Spring 2013

Continuum

Paul’s Point

Delivering Quality Performance through the use of Business Intelligence Tools

Consumer Health ConversationsSanofi Canada/TELUS Health partnership creates innovative diabetes self-management platform

Innovation in healthcare delivery: Telehomecare

Continuum | Spring 2013 2

Welcome to another edition of Continuum.

Like many of you, I have loved ones who have experienced or are experiencing health issues. I constantly worry about whether our healthcare system optimizes resources in a way that ensures better health

outcomes. In particular, complex medical conditions requiring coordination of the health care professionals using a collaborative approach and incorporating evidence-based practices are particularly top of mind for me.

Working at TELUS Health, I get immense satisfaction from the numerous contributions we make to providing technology solutions that enable better health outcomes. Of particular note, is our acquisition of the PS Suite EMR business which closed on March 4, 2013.

Approximately 56 per cent of Canadian physicians currently use EMRs in their practice, and with this acquisition, TELUS Health now reaches more than 30% of these users or 9,000 physicians across the country. This means that on an annual basis, TELUS Health EMRs are part of more than 25 million patient encounters in Canada. For more information on this acquisition and what it means, I would encourage you to visit www.telushealth.com.

The acquisition of PS Suite EMR fits perfectly with the TELUS Health three-step strategy of expanding reach, delivering on advanced collaborative health services and driving better outcomes. To illustrate, the PS Suite EMR acquisition will reach more physicians. Linking these physicians to their patients as well as the broader continuum of care is facilitated through collaborative health services. And finally capitalizing on data analytics using non-confidential data which is captured through the EMR can lead to improvements, driving even better health outcomes. At TELUS Health, we call this the “virtuous” 3-step circle.

In this issue of Continuum, we share with you several articles about initiatives that we have recently been involved with including:

■Sanofi STARsystem portal, a collaborative health service example enabling a pharmaceutical company to play a bigger role in empowering those living with diabetes to better self-manage their health;

■Fraser Health Authority’s performance management system, a business intelligence system designed by TELUS Health, enabling the identification of improvement opportunities in the delivery of care, leading to better health outcomes for residents of the Fraser Valley; and

■Telehomecare, enabling collaborative health services between physicians, care teams and their patients to deliver care in the comfort of one’s home.

It always gives me great pleasure to share with you our contributions to the healthcare system and in particular our role in ensuring better health outcomes for ourselves and our loved ones.

Sincerely, Paul

Paul Lepage

President

TELUS Health Solutions

Paul’s Point

Continuum | Spring 2013 3

Consumer Health ConversationsSanofi Canada/TELUS Health partnership creates innovative diabetes self-management platform

It’s no surprise that the swift rise of chronic diseases in Canada is exerting unprecedented pressure on our healthcare system. Among other distressing results, it’s now calculated that more than 3 million Canadians live with diabetes1.

As a result, patients living with this disease must make judicious self-management decisions on a daily basis, on issues ranging from diet and nutrition to hydration and exercise. This process can be challenging when information sources on chronic disease management are difficult to obtain, erroneous or non-authoritative.

Sanofi Canada, recognized this situation and identified it as an opportunity for innovation for diabetes support. In March 2012, Sanofi Canada launched the STARsystem, an innovative web-based diabetes support platform accessible through its cross Canada BGStar and iBGStar blood glucose monitoring system.

Addressing unmet needsThe STARsystem provides people living with diabetes anywhere, anytime access to educational and self-management health tools. The platform enhances the knowledge and education of Canadians living with diabetes and provides personalized support and advice on five key areas of diabetes management:

Monitoring blood glucose levels

Managing patterns

Nutrition

Physical activity

Emotional well-being

Following a simple, user-friendly format, users answer a series of preliminary questions to determine their level of knowledge about diabetes. This “intake” process then allows the system to suggest relevant, up-to-date content that is closely tailored to each patient’s situation, preferences and expertise level. Users can then access and track this content through a personalized dashboard.

Building for the futureTELUS Health initially met with Sanofi Canada to understand the company’s needs and to provide solutions for hosting, operations, database and security. TELUS brought in its own technology development partner and assembled a 10-person team to develop an entirely new platform.

Over the following six months, the TELUS Health team collaborated closely with Sanofi Canada and its partners to facilitate each partner’s contribution, refine the technology and platform, and ensure that scalable functionality enabling future expansion of the system’s capabilities was built in. As Stéphane Couture, Director Product Manager for TELUS Health, notes “We asked ourselves: what is currently possible, and what does the platform need to do in the future? Once we understood this, we were able to innovate and incorporate development options for the future.”

1 http://www.diabetes.ca/files/Diabetes_Fact_Sheet.pdf

Continuum | Spring 2013 4

A future-forward approachThis future-forward approach enabled the addition of dozens of informative and interactive articles, videos and other educational material to the resource database, a process which will be updated on a regular basis to ensure users can always access the most up-to-date and current research and information on their condition.

It also enabled the later addition of material created by The “Entourage”, a group of Canadian diabetes experts selected by Sanofi Canada as content providers. The Entourage has assembled a series of easy-to-understand videos and articles to explain the five key aspects of diabetes and provide users with additional interactive tools to better self-manage their diabetes.

Finally, the platform’s capabilities will soon offer users access to a free 90-minute health coaching session by phone, as well as unlimited online support for six months. During these informative phone sessions, health coaches offer encouragement, help patients set realistic goals and discuss various options to achieve them.

This is a particularly important feature, as studies have shown personalized health coaching is an extremely effective tool in encouraging patients to adopt positive behavioural changes, which in turn lead to better diabetes management and quality of life. A recent Australian study identified that participants in a diabetes self-management clinical trial who received personalized telephone coaching to help manage their chronic disease reported significantly greater improvements in general health, health distress, coping with symptoms, self-efficacy and social functioning than those receiving other self-management models.2

The same study also identified tailored self-management support as providing improvements to the patient’s well-being over generic disease management approaches. This implies that the Starsystem approach which integrates both telephone coaching and personalized self management education has potential to provide more comprehensive training and support for diabetes patients.

Support from the eHealth industryIndustry recognition for this innovative development was given in November 2012 as the STARsystem platform was honoured with the Digital Innovation Award. This award is presented to an organization that has applied new products and/or technology in a creative

manner for the Canadian eHealth market

Looking aheadThe company is eyeing further improvements of the STARsystem, in particular to explore potential enhancements in general health, health distress, coping with symptoms, self-efficacy and social functioning for people living with diabetes.

TELUS Health is confident that its partnership with Sanofi Canada, and the value the STARsystem platform offers to people living with diabetes, that the system will help empower Canadians to take charge of their disease and make informed health self-management decisions on a daily basis. This is one of the many areas in which TELUS Health is investing time and resources in order to help achieve our vision of enabling Canadians to improve their own state of health, while also alleviating pressure on the healthcare system.

2 Francis CF, et al. Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects. Australian Health Review 2007:31(4): 499-509

Continuum | Spring 2013 5

Delivering Quality Performance through the use of Business Intelligence ToolsTELUS Health has been working with Fraser Health over the last year and a half to produce interactive scorecards to display their Quality and Performance Key Performance Indicators (KPIs) using the MicroStrategy platform. This has been an exciting, challenging and ground breaking project, and if business intelligence, performance visualization, and data management are important at your organization, we would like to share our story with you.

The Challenge

Quality and Performance has been identified as an area of focus in support of the Fraser Health (FH) Quality and Safety strategic imperative. Reporting and measurement of these parameters requires a special focus within the Health Authority and as a result, current reporting required a review of the accountability for quality and patient safety at all levels of the organization. To enhance the current situation, an FH Executive requested the development of a strategic quality and performance management system that would correspond with the financial accounting practices and enable patient-centered, quality-driven resource allocation. The system would be designed to enable a balanced assessment of the relationship between quality and patient safety measures and other aspects of organizational performance.

The Solution

TELUS Health Solutions has worked with Fraser Health since September 2011 on the development and implementation of a Quality and Performance Management System (QPMS) and the supporting structures and presentation tools for the QPMS scorecard. The scorecards are designed to cover 17 clinical programs and comprise tools, processes, policies, procedures and indicators for clinical programs across the Health Authority.

The system is being built using the MicroStrategy Business Intelligence (BI) Platform. This BI platform provides advanced analytics, reporting and intuitive dashboards that enable informed, data-driven decisions and has proven to meet the Health Authority’s requirements. TELUS provided strategic services and insight, project management, and implementations to guide the QPMS scorecard development.

The Findings/outcomes

The project has now delivered all 17 scorecards for the required clinical programs. While the technical aspects of the scorecards have been delivered successfully, the key findings are in the softer aspects of their coverage.

End users hold the key to success - ensuring engagement in all project stages from understanding the business rules of data extraction and use, to developing training packages to help them use the scorecards to optimal benefit.

Accountabilities - a great tool alone will not shift the culture of the organization. Change management is required to ensure the scorecard is used to drive conversations about quality improvement opportunities and ensure that leaders understand how their programs can be adapted to improve the quality of care and performance.

Timeliness of data input - manual processes such as updating medical records can lead to a time lag which invariably leads to KPI values changing in consecutive reporting periods. Data must be entered in a timely manner to ensure an accurate report.

Continuum | Spring 2013 6

Through the completion of the QPMS project, Fraser Health has achieved the following objectives:

The technical capability to report on their quality and performance indicators

The implementation of a supporting Infrastructure for staging, loading, and transforming data through automated means

Providing the opportunity for end-users to include qualitative commentary with scorecard value

The development of in-house capacity to maintain and update the back-end infrastructure, and front-end reporting tools.

A sustainment model that allow changes to be made to existing measures and the ability to introduce additional ones

An example of the Scorecard

About Transformation Services

The TELUS Health Transformation Services team provides independent consulting and services to health authorities, governments, large integrated providers and clinicians across Canada and the United States. The TELUS team can help your health organization build and execute a practical and effective transformation agenda.

Using MicroStrategy mobile BI technology, TELUS has worked with a Fraser Health team to build their Quality and Performance Management System scorecards.

This sample screen shot is the first of 5 levels that progressively drills down to program and KPI level to enable program owners to assess their performance.

Finally, a write back feature allows managers to input comments and analysis on steps that can be taken to improve or maintain performance.

Continuum | Spring 2013 7

Innovation in healthcare delivery: Telehomecare Chronic disease management is a major problem facing healthcare systems in both Canada and around the world. The cost of chronic illness, disability and death in Canada is estimated at $80 billion. For example, diabetes affects three million Canadians, cardiovascular disease is the underlying cause of death for one in three people, and cancer represents at least nine per cent of total healthcare costs across the country. In addition, aging populations coupled with shortages of health practitioners have significantly increased the strain on the healthcare system resulting in policies being established to make the shift towards ambulatory and home care. In fact, many reports indicate that the availability of human and financial resources makes it difficult to meet the growing demand for healthcare, and that solutions are costly and increasingly hard to find.

Telehealth - an essential link in the remote healthcare delivery chainGiven the current challenge of optimizing resources, the judicious use of information and communication technologies (ICT) is one of the key factors to success. Telehealth is one such innovative use of ICT that reshapes healthcare delivery and is most commonly defined as the secure delivery of health-related services and information using telecommunications, including internet or web-based applications. Telehealth, enables clinical consultation, healthcare management, general health promotion and professional education and is an essential link in the remote healthcare delivery chain. More simply, telehealth supports healthcare delivery, health education and the distribution of health related information.

A growing number of telehomecare programs, one of the most common applications of telehealth, are available in Canada and in other parts of the world. Telehomecare can be defined as the use of ICT for a two-way transfer of information and data required for medical diagnosis, treatment, consultation, training and health maintenance, remotely between a patient and their health care providers. Its main purpose is to provide patient education, monitor a patient’s symptoms and provide immediate response to conditions that necessitate a medical intervention. The value of such a program is of particular benefit to Canadians with medical conditions requiring ongoing monitoring including the aging as well as individuals living with chronic conditions.

Care in the comfort of one’s homeHome care monitoring or telehomecare provides patients with care, from a distance. This is done through innovative technology such as TELUS Health’s Remote Patient Monitoring (RPM) solution, a tool to help clinicians monitor and respond to a patient’s condition. With RPM, patients take traditional biometric measurements and answer relevant questions based on clinical protocols and diagnosis. This data then provides a holistic snapshot of the patient’s condition to their healthcare team in real time. The healthcare team can then easily analyze the results, take action and/or adjust treatment accordingly.

The benefits of telehomecare are numerous and include real time monitoring in the comfort and safety of a patient’s home, faster response to a patient’s current condition, care coordination through better organization of multidisciplinary teams, medical alerts based on pre-established biometric values, and medication and other reminders. Travel time, hospital visits and burdens on both the patient and the healthcare system are reduced while improving the care team’s efficiency and ability to monitor patients. The setup costs for the patient are low and allow patients without internet at home to access the system without compromising on performance. By leveraging TELUS’ expertise in mobility, patients are provided with a dedicated tablet which gives them the ability to enter their data using an easy to use browser version of the application.

Continuum | Spring 2013 8

Major economic and structural benefits offered by telehomecareAging populations are on the rise, as are the number of patients suffering from chronic diseases. Currently, these patients expend up to 75% of our healthcare resources. Recent research from HEC-Montréal, an international business school, has demonstrated that significant cost savings and improved outcomes can be achieved through technology-assisted patient home monitoring programs.

The Canadian study, entitled Home Tele-monitoring for Chronic Disease Management: An Economic Assessment1, was conducted over a 21month period among 95 patients with various chronic diseases. The study began 12 months before the introduction of remote patient monitoring. Nurses taught the patients how to use the TELUS Health RPM solution and on average, a training session lasted one hour (pre). The patients were then monitored at home remotely for four months (peri), and the study continued for five months after the technology was removed (post).

To summarize the study results for patients managed through such programs, investigators observed:

24% decrease in emergency department visits;

66% decrease in the number of hospitalizations; and

41% decrease in associated healthcare delivery costs.

In addition, the findings of the study indicated that patient attitudes toward the technology were positive and that it offers major structural and economic benefits, notably a substantial reduction in the number of hospitalizations and visits to the Emergency room. This in turn frees up much needed capacity within acute care settings shifting the burden from chronic disease crisis to ongoing management of chronic disease.

Emergency room visitsIn order to assess the impact of home telemonitoring on the consumption of health care services, the study tracked the number of patients who visited emergency as well as the number of visits that were made during the pre, peri and post periods of technology deployment.

Table 1 shows that the number of patients who visited the emergency room went from 57 prior to using the technology (pre) to 34 once the technology was in place and then removed (peri and post), representing a sharp decline of 40%. Similarly, the number of visits to emergency went from 91 (pre) to 60 (peri and post), representing a decrease of 24%.

Table 1. Emergency room visits

0

50

100

150

200

250

300

350

400

Total number ofvisits to the

Emergency room

Total number ofpatients who visited

the Emergency room

HypertensionDiabetesChronic ObstructivePulmonary Disease

(COPD)

Heart failure

Number of patients who visited the Emergency room at least once

Length of observationperiod (averagenumber of days)

365

121

244

25 11 5 19 7 4 10 5 1 3 1 0

5724 10

91

37 23

Post

Peri

Pre

1 Study authored by Dr. Guy Paré, Canada Research Chair in Information Technology in Healthcare, HEC Montréal, Placide Poba-Nzaou, Assistant Professor, Faculty of Management, Université du Québec à Montréal and Dr. Claude Sicotte, Professor of Health Administration, Faculty of Medicine, Université de Montréal,-

Continuum | Spring 2013 9

Number of hospitalizations The second healthcare consumption index measured by the study is related to hospitalizations, both the number of patients who required hospitalization as well as number of stays.

Table 2, provides comparisons on hospitalization data collected by the study and shows of the number of patients who were hospitalized went from 57 (pre) to 18 (peri and post) resulting in a significant decrease of 68%. In addition and the total number of hospital stays went from 80 (pre) to 27 (per and post) representing a decline of 66%.

Table 2. Number of hospitalizations

0

50

100

150

200

250

300

350

400

Post

Peri

Pre

Total number ofhospital stays

Total numberof patients who

were hospitalized

HypertensionDiabetesChronic ObstructivePulmonary Disease

(COPD)

Heart failure

Number of patients who were hospitalized at least once

Length of observationperiod (averagenumber of days)

365

121

244

25 7 3 19 5 1 9 2 0 3 0 0

57

14 4

80

18 9

Benefits of telehomecare being proven in Canadian researchThe results of the HEC-Montréal study are generally positive. Annually, the telehomecare program generated savings of $1,557 per patient compared with traditional homecare2, for a net cost reduction of 41%. In addition to showing encouraging results from the economic analysis, the study also revealed interesting findings about positive patient perceptions of the electronic device. When participants were asked to indicate their level of satisfaction with the technological device, respondents indicated a satisfaction level of slightly higher than 4 on a scale of 5. When asked if participants could keep the automated telemonitoring system, 80% said they would.

Important to note is the economic analysis was performed from a healthcare point of view and compared the costs incurred with health service consumption before (baseline) and after the intervention as well as the cost of operating the home telemonitoring program. Costs associated with the technology used were assumed by the health facility and both intervention types (traditional home care and telehomecare) took place in the home.

Whilst the study did not provide conclusive results on why key healthcare consumption metrics continued to decline once the technology was removed, one can only hypothesize this was a direct result of increased awareness and knowledge, as well as proactive self-management of the patient’s condition provided by the training and discipline of monitoring when the solution was in the home.

Telehealth and more specifically, telehomecare is redefining the way that healthcare is delivered in Canada, resulting in improved patient outcomes, increased access to care and healthcare system efficiency. For patients, this means receiving care in the comfort of their home, less emergency room visits, fewer and reduced duration of hospitalizations, reduced travel time and expense and increased access to services. For healthcare practitioners, it means more informed decision making, increased patient compliance and more efficient coordination of care. It is through investments in technology such as the TELUS Health Remote Patient Monitoring (RPM) solution that we can leverage technology and turn information into better health outcomes for all Canadians.

2 Traditional homecare in this study is defined as in-home visitations by licensed nurses.

Questions?

healthcaresolutions@telus.com

1-888-709-8759

telushealth.com