BC Care Providers ConferencePanel Discussion

Transforming Innovations Into Quality Home Care Experiences

May 25, 2015

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Role of innovation

• independence in tasks of daily living

• cognition and memory

• education and employment

• computer access

• communication and social interaction

• therapy, exercise and recreation

• mobility

Well Being/Quality of Life

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Settings for innovation

Informal to Formal Supports & Care

Num

ber a

nd In

tens

ity o

f Car

e ne

eds

@Home@hospital

@ Residential Care

To promote:• Quality of life• Prolong Functioning at Home• Alternative methods of care• Capacity of caregiver• Greater options for service

providers

To promote:• Rapid Assessment• Rapid Stabilisation• Rapid transfer• Alternative methods of care

To promote:• Quality of Life• Alternative methods of care• Enhanced Capacity• Enhanced Safety

Prog

ress

ion

of N

eed

Health systems world-wide - including BC’s - face extraordinary challenges that require rethinking the models under which the systems are delivered. This includes exploring targeted innovative practices and strategies as well as the need to adopt innovative tools to help maximize system resources and improve patient outcomes

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Benefits of Technology

Benefit to Person, Family and Caregivers

Benefit to System Benefit to Service Providers

• Increased choice, safety, independence and sense of control

• Improved quality of life • Maintenance of ability to

remain at home • Reduced burden placed on

caregivers • Improved support for

people with long-term health conditions

• Enhancing mental health resilience and protective factors

• Potential to arrest progression of diabetes/dementia

• More timely, cost effective intervention

• reduced acute hospital admissions

• more timely acute hospital discharge planning

• Delay in need for residential and nursing home care

• Improved ability to redistribute spending on services

• Re-purpose of nursing resources

• Consistent scheduling • Real time monitoring of

health status• Reduced travel

requirements• Greater networking

capacity between Nurse, Physician and Patient and Carer.

• Alternative options to more costly and intrusive interventions – e.g. physical, pharmaceutical and environmental constraints, remote tracking devices etc..

• Targeted innovative technologies benefit the person, family, system and service providers:

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CanAssist’s Innovative practices

Mandate:To improve the independence and quality of life of people of all ages and representing the full spectrum of disabilities bydeveloping innovative, customized technologies where there are gaps in existing services.

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Phone-in Monitoring System

• allows caregiver to leave home and remotely checkon client’s activity

• a few sensors placed inhome monitor activity

• uses existing phone line (no internet access required)

• requires no special equipment or subscriptions

• caregiver calls to receive automated information

• reduces caregiver burnout and increases client’s ability to stay home longer

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• designed to discourage wandering at night

• small screen mounted in bedroom reinforces when it is night time

• screen on door to outsideturns on when approached (motion detector)

• uses personalized text or video messages to redirect individual

Wandering Deterrent System

My Things App

• helps people with dementia explore personally meaningful music and photos

• entertains, sparks memories, encourages conversation, reduces resistance to care

• designed for those in care facility

Lift for Manual Wheelchair

• customized lift for easily transporting chair into vehicle

• improvements made to existing commercial products

• improves safety for older spouse and other caregivers

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Simplified DVD Player• enables clients to control DVDs easily

and independently• system can store a large DVD

collection electronically• controlled by a large single button

(in this example, mounted the inside bed, allowing client to skip between videos)

• additional videos can easily be added to the collection simply by inserting a DVD

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Categories of adapted technologies

for adults

Simple environmental controls

Easy-to-use household tools and

devices

Simple memory aids

Easy-to-usephones

Apps for scheduling and completing tasks

Home safety devices

Remote Monitoring, Patient Coaching and Virtual Care

Inno

vatio

n fo

r a H

ealth

ier T

omor

row

Improving Outcomes and Reducing Costs

REMOTE PATIENT MONITORING

Leverage technology to capture vitals and health information while connecting with patients when care workers are not there

Using wireless technology to

connect patients living with chronic

disease(s) to a Registered Nurse

who monitors their vital signs remotely

Provides assessment of vital signs,

information about managing their

chronic condition, medication

compliance and adjustments to their

care plan

Service is operated from We Care's

Monitoring Centre in-house Monitoring

Centre

USING TECHNOLOGY FOR BETTER HEALTH

Provides remote monitoring of vital signs (one nurse, approx. 100 clients)Family physician provides target range for vital signs

We Care’s eHealth RN monitors results daily:

Vital Signs Measured:

Features:

• Check-In, Surveys & Patient Reminders • Video Conferencing Supporting Virtual Visits • Telehealth Dashboard for Staff • Supporting 200+ Bluetooth Connected Wellness & Medical Devices • Schedule Visibility & Requests • Configurable Monitoring Flow

Blood Pressure

Pulse Blood Glucose

Weight Pulse Oxygen

Mood

COMMUNICATION

Client

ADDED FEATURE: PATIENT AND FAMILY PORTAL

Patient, Family and Care Giver Access Leads to Improved Outcomes

While enhancing a Patient-Centered approach

Care Team Profiles and informationProgress Reports

Visibility to Care PlanEducation content Health and Wellness

Video Conferencing and ChatNavigational Support

We Care Nurse ambassador for communication across the health team:Intake/discharge reports to family physician

Communication on client progress to referralSupport and health updates to family caregiver

Scheduled coaching with client, ongoing support and health updates

Machine Learning Results – People on Re-ACT

Current Algorithms are predicting 72% of adverse effect (re-admissions, ER visits, fall)

50% fewer false positives than alerts based on simple vital sign thresholds

COST SAVINGS

# falls# of clients w/hospital admission

# of times admitted

Length of stay (days)

Cost of stay

Pre Re-Act 5 24 25.5 208.5 $110,794

On program 4 7 6.5 42.5 $22,482

% Difference -20% -71% -75% -80% -80%

Represents $289,015 in savings across 106 clients

*Based on costs of $138 per ER visit and $532 per nightly medical hospital bed

**Data captured from 33 intake questionnaires and on program questionnaires from a subset of randomly selected clients serviced in 2013 and 2014 (raw data in supplemental excel)

IMPROVED RESOURCE UTILIZATION

For 100 clients NOT on THE SYSTEM: would require weekly nursing visit (approx. $65/visit) and 2 medication reminders a day (approx.

$27 a visit).

The annual cost of delivery service exceeds $2 million Our current servicing costs including equipment represents a fraction of this

cost Better use of a Professional Caregivers time could be spent with high need

patients and help reduce wait times and hospital to home waitlists

DECREASE OF EVENTS

Pre- React On Program Comparison

Experienced

Visit to Hospital

Experienced a Fall

Experienced Visit to

HospitalExperienced

a FallChange in

VisitsChange in

Falls

Clients with 2 chronic conditions 8 2 3 1 -63% -50%

Clients with 3+ chronic conditions 16 3 4 3 -75% 0%

• n=33• Correlation between number of chronic conditions and incidence of events• Dramatic decrease in hospital visits across both groups after being on the program

POST DISCHARGE EVENTS

Pre Re-act On Re-act Post Re-act0

2

4

6

8

10

12

14

16

Admitted to hospital or ER VisitsExperienced a fall

*Based on 21 of previous 33 surveyed clients (could not interview remaining due to death, no response, other)

**Some increase in client events expected subsequent to discharge off program and end of nurse monitoring

*** 2 post Re-Act hospital visits due to pneumonia not necessarily linked to chronic condition

SELF MANAGEMENT ASSESSMENT

Understanding

medication, taking on time STDEV

Confident and knowledgeable

in managing my disease STDEV

Vital Signs: Knowledge of normal

range STDEV

Knowledge of

community resources STDEV

Pre Re-Act 8.5 2.5 6.8 2.1 7.2 2.3 6.9 2.3

On program9.3 1.0 9.3 1.4 8.2 1.5 8.4 1.5

% Difference 10.2% 37.2% 14.3% 22.3%

n=33

Increase in confidence and understanding across all goal categories while on the program Greatest increase seen in disease management STDEV decreased across responses

Virtual Care

The future of home care will be 24/7 access to a registered nurse on demand

Patient-facing tablet application used directly by the patient (RPM-style deployment) used by a PSW while with a patient (Virtual Visit-style

deployment or in a delegated authority/task model) Family Caregiver support on demand Patient support on demand Video conferencing capability Machine learning algorithms computing probability of

negative events

Virtual Care Features

Family PortalAccess to certain aspects of their patient information can be exposed to their family, loved ones, or extended care teams.

Patient RecordThe secure patient record allows a care worker to access important information about a patient. The information displayed is configurable and can be easily extended.

TeleHealth PortalThe TeleHealth portal features a set of functionally targeted at helping a care worker in a TeleHealth call centre manage the care for scores of patients. It can also be used by nurses in a call centre to conduct virtual visits with a PSW on-site with the patient

BC Care Providers Association Annual Conference 2015

Epsilon™ Powered Innovation in Home Care Technology

Bayshore’s Epsilon™ platform

Technology and process ecosystem working seamlessly to provide personalized, borderless care

1. Point of care data collection2. Point of care decision support3. Real-time data sharing and

collaboration4. Better care. Lower cost.

Bayshore’s Epsilon™ platform

Epsilon™ Core Services

• Advanced collection of critical data at the point of care

• Evidence-based, best practice guidelines to get the best possible outcome for clients

• In-home remote monitoring devices and self-care

Epsilon™ Core Services

• Critical information – available to those that need it – quickly and reliably

• Advanced Virtual Clinic– Virtual Care Room– Virtual Waiting Room– Adhoc virtual visits– Online questionnaires– Wellness Education

Epsilon™ Core Services

• Automated provider reporting– System to system

integration to deliver critical data as soon as it is created

• Curated information portals– Customized, relevant

content and analysis– Access, continuity of

care, outcomes, client satisfaction … all information available 24x7

Epsilon™ Core Services

• Driving efficiency in operations – to enable technology investments

• Integrated referral management system– Easy to connect– Quick referral

acceptance

• Advanced employee tools to allow self-management and schedule coordination