Enhancing Access by Enhancing Access by Bridging the DistanceBridging the Distance

The New Brunswick The New Brunswick TelehealthTelehealth ExperienceExperience

February 2007

The New Brunswick ContextThe New Brunswick Context

•• New Brunswick is a rural province New Brunswick is a rural province with a geographically dispersed with a geographically dispersed populationpopulation

•• We are required by law to offer We are required by law to offer health services in two official health services in two official languageslanguages

•• Tertiary services are concentrated Tertiary services are concentrated in NBin NB’’s 3 largest cities in the south: s 3 largest cities in the south: MonctonMoncton, Saint John & Fredericton, Saint John & Fredericton

Challenges and CreativityChallenges and Creativity

GeographyGeography AccessAccess

Population concentrationPopulation concentration Wait timeWait time

Location of servicesLocation of services

Creative service delivery approachesCreative service delivery approachesutilizing technology to improve access utilizing technology to improve access and wait times.and wait times.

NB NB -- Early Innovator in Early Innovator in TelehealthTelehealth

““Imagination is more important than Imagination is more important than knowledge.knowledge.””

TelehealthTelehealth DefinitionDefinition

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

TelehealthTelehealth in NBin NB

Bridging distances by bringing Bridging distances by bringing quality health services and quality health services and information to all New information to all New BrunswickersBrunswickers..

VISIONVISIONIndependent of the location of patientIndependent of the location of patient

and providers, telehealth will:and providers, telehealth will:

Empower consumers and communities Empower consumers and communities

Improve access to needed services and Improve access to needed services and expert resourcesexpert resources

Decrease wait times for health services Decrease wait times for health services

Maximize opportunities for selfMaximize opportunities for self--care care and compliance to treatment plansand compliance to treatment plans

Mobilize new opportunities for Mobilize new opportunities for patients, families and communities to patients, families and communities to prevent illness and promote wellnessprevent illness and promote wellness

Guiding PrinciplesGuiding Principles•• Alignment with the provincial health plan Alignment with the provincial health plan •• Improve access/wait timesImprove access/wait times•• Clinical programs, not technology, drive Clinical programs, not technology, drive

prioritiespriorities•• Provides value for client, provider and Provides value for client, provider and

funderfunder•• Respect for preference of language, culture, Respect for preference of language, culture,

location of service location of service •• Integration with clinical programs & EHRIntegration with clinical programs & EHR•• Respect for privacy & confidentiality Respect for privacy & confidentiality •• Ease of use Ease of use •• Adopt standards of best practiceAdopt standards of best practice

Perth

Dalhousie

Bathurst

Lamèque

Tracadie-Sheila

Miramichi

St-Quentin

PlasterRock

Bath

Woodstock

Oromocto

HarveyMcAdam

St. Stephen

Saint John (St. Joe’s)

Moncton (City)

Albert

Sackville

Ste-Anne-de-Kent

Minto

Sussex

Grand Manan

Black’sHarbour

Grand Falls

Saint John

Moncton(Dumont)

Campbellton

Fredericton

Edmundston

Regional Centres

Hospital/ CHC

Telehealth Infrastructure

Doaktown

Deer Island

Campobello Island

TeleNutrition

TeleEducationTeleGenetics

TeleCare

TeleOncology

Matapedia, PQ

Montague, Souris, Summerside, Charlottetown, PEI

Amherst, NS

TeleCardiologyTeleNephrologyTeleRehabilitation

TeleHomeCareTeleneurosurgery

QEII Halifax, NS

IWK Halifax, NS

TelePaediatrics

TeleMental Health

Caraquet

Dalhousie

Bathurst

Caraquet

Lamèque

Tracadie-Sheila

Miramichi

St-Quentin

PlasterRock

Perth

Bath

Woodstock

Oromocto

HarveyMcAdam

St. Stephen

Saint John (St. Jos)

Moncton (The)

Albert

Sackville

Ste-Anne-de-Kent

Minto

Sussex

Grand Manan

Black’sHarbour

Grand Falls

Telei4 PACS Connections

Other DI Connections

Provincial and Atlantic

Network Connection

Halifax NS QEII Hospital

Saint John

Moncton(Dumont)

Campbellton

Fredericton

Edmundston

Regional Centres

Hospital

DI Infrastructure

Enhancing AccessEnhancing Access

““Taking the hype out of Taking the hype out of TelehealthTelehealth and utilizing available technology, and utilizing available technology, allows us as health care providers allows us as health care providers to seize opportunities to increase to seize opportunities to increase access to quality holistic health access to quality holistic health care. We are limited only by our care. We are limited only by our imaginationimagination””..

Krisan Palmer, Manager, Krisan Palmer, Manager, TelehealthTelehealth Department, Department, Atlantic Health Sciences CorporationAtlantic Health Sciences Corporation

New Brunswick Heart CentreNew Brunswick Heart Centre

•• The New Brunswick Heart Centre (NBHC) The New Brunswick Heart Centre (NBHC) provides tertiary cardiac care to the provides tertiary cardiac care to the province of New Brunswick province of New Brunswick

•• Initiated Initiated telehealthtelehealth service in the 90s as a service in the 90s as a result of issues relating to access and result of issues relating to access and continuity of carecontinuity of care

•• As a result of this and other program As a result of this and other program improvements, currentlyimprovements, currently–– 96% of all coronary artery bypass surgeries 96% of all coronary artery bypass surgeries

are completed within 182 daysare completed within 182 days

Clinical Issues Prompting System ChangesClinical Issues Prompting System Changes

Cardiac TriageCardiac Triage

•• No objective, systematic approach in No objective, systematic approach in referrals or prioritizationreferrals or prioritization

•• Loss of patient dataLoss of patient data

•• InequitiesInequities

Following surgeryFollowing surgery

•• 32.3% reaccess rate to local 32.3% reaccess rate to local emergency emergency

•• 54% of those readmitted54% of those readmitted

•• No communication to the Heart CentreNo communication to the Heart Centre

•• Inappropriate case managementInappropriate case management

Objectives for Objectives for TelehealthTelehealth UseUse

•• Objective, systematic approach to Objective, systematic approach to cardiac triagingcardiac triaging

•• Increase access to specialized Increase access to specialized scarce resources and reduce wait scarce resources and reduce wait times times

•• Increase quality and continuity of Increase quality and continuity of carecare

•• Extend the hospital into the homeExtend the hospital into the home•• Decrease reaccess, readmission Decrease reaccess, readmission

ratesrates•• Eliminate geographyEliminate geography

Cardiac Triage Cardiac Triage -- TeleconsultationTeleconsultation

•• Contact system through remote Contact system through remote terminal at any time of dayterminal at any time of day

•• Data stored on server at the Heart Data stored on server at the Heart Centre Centre

•• Maintain list of all patients and Maintain list of all patients and provide feedback to referring provide feedback to referring centres re: where patients are on centres re: where patients are on the listthe list

•• Utilization of an acuity/priority Utilization of an acuity/priority scoring system to objectively rank scoring system to objectively rank patients for transferpatients for transfer

• Real-time interactive clinical monitoring system (ECG, NIBP,SP02)

• Fully interactive audio and video

• Wound Management • Works on standard phone

line (POTS)

Post Surgery –Hospital to Home Monitoring

Results Results --Quality Quality

•• Ease of access to expert advice Ease of access to expert advice improved quality of care, improved quality of care, and and reduced reaccess rates by reduced reaccess rates by study patients during study patients during immediate post discharge immediate post discharge periodperiod

•• Clinically valuable, treatment of Clinically valuable, treatment of symptoms before emergentsymptoms before emergent

Results Results --AcceptabilityAcceptability

•• Patient satisfaction Patient satisfaction –– 80 80 –– 100%100%•• Clinician satisfaction Clinician satisfaction –– 80 80 –– 100%100%

•• TechnologyTechnologyPerformance 91 Performance 91 -- 100%100%Peripherals 92 Peripherals 92 -- 99%99%

Overall EvaluationOverall Evaluation

•• Determined clinically equivalentDetermined clinically equivalent•• Improved access/wait timesImproved access/wait times•• Enhanced capacityEnhanced capacity•• Cost of access to care is Cost of access to care is

significantly reduced for patients significantly reduced for patients and their familiesand their families

TestimonialsTestimonials

•• ““It is an excellent program, easy to It is an excellent program, easy to use.We feel really secure knowing we use.We feel really secure knowing we are being monitored daily by our are being monitored daily by our nurse. It lessens our fear of something nurse. It lessens our fear of something happening.happening.”” ––patientpatient

•• ““ItIt’’s facilitates great collaboration s facilitates great collaboration with the specialists at the heart with the specialists at the heart centrecentre””-- remote MDremote MD

•• ““You are angels in a suitcase!!You are angels in a suitcase!!””-- patientpatient

TelehealthTelehealth and the New and the New Brunswick Heart CentreBrunswick Heart Centre

•• An integral component of the New An integral component of the New Brunswick Heart CenterBrunswick Heart Center

•• TeleconsultationTeleconsultation and home monitoring and home monitoring are key components for appropriate are key components for appropriate access and wait timesaccess and wait times

•• Home monitoring provides service to Home monitoring provides service to over 450 patients a yearover 450 patients a year

•• Has undergone planning for technology Has undergone planning for technology enhancement and incorporation of all enhancement and incorporation of all information collected into the Regioninformation collected into the Region’’s s Clinical information SystemClinical information System

OutpatientClinics

• Real-time interactive audio and video

• Data channel allows auscultation of heart and lung sounds

• Wound management• Echocardiograms,• X-rays

TelehomecareTelehomecareEMPcare@homeEMPcare@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 service95% - recommend to others93% - 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.

And there are many other And there are many other examplesexamples……

•• TelementalTelemental health health –– provision of provision of emergency mental health services emergency mental health services and consultation services in areas and consultation services in areas without this expertise. Increased without this expertise. Increased access to specialty services and access to specialty services and reduced wait times. reduced wait times.

•• Oncology services Oncology services ––provision of provision of education and information from a education and information from a provincial cancer centre to the provincial cancer centre to the northern regions. Increased access northern regions. Increased access to specialty services and reduced to specialty services and reduced wait times. wait times.

NephrologyNephrology

Satellite Dialysis Unit• Access to EHR

Physician order entryReview of diagnostics

• Wound ManagementOverall improved access toservices and greatly reduced patient travel.

SummarySummary

TelehealthTelehealth can be a positive enabler can be a positive enabler for enhancing access, reducing for enhancing access, reducing wait times and increasing capacity wait times and increasing capacity whenwhen……..–– It is embedded in the model for It is embedded in the model for

service deliveryservice delivery–– It is program driven not technology It is program driven not technology

drivendriven–– There has been effective change There has been effective change

management and support in placemanagement and support in place

TelehealthTelehealth, , a NB success story as defined bya NB success story as defined by……

•• Enhanced accessEnhanced access

•• Reduced wait timesReduced wait times

•• Increased capacityIncreased capacity

•• Patient and provider satisfactionPatient and provider satisfaction

•• Quality care/outcomesQuality care/outcomes

•• Patient efficacy/self managementPatient efficacy/self management

•• Knowledge transfer/educationKnowledge transfer/education

•• Patient support/holistic carePatient support/holistic care

•• Innovation/technology performanceInnovation/technology performance

•• CostCost

•• Attitude changes Attitude changes –– ““Just the normal way we do businessJust the normal way we do business””

SuccessSuccess……as acknowledged by as acknowledged by othersothers

Thank YouThank You

Enhancing Access by Enhancing Access by Bridging the DistanceBridging the Distance

The New Brunswick Telehealth The New Brunswick Telehealth ExperienceExperience