1. Fast Forward 10 Years: Health Care in Ontario Presentation to Grey Bruce Health Services Cathy Fooks President and CEO The Change Foundation

2. Established by the OHA in 1995 to support change in Ontario’s health care system Currently $60 million endowment First ten years spent as a granting agency Recently evolved into a policy think tank Two areas of concentration: health integration and quality improvement in community care

3. Focus on Change People Health Care Technology and Information 1) What will be different? 2) How will affect patients?

4. People – Aging Population, Ontario Source: Statistics Canada

5. People - We Are Living Longer – Life Expectancy (Ontario) Source: Statistics Canada

6. People – More Chronic Disease, Ontario Source: Statistics Canada

7. People – Five Year Survival Rate, Cancers, Ontario Source: Cancer Care Ontario

8. People – More Immigration, Ontario Source: Statistics Canada

9. People – Increasing Levels of Education, Ontario Source: Statistics Canada

10. People – Changes in Places of Work, Ontario Source: Statistics Canada

11. Health Care – The Budget Dollar, Ontario Source: Ontario Government

12. Health Care – Components of Provincial Spending within Ontario Health Care (Public $) Source: CIHI

13. Health Care – Changes in Hospital Care, Ontario Source: CIHI

14. Health Care - Care in the Community Pollara Health Care in Canada 2007 survey 27% of Ontarians report that they have personally cared for a family member or close friend with a serious health problem in the past 12 months. Nationally: –35% of 45 - 64 year-olds have provided care –1 in 10 had to quit work to care for loved one –41% had to use personal savings to survive during this time –22% had to take one or more months off work –41% reported that the result of caring for a family member or close friend had a negative impact on their mental health –38% reported that the experience had a negative impact on their physical health –40% reported that the experience had a negative impact on their finances

15. Health Care – Age Standardized Average Length of Stay in Hospital, Comparisons, Canada Source: CIHI

16. Health Care – Use of Telehealth, Ontario Source: MOHLTC

17. Health Care - % of all personal expenditures on health care, Canada Source: Statistics Canada 19994.8% 20035.2% 20075.5%

18. Health Care – Personal Expenses, $millions, Canada

19. Health Care – Ontarians in Family Health Teams, Source: MOHLTC

20. Health Care - After Hours Care, Ontario Source: NPS, 2007 % Answering Yes: 79.7% have physician available for patient care during non office hours 31.4% staffed clinic by physician or others in practice 12.9% medical telephone advice with access to medical record 25.8% medical telephone advice without access to medical record

21. Health Care – Use of Email by Physicians Source: NPS, 2007 53.2% use to communicate with colleagues for clinical purposes 64.9% use to communicate with colleagues for other purposes 15.4% use to communicate with patients for clinical purposes 5.3% use to communicate with patients for other purposes

22. Health Care – Local Health Integration Networks (LHINs) Currently, 14 LHINs in the province Under the auspices of the LHINs: –Public hospitals (2007/08) –Mental health & addictions agencies (2008/09) –Community support service agencies (2008/09) –CHCs (2008/09) –LTC Homes (2008/09) –CCACs (2009/10)

23. Health Care - LHINs Not under the auspices of the LHINs: –Physicians –Public health –Ambulance services –Labs –Provincial networks and priority programs

24. Regional Health Authorities Elsewhere in Canada One regional Board to organize, fund and deliver continuum of services Primary care not yet included although western provinces moving in this direction Integrated information management systems Will be the first to have electronic health records for all

25. Health Care - Performance Measurement/Reporting LHIN accountability agreements with government contain reporting indicators Provider accountability agreements with LHINs contain reporting indicators Government produces some public information Waits time data on web for selected procedures Not yet standardized

26. Technology and Info – by 2010 Source – Canada Health Infoway

27. Technology and Info – Electronic Health Record Software from Microsoft From the Microsoft web site: EHR Can be accessed wherever and whenever they are needed. Give doctors and hospital workers accurate, timely information. Increase responsiveness by providing mobile access to records through devices such as Pocket PCs and tablet PCs Enable patients to participate more fully in their own care. Provide greater security and privacy Reduce costs and increase efficiency by replacing paper-based processes.

28. Technology and Info – Hospital Specific Info, UK NHS Choices – Central Web site in England www.nhs.uk Sort by city, table with all hospitals doing the procedure Set of standardized questions including wait times, how many surgeries they do a year, mortality rates, readmission rates, scorecard information Book appointments online

29. Technology and Info – Hospital Specific Info, US Hospital Compare, US www.hospitalcompare.hhs.gov Search on city, hospital name, procedures, quality scores, patient satisfaction surveys etc. Also shows medicare payments and volumes by hospital

30. Technology and Info – Wait Times in Ontario How Wait Time Information Can Help You You can use wait time information to find hospitals with the shortest wait for the procedure you need. You can ask your doctor if they can refer you to another specialist or hospital with a shorter wait. www.health.gov.on.ca Wait times for small number of procedures by hospital and by LHIN

31. Technology and Info – Hospital Specific Info, Ontario Some hospitals have balanced scorecards on their web sites No central, searchable site yet No standardized reporting on outcomes

32. Technology – Use of Robotics Carebots in the home Robotic patient assessment Robotic surgery "People want to stay in their houses but their kids have trouble looking after them. If you have a long-term care type of companion which … would keep an eye on the person and talk to the person … family members could talk to the person through the robot. The robot would keep track of where the person is actually moving or if they're lying on the floor in the bathroom, has taken their drugs, has followed their normal routine.“ Alan Mackworth, UBC

33. Technology and Information – Mapping Human Genes Human Genome Project has completed mapping 25,000 human genes Results will: Improve diagnosis of disease Detect early the genetic predispositions to disease Support rational drug design Provide gene therapy

34. People In Ten Years – What Does it Mean? Older patients living longer with chronic disease People receiving more intensive health care in their homes Continued reliance on informal caregivers Prepared to pay out of pocket or for extra insurance

35. People in Ten Years – What Does it Mean? Increased diversity of cultural makeup Changed expectations about care, family roles Higher levels of education – more informed and demanding consumer

36. Health Care in Ten Years – What Does it Mean? Greater consolidation of specialized programs, technical infrastructure as increasing evidence on volumes and quality is available Distance to become less of an issue as technologies allow communication and care over large geographic areas Role for smaller hospitals may change More health care resources at home over longer periods of time (not palliative) to deal with chronic disease More non health care resources at home to delay admission to a facility

37. Health Care in Ten Years – What Does it Mean? Not clear who will pay for things not currently publicly funded Stronger relationship between primary care and hospitals – FHTs in the hospital? Much more primary care delivered by teams and non-MDs Change in the hours of access – evenings not considered “after hours” More reporting and outcomes measures made public

38. Health Care in Ten Years – What Does it Mean? Not sure about governance – LHINs will look different – may have more providers or services under their auspices –may have more authority Depending upon what the LHINS look like, maybe changes to local governance as well

39. Technology and Info - What Does it Mean? Patients will have their own electronic record in their home and on their hand held devices Provider specific real time waits (hospitals and maybe primary care) on the web (check that day) Booking online for everything Greater use of robotics in the community and in hospitals Greater use of genetic information in prevention, diagnosis and treatment efforts