D3 consumer health

Consumer Digital Healthcare: Fad, or the natural evolution of health care?

Presenter Disclosure • Presenters: • Rod Burns, Chief Information Officer • Marc Gordon, PM/IM Program Lead • Relationships with financial sponsors: • None

The Alliance represents 107 communitygoverned primary care organizations Membership is unified and organized: • • • •

73 Community health centres (CHCs) 10 Aboriginal health access centres (AHACs) 16 Nurse Practitioner Led Clinics (NPLCs) 10 Community Family Health Teams (CFHTs)

Alliance Members are Different • Members are the only part of the Primary Care sector that report directly to the LHINs (accountability) • All clinical staff are salaried. No fee-for-service • All members endorse the Model of Health and Wellbeing and Health Equity Charter • Serving 600,000/5% of Ontario’s population • Serve those who face barriers to health (e.g. linguistic e.g. Francophones, cultural e.g. Indigenous peoples, homeless, remote, poor, etc.)

• AOHC provides privacy and security services to members as part of its PM/IM Program

Models of Health and Wellbeing

• Evidence-based • Every CHC/AHAC has endorsed and adopted • Evaluation Framework revised to include all aspects of MHWB • Indicators related to process and outcomes to demonstrate and ensure continued high quality

Information Management Strategy v2.0 Personal Health Records & Collaboration

ACCESS

CONNECT

INFORM

1.

2.

3.

4.

“Get Electronic” “Share your Data” “Promote Collaboration” “Improve Health”

PROTECT

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Consumer Health: What does this mean?

Will “I” become a participant in my Health Care instead of a recipient?

Will “I” be able to keep track of my Health Information?

Will “I” share the what is needed with those who should be in the know?

Will “I” connect with others and grow from shared learnings?

Will “I” educate myself on what I need to know?

Will “I” be engaged in my care?

Two Approaches for Learning

Technology Reviews/Pilots

Focus Groups

Quadruple Aim Approach

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Digital Consumer Healthcare: Levels of Sophistication

Wearables Multiple portals Provincial approach Big data/deep analytics

PHR

Referrals

L1

Basic analytics Strong analytics

EMR L2

Provincial Assets

Structured and unstructured data

L3

L4 L# = Level of sophistication

Functional Requirements • • • • • • • • • • •

Workflow integration Bi-directional data-sharing Integrated EMR documentation Multilingual support Cloud-based performance Hybrid pointer/repository Privacy and security Training and support Device-agnostic Activity and Bio-Tracker Integration Social media integration/gamification

1. Black Creek CHC Diabetes Project Challenge:  local population at higher risk of Type 2 Diabetes;  limited resources for professional help

Solution:  personalized health coaching program tailored to needs  mobile app enabling communications with health coach & education

Partners:

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Black Creek CHC Diabetes project: Lessons Learned • Participants successfully increased their daily exercise and reduced their food intake, reducing risk factors • Participants realized an 18% reduction in their blood glucose levels (HbA1c) and could reduce their medication (Diamicron) levels

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2. miDASH Pilot Project • A collaboration between Health Quality Innovation Collaborative to test their miDASH Personal Health Record (PHR) to 3 member centres.

N’Mninoeyaa AHAC

• Insufficient adoption by users • Missing capabilities and integration contributed to low usage Association of Ontario Health Centres

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miDASH pilot project: Lessons Learned • Integration with EMR is Key • Resistance from clinicians (duplicate entry, workflow) • Restricted capabilities of application

• Strong approach to change management required • Good quality training materials are a must • Strong buy-in from participating organization is crucial

• Clear reporting and communication necessary • Clear expectations set in the beginning • Need to know who uses application • Evaluate client experience and IHI Triple Aim dimensions

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MaRS Procurement by Co-Design • MaRS Discovery District - One of world’s largest innovation hubs • Procurement by Co-Design - allowing Health Service Providers to participate in the development of innovative solutions • Two times up to $25K grants awarded to participating teams; • Providers and vendors working together creating innovative solutions.

• • • •

Providers: AOHC Vaughan CHC Black Creek CHC Noojmowin-Teg AHAC

Association of Ontario Health Centres

Vendor: • NexJ Health Inc. Vendor: • OrbCare Inc.

MaRS Procurement by Co-Design project

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Client Focus Groups • Individual/Family/Informal care provider has access to health records • Reduce in-person visits and wait times – on-line access

• Increased self-management of health and well being • Increase communication with providers

• Receive timely alerts and reminders of health action • Access to validated health information sources

Technology Features Important to Clients  eView (client access to their vitals, lab results, health patterns, etc.)  eCommunication (client communication with health care team via secure messaging)  eReferral (allowing the client to do self-referrals and allow access to PHR)  eBooking (allowing the client to schedule appointments online)  Client-Driven Care Team (client can modify their circle of care and accept/reject those in it)  Social Groups (client can participate in groups, both private and public for learning and support)

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Possible benefits for the centre/provider • • • • • •

Single sign-on with context sharing Improve resource scheduling/utilization and efficiency Increase availability for individuals requiring in person visit Increase client engagement and monitor client development Cost effective Client information is available from all sources

Modified Maslow’s Hierarchy of Needs Consumer Digital Healthcare Services Hierarchy *

• Self-Management – easy to interpret analytics • Health Coaching – expert, unbiased advisor • Educational Resources – pre-validated content • Transactional Capability – e-scheduling, eprescribing • Personal Health Record Repository – * Burns, R. Leadership Guidance on Critical Success Factors for a Digital Consumer Health Strategy, March, 2018. filterable views

Evolution of Consumer Health

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Four Dynamic Client Archetypes

Client Health Status

Client Motivation Status Motivated Unmotivated

Healthy

Unhealthy

Healthy/Motivated

Unhealthy/Motivated

Healthy/Unmotivated

Unhealthy/Unmotivated

Goal: solution must engage all 4 archetypes and dynamic nature

Consumer Health Insights Goal: preserve/enhance trust relationship • Clients want to be more involved in their care • Customer Relationship Management design • One size Does NOT fit all – need to address all four client archetypes • No silver bullet in the market Challenge: shift in provider-client power dynamic • Need provider engagement • Health coaching can enhance client collaboration • Collective Impact approach for sustainability • Building community-based digital capacity

Consumer Health Insights (cont’d.)

• • • • • • • • •

Holistic perspective of the person…

Health is 24/7… (geography/time paradigms) 13.5M Health Systems in Ontario – not 1…

Community-based Digital Capacity Building…

IHI’s Quadruple Aim… CRM/Social Media…

Transactional capabilities…

Analytics, influence decision-making/behaviour change, improved health…

Risk-sharing/outcomes-based…

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Critical Success Factors • • • • • • •

Maintaining/enhancing the relational trust paradigm between client & provider(s) Design considerations addressing the 4 client archetypes and dynamic nature of clients Focusing on change management and sustainability Using a Collective Impact approach Building community digital capacity for sustainability Using outcomes-based procurement strategies Rigorous, multi-dimensional evaluation

THANK YOU/MERCI/MIIGWETCH

Rodney Burns, CIO/CPO – rodney@aohc.org Marc Gordon, PM/IM Program Lead – marc@aohc.org