1. Mental Health Engagement Network (MHEN): Connecting clients with their health team Jeff Reiss MD, MSc, FRCPC City-wide Site Chief, Mental Healthcare Program – LHSC; Vice Chair, Dept. of Psychiatry – UWO; Associated Scientist - Lawson Health Research Institute Nick Zamora BscPhm, MBA, CHE Chief Clinical Advisor TELUS Health

2. Mental Health Engagement Network Canadian Innovation through Partnerships o Canada Health Infoway: Consumer Health Innovation Program o Lawson Research Institute: Comprehensive evaluation expertise around innovative technologies o LHSC and SJHC: Pushing transformation o TELUS Health: Investment in consumer health engagement solution 2

3. The Health and Care Challenge o 20% of Canadians experience mental illness, only 1/3 receive treatment o 500,000 employed Canadians are unable to work due to mental illness in any given week (2/3 disability cases + 1/3 FT absenteeism) o Mental health is the number one cause of disability in Canada, accounting for nearly 30% of disability claims and 70% of the total costs o Current treatment cost estimates of mental illness: depression: $5 billion schizophrenia: $2.7 billion uninsured mental health services: $6.3 billion 3 $51B in lost productivity and healthcare costs

4. Objectives o Improve the health outcomes and quality of life for people living with schizophrenia or mood disorders o Put novel technology in the hands of clients and their clinical team o Deploy and evaluate customized PHR application that leverages TELUS health space®, powered by Microsoft Healthvault®, and provides: Patient access to their own health information (through LIDB) Interactive tools such as a mood monitor and journaling Standardized health services Ongoing monitoring of activities with alerts and reminders Regular communication between clients and their care team 4

5. Project Design o 400 research participants recruited who have been diagnosed with a mood disorder or a psychotic disorder o 54 care providers recruited to provide client care using new technology o Participants recruited through staff caseloads who have volunteered at outpatient programs in London and surrounding areas including: London Health Sciences Centre and St. Joseph’s Health Care Community agencies such as the Canadian Mental Health Association (London Middlesex Branch) and WOTCH Community Mental Health Services 5

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7. Mobile Patient Interface is connected 7 Mental Health Clinicians & Community Care Providers Jurisdictional, regional & local administrators Clients Family & Other Supporters 400 clients provided with smartphones AND access their Smart record Access via web or mobile on own device (no devices provided by project) 55 devices will be provided to community care providers by project Remaining care providers will access using web and/or mobile from own device Web access

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16. Mobile View 16

17. Provider Portal 17

18. Faculty/Presenter Disclosure Faculty: Jeff Reiss Relationships with commercial interests: – Grants/Research Support: Canada Health Infoway and TELUS Health – Speakers Bureau/Honoraria: none – Consulting Fees: none – Other: none

19. Project Design o Delayed implementation approach o Participants were randomized into Group 1 (early intervention) or Group 2 (later intervention) o Participants are provided with a handheld device, a TELUS Health Space account, and a Lawson SMART record timed according to their intervention group and receive training on the handheld device and Lawson SMART record

20. Project Design (Cont.) o Participants will complete a total of 4 interviews, every 6 months for a total of 18 months o Focus groups take place at multiple points in time during the study o Data collected includes use of devices, perception of usefulness, quality of life, empowerment, general health, and use of health and social services (including hospitalizations and emergency room visits as well as other services)

21. Expected Outcomes o The overall hypothesis is that the usage of smart health information technology will improve quality of life and reduce health care system costs by providing: care providers can closely monitor the individuals recovery process real-time communication with their care provider team scheduling appointments and request medication refills track clients in regards to medication adherence and adverse reactions provide earlier intervention before a crisis situation arises provide continued support between formal face to face clinical visits o To confirm this hypothesis we will use a standardized evaluation framework that will provide project outcomes on the basis of effectiveness, economic, policy, and ethical analyses

22. Desig n Phase 1 Dev 2015 2013 20122011 2014 Mental Health Engagement Network – PROJECT TIMELINE Phase 2 – Next 200 Clients Implementation Into Care..... Phase 2 Dev Phase 1 – First 200 Clients Care Providers Wireless 18 mths I-Pads Desig n augaug augaug marmar marmar

23. Descriptive statistics n = 400 Age Mean38.5 Std. Deviation13.8 Minimum18 Maximum78 Sex FrequencyPercent Female15538.7 Male24561.3 Total400100.0

24. Descriptive statistics n = 400 Mental HealthFrequencyPercent Developmental Handicap3.75 Anxiety Disorder12832 Disorder of Childhood/Adolescence 205 Organic3.75 Substance-Related Disorder5513.75 Personality Disorder256.25 Psychotic Disorder23358.25 Mood Disorder23759.2 Other102.5 Unknown2.5

25. Descriptive statistics n = 400 Have you ever had a psychiatric hospitalization? FrequencyPercent No5614 Yes34385.75 Missing1.25 Total400100 Estimated total number of psychiatric hospitalizations Mean7.7 Std. Deviation10.8 Minimum1 Maximum100 n = 343

27. Accessing the Lawson SMART record

28. Lawson SMART record Usage

29. Thinking of your personal health record how do you feel about its ease of use? (n=147)

30. How do you feel about having your own personal health record? (n=178)

31. How do you feel about connecting with your health care provider using the smart phone? (n=161)

32. How do you feel about being able to share your health information with other health care providers? (n=160)

33. Summary of Focus Groups Feedback Benefits / positive changes through the use of the Lawson SMART record and iPhone – Care providers more accessible to their clients and vice versa – Boost clients self esteem – Clients feel more connected Care provider Other community supports – Facilitates self-awareness within clients and promotes self-reflection Privacy and confidentiality with regards to the Lawson SMART record – No major concerns Workflow Impact – Time savings – Increased productivity during client meetings

34. Where do we go from here? Approach to Maintain 400 Clients & Strengthen Solution MHEN is a game changer! Work with System Change Agents to Scale and Sustain 1.Build on what has been done in London 2.Create Governance Sustainability and Future Development Committee 3.Link to programs and organizations with same mandate: The Sandbox Project, CIHR SPOR TRAM Who, How and Why: Business Plan, Evaluation Engage Private Sector & Other Jurisdictions Ontario Expansion & Establish National Sites Evaluation, Development & Sustainability Planning, Funding, Executing National Expansion Expand: MH Conditions & Co-Morbidities Expand to Youth & Link with Sandbox and TRAM SPOR Mental Healthcare System Redesign 34

35. Questions? Questions for Dr. Jeff Reiss: jreiss4@uwo.ca Questions for Nick Zamora: nick.zamora@telus.com

36. MHEN: Transforming the System, Transforming Lives MAIN OBJECTIVES Early Intervention: Monitoring patients moods with automation of alerts to contact care providers: next of kin, substitute decision maker, family doctor, etc., so services are integrated and coordinated Care is Proactive and Ongoing: Through TELUS health space, clients will be able to access health tools to support them in their recovery, and beyond Person Driven Access to Care Plans: While this project is aimed to manage a difficult illness, the lessons learned would support future system redesign for the whole population Medication Management: most sought after information by community agencies. Patients can leverage their personal health record to inform care providers so better decision-making This will ensure that the new care provided is based on prior care for continuity of care Data Integration: To better utilize Provincial Assessment tools like the OCAN survey and RAI, which is used in hospitals, but not in community mental health Integrated Referral System Research Data: This project will support the future linkage with other social services, such as income support information to elevate clients from becoming homeless. Research data will inform policy-makers 36

37. Methodology Technology Implementation At Phase 1 (first 3 months of project), the 200 participants in Group 1 will be provided with a PHR through TELUS health space, as well as they will be introduced to smart phone technology to ready them for deployment of the prompts and reminders Two months later, they will be provided with a handheld device. A delayed implementation plan will be used (but will have no effect on the standard of care for the remaining 200 participants), so the remaining 200 participants in Group 2 will initially act as a control group, but at Phase 2 (six months later – approximately June 2012) the remaining 200 participants will be introduced to the technology in the same order (PHR -> Smart Phone) Group 2 will have the benefit of any enhancements made during Phase 1 of the project 37

38. Methodology Specifically, the study participants will receive the following: access to TELUS health space a PHR application account access to an online thought diary and mood diary both linked to personalized recovery/relapse prevention plan access to a voice scale that assesses auditory hallucinations (for patients with schizophrenia) access to a medication side-effect monitoring diary, to trigger a review of medications, as well as alerts to care providers related to prescription renewals a handheld device and data plan which will facilitate mobile access to the applications and interactive tools individualized proactive prompts and cues to help them structure their days (e.g. reminder to take medication at 8:00 am) 38

39. Methodology Quantitative Data Collection Individual interviews with patient participants will be held at the baseline period and then every 6 months for 18 months Data collected will include use of devices, perception of usefulness, quality of life, general health and use of health and social services (including hospitalizations and emergency room visits as well as other services) The knowledge learned through Group 1, over the initial 6 months, will provide baseline and comparative data to understand the client’s perceptions for designs and outcome purposes of the technology intervention Improvements in the technology approaches made during the initial 6 month period will enhance the tools for Group 2. We are expecting different feedback from groups, one to guide development and one to improve what is developed 39

40. Methodology Quantitative Data Collection The structured interviews will involve the following seven questions: 1.Demographic Form 2.Quality of Life – Brief Version (QoL-BV) 3.Health, Social, Justice Service Use 4.Medical Outcomes Study 36-item Short Form Health Survey (SF-36) 5.EQ-5D Health Utilities Index 6.Community Integration Questionnaire 7.Perception of Smart Technology Form 40

41. Methodology Qualitative Data Collection Focus groups will take place at multiple points in time during the study For Group 1, the focus groups will take place: 1) 2-3 months after initial implementation to discuss initial developments, usability and adoption (focus on the PHR health space solution) 2) within the next 6 months to discuss addition of phones and issues related to maintenance or loss 3) a final set of meetings 6 months later to discuss the benefits and pitfalls of the technology to form base recommendations for the next phase of study Group 1 will have the opportunity to provide input on the initial technology design framework, supporting user-centred design (UCD) for novel tool development 41

42. Methodology Qualitative Data Collection For Group 2, the focus groups will take place: 1) prior to implementation to understand how they use technology before the new approach is introduced and starting with the PHR and health space program 2) 2-3 months after initial implementation to discuss initial development, usability and adoption of phones 3) within the next 6 months to discuss maintenance or loss Focus groups with staff/healthcare providers will also be held so that issues can be identified and addressed quickly 42