Telehealth projects target diabetes, mental health and kidney failure

The Ontario Telemedicine Network (OTN) has launched three new demonstration projects this fall under its “Home is the Hub” umbrella. Working with the private sector and established healthcare providers, OTN’s initiatives are designed to discover whether new patient groups can benefit from remote patient monitoring.

OTN already oversees a well-established and successful Telehomecare program that supports Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF) patients with self-management coaching and remote monitoring.

The new projects, supported by Canada Health Infoway and the Ontario Ministry of Health and Long-Term Care, use remote patient monitoring in the management of chronic kidney disease, mental health and diabetes.

“We’re testing the potential for innovation in the healthcare system, not just through the outcomes of these particular projects, but through the approach we’re taking to create an evaluation framework,” says Ed Brown, OTN’s chief executive officer.

“We want to learn to fail fast or succeed quickly. We want to create the conditions for patient empowerment and faster, cheaper, better healthcare that can be sustained.

“In every case, we have to test for patient-centredness – whether the patient will like and use it. We have to find out if providers like it and use it. We have to learn if the expected outcomes are achieved and we have to ensure it adds value to healthcare delivery and supports the Ministry of Health’s transformation agenda.

“Finally,” says Brown, “we have to figure out how it can scale. If it doesn’t scale, it isn’t an innovation – it’s just another invention.”

That’s why for Brown and the OTN team, the new remote patient monitoring projects are vital to the future of healthcare in Ontario.

“It’s exciting because we’re going to learn so much,” says Laurie Poole, OTN’s vice president of telemedicine solutions. “With Telehomecare, we learned about technology as an enabler in the home and about the fact that coaching for self-management works. But the most important thing we learned is that there is so much more to do.”

A key component of the process will be evaluation. “We’ll be working with a leading academic research organization that will help us study this in real-time so we can learn and adjust as we go along,” says Rhonda Wilson, OTN’s Telehomecare executive lead, who spearheaded project development.

“Real-time research will allow us to learn if the approach works for the patients, for the family and volunteer caregivers, as well as whether the healthcare providers like it.”

The evaluation process will also shed light on whether the projects have a positive impact on the sustainability of the healthcare system, Poole adds.

For Wilson, the projects are a dream come true. “All my working life I’ve tried to figure out how to make healthcare an integrated part of everyday life.

Telehomecare, these projects – and all the iterations that will come after – are the first steps.”

Diabetes: The rising prevalence of all forms of diabetes in Ontario outstrips the healthcare system’s ability to provide preventive and disease management services. Fewer than half of all people with type 2 diabetes are regularly tested for blood sugar levels, blood pressure and cholesterol levels or kidney function.

Surveys indicate that people with diabetes receive too little education and too little support.

With partners WellDoc, a digital health technology company, and Samsung, OTN will work with three diabetes education centres to provide patients with a customized mobile self-management and lifestyle tracking tool. Jane DeLacy, executive director of clinical programs at William Osler Health System, draws on her experience with Osler’s successful OTN Telehomecare program to project the impact of the new trial.

“The combination of immediate feedback and the availability of a healthcare professional has a huge impact on hospital and ER visits,” she says. “And it’s more patient-centred.”

DeLacy says the frail elderly, those with mobility issues and those who don’t have anyone to take them to appointments, will have better access to healthcare.

Mental health: In any given year, one in five people in Canada experience a mental health problem. According to a 2012 study, while 91 percent of Canadians were prescribed the medication they sought, only 65 percent received the therapy they felt they needed. Access to evidence-based psychotherapy is limited and wait-lists are long. As of April 30, 2015, Ontario Shores Centre for Mental Health Sciences alone had hundreds of patients on waiting lists for outpatient treatment.

Working with partners Ontario Shores and Lakeridge Health, OTN will pilot a social media-based online early intervention service for people 16 and older who suffer from mental health problems.

Members come together online anonymously to share feelings, join guided online courses and assess themselves to set goals and track progress. The online interactions are monitored by an automated system that issues alerts if ‘danger words’ are used and by clinicians trained in how to intervene.

For Sheila Neuburger, executive vice president of clinical services at Ontario Shores, the bottom line on the trial is straightforward: “We’ve been looking for something to help our waiting list people. I think we’ve found it.”

Moreover, she says, the online community can be a constant in people’s lives, even when patients have a therapist. “Your therapist appointments might be once a month. This is a 24/7 resource people can access from wherever they are.”

Chronic kidney disease: In Ontario, about 10,500 patients receive some form of dialysis, either hemodialysis (HD) in a healthcare setting or peritoneal dialysis (PD) that can be performed at home.

PD is associated with numerous benefits over HD, including a survival advantage. It is also the least costly form of dialysis. But studies show that the low uptake of home dialysis is the result of patients’ fear of caring for themselves once separated from their healthcare team.

Support for patients to successfully transition to independent dialysis at home may be achieved with the addition of technology to the patient’s care plan.

Working with the London Health Sciences Centre (LHSC) and eQOL Inc, a company started up through Toronto’s MaRS innovation hub, OTN will conduct a randomized control trial to study the use of a remote telemonitoring solution to improve health-related quality of life and peritoneal dialysis (PD) management for patients undergoing PD.

Dr. Arsh Jain, LHSC medical director for peritoneal dialysis, says home-based peritoneal dialysis creates a burden for patients who experience anxiety about all of the tasks associated with choosing home dialysis over the more costly in-centre dialysis.

“We had tele-home-monitoring for a number of years, but it was such old technology. We needed to move things on, replace the pen-and-paper strategy patients used for recording data, automate the ordering of supplies, do away with nurses transcribing data. This technology gives us the opportunity to do that. Best of all, the trial gives us eyes in the home so we can see how the patient is doing.”