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Fast Forward 10 Years: Health Care in Ontario

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Currently $60 million endowment. First ten years spent as a granting agency ... Greater use of genetic information in prevention, diagnosis and treatment efforts ... – PowerPoint PPT presentation

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Title: Fast Forward 10 Years: Health Care in Ontario


1
Fast Forward 10 Years Health Care in Ontario
  • Presentation to Grey Bruce Health Services
  • Cathy Fooks
  • President and CEO
  • The Change Foundation

2
The Change Foundation
  • Established by the OHA in 1995 to support change
    in Ontarios health care system
  • Currently 60 million endowment
  • First ten years spent as a granting agency
  • Recently evolved into a policy think tank
  • Two areas of concentration health integration
    and quality improvement in community care

3
Focus on Change
  • People
  • Health Care
  • Technology and Information
  • 1) What will be different?
  • 2) How will affect patients?

4
People Aging Population, OntarioSource
Statistics Canada
5
People - We Are Living Longer Life Expectancy
(Ontario)Source Statistics Canada
6
People More Chronic Disease, OntarioSource
Statistics Canada
7
People Five Year Survival Rate, Cancers,
OntarioSource Cancer Care Ontario
8
People More Immigration, OntarioSource
Statistics Canada
9
People Increasing Levels of Education,
OntarioSource Statistics Canada
10
People Changes in Places of Work,
OntarioSource Statistics Canada
11
Health Care The Budget Dollar, OntarioSource
Ontario Government
12
Health Care Components of Provincial Spending
within Ontario Health Care (Public )Source CIHI
13
Health Care Changes in Hospital Care,
OntarioSource CIHI
14
Health Care - Care in the Community
  • Pollara Health Care in Canada 2007 survey
  • 27 of Ontarians report that they have personally
    cared for a family member or close friend with a
    serious health problem in the past 12 months.
  • Nationally
  • 35 of 45 - 64 year-olds have provided care
  • 1 in 10 had to quit work to care for loved one
  • 41 had to use personal savings to survive during
    this time
  • 22 had to take one or more months off work
  • 41 reported that the result of caring for a
    family member or close friend had a negative
    impact on their mental health
  • 38 reported that the experience had a negative
    impact on their physical health
  • 40 reported that the experience had a negative
    impact on their finances

15
Health Care Age Standardized Average Length of
Stay in Hospital, Comparisons, CanadaSource CIHI
16
Health Care Use of Telehealth, OntarioSource
MOHLTC
17
Health Care - of all personal expenditures on
health care, CanadaSource Statistics Canada
  • 1999 4.8
  • 2003 5.2
  • 2007 5.5

18
Health Care Personal Expenses, millions, Canada
19
Health Care Ontarians in Family Health Teams,
Source MOHLTC
20
Health Care - After Hours Care, OntarioSource
NPS, 2007
  • Answering Yes
  • 79.7 have physician available for patient care
    during non office hours
  • 31.4 staffed clinic by physician or others in
    practice
  • 12.9 medical telephone advice with access to
    medical record
  • 25.8 medical telephone advice without access to
    medical record

21
Health Care Use of Email by PhysiciansSource
NPS, 2007
  • 53.2 use to communicate with colleagues for
    clinical purposes
  • 64.9 use to communicate with colleagues for
    other purposes
  • 15.4 use to communicate with patients for
    clinical purposes
  • 5.3 use to communicate with patients for other
    purposes

22
Health Care Local Health Integration Networks
(LHINs)
  • Currently, 14 LHINs in the province
  • Under the auspices of the LHINs
  • Public hospitals (2007/08)
  • Mental health addictions agencies (2008/09)
  • Community support service agencies (2008/09)
  • CHCs (2008/09)
  • LTC Homes (2008/09)
  • CCACs (2009/10)

23
Health Care - LHINs
  • Not under the auspices of the LHINs
  • Physicians
  • Public health
  • Ambulance services
  • Labs
  • Provincial networks and priority programs

24
Regional Health Authorities Elsewhere in Canada
  • One regional Board to organize, fund and deliver
    continuum of services
  • Primary care not yet included although western
    provinces moving in this direction
  • Integrated information management systems
  • Will be the first to have electronic health
    records for all

25
Health Care - Performance Measurement/Reporting
  • LHIN accountability agreements with government
    contain reporting indicators
  • Provider accountability agreements with LHINs
    contain reporting indicators
  • Government produces some public information
  • Waits time data on web for selected procedures
  • Not yet standardized

26
Technology and Info by 2010Source Canada
Health Infoway
27
Technology and Info Electronic Health Record
Software from Microsoft
  • From the Microsoft web site EHR
  • Can be accessed wherever and whenever they are
    needed.
  • Give doctors and hospital workers accurate,
    timely information.
  • Increase responsiveness by providing mobile
    access to records through devices such as Pocket
    PCs and tablet PCs
  • Enable patients to participate more fully in
    their own care.
  • Provide greater security and privacy
  • Reduce costs and increase efficiency by
    replacing paper-based processes.

28
Technology and Info Hospital Specific Info, UK
  • NHS Choices Central Web site in England
  • www.nhs.uk
  • Sort by city, table with all hospitals doing the
    procedure
  • Set of standardized questions including wait
    times, how many surgeries they do a year,
    mortality rates, readmission rates, scorecard
    information
  • Book appointments online

29
Technology and Info Hospital Specific Info, US
  • Hospital Compare, US
  • www.hospitalcompare.hhs.gov
  • Search on city, hospital name, procedures,
    quality scores, patient satisfaction surveys etc.
  • Also shows medicare payments and volumes by
    hospital

30
Technology and Info Wait Times in Ontario
  • How Wait Time Information Can Help You
  • You can use wait time information to find
    hospitals with the shortest wait for the
    procedure you need. You can ask your doctor if
    they can refer you to another specialist or
    hospital with a shorter wait.
  • www.health.gov.on.ca
  • Wait times for small number of procedures by
    hospital and by LHIN
  •  

31
Technology and Info Hospital Specific Info,
Ontario
  • Some hospitals have balanced scorecards on their
    web sites
  • No central, searchable site yet
  • No standardized reporting on outcomes

32
Technology Use of Robotics
  • Carebots in the home
  • Robotic patient assessment
  • Robotic surgery
  • "People want to stay in their houses but their
    kids have trouble looking after them. If you have
    a long-term care type of companion which would
    keep an eye on the person and talk to the person
    family members could talk to the person through
    the robot. The robot would keep track of where
    the person is actually moving or if they're lying
    on the floor in the bathroom, has taken their
    drugs, has followed their normal routine.
  • Alan Mackworth, UBC

33
Technology and Information Mapping Human Genes
  • Human Genome Project has completed mapping 25,000
    human genes
  • Results will
  • Improve diagnosis of disease
  • Detect early the genetic predispositions to
    disease
  • Support rational drug design
  • Provide gene therapy

34
People In Ten Years What Does it Mean?
  • Older patients living longer with chronic disease
  • People receiving more intensive health care in
    their homes
  • Continued reliance on informal caregivers
  • Prepared to pay out of pocket or for extra
    insurance

35
People in Ten Years What Does it Mean?
  • Increased diversity of cultural makeup
  • Changed expectations about care, family roles
  • Higher levels of education more informed and
    demanding consumer

36
Health Care in Ten Years What Does it Mean?
  • Greater consolidation of specialized programs,
    technical infrastructure as increasing evidence
    on volumes and quality is available
  • Distance to become less of an issue as
    technologies allow communication and care over
    large geographic areas
  • Role for smaller hospitals may change
  • More health care resources at home over longer
    periods of time (not palliative) to deal with
    chronic disease
  • More non health care resources at home to delay
    admission to a facility

37
Health Care in Ten Years What Does it Mean?
  • Not clear who will pay for things not currently
    publicly funded
  • Stronger relationship between primary care and
    hospitals FHTs in the hospital?
  • Much more primary care delivered by teams and
    non-MDs
  • Change in the hours of access evenings not
    considered after hours
  • More reporting and outcomes measures made public

38
Health Care in Ten Years What Does it Mean?
  • Not sure about governance LHINs will look
    different may have more providers or services
    under their auspices
  • may have more authority
  • Depending upon what the LHINS look like, maybe
    changes to local governance as well

39
Technology and Info - What Does it Mean?
  • Patients will have their own electronic record in
    their home and on their hand held devices
  • Provider specific real time waits (hospitals and
    maybe primary care) on the web (check that day)
  • Booking online for everything
  • Greater use of robotics in the community and in
    hospitals
  • Greater use of genetic information in prevention,
    diagnosis and treatment efforts

40
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