cathy seguin, vice president, international affairs, sickkids toronto

The Canadian Pathway to an Integrated

System for the Delivery of Children’s

Health Care

National Healthcare Conference, Ireland

April 2014

• Canadian Healthcare System

• Introduction to SickKids

• Integrated System of Health

• Evolving Models of Integrated Care

Agenda

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Medicare in Canada

“Canada's national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis.”

Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage.”

Source: Health Canada www.hc-sc.gc.ca

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Canada Health Act Public Administration

Comprehensiveness

Universality

Portability

Accessibility

(No Private Care)

Canadian Healthcare System Funding Model

The Federal government transfers funds to provinces and territories

The funding is a mix of public (70%) and private (30%)

Provincially, in Ontario, the Ontario Ministry of Health and Long-term Care

(MoHLTC) is responsible for stewardship, setting legislation and strategy

• There are 14 Local Health Integration Networks (LHINs) that plan, fund

and integrate services at the local level

• 14 Community Care Access Centres (CCACs)

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Agenda

5





Vision

MissionAs innovators in child health since 1875,

we lead and partner to improve the health of children provincially, nationally and internationally through the integration of care, research and education.

ValuesExcellence, Integrity, Collaboration,

Innovation

• Established in 1954

• Canada’s first child health RI


• Advances education at SickKids

• Connects and supports the many education initiatives underway across the organization and beyond


• Largest non-governmental granting agency in child health in Canada

• Over the past 2 years, the Foundation has provided over $200 million to the Hospital


• Collaborates with international partners to improve children’s health globally through the advancement of child health education, clinical and research initiatives

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The Hospital for Sick Children

OUR PEOPLE

10,000Total headcount on 31 March 2013

The Hospital for Sick Children encompasses a large number and wide variety of divisions and units

255 specializations and sub-specializations

1,102Research Staff

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1,486Residents, Fellows &

Students

5,195Hospital Staff

(Excluding Fellows & Students)

1,573Volunteers

653Physicians

(Active & Associate Medical Staff)

More Than a Hospital…A Community

15,000 admissions

12,000 operations

280,000 outpatient visits

64,000 Emergency Room visits

Average length of stay 6.6 days

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Annual Activity

Centre for Research and Learning

• Opened Sept 2013• Corner of Bay and Elm St.

in downtown Toronto• 21 Stories plus below-

grade parking• 750,000 square feet• $400MM project cost 9

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1971

2000

2001

2013

1908First Canadian milk pasteurization plant installed – 30 years before it is mandatory

1930

1951Moved to current location at 555 University Avenue

1954Research Institute is established – a first at a Canadian hospital

1919

Development of Pablum

1957 Salter’s congenital hip dislocation procedure developed

1963 Mustard’s "blue baby“ procedure developed1964Opened paediatric intensive care units – one of the first in North America

1972SickKids Foundation was established

1989Cystic Fibrosis gene discovered

1993Opened the Atrium, a $232M state-of-the-art patient facility

20032004

2006

Potential of stem cells found in adult skin

Cancer stem cell for brain tumours identified

Copy number variation in genome discovered

2007Opened state-of-the-art paediatric cardiac diagnostic interventional unit

2007 Key breakthrough in diabetes – discovery of link between diabetes and the nervous system

Led autism genome discovery2009

Paediatric world first: transplant procedure using Interventional Lung Assist device

Canadian first: baby receives heart procedure in utero

Opened world’s first paediatric magnetoencephalography (MEG) facility

Research & Learning Tower opens

First successful separation of conjoined twins

Opened world’s first Image-Guided Therapy suite

1875SickKids is founded –

the second children’s hospital in the British Empire

2008

2010Groundbreaking of The Research & Learning Tower 2010

New genetic findings linking key genetic variations to autism.

SickKids’ Legacy of Innovation

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Blood transfusion pioneered

Impact

& Innova

tion

Faci

litie

s &

Infr

ast

ruct

ure

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Agenda

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Drivers for Health System Integration in Canada

Canadian Healthcare

SystemIncreasing Costs

Increasing Utilization of

Services

Healthcare Provider Shortage

Fragmentation and Duplication

in Healthcare “system”

New Funding Models

Improving Health Outcomes

Enhancing the Patient and

Family Experience

Health System Integration

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Value Proposition for Health System Integration

Health Outcomes Patient and Family Experience Provider Productivity and Satisfaction

Costs Inefficient Use of Scarce System

Resources Fragmentation of Care

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Social determinants of health

Preventive health

Primary care

Advocacy Care deliveryAdvising

Few potential actors

Many potential actors

SickKidsToday

Research

Quaternary medical care

Tertiary care

Emergency and secondary hospital careIncreasing public spending

There are Many Ways to Have Impact Across the Healthcare System

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How do we define ourselves?

• What set of services do children and families need us to deliver across these patient cohorts?

• How do we facilitate a coordinated system?

• How can we enhance, facilitate, or otherwise impact those necessary services that we don’t directly deliver?

• What partnerships do we leverage to improve the system?

We Will Need to Define Our Identity in the Healthcare System

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ProvincialNational

Child & Child & FamilyFamily

Canadian Paediatric Society

Canadian Association of Paediatric Surgeons

Children’s Mental Health Ontario

Provincial Council for Maternal and Child Health

Ontario Association of Children’s Rehabilitation CentresOntario Association for Infant and Child Development

electronic Child Health Network (eCHN)

Local

CCAC’s SickKids

LHIN’s

Paediatric Partnerships that Exist to Define & Execute the Strategy

Canadian Association of Paediatric Health Centres





Agenda

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Integrated Complex Care Model

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Family Lead

Clinical Lead

Systems Lead

Child

Family Health TeamsPrimary Care Providers

Community Health Centres

ClinicsInpatient Programs

ClinicsInpatientPrograms

Support ServicesRespite

Day CareSchools

CCAC Care Coordination CCAC Service Provider Direct

Health & Support Services

0.14% of Ontario’s paediatric population uses 54% of provincial paediatric resources

Ontario Paediatric Tertiary Hospitals

Tertiary Paediatric Sites

Community-based SickKids Complex Care Hospital Programs

• 3.0 M children 0-18 yrs

• Inpatient distribution by tertiary centre:

• SickKids 42%

• Hamilton 18.5%

• Ottawa 18%

• London 15.3%

• Kingston 6.2%

eCHN – A Made in Ontario EHR Solution

C

C C

CC

C

C

C

C

eCHN PARTNER SITES:

• 106 Hospital sites

• 80+ Community Care Access sites

• 2100+ Physician offices (incl. clinics)

• 30+ Children’s Treatment Sites

• 2.3M+ patientsC

C

C

CC

C

CC

C

C

eCHN GROWTH:

• Unique users: 5,143 (+240% since 2011)

• Monthly logins: 13,000 (+ 116% since 2011)

• Documents viewed in 2013: 380,000 (+36% since 2011)

• OLIS lab results added

• Added Diabetes tracking tool

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eCHN

Hospital Partner

Community Care PartnerC

SickKids Telepsychiatry Sites

SickKids

Telepsychiatry Sites

• Connects mental health experts with patients, families/ caregivers and professionals

• Provides clinical assessments, capacity building and education

• 2000 appointments per year

• External partners: Children's Mental Health

Agencies Hospitals Physicians Schools Young Offender Facilities Nursing Stations

• 35% of our work is with First Nations and Aboriginal communities

• access up to 75 Child and Adolescent Psychiatrists with subspecialization

• Hospitals as highly concentrated

points of health care

• Medical records as a disconnected

set of snapshots of health• Patients depend on medical system

for monitoring, decision making,

access• Patients responsible for integration

across points of contact

• Care is distributed across a number

of venues depending on the

necessary degree of specialization• Medical records are a continuous

representation of patient state• Patients have greater ability for self-

monitoring, participating decision

making • System provides integration across

venues

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The Future is Systems That Transcend Time, Space and Specialty

Looking Inward

• Where can we improve quality and

better manage resources?• Where can we redesign systems to

be more efficient?• How do we prepare to do more with

(relatively) less? Technology People Processes

Looking Outward

• Where else in the system can we

help improve quality and resource

management?• How do we share what we’ve

learned about efficient and effective

systems for paediatric care?• How do we anticipate changes in

other parts of the system?

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Questions to Frame Our Thinking Going Forward

cathy seguin, vice president, international affairs, sickkids toronto

Health & Medicine