Future State Environmental Scan

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SCARBOROUGH AND ROUGE HOSPITAL
Future Visioning Discussion
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Table of Contents
BACKGROUND ................................................................................................................................................ 3
SECTION 1: The Hospital of the Future – Broad Trends ................................................................................ 4
1. The Internet of Things ....................................................................................................................... 4
2. Robotics and Automation .................................................................................................................. 5
3. Healing / Well-being Space Design .................................................................................................... 6
4. The Digital Patient Experience ........................................................................................................... 8
SECTION 2: Partnership Options ..................................................................................................................11
Opportunity 1 – Community Hubs ...........................................................................................................11
Opportunity 2 – Public-Private Partnerships ...........................................................................................13
Opportunity 3 – Hospital-Community Partnerships ................................................................................15
Opportunity 4 – Regional Care Programs ................................................................................................17
SECTION 3: Program-Specific Innovations and Trends ................................................................................18
1. Cardiology ........................................................................................................................................19
2. Post-Acute Care and Stroke .............................................................................................................48
3. Critical Care ......................................................................................................................................22
4. Emergency Services .........................................................................................................................24
5. Medicine ..........................................................................................................................................27
6. Mental Health ..................................................................................................................................33
7. Nephrology and Chronic Disease Management ..............................................................................36
8. Oncology ..........................................................................................................................................40
9. Palliative Care ..................................................................................................................................43
10. Seniors’ Health .............................................................................................................................48
11. Surgery .........................................................................................................................................59
12. Maternal and Child Health ...........................................................................................................27
13. Pediatrics .....................................................................................................................................48
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BACKGROUND & OBJECTIVE

The following document is designed to support the master planning initiative underway at SRH. It will
provide you with the background information necessary to understand and participate in the first stage
of the process, known as Clinical Services Planning.
Building on the last round of user group sessions, which validated the current state in each SRH
program, this document is meant to support an exploration of the future state of clinical services. The
information contained here is meant to help you:
a) Understand what types of developments are within the realm of possibility, and
b) Inspire you to think about how SRH can be innovative in its future models of care.
What’s in this Document?

This document describes ways in which the health care system is evolving to meet the changing needs of
patients, evolving processes and policies in the industry, and the incorporation of new technologies to
the care model. These developments are important to keep in mind as SRH considers its future.
Demographic and economic trends, coupled with advancing technologies, will have significant
implications for how hospitals of the future will be staffed, sized, and designed.
In the following report,
- Section 1 describes the hospital of the future – the ways in which hospitals are involving to
incorporate new technologies and ways of delivering care.
- Section 2 describes models of partnership that SRH may consider in maximizing its resource use
and getting to the future state in a collaborative, community-focussed way.
- Section 3 describes innovative technologies and care models, parsed out by user group, which
are already happening around the world.
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SECTION 1: The Hospital of the Future – Broad Trends

The following section describes trends or technologies that are on the horizon for future healthcare
delivery, and are potentially adoptable across all program/clinical areas.
1. The Internet of Things
What is it?
• The Internet of Things (IoT) is a term that refers to the connection of physical devices and objects to
the internet
• IoT enables dynamic integration of sensors, processes, and people to drive insight and efficiency
within hospitals
• Through IoT, there are greater opportunities for data analytics - individual data streams are
processed and analyzed to find patterns that will drive decision-making
Use in Healthcare Context
IoT can be incorporated in the hospital environment in any number of the following ways:
Opportunity Examples of IoT Capabilities

Wait time • Automate arrival check-in when the patient enters the facility
management • Track and optimize patient wait times in facility waiting rooms
• Track patient condition using wearable devices
Remote patient
• Compare personal baselines to real-time monitoring of vitals, treatment
monitoring
compliance, and alert health care providers to threshold breaches
• In-facility equipment / consumable tracking for compliance and
sterilization monitoring
Facility management
• Monitor internal environment and energy usage and dynamically modify
and optimization
conditions - optimize building climate control to lower costs and
improve climate quality
• Real-time location system (RTLS) to direct patients and visitors to the
Hospital wayfinding
hospital rooms and clinics
• Help surgical teams perform surgeries more effectively through optic
Surgical optimization
lead guidance and augmented reality
Medical devices of the • Track condition, part, and system failures and optimize operating
future performance for better availability, patient care, and outcomes
Implications for Health Systems
• Data collected through IoT will empower clinicians with decision support models and tools to better
their clinical practice and improve efficacy of targeted treatment plans
• IoT will be used to create improved efficiencies in operations, care coordination, and flow through
the hospital, leading to reduced resource use for hospitals and a better experience for patients and
families
• IoT tools will support improvement of health outcomes through real-time communication/sharing of
data between providers and patients
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2. Robotics and Automation

What is it?
• Robotics refers to complex machines that automate processes with extreme precision and advanced
interactions
• Robotic Process Automation (RPA) refers to applications that deliver rule-based repeatable tasks,
typically performed by humans, through use of technology
Opportunity Examples of RPA Capabilities

Direct Patient Care • Surgical robots that are able to perform care with direction from the
surgeon; robot controlled instruments give the surgeon better precision
and flexibility (e.g., da Vinci Surgery)
• Nanorobots will be able to be placed in an individual’s body to carry out
precise, delicate tasks (e.g., plaque busters have a micro drill head that
removes plaque from arteries)
• Robotic prosthetics will allow individual to control muscle movement
and give touching sensation
Indirect Patient Care • Interactive avatar talks with patients, reads body language (gesture,
posture, tone, facial expressions) to determine health status and
whether seeing a doctor is required; if so, all information is then passed
onto doctor
Home Healthcare • With the rise in the elderly population and a decline in people available
to take care of them, robots will assist in providing home care
• Robots will provide an immersive telepresence more broadly than audio
and video communications by being able to move through remote
control, allowing physicians to access patients with greater ease than
before
Healthcare Workflow • RPA can be used to minimize the involvement of human employees in
the patient scheduling process and can also help optimize appointment
turnout by managing appointments with patients
• RPA can be used to automate manual data entry processes
• Use of robotics in health systems will allow organizations to revise the way they consider their
workforce. Robotics, and other automated tools have enormous potential 1 to resolve current and
future health care workforce pain points. Health care providers should embrace strategies where
talent can collaborate with technology to improve efficiency instead of competing against each
other.
• Use of robotics will lend to more precise interactions with patients and enable the possibilities for
care outside of the hospital setting.
1 Further reading : www2.deloitte.com/global/en/pages/life-sciences-and-healthcare/articles/global-health-care-sector-outlook.html
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Case Example: Nursing License Verification through RPA
3. Healing / Well-being Space Design

What is it?
• Hospitalized patients experience disrupted sleep, separation from routine and their community,
severe lack of privacy, and relinquishment of autonomy within their physical space 2 – although
necessary, these features do not lend to a feeling of comfort and well-being
• It has been observed that the hospital environment itself has an impact on patients’ well-being and
recovery process, and therefore, new concepts like therapeutic environments, healing
spaces/environments, and supportive design are an expectation of future health care delivery
Opportunity Examples of Health/Well-Being Space Design

Stress reduction • Noise reduction
through a • Access to daylight and appropriate lighting
therapeutic • Areas for family respite
environment • Proximity to other staff
• Decentralized observation, supplies, and charting
• Positive distractions, such as interactive art, fireplaces, aquariums, internet
connection, music, or soothing video or light installations
Flexible multi-use • Rooms can be adjusted to accommodate different patient need types with
spaces existing infrastructure and supports, to minimize patient transfer between
units
o The optimization of this design is acuity-adaptable care delivery
models, wherein a hospital keeps a patient in the same room from
admission to discharge, regardless of acuity level
• Enhance the patient’s feeling of being in control through options and choices –
e.g. privacy versus socialization, lighting level, type of music and quiet versus
active waiting areas
• Hoteling system across sites for staff workspace
• DIRTT Walls are interior walls that can be disassembled, moved and
reconfigured. The walls can integrate power, sound and display technology
while being easily demountable and repositionable based on functional needs,
allowing a modular environment
2 Source : https://www.ivey.uwo.ca/healthinnovation/blog/2017/8/care-by-design/
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Space design to • Ventilation and filtration systems to control and prevent the spread of
increase patient infections
safety • Hand-wash monitoring system that uses radio-frequency identification
technology
• Surfaces constructed with materials that can be easily decontaminated
• Standardizing room layout, location of supplies and medical equipment
Population-specific • Designing spaces that are oriented to different population types, for example:
design o Positive distraction such as artwork, mobiles, landmarks at a child's
height for pediatric population
o Cushion flooring, large font signage, bright lighting, easy access call
bells to increase safety for senior population
o Maintaining elements of residential space (e.g. "streets", communal
spaces, private "houses") to create calm and privacy for mental health
population
Case Example – Karolinska University 3
3 www.karolinska.se/en/karolinska-university-hospital/Future-Karolinska/state-of-the-art-with-advanced-care/
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• Future design of hospital spaces within a well-being perspective increases accessibility and ensures
that all patients feel welcome and comfortable.
• Hospitals can also actively improve health by prioritizing design elements that reduce stress and
promote healing.
4. The Digital Patient Experience

What is it?
• Consumer interest in and use of technologies for health and fitness purposes is growing
• The increase in data and information access, mobile applications, and personal health devices is
accelerating the pace of consumer engagement in health care, meaning that hospitals will have to
plan for patients who demand digital connection, communication, monitoring and responsiveness
from their health care providers
• Patients are expecting healthcare services to be available anytime and anywhere, including
remotely, giving rise to alternative delivery models
• Patients of the future will leverage the following formats (and more) to interact with health care
services:
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Applications in Healthcare Context
Opportunity Patient Use Examples

Social networks • Online communities can empower patients and provide a source of
information and social/emotional support
• Tapping data from social media and online communities to give health
care organizations the ability to track consumer experience and
population health trends in real-time
Digital Channels for • Patients may access services in the future using personal devices
Patient Interaction (laptops, tablets, smartphones, desktops) to communicate with their
healthcare provider and access their health records
Telehealth • For patients with congestive heart failure, diabetes, depression, and
other chronic conditions, digital health technologies such as home
telemonitoring can reduce hospital readmissions and increase the ability
of individuals to live independently
Gamification • Using a structured form of play to create an engaging patient experience
leveraging fun and motivational elements
• Digital games have the unique ability to give immediate feedback, to
adjust challenge to levels of accomplishment, and to tailor the timing
and substance of rewards, to give the patient motivation to achieve
health goals
Case Example: D.Assist 4
D.Assist is an AI enabled patient communication solution enabling patients to request assistance without
the need to press a button. Simply by speaking their request, nurses are alerted to their need, with AI
prioritising and smart-routing requests to the right resource to meet the patient’s needs.
The solution captures a spoken request for assistance in the patient’s room, which is understood by the
system and converted to text. The message is then assessed using AI services and processed to identify
the patient’s request and determine how best to respond. In many cases D.Assist is able to respond to
the patient from a database of FAQs, relieving nurses’ workload. Where physical assistance is required,
the request is assigned a priority, and routed to the most appropriately skilled team to respond to the
patient, displaying the patient need with a target time in which to respond. While this is happening, the
patient receives a confirmation that their request has been made to the nursing team, providing them
with important emotional reassurance.
4 https://www2.deloitte.com/au/en/pages/public-sector/solutions/dassist.html
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• Health care systems of the future should consider extending their focus beyond price and quality of
care to creating a customer-centered relationship. Health care has an opportunity to learn from
other industries (consumer products, financial services, and hospitality, as examples) how to more
effectively target, serve, communicate with, and retain customers and patients.
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SECTION 2: Partnership Options

The Ontario Ministry of Health and LHINs have set clear objectives to bring together different health
care providers and agencies, across federal, provincial and local levels, to engage in coordinated
planning of the patient’s healthcare journey. Strategic partnerships focus on shared gains and the
creation of value through combined risk, funding, and resource contribution. They cover enterprise wide
projects and create material and transformational value for partners across the breadth of their
portfolio. They are typically acquired when new capabilities need to be built out.
Establishing programs that facilitate collaborative planning aim to optimise the use of resources and
maximise benefits to both providers and users of health care services. This section explores different
models for partnership with organizations external to SRH.
Opportunity 1 – Community Hubs

What is it?
A community Hub can be a school, a neighborhood centre or another public space that offers co-located
or integrated services such as education, health care and social services. The partnership of multiple
services allows for greater resources and services to address users' unique needs.
An integrated community hub would be supported by shared front and back office operations. A
common reception and way-finding would welcome consumers/visitors, supporting a person-centred,
friendly experience, guiding people to their desired services. A warm hand-over between services would
be facilitated and all partners would be aware of other programs/services available within the
community hub (or beyond) to ensure individuals in need get access to the services that they require 5.
Community Hubs in Practice
The Government of Ontario implemented a Strategic Framework and Action Plan for Community Hubs in
2016. Ontario's hubs are still emerging, as the governments focus on building community capacity,
making use of public spaces, and removing barriers to community hub development 6.
Below are sample models of community hubs and how they can support the patient journey7:
Partnership
Sample Case Study Outcomes
Model
Co-location of Mr T has advanced dementia and is having treatment to Co-location enabled
Services manage his symptoms. He lives with his wife, who is services to share
struggling to meet his needs. contact details,
Mr T's wife brought him to the ED. The plan was for Mr T enabling Mr T to be
to be supported at home, but no intermediate care or supported at home
rapid response was available. The default position would and avoid a hospital
be to admit Mr T to hospital. admission.
5
Source: http://supportinhaltonhills.ca/wp-content/uploads/2015/12/Integrated-Community-Health-Hubs-Proposed-Model-Mississauga-
Halton-LHIN.docx
Source: https://www.ontario.ca/page/one-year-progress-update-community-hubs-ontario-strategic-framework-and-action-plan#section-3
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Adapted from http://www.caringtogether.info/community-hub-case-studies/)

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Due to improved working relationships from co-location of

services in this community hub, the ED nurse contacted a
social worker and arranged an urgent joint visit the next
day.
The social worker and a Hub nurse visited Mr T at home
and completed a holistic assessment. A patient care plan
was completed with Mr and Mrs T.
Integration of Mrs H, aged 99, lives alone and is fiercely independent. Different service
Services Mrs H’s health is deteriorating, with memory loss and areas made a joint
reduced vision and mobility. From sleeping in her chair, decision about the
Mrs H developed oedematous (swollen tissue) and infected patient's treatment
legs which were dressed by home and community care to facilitate Mrs H
nurses a few times a week. continuing to live
Mrs H started to neglect her personal care, develop safely at home.
continence problems and began leaving her oven on,
creating a fire risk in her kitchen.
After being flagged by home and community care, her case
was discussed at a multi-disciplinary team meeting
through the hub model, at which it was agreed for the
social worker to visit for a review.
The social worker arranged for financial support through
Ontario Social Services, incontinence services, a fire home
safety check, installation of assistive technology, and
caregiver support for Mrs H’s nephews.
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Opportunity 2 – Public-Private Partnerships

What is it?
In the context of the infrastructure sector, public-private partnerships (PPP) take the form of long-term
contracting arrangement between the public and private or voluntary sectors. The facility typically
remains publicly owned and regulated. The private sector partner is offered a long-term bundled
concession to undertake some combination of facility design, construction, financing, operations and
maintenance in return for either user fee revenues or paid a pre-determined annual fee. Partnership
structures vary along a spectrum of responsibility outlined in the figure below 8.
PPPs are especially desirable in the healthcare context given many hospitals and healthcare
organizations have limited budgets both for capital planning and operationally. In the Canadian context,
hospitals and healthcare account for the highest number of PPPs.
Below are examples of successful healthcare PPPs in the Canadian context.
Example Benefits
Hospital Infrastructure Partners (NOH) Partnership • Increased value for money
Inc. Partnered with Halton Healthcare Services to • An expansion of services provided to the
build a new hospital with a capacity of 457 inpatient community
beds9. The hospital includes the following services: • The design and construction of the new
• Acute care programs including Maternal Child, hospital adheres to the guidelines and
Adult and Child and Adolescent Mental Health sustainability principles of the Leadership in
8 Source:
http://www.sauder.ubc.ca/Faculty/Research_Centres/Phelps_Centre_for_the_Study_of_Government_and_Business/Events/UBC_P3_Conferen
ce/~/media/Files/Faculty%20Research/Phelps%20Centre/2013%20P3%20Conference/Papers/s6%20%20Siemiatycki%20Is%20There%20a%20Di
stinctive.ashx
9 Source: http://www.p3spectrum.ca/project/info/?id=129
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Example Benefits
inpatient units, Medical Surgical, Emergency, and Energy and Environmental Design (LEED)
Complex Continuing Care; rating system
• Outpatient programs and services including
Surgical Daycare, Cancer Clinic, Outpatient
Rehabilitation, Diagnostic Imaging, Halton
Rehabilitation Program and Neurophysiology;
• Educational and learning services including more
than 60 central meeting and training facilities and
a clinical teaching laboratory; and
• Support services such as medical device
reprocessing, inpatient pharmacy and biomedical
engineering.
• The new hospital is publicly owned and publicly
controlled. Hospital services will continue to be
publicly funded and publicly administered.
• Hospital Infrastructure Partners used green
building practices such as:
o Using building materials with recycled
and locally sourced products and
diverted 75 per cent of construction
waste from the landfill;
o Reducing indoor water use by 30 per cent
by installing highly efficient plumbing
fixtures;
o Minimizing solar heat gain by installing
reflective roofing; and
o Incorporating design elements that
respond to climate conditions
Lakeridge Health partnered with Aecon Buildings • Increased capacity for up to 216 new beds—
and Concessions, divisions of Aecon Group Inc. 32 of which have in-room medical lifts.
(Aecon), to build and finance the LH Oshawa hospital • The project agreement provided that the
redevelopment project10. builder was responsible for all increased
The redevelopment project resulted in an additional financing costs resulting from any builder
20,000 square feet of space built over Lakeridge delay.
Health Oshawa’s existing facility and renovation of • Increased ability to meet the community's
existing facilities including: needs with modern and fully equipped
• Construction of two new floors for pediatric facilities.
support, child and adolescent mental health
inpatient support, and maternal program
administration;
• Renovations of ambulatory maternal care, adult
mental health support and administration,
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Example Benefits
rehabilitation support, patient management
services, and the maternal newborn program;
• State-of-the-art reverse osmosis room to purify
water used in dialysis;
• Capacity for a forty-station hemodialysis area;
• More single patient and semi-private rooms for
privacy and infection control;
• Isolation rooms to help reduce hospital-acquired
infections; and
• Secured access areas for patient safety.
The Abbotsford Regional Hospital and Cancer Centre • The hospital was the first ground-up
is a partnership between Access Health Abbotsford integration of a cancer centre with an acute
and the B.C. Ministry of Health Services, the care hospital in Western Canada.
Provincial Health Services Authority, BC Cancer • Payments to the private sector began when
Agency, Fraser Health Authority and the Fraser Valley construction was completed, providing a
Regional Hospital District 11. strong incentive to finish construction on time.
The centre was planned as a state of the art 300 bed A performance-based payment system gives
replacement for the aging acute care hospital and the private sector an incentive to meet or
provided enhanced and specialized health services to exceed contract requirements or else be
more than 480, 000 community members. financially penalized.
Access Health Abbotsford designed, built, financed • Capacity has increased in every facet of
and maintained the new hospital and cancer centre hospital operations including an expanded
and the Fraser Health Authority and BC Cancer maternity ward and Intensive Care Unit, and
Agency provided all public health services. increased capacity for mental health and
palliative care.
• The integrated cancer centre, which handles
an estimated 60,000 patients annually, means
patients in the Fraser Valley no longer have to
travel a minimum of 45 kilometres to Surrey
for treatment.
Opportunity 3 – Hospital-Community Partnerships

What is it?
Hospitals and health systems are ideally positioned to improve the health of their communities. Not only
do they have expertise in improving health, most hospitals are one of the largest employers in their
communities and have strong reputations as major community stakeholders. Effective and sustainable
hospital-community partnerships are critical to building a healthy community.
Leveraging existing assets in the community is an effective way to strengthen partnerships. An asset-
based development plan focuses on identifying available resources within the community and building
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stronger relationships between all community organizations. Assets can be people, physical structures
or places, community services and community organizations.
Potential Hospital-Community Partnership Structures
Hospitals and community organizations may structure their partnerships differently depending on the
need being addressed. The figure below, developed by the Health Research and Educational Trust 12
(HRET, Chicago) shows a range of partnership structures with varying degrees of formality:
Examples of Hospital-Community Partnerships
Example Benefits / Outcomes

Southwestern Vermont Medical Center has worked with the local Supports healthy behaviours
government on projects such as the building of biking and walking and quality of life in a long-term
paths. One such project is a path and boardwalk that will connect context.
two affordable housing complexes, so that residents can safely
walk to schools, jobs and grocery stores.
Seattle's Swedish Medical Centre joins with important community Supports preventative health
partners such as Planned Parenthood, the YWCA, and the Center and increases access to services.
for Multicultural Health to provide a Mobile Mammography
Program. The program includes two Breast Care Express coaches
which deliver experienced technologists and mammography
12 Source : http://www.hpoe.org/Reports-HPOE/2016/creating-effective-hospital-community-partnerships.pdf
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equipment to locations convenient for women - places in their

community or at their workplace.
In partnership with the school of nutrition at Ryerson University Community insights can be used
and the dietary risk factors working group of the Toronto Cancer to develop programming,
Prevention Coalition, Toronto's Sunnybrook Hospital conducted a services and resources to best
needs assessment/survey related to healthy eating, physical meet the needs of the target
activity and healthy body weight of women attending high-risk group.
breast cancer clinics at Sunnybrook.
Paris Community Hospital in Illinois formed the Bee Well of Edgar Opportunity for health
County, a community wellness coalition. This coalition is in its first promotion and education, while
year of providing educational vegetable gardens to teach residents having an environmental
about gardening and healthy food choices. impact.
Opportunity 4 – Regional Care Programs

What is it?
Improving health from a population lens may benefit from the approach of a regional care model, to
maximize sharing of information and resources, as well as increase and standardize quality, access, and
sustainability. A regional approach may define its boundaries by 13:
1. Following geopolitical boundaries (e.g. provincial ministries of health)

2. Following natural patient pathways or specific disease groups (e.g. Ontario Renal Network)
3. Following the optimal population base over which to design services (e.g. LHINs)
Placeholder: we are having trouble finding good examples of this that aren’t super
complex / require government intervention and policy change to execute. Can we delete
this section? Or are there ways you can suggest adding to it?
13 https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/developing-a-regional-health-system-strategy
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SECTION 3: Program-Specific Innovations and Trends

The following section describes future-thinking case examples, technologies and models of care by program area. These examples are meant to
support a discussion of how innovations such as these may be applied to enhance care delivery at SRH. Each example is categorized into either:
o a technology focused innovation (introduction of a new technology to the care model)

o a care model focused innovation (using a new method, framework, or service in the delivery of care)
This section explores the following program areas:
1. Cardiology
2. Critical Care
3. Emergency Services
4. Maternal and Child Health
5. Medicine
6. Mental Health
7. Nephrology and Chronic Disease
8. Oncology
9. Palliative Care
10. Pediatrics
11. Post-Acute Care and Stroke
12. Senior’s Health
13. Surgery
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1. Cardiology
TECHNOLOGY INNOVATIONS – Cardiology

Name Description Benefits/Outcomes
Seeq Mobile • Developed by Medtronic14, the Seeq Mobile Cardiac Telemetry System is a Band Aid-like • Because this device is an
Cardiac patch that monitors heart activity and transmits that data over a cellular network inconspicuous and easy-
Telemetry • Indicated for patients who have experienced symptoms that suggest an irregular heartbeat to-use adhesive patch,
System (US) such as fainting, lightheadedness, vertigo, palpitations or shortness of breath and whose patients are more likely to
symptoms were not detected by a 24-hour Holter monitor (a standard Holter monitor is wear it continuously,
much more burdensome for the patient, as it is equipped with a variety of electrodes and allowing for more
monitors) consistent and
• The monitor is water resistant and can be worn up to 30 days comprehensive capturing
of data
Google Glass • Google Glass consists of a headset that sits on your face like a pair of eyeglasses. This • In the future, this
(US) wearable computer can take pictures, record videos, and wirelessly transmit data technology could allow
• Physicians can wear the hands-free device during medical procedures to record and transmit cardiac patients to benefit
images without having to handle cameras and contaminate the sterile surgical environment from the expertise of
• In one study15, angiographic images broadcast through Google Glass to computers or iPads cardiologists around the
were sharp enough to be accurately interpreted by experts who weren't present during the globe
procedure
CARE MODEL INNOVATIONS – Cardiology

Off-site • In this model, a dedicated off-site facility provided continuous cardiac rhythm monitoring for • Off-site monitoring can
Central patients in the Cleveland Clinic main campus and 3 regional hospitals minimize noise distraction
Monitoring • 1 monitoring technician provides continuous cardiac monitoring for up to 48 patients and from hospital activity,
Using also provides blood pressure, pulse oximetry, and respiratory rate notifications on request centralize staffing, and
Standardized allow standardized
practices
14 Source : http://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/cardiac-monitors/seeq-mct.html
15 Source : https://www.health.harvard.edu/heart-health/5-new-cardiac-technologies-to-watch
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Cardiac • Each workstation at the offsite location includes the electronic medical record with a
Telemetry (US) monitored patient census populated by a clinician’s order, and a telephone system
with regularly updated nursing assignments
• Patient monitoring is regarded as a shared responsibility between the central
monitoring unit (CMU) and on-site nursing, with both sides accountable in the
process. Protocol-driven CMU communication with nursing staff occurs via direct
mobile phone or use of a crisis phone for emergencies to prevent delays
• In this study16, telemetry standardization was associated with 15.5% monitored patient
census reduction without increasing cardiopulmonary arrests. Central monitoring detected
rate and rhythm changes in 79% of patients within 1 hour of emergency response team
activation, with discretionary direct notification associated with 93% return of spontaneous
circulation among coded patients
One-Stop • The National Health Service (NHS) has developed a care map to identify the flow from • Better utilization of
Cardiology referral to diagnosis, intervention, care, and follow-up and rehabilitation current services and
Clinics (UK) • One of the components is the one-stop cardiology clinics which provides diagnostics, clinical increase patient
opinion and management plan (with time for the patient to understand and discuss the satisfaction and
diagnosis, medication, and treatment options) in one visit. Following the visit, a report is engagement in
faxed to patients GP within 24 hours17 treatment.
• Some key takeaways include: • Better continuity of care
o Systematic triage at the front end of the process can reduce unnecessary across primary care and
appointments leading to reduced waiting times for all patients; acute care services.
o Changing the management of referrals from a central system to one where the
department administers their own referrals was an essential step in developing
triage systems to manage demand and cut waiting times;
▪ Triage of referrals by a cardiac technician identifies more than one in
four referrals as suitable for ‘test only’
▪ Triage of referrals by lead nurse for rapid access chest pain clinic (RACPC)
can identify all referrals that meet the criteria for RACPC (approximately
one in three referrals);
16 Source : https://jamanetwork.com/journals/jama/fullarticle/2540401
17 Source: http://www.improvement.nhs.uk/heart/sustainability/rtt_map.pdf
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o Diagnostic tests are arranged for on the same day as the clinic visit (or in
advance for 7 day event monitoring, etc.);
o Reducing follow-up appointments (from having care plans developed in the
initial visit) has reduced the number of no-show appointments;
o Addressing letters containing management plan to patients (copied to GP) is
both ‘doable’ and popular with patients and GPs
Kitchener • St Mary’s Regional Cardiac Care Centre has received international recognition for a • Expands the
Cardiac Centre protocol that allows the Centre’s cardiologists to diagnose an ST-Elevated Myocardial organizations ability
(Ontario) Infarction (STEMI) while the patient is being attended to by advanced paramedics in the to extend care
field – before they even arrive in hospital18 beyond the doors of
• St. Mary’s Regional Cardiac Care Centre has established a protocol with patients in the hospital.
Waterloo Region receiving access to emergency angioplasty within as little as 36 minutes • Better patient
from when the ambulance first arrives on the scene outcomes are
• The protocol is the result of a partnership with Waterloo Regional Emergency Medical achieved as a result
Services and was launched in October 2007. Known as “External Code STEMI”, it sees of earlier treatment.
advanced-care paramedics wirelessly transmit the results of a 12-lead electrocardiogram
from the field directly to a BlackBerry carried by interventional cardiologists at the
Centre
• The interventional cardiologist provides an ECG diagnosis immediately, and if
appropriate, the patient bypasses the hospital’s emergency department, proceeding
directly to the cardiac catheterization lab
18 Sources: https://www.smgh.ca/_uploads/PageContent/documents/AnnualReport08.pdf; and

http://www.smgh.ca/innerpage.aspx?x=tQ5bwuwDmtuhKG2l0KM1raXTluNhjh1tc4CmUxqt9AXQ2exg6NTwZo%2bNK8JnqrIZ; and
http://www.ccn.on.ca/pdfs/CCN%202007-2008%20Annual%20Report.pdf
21
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2. Critical Care
TECHNOLOGY INNOVATIONS – Critical Care
CareEvent • Philips CareEvent Software is integrated with patient monitoring systems and delivers • Increases speed of
Management alerts directly to a smartphone 19 response by leveraging
System (Global) • Through the app, the clinician can determine the validity and priority of the alarm, and smartphone notification
make a decision to respond, escalate to a colleague, or dismiss and secure messaging
between members of the
• Secured text messaging allows care teams to communicate with each other using the
clinical team
mobile app
• This way, other clinicians outside the unit can also be looped in to the notification and
communication system
• Data about alarm reporting can be analyzed to track best practices (e.g. behaviour in
response to different alarms and compliance with policy)
Textile Dressing • Difficult to manage wounds do not heal oftentimes because topical medications can’t be • Increases quality and
for Temporal administered in a controlled fashion and just when needed. To apply a drug onto a chronic safety for wound care –
and Dosage wound, the dressing has to be removed, exposing the wound to potential infections and downstream implications
Controlled Drug causing discomfort to the patient could be that patients heal
Delivery (US) • University of Nebraska-Lincoln, Harvard Medical School, and MIT have brought together faster and improve flow
their expertise in different fields to create a smart bandage that releases meds in a precise through the hospital
manner
• The bandage is based on cotton threads that are wrapped by a conductive shell. These
threads are also encapsulated by a hydrogel coating within which antibiotics, growth
factors, or other drugs can be safely embedded
• The conductive, drug laden threads are laid out in a criss-cross pattern. Electric current can
then be passed through any two threads that are perpendicular to each other, heating up
the area where the threads intersect and melting the hydrogel coating, releasing the
encapsulated drugs at a precise time and dose
Digital Wall / • Cleveland Clinic launched a command center named Bunker on the hospital’s main campus • Centralized monitoring
Clinical allows for better
19 Source: https://www.philips.com.au/healthcare/product/HCNOCTN348/careevent-event-management-system
22
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TECHNOLOGY INNOVATIONS – Critical Care

Command • A team of physicians, critical-care nurses, and technical staff monitors data on a digital collaborative
Centre (US) wall— an image of a patient’s vital signs—in real time at the intensive care units of the main interprofessional decision
campus and community hospitals making and is cost-
• Each patient has a tile that provides their personal details and vital signs trend line. effective.
Algorithms stratify patients based on risk profiles and suggest interventions
CARE MODEL INNOVATIONS – Critical Care

Medi-Hotels • Developed through the Australian Resource Centre for Healthcare Innovations, Medi-hotels • Designed to be a simple
(Australia) are a non-ward type of accommodation for patients who require minimal support or solution to free up
supervision (people who need to be close to a hospital, but don’t necessarily require a expensive hospital beds so
hospital bed) more patients can be
• The Medi-hotel model is comprised of: treated and wait lists
o Inexpensive accommodation in close proximity to a hospital shortened
o A nurse on-call at all times • Patients can recover in a
o Patients are equipped with appropriate communication devices to establish less clinical atmosphere
immediate contact with hospital staff in case of emergency while freeing up beds
• Staff provide assistance with everyday tasks, companionship, nourishment and transfers to within the main hospital -
and from hospitals has a positive effect on
• Medical staff such as nurses, physiotherapists and occupational therapists visit the patient both patient recovery and
waiting times.
Home • Home mechanical ventilation (HMV) has emerged as a method for treating stable chronic • Currently there is a trend
Mechanical respiratory failure, particularly restrictive neuromuscular diseases. The goal of HMV is to in which mechanically
Ventilation help ventilator-dependent individuals function at their highest possible level, while vented patients are in
Model (Canada) decreasing hospitalization and improving quality of life for patients critical care beds at SRH
• The four main criteria for successful HMV include: decreasing availability of
o Clinical stability. Good candidates for HMV are patients who have a stable beds.
disease course, with little or no air flow limitation requiring frequent changes
of ventilator settings. Patients who are not optimal HMV candidates include
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those with concomitant medical conditions that require frequent monitoring • This model provides an
and medical intervention, and those with progressive diseases that require alternative model of care
frequent changes in ventilator settings to better utilize resources.
o Patient and family desire for HMV
o Ability to learn and perform the care needed
o Accessible resources. The patient must be able to use appropriate rooms, and
a safe emergency evacuation route must be available
3. Emergency Services
TECHNOLOGY INNOVATIONS – Emergency Services

Electronic • Cloud-based triage system developed in Ontario through CCO • Improve patient safety
Canadian Triage • Triage nurses enter patient information into a web application and a CTAS score is and quality of care by
and Acuity Scale calculated based on their entries and the national triage guidelines standardizing application
(eCTAS) • Currently used in 120 participating hospitals across Ontario of national triage
• The eCTAS solution also shows ER nurses if the patient presenting has been at other guidelines (CTAS) across
emergency departments, and provides the record of triage, but not the diagnostic record Ontario
• Intended outcomes: • Enhance accountability
o Improve patient safety and quality of care by standardizing application of through the timely
national triage guidelines (CTAS) across Ontario collection and analysis of
o Enhance accountability through the timely collection and analysis of triage data triage data
Driverless • As the development of driverless cars continues, the potential for turning cars into points- • Better utilization of first
Ambulances of-care may take some strain off emergency services responders for treatment
(Global) • Future ambulances may be able to measure vital signs passively and store the recorded data and better patient
in clouds outcomes
• Real time transmission of
clinical information to end
destination for earlier
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TECHNOLOGY INNOVATIONS – Emergency Services

triage, assessment and
treatment
Pulsara App for • Pulsara is a US startup whose app allows paramedics to alert an emergency department • Improvement of patient
Emergency Care before arrival flow and triage through
Communication • It does so by calculating the estimated time of arrival based on GPS, and offers the ability the emergency
(US) to attach pictures of the ECG, the injury, the medicine list of the patient, send the personal department
data and the parameters of the patient, etc. • More timely and
appropriate patient care
Medical Drones • Google has patented a device that can call for a drone in emergency situations to fly in • Timely emergency
(Global) with life-saving medical equipment on board response that can improve
• U of T researchers are experimenting with using drones to deliver AED devices directly to patient outcomes
people who have suffered a heart attack, in response to the fact that 85 percent of cardiac
arrests happen outside hospitals and AEDs are hard to reach during off-hours
CARE MODEL INNOVATIONS – Emergency Services

Sunnybrook • Developed by Sunnybrook Hospital as a pilot in 2010, has led to a decrease in hospital • More timely care: average
Rapid Referral admissions since implementation time from ED physician
Clinic (Ontario) • Adult patients with serious health issues who need prompt, but not immediate, care may referral to the patient’s
be referred by an emergency department doctor to the Rapid Referral Clinic (RRC). There, appointment in the clinic
they will be seen within a few days by an internist was 63 hours; 50% of all
• Designed for patients with an internal medicine condition who might otherwise have to patients were seen by
wait many hours in emergency for a consultation, be discharged and wait weeks to see a clinic physicians within 48
specialist, or be admitted. Instead, they can be diverted* and leave the ER with an hours and 69% within 72
appointment to be seen hours20
• *A diverted admission is a patient whom the internal medicine team would have • Reduced admissions and
admitted to the hospital but was treated as an outpatient instead Space referrals: Sunnybrook
constraints estimates that the RRC
20 Source: https://hbr.org/2013/10/reducing-unnecessary-admissions-of-general-medicine-patients-from-the-emergency-department
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• Sunnybrook’s challenges with this model have included: diverts, on average, five
• Subjective calls (decisions about which patients should be diverted are the opinion admissions to the hospital
of the clinic internist) and 18 ED referrals away
• Space constraints from the internal medicine
admission service every
week
Short Stay Units • Short Stay Units (SSU) have been developed to provide a short period of assessment, course • Delivers the appropriate
(Global) of therapy or observations for a group of patients who no longer require active ED care. In care, at the appropriate
the past these patients would have just remained in the ED21 level in the appropriate
• Examples include Emergency Medical Units (EMU); Short Stay Observation (SSO) Units; space.
Clinical Decision Units (CDU); Medical Assessment and Planning Units (MAPU); Admission • Allows for better co-
Units; Chest Pain Units (CPU); Surgical Acute Review & Assessment (SARA); 23 hour wards location of services.
• These units are designed to provide short-term (<24 hours) assessment and/or therapy for
select conditions in order to streamline the episode of care. SSU front load resources to
provide an intensive period of evaluation, treatment and supervision. The emphasis is on
enhancing patient flow through ED by allowing for early transfer out and improving ED bed
access
North Somerset • The North Somerset Primary Care Trust’s (NSPCT) principal aim for an Urgent Care Centre • Reduction of unnecessary
Urgent Care (UCC) is that it should look to reduce non-elective admissions to acute care but given care at admissions.
Model (UK) the right place, at the right time by the right person. • The provision of care by
• This project has chosen to link the objective of the UCC to a GP led health centre. The Model the appropriate provider
includes incorporating a GP role in the ED Triage, in Minor Injury, in Major Illness/Injury, in and a reduction in wait
Community Team times.
• The GP has bigger roles in the Triage area to be the ‘gate keeper’ for appropriate patients
ensuring that inappropriate patients are not admitting to the ED. The GP also plays a bigger
role is minor illness. There are a number of patients who present at hospital with minor
illness. In many cases, these are patients who could be more appropriately seen in primary
care
Expanded • Expanded scope roles for paramedics have evolved in Australia’s rural areas because of the • Better utilization of
Paramedics difficulties associated with delivering pre-hospital services to populations that are ambulance and
Roles in Rural geographically sparse but still in need of fast-response pre-hospital services. Community emergency department
engagement is considered an important aspect of primary health care because it allows services.
21 Source: http://www.archi.net.au/e-library/build/moc/implementing_emoc/aboutssu
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Delivery collaborations of people to address issues that influence their wellbeing through a sharing • Decreased wait times and
(Australia) of responsibility, power and resources. In the context of this model, community improved use of
engagement is about the collaboration between Emergency Service Providers (ESP) and appropriate services
rural communities to address health issues22 (primary care).
• Expanded scope paramedics can engage with communities at the level of the general public,
local committees, and local ambulance volunteers. Expanded scope paramedics community
engagement promotes the health of rural communities in three key ways, by:
(i) increasing community response capacity;
(ii) linking communities more closely to ambulance services; and
(iii) undertaking health promotion and illness prevention work at the community level
4. Maternal and Child Health

TECHNOLOGY INNOVATIONS – Maternal and Child Health
My Birthplace • Portsmouth Hospitals NHS Trust (UK) developed this computerized decision-making tool to • Patient and family
app (NHS) (UK) help pregnant women and their partners to choose whether they would prefer to have empowerment and
their baby on a hospital labour ward, in a midwife-led unit or at home education, leading to
• Provides pregnant women and their partners with objective information about different greater access to different
places to give birth, including national and local outcomes for each option care types
• Supports women to take the lead in asking questions about Place of Birth
Patient-facing • SickKids and NexJ health are developing and testing a secure online shared care plan • More efficient and
Virtual Care available to all caregivers (parents, physicians and therapists) that will serve children living comprehensive
Platform for at home with rare, complicated and life-threatening health problems communication between
Maternal & Child • It will include appointment scheduling and communication capabilities in addition to the care providers and the
Health (Ontario) shared care plan patient allowing for better
remote care and follow-
up.
22 Source: http://www.rrh.org.au/publishedarticles/article_print_839.pdf
27
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CARE MODEL INNOVATIONS – Maternal and Child Health

Take-Home HPV • Developed through the Health Innovation Team comprised of: Saint Elizabeth Health, Eve • Intended outcome is to
Screening Medical, Women's College Hospital, N'Mninoeyaa Aboriginal Health Access Centre, Access increase access to HPV
Program Alliance, Roche Diagnostics, Mount Sinai Hospital screening for women who
(Ontario) • (HPV) screening program that will provide women with a kit they can take home to collect a are uncomfortable or
vaginal sample. After dropping their test into any Canada Post box, results are then available experience difficulty
online through a secure portal within a week getting to an appointment
• Team is working in partnership with Aboriginal Health Access Centres to produce a solution for a physical exam,
that is culturally appropriate for Indigenous populations leading to improved
health outcomes for this
patient population
MOREOB Program • MOREOB (Managing Obstetrical Risk Efficiently) is a comprehensive, three-year, patient • Better alignment and
(Canada) safety, professional development, and performance improvement program for caregivers engagement of care
and administrators in hospital obstetrics units. The Program structure is based on: safety as teams.
the priority, effective communication, teamwork, decreased hierarchy in emergencies, • Better standardization of
practice for emergencies, and reflective learning. care and safety.
• The MOREOB Program is delivered to hospitals on-site. A local, inter-professional Birthing
Unit Core Team is trained, by expert facilitators, and empowered by hospital administration,
to lead all unit healthcare workers in the implementation of patient care and safety
processes that are adapted to the unit’s needs and practice environment.
Early Hospital • Clinical trial performed at the Center for Low Birthweight Research, University of • Early discharge was found
Discharge of Pennsylvania, School of Nursing. to be safe, feasible and
Women • Key findings from the clinical trial indicate: cost-effective.
Delivering by o Women who were discharged early and received transitional home care • Increased bed capacity.
Unplanned services by clinical nurse specialists were sent home a mean of 30.3 hours
Caesarean (US) earlier than the control group
o They had significantly greater satisfaction with care, more of their infants had
timely immunizations at the end of follow-up, and they had a 29% reduction in
health care charges compared to the control group receiving routine care.
o Although there were no statistically significant differences in maternal and
infant rehospitalizations and acute-care visits, there were more maternal
28
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CARE MODEL INNOVATIONS – Maternal and Child Health

rehospitalizations in the control group than in the nurse specialist-followed
group (three versus zero)
o No statistically significant differences were found between the groups in the
outcomes of maternal affect and overall functional status.
Specialized Case • A multidisciplinary approach using a neonatology independent physicians association, • Reduced inpatient stays
Management affiliated hospitals, a pediatric home care company, and a health maintenance organization and improved care
and Home Care was designed to promote earlier safe discharge of infants from intensive care. Infants delivery.
for Early receive case management and early discharge home with home oxygen, monitoring,
Discharge (US) intravenous antibiotics, gavage feedings, phototherapy, or nutritional management for poor
weight gain23
5. Medicine
TECHNOLOGY INNOVATIONS – Medicine
SpeechMED • The SpeechMED Patient App is a HIPAA Compliant application, installed on a • Increases
Multilingual tablet or phone, allows patients to hear medical information in the language that accessibility to
Patient they understand information, which
Engagement • The ability to listen to the information helps patients understand discharge leads to better
Platform (US) instructions regardless of age, vision, language preference or literacy level compliance and
• The application gives them access to their discharge instructions, and allows them outcomes
to receive audio appointment and medication reminders, read in the language of • Reduces chances of
their choice medical errors
• Patients can also use the device to create audio messages for themselves, or their caused by
caregivers, and gives them a way to view important contact information miscommunication
• Data can either be entered by hospital employees, via the ‘Hospital Admin Portal’,
or by the patient, via the ‘Patient Portal’, or a combination of both
23 Source: http://cpj.sagepub.com/content/37/6/353.short
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TECHNOLOGY INNOVATIONS – Medicine

Smart Inhaler • The Smartinhaler™ solution is an ecosystem of devices and apps that help patients • Allows data
(New Zealand) and health specialists manage respiratory conditions and medications24 collection and
• The Bluetooth-enabled Smartinhaler™ medication sensors wrap around patients monitoring, helping
existing inhalers and automatically sends usage data to their smartphone. Using providers manage
the Smartinhaler™ mobile app enables the patient and health care professionals respiratory
to track medication adherence, set daily reminders, and discover insights into conditions and
their medication usage improve outcomes
• The next generation device records the date and time the inhaler is used and • An easy to use
automatically transmits this information to an app on the patient’s phone or adherence solution is
tablet. The SmartTouch stores the history of patient medication usage patterns, likely to improve self-
allowing physicians to also review the information and help make evidence-based tracking and
decisions on how best to meet the patient’s needs. The SmartTouch can be used empowerment
in home monitoring programs, such as hospital re-admission prevention
programs, where maintaining medication adherence after hospital discharge is a
key objective
CARE MODEL INNOVATIONS – Medicine

Early COPD • This model, developed in Ireland, is a respiratory outreach programme that comprises • The pilot program
Discharge Care early discharge care followed by continued rapid-access out-patient support, to reduce the demonstrated that
Model (Ireland) need for hospital readmission patients experienced
• The following care package was provided to patients post-early discharge: fewer emergency
• Clinical assessment and examination department presentations
• Education regarding their condition and proper use of medication including and hospital readmissions
inhalers and nebulizers for acute exacerbations of
• Smoking cessation advice COPD than prior to
• Chest physiotherapy enrolment
• Individual home exercise program
• Provision of self-management plans to suitable patients
24 Source: https://www.adherium.com/news/adherium-receives-fda-clearance-for-smartinhaler-sensor-for-astrazenecas-symbicort-inhaler
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• Contact numbers to reach the early discharge team
• Patients are visited by the nurse or the physiotherapist at home the day after discharge,
with subsequent visits conducted over a 14-day period as required. All patients are given
further follow up appointments to see the team at 6 weeks and 3 months
Acute/Post • In the Acute/Post-Acute Care/GP (APAC/GP) Shared Care model the GP and the APAC team • Reduction in the rates of
Acute Care/GP work closely together to manage the patient in the community. The GPs role is to establish admissions to the
Shared Care the clinical diagnosis, prescribe and administer the first dose of treatment. The APAC team medicine unit and
(Australia) under the ongoing clinical management of the GP continues the care25 redistribution of resources
• This model ensures that where possible the patient does not need to go to hospital for to provide the right care in
initiation of clinical care. Conditions specifically targeted in this model are those that have the right place.
not responded to oral antibiotics or other interventions or therapies
St. Mary's Chest • The St. Mary Hospital’s chest program is a unique model of care that consolidates all • The co-location of patients
Program respiratory patients (acute, postoperative and chronically ill) and an expert team into one by need (when warranted
(Ontario) unit. Patients admitted to the unit have any number of respiratory issues: they may require by volume) allows for the
ventilatory support, non-oncology palliative care, or they may be recovering from thoracic provision of specialized
surgery. Despite their diverse needs, all patients have access to expert care from an services and improved
interdisciplinary team, all of whom are experts in managing acute and chronic respiratory patient outcomes.
illness26 • Can be applicable to
• The program also offers: disease processes other
o An Airway Clinic – an outpatient education and rehabilitation service for than respiratory, for
patients with asthma or chronic obstructive pulmonary disease (COPD). example gastroenterology,
o The Short-Term Rehabilitation Unit (STRU) for patients who no longer require infectious disease, etc.
the care of an acute setting
25 Source: http://www.pccs.org.au/for-health-professionals/resource-centre/gp-shared-care/
26 Source: https://www.smgh.ca/_uploads/PageContent/documents/AnnualReport08.pdf
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Hospital at • Hospital at Home is an innovative health care model that provides hospital-level care in a • Decreased costs for the
Home (The patient’s home as a full substitute for acute hospital care. hospital compared with
Portland • A patient requiring admission for one of the target illnesses is identified in the emergency traditional acute care and
Veteran Affairs department or ambulatory site and patient’s medical appropriateness for care in Hospital at the creation of inpatient
Medical Center) Home is determined bed capacity.
(US) • If appropriate, a patient is offered the option of HAH. If HAH is selected the patient is
transported home
• Once home, the patient receives extended nursing care for the initial portion of their
admission. When appropriate, nursing care transitions to intermittent nursing visits. Nurses
are available 24 hours a day/7 days a week for any urgent or emergent situation
• The patient is evaluated daily at home by the Hospital at Home physician who completes an
assessment and continues to implement appropriate diagnostic and therapeutic measures.
The physician is available 24 hours a day/7 days a week for any urgent or emergent situation
• Illness-specific care maps, clinical outcome evaluations, and specific discharge provide a
pathway for care
• The patient can receive diagnostic studies such as electrocardiograms, echocardiograms,
and x-rays at home, as well as treatments including oxygen therapy, intravenous fluids,
intravenous antibiotics and other medicines, respiratory therapy, pharmacy services and
skilled nursing services27
ParkinsonNet • ParkinsonNet (PN) was created in 2004 by Bastiaan Bloem, a neurologist, and Marten • Creates a network to
(Netherlands) Munneke, a physiotherapist, at Radboud University Medical Center in Nijmegen after they increase access to services
concluded that the lack of PD-specific knowledge among allied health professionals along and information to PD
with an absence of practice guidelines was producing unacceptable variations in the quality patients
of care, with suboptimal health outcomes and high costs as a result • Helps to establish
• ParkinsonNet was developed with the goal of providing the best possible care to PD patients consistency in PD care
and their families, with an emphasis on home- and community-based care delivery
• It consists of a set of geographically based, multidisciplinary networks of allied health • Reduces system-cost
professionals who are committed to providing services to PD patients using evidence-based through home- and
practice guidelines. The program is facilitated by an IT platform to which patients and their community based-care
families have access and that enables the provision of quality-related feedback 28
27 Sources: http://www.med-ic.org and http://www.hospitalathome.org/files/081022_Case_Example_Portland_NEW_TEMPLATE_3.pdf
Source: http://www.commonwealthfund.org/publications/casestudies/2016/dec/parkinsonnet
28
32
CONFIDENTIAL
6. Mental Health
TECHNOLOGY INNOVATIONS – Mental Health

Virtual Reality to • VR is being used to help some soldiers with post-traumatic stress disorder (PTSD) Creates a safe environment
treat PTSD (US) • Massachusetts General Hospital's Home Base Program uses Facebook’s Oculus Rift is for the patient and can be
experimenting with exposure therapy, where a patient can experience driving a used remotely and
Humvee down a desert road or mountain pass or recreating an improvised explosive efficiently.
device blast or attack
• In a safe and controlled environment, the soldiers can learn how to deal with instances
that might otherwise be triggers to behavior that could be destructive to themselves
and others29
Artificial • In these programs, researchers use computers to comb through massive amounts of Early identification and
Intelligence to data, such as electronic health records, social-media posts, and audio and video treatment leads to better
identify Suicide recordings of patients, to find common threads among people who attempted suicide. patient outcomes and fewer
Risk (US) Then algorithms can start to predict which new patients are more likely to be at risk 30 incidences of preventable
• Examples: death.
• Facebook’s AI system is programmed to spot potential suicidal language and
alert authorities
• Emotional intelligence software from Boston-based Cogito Corp. analyzes data
from users’ phones, such as the frequency with which they text or call and
how much they have traveled in a given week; users also record short audio
diaries that the system analyzes. Cogito says its app can detect depression and
suicidal behavior with more than 80% accuracy
• The SAM app developed at the Cincinnati Children's Hospital records sessions
between therapists and patients, then analyzes linguistic and vocal factors to
provide a real-time assessment of a patient at risk for suicide
29 Source: http://www.pbs.org/wgbh/nova/next/body/vr-therapy/
30 Source: https://www.wsj.com/articles/ai-helps-identify-people-at-risk-for-suicide-1519400853)
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CARE MODEL INNOVATIONS – Mental Health

Neighborhood • Al Wakra Psychiatric Hospital in Doha, Qatar is a space with 14 mental health wards • Patients can recover in a
Connectivity and outpatient and inpatient pavilions that more closely resemble a community than a less clinical atmosphere
Design for hospital through incorporation of
Psychiatric • The patient units are the primary building modules organized around a simple main cultural elements
Patients (Qatar) "street"
• Control points and convenient visual access are maintained within the main
street and patient units to provide security
• The design retains aspects of Qatari culture to provide a sense of calm to the patients,
such as:
• Main "street" recreates the feeling of a traditional souk market
• Stables for falcons and horses (part of Qatari culture) incorporated into the
surrounding landscape
• Reference to "neighborhoods" and "villages" rather than "wards" helps
maintain the feeling of familiar surroundings 31
Community • The Harris County Community Behavioral Health Program is a new integrated care • The model is applicable to
Behavioural program operating in community health centers serving low-income uninsured patients in Scarborough of
Program (US) residents in Houston, Texas. CBHP integrated behavioral health staff into the daily lower socioeconomic
patient care process at 11 community centers. Psychiatrists were hired to provide status who may have
psychiatric services one to two days per week, and master's-level behavioral health difficult accessing
specialists were hired to provide psychotherapy throughout the week at each psychotherapy services
community center. A director was hired, and some hospital-based psychiatrists were otherwise.
reassigned to provide services in the community centers. CBHP delivers behavioral • The satisfaction of
health and substance abuse screening, counseling, and treatment at each community providers was higher.
center in close collaboration with the existing primary care staff 32 • Patient symptoms
• CBHP's services include evaluation and treatment of scheduled patients, walk-in improved.
services for patients in crisis, and curbside consultations to primary care physicians in
order to support behavioral health interventions implemented by primary care
31Source: //www.callisonrtkl.com/wip/winners/al-wakra-psychiatric-hospital/
32 Source: http://psychservices.psychiatryonline.org/cgi/content/full/59/4/356
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physicians themselves. Any center provider can refer patients to the behavioral health
specialists or psychiatrists for screening, assessment, and treatment
• By co-locating behavioral and medical providers and by furthering the scope of
behavioral interventions by primary care physicians, CBHP intended to provide
behavioral services to more patients, shorten long waiting periods for behavioral
Cross-Cultural • Vancouver’s Cross Cultural Mental Health Services encompass both formal and informal • The service ensures that
Mental Health sectors of the healthcare system, are provided at primary, secondary and tertiary levels appropriate mental health
Model (BC) of healthcare delivery and are available through hospital- and community-based services are provided to
services.The purpose of the program is to increase the appropriate utilization of all individuals regardless
community mental health services by seriously mentally ill members of ethnocultural of race or culture.
minorities in Vancouver and Richmond. To accomplish this purpose, a new role in the
system was defined — one that acts as a link and a mutual change agent between
community mental health services, the ethnic communities, and the existing network of
individuals and agencies providing human services to immigrants and refugees 33
• The program currently has a staff of five, consisting of one full time person to work with
each of the following communities: Chinese, South Asian, Latin American, Southeast
Asian (mainly Vietnamese), and First Nations
• The approach focuses on indirect or facilitative services such as education, consultation
and training, service brokerage, and service coordination. Some direct clinical services
are offered, depending on the skill set of the staff member, and almost always in the
form of co-therapy with existing clinical staff
• The target populations of the program include members of the general ethnic public,
community gatekeepers (e.g., ethnic workers in immigrant-serving agencies or in
private practice), community mental health staff, and other mainstream service
providers who work in areas such as immigration, education, welfare, and the broader
health disciplines
33
Source: http://tps.sagepub.com/cgi/content/abstract/42/3/478; http://www.calgaryhealthregion.ca/hswru/documents/reports/HEALTH%20SYSTEMS%20INTEGRATION_2007.pdf;
http://www.cmha.bc.ca/files/09.pdf
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Dementia • The concept originated in Hogeweyk, NL in 2007 - The dementia village is a nursing • Creates a better quality of
Village home disguised to look like the outside world. It helps people with mild to severe life by establishing a
(Netherlands) dementia suffer a little bit less in their remaining years 34 familiar, "normal"
• The village is comprised of 23 houses, each with six to seven residents and a caregiver environment that
who cooks, takes people to social events, helps them go grocery shopping at the village dementia patients
market, and watches over them to ensure their safety. understand
• A smaller-scale Hogewey was created in Penetanguishene, ON - relatives of the • Helps to preserves
residents are pleased with how happy their family members seem to be in the new people's sense of
facility – oen being built in Langley BC autonomy
• Creates a "safe"
environment for people
with dementia
7. Nephrology and Chronic Disease Management

TECHNOLOGY INNOVATIONS – Nephrology and Chronic Disease Management
Gamification of • Gamification in the healthcare sector can be used to digitize the lifecycle of • Apps such as these
Chronic Disease chronic disease and motivate patients to manage their disease engage patients and make
Management • Linked with a reward system, fitness wearables and fitness apps provide one of them eager to succeed in
(US, South most simplified forms of healthcare gamification: managing their chronic
Africa, France) o Oscar Health, an insurer in the US, incents use of telemedicine and an disease
• Apps can also help
engaging digital app for health status monitoring, and partners with
increase accountability
hospitals to ensure patient medication and treatment adherence
and provide a channel of
o South African insurance company Discovery offers a thorough health and
data collection and
well-being reward system called Vitality in an effort to encourage communication
healthier member behaviors and lifestyles
34 Source: https://www.dementiavillage.com/
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TECHNOLOGY INNOVATIONS – Nephrology and Chronic Disease Management

o French insurance company AXA has entered into a partnership with the
fitness app Runtastic to offer additional features to its clients for free
OpenAPS • OpenAPS is an open and transparent effort to make safe and effective basic • Reduces burden of Type 1
Artificial Artificial Pancreas System (APS) technology widely available to more quickly Diabetes
Pancreas(US) improve and save as many lives as possible • Accelerates the pace of
• Basic overnight closed loop APS technology is more widely available to anyone innovation toward new
with compatible medical devices who is willing to build their own system. Type 1 diabetes
• The goal is to make safe and effective APS technology available more quickly, to treatments
more people, rather than just waiting for current APS efforts to complete clinical •
trials and be FDA-approved and commercialized through traditional processes.
• The body of work by the OpenAPS community includes a safety-focused reference
design, a toolset, and an open source reference implementation that can be used
by any individual – or any medical device manufacturer
https://openaps.org/what-is-openaps/"
CARE MODEL INNOVATIONS – Nephrology and Chronic Disease Management

Telehealth • An integrated telehealth network providing clinical consults for a variety of services • Patient outcomes
Assistance including dental health, behavioural health, and disease management programs was improved for diabetes
Centre (US) successfully developed and implemented in Knoxville, Tennessee patients
• A centralized hub was located at the University of Tennessee and connected to a • Wait time reduced for
variety of health care agencies in the counties emergency department
• Communication systems for both programs were a combination of videoconferencing,
normal telephone conversation, and remote monitoring between patients and
registered nurses at the telemedicine centre as well as equipment which provided
specialized readings appropriate to the patient population
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• Specific to chronic disease management, health care providers ‘visited’ weekly via
teleconferences, and participants had incremental education over time, thereby
supporting lifestyle changes
Intermountain • Intermountain Health Care in Salt Lake City, Utah, has a national reputation for • Patients had better
Care chronic disease care, quality improvement, and innovations in electronic medical control of their blood
Management records. The program has two main components: the introduction of a care sugar and were more
Plus Model (US) manager (a nurse or social worker) and effective use of an electronic information likely to be tested
technology system resulting in fewer
• The care manager-in consultation with the patient, family, physicians, and other long term
health care providers-assesses the patient's needs, creates a care plan, and acts as complications and
a catalyst to make sure the care plan occurs35 reductions in
• An electronic information system facilitates the work of the interdisciplinary team by hospitalizations.
incorporating protocols and reminders for optimal care of patients. For example, the • Electronic prompts
Care Management Tracking database keeps track of tasks, such as following up with and monitoring will
other clinicians, calling patients to check in with them, and assuring tests are ordered. increase touchpoints
It also keeps track of patient outcomes. A Patient Summary sheet contains pertinent with patients.
health information. Electronic messaging systems help providers gain access to care
plans, remind them about the best health care practices for the patient's condition,
and facilitate communication among the health care team. The system also creates
reports for ongoing assessment and administration of a care management program
35 Source: http://www.jhartfound.org/ar2007html/model2_care_management_plus_p2.html; http://www.jhartfound.org/ar2007html/model2_care_management_plus_p3.html;

http://www.caremanagementplus.org
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NSW Aboriginal • Both diabetes and cardiovascular disease are national health priorities. It is well • Patients benefit from
Vascular Health recognised that indigenous people suffer an excessive burden of vascular disease. a more
Program Vascular disease is the primary cause of preventable mortality and morbidity in comprehensive
(Australia) indigenous Australians, who have a far higher prevalence of cardiovascular definition of chronic
disease, renal disease, diabetes, and stroke, compared with non-indigenous disease management
populations36 and can address the
• Primary prevention messages relating to health and lifestyle are the same for interdependence of
diabetes and heart disease. Common lifestyle adjustments and some common chronic disease co-
medical treatments are necessary to manage and prevent progression of these morbidities.
vascular diseases. Programs that integrate clinical risk reduction and primary • Integration and
prevention strategies have the potential to delay the onset of vascular disease in operationalization of
indigenous populations and to minimise adverse health outcomes for those with service provision for
established disease. An integrated health and lifestyle approach is consistent with better resource use
the strategic direction of national and state policies for other populations and is in and fewer patient
keeping with holistic indigenous conceptions of health and illness. visits.
36 Source: http://www.publish.csiro.au/?act=view_file&file_id=NB02062.pdf
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8. Oncology
TECHNOLOGY INNOVATIONS – Oncology
Watson • Watson Oncology is an AI solution that helps physicians quickly identify key • Implementation of this
Oncology – information in a patient’s medical record, surface relevant evidence and explore tool has the potential to
Artificial treatment options improve patient care by
Intelligence (US) • A collaboration of IBM and Memorial Sloan Kettering, Watson Oncology provides making best practices
individualized treatment options for patients based on their specific case details and and evidence –based
existing clinical evidence37 information easier to
• Watson supports oncologists in the following ways: access
• Consume and keep pace with the growing body of medical literature, • Reduces the burden on
guidelines, trials, articles, and patient data individual clinicians to
• Understand the longitudinal medical record and applying natural language keep pace with medical
processing and advanced cognitive algorithms to each unique patient case literature and process
relevant information
• Generate a list of potential treatment options ranked by applicability—
recommended, for consideration, and not recommended • Helps tailor insights to
each patient's unique
• Review treatment options and supporting evidence side by side to understand
needs
Watson’s rationale and quickly access the relevant articles and clinical data
• In a double-blinded study, the doctors at Manipal Hospitals found that Watson was
concordant with the tumor board recommendations in 90 percent of breast cancer
cases
Liquid Biopsy • Researchers are exploring liquid biopsies, which are a way to analyze tumor • Earlier recognition and
(Global) material in fluids such as blood, urine, or saliva. Liquid biopsy extracts cancer cells more targeted
from a fluid sample and has the potential to revolutionize cancer treatment by treatment leading to
non-invasively monitoring cancer cells38 better outcomes and
• Liquid biopsies that use circulating tumor DNA might be able to detect cancer at quality of life.
an early stage, when treatment can be most successful. Some research shows that
37 Source: Presentation by Prof. Dr. S.P. Somashekhar, Chairman, Manipal Comprehensive Cancer Center, Manipal Hospitals, Bangalore, India at the San
Antonio Breast Cancer Symposium, December 9th, 2016)
38 Source: https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-care-current-january9-2018.html
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TECHNOLOGY INNOVATIONS – Oncology

these kind of tests can detect cancer in blood samples months before diagnosis
using traditional methods such as imaging
• The National Cancer Institute (US) supports an initiative to advance the
development and testing of liquid biopsy technologies. It is working to create a
public-private partnership to bring multi-disciplinary teams together to advance
the field
CARE MODEL INNOVATIONS – Oncology

Survivorship • SEMICC is a patient-centred approach developed by Princess Margaret • Strengthens the sense
Empowerment Hospital/University Health Network that focus on the leading practice domains of self- of community and offers
Model for empowerment and enabling clinical and information technology39. Key elements of the increased sense of
Integrated program include: psychosocial support for
Cancer Care o Empowerment – prepare survivors to manage their health with appropriate patients.
(SEMICC) self-management support
(Ontario) o Recruit and train cancer survivors as a human resource
o Reallocate healthcare human resources through changing scopes of practice
o Apply e-health technologies to provide care at point of need: clinic,
community and home
o Organize patient and population data to facilitate education, survivorship
research and efficient and effective survivorship care
• Princess Margaret Hospital created a Breast Cancer Survivorship Program that
supports survivors throughout the continuum of care. It features on survivor
empowerment, a dedicated space for survivorship care; it’s designed to promote a
culture of wellbeing, and contains public meeting spaces, conference rooms and
consultation rooms. Clinics are available to help manage symptoms and cancer
treatment side effects
39 Source: SEMICC: A new model for cancer Survivorship Care, Princess Margaret Hospital / University Health Network, 2008;
http://www.survivorship.ca/; http://www.cahspr.ca/Portals/0/documents/Urowitz.pdf
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Integrated This model suggests that the general practitioner and other health care providers in the • Increased collaboration
Primary Care community, including allied health, pharmacy and nursing have an active role in the care of with primary care
and Cancer Care the cancer patient from diagnosis through to palliative care. It is important to consider the ensures more patients
Services impact of a cancer diagnosis on significant others including partners, carers and are able to access
(Australia) dependents. Furthermore, the flow of timely and accurate information to and from services closer to home
primary care may have a profound impact on the patients experience through the cancer even if hospital services
journey40 are co-located by site.
Dedicated • The Jay Monahan Center for Gastrointestinal Health at the New York Presbyterian • Care is provided in a
Gastrointestinal Hospital is one of only a few comprehensive cancer and wellness centers in the U.S. seamless and convenient
Cander and exclusively dedicated to gastrointestinal health. The Center offers an array of services, manner for patients.
Wellness Centre from prevention and early detection to treatment, research, education and
(US) community outreach41
• Unique aspects of this program include:
o Gastroenterologists, oncologists, and surgeons meet with patients in one
single setting to coordinate all aspects of patient care and patients and
families have access to social workers, genetic counsellors, and nutritionists
o There is no waiting room. Instead patients and families wait for their
appointments in the education center, where they can access the internet,
books, brochures, and videos for the latest information on gastrointestinal
health, prevention, and treatment
o An on-site education coordinator is available for patients and families to
provide one-on-one assistance with accessing information on screening,
treatment, clinical trials, and education and support programs
o The Center promotes education on prevention, screening, and the latest
advances in cancer treatment for its patients and families, the general public,
and other health professionals, both locally and globally. Through its education
and outreach initiatives, the Center focuses on the promotion of early
40 Source: http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Integrated_Primary_Care_&_Cancer_Services_Model_of_Care.pdf
41 Source: http://nyp.org/news/hospital/227.html
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screening, knowledge of the latest in cancer treatment, and access to clinical
trials
o The Center offers a comprehensive website and video library dedicated to the
promotion of gastrointestinal health and gastrointestinal cancer treatment,
care, and support
9. Palliative Care
TECHNOLOGY INNOVATIONS – Palliative Care
Cognitive- • Cognition-activity Assessment in Response to Rx Interventions (CARRI) project aims to • Will provide a better
activity develop a mobile health (“mHealth”) tool that combines the information from an understanding of pain
Assessment in application on an iPad and from an activity monitor worn on the wrist to measure management in a
Response to Rx brain function and physical activity, to improve understanding of the effects of pain population that may not
Interventions medications on older adults with chronic pain be adequately treated at
(CARRI) (US) • The tool was created to allow both providers and patients to be able to have realtime this time.
feedback on how a medicine is affecting them in a way that they may have difficulty • Improved pain
describing management for
• The tool aims to: patients leading to
• Eliminate recall bias better quality of life and
• Enable better evaluation of fluctuations in medication effectiveness and outcomes.
harms (for example pain intensity or cognitive effects) over the course of the
day
• Provide faster turn-around time for accurate assessments that could be useful
for guiding therapy in real time
Canadian Virtual • Canadian Virtual Hospice is a fully bilingual online resource staffed by experts in • Service is highly personal
Hospice palliative care that provides information and personalized support to patients and and individualized, and
(National) families facing life-threatening illness and to the health providers who care for them yet completely private -
a safe place to ask any
question and seek help
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• A four-year, $2.4 million investment by the Canadian Partnership AgainstCancer, with any troubling
Health Canada and the Winnipeg Regional Health Authority enables theCanadian feeling
Virtual Hospice to offer new features and, at the same time, raisepublic awareness • Provides ready access to
about the valuable information, support and resourcesavailable to Canadians at this the type of specialized
online site42 expertise about palliative
care that may not be
• The website includes an Ask a Professional feature, which invites patients, families and
available in every
health care providers to submit personal queries about terminal illness.
community
o Each question is handled by an inter-disciplinary team of palliative care
• intimacy and accessibility
experts including doctors, nurses, social workers and a spiritual care advisor of the Internet provides
o This team provides detailed, personalized, confidential responses addressing unique opportunities to
the medical and emotional concerns that arise during terminal illness bridge gaps of time,
• The site offers: geography and personal
o Asked and Answered, a collection of more than 80 questions asked by isolation
Canadians and the responses from the Ask a Professional team, with
identifying information removed to protect confidentiality.
o The Glossary, provides a list of accessible definitions for common palliative
care terms;
o The Exchange offers Canadian researchers, clinicians and other leaders in
palliative care the opportunity to share the latest research, best practices and
innovations in peer reviewed articles;
o For Professionals offers key resources and new tools for people working,
volunteering and conducting research in palliative care
Vital Talk (US) • In-depth communication and the family meeting are hallmarks of palliative care. Vital • In-depth communication
Talk is a website focused on supporting clinicians in effective communication practices with people facing
with patients and families43 serious illness is essential
• For instance, a clinician might learn the steps involved in breaking bad news to a to providing high-quality
patient, such as laying out options, weighing pros and cons, offering a prognosis, and care. Tools like this help
42 Source: http://www.virtualhospice.ca
43 Source: Vitaltalk.org
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reinforcing positives, while keeping in mind the patient’s perspective on the situation support the knowledge
and remaining empathetic and skill required for this
• Vital Talk provides a website with video clips as well as a phone app that allows level of complex
providers to receive input and feedback on communication communication
Quality Data • Quality Data Collection Tool (QDACT) is a point-of-care, technology- based quality • Real-time collection
Collection Tool monitoring system for palliative care. It combines patient-reported data with critical of data, as well as a
(US) palliative care steps such as advance-care planning and inclusion of caregivers 44 lens to best practice
• The goal of QDACT is to document care quality and link measures of quality of life to care steps, allows for
outcomes in palliative care a higher quality care
• The tool collects data on quality while clinicians take care of patients, to help remind experience
clinicians of some areas to focus on or some unmet needs to address
CARE MODEL INNOVATIONS – Palliative Care

Rural Palliative • The Rural Palliative Home Care Project was an inter-provincial initiative funded by the • In regions where there
Home Care Federal Health Transition Fund, to develop, implement and evaluate a palliative care are limited numbers of
Project (Nova program in three rural communities. Participating regions were the Northern Health inpatient palliative beds
Scotia & PEI) Region in Nova Scotia, and East Prince and Southern Kings Health Regions in Prince and/or scarcity of
Edward Island. Western Health Region, Nova Scotia was the comparison region45. hospice beds, models to
• The key elements of the integrated palliative care program were: support palliative
• Access and referral through a regional single-entry point. patients at home
• A common palliative care assessment tool and a palliative home chart used increases quality of care
collaboratively with all agencies and interdisciplinary team members. from the comfort of the
• Coordination through an identified case manager for each client and family patient's home.
and weekly palliative care rounds.
44 Source: https://www.ncbi.nlm.nih.gov/pubmed/27348507
45 Source: http://www.sfdph.org/dph/comupg/oprograms/CHPP/Injury/CHIPPS.asp; http://www.cdc.gov/ncipc/falls/FallPrev2.pdf
https://www.gov.ns.ca/health/reports/pubs/Palliative_Care.pdf
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• Care delivery by an interdisciplinary team, in consultation with the palliative
care resource /consult team and the patient/family. One demonstration site
provided enhancements in nursing, respite and medication coverage.
• Consultation/resource teams that included physicians and nurses and, in some
sites, social workers and pharmacists, to provide consultation and leadership
in palliative care.
• Community resource linkages to provide support in palliative care
volunteerism, support for the acquisition of equipment and support in public
awareness.
• From this program several key recommendations were noted, including:
• Palliative care be identified as a core essential service with home identified as
the preferred setting. Service elements will include:
▪ A coordinated and integrated network of services accessible 24
hours/day.
▪ A palliative care consult/resource team with expertise in pain and
symptom management and advanced care planning.
▪ A leadership structure responsible for program planning,
administration and accountability within an integrated framework.
• Funding of an integrated palliative care program should include planning,
development, service delivery, education, evaluation and program support.
Specifically, funding would include:
▪ 24-hour access to home care services that can address pain and
symptom issues, respite and emotional crisis in the home for palliative
patients and families.
▪ Palliative home care medications from a specified home care
formulary.
▪ Appropriate reimbursement for family physicians providing palliative
home care.
▪ Equipment necessary to promote comfort in the patient’s home.
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TriCentral • The TriCentral Palliative Care Program (TCPC) began formally in 1998 as a method of • Improved care delivery
Palliative Care helping seriously patients find a balance between the extremes of too little care and at the end of life with
Program (US) too much. It was initiated as an alternative to the hospice program at Kaiser improved cost
Permanente. Physicians were reluctant to refer to the hospice program because of effectiveness of care.
three reasons: physician uncertainty in determining life expectancy, patient
unwillingness to forego curative care, and other negative connotations of the word
‘hospice’46
• As a result, TCPC was created. It is an outpatient service housed in the Home Health
Department which focuses on ‘superb pain management and other comfort care in the
patient’s home’. Three key differences between the hospice and palliative care
programs are:
o Physicians are asked to refer patients with a prognosis of 12 months or less to
live (as opposed to 6 months)
o Patients do not have to forego curative care as they would in a hospice
program
o Patients are assigned a palliative care physician who coordinates care across
providers to decrease fragmentation across the system
Delivering • The Delivering Choice Programme47 is a national program across England with the • Better coordination and
Choice objective of developing services to facilitate palliative care patients to care for and die quality of care delivery.
Programme (UK) in their place of choice. The 3 main objectives include: • Patients more likely to
o To work in partnership with the local providers and commissioners to develop die at home (if
24-hour services that will meet the local needs and ensure: The best possible preferred).
care for palliative care patients; Equity of access to services; appropriate • Reduction of emergency
support services for patients and carers; and Information on choice for place of hospital admissions in
care and death is available to all; the last month of life.
o Evaluation of the impact of the Programme on health services.
o Sharing findings and learning more widely
46 Source: http://www.growthhouse.org/palliative/toolkit.html
47Source: http://www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/commissioning-services/Delivering-Choice-Proramme-in-
Somerset-and-North-Somerset-Final-Report.pdf
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10. Pediatrics
TECHNOLOGY INNOVATIONS – Pediatrics
Project EVO • The University of California, San Francisco (UCSF) and Akili Interactive Labs, which is • Gamified technologies
Game for developing several app-based games for neurocognitive assessment and therapies, ran like this are easy for
SPD/ADHD (US) a pilot to evaluate the use of Akili’s Project Evo game for children with Sensory children to use and can
Processing Disorder and ADHD be tailored to their
• Project Evo is comprised of three tasks: perceptual discrimination, visuomotor tracking specific needs
and multitasking ability. Each task is performed simultaneously during the game, and • Treatment can be
Project Evo uses adaptive algorithms to assess differences in cognitive ability administered outside of
• All 57 children in the study improved with Project Evo, and those with SPD and the hospital setting
inattention showed statistically significant improvements in their capacity for • Can create expanded
attention screening and
potentially supportive
services for children with
the condition
Imatgina (Spain) • The Philips Foundation, CurArte Foundation and Hospital Vall d´Hebrón developed • Transforms
‘Imatgina’, an advanced patient-centric initiative in pediatric radiology designed to radiology for
enhance children’s test experience48 children into a
• Through discovery and games, children find out in advance what their diagnostic friendly, fun and
imaging tests will be like, what sensations they are likely to feel and how long the tests informative
will take experience
• ‘Imatgina’ is based on three key elements: education, gamification and atmosphere • Creates a positive
• Sample modifications for this population include: impact on the
o Entrance corridors to the various different consultation rooms and the CT wellbeing of patients
scanner have been transformed into a spaceship. and their families
48Source: https://www.philips.com/a-w/about/news/archive/standard/news/press/2016/20161006-the-philips-foundation-curarte-foundation-
and-hospital-vall-d-hebron-announce-imatgina.html "
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TECHNOLOGY INNOVATIONS – Pediatrics

o Children can explore the radiology department before arriving at the hospital • Alleviates anxiety
using 3D animations of the rooms provided through a mobile app and fear in the
o Two anatomy-based games to entertain young patients and enable them to children and reduces
learn the stress levels of
their parents
CARE MODEL INNOVATIONS – Pediatrics

Improving • IMPACT DC uses families’ familiarity with the emergency department (ED) as a site • Strengthens the
Pediatric of care to recruit them into a program that provides asthma education and relationship
Asthma Care in encourages families to seek a long-term relationship with their primary care between patients
the District of provider. Within two weeks after an asthma-related ED visit, patients return to the and their families
Columbia IMPACT DC Asthma Clinic where they are taught both medical and environmental with primary care
(IMPACT-DC) management of asthma. The follow-up clinic operates within the ED itself and also services in the
(US) at a community site within an area of high pediatric asthma prevalence. IMPACT community to
DC also works with school nurses and local organizations to provide necessary decrease the
equipment, smoking cessation education, tenant advocacy, outreach and home number of
visits.49 unplanned ED visits.
• The program showed results in changes to lifestyle behaviours and awareness for • Can be modified to
environmental triggers that cause asthma flare-ups as well as a reduction in address SRH specific
unplanned visits to the ED. disease processes.
Mount Sinai • Mount Sinai Adolescent Health Center (MSAHC) is a free-standing clinic designed • Adolescents and
Adolescent exclusively to meet adolescents' health needs in a teen-friendly, accessible Youth are in a
Health Center environment transitionary period
(US) • Physical, emotional, behavioral, and reproductive issues are integrated into the visit and can often "fall
and viewed as essential components of primary care through the cracks"
of services.
49 Source: http://www.pediatricasthma.org/emergency_departments/washington_dc
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CARE MODEL INNOVATIONS – Pediatrics

• MSAHC staff include six adolescent medicine specialists, an ob/gyn, 20 clinical social Establishing a
workers, three health educators, two child psychologists, a child and adolescent dedicated clinic
psychiatrist, a dietician, nurse practitioners, physician's assistants, and ambulatory ensures follow-up
care technicians and patient
• Collaborate with the aim of providing each patient with a coordinated, highly retention which can
individualized care program decrease poor
• Through both weekly interdisciplinary team meetings and frequent informal health outcomes in
communications, staff members develop, review, and refine patient care plans adulthood.
together
The Declan • The DDCCP is a program offered at Brenner Children's Hospital in North Carolina • Higher incidence of
Donoghue within the pediatric palliative care and complex care program that aims to reduce correct diagnosis
Collaborative the morbidity and mortality in children with undiagnosed complex medical was achieved.
Care Program conditions50. • Better care for the
(UC) • Eligible children are connected with a care coordinator who organizes the child's patient and better
clinical and medical information (including primary care, emergency care, inpatient clinical outcomes.
care, laboratory tests and procedures) and collects a detailed history.
• A meeting is organized and all the patients care providers and clinicians are
invited. Discussion at the meeting leads to a detailed report including potential
diagnoses and a plan for next steps. The child undergoes further testing with input
from the team until a diagnosis is reached.
50 Source: http://pediatrics.aappublications.org/content/139/5/e20163373
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11. Post-Acute Care and Stroke

TECHNOLOGY INNOVATIONS – Post-Acute Care and Stroke
Exoskeletons • An exoskeleton is a wearable robot which supports or, in some cases, substitutes for the • Implementation could
(Global) user’s own movements decrease the number of
• An exoskeleton can serve as an alternative to wheelchairs, providing mobility and rehabilitation tools
increasing patient’s independence in daily life. They can also be used as assistive devices in needed, and the total cost
rehabilitation exercises of rehabilitation
• The use of exoskeletons can increase the possibilities and effectiveness of rehabilitation, • Use of this tool could
especially neurorehabilitation, through intensive all day functional therapy during normal reduce the number of
life activities therapists needed by
allowing even the most
impaired patient to be
trained by one therapist
Kaiser • The telestroke program allows emergency physicians in hospitals without in-house • Telehealth, which
Permanente stroke neurology and neurological intensive care units to activate a neurologist at a includes the
Telestroke remote location, often before the suspected stroke patient arrives via ambulance to telestroke program
Program (US) the emergency department51 covered in this
• Emergency department staff then align their efforts: research, helps fill
gaps in care through
o Pharmacy staff prepare clot-busting medications early so they’re ready to go
the use of
when the patient needs them.
telecommunication
o An on-call, specially trained stroke neurologist uses videoconferencing to
examine the patient with a telestroke cart, which includes a video camera and technologies to
link to test results and the patient’s electronic medical record. provide long-distance
o A radiologist quickly reads neuroimaging studies. medical information
o The stroke alert team reviews a checklist to ensure r-tPA can be administered and services
safely. • Allows health care
• Diagnostic images of the patient’s brain are available instantly to both the emergency organizations greater
and remote physicians via electronic health record, and the neurologist can assess the capacity to provide
patient visually using video technology, all of which saves precious minutes specialized services
51 Source: https://share.kaiserpermanente.org/article/the-need-for-speed-fast-stroke-treatment-saves-lives/
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TECHNOLOGY INNOVATIONS – Post-Acute Care and Stroke

to help meet patient
needs
BioStampRC® • The system refers to a body-worn sensor that is flexible and soft that conforms to the • Easily accessible and
(US) contours of the human body52 encrypted data that
• The sensor allows the patient to exercise, sleep and continue their activities of daily allows for better
living while collecting pertinent data. Data available includes raw kinematic and patient data and care
electrophysiological data delivery.
CARE MODEL INNOVATIONS – Complex Care, Rehab, Stroke

Low Tolerance • Toronto Rehab’s E.W. Bickle Centre for Complex Continuing Care has a Low Tolerance Long • Without this opportunity
Long Duration Duration (LTLD) rehabilitation program that addresses the needs of individuals whose lives for rehab at a level and
(LTLD) Stroke have been affected by a neurological injury or illness or by a complicated medical illness, pace they can tolerate,
Rehab Program surgical procedure or trauma many of these patients
(Ontario) • It involves a longer course of rehabilitation than traditional active rehabilitation programs, would remain indefinitely
with patients spending shorter periods of time in therapy each day in hospital or a chronic
• The program tries to get patients back home, to assisted living in the community, to a care environment
nursing home or to the point where they can tolerate high-intensity rehabilitation.
• The inter-professional team includes physicians, nurses, physiotherapists, occupational
therapists, speech language pathologists, pharmacists, an advanced practice clinician,
service coordinator, social worker and other health professionals
Veteran Affairs • The Veteran Affairs (VA) home-based primary care model enables physicians to designate a • As patients become
Home Based portion of their time as salaried staff to the home care program. There is close cooperation frailer and live longer
Primary Care among nurses, social workers and other team members, and the physician is free to work with more complex
Model (US) with the patient directly or with the team on behalf of the patient53 co-morbidities, they
are able to receive
52 Source: https://www.mc10inc.com/our-products/biostamprc
53 Source: http://ihrp.uic.edu/content/study-shows-benefits-innovative-va-home-care-model
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• VA Home Based Primary Care provides comprehensive, interdisciplinary, primary care in appropriate care in
the homes of veterans with complex medical, social, and behavioral conditions for whom the home and live
routine clinic-based care is not effective more successfully at
• In contrast to other home care systems that target patients with short-term remediable every stage of their
needs and provides episodic, time-limited and focused skilled services. Home Based disease progression.
Primary Care (HBPC) targets patients with complex, chronic, progressively disabling disease • Incentivizes
and provides comprehensive, long term home care. HBPC is designed to serve the physicians and care
chronically ill through the months and years before death, providing primary care, providers to keep
palliative care, rehabilitation, disease management and coordination of care services. patients out of the
• The VA home-based primary care model features: hospital.
o Comprehensive, longitudinal primary care
o Interdisciplinary team: Nurse, Social Worker, Physician, Therapist, Dietitian,
Pharmacist
o Delivered in the home
o Complex, chronic, disabling disease
o When routine clinic-based care is not effective
Self-Managed • This approach relies heavily on the capacity of individuals and families to identify needs • Improved choice for
Care Programs and purchase services. A range of self-managed care models are now being used by patients about how
(Alberta) seniors, persons with disabilities and children with continuing care needs. Three such and where they
models are found in Alberta54 receive services, as
• Alberta's Self-Managed Care Program is available to people of any age who are eligible well as increased
for home care, have stable medical conditions or care needs and require personal care autonomy.
services. Applicants are assessed by an occupational therapist who determines the
number of hours of care an individual is eligible for per month and assigns a care
budget. Care recipients may receive funds directly into their bank accounts to hire and
train care providers or they may elect to have family members or friends manage funds
and care on their behalf. Consumers who are legally incapacitated (e.g., people with
54
Source: http://www.longwoods.com/product.php?productid=19223&cat=508&page=1; http://www.hc-sc.gc.ca/hcs-sss/pubs/home-domicile/2006-self-
auto/find-conclus-eng.php
53
CONFIDENTIAL

developmental disabilities, seniors with dementia) may have their care managed by a
legal guardian. Consumers receive funds through three different streams: client
managed, delegate managed and sponsor managed
Programs of All- • Programs of All-inclusive Care for the Elderly (PACE) serve seniors with chronic care needs • Patients can be
inclusive Care by providing access to the full continuum of preventive, primary, acute, and long term care supported in the
for the Elderly services. PACE programs take elements of traditional health care system and reorganize community longer to
(PACE) (US) them in a way that makes sense to families, health care providers, and the government prevent hospitalization or
programs and others that pay for care 55 lengths of stay.
• The PACE program features a comprehensive medical and social service delivery system
using an interdisciplinary team approach in an adult day health center that is
supplemented by in-home and referral services in accordance with participants' needs.
• Adult day care that offers nursing; physical, occupational and recreational therapies;
meals; nutritional counseling; social work and personal care
Fredericia Model • A program originated in Denmark, where a personal trainer comes to the home of a senior • Empowers the senior to
- Personal citizen and co-creates rehabilitation plan to increase the fitness of the individual 56 perform tasks on their
Trainers Visit • The trainer asks a very simple question… “What would you like to be able to do again?”, own
Seniors focusing on bringing back the ability to function in a self-reliant way • System cost-savings
(Denmark) o Example: Imagine I’m an elderly woman and I’m having trouble putting on my (fewer PSW
control socks. Instead of a caretaker coming to my home twice a day to put them appointments; greater
on and take them off, under this the new model a personal trainer would come to overall health)
my home and work with me to get stronger on a 6-8 week program so that I can • Helps to increase quality
manage my socks myself. of life for seniors
• The public service is treated as an intervention rather than a long-term relationship
55 Source: http://www.cms.hhs.gov/PACE/; http://www.npaonline.org; http://www.nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=117

56 Source: https://challenges.openideo.com/challenge/mayo-clinic/inspiration/the-fredericia-model-maintaining-everyday-life-as-long-as-possible-1
54
CONFIDENTIAL
12. Seniors’ Health

TECHNOLOGY INNOVATIONS – Senior’s Health
Artificial • Care Angel is an automated “virtual caregiving assistant” that can be set up to call a • Improve safety and quality
Intelligence – patient’s landline or cellphone to ask guided, conversational questions, such as “How are of care through remote
Care Angel you feeling?” and “Have you taken your medications?” monitoring in a manner
Mobile App (US) • “ANGEL” ((A)utomated, i(N)telligent monitorin(G), car(E)giving p(L)atform) will respond to that requires low resource
voice answers and then translate them into alerts, reports and actionable items in the app use and is patient centric
or via notification to keep the provider or the family/caregiver up to date on the patient’s (easy for seniors to use)
status
• Because Care Angel interfaces with older adults through their cell phone or home phone, it
doesn’t require them to learn any new technology that they may not be comfortable with
• The app eases some of the stress of caregiving for family members by alerting them if the
healthcare assistant detects any unusual behavior in their daily activities
Nymbl • Nymbl has developed a comprehensive system for measuring, tracking and improving • Tool supports
Smartphone balance. It can be used in a clinical setting or at home, and all interactions can be tracked preventative health to
Balance remotely as well as integrated with hospital HER 57 reduce falls risk in
Assessment (US • Nymbl offers a range of balance tools for health providers, including fall risk assessments, seniors, in an easy to
and UK) digital balance evaluations and balance training interventions incorporate format that
• The Balance Training app can be used by patients at home. Cognitive challenges does not require a clinical
are displayed on the smartphone screen during the exercises, and all exercises are setting
animated and clearly explained
• For wellness professionals, Nymbl also offers a complete toolkit for inserting 15
minute balance segments into existing classes and individual training sessions with
an option to manage and monitor patients through a Coach Portal
Robear Robotic • Japanese research institute Riken has developed a bear-like robot to assist in care for the • Supports "aging in place"
Caregiver (Japan) elderly 58 (care at home)
• Robear is designed to perform tasks such as helping elderly patients stand up, or lifting • Supports caregivers with
them from a bed into a wheelchair daily tasks
57
Source: http://nymblscience.com/
58 Source: https://www.engadget.com/2015/02/26/robear-japan-caregiver/
55
CONFIDENTIAL
TECHNOLOGY INNOVATIONS – Senior’s Health

• The robot incorporates three types of sensors, which allow for gentle movements, • Assistance with mobility
ensuring that the robot can perform power-intensive tasks such as lifting patients without reduces falls risk and
endangering them empowers patient
independence
CARE MODEL INNOVATIONS – Senior’s Health

Home at Last • The Home at Last (HAL) Program is a partnership between hospitals and community • Improve patient flow
Program support service agencies – developed by Downsview Services for Seniors (Toronto) • Reduce wait times for
(Ontario) • Key features of the program include: discharge
• Assessment for eligibility • Ensure basic community
• Discharge planner contacts HAL Care Coordinator at the lead community support supports are in place to
service agency to make arrangements for the PSW and transportation from the ensure smooth transition
hospital from hospital to home
• The morning of discharge, the HAL PSW arrives at hospital to escort patient home • Reduce the need for re-
• Once home, the HAL PSW ensures there are groceries in the home, prescriptions admits once patient is
filled. back home with ongoing
• PSW prepares a meal or snack and stays with client until family arrives or until supports in the home
client is settled. (connects patient/client
• Next morning, HAL Care Coordinator follows-up with client to determine what on- with services)
going needs are required, e.g. Instrumental Activities of Daily Living (meal
preparation, housework) or assistance with Activities of Daily Living (ADL),
(bathing, transfer, toilet use) and arranges CSS services.
• HAL Care Coordinator makes referrals to the local CCAC, Family Health Team, other
CSS agencies or Community Health Centre etc. as appropriate and follows up
PRISMA Model • An inter-sectoral cooperative model is at the core of Quebec's Program of Research to • Greater integration with
(Quebec) Integrate Services for the Maintenance of Autonomy (PRISMA) that aims to meet the care other health system
needs of frail seniors providers increases
effectiveness
56
CONFIDENTIAL

• This model relies heavily on coordination among independent providers (funded through • Shared resource model
different sources), which retain their own governance but agree to participate under an reduces cost burden on a
umbrella system single organization
• Coordination takes place at multiple levels, including a joint governance board, a service
coordination committee, and case managers that manage care delivery
• PRISMA has several features that promote the most appropriate use of services across the
continuum:
• A single point of entry
• Support for frail seniors who require multiple services and complex service
coordination by case managers who assess needs, plan services, negotiate and
coordinate required services and ensure that services are provided
• A single assessment instrument that elaborates a case-mix classification system
used to determine the service needs of individuals and populations
• An inter-institutional electronic clinical chart that makes critical information
available to providers and consumers in real time
ASSIST Model • The model stands for “All-inclusive, seamless, services for, independence of, seniors • Improved service access,
(Mississauga for, today and tomorrow.” The ASSIST Access, Information, Referral and Intake Project navigation and continuity
Halton LHIN) is designed to address the need for a more decipherable, systematic, co-ordinated and of services for seniors
(Ontario) collaboratively orchestrated referral system that supports a flow of clients across and caregivers
service continuum and early identification of at risk seniors in the community. These • Strengthened system
improvements will provide a more supportive system for client navigation and access knowledge, relationships
by facilitating increased knowledge, skills, and inter-organizational communications and integration of intake
across the intake staff. These improvements are the essential building blocks for the practices among the staff
automation of referrals across the health service providers 59. of agencies/providers
• The core components of the model include: • Enhanced and more
• Central Intake/Referral effective information and
• Common Assessment referral practices among
• Senior’s Health and Wellness Centers based in Primary Care/Prevention staff across organizations
59 Source: http://www.peelseniorlink.com/downloads/CSS-BCC-conf-7-6-26.ppt;
http://www.mississaugahaltonlhin.on.ca/uploadedFiles/Public_Community/Health_Service_Providers/CSS%20%20MHA%20Presentation%20-
%20Sector%20Mtg%20Dec%2010,%202009%20Final.pdf
57
CONFIDENTIAL

• Care Coordinators/Case Managers that follow client throughout the continuum of • Leveraged deployment of
care. existing providers in the
• Shared electronic health record across the system CE LHIN
• The model embraces the following: • Enhanced seniors’ health,
• Builds on primary health care wellness and
• Seniors’ Health and Wellness Centres are geographically dispersed and independence through
interconnected hubs that provide common information, intake, assessment, leveraging an improved
referral, and delivery community support
• Access services through any of the providers or central call-in number service capacity within an
• Care coordinators linked to primary care physicians/FHT through the SHWC and integrated and
are integral to system navigation and care delivery coordinated health
system delivery model
• Optimization of health
care resources and flow
of clients across the
continuum
Jersey Post - • The Jersey Post is piloting a call and check service in conjunction with Jersey Health and • Provides peace of
Elderly Check Social Services60. mind for the families
(US) • Postal workers on their route provide a regular visit to people who would benefit from of vulnerable seniors,
a bit of extra help – daily, weekly or as agreed. Staff have a brief conversation with the who may not be able
customer to ascertain how they are and if they need anything. to visit regularly
• Workers do not provide medical services but are able to relay important messages or • May reduce time to
requests back to designated contacts or authorities for action. treatment for seniors
who fall ill at home
60 Source: http://www.bbc.com/news/world-europe-jersey-28033181"
58
CONFIDENTIAL
13. Surgery
TECHNOLOGY INNOVATIONS – Surgery
Virtual Reality • Virtual reality software systems combine imaging from MRIs, CT scans and angiograms to • Can be used remotely
Systems create a three-dimensional model that physicians and patients can see and manipulate and provides a realistic
(Global) • Can be applied to both patient and provider education: experience for the
• Traditionally, doctors can show their patient a standard physical model of the brain patient which leads to
or of the spine, but with VR, providers can immerse patients in their own anatomy, greater reassurance,
so they can very clearly get a sense of what’s going on communication, and
• Surgeons can use VR to practice an upcoming operation. Because they’re understanding
practicing on images from the actual patient, rather than a generic brain, they can • Better patient outcomes
map out the surgery ahead of time given the ability to
• Tool can also be used to train residents in understanding anatomy and learning practice specific cases
about different types of diagnoses they may encounter in future practice beforehand
Surgical • Maryland-based company Surgical Theater has combined flight simulation technology with • This technology helps
Navigation advanced CT/MRI imaging for use in brain surgery as it enables surgeons to perform a real- combine patient data
Advanced life “fly through” of a “patient-specific” surgery61 with surgical guidance in
Platform (SNAP) • The SNAP is connected to standard operating room navigation systems and provides an innovative format, to
(US) advanced imaging capabilities including multiple 3D points of view that allow surgeons to help clinicians figure out
view their case from a microscope perspective and in another view from behind the tumor the safest and most
• One additional feature of the SNAP is a dynamic segmentation which allows for making efficient approach to
specific structures semitransparent to observe vessel structure inside the tumor and tumor performing surgery
boundaries. The SNAP also has other visualization options not available in other navigation
or imaging platforms
Axial 3D - • These custom medical models are 3D-printed reproductions of CT and MRI scans 62 • Having access to a
Preoperative • A high-resolution 3D model gives doctors a more holistic view than the conventional patient’s full-scale
Planning with 3D 2D realm of radiography - having access to a tangible, scale model of what is inside the anatomical model allows
61 Source: Link: http://www.surgicaltheater.net/site/products-services/surgical-navigation-advanced-platform-snap
62 Source: https://formlabs.com/blog/3d-printed-medical-models/
59
CONFIDENTIAL
TECHNOLOGY INNOVATIONS – Surgery

Printed Models patient allows surgeons to visualize and explore the ailment or injury in real space and surgeons to more
(UK) reach a much more comprehensive understanding of their patient’s medical situation accurately diagnose and
and decide on the best course of treatment determine treatment for
• For example, Axial3D uses cancer patient scan data to produce bespoke liver that patient
models that surgeons use to decide whether to remove a tumor or perform • Creating aids for pre-
chemotherapy surgical planning may
• 3D modeling also allows surgeons to plan and practice for operations. With a patient- reduce the time spent in
specific 3D model, surgeons can trial new techniques and prepare equipment well in
surgery, reduce use of
advance of stepping into the operating theatre
resources, and reduce
the risk of complications
and speed recovery for
the patient
CARE MODEL INNOVATIONS – Surgery

Shepton Mallet • UK Specialist Hospitals (UKSH) opened its Shepton Mallet NHS Treatment Centre • Decreased length of stay
NHS Treatment (SMTC) in July 2005, with the aim of developing a pathway for hip and knee in hospital and better
Centre (UK) replacement procedures that improved upon existing UK performance standards and utilization of services.
produced superior clinical results and high levels of patient satisfaction63 • Faster patient
• In 2005, the typical length of stay (LOS) for joint replacements at National Health mobilization and
Service (NHS) trusts in the UK averaged over 7 days. As part of its introduction of improved patient
innovation into the UK healthcare market, UKSH partnered with the New York- outcomes.
Presbyterian Healthcare System to develop a 4-day LOS model for joint replacements.
• The 4-day LOS pathway had to be achieved whilst maintaining excellent clinical
outcomes as well as high levels of patient satisfaction. The model needed to be
sustainable and not increase the burden on local NHS resources. Critical components
of the successful pathway included:
63 Source: http://www.a4hi.org/symposium/2008/abstracts/Alex.pdf
60
CONFIDENTIAL
• Placing patients in charge of their care and recovery in the centre

• Integration of patient education at pre-surgical assessment
• Early, individualized assessment and integration of rehabilitation needs
• Individualized physiotherapy plans beginning with pre-assessment on day 1 and
extend through post discharge with follow-up phone calls to encourage plan
adherence and assess progress
• 99% use of regional and local anesthetic during the surgical procedure
• Optimal use of post-operative analgesia
• Educating patients to self-administer low molecular weight heparin post discharge
(to reduce the risk of venous thrombosis and pulmonary embolism)
• Maintaining a zero-hospital acquired MRSA rate
• Ensure patients’ home equipment was in place on discharge.
Bone and Joint • In this service delivery model, community-based clinics serve as the hub for services. • Patients have a greater
Health Institute Devoted strictly to hip and knee care for patients, the clinics are a one-stop shop providing improvement in general
Hip and Knee or managing all services other than surgery – including assessment of their condition, health and report less
Replacement diagnosis, education and instruction, and follow-up after surgery. While services are pain post-operatively.
Model (Alberta) offered in community areas, one stop clinics must be located where access to services is • Wait times to see a
practical and centrally located64 surgeon and between
• Access to a multi-disciplinary team within the clinic promotes a patient-centered consultation and surgery
approach. Services are fully integrated and standardized so that patients receive the same
decreased.
type and level of treatment regardless of where they are located in Alberta. Post-surgery,
• Reports of satisfaction
all care is coordinated through the case manager at the clinics, including education. Family
physicians are also updated on their patient’s treatment and condition from patients and health
care providers are higher.
64 Source: http://www.albertaboneandjoint.com/innovation.asp; http://medicine.ucalgary.ca/about/hipandknee
61

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CONFIDENTIAL

SCARBOROUGH AND ROUGE HOSPITAL

Future Visioning Discussion

BACKGROUND & OBJECTIVE

What’s in this Document?

In the following report,

SECTION 1: The Hospital of the Future – Broad Trends

1. The Internet of Things

Use in Healthcare Context

Opportunity Examples of IoT Capabilities

Implications for Health Systems

2. Robotics and Automation

Use in Healthcare Context

Opportunity Examples of RPA Capabilities

Implications for Health Systems

1 Further reading : www2.deloitte.com/global/en/pages/life-sciences-and-healthcare/articles/global-health-care-sector-outlook.html

Case Example: Nursing License Verification through RPA

3. Healing / Well-being Space Design

Use in Healthcare Context

Opportunity Examples of Health/Well-Being Space Design

Case Example – Karolinska University 3

Implications for Health Systems

4. The Digital Patient Experience

Applications in Healthcare Context

Opportunity Patient Use Examples

Case Example: D.Assist 4

Implications for Health Systems

SECTION 2: Partnership Options

Opportunity 1 – Community Hubs

Community Hubs in Practice

Adapted from http://www.caringtogether.info/community-hub-case-studies/)

Due to improved working relationships from co-location of

Opportunity 2 – Public-Private Partnerships

Below are examples of successful healthcare PPPs in the Canadian context.

Opportunity 3 – Hospital-Community Partnerships

Potential Hospital-Community Partnership Structures

Examples of Hospital-Community Partnerships

Example Benefits / Outcomes

equipment to locations convenient for women - places in their

Opportunity 4 – Regional Care Programs

1. Following geopolitical boundaries (e.g. provincial ministries of health)

SECTION 3: Program-Specific Innovations and Trends

o a technology focused innovation (introduction of a new technology to the care model)

This section explores the following program areas:

TECHNOLOGY INNOVATIONS – Cardiology

CARE MODEL INNOVATIONS – Cardiology

CARE MODEL INNOVATIONS – Cardiology

CARE MODEL INNOVATIONS – Cardiology

18 Sources: https://www.smgh.ca/_uploads/PageContent/documents/AnnualReport08.pdf; and

TECHNOLOGY INNOVATIONS – Critical Care

CARE MODEL INNOVATIONS – Critical Care

TECHNOLOGY INNOVATIONS – Emergency Services

TECHNOLOGY INNOVATIONS – Emergency Services

CARE MODEL INNOVATIONS – Emergency Services

4. Maternal and Child Health

CARE MODEL INNOVATIONS – Maternal and Child Health

CARE MODEL INNOVATIONS – Maternal and Child Health

TECHNOLOGY INNOVATIONS – Medicine

CARE MODEL INNOVATIONS – Medicine

CARE MODEL INNOVATIONS – Medicine

CARE MODEL INNOVATIONS – Medicine

27 Sources: http://www.med-ic.org and http://www.hospitalathome.org/files/081022_Case_Example_Portland_NEW_TEMPLATE_3.pdf

TECHNOLOGY INNOVATIONS – Mental Health

CARE MODEL INNOVATIONS – Mental Health