Even the best solutions can have unexpected consequences. Consider health care, where for centuries, the main objective was to overcome illness so that people could live longer.
And what happened? Now that we’re indeed living many years—perhaps even decades—longer, many of us find we’re more prone to painful or debilitating chronic conditions that are often the hallmarks of advanced age.
What’s needed is nothing less than a new monitoring strategy for maintaining our quality of life—a challenge that CIUSSS West-Central Montreal is confronting with telehomecare, a form of telehealth, which uses digital technology to connect users with their healthcare team.
“The beauty of the program is that it encourages people to play a role in guiding their own care,” says Lilly Luan, a Telehealth Clinical Pilot who led the 2017 launch of Telehealth in our CIUSSS.
“Our clients find it a very empowering exercise. The act of measuring and recording information about their illness at regular intervals sensitizes them to the symptoms, risk factors and lifestyle behaviours associated with their condition.”
Participants are issued a licence to enter their data into their password-protected files online on their personal computer or on an iPAD that telehomecare provides. From the comfort of home, the client or a caregiver fills in relevant health-related information, such as weight or blood pressure, at regular intervals.
The data that’s requested is customized to the client’s healthcare profile—for instance, those living with heart failure, diabetes, hypertension, chronic obstructive pulmonary disease, or some combination of these chronic conditions.
Then the telehomecare system monitors the updates. If any of the data that the client feeds into the system falls outside a pre-determined range, the pivot nurse receives an alert about the presence of a potential problem.
Telehomecare is available to clients for periods of varying length, as their situation requires. For those whose chronic condition needs to be closely monitored—for instance, in the weeks after discharge from hospital—it is installed for one to three months. Meanwhile, a longer-term telehomecare plan of six to 12 months teaches clients how to manage their disease.
Frontline nurses serving Support Program for the Autonomy of Seniors (SAPA) homecare clients have reported on the usefulness of telehomecare in raising awareness among their clients of their medical condition. Ms. Luan, who is a SAPA Program Manager at CLSC Benny Farm, cites a 90-year-old participant in the program who was experiencing kidney problems, who realized that her swollen ankles were linked to her consumption of high-sodium canned goods.
“It has been remarkable to see some of our clients—with an average age of 85 years old—embrace this technology, and the greater sense of autonomy it brings. Instead of relying entirely on their healthcare team to identify these links, they are now able to connect some of those dots themselves,” she explains.
Marie-Josée Grenon, a SAPA Clinical Nursing Supervisor at CLSC Park Extension, is a telehomecare ‘super user’, whose role is to offer the frontline nurse support on clinical matters and decide how best to follow up with a client who has triggered an alert. Telehomecare is implemented in each of the five CLSCs, each site with a dedicated super user.
“The clients’ updates in the system reduce unnecessary home visits by nurses, freeing them up to provide care for patients who may have experienced a sudden decline in their condition and require urgent attention,” points out Ms. Grenon.
“This arrangement is complementary to home visits by the nurse—it’s not about reducing services or replacing nurses,” adds Sharon Pilgrim, the telehomecare super user at CLSC René-Cassin. “It’s about creating the conditions that allow our teams to meet the many and varying needs of our patient population, so that they can deliver the right care, to the right person, at the right time.”
The program not only minimizes needless visits by nurses to the homes of clients who do not require an in-person intervention, it also helps those clients to avoid unnecessary visits to the hospital. Traditionally, if a client with a chronic condition was seen on a bi-weekly basis by a homecare nurse, a worrisome change in their illness was more likely to go undetected between visits. A two-week decline in their medical condition might very well have led to hospitalization.
Now that that information is fed into a system at regular intervals rather than gathered exclusively during home visits, the nurses will learn of a downturn with minimal delay. Moreover, the clients themselves often become more aware of tell-tale signs of deterioration as they closely monitor their own health status.
The result? The medical team can intervene immediately to prevent further deterioration, and spare that client a trip to the Emergency Room or clinic. As an example, a 101-year old CIUSSS client who is enrolled in the telehomecare program was reported to be confused one day. A simple assessment was carried out and they received prompt treatment for a urinary tract infection, avoiding the necessity of a visit to the doctor.
One further advantage is that an already more vulnerable patient population is spared having to travel to that healthcare facility, which may already be a challenge if they have difficulty with their mobility. They are also not risking exposure to viruses that lurk in waiting rooms.
Frontline nurses, who each follow several dozen clients, evaluate which ones would benefit from the service. To be eligible for telehomecare, a candidate must be both physically and cognitively
able to use the basic software needed to track their condition, or have a caregiver who can reliably take on this task. They must also be able to communicate in French or English.
Telehomecare programs have also been introduced at Family Medicine Groups (FMGs) within our network, including a pilot project at the Goldman Herzl Family Practice Centre, reaching a more mobile clientele.
“Clients are amazed at what can be solved on their iPad,” says the CIUSSS Associate CEO, Francine Dupuis. “Fundamentally, though, telehomecare is a revolutionary healthcare model as much for its integration of technology as its engagement of our clients as active participants in their ongoing care.”
Telehomecare in CIUSSS West-Central Montreal: a snapshot
Homecare nurses trained to use telehomecare: 80
Telehomecare licenses available to clients: 100
Clients participating in the program (January 2019): 35
CLSCs taking part in the telehomecare program: 5
*RUIS McGill provides the technology and IT support for telehomecare.
Telehealth services abound in CIUSSS
Telehomecare is but one of many incarnations of Telehealth. Additional forms have been implemented at other sites in the network, and will be profiled in upcoming editions of 360. Here is a small sampling of other initiatives.
Telescreening, which uses technology to collect digital imaging for medical specialists, is available in our CIUSSS for diabetic clients, who are often at higher risk for illnesses of the eye. At CLSC Park-Extension, these clients can undergo a retinal scan, which is sent to an ophthalmologist for screening and, when required, follow-up.
Mount Sinai Hospital, meanwhile, was the first health centre in Quebec to offer telerehabilitation for pulmonary rehabilitation patients from facilities across the province. Patients at hospitals in Joliette and Verdun, for example, participate in live broadcasts of exercise classes, as well as theoretical courses offered several times a week at Mt. Sinai, where patients with chronic respiratory diseases learn to manage their symptoms. “The research on pulmonary rehabilitation is conclusive,” affirms Program Director Dr. Nathalie Saad. “The program helps patients better manage their disease at home through education on self-management techniques, resulting in fewer trips to the Emergency.”