Telehomecare Central West LHIN Steering Committee Bonnie Burnes William Osler Health System May 29, 2013 TELEHOMECARE Central West LHIN Steering Committee William Osler Health System Bonnie Burnes Andrea Martin Allison Philpot May 29, 2013

Telehomecare in Central West LHIN 2 Program Hosted by William Osler Health System Progress to date: Funding for fiscal confirmed on January 2, 2013 Program officially launched January 28, 2013 Five nurses and one Coordinator hired Issues including software inefficiencies have been resolved E-referral model originally contemplated more complex Referral and Enrollment trending upward Originally stated Patient Targets included: 75 patients by March % of this was reached 250 by July – at current rate, may not be reached

Telehomecare in Central West LHIN 3 Program Hosted by William Osler Health System Lessons Learned to date: Starting with “sickest” patient not the ideal target group Home visit design – learning curve External Working Group – major support to program initially Internal IT involvement – absolutely required to achieve program efficiencies Hospital model works – discharge planners a significant source of referrals Engagement role – required and critical to ongoing referral process

Telehomecare in Central West LHIN 4 Program Hosted by William Osler Health System TOTAL NUMBER OF REFERRALS: 153 TOTAL NUMBER OF ENROLLMENTS: 84 (55%) TOTAL NUMBER PENDING: 25 (waiting for connection with patient or MD) TOTAL NUMBER OF DISCHARGES: 14 (4 expired, 4 admitted to acute care, 4 admitted to nursing home, 1 too sick to continue, 1 didn’t like program) INELIGIBLE or DECLINED REFERRALS: 44 (29%) Died during referral: 19 No interest: 17 No phone/line: 4 Too sick/palliative: 4 Major referrers: Wise Elephant FHT; Headwaters Heath Care Centre, Osler Discharge Planners Pending referrals expected: DAFHT; Rexdale CHC, CCAC

Telehomecare in Central West LHIN 5 Program Hosted by William Osler Health System

Enrollment Strategy 1- Targeted Adoption Description: Easily identified and implementable activities to increase patient numbers. ActivitiesOutcomes What have we done? Presented at huddles – Medicine, Cardiology, Respirology Presented at Osler’s CHARM (HF) and COPD clinics, LHIN Diabetes Self- Management Presentations to EGH and BCH Primary Care groups Assisted DAFHT and Wise Elephant FHT to scan records for potential patients Engagement Lead Posting approved 47% of referrals from discharge planners 46% from community doctors Resulted in 80+ referrals (pending) Telehomecare in Central West LHIN

Enrollment Strategy 1- Targeted Adoption (con’t) Description: Easily identified and implementable activities to increase patient numbers. ActivitiesOutcomes What have we done? Presentations and electronic support materials provided to Rexdale CHC, DAFHT and Central West CCAC, Rapid Response Nurses, Headwaters Health Care Centre Pending referrals from CCAC and CHC Next Steps Further presentations: Osler ED, Osler Diabetes clinics, Headwaters General Medicine and Headwaters ED Follow up presentations: FHTs and CHCs Hire Engagement Lead Gaining updated list of recently discharged patients for active calling from Osler Ongoing presentations: Bramalea CHC and four remaining FHTs, HealthLinks Connect with clinical leads to learn how to build Telehomecare into pathways for COPD and HF Telehomecare in Central West LHIN

Description: Communications activities to support awareness across the LHIN ActivitiesOutcomes What have we done? Created THC program page on Osler external website Joined Yammer THC Group to share program development with community care providers Published article in Osler Voices and Inside Osler newsletters Participated in Telehomecare video produced by OTN – Osler provided patient and physician Issued joint news release with Central West LHIN Increased community knowledge and recognition of program service for community and internal staff At least five referrals from newsletter Telehomecare in Central West LHIN Enrollment Strategy 2- Broad Awareness

Description: Communications activities to support awareness across the LHIN ActivitiesOutcomes What have we done? Included THC content in Osler feature in Rexdale Community News Aligned THC program with Central West CCAC and Rapid Response Nurse program THC featured in CEO blog on OslerNet Two THC articles in eVoices newsletter (internal) Telehomecare message and information sheet posted to Central West LHIN website THC articles of references appeared in Brampton Guardian, Orangeville Citizen and YourMississaugaBiz.com Next Steps “Learn to Live Well with Osler” community education sessions Rogers Daytime TV – Osler segment on THC Health Fairs Telehomecare in Central West LHIN Enrollment Strategy 2- Broad Awareness (con’t)

Description: Use of Key Champions and Key Influencers to raise awareness and increase referrals. ActivitiesOutcomes What have we done? from Drs. Frank Martino, and Jeffrey Ashley; two follow ups sent at bi-weekly intervals Dr. Frank Martino participated in Telehomecare video produced by OTN 46% of referrals to date from community MD offices THC referral form accessed 34 times as a result of campaign Next Steps Lunch and Learns and other presentations on-site by key champions 10 Enrollment Strategy 3 – Key Champions Telehomecare in Central West LHIN

Description: Meet with organizational Executive Leads to gain program support to advocate for Telehomecare ActivitiesOutcomes What have we done? Connected with CCAC, Headwaters and Osler Leadership to target potential patients Ongoing referrals Next Steps Refreshed patient list from Headwaters Refreshed patient list from Osler Telehomecare in Central West LHIN Enrollment Strategy 4- Executive Leads

Telehomecare in Central West LHIN 12 Next Steps: Requested Engagement Lead role in budget; no confirmation yet  Hire Engagement Lead  Continue Targeted Adoption  Pursue Broad Awareness  Foster Relationships with Key Champions and Executive Leads Program Hosted by William Osler Health System