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‘More People, Healthier, Longer’ The York Region eHealth Project
Dr. Harvey Skinner, Dean Faculty of Health, York University, Toronto, Canada
Luxembourg Health Summit, May 3, 2012
local
global
How many people in India have access to mobile phones?
Amber Fort, Jaipur
Chronic conditions leading cause of death . . .
Chronic Disease and Obesity: GLOBAL HEALTH ISSUES
WHO. World Health Statistics. 2008.
Kelly T. Int J Obesity. July 8, 2008.
Global overweight
and obesity
57.8% 2030
2005 33%
By 2030, chronic conditions will cause 75% of all deaths globally
Our Lifestyle PUTS US AT RISK
• Inactivity increases insulin resistance, which is intimately linked to type 2 diabetes
• Only 49% of Canadians (aged 20+) are at least moderately active during their leisure time.
• Every 2 hours per day of television watching has been shown to be associated with a 14% increase in the risk of type 2 diabetes.
• 150 minutes of Physical Activity per week is associated with a ~60% decrease in the risk of type 2 diabetes
www.cflri.ca.
Hu FB. JAMA. 2003.
The Challenges are Large
but not Insurmountable
What if eHealth could enable game changing Health Solutions?
Overview of the Connected Wellness Platform eHealth system for delivering people-centred health
Illustrate mobile eHealth technology for care of diabetic patients and health promotion with university students
Outline research projects underway for improving patient outcomes and system transformation
The BIG Idea
‘Keeping more people healthier longer’
Building an integrated and sustainable health promoting & care system
Addressing both the Demand and Supply sides of the system
‘First Health, Then Medicine’
York Region/GTA
‘innovation ecosystem’
0ne million people, fastest
growing region in Canada,
culturally diverse
Demonstration Model projects for designing and testing integrated solutions:
• patient health outcomes
• clinician/staff workload & satisfaction
• service utilization
• system quality & safety
• savings: return on investment
© 2
011
Nex
J Sy
stem
s In
c. C
on
fid
enti
al a
nd
Pro
pri
etar
y.
• Cloud-based software system
– Allows patients, their family, their friends and their care teams to collaboratively manage health and wellness through the use of innovative applications
– Will assist in chronic disease management for patients and health professionals who use the system
– Enables collaborative care teams by providing transparency and security among service providers while respecting privacy
The Connected Wellness Platform
$15.5 Federal Government funding for the development of the Platform. The total project size is $37 million.
Collaborative effort of York University (the applicant and administrator of the project), NexJ Systems, McMaster University and other academic, and industry partners
Delivering People-Centred Health
Provider Registry
Extensible Electronic
Health Records
Patient Registry
Health Analytics
• EMRs • EHRs • Google
Health • Health Vault • OntarioMD
External Systems
Patient Portal
• CCR • CCD • CDS
Provider Health Platform
Consumer Health Platform
Analytics Server EHR Server
Universal Health Connector
Provider Portal
Disease Surveillance
Health Insurance
Shared EHR
Credentialing
Health Coaching
HIAL
HL7
Identifies provider credentials Identifies patients & consents Stores clinical data
Integrated view of patient’s Electronic Health Record Personal Health Record
Connectivity & integration of medical device data
Connectivity & clinical data exchange
Maintain de-identified data for analysis & reporting
Patients maintain PHR & interact with care team
Consumer applications enable interactive care
Integrated Provider Portal applications extend collaborative care
11
Provider Registry
Patient Registry
Electronic Medical Record
Mobile eHealth
Provider Portal
Patient Portal
Physician Credentialing
Evidence-based Best Practices
Behavior Change for Wellness
Disease Screening
Analytics on Outcomes
eHealth Deployment Strategy
eHealth Solutions Condition by Condition
Legacy Connectivity
Health Information Exchange
Health Coaching enabled by eHealth
Type 2 diabetics given free BlackBerry (& data) pre-loaded
with NexJ Health Coach
Log diet, exercise, mood and energy
Health Coach monitors, prescribes plans & motivates via mobile or a
secure portal
Daily secure communications & reminders via mobile
Culturally congruent instructional videos
Instructional Multimedia
Trusted multimedia content from health library
Context aware
delivery
Personalized 1-on-1 instructional messages
Secure Messaging
Allows patients to communicate with their care team
Built into portal Secure and auditable
Tracking “How I Feel”
Allows patients to track their wellbeing and observations
Meal Tracking
Easy-to-use logging of food intake
Allows Patients to take a photo, and comment
Tracks portion size, source and healthiness
Exercise Log
Allows users to log their exercise duration intensity and comments
Biomedical Measurements
Allows Patients to capture their readings from biomedical devices
Supports □ Blood Pressure
□ Glucose
□ Weight
□ Body Temperature
Bluetooth connectivity option enables automatic uploading of readings
Medication Adherence
Personalized medication tracking
Enables Patients to be reminded to take their medications
Allows logging of adherence and comments
Personal Health Coaching to Promote Behaviour Change
Provider Portal
Physician prescribes
personalized health
metrics for patient to
track condition.
Mobile Health Coach
Patient receives health
coaching and records
personal health metrics.
Patient Portal
Patient understands the
relationship between their
behaviour, bio-metrics, and
how they feel. The patient
becomes self managing
through sustained behaviour
change.
What is diabetes control and why should we care?
Adapted from DCCT Research Group: N Eng J Med. 1993;329(14):977-986. * AACE recommends A1c ≤6.5 (AACE Guidelines. Endocr Pract. 2007.13(Suppl):13-68.).
1
3
5
7
9
11
13
15
6 7 8 9 10 11 12
Eye disease
Kidney disease
Nerve damage
A1c (%)
Rel
ativ
e R
isk
of
Co
mp
licat
ion
s ( ‘
X’
tim
es m
ore
like
ly (
7.0* CDA Target
Risk Reduction with Lowered A1c
17
STRESS PHYSICAL ACTIVITY
Model Patient: North York Family Health Team Dr. Paul Ritvo and Colleagues
• Baseline HbA1C = 8.5%
• 3 month HbA1C = 7.0% - Reduction of 1.5%
• Physician decreased daily dose of Diamicron from 60mg -> 30mg in Response to lower glucose levels
Blood Glucose – Daily View June 8 – June 18, 2011
Blood Glucose – Daily View October 23 – October 30, 2011
Blood Glucose – Weekly AVG June 2011 – Oct 2011
Radical
reduction by
week 4
results in
physician
reduction of
Diamicron
dose
Regulation
then under
more
behavioural
control
Exercise & Blood Glucose – Daily View August 29 – September 26
Exercise
increases to
several
sessions/
wk.
Death in
family
results in 3-
day
exercise
gap &
glucose
spike,
followed by
resumption
& reduction
Food View October 16-19
Food pictures
reflect healthier
choices
Close up of Food October 17, 2011 – 6:24pm
*Note: absence
of simple
carbohydrates
& introduction
of salad
Healthy Eating ‘app’
• While eating choice is being made….help someone make healthier choice
• After GPS location, ‘app’ suggests proximal eating place
• With additional ‘click’, healthy options per eating place viewed
Health Coach: a New Health Profession
Core Competencies
•Uses cognitive-behaviour & motivational strategies to foster healthy behaviour
•Integrates health-behavioural programming with mobile technology
•Skilled in accessibility - working with people with a disability (eg. communication)
•Helps people navigate both the health care and health promotion systems
•Plays a key integrator role in health teams and community agencies
Training
•Basic: certificate subspecialty linked with undergraduate programs
•Advanced: professional Master’s, graduate Master’s Certificate
•Professional Development: short programs offered by the Health Leadership
and Learning Network (HLLN)
Research & Development
•Developing and evaluating (evidence based) Health Coaching initiatives at the
individual, organizational, and systems levels
33
Possibilities for Luxembourg?
Lets Have An Inspired Dialogue
Harvey A. Skinner PhD, CPsych, FCAHS Dean, Faculty of Health
York University, HNES Room 443 4700 Keele Street Toronto, ON, Canada M3J 1P3 Voice: 416-736-5340 Mobile: 416-520-7615 Email: [email protected]