Telehomecare: holding a promise of collaborative healthcare
May Tuason, Jeffrey Ho
With the right care model, telehomecare lets clinicians touch more patient and family lives than ever before. What success takes is a healthy commitment to change and integrating care across settings.
In Canada, patients receive world-class care. To ensure this level of care continues under the pressures of increasing costs and constrained public health budgets, telehomecare, a sub-field of telehealth, is a viable approach to increasing access to care at lower costs. Provinces across Canada are turning to telehomecare as a key action for empowering patients to successfully manage their health conditions in the comfort of their homes with improved access to services across the care continuum. According to COACH’s 2013 study of Telehealth in Canada1, the rate of growth for telehome care is well below the overall growth of telehealth services. Telehomecare currently exists in Ontario, Quebec, New Brunswick, British Columbia and the Yukon Territory. The most common disease pathways supported by these programs include Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and to a lesser extent, Diabetes and Mental Health.
How can telehomecare technology help to solve our health system’s problems? Simply installing an application and providing equipment to patients and providers does not allow an organization to maximize the value from its investment in the technology. Just as any new initiative requires a vision, champions, and the right incentivization, so too, does the introduction of telehomecare in an organization.
Integrated Care Planning As An Enabler.
Cost savings, by way of reducing the number of hospitalizations and reducing length of stay are typically identified as positive outcomes of telehomecare. Critical to both of these benefits is a well thought out, well planned, and well implemented integrated care model. At the heart of this model is the patient and their family who are then supported by primary and community based care teams. Integrated care planning from the inception of the care model right through to the patient’s transition to the home is critical for success. Hospital avoidance is the result of successful care management at home by patients, their families and integrated primary and community teams. However, reducing length of stay through telehomecare takes motivated patients, education, development of trust and integrated care planning between primary, community, specialty and acute care providers during the patient’s hospital stay and right through to their transition from hospital to home. When hospital care providers are aware, informed, and trust that community providers can closely monitor and quickly intervene with appropriate measures at the first sign of a patient’s deterioration, more confidence is instilled to release patients sooner than their expected length of stay. Integrated care planning in a telehomecare setting requires partners and champions from across the care continuum if maximal benefit from telehomecare is to be realized.
Models of Telehomecare
Several care models involving telehomecare exist in Canada. Models of care can range from programs delivering services from their private offices, through specialty clinics or community offices, to contracting the service need to large, centralized tele-nurse triage centres, leaving infrastructure considerations and training needs to a smaller group. There may be consideration to implement a few models in different parts of the organization.
For example, in the Ontario Telemedicine Network (OTN), telehomecare nurses must complete a curriculum to obtain the OTN Telehomecare Certification (which includes modules for clinical and patient self-management support, privacy and security, processes and tools, and practicum). An online virtual platform has been introduced for patients, telehomecare nurses and other healthcare professionals to share their experiences, challenges, and proposed solutions for reference in order to build a community of practice. When healthcare organizations become contractual members of OTN, they receive OTN assistance and support for development of telemedicine applications and programs. A well-known advantage to patients living in rural areas is to avoid the need to travel long distances to major health centres, travelling instead to local hospitals where telemedicine equipment is set up. As infrastructure grows and organizations’ use of Telehealth services becomes more sophisticated, as seen in OTN, patients are now traveling less to their local hospitals, and more are connecting with their physicians through equipment installed in their own homes with the support of OTN, further reducing the burden of travel, leading to improved quality of living.