Canada s Tele Care Programs Single Entry Points for

Canada’s Tele. Care Programs: Single Entry Points for Health Information, Education and Advice e Health 05 Tromsø, Norway Lois Scott

Helping people make health decisions

Objectives of This Session • Provide a brief overview of Clinidata and current services • Demonstrate Telehealth’s role in supporting Public Health by describing the SARS experience in Ontario, Canada • Describe Telehealth’s fit with Primary Care Reform • Identify “possibilities” of integrating Telehealth into Health Care System

Clinidata Corporation • A pioneer in the delivery of Telehealth services in Canada • Services available to >18 million Canadians • >1. 8 million calls per year with >6 million calls answered since 1997 • 6 telehealth sites staffed by >350 experienced professional nurses

Clinidata’s Clients

Public Health • Health Surveillance • Public Health Information • West Nile Virus Info • Rabies Info • Prenatal Info • Support during PH Outbreaks • Pneumonia Vaccination Program • Emergency Measures • Immunizaion Reminders • Tobacco Cessation Service • Quarantine • STD Info and Reporting Pharmacy • Treatment adherence • Drug Information (prescription, over the counter, natural products) • Interaction Information 24/7 Client Toll-free Access Primary Healthcare • Symptom assessment and referral (Triage) • General Health Information • Community Resource Info • Chronic Disease Management and Support • After hours support for Primary Care Physicians and Nurse Practitioners • Medication management Interpreter Services in over 110 languages/TTY Nurses, Pharmacists Homecare • Self care solutions (Triage) • Decision support • Health information • Telemonitoring • Referral to Homecare and other Support Services • Support to Patients & Non-Professional Caregivers Referral to Physicians , Social Workers & Other Health Care Professionals Acute Care Occupational Health Emergency Services • Non-Urgent Call Support • Case management • Benefits navigation and referral • Attendance Management • Employee Assistance Provider • Wellness and Health promotion • Symptom Triage and Management Advice • Patient navigation • Poison Control • Psyco-social Crisis Intervention • Organ & Tissue Donor Info

Chronic Disease Support

Some Unplanned/Unexpected Roles • Significance of Support for Public Health • Family Violence Reporting • Integration with Primary Care • Health Advocate/Health Information Interpreters

Interface with Public Health • Meningitis Incidents • West Nile Virus • Identification of E-coli in Water Supply of a Village • SARS

SARS in Ontario

Incoming Calls • SARS • Seasonal Trend • Norwalk Virus

Incoming Calls Per Day (Mar 26: Prov Emergency Declared; May 23: SARS II)

Telehealth’s Role • Answer incoming calls (used Telehealth Ont 1 -800 number) • Provide general SARS info and Community Resource info • Establish Audio Tape Library as 1 st contact point • Complete initial screening re quarantine; refer those requiring more in-depth assessment to PH • Create SARs clinical guideline based on case definition provided by Public Health and install it in automated DSS (symptom and asymptomatic guidelines) • Ensure info being provided by telenurses was the most current from PH • Brief nurses at the beginning and during (if needed) each shift

Telehealth’s Role • Participate in daily briefings with PH & Ministry of Health • Communicate regularly with Provincial SARS Operational Centre • Provide daily and sometimes every 4 hour reports regarding SARS calls by postal code, gender, nature of call, disposition, etc • Provide analysis of SARS calls trending and call patterns • Provide assistance with media relations as requested

Why was Telehealth able to respond so quickly and effectively… • Previous experience responding to other PH crisis • Existing relationship with PH • Essential infrastructure already established: • • Experienced Telenursing staff Sophisticated telephone system; queuing systems Automated Clinical Decision Support Software Ability to add/modify new clinical guidelines within minutes Telenursing stations Virtual Queue shared by 4 telehealth centres in Ontario Educators to disseminate information as briefings prior to shifts, etc.

Some Observations • Media had major impact on call volumes • Nurses worked incredibly long hours/ > productivity • Automation is absolutely necessary • Integration with other stakeholders is essential • Dissemination of information is a challenge • Public’s expectations were high, as was their anxiety • Web based services would have been very helpful

Telehealth & Primary Heath Care • Ensure 24/7 access to quality health information and services • Provide information re symptom management, non-urgent conditions, medication and treatment issues and chronic disease management which is evidence-based • Provide wellness/promotion information via several different channels • Facilitate patient education at the “most educable moment” • Minimize duplication of efforts/encourages effective team work; maximize use of scarce resources such as nursing staff, costly telemonitoring infrastructure, etc. • Supports physicians in under-resourced areas

Public Health • Surveillance • Pandemic Flu Response Pharmacy • Adverse effects reporting • Eligibility Line for Publicly-funded meds Primary Healthcare • Chronic Disease Managment • Patient Test Results (Anti-coagulant Therapy) • Appointment Reminders & Scheduling • Medication Compliance Monitoring and Counseling Telephone Remote Monitoring Web based self triage Info by Email Web based Info Audio Library IVR surveys Text Based Cell Phones Homecare • Chronic Disease Management • Caregiver Dispatch • Homecare Referral • Self Monitoring Support • Anti-coagulation Management • Family Support Services • Needs Assessment • • Acute Care Occupational Health Emergency Services • Ambulance Dispatch • Staff Wellness Programs • Lunch Box Health Education via Webinars, Seminars, etc • Benefits Navigation and referral • Claims Adjudication Support • Pre-admission Coaching • Discharge Family Support • Patient Navigation • Bed Availability Info • Tertiary Service Info and Referral • Surveys of general public for governments, hospitals, etc • Validation of Wait List Info

Thank you!