Canada’s TeleCare Programs: Single Entry Points for Health Information, Education and Advice

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

2. Helping people make health decisions

3. 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

4. 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

5. Clinidata’s Clients

6. 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 Primary Healthcare Pharmacy •Treatment adherence •Drug Information (prescription, over the counter, natural products) •Interaction Information •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 24/7 Client Toll-free Access Interpreter Services in over 110 languages/TTY Nurses, Pharmacists Referral to Physicians , Social Workers & Other Health Care Professionals Homecare •Self care solutions (Triage) •Decision support •Health information •Telemonitoring •Referral to Homecare and other Support Services •Support to Patients & Non-Professional Caregivers Acute Care •Symptom Triage and Management Advice •Patient navigation •Poison Control •Psyco-social Crisis Intervention •Organ & Tissue Donor Info Occupational Health Emergency Services •Non-Urgent Call Support •Case management •Benefits navigation and referral •Attendance Management •Employee Assistance Provider •Wellness and Health promotion

7. Chronic Disease Support

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

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

11. SARS in Ontario

12. Incoming Calls • SARS • Seasonal Trend • Norwalk Virus

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

14. 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 1st 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

15. 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

16. 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.

17. 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

18. 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

19. Public Health •Surveillance •Pandemic Flu Response Primary Healthcare Pharmacy •Adverse effects reporting •Eligibility Line for Publicly-funded meds •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 •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 Occupational Health Emergency Services •Ambulance Dispatch •Staff Wellness Programs •Lunch Box Health Education via Webinars, Seminars, etc •Benefits Navigation and referral •Claims Adjudication Support

20. Thank you!