Download - Virtualizing Healthcare_Competing Visions KK
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Virtual Care
Competing Visions?
ITCH 2015Victoria, British Columbia
Jim MurphyKarim Keshavjee MD, MBADon LajoieFebruary 27, 2015
www.sykesassistance.com
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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
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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)
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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
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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
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Stakeholder Engagement
Primary Care
Physicians
Nurses
Pharmacists
Nutritionists
Chronic Disease
Managers
Association Leaders
Executive Directors
The Problem
Acceptable Solutions
20 Structured 45 minute interviews
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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
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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
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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
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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
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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)
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• 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
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Virtually Supported Primary Care Teams
• 24/7• 80/20• Services ƒ (The Contract)• Shared and scalable Telehealth services
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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
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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)
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Sykes Assistance Services
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