A Telehealth Platform for Patients with Cancer

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1 A Telehealth Platform for Patients with Cancer Dr. Antonia Arnaert, Associate Professor McGill School of Nursing, Associate Member DCECS-SMHC / Tel: Mr. Zoumanan Debe, Graduate MD (outside Canada), Telehealth Research Coordinator dd. 25/01/2010 Canadian Partnership Against Cancer

2 Evolution of Health Care Improvements 1990 s Cost Savings Early 2000 s Access TODAY Cost Savings, Access and Quality Strategies 1. ehealth / Telehealth 2. Care Pathways 3. Capacity Planning 4. Health Human Resources 5. Performance Management

3 New Healthcare Delivery Models Healthcare Systems are Under Tremendous Pressure Call for a New Healthcare Delivery Model based on preventative and person-centred health systems. This new model can only be achieved through proper use of ehealth, in combination with appropriate organisational changes and skills.

4 What is ehealth? Telehealth? Informatics? Global Health Global e-health [e-commerce] e-health [e-learning] Telehealth Health Informatics [Telemedicine] [Decision Support [Telepaediatrics] [Teleradiology] [Telehealth Anywhere, Anytime] [EMRs] [PHR] [EHRs] Systems] [Surveillance Systems] [Telenursing] Scott RE

5 What is ehealth? Telehealth? Informatics? The e in ehealth stands NOT only for electronic, but implies other e s : Efficiency Evidence based Encouragement Enabling Ethics Enhancing quality Empowerment Education Extending Equity Eysenbach, G. (2001) Journal of Medical Internet Research; 3(2) e:20;

6 The Solution Health Management Patients are discharged with prescriptions, education, instructions, & action plans on how to comply Without follow-up, patients often fall into noncompliance due to misunderstanding, depression, lack of information, and the overall complexity of living with their disease. Nurses & other healthcare providers need a view of what is happening with their patients between visits.

7 Quality Care Anytime, Anywhere Personalized Care depending on Patient s Needs Alarm Systems Remote Patient Monitoring Videoconferencing Glucose Meter Weight Scale Pulse Oximeter

8 Telehealth Anytime Anywhere: Benefits Better access to services Shortened wait-times (earlier interventions, prevention focus) Reduced complications and exacerbations Patient self-management of symptoms Improved acute care discharge planning Reduce patient travel Reduced reliance on home family resources Improved support for informal caregivers Enhanced collaboration between sectors & healthcare providers Limiting unnecessary referrals Improved care team productivity Extended system capacity / health human resources Reduced / delayed long-term care admissions Improved adherence to drug regimens Source: Canada Health Infoway (2007). Home Telehealth Business Case Report

9 1997 the Minister of Health & Social Services of Quebec established Programme Québécoise de Lutte Contre le Cancer to respond to the holistic needs of the cancer population and to develop an integrated health network Recommendation: to establish the role of IPO-Nurse (Infirmière Pivot en Oncologie)

10 IPO-Nurses Perceptions Towards HTH Readiness for Change

11 Telehealth Research Program 3 PHASES: Phase 2: Feasibility Study Testing a home telehealth platform for patients with new stomas and their family caregivers using videoconferencing Services: The provision of telehealth nursing services through videoconferencing to patients with a new stoma for a period of 4 months. Start: March 2009 April 2010 Sample: 9 Patients (Patient #10 will be enrolled next week) Clinicians: Marie-France Dubé, Stoma Nurse at SMHC Dail Jacob, IPO Nurse (patients with colo-rectal cancer) 2 Homecare nurses from Health Access Santé Industrial Vendor: PHD Medical

12 Telehealth for Patients with a New Stoma Handheld Camera Patient HOME Private Homecare Company Internet ADSL Home Care Nurses = Case Managers Cancer Care Room 3402 M. F. Dubé, Stoma nurse D. Jacob, IPO nurse = Expert Managers

13 Home Telehealth for Patients with a New Stoma I feel much safer with it [videoconferencing system] there now. I feel more confident I m totally at ease and the nurses understand you and they can talk to you from human to human, you know? I see her [the nurse] on the T.V., and I m talking to her expressions, I see her quite a bit. So yes I feel totally at ease with that [videoconferencing system] The advantages is that I m more comfortable in my own home, you know? And for me to get at SMHC, for example, for my chemo day. We leave her at 5:30am, because he [her husband] has to drop me at SMHC at 7:00am, So I m there from 7:00am in the morning and I m not seen till 9 or 10 o clock. So I m there for a long time, whereas sitting here I ll be fine.

14 Home Telehealth for Patients with a New Stoma Videoclip participant after project

15 Successful Telehealth Services Telehealth-BELT TM Bandwidth Education/ Equipment Leader Team

16 Telehealth Research Program 3 PHASES: Phase 2: Feasibility Study Testing a home telehealth platform for palliative patients and their family caregivers within the Quebec healthcare system Services: The provision of telehealth nursing services through videoconferencing and remote patient monitoring to palliative patients for for a period of 4 months. Start: Mid-February 2010 July / August 2010 Sample: 20 Palliative patients diagnosed with cancer 10 own PC (high-speed Internet) & 10 Tablet PC (Telephone) Clinicians: 3 IPO nurses (D. Jacob, R. Roy, J. Ramsahai) Palliative care team CSSS de la Montagne (3 nurses, 1 psychologist) Info-Santé CSSS de la Montagne Industrial Vendor: TELUS Health Solutions

17 What is Remote Patient Monitoring? RPM = a system that collects and transmits regular patient monitoring data (vital signs, activities, pain & symptoms) between a patient and a healthcare provider responsible for monitoring, interpreting and analysing the data.

18 Telehealth for Palliative Patients HOME Patients Caregivers Info-Santé Team = After Hours Support Remote Patient Monitoring Videoconferencing ADSL Internet Palliative Care Team = Case Managers 3 Nurses 1 Psychologist Cancer Care Room IPO nurses MF. Dubé, Stoma nurse = Expert Managers

19 Data Pathway of the Telehealth System Clinical Workstations at CSSS de la Montagne Clinical Workstation at SMHC RPM VC RITM RPM + VC TELUS Server Integration in the PUBLIC Healthcare System RPM Clinical Workstations at Info-Santé SMHC ADSL Emergency Line Only for VC sessions www 10 PC High-Speed Internet Home Clinical Workstation 10 Tablet PC Telephone Line

20 Patient Care Pathways for Pain & Symptom Management Pain Rating & Control Coping with Pain Fatigue Bowel Movement Neuropathy Medication Adherence Appetite & Weight Sleep Pattern Family Burden

21 PATIENT PORTAL

22 Telus RPM System CLINICIAN PORTAL

23 THANK YOU SMHC Foundation for Supporting this Clinical Innovative Research Program

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