluation. Key responsibilities and accountabilities will include: I. Active leadership involvement of all partners in project governance (LHIN, CCAC, Service Provider Organizations) II. Sign off on project funding and data sharing agreements. III. IV. Commitment to implement specific wound care technology solution as procured by OTN Confirmation of clinical model (eligible patients, adoption of best practice care pathways, communication among circle of care, etc.) V. Commitment to clear project plans and to meet patient adoption targets VI. VII. VIII. IX. Recruit motivated staff resources to support project deliverables as defined by funding agreement Ensure effective and clinical supervisory support Ability to recruit and retain dedicated care team to support the project Project site communications (including all partners), adoption and change management support X. Collection of evaluation data, including patient feedback and costing information XI. Active participation in sustainability planning and lessons learned reports Telewound Care EOI Page 6 of 12

3 EOI SUBMISSION REQUIREMENTS Submitting partners are requested to complete the following requirements and provide evidence to support their submission in attached appendices. Guidelines are provided on the length of the reply to each question (ex. 2 pages or 500 words) to encourage a concise and focused response. 3.1 Collaboration (15%) 3.1.1 Lead Organization and Project Partners Please list your project partners contact information. Sign off is required by all partners and MUST include a signature from LHIN leadership. A template for sign off is provided at the end of this document. Role Name Email Phone 3.1.2 Description of partners Please describe your lead organizations and project partners, including roles/responsibilities. Describe the ability of project lead organization and partners to provide leadership to support project success and collaboration. Describe how partners will collaborate to achieve project outcomes and deliverables? Describe how the LHIN will be engaged in this project. Describe the leadership support. (500 word maximum) 3.1.3 Partner experience Outline the lead organization and partners previous project experience and outcomes (evidence of past experience is requested). How have your organizations worked together in the past? Provide a description of any past experience(s) embedding technology into care model. (350 word maximum) 3.2 Clinical Process Flows (10%) 3.2.1 Project impact Describe impact of proposed project on health system performance, patient outcomes and improvements in care provision and patient experience. (350 word maximum) 3.2.2 Current care delivery model a) Describe current wound care delivery model and how proposed project will impact project objectives outlined above. (250 word maximum) b) Describe your current application of wound care pathways to support evidence based practice. (250 word maximum) c) Describe your processes and clinical work flows from wound care referral intake, assessment, care plan and communication with the patient s circle of care. (250 word maximum) Telewound Care EOI Page 7 of 12

d) Describe the process to access a wound care expert resource if healing is delayed and complications arise. How is care transitions managed? (250 word maximum) Include evidence of care pathways, process flows, best practice guidelines, etc. in supporting appendices. 3.3 Patient, Caregiver, and Clinician Engagement (25 %) 3.3.1 Target patient population Please describe the target patients for project enrolment including eligibility criteria. Provide evidence to support sufficient patient volume to support project patient targets of a minimum of 400 patient enrolments. Please include data analysis in attached appendix, related to patient referrals, visits, length of stay, hospital admissions/ed visits, etc. as proof of sufficient target patient volume. (350 word maximum) 3.3.2 Patient and caregiver engagement Please describe your strategies to engage key stakeholders, patients and caregivers in this project to meet project timelines and deliverables (i.e. referrals, adoption targets, patient and caregiver participation in evaluation, etc.) (350 word maximum) 3.3.3 Change management Please describe your strategies to support front line staff through the change management process as the project begins, evolves and, matures. What potential barriers and risk to implementing the proposed project? What are the mitigation strategies? (350 word maximum) 3.4 Evaluation (20%) Describe ability of lead organizations and partners to participate in project evaluation and report on project impacts and outcomes over course of project implementation. What key metric should be included in the project evaluation? Describe the availability of resources (i.e. Decision Support, PM) and data sources to support components of project evaluation data collection and analysis. (350 word maximum) Telewound Care EOI Page 8 of 12

4 TIMELINES 4.1 Project Plan (5%) A high level project plan has been provided. Describe your ability to meet the project timeline, potential risk, barriers and mitigation strategies. Task Name Start Finish Site project team selection Nov. 2016 Dec. 2016 Agreements Dec. 2016 Jan. 2017 Develop clinical model Nov. 2016 Feb, 2017 Process flow development Patient and clinician engagement plan Jan. 2017 March 2017 Evaluation plan Site implementation plan Dec. 2016 June 2017 Training Feb. 2017 April 2017 Patient enrollment Feb. 2017 March 2018 Adoption target - active use Feb. 2017 April 2018 Evaluation report Feb. 2017 March 2018 Lessons learned and sustainability plan Dec. 2017 March 2018 Project Close out March 2018 June 2018 5 FUNDING AND IN- KIND CONTRIBUTIONS 5.1 Funding (5%) Funding up to $100,000 will be available over the course of the project to 3 successful EOI applicants. Funding is provided to support the following project roles/activities for lead and partner organizations: Project Manager & Project coordinator(s) Business lead Network/IT support Privacy lead Communication lead Decision support analyst Funding cannot be utilized to support the hiring of clinicians for direct patient care related to the project, capital purchases, conference attendance, computers or devices. Provide an overview of the project resources you would acquire with project funding from OTN and required qualifications for these roles. Telewound Care EOI Page 9 of 12

5.2 In Kind Contributions Describe any cash or in kind contributions from the lead organization and partners to support project implementation. Provide a high level budget outlining the key activities and associated in kind budget. 6 SUSTAINABILITY AND SPREAD 6.1 Sustainability and Spread (20%) Describe how the proposed project can be sustained beyond the project completion and scaled to spread across your LHIN. If successful describe the availability of ongoing resources for sustainability or what source of funding support can you propose for ongoing operations of the model. Please outline past experience with scaling a similar initiative from a project to ongoing operations. (500 word maximum) Telewound Care EOI Page 10 of 12

7 APPENDIX A: EVALUATION OF RESPONSES A weighted scale is used to evaluate the seven components (7) of the EOI response. The percentage allotment is: Submission Requirements Collaboration Between Organization Partners 15 Clinical Process Flow 10 Patient, Caregiver and Clinician Engagement** 25 Evaluation 20 Project Timing 5 Funding and Budget Plan 5 Sustainability Planning 20 Percentage Allotted **Patient, Caregiver and Clinician Engagement evaluation threshold must be at least 70% of the total available points (at least 17.5 of the possible 25). A response that does not achieve 70% of the total available points in this section will not receive further consideration in the process. Two steps of the Evaluation Scoring process are: 1. Independent Scoring. The total of all sections is added to give the overall percentage score. 2. Group Discussion During group discussions, evaluators may determine a need for oral or written clarification on a response: Clarifications may: Be different for each responder Address one (1) or more responder s response Responders shall only provide additional information to clarify their original response This is not an opportunity for the responder to change their response to the original question Scoring Guide Percent Score Quality of Response Description 90-100 Excellent The response addresses the requirements completely, exhibits outstanding knowledge, creativity, Strengths Relative to Requirements Meets requirements - numerous strengths in key areas. Weaknesses None Confidence in Proposed Approach Very High Telewound Care EOI Page 11 of 12

innovation or other factors to justify this rating. 80-89 Good The response addresses the requirements completely and addresses some elements of the requirements in an outstanding manner. 70-79 Moderate The response addresses most elements of the requirements. 60-69 Marginal The response meets some of the EOI requirements. 0-59 Unacceptable The response meets a few to none of the EOI requirements. Meets requirements - some strength in key areas. Meets most requirements - minimal strengths provided in their response. Meets some of the requirements with some clear strength. Meets a few to none of the requirements with few or no clear strengths. Minor - not in key areas Moderate - does not outweigh strengths Exist in key areas - outweighs strengths Significant and numerous High Moderate Low No Confidence At the conclusion of the evaluation scoring process the top three ranked proponents will be selected to enter into a Form of Agreement to participate on this project. Telewound Care EOI Page 12 of 12