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Enhancing Access by Bridging the Distance

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Presentation on theme: "Enhancing Access by Bridging the Distance"— Presentation transcript:

1 Enhancing Access by Bridging the Distance
The New Brunswick Telehealth Experience February 2007

2 The New Brunswick Context
New Brunswick is a rural province with a geographically dispersed population We are required by law to offer health services in two official languages Tertiary services are concentrated in NB’s 3 largest cities in the south: Moncton, Saint John & Fredericton

3 The Atlantic Health Sciences Corporation is New Brunswick’s largest multi-facility accredited Regional Health Authority. Comprised of 12 hospitals and health centers extending across 200 kilometers, AHSC serves a catchment population of 200,000 in the Southwestern part of the province. With a geographically distributed workforce of 5,000 24/7 employees in 12 sites, it is easy to imagine the potential benefits that could be realized through an e-learning initiative.

4 Challenges and Creativity
Geography Access Population concentration Wait time Location of services Telehealth Creative service delivery approaches utilizing technology to improve access and wait times.

5 NB - Early Innovator in Telehealth
“Imagination is more important than knowledge.”

6 Telehealth Definition
“The use of information and communication technology to deliver health services, expertise and information over distance.”

7 Telehealth in NB Bridging distances by bringing quality health services and information to all New Brunswickers.

8

9 VISION Independent of the location of patient
and providers, telehealth will: Empower consumers and communities Improve access to needed services and expert resources Decrease wait times for health services Maximize opportunities for self-care and compliance to treatment plans Mobilize new opportunities for patients, families and communities to prevent illness and promote wellness

10 Guiding Principles Alignment with the provincial health plan
Improve access/wait times Clinical programs, not technology, drive priorities Provides value for client, provider and funder Respect for preference of language, culture, location of service Integration with clinical programs & EHR Respect for privacy & confidentiality Ease of use Adopt standards of best practice

11 Telehealth Infrastructure
Matapedia, PQ Montague, Souris, Summerside, Charlottetown, PEI Amherst, NS TeleCardiology Caraquet Regional Centres Hospital/ CHC TeleOncology TeleRehabilitation Dalhousie Campbellton Lamèque IWK Halifax, NS TelePaediatrics TeleNephrology St-Quentin Edmundston Tracadie-Sheila Bathurst Miramichi Grand Falls Plaster Rock TeleCare TeleMental Health Doaktown Perth Bath Ste-Anne-de-Kent Woodstock Minto Moncton (Dumont) TeleHomeCare Moncton (City) Fredericton Oromocto Sussex Sackville Harvey Albert McAdam Teleneurosurgery QEII Halifax, NS TeleNutrition TeleEducation TeleGenetics Saint John (St. Joe’s) Saint John St. Stephen Black’s Harbour Deer Island Campobello Island Grand Manan

12 Telei4 PACS Connections Provincial and Atlantic Network Connection
DI Infrastructure Other DI Connections Dalhousie Caraquet Campbellton Lamèque Telei4 PACS Connections St-Quentin Edmundston Tracadie-Sheila Bathurst Miramichi Regional Centres Grand Falls Plaster Rock Hospital Perth Bath Ste-Anne-de-Kent Woodstock Minto Moncton (Dumont) Moncton (The) Fredericton Oromocto Provincial and Atlantic Network Connection Halifax NS QEII Hospital Sussex Sackville Harvey Albert McAdam Saint John (St. Jos) Saint John St. Stephen Black’s Harbour Grand Manan

13 Enhancing Access “Taking the hype out of Telehealth and utilizing available technology, allows us as health care providers to seize opportunities to increase access to quality holistic health care. We are limited only by our imagination”. Krisan Palmer, Manager, Telehealth Department, Atlantic Health Sciences Corporation

14 New Brunswick Heart Centre
The New Brunswick Heart Centre (NBHC) provides tertiary cardiac care to the province of New Brunswick Initiated telehealth service in the 90s as a result of issues relating to access and continuity of care As a result of this and other program improvements, currently 96% of all coronary artery bypass surgeries are completed within 182 days

15 Clinical Issues Prompting System Changes
Cardiac Triage No objective, systematic approach in referrals or prioritization Loss of patient data Inequities Following surgery 32.3% reaccess rate to local emergency 54% of those readmitted No communication to the Heart Centre Inappropriate case management

16 Objectives for Telehealth Use
Objective, systematic approach to cardiac triaging Increase access to specialized scarce resources and reduce wait times Increase quality and continuity of care Extend the hospital into the home Decrease reaccess, readmission rates Eliminate geography

17 Cardiac Triage - Teleconsultation
Contact system through remote terminal at any time of day Data stored on server at the Heart Centre Maintain list of all patients and provide feedback to referring centres re: where patients are on the list Utilization of an acuity/priority scoring system to objectively rank patients for transfer

18 Hospital to Home Monitoring
Post Surgery – Hospital to Home Monitoring Real-time interactive clinical monitoring system (ECG, NIBP,SP02) Fully interactive audio and video Wound Management Works on standard phone line (POTS)

19 Results -Quality Ease of access to expert advice improved quality of care, and reduced reaccess rates by study patients during immediate post discharge period Clinically valuable, treatment of symptoms before emergent

20 Results -Acceptability
Patient satisfaction – 80 – 100% Clinician satisfaction – 80 – 100% Technology Performance % Peripherals %

21 Overall Evaluation Determined clinically equivalent
Improved access/wait times Enhanced capacity Cost of access to care is significantly reduced for patients and their families

22 Testimonials “It is an excellent program, easy to use.We feel really secure knowing we are being monitored daily by our nurse. It lessens our fear of something happening.” –patient “It’s facilitates great collaboration with the specialists at the heart centre”- remote MD “You are angels in a suitcase!!”-patient

23 Telehealth and the New Brunswick Heart Centre
An integral component of the New Brunswick Heart Center Teleconsultation and home monitoring are key components for appropriate access and wait times Home monitoring provides service to over 450 patients a year Has undergone planning for technology enhancement and incorporation of all information collected into the Region’s Clinical information System

24 Outpatient Clinics Real-time interactive audio and video
Data channel allows auscultation of heart and lung sounds Wound management Echocardiograms, X-rays

25 Telehomecare EMPcare@home
Provincial Telehomecare demonstrator initiative New approach to care of patients with a chronic care disease 85% decrease in hospital admissions for patients 55% decrease in emergency room visits 96% - overall patient satisfaction with service 95% - recommend to others 93% - better knowledge of health condition Overall, improved access to appropriate care when required resulted in enhanced patient outcomes, decreased utilization of hospital care and therefore enhanced capacity for hospital based services.

26 And there are many other examples…
Telemental health – provision of emergency mental health services and consultation services in areas without this expertise. Increased access to specialty services and reduced wait times. Oncology services –provision of education and information from a provincial cancer centre to the northern regions. Increased access to specialty services and reduced wait times.

27 Nephrology Satellite Dialysis Unit Access to EHR Physician order entry
Review of diagnostics Wound Management Overall improved access to services and greatly reduced patient travel.

28 Summary Telehealth can be a positive enabler for enhancing access, reducing wait times and increasing capacity when…. It is embedded in the model for service delivery It is program driven not technology driven There has been effective change management and support in place

29 Telehealth, a NB success story as defined by…
Enhanced access Reduced wait times Increased capacity Patient and provider satisfaction Quality care/outcomes Patient efficacy/self management Knowledge transfer/education Patient support/holistic care Innovation/technology performance Cost Attitude changes – “Just the normal way we do business”

30 Success…as acknowledged by others

31 Thank You Enhancing Access by Bridging the Distance The New Brunswick Telehealth Experience

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