Fast Forward 10 Years: Health Care in Ontario

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Fast Forward 10 Years Health Care in Ontario

• Presentation to Grey Bruce Health Services
• Cathy Fooks
• President and CEO
• The Change Foundation

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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

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Focus on Change

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

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People Aging Population, OntarioSource
Statistics Canada
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People - We Are Living Longer Life Expectancy
(Ontario)Source Statistics Canada
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People More Chronic Disease, OntarioSource
Statistics Canada
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People Five Year Survival Rate, Cancers,
OntarioSource Cancer Care Ontario
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People More Immigration, OntarioSource
Statistics Canada
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People Increasing Levels of Education,
OntarioSource Statistics Canada
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People Changes in Places of Work,
OntarioSource Statistics Canada
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Health Care The Budget Dollar, OntarioSource
Ontario Government
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Health Care Components of Provincial Spending
within Ontario Health Care (Public )Source CIHI
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Health Care Changes in Hospital Care,
OntarioSource CIHI
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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

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Health Care Age Standardized Average Length of
Stay in Hospital, Comparisons, CanadaSource CIHI
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Health Care Use of Telehealth, OntarioSource
MOHLTC
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Health Care - of all personal expenditures on
health care, CanadaSource Statistics Canada

• 1999 4.8
• 2003 5.2
• 2007 5.5

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Health Care Personal Expenses, millions, Canada
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Health Care Ontarians in Family Health Teams,
Source MOHLTC
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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

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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

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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)

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Health Care - LHINs

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

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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

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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

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Technology and Info by 2010Source Canada
Health Infoway
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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.

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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

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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

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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
•  

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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

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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

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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

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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

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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

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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

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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

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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

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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

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