View From the North
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The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. It provides clinical telemedicine services, emergency telemedicine, healthcare provider education, store-and-forward services, and telehomecare across Ontario. In 2009/10, OTN had over 125,000 patient encounters through over 1,200 sites. Studies show telemedicine reduces costs and travel burdens while improving access to care. OTN aims to make telemedicine a mainstream part of healthcare delivery and education in Ontario.
View From the North
- 1. View from the North Dr. Ed Brown, CEO The Ontario Telemedicine Network
- 2. Overview • OTN activities and results • How does it work? - the key success factors • Telemedicine as a driver for a high performing health care system
- 3. Ontario = California + Texas + Maryland
- 4. Ontario: 415,000 sq mi 13 million people Virginia: 43,000 sq mi 8 million people 4
- 5. OTN: Available Everywhere • One of the world’s largest & most active TM networks. • Programs & services delivered at more than 1,200 sites using 2,100 telemedicine systems Page 5
- 6. OTN Vision Telemedicine will be a mainstream channel for health care delivery and education. Page 6
- 7. OTN Service Channels 1. Clinical Telemedicine – live interactive videoconferencing for patient care 2. Emergency Telemedicine 3. Health Care Provider Education & Administration 4. Store-Forward Telemedicine – Ophthalmology, Dermatology and Wound Care 5. Telehomecare – Remote monitoring and self-management coaching for patients with significant chronic disease
- 9. Participating Organizations • All Hospitals • Professional Associations • First Nations Communities • Public Health Units • Medical and Nursing • Regional Infection Control Schools Units • Cancer Centres • Ontario Agency for Health • Psychiatric Hospitals Protection & Promotion & • Family Health Teams and Public Health Labs CHCs • Community Living Centres • Community Mental Health • Addiction Treatment Centres Facilities • CCAC Offices • Specialists’ Offices and • LHIN Offices Homes • Federal and Provincial • Rural Nurse Practitioners Prisons • Long-Term Care Homes
- 10. Active Sites by Setting 2009/10
- 11. 2010 Utilization Total Patient Encounters 125,206* Educational 11,408 Administrative 12,640 Total Events 149,254 * not including telehomecare Page 11
- 12. Clinical Specialties in Telemedicine • Bariatrics • Ophthalmology • Cardiology • Orthopedics • Dermatology • Pediatrics • Endocrinology • Physiotherapy • General Surgery • Rehabilitation Medicine • Mental Health & • Speech Pathology Addiction • Teleradiology • Nephrology & Dialysis • Telestroke • Neurology • Urology • Occupational Therapy • ENT • Oncology • And 30 others
- 13. Top 5 Therapeutic Areas of Care (Provincial) 2009/10 53%
- 14. Patient Survey Results 2008/09 data 97% were satisfied with their telemedicine visit. 79% said that telemedicine allowed them to see their provider sooner. agreed that telemedicine allows them to have more 85% regular follow-up. 83% agreed that telemedicine helps their providers work better as a team to care for them.
- 15. Avoided Travel in the North 50,000,000 45,000,000 45,912,636 40,000,000 35,000,000 36,494,370 30,000,000 32,237,562 25,000,000 20,000,000 18,839,887 14,944,489 15,000,000 12,051,205 12,635,185 10,000,000 10,043,273 8,871,796 5,000,000 0 2007/08 2008/09 2009/10 Avoided Travel in the North (kms) Estimated NHTG Cost Avoidance($) Pollutant Load Eliminated (kgs)
- 16. 2. Tele-Emergency Services • Acute stroke • Burn • Crisis psychiatry • Sign language services Pilot Projects: • Critical care • Trauma • Long-term care triage Page 16
- 17. Outcomes (2009/10) Telestroke • 405 consultations and 125 tPA deliveries • 15 lives saved and $1.43M in hospital costs avoided Mental health crisis • Hospitals avoided 395 admissions/transfers
- 18. 3. Education & Administration
- 21. Outcomes (2009/10) Education • Accessed by 362,597 learners Travel for meetings and training • One hospital reported saving $119,000
- 22. 4. Store Forward Tele-Dermatology
- 24. Outcomes (2009/10) Tele-dermatology • Mean time from referral to consultation result was 5.9 days via store-forward vs 6 months or greater face-to-face Ophthalmologist - Retinal Specialists • Reported seeing 10 patients in 40 minutes using telemedicine vs. 10 patients in 3 hours in the office Retinal screening for diabetics • 34% of patients had untreated pathology identified
- 25. 5. Telehomecare for Chronic Disease Management
- 26. Telehomecare/CDM Study Outcomes Self-reported data from 813 enrolled patients with CHF and COPD • 64 – 66 % decrease in hospital admissions • 72 – 74% reduction in emergency department visits • 16 – 33% decrease in number of primary care physician visits • 95 – 97% reduction in walk-in clinic visits • High levels of patient and provider satisfaction • More than $5 in avoided hospital costs for every $1 invested
- 27. MoHLTC Data (courtesy of OHA)
- 28. What Does OTN Do? 1. Harmonized governance 2. Technical standards 3. Supporting services 4. Inclusive membership model 5. Service effectiveness and evolution – Policies, procedures, cost reduction 28
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- 32. Transactional Analysis of Declining Cost Over Time 160 140 Variable Cost of All Clinical Transactions Transactions/Dollars 122 120 102,000 100 (thousands) 80 93 60 40 43 Variable Cost Self Service 20 28 Clinical Visits 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Years
- 33. Marketing
- 34. The Key Driver - Provider Innovation • Surgical Telementoring in Niagara • Regional Cancer Centres in Northern Ontario • Child & Adolescent Virtual Psychiatric Emergency Room in Central East Page 34 34
- 36. Priorities 2011 - 2014 1. Continue to increase provider awareness and adoption in support of key health care system priorities 2. Establish population-based telehomecare to support CDM 3. Develop a provincial retinal screening program 4. Continue to evolve a simple, unified, lower cost virtual telemedicine channel to support health system transformation 36
- 37. Telemedicine Potential 2014 When we are done… Benefit Annual Outcome Hospital beds freed up 800 Northern Travel Grants avoided more than $35 M Miles of travel avoided 100’s of millions Avoided emergency department visits 120,000 Reduction in wait times for specialist 50% appointments (select specialties) Avoided critical care transfers in Northern 435 Ontario 37
- 38. Telemedicine Potential 2014 Benefit Annual Outcome Avoided nursing home admissions 17% Reduction in serious visual impairment 5,574 people Avoided stroke mortality or severe morbidity 68 people Increased productivity for select specialties Up to 30% Improved knowledge transfer and mentoring Improved collaboration Enabler for transformation of our health system 38