Mental Health Engagement Network (MHEN):  Connecting clients with their health team
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Mental Health Engagement Network (MHEN): Connecting clients with their health team. Jeff Reiss MD , MSc, FRCPC City-wide Site Chief, Mental Healthcare Program – LHSC; Vice Chair, Dept. of Psychiatry – UWO; Associated Scientist - Lawson Health Research Institute

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Mental Health Engagement Network (MHEN): Connecting clients with their health team

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Mental health engagement network mhen connecting clients with their health team

Mental Health Engagement Network (MHEN): Connecting clients with their health team

Jeff Reiss MD, MSc, FRCPC

City-wide Site Chief, Mental Healthcare Program – LHSC; Vice Chair, Dept. of Psychiatry – UWO;

Associated Scientist - Lawson Health Research Institute

Nick Zamora BscPhm, MBA, CHE

Chief Clinical Advisor TELUS Health


Mental health engagement network canadian innovation through partnerships

Mental Health Engagement Network Canadian Innovation through Partnerships

  • Canada Health Infoway: Consumer Health Innovation Program

  • Lawson Research Institute: Comprehensive evaluation expertise around innovative technologies

  • LHSC and SJHC: Pushing transformation

  • TELUS Health: Investment in consumer health engagement solution


The health and care challenge

The Health and Care Challenge

$51B in lost productivity and healthcare costs

  • 20% of Canadians experience mental illness, only 1/3 receive treatment

  • 500,000 employed Canadians are unable to work due to mental illness in any given week (2/3 disability cases + 1/3 FT absenteeism)

  • Mental health is the number one cause of disability in Canada, accounting for nearly 30% of disability claims and 70% of the total costs

  • Current treatment cost estimates of mental illness:

    • depression: $5 billion

    • schizophrenia: $2.7 billion

    • uninsured mental health services: $6.3 billion


Objectives

Objectives

  • Improve the health outcomes and quality of life for people living with schizophrenia or mood disorders

  • Put novel technology in the hands of clients and their clinical team

  • Deploy and evaluate customized PHR application that leverages TELUS health space®, powered by Microsoft Healthvault® , and provides:

    • Patient access to their own health information (through LIDB)

    • Interactive tools such as a mood monitor and journaling

    • Standardized health services

    • Ongoing monitoring of activities with alerts and reminders

    • Regular communication between clients and their care team


Project design

Project Design

  • 400 research participants recruited who have been diagnosed with a mood disorder or a psychotic disorder

  • 54 care providers recruited to provide client care using new technology

  • Participants recruited through staff caseloads who have volunteered at outpatient programs in London and surrounding areas including:

    • London Health Sciences Centre and St. Joseph’s Health Care

    • Community agencies such as the Canadian Mental Health Association (London Middlesex Branch) and WOTCH Community Mental Health Services


Mobile patient interface is connected

Mobile Patient Interface is connected

Mental Health Clinicians & Community Care Providers

Family & Other Supporters

Clients

  • Web access

  • 400 clients provided with smartphones AND access their Smart record

Jurisdictional, regional & local administrators

  • Access via web or mobile on own device (no devices provided by project)

  • 55 devices will be provided to community care providers by project

  • Remaining care providers will access using web and/or mobile from own device


Mobile view

Mobile View


Provider portal

Provider Portal


Faculty presenter disclosure

Faculty/Presenter Disclosure

  • Faculty: Jeff Reiss

  • Relationships with commercial interests:

    • Grants/Research Support: Canada Health Infoway and TELUS Health

    • Speakers Bureau/Honoraria: none

    • Consulting Fees: none

    • Other: none


Project design1

Project Design

  • Delayed implementation approach

  • Participants were randomized into Group 1 (early intervention) or Group 2 (later intervention)

  • Participants are provided with a handheld device, a TELUS Health Space account, and a Lawson SMART record timed according to their intervention group and receive training on the handheld device and Lawson SMART record


Project design cont

Project Design (Cont.)

  • Participants will complete a total of 4 interviews, every 6 months for a total of 18 months

  • Focus groups take place at multiple points in time during the study

  • Data collected includes use of devices, perception of usefulness, quality of life, empowerment, general health, and use of health and social services (including hospitalizations and emergency room visits as well as other services)


Expected outcomes

Expected Outcomes

  • The overall hypothesis is that the usage of smart health information technology will improve quality of life and reduce health care system costs by providing:

    • care providers can closely monitor the individuals recovery process

    • real-time communication with their care provider team

    • scheduling appointments and request medication refills

    • track clients in regards to medication adherence and adverse reactions

    • provide earlier intervention before a crisis situation arises

    • provide continued support between formal face to face clinical visits

  • To confirm this hypothesis we will use a standardized evaluation framework that will provide project outcomes on the basis of effectiveness, economic, policy, and ethical analyses


  • Mental health engagement network mhen connecting clients with their health team

    Mental Health Engagement Network – PROJECT TIMELINE

    mar

    aug

    2011

    2012

    2015

    2013

    2014

    Design

    Phase 1 Dev

    Care Providers Wireless 18 mths I-Pads

    Phase 1 – First 200 Clients

    Design

    Phase 2 Dev

    Phase 2 – Next 200 Clients

    Implementation Into Care.....


    Descriptive statistics n 400

    Descriptive statisticsn = 400


    Descriptive statistics n 4001

    Descriptive statisticsn = 400


    Descriptive statistics n 4002

    Descriptive statisticsn = 400


    Accessing the lawson smart record

    Accessing the Lawson SMART record


    Lawson smart record usage

    Lawson SMART record Usage


    Thinking of your personal health record how do you feel about its ease of use n 147

    Thinking of your personal health record how do you feel about its ease of use? (n=147)


    How do you feel about having your own personal health record n 178

    How do you feel about having your own personal health record? (n=178)


    How do you feel about connecting with your health care provider using the smart phone n 161

    How do you feel about connecting with your health care provider using the smart phone? (n=161)


    Mental health engagement network mhen connecting clients with their health team

    How do you feel about being able to share your health information with other health care providers? (n=160)


    Summary of focus groups feedback

    Summary of Focus Groups Feedback

    • Benefits / positive changes through the use of the Lawson SMART record and iPhone

      • Care providers more accessible to their clients and vice versa

      • Boost clients self esteem

      • Clients feel more connected

        • Care provider

        • Other community supports

      • Facilitates self-awareness within clients and promotes self-reflection

    • Privacy and confidentiality with regards to the Lawson SMART record

      • No major concerns

    • Workflow Impact

      • Time savings

      • Increased productivity during client meetings


    Mental health engagement network mhen connecting clients with their health team

    Where do wegofromhere?

    2013

    Who, How and Why:

    Business Plan, Evaluation Engage Private Sector & Other Jurisdictions

    MHEN is a game changer!

    Work with System Change Agents to Scale and Sustain

    Build on what has been done in London

    Create Governance Sustainability and Future Development Committee

    Link to programs and organizations with same mandate: The Sandbox Project, CIHR SPOR TRAM

    Evaluation , Development & Sustainability Planning, Funding, Executing

    Approach to Maintain 400 Clients & Strengthen Solution

    Expand to Youth & Link with Sandbox and TRAM SPOR

    2014

    Expand: MH Conditions & Co-Morbidities

    Ontario Expansion

    & Establish National Sites

    National Expansion

    2015

    Mental Healthcare

    System Redesign


    Mental health engagement network mhen connecting clients with their health team

    Questions?

    Questions for Dr. Jeff Reiss: [email protected]

    Questions for Nick Zamora: [email protected]


    Mhen transforming the system transforming lives main objectives

    MHEN: Transforming the System, Transforming LivesMAIN OBJECTIVES

    • Early Intervention: Monitoring patientsmoods with automation of alerts to contact care providers: next of kin, substitute decision maker, family doctor, etc., so services are integrated and coordinated

    • Care is Proactive and Ongoing: Through TELUS health space, clients will be able to access health tools to support them in their recovery, and beyond

    • Person Driven Access to Care Plans: While this project is aimed to manage a difficult illness, the lessons learned would support future system redesign for the whole population

    • Medication Management: most sought after information by community agencies. Patients can leverage their personal health record to inform care providers so better decision-making This will ensure that the new care provided is based on prior care for continuity of care

    • Data Integration: To better utilize Provincial Assessment tools like the OCAN survey and RAI, which is used in hospitals, but not in community mental health Integrated Referral System

    • Research Data: This project will support the future linkage with other social services, such as income support information to elevate clients from becoming homeless. Research data will inform policy-makers


    Methodology

    Methodology

    Technology Implementation

    At Phase 1 (first 3 months of project), the 200 participants in Group 1 will be provided with a PHR through TELUS health space, as well as they will be introduced to smart phone technology to ready them for deployment of the prompts and reminders

    Two months later, they will be provided with a handheld device. A delayed implementation plan will be used (but will have no effect on the standard of care for the remaining 200 participants), so the remaining 200 participants in Group 2 will initially act as a control group, but at Phase 2 (six months later – approximately June 2012) the remaining 200 participants will be introduced to the technology in the same order (PHR -> Smart Phone)

    Group 2 will have the benefit of any enhancements made during Phase 1 of the project


    Methodology1

    Methodology

    Specifically, the study participants will receive the following:

    • access to TELUS health space

    • a PHR application account

    • access to an online thought diary and mood diary both linked to personalized recovery/relapse prevention plan

    • access to a voice scale that assesses auditory hallucinations (for patients with schizophrenia)

    • access to a medication side-effect monitoring diary, to trigger a review of medications, as well as alerts to care providers related to prescription renewals

    • a handheld device and data plan which will facilitate mobile access to the applications and interactive tools

    • individualized proactive prompts and cues to help them structure their days (e.g. reminder to take medication at 8:00 am)


    Methodology2

    Methodology

    Quantitative Data Collection

    Individual interviews with patient participants will be held at the baseline period and then every 6 months for 18 months

    Data collected will include use of devices, perception of usefulness, quality of life, general health and use of health and social services (including hospitalizations and emergency room visits as well as other services)

    The knowledge learned through Group 1, over the initial 6 months, will provide baseline and comparative data to understand the client’s perceptions for designs and outcome purposes of the technology intervention

    Improvements in the technology approaches made during the initial 6 month period will enhance the tools for Group 2. We are expecting different feedback from groups, one to guide development and one to improve what is developed


    Methodology3

    Methodology

    Quantitative Data Collection

    The structured interviews will involve the following seven questions:

    • Demographic Form

    • Quality of Life – Brief Version (QoL-BV)

    • Health, Social, Justice Service Use

    • Medical Outcomes Study 36-item Short Form Health Survey (SF-36)

    • EQ-5D Health Utilities Index

    • Community Integration Questionnaire

    • Perception of Smart Technology Form


    Methodology4

    Methodology

    Qualitative Data Collection

    • Focus groups will take place at multiple points in time during the study

    • For Group 1, the focus groups will take place:

      1) 2-3 months after initial implementation to discuss initial developments, usability and adoption (focus on the PHR health space solution)

      2) within the next 6 months to discuss addition of phones and issues related to maintenance or loss

      3) a final set of meetings 6 months later to discuss the benefits and pitfalls of the technology to form base recommendations for the next phase of study

    • Group 1 will have the opportunity to provide input on the initial technology design framework, supporting user-centred design (UCD) for novel tool development


    Methodology5

    Methodology

    Qualitative Data Collection

    • For Group 2, the focus groups will take place:

      1) prior to implementation to understand how they use technology before the new approach is introduced and starting with the PHR and health space program

      2) 2-3 months after initial implementation to discuss initial development, usability and adoption of phones

      3) within the next 6 months to discuss maintenance or loss

    • Focus groups with staff/healthcare providers will also be held so that issues can be identified and addressed quickly


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