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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?