1. Telehealth Ontario Surveillance: Future Considerations Alex Perry June 13, 2008

2. 2 Agenda Research objectives Research objectives Relevance of research questions Relevance of research questions Investigative approach Investigative approach Questions / comments Questions / comments

3. 3 Research Objectives Can Telehealth Ontario calls provide advance information about hospital emergency department visits and hospital admissions for respiratory illness? Can Telehealth Ontario calls provide advance information about hospital emergency department visits and hospital admissions for respiratory illness? 1.Are Telehealth calls related to hospital admissions for respiratory illness at the health unit level? 2.How can Telehealth be used to provide advance warning for increases in emergency department visits for respiratory illness?

4. 4 Application of Results Plan hospital service provision Plan hospital service provision Initiate timely institutional and public health interventions Initiate timely institutional and public health interventions Facilitate clinical decision making Facilitate clinical decision making

5. 5 Approach 1.Are Telehealth calls related to hospital admissions for respiratory illness at the health unit level? Examine strength and temporality of association between Telehealth calls and hospital admissions Examine strength and temporality of association between Telehealth calls and hospital admissions Do age group or geographic sub-groups provide a better signal or more warning? Do age group or geographic sub-groups provide a better signal or more warning?

6. 6 Approach 2.How can Telehealth be used to provide advance warning for increases in emergency department visits for respiratory illness at the health unit level? Define “important increase” in emergency department visits Define “important increase” in emergency department visits Identify important increases in NACRS data Identify important increases in NACRS data Apply signal processing techniques to Telehealth data Apply signal processing techniques to Telehealth data (Modified CUSUM, Parallel Cascade Identification) Assess performance: sensitivity, specificity, timeliness Assess performance: sensitivity, specificity, timeliness

7. Telehealth Ontario Surveillance: Future Considerations Questions / Comments?