A Telehealth Platform for Patients with Cancer Dr. Antonia Arnaert, Associate Professor McGill School of Nursing, Associate Member DCECS-SMHC Antonia.arnaert@mcgill.ca / Tel: 514-398-5624 Mr. Zoumanan Debe, Graduate MD (outside Canada), Telehealth Research Coordinator Zoumanan.debe@mcgill.ca dd. 25/01/2010 Canadian Partnership Against Cancer
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
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.
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 2004-2009
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; http://www.jmir.org/2001/2/e20
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.
Quality Care Anytime, Anywhere Personalized Care depending on Patient s Needs Alarm Systems Remote Patient Monitoring Videoconferencing Glucose Meter Weight Scale Pulse Oximeter
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
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)
IPO-Nurses Perceptions Towards HTH Readiness for Change
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
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
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.
Home Telehealth for Patients with a New Stoma Videoclip participant after project
Successful Telehealth Services Telehealth-BELT TM Bandwidth Education/ Equipment Leader Team
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
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.
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 3402 3 IPO nurses MF. Dubé, Stoma nurse = Expert Managers
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
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
PATIENT PORTAL
Telus RPM System CLINICIAN PORTAL
THANK YOU SMHC Foundation for Supporting this Clinical Innovative Research Program