The Canadian Pathway to an integrated System for the delivery of Children's Healthcare

1. The Canadian Pathway to an Integrated
System for the Delivery of Children’s
Health Care
National Healthcare Conference, Ireland
April 2014

2. • Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
2

3. Medicare in Canada
“Canada's national health insurance program, often referred to as "Medicare", is
designed to ensure that all residents have reasonable access to medically necessary
hospital and physician services, on a prepaid basis.”
Instead of having a single national plan, we have a national program that is
composed of 13 interlocking provincial and territorial health insurance plans, all of
which share certain common features and basic standards of coverage.”
Source: Health Canada www.hc-sc.gc.ca
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Canada Health Act
 Public Administration
 Comprehensiveness
 Universality
 Portability
 Accessibility
 (No Private Care)

4. Canadian Healthcare System Funding Model
 The Federal government transfers funds to provinces and territories
 The funding is a mix of public (70%) and private (30%)
 Provincially, in Ontario, the Ontario Ministry of Health and Long-term
Care (MoHLTC) is responsible for stewardship, setting legislation and
strategy
• There are 14 Local Health Integration Networks (LHINs) that
plan, fund and integrate services at the local level
• 14 Community Care Access Centres (CCACs)
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5. Agenda
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• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care

6. Vision
Mission
As innovators in child health since
1875, we lead and partner to improve
the health of children provincially,
nationally and internationally through
the integration of care, research and
education.
Values
Excellence, Integrity, Collaboration,
Innovation
• Established in 1954
• Canada’s first child health RI
• Established in 2007
• Advances education at SickKids
• Connects and supports the many
education initiatives underway across
the organization and beyond
• Established in 1972
• Largest non-governmental granting
agency in child health in Canada
• Over the past 2 years, the Foundation
has provided over $200 million to the
Hospital
• Established in 2006
• Collaborates with international partners
to improve children’s health globally
through the advancement of child
health education, clinical and research
initiatives
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The Hospital for Sick Children

7. OUR PEOPLE
10,000Total headcount on 31 March 2013
The Hospital for Sick Children encompasses a large
number and wide variety of divisions and units
255 specializations and sub-specializations
1,102
Research Staff
7
1,486
Residents, Fellows &
Students
5,195
Hospital Staff
(Excluding Fellows & Students)
1,573
Volunteers
653
Physicians
(Active & Associate Medical Staff)
More Than a Hospital…A Community

8.  15,000 admissions
 12,000 operations
 280,000 outpatient visits
 64,000 Emergency Room visits
 Average length of stay 6.6 days
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Annual Activity

9. Centre for Research and Learning
• Opened Sept 2013
• Corner of Bay and Elm St.
in downtown Toronto
• 21 Stories plus below-
grade parking
• 750,000 square feet
• $400MM project cost
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10. 10
1971
2000
2001
2013
1908First Canadian milk pasteurization plant installed – 30 years before it
is mandatory
1930
1951
Moved to current location at 555 University Avenue
1954
Research Institute is established – a first at a Canadian
hospital
1919
Development of Pablum
1957
Salter’s congenital hip dislocation procedure developed
1963 Mustard’s "blue baby“ procedure developed1964
Opened paediatric intensive care units – one of the first in
North America
1972SickKids Foundation was established
1989
Cystic Fibrosis gene discovered
1993Opened the Atrium, a $232M state-of-the-art patient
facility
2003
2004
2006
Potential of stem cells found in adult skin
Cancer stem cell for brain tumours identified
Copy number variation in genome discovered
2007Opened state-of-the-art paediatric cardiac
diagnostic interventional unit
2007 Key breakthrough in diabetes – discovery of link
between diabetes and the nervous system
Led autism genome discovery2009
Paediatric world first: transplant procedure
using Interventional Lung Assist device
Canadian first: baby receives heart
procedure in utero
Opened world’s first paediatric
magnetoencephalography (MEG) facility
Research & Learning Tower opens
First successful separation of conjoined twins
Opened world’s first Image-Guided Therapy suite
1875
SickKids is founded –
the second children’s hospital in the British Empire
2008
2010Groundbreaking of The Research & Learning
Tower
2010
New genetic findings linking key genetic
variations to autism.
SickKids’ Legacy of Innovation
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Blood transfusion pioneered

11. 11
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
1

12. Drivers for Health System Integration in Canada
Canadian
Healthcare
SystemIncreasing Costs
Increasing
Utilization of
Services
Healthcare
Provider
Shortage
Fragmentation
and Duplication
in Healthcare
“system”
New Funding
Models
Improving Health
Outcomes
Enhancing the
Patient and
Family
Experience
Health System Integration
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13. Value Proposition for Health System Integration
 Health Outcomes
 Patient and Family Experience
 Provider Productivity and Satisfaction
 Costs
 Inefficient Use of Scarce System
Resources
 Fragmentation of Care
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14. Social determinants of health
Preventive health
Primary care
Advocacy Care deliveryAdvising
Few potential actors
Many potential actors
SickKids
Today
Research
Quaternary medical care
Tertiary care
Emergency and secondary hospital care
Increasing
public
spending
There are Many Ways to Have Impact Across the Healthcare System
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15.  How do we define ourselves?
• What set of services do children and families need us to deliver
across these patient cohorts?
• How do we facilitate a coordinated system?
• How can we enhance, facilitate, or otherwise impact those
necessary services that we don’t directly deliver?
• What partnerships do we leverage to improve the system?
We Will Need to Define Our Identity in the Healthcare System
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16. Provincial
National
Child &
Family
Canadian Paediatric Society
Canadian
Association of Paediatric Surgeons
Children’s Mental Health Ontario
Provincial Council for Maternal and Child Health
Ontario Association of Children’s Rehabilitation Centres
Ontario Association for Infant and Child Development
electronic Child Health Network (eCHN)
Local
CCAC’s SickKids
LHIN’s
Paediatric Partnerships that Exist to Define & Execute the Strategy
Canadian Association of Paediatric Health Centres

17. • Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
1

18. Integrated Complex Care Model
Page 18 18
Family
Lead
Clinical
Lead
Systems
Lead
Child
Family Health Teams
Primary Care Providers
Community Health Centres
Clinics
Inpatient
Programs
Clinics
Inpatient
Programs
Support Services
Respite
Day Care
Schools
CCAC Care Coordination
CCAC Service Provider Direct
Health & Support Services
0.14% of Ontario’s paediatric population uses 54% of provincial paediatric resources

19. Ontario Paediatric Tertiary Hospitals
Tertiary Paediatric Sites
Community-based SickKids
Complex Care Hospital Programs
• 3.0 M children 0-18 yrs
• Inpatient distribution by
tertiary centre:
• SickKids 42%
• Hamilton 18.5%
• Ottawa 18%
• London 15.3%
• Kingston 6.2%

20. eCHN – A Made in Ontario EHR Solution
C
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eCHN PARTNER SITES:
• 106 Hospital sites
• 80+ Community Care Access sites
• 2100+ Physician offices (incl. clinics)
• 30+ Children’s Treatment Sites
• 2.3M+ patients
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eCHN GROWTH:
• Unique users:
5,143 (+240%
since 2011)
• Monthly logins:
13,000 (+ 116%
since 2011)
• Documents
viewed in 2013:
380,000 (+36%
since 2011)
• OLIS lab results
added
• Added Diabetes
tracking tool
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eCHN
Hospital Partner
Community Care PartnerC

21. SickKids Telepsychiatry Sites
SickKids
Telepsychiatry Sites
• Connects mental health
experts with patients,
families/ caregivers and
professionals
• Provides clinical
assessments, capacity
building and education
• 2000 appointments per
year
• External partners:
 Children's Mental Health
Agencies
 Hospitals
 Physicians
 Schools
 Young Offender Facilities
 Nursing Stations
• 35% of our work is with
First Nations and
Aboriginal communities
• access up to 75 Child
and Adolescent
Psychiatrists with
subspecialization

22. • Hospitals as highly concentrated
points of health care
• Medical records as a disconnected
set of snapshots of health
• Patients depend on medical system
for monitoring, decision making,
access
• Patients responsible for integration
across points of contact
• Care is distributed across a number
of venues depending on the
necessary degree of specialization
• Medical records are a continuous
representation of patient state
• Patients have greater ability for self-
monitoring, participating decision
making
• System provides integration across
venues
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The Future is Systems That Transcend
Time, Space and Specialty

23. Looking Inward
• Where can we improve quality and
better manage resources?
• Where can we redesign systems
to be more efficient?
• How do we prepare to do more
with (relatively) less?
 Technology
 People
 Processes
Looking Outward
• Where else in the system can we
help improve quality and resource
management?
• How do we share what we’ve
learned about efficient and
effective systems for paediatric
care?
• How do we anticipate changes in
other parts of the system?
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Questions to Frame Our Thinking Going Forward