Virtual Rehabilitation

Patients suffering from chronic diseases tend to be at high-risk for repeat hospital admissions. These hospital stays are usually of high cost, resource-intensive and cause psychological distress for many patients. With the aging population, the number of patients with chronic diseases is increasing and there is an urgent need to expand chronic disease programs, such as the respiratory program, at St. Joseph’s Healthcare Hamilton (SJHH). That being said, physical space is limited and expansion of this space would generate significant additional costs to the organization. By offering a virtual program, SJHH is enabled to reach a greater number of patients compared to traditional on-site rehabilitation methods.

SJHH is seeking a technology solution that can integrate with their Hospital Information System (HIS), Epic, and be used to support a virtual rehabilitation program for Chronic Obstructive Pulmonary Disorder (COPD) patients to help improve patient’s access to care, physical activity and disease self-management, while reducing the risk of hospital readmission and Emergency Department (ED) visits.

Objectives:

1. Expand the capacity and models of care for the SJHH respiratory program by introducing virtual rehabilitation care pathways.
2. Reduce hospital readmissions and emergency department visits for COPD patients by providing access to virtual rehabilitation post exacerbation, which is associated with reducing exacerbations, patient-reported dyspnea, exercise intolerance and rates of hospitalization.

Essential (mandatory) outcomes

The proposed solution must:

Clinical requirements:

1. The proposed solution must have the capacity to support a minimum of 100 patients per month.
2. Reduce patient visits to the emergency department for COPD patients by 50% or more.
3. Reduce patient re-admissions to hospital for COPD patients by 50% or more.
4. Demonstrate high patient satisfaction in the virtual rehabilitation program and technology solution, as measured via a patient satisfaction survey.

Technical requirements:

1. Deliver a virtual care solution that can support a bi-directional integration with the SJHH Epic HIS system, including the transfer of select patient and biometric data, questionnaire responses, notification messages, and tasks from the solution into Epic.
2. Deliver a virtual care solution that has a dedicated tablet (or some other device) and biometric devices for patients to use remotely from home to access the platform.
3. Deliver a solution that enables real-time access to patient data by clinicians.
4. Deliver a virtual care solution that enables scheduled and ad-hoc virtual (video) visits via a tablet (or some other device) to ensure patient accessibility, allowing for the care provider and the patient to meet virtually.
5. Deliver a virtual care solution that offers customized care plans and workflows with the ability to configure and deliver customized alerts, notifications, questionnaires, tasks, and educational materials to the patient and/or clinician based on the care plan assigned (with preference to vendors who offer professional services who can support the development of the customized care plans and workflows).
6. Deliver a virtual care solution that can capture and securely store the patient’s biometric data, including data from an oximeter and blood pressure monitor, saved to the Cloud.
7. Deliver a virtual care solution that has the ability to customize and share educational materials (including text, webpage, PDF, video, and images) with patients based on their care plan.
8. Deliver a virtual care solution that offers the ability for multiple clinical personnel and family members to use the solution to better support and coordinate care.
9. Deliver a virtual care solution that offers customizable and permission-based access for end users.
10. Capable of supporting multiple languages through the patient-facing and provider-facing solution, at minimum English and French, in order to align with our Francophone Ontario Health Team priority population.
11. Implement a solution that is integrated with the Epic Health Information System.

Regulatory requirements:

1. Patient private health information is to be stored solely in Canada.
2. Provide and sign agreements to support privacy, data sharing, and data storage between participating organizations in compliance with legislative requirements.
3. Demonstrate commitment and ability to meet security legislative requirements by providing, updating, and completing a comprehensive software system security review.

Additional outcomes

The solution should demonstrate the capacity to expand functionality in chronic respiratory disease management and Chronic Kidney Disease (CKD) patients. CKD is a priority patient population at SJHH and these patients would receive significant value from a virtual rehabilitation program.

Additionally, the solution must provide technical support during the project and post-implementation and include the development of training materials, workflow diagrams, architectural documentation, and other project-related documents to support the operationalization, evaluation, and potential scaling of the project to other organizations.

The maximum duration for a project resulting from this Challenge is: 6 months

Like many hospitals across Canada, SJHH faces challenges with an episodic care system that tends to be reactive rather than proactive. There are few opportunities for care providers to intervene when a patient’s health deteriorates to prevent high-risk and resource intensive events. Patients with COPD, in particular, require close monitoring and are at high risk for repeat hospital admissions. With an aging population and the high cost of treating chronic diseases, it is important for acute care facilities to explore new, innovative modes of care delivery that leverage technological advancements to provide a high standard of patient care that is efficient, safe, and effective in supporting these patients. It is important for SJHH to explore virtual care pathways for these patients due to the limited physical space available in the hospital. To expand the physical space in the hospital to support expansion of on-site rehabilitation services, it would require substantial capital expenditure and a lengthy timeline to implement. 

Preliminary research indicates that virtual rehabilitation is effective at supporting chronic disease patients. Virtual rehabilitation is expected to reduce depression and anxiety, as well as increase effective disease self-management. Better disease self-management is associated with improved blood pressure control, reduced psychological distress, better diet, and increased physical activity – which are key mediators of hospital re-admission risk in CKD patients (Havas and Bonner, 2018). 

As SJHH continues the important work of piloting new and innovative technology, it is imperative for the organization to also ensure that the patient health information created through these new systems is being seamlessly and efficiently uploaded into the Epic Health Information System. Without this integration, clinicians would be required to log into two separate systems to review patient data, resulting in lost efficiency and duplication of effort to find, track, document, and update information. Furthermore, without an integration, researchers and leaders in the organization would not be able to easily pull and compare the data from Epic for reporting, evaluation, and quality improvement purposes. 

By offering an integrated solution, SJHH will optimize clinician efficiency, improve access to information for patients and providers, as well as maintain the integrity of SJHH’s Epic HIS system.