Cathy Seguin, Vice President, International Affairs, SickKids Toronto
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Transcript of Cathy Seguin, Vice President, International Affairs, SickKids Toronto
The Canadian Pathway to an Integrated
System for the Delivery of Children’s
Health Care
National Healthcare Conference, Ireland
April 2014
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
2
Medicare in Canada
“Canada's national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis.”
Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage.”
Source: Health Canada www.hc-sc.gc.ca
3
Canada Health Act Public Administration
Comprehensiveness
Universality
Portability
Accessibility
(No Private Care)
Canadian Healthcare System Funding Model
The Federal government transfers funds to provinces and territories
The funding is a mix of public (70%) and private (30%)
Provincially, in Ontario, the Ontario Ministry of Health and Long-term Care
(MoHLTC) is responsible for stewardship, setting legislation and strategy
• There are 14 Local Health Integration Networks (LHINs) that plan, fund
and integrate services at the local level
• 14 Community Care Access Centres (CCACs)
4
Agenda
5
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Vision
MissionAs innovators in child health since 1875,
we lead and partner to improve the health of children provincially, nationally and internationally through the integration of care, research and education.
ValuesExcellence, Integrity, Collaboration,
Innovation
• Established in 1954
• Canada’s first child health RI
• Established in 2007
• Advances education at SickKids
• Connects and supports the many education initiatives underway across the organization and beyond
• Established in 1972
• Largest non-governmental granting agency in child health in Canada
• Over the past 2 years, the Foundation has provided over $200 million to the Hospital
• Established in 2006
• Collaborates with international partners to improve children’s health globally through the advancement of child health education, clinical and research initiatives
6
The Hospital for Sick Children
OUR PEOPLE
10,000Total headcount on 31 March 2013
The Hospital for Sick Children encompasses a large number and wide variety of divisions and units
255 specializations and sub-specializations
1,102Research Staff
7
1,486Residents, Fellows &
Students
5,195Hospital Staff
(Excluding Fellows & Students)
1,573Volunteers
653Physicians
(Active & Associate Medical Staff)
More Than a Hospital…A Community
15,000 admissions
12,000 operations
280,000 outpatient visits
64,000 Emergency Room visits
Average length of stay 6.6 days
8
Annual Activity
Centre for Research and Learning
• Opened Sept 2013• Corner of Bay and Elm St.
in downtown Toronto• 21 Stories plus below-
grade parking• 750,000 square feet• $400MM project cost 9
10
1971
2000
2001
2013
1908First Canadian milk pasteurization plant installed – 30 years before it is mandatory
1930
1951Moved to current location at 555 University Avenue
1954Research Institute is established – a first at a Canadian hospital
1919
Development of Pablum
1957 Salter’s congenital hip dislocation procedure developed
1963 Mustard’s "blue baby“ procedure developed1964Opened paediatric intensive care units – one of the first in North America
1972SickKids Foundation was established
1989Cystic Fibrosis gene discovered
1993Opened the Atrium, a $232M state-of-the-art patient facility
20032004
2006
Potential of stem cells found in adult skin
Cancer stem cell for brain tumours identified
Copy number variation in genome discovered
2007Opened state-of-the-art paediatric cardiac diagnostic interventional unit
2007 Key breakthrough in diabetes – discovery of link between diabetes and the nervous system
Led autism genome discovery2009
Paediatric world first: transplant procedure using Interventional Lung Assist device
Canadian first: baby receives heart procedure in utero
Opened world’s first paediatric magnetoencephalography (MEG) facility
Research & Learning Tower opens
First successful separation of conjoined twins
Opened world’s first Image-Guided Therapy suite
1875SickKids is founded –
the second children’s hospital in the British Empire
2008
2010Groundbreaking of The Research & Learning Tower 2010
New genetic findings linking key genetic variations to autism.
SickKids’ Legacy of Innovation
10
Blood transfusion pioneered
Impact
& Innova
tion
Faci
litie
s &
Infr
ast
ruct
ure
11
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
11
Drivers for Health System Integration in Canada
Canadian Healthcare
SystemIncreasing Costs
Increasing Utilization of
Services
Healthcare Provider Shortage
Fragmentation and Duplication
in Healthcare “system”
New Funding Models
Improving Health Outcomes
Enhancing the Patient and
Family Experience
Health System Integration
12
Value Proposition for Health System Integration
Health Outcomes Patient and Family Experience Provider Productivity and Satisfaction
Costs Inefficient Use of Scarce System
Resources Fragmentation of Care
13
Social determinants of health
Preventive health
Primary care
Advocacy Care deliveryAdvising
Few potential actors
Many potential actors
SickKidsToday
Research
Quaternary medical care
Tertiary care
Emergency and secondary hospital careIncreasing public spending
There are Many Ways to Have Impact Across the Healthcare System
14
How do we define ourselves?
• What set of services do children and families need us to deliver across these patient cohorts?
• How do we facilitate a coordinated system?
• How can we enhance, facilitate, or otherwise impact those necessary services that we don’t directly deliver?
• What partnerships do we leverage to improve the system?
We Will Need to Define Our Identity in the Healthcare System
15
ProvincialNational
Child & Child & FamilyFamily
Canadian Paediatric Society
Canadian Association of Paediatric Surgeons
Children’s Mental Health Ontario
Provincial Council for Maternal and Child Health
Ontario Association of Children’s Rehabilitation CentresOntario Association for Infant and Child Development
electronic Child Health Network (eCHN)
Local
CCAC’s SickKids
LHIN’s
Paediatric Partnerships that Exist to Define & Execute the Strategy
Canadian Association of Paediatric Health Centres
• Canadian Healthcare System
• Introduction to SickKids
• Integrated System of Health
• Evolving Models of Integrated Care
Agenda
17
Integrated Complex Care Model
Page 18 18
Family Lead
Clinical Lead
Systems Lead
Child
Family Health TeamsPrimary Care Providers
Community Health Centres
ClinicsInpatient Programs
ClinicsInpatientPrograms
Support ServicesRespite
Day CareSchools
CCAC Care Coordination CCAC Service Provider Direct
Health & Support Services
0.14% of Ontario’s paediatric population uses 54% of provincial paediatric resources
Ontario Paediatric Tertiary Hospitals
Tertiary Paediatric Sites
Community-based SickKids Complex Care Hospital Programs
• 3.0 M children 0-18 yrs
• Inpatient distribution by tertiary centre:
• SickKids 42%
• Hamilton 18.5%
• Ottawa 18%
• London 15.3%
• Kingston 6.2%
eCHN – A Made in Ontario EHR Solution
C
C C
CC
C
C
C
C
eCHN PARTNER SITES:
• 106 Hospital sites
• 80+ Community Care Access sites
• 2100+ Physician offices (incl. clinics)
• 30+ Children’s Treatment Sites
• 2.3M+ patientsC
C
C
CC
C
CC
C
C
eCHN GROWTH:
• Unique users: 5,143 (+240% since 2011)
• Monthly logins: 13,000 (+ 116% since 2011)
• Documents viewed in 2013: 380,000 (+36% since 2011)
• OLIS lab results added
• Added Diabetes tracking tool
20
eCHN
Hospital Partner
Community Care PartnerC
SickKids Telepsychiatry Sites
SickKids
Telepsychiatry Sites
• Connects mental health experts with patients, families/ caregivers and professionals
• Provides clinical assessments, capacity building and education
• 2000 appointments per year
• External partners: Children's Mental Health
Agencies Hospitals Physicians Schools Young Offender Facilities Nursing Stations
• 35% of our work is with First Nations and Aboriginal communities
• access up to 75 Child and Adolescent Psychiatrists with subspecialization
• Hospitals as highly concentrated
points of health care
• Medical records as a disconnected
set of snapshots of health• Patients depend on medical system
for monitoring, decision making,
access• Patients responsible for integration
across points of contact
• Care is distributed across a number
of venues depending on the
necessary degree of specialization• Medical records are a continuous
representation of patient state• Patients have greater ability for self-
monitoring, participating decision
making • System provides integration across
venues
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The Future is Systems That Transcend Time, Space and Specialty
Looking Inward
• Where can we improve quality and
better manage resources?• Where can we redesign systems to
be more efficient?• How do we prepare to do more with
(relatively) less? Technology People Processes
Looking Outward
• Where else in the system can we
help improve quality and resource
management?• How do we share what we’ve
learned about efficient and effective
systems for paediatric care?• How do we anticipate changes in
other parts of the system?
23
Questions to Frame Our Thinking Going Forward