Infrastructure of Rural Vitality: The Future of Rural Health Services

Jim WhaleyRural Vitality Conference(May 23, 2008)

Presentation Overview

Rural Health Reality Hard Infrastructure: E-health Soft Infrastructure: Regionalized

Networks of Care

Rural Reality

Rural residents in Canada are more likely:

to be in poorer socioeconomic conditions;

to have lower educational attainment;

to be involved in economic activities with higher health risks (e.g. farming, mining, logging etc.) and to exhibit less desirable health behaviours.

Report Conclusion

Conclusion (cont’d)

These factors may be compounded by less access to prevention, early detection, treatment or support services to make good health status even more difficult to achieve in rural or remote areas.

Inverse Care Law

‘Inverse Care Law’ = people in rural communities have poorer health status and greater needs yet they have greater difficulty accessing required health services

– Romanow report, 2002

Key Findings from SE LHIN’s Integrated Health Services Plan (Fall 2006)

Oldest population profile of any LHIN Most rural population in Southern Ontario Limited access to primary health care High risk factors for many chronic diseases Transportation for non-urgent medial care is

a major problem

Population per Square Kilometre for SE LHIN Sub-Areas

SE LHIN Sub-Area 2004 Population per Sq. Km.

Belleville 199.6 Kingston and Islands 197.0 Quinte West 74.3 Brockville 47.0 SE Leeds Grenville 30.8 Tyendinaga Napanee 27.8 Grand Total 26.8 Smiths Falls, Perth, Lanark 25.5 Prince Edward County 25.1 Gananoque Leeds 24.4 Stone Mills Loyalist 22.5 South Frontenac 18.9 Rideau Lakes 15.4 Central Hastings 8.6 North Hastings 5.5 Addington N/C Front. 2.7

The Geography of Health

In the past few years, increasing attention has been given to the role of place in shaping people’s health experiences. However, most of the theoretical work on place and health has been based on studies of urban environments….

– CIHI, “How Healthy Are Rural Canadians?”, 2006, p. i

Place is now recognized as a

determinant of health

E-Health and Rural Health Care?

What happens if we remove geography from the delivery of health care?

The Death of Distance?

The Internet offers a glimpse of the future…a world where transmitting information costs almost nothing, where distance is irrelevant, and where any amount of content is instantly accessible”.

TELEHEALTH – the future is now!TELEHEALTH – the future is now!

1. Provide and support healthcare at a distance

2. Collect, organize & share information & knowledge among providers & patients

The use of electronic information and communications technologies to:

Dr. Robert Filler, Hospital for Sick Children, President of Canadian Society for Telehealth

Electronic Healthcare Applications

MEDICINE AT A DISTANCE

E-HEALTH INFORMATION

EDUCATION & TRAINING

TELE-HOMECARETELEPHONE TRIAGE

DATA TRANSFER

With nearly 200 partners in Ontario including: academic health science centres, community hospitals, psychiatric hospitals, clinics, nursing stations, medical and nursing schools, professional organizations, Community Care Access Centres, LHINs, long-term care homes, educational facilities and public health, Ontario Telemedicine Network (OTN) membership provides access to the world's largest collaborative community of telemedicine-enabled organizations, enabling participation in clinical, educational and administrative events.

Benefits of Telehealth in Rural Ontario

■ Improved access to care

■ Health professional recruitment / retention

■ Reduce cost of patient/physician travel

International Telehealth Links

Family Doctor

Hospital

Community Services

21st Century Healthcare

EHR

Shared Electronic Health Records

Connecting the Community of Providers

in Listowel, Ontario

CSTAR – Robotic Surgery

Canadian Surgical Technologies & Advanced Robotics (CSTAR) is a collaborative research program of London Health Sciences Centre and Lawson Health Research Institute, located at the University of Western Ontario.

(Ontario Medical Review May 2000)(Ontario Medical Review May 2000)

How can we improve coordination in health care?

Can you say LHINs….

25

8992

92

93

94

94

96

96

97

Health Regionalization across Canada (number = year of implementation)

14 Local Health Integration Networks

Local Health Integration NetworksLHIN Areas:

3. Erie St. Clair

4. South West

5. Waterloo Wellington

6. Hamilton Niagara Haldimand Brant

7. Central West

8. Mississauga Halton

9. Toronto Central

10. Central

11. Central East

12. South East

13. Champlain

14. North Simcoe Muskoka

15. North East

16. North West

South East Local Health Integration Network (SE LHIN)

LHIN Mandate

INTEGRATION& SERVICE

COORDINATION

ACCOUNTABILITY& PERFORMANCE

MANAGEMENT

COMMUNITYENGAGEMENT

FUNDING& ALLOCATING

LOCAL HEALTHSYSTEM PLANNING

SE LHIN Priorities for Change

Access to Care– Primary care, rehab services, mental health &

addiction services, transportation to/from care Availability of Long Term Care Services Integration of Services along Continuum of

Care Integration of e-Health Regional Health Human Resource Planning

Rural Partnership Models

Integrated Networks

Alliances

Partnerships

Mutual need is the ‘glue’ that bonds an Alliance

Partnerships are motivated by the need to integrate a fragmented system or improve community well-being

Driven by the financial imperatives of reduced costs and increased efficiencies.

Successful Partnerships

Created voluntarily as opposed to mandated More likely in communities with more

‘resources’ (economic + ‘social capital’) Driven by shared vision & mission Requires action planning for community or

system change Strong civic leadership & technical support

for volunteer decision-making

LHIN Questions?

Will LHINs be able to better coordinate care between urban and rural health facilities?

Will LHINs be able to better coordinate care between rural health providers in same community? (e.g. hospital, medical clinic, homecare, long term care etc.)

Will LHIN planning emphasize transportation or e-Health solutions?