2011 Virginia Telehealth Summit presentation

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

8. 1. Clinical Telemedicine

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

19. OTN Event Calendar

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

23. Tele-Ophthalmology &
Retinal Screening

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
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29. OTN’s Multi-Enterprise Network
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30. End-Point Eco-System

31. 31

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
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35. Health System Goals

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
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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
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39. Follow us
@OTNTelemedicine