Digital Health Futures Advancing person-centred innovation
June, 2019
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Workshop Agenda 1. Introductions • •
Nancy LeFebre, Senior Vice President, Chief Clinical Executive, SE Health Rodney Burns, Chief Information Officer, Alliance for Healthier Communities
2. Case Studies • •
SE Health Alliance for Healthier Communities
3. Discussion • •
Wicked Questions Q&A 4
Disclosure: I have a vested interest in a sustainable healthcare system
I am motivated in my work by my personal interest of my children’s, children’s, children (acknowledgement of Indigenous Grandfather teachings) My professional (and personal) focus is an efficient and effective healthcare system. It is my position that this can only be achieved with meaningful involvement of individuals as a member of their own care team As a person that pays for and uses the healthcare system, I have a myriad of self-serving interests! Be forewarned… BTW – there is no such thing as e-Health or digital health… 5
Vision The best possible health and wellbeing for everyone in Ontario.
Mission We champion transformative change to improve the health and wellbeing of people and communities facing barriers to health. 6
Information Management Strategy v2.0
Personal Health Records & Collaboration CIHI Canada Health Infoway (PrescribeIT) Connecting Ontario e-Consult e-Referral e-Notification
1. 2. 3. 4.
“Get Electronic” “Share your Data” “Promote Collaboration” “Improve Health”
BIRT
Mental Health & Wellbeing Outcomes CI Resource & CIW
Quality Improvement
CHC Case Costing Panel Size % Admin
ACCESS
PS Suite EMR/ Meaningful Use
CONNECT
INFORM
PROTECT
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Alliance Consumer Health-’e’ Strategy Guiding Principles 1. 2.
3.
First, the Trust Paradigm 24/7 • Remove time and geography challenges • A part of all stages and transitions in life • More than a medical perspective Quadruple Aim Evaluation • Client Experience • Cost (all perspectives!) • Value – cost & outcomes • Clinician Experience
4.
5.
6. 7.
Democratization of healthcare • Shifting power differential Four Dynamic Client Archetypes: • Healthy/Motivated* • Healthy/Unmotivated • Unhealthy/Motivated • Unhealthy/Unmotivated Collective Impact Approach Community-based digital capacity building
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Alliance Consumer Health-’e’ Strategy Consumer Digital Healthcare Hierarchy of Needs*
* Based on Maslow’s Hierarchy of Needs
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Information Governance
“Without data,
you’re just another person with an opinion” J. Edwards Deming
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Holistic Approach to Health System Transformation Health & Wellbeing for All Policy Change
Advocacy Knowledge Translation & Communications
Research & Program Evaluation App.s, Business Intelligence, Decision Support
Data, Standards, Operational Excellence
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Digital Healthcare - Considerations • Digital Humanism • The Age of False News and Alternative Facts • Artificial Intelligence, Machine Learning • Privacy & security of Personal Health Information
• Sustainability • Personal affordability
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Wicked Questions for Discussion 1. Can technology enhance person-centred healthcare? • •
What accommodations are needed for adoption? What are considered ‘low-hanging fruit’?
“The blockbuster drug of the century [is] an engaged patient” (Kish, 2012)
2. In an era of digital footprints & Big Data, is there such a thing as ‘privacy’?
3. Will ‘Value-Based Healthcare’ policy further digital healthcare?
4. Any other advice/thoughts as we move forward? 14
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Questions? Comments?
To request a copy please contact: IMS@allianceON.org 19
Information Governance Model
EMR Vendor relationship management Provincial OMD baseline specifications
Information management strategy
Model of Health & Wellbeing Evaluation Framework & ENCODE FM Performance Management Framework
Data sharing agreements: CHCs authorize Alliance to share data Data partnerships (CIHI, ICES)
Business Intelligence Reporting Tool including an indicator dashboard
Performance reporting for accountability
Executive Leadership Networks Data Management Coordinators Performance Management Committee Regional DS Specialists Information Management Committee Staff Training
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Digital Health Futures Advancing person-centred innovation
110 Years in Health Care 9,000 Employees Nationally 20,000 Homecare Visits/Day Growth through Diversification
Creating the Brighter Future of Health at Home Bringing our knowledge, vision and expertise to how people live and age at Home.
Spreading Hope and Happiness Our people, our culture.
Home Care
Business Focus
Seniors Lifestyle
Family Caregivers
Areas of Impact
Empowering Patients and Caregivers
Mobilizing Communities
Transforming Care Systems
Educating for Excellence
Honouring End of Life Journeys
Inspiring Possibilities
Innovating for 110 Years
Future of Health
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Central paradigm: The system
New paradigm: The Person
Future of Health
$
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Central paradigm: The system
New paradigm: The Person
Future of Health
$
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Central paradigm: The system
New paradigm: The Person
Future of Health Today: System TIMING
Reactive, sick care Proactive, preventative, predictive
PRECISION 1 size fits all, crude, analog
Personalized, intelligent
MODALITY Institution-centred
Digi-cal | decentralized
DURATION Episodic, intermittent, silo’d
Continuous | team
Provider
People-powered
CURRENCY Volume, inputs, costs
Value, outcomes
POWER
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Future: Person
Human Anatomy & Physiology
Hippocrates
500 BC500 AD
5001500
Black Plague
10 Source: Adapted from PWC Health
1628
Smallpox vaccination
Microbes & disease
1796
1870s
1670
Microscopy of cells
1799
Anaesthesia
Antibiotics
1895
X rays
1928
DNA structure Watson & Crick
1948
1953
WHO established by UN
1st "test tube baby“
Human Genome
1978
2003
1971
Medical Imaging MRI, CAT
1983
HIV virus causes AIDS
2008
Digitization
Healthcare’s Boldest Moves Into the Next Decade DIGITAL HEALTH IS EXPECTED TO GROW TO 380 BILLION DOLLARS INTERNATIONALLY IN THE NEXT 5 YEARS 11
Shift Enablers‌. Shifter
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Opportunity / Impact Digital Assistants
The future is voice
Hospital in the home
Smart Homes: Connected health
Digital therapeutics
Changing behaviours
Data age
Predictive, personalized, preventative
Data fusion
PHI + EMR + Environment
New relationships
Partnerships
Human / Machine
Shifting: From Internet of Things to Intelligence of Things Early Detection‌ New Care Pathways
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Shifting Knowledge Into The Hands of the Consumer
Changing the conversation: Two Way 14
Shifting from Institutions to Care Anywhere Innovative service delivery models: New Tools
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Shifting: How We Age Enabling independence: Aging in Place
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OUR SWEETSPOT DESIRABILITY
Can we CAPTURE value? • Solution-market fit? • Sustainable business model? • Finance-able? • SE uniquely positioned to win? 17
VIABILITY
Can we CREATE value? • Problem-solution fit? • Address users pain points or gain points? • Can they use it seamlessly?
FEASIBILITY
Can we DELIVER value? • Operationally feasible? • Requires new capability, processes? • Can tech be leveraged? • Legally feasible?
Innovation Process
Starting with the Product
Starting with the Problem
Frame Intent
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Deep Dive
Generate Concepts
Test
Is this a good problem for SEFutures to tackle?
What are the key Opportunity Spaces?
Do we have concepts(an MVP) that are ready to be tested?
Is our concept ready to be made into a product?
Is this a good opportunity for SE?
How will the product work? Will the product generate new value for SE?
Are we ready for a pilot?
Are we ready to scale?
Testing, Learning and Designing with Digital Health
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Post-Acute Model of Care: Special Populations PPATH
Putting Patients at the Heart
2 Days
Cardiac Surgery Bundled Care Success
Length of Stay
38% Integrated Care Integrated Coordinators Patient Record (ICCs)
Readmission Rate
Virtual Care & Tele-monitoring
13% Follow-Up Clinic
Virtual Rounds 20
24/7 Phone Line
Overall Costs
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Adapting Dutch Buurtzorg Model to Ontario
H.O.P.E Model for Home and Community Care
0 1
0 2
Self-Directed Teams
0 4 21
Comprehensive, 24/7, Client/Family Centred Care
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Informal Care & Community Supports
Knowledge Network, Entrepreneurial Innovation, Powered by Simple Processes & Technology
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Seniors Like Steve
$27000
Average after tax income of a
Canadian
<20%
Have 5 years of savings
How might we provide affordable spaces for seniors that optimize personal seniorliving citizen agency and meaning? 22
Advancing Person Centred Innovation . •
Determine the starting point
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Step up Innovation
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Reimagine programs and models of care – Digital First, Physical Second
BE BOLD 23
The Future is Here! Nancy Lefebre nancylefebre@sehc.com @nancylefebre
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