Presentations - Central West LHIN

TELEHOMECARE
Telehomecare
Central
West LHIN
Steering Committee
Central West LHIN
William
Osler Health System
Steering
Committee
Bonnie Burnes
Andrea Martin
Allison Philpot Bonnie Burnes
William Osler Health System
May 29, 2013
May 29, 2013
Telehomecare in Central West LHIN
Program Hosted by William Osler Health System
Progress to date:
• Funding for fiscal 2012-13 confirmed on January 2, 2013
• Program officially launched January 28, 2013
• Five nurses and one Coordinator hired
• Issues including software inefficiencies have been resolved
• E-referral model originally contemplated more complex
• Referral and Enrollment trending upward
Originally stated Patient Targets included:
• 75 patients by March 31 - 59% of this was reached
• 250 by July – at current rate, may not be reached
2
Telehomecare in Central West LHIN
Program Hosted by William Osler Health System
Lessons Learned to date:
• Starting with “sickest” patient not the ideal target group
• Home visit design – learning curve
• External Working Group – major support to program initially
• Internal IT involvement – absolutely required to achieve program efficiencies
• Hospital model works – discharge planners a significant source of referrals
• Engagement role – required and critical to ongoing referral process
3
Telehomecare in Central West LHIN
Program Hosted by William Osler Health System
Osler
Other
(Cardio,
Physio)
3%
CCAC (1%)
Headwaters
(39%)
MD
Offices
36%
Osler
Discharge
Planners
21%
Sources of THC Referrals
TOTAL NUMBER OF
REFERRALS: 153
INELIGIBLE or
DECLINED REFERRALS:
44 (29%)
TOTAL NUMBER OF
ENROLLMENTS:
84 (55%)
Died during referral: 19
No interest: 17
No phone/line: 4
Too sick/palliative: 4
TOTAL NUMBER
PENDING:
25 (waiting for connection
with patient or MD)
Major referrers: Wise
Elephant FHT; Headwaters
Heath Care Centre, Osler
Discharge Planners
TOTAL NUMBER OF
DISCHARGES: 14
Pending referrals
expected: DAFHT; Rexdale
CHC, CCAC
(4 expired, 4 admitted to
acute care, 4 admitted to
nursing home, 1 too sick to
continue, 1 didn’t like
program)
4
Telehomecare in Central West LHIN
Program Hosted by William Osler Health System
THC Patient Enrollment Numbers (updated May 27, 2013)
80
70
60
50
40
30
20
10
0
5
Telehomecare in Central West LHIN
Enrollment Strategy 1- Targeted Adoption
Description: Easily identified and implementable activities to increase patient numbers.
What have we done?
Activities
Outcomes
•
47% of referrals from discharge planners
•
•
•
•
Presented at huddles – Medicine,
Cardiology, Respirology
Presented at Osler’s CHARM (HF) and
COPD clinics, LHIN Diabetes SelfManagement
Presentations to EGH and BCH
Primary Care groups
Assisted DAFHT and Wise Elephant
FHT to scan records for potential
patients
Engagement Lead Posting approved
46% from community doctors
Resulted in 80+ referrals (pending)
Telehomecare in Central West LHIN
Enrollment Strategy 1- Targeted Adoption (con’t)
Description: Easily identified and implementable activities to increase patient numbers.
Activities
Outcomes
What have we done?
•
Presentations and electronic support
materials provided to Rexdale CHC,
DAFHT and Central West CCAC, Rapid
Response Nurses, Headwaters Health
Care Centre
Pending referrals from CCAC and CHC
Next Steps
•
Further presentations: Osler ED, Osler Diabetes clinics, Headwaters General
Medicine and Headwaters ED
Follow up presentations: FHTs and CHCs
Hire Engagement Lead
Gaining updated list of recently discharged patients for active calling from Osler
Ongoing presentations: Bramalea CHC and four remaining FHTs, HealthLinks
Connect with clinical leads to learn how to build Telehomecare into pathways for
COPD and HF
•
•
•
•
•
Telehomecare in Central West LHIN
Enrollment Strategy 2- Broad Awareness
Description: Communications activities to support awareness across the LHIN
What have we done?
Activities
Outcomes
•
•
Increased community knowledge and
recognition of program service for
community and internal staff
•
At least five referrals from newsletter
•
•
•
•
Created THC program page on Osler
external website
Joined Yammer THC Group to share
program development with community
care providers
Published article in Osler Voices and
Inside Osler newsletters
Participated in Telehomecare video
produced by OTN – Osler provided
patient and physician
Issued joint news release with Central
West LHIN
Telehomecare in Central West LHIN
Enrollment Strategy 2- Broad Awareness (con’t)
Description: Communications activities to support awareness across the LHIN
What have we done?
Activities
Outcomes
•
•
•
•
•
Next Steps
Included THC content in Osler feature in
Rexdale Community News
Aligned THC program with Central West
CCAC and Rapid Response Nurse
program
THC featured in CEO blog on OslerNet
Two THC articles in eVoices newsletter
(internal)
THC articles of references appeared
in Brampton Guardian, Orangeville
Citizen and YourMississaugaBiz.com
•
Telehomecare email message and
information sheet posted to Central
West LHIN website
•
•
•
“Learn to Live Well with Osler” community education sessions
Rogers Daytime TV – Osler segment on THC
Health Fairs
Telehomecare in Central West LHIN
Enrollment Strategy 3 – Key Champions
Description: Use of Key Champions and Key Influencers to raise awareness and increase
referrals.
What have we done?
Next Steps
Activities
Outcomes
•
• 46% of referrals to date from
community MD offices
Email from Drs. Frank Martino, and Jeffrey
Ashley; two follow ups sent at bi-weekly
intervals
• THC referral form accessed 34
times as a result of email
campaign
•
Dr. Frank Martino participated in
Telehomecare video produced by OTN
•
Lunch and Learns and other presentations on-site by key champions
10
Telehomecare in Central West LHIN
Enrollment Strategy 4- Executive Leads
Description: Meet with organizational Executive Leads to gain program support to advocate for
Telehomecare
Activities
Outcomes
What have we done?
•
Connected with CCAC, Headwaters
and Osler Leadership to target
potential patients
•
Next Steps
•
•
Refreshed patient list from Headwaters
Refreshed patient list from Osler
Ongoing referrals
Telehomecare in Central West LHIN
Program Hosted by William Osler Health System
Next Steps:
Requested Engagement Lead role in 2013-14 budget; no confirmation yet

Hire Engagement Lead

Continue Targeted Adoption

Pursue Broad Awareness

Foster Relationships with Key Champions and Executive Leads
12
Connecting Patients to Care
Telemedicine in the Central West LHIN
Status Update
May 29, 2013
OTN Clinical Services
Room based video conferencing
Personal Computer Video Conferencing (PCVC)
Store Forward Telederm
Personal Computer Video
Conferencing (PCVC)
A web-based
videoconferencing
service that enables
Health Care Providers to
perform consultations
from a PC or laptop.
Secure and appropriate
for clinical appointments
Communicates
seamlessly with room
based systems
Store Forward Telederm
A service which allows
doctors to securely send
photographs of
dermatological issues to
Ontario dermatologists
Images are taken with a
digital camera and stored
on the Medweb server.
Physician advice is
communicated via the
secure server.
Successes
Albion Appletree Ltd.
– Unique model
OATC Brampton
– Unique model
Dr. Sandra Romain
– pre-established relationship
CMHA Peel
– TM nurse site, active promotion
Headwaters Health Care Centre
– TM nurse site, active promotion
Mel Lloyd FHT
– TM nurse site, active promotion
William Osler Health System
– TM nurse site, active promotion
Successes
Mental Health and Addictions
– MoHLTC provided 1.75 million dollars for
Telemedicine equipment. Equipment to be used
primarily for MH & A with a focus on addictions
services.
– Proposals submitted to the MH & A Task Force for
Telemedicine equipment during two phases.
– Sites awarded equipment based on strength of
proposals.
Successes
Bramalea CHC
Bramalea CHC – Malton site
CMHA – Peel (Caledon)
Dufferin Area FHT
Hope Acres Addiction and Rehabilitation Centre
Pine River Institute
SHIP – Dufferin County site
SHIP – Main site
SHIP – Wilkinson site
WOHS – Brampton Civic Hospital
WOHS – Etobicoke General
WOHS – Withdrawal Management Centre
Challenges
Currently at Health Service Provider sites with LHIN funded
nurses there is a lower than expected utilization of
Telemedicine. The following have been noted as reasons why
utilization is low:
– Lack of Awareness
• Physicians and patients are not always aware Telemedicine is available
– Lack of Access to Consultants
• Telemedicine needs to be valued, easy to access, easy to use and
affordable
– Lack of Dedicated Space
• Many sites have difficulty finding rooms in which to conduct telemedicine
activity
– Individualized Approach to Adoption
• Effective growth requires a systematic approach and the establishment of
strategic partnerships.
– Remuneration
• Many organizations do not have the funds necessary to cover sessional fees
Potential Opportunities
Adopt best practices from successful sites
– Attempted securing Appletree representative for a
presentation
– Unsuccessful in doing so
– Currently working on securing an OATC
representative
Conduct a needs assessment with Central West
LHIN HSPs
Identify key partnerships
Are there others?
Total Utilization
250000
200000
150000
Clinical
100000
50000
0
Educational
Administrative
2012-2013 Clinical Telemedicine
Utilization Across all LHINS
2012-13 Clinical Utilization
in Central West LHIN
350
300
250
200
150
Q1
100
Q2
50
0
Q3
Q4
Therapeutic Areas of Care
Sites and Systems by LHIN: Q4 12/13
LHIN
Active
Sites
Active
Systems
LHIN
Active
Sites
Active
Systems
1
82
149
8
76
119
2
176
356
9
92
159
3
77
120
10
128
238
4
137
234
11
168
358
5
20
29
12
77
139
6
25
54
13
273
478
7
103
313
14
168
265
Current Status
Anecdotally:
– Clinical utilization is trending up
– Awareness seems to be increasing
– Provisioning process for Mental Health and Addiction
project sites is progressing
Needs Assessment/Capacity Survey
Goals and Objectives
– Retain Telemedicine Nurse funding
– Current state assessment of clinical needs that
Telemedicine may be able support
– Identify organizations/sites that have capacity to provide
care via Telemedicine
– Provide telemedicine enabled organizations with
information that will facilitate connections between
providers and patients
What do you wish to gain from this survey?
Who should be the Target Audience?
– MoHLTC funded?
– Telemedicine users vs. non-users?
Needs Assessment/Capacity Survey
What we need from you
– Endorse/Support the completion of this Needs
Assessment
– Identify any other organizations that should be
included in this survey
Next Steps
Contact OATC to present and identify best
practices
Conduct Survey and Analyze
Present key findings and recommendations at
August Steering Committee meeting
Is there anything else?
Thank you for your time and attention!
Require Additional Information?
Please contact:
Central West LHIN Regional Manager
Paul Pittman
[email protected]
1-866-454-6861 x4501
or visit
www.otn.ca
Narcotics Strategy
and OTN
DRAFT
Current State of Addictions
• Addictions-funded HSPs in 12-13
– five in total
– partnered with two outside Central West
– up from four in 11-12
• Landscape in 10-11
– two HSPs
– 1,331 service recipients
– case management, assessment and treatment,
withdrawal management
• Higher than provincial average use of
cocaine
Current State of Addictions
Concurrent Disorders*
• 25 cross-sector member organizations of
the Concurrent Disorders Network
• wide adoption and implementation of
GAIN Short Screener
• 1,640 completed by spring 2012
• 456 clients endorsed high mental health
and substance use in past year
• 219 in past month
Osler Repeat Visit Study
• Conducted client chart audits
• Covered records from Q3 and Q4 10-11
• Substance use repeat visitor profile:
male, mid 30’s, alcohol
Dual Diagnosis Snapshot
• Four providers identified 54 complex
cases in 2011 records
• Addictions, developmental disability,
trauma, mental illness
• 28% of clients had a concurrent disorder
Dual Diagnosis Snapshot
• 92 of 149 visits attributed to six individuals
• 40 clients had average inpatient stay of 93
days
• Half the clients lacked treatment direction
Narcotics Strategy
• Narcotics Safety and Awareness Act (2011)
• Strategy driven by an MOHLTC Expert Panel
• Proper use, prescribing and dispensing of
prescription narcotics and other controlled
substance medications
• Ensure that people who need them continue
to have access
• Reduce the misuse, addiction, unlawful
activities and deaths related to these
medications
Local Narcotics Strategy
• OTN units allocated in 11-12 as per
approved Central West LHIN plan
• $1M funded in 12-13 as per MOHLTC
directive
• Pregnant/parenting women and individuals
with opioid addictions
• Provincial framework
Local Narcotics Strategy
• Service Delivery partners include:
– Canadian Mental Health Assoc./Peel
– Family Transition Place
– Jean Tweed*
– Peel Addiction Assessment & Referral Centre*
– Punjabi Community Health Services
– William Osler Health System
Local Narcotics Strategy
• Community Treatment
– pregnant/parenting women, individuals
– targeted populations include South Asian
residents and youth
– community workers and limited nursing
• Case Management – MMT
– priority is pregnant/parenting women
• Community Development
Local Narcotics Strategy
• Clinical Coordinator
– collective efficacy to provincial framework and
functional centres as defined
– cross-sector service partnerships
– development of Addiction Services Strategy
• OTN Facilitator
– multi-site support including for scheduling,
procedures development, training,
troubleshooting
• Work Group
Meeting Needs with OTN
• Improve access by rural, suburban, and
urban residents to services
• Build on existing eight community mental
health and addiction service providers
• Neutralize the travel distance between
residents and services and between services
• Create addiction and mental health “service
locations” across the LHIN
Meeting Needs with OTN
• Enhance capacity to respond where clients
present e.g. emergency departments,
shelters
• Better connect health resources to addiction
and mental health services
• Facilitate cross-LHIN boundary service
delivery e.g. consultations, sessionals
OTN Sites
• See handout
– sites overview including unit type
– mapped to show geographic coverage
– indicates type of organization
•
•
•
•
Health
Mental health
Addictions
MH&A
OTN Resources for Strategy
Agency
Resources
BCHC*
prepared to assign an RN or RPN to the role of T-med Coordinator,
health informatics and IT support
CMHA/Peel
1 FTE T-med Nurse, 1.0 T-med Admin., 1 FTE I.T.
DAFHT
deploying staff to support moving forward, ongoing clinical training
Hope Acres
led by the Program Director and Nurse/Intake Worker and supported
by onsite IT person, additional support from Toronto
SHIP
implementation supported through I.T./I.M. supported by 2 FTEs
WOHS*
1.0 RN FTE for Brampton Civic , Etobicoke General and WMC sites, Tmed Dept., I.T.
*Phase 2
Unit Installation Status
Site by Provider and Location
Bramalea CHC – Brampton
Bramalea CHC – Malton
CMHA Peel – Caledon
Dufferin Area FHT
Hope Acres Addictions & Rehabilitation Centre
Jean Tweed^
Peel Addiction Assessment and Referral Centre
Pine River Institute*
Rexdale CHC^
Supportive Housing In Peel – Dufferin County Site
Supportive Housing In Peel – Main Office
Supportive Housing In Peel – Wilkinson site
William Osler Health System – Brampton
William Osler Health System – Etobicoke
William Osler Health System – WM Centre
Installed
Projected
“Live” Date
Circuit
Equip.
n
n
y
n
n
n
n
n
n
n
Early September
Early September
Late April
Late August
Mid June
y
n
y
n
Mid April
Early September
n
n
n
existing
existing
existing
n
n
n
n
n
n
Early August
Early August
Early August
Late April
Late April
Late April
Comments
from OTN
Issues Identified
• Installing the OTN units
• Building the team (incl. role clarification)
• Establishing e-management
–
–
–
–
•
•
•
•
•
OTN scheduling system
communication
coordination
common language
Training (certification) and Uptake (incl. barriers)
Integration of OTN to clinical practices
Promotion
Modelling use of OTN
Priorities for Access
Next Steps
• Determine an approach to connect work of
LHIN TH/TM Committee and Narcotics
Work Group
• TH/TM Committee to share work to date
and plans with Work Group
• Work Group developing an implementation
plan and related work plan
Contacts
Christine Devoy, CMHA/Peel
[email protected]
Wendy Ross, WOHS
[email protected]
Suzanne Robinson, Central West LHIN
[email protected]