Tele-Palliation Pilot

Trina Diner, BA(IT), MMSci

Manager: Palliative Care & Telemedicine Services

Thunder Bay Regional Health Sciences Centre

OTN Telemedicine Forum

June 11, 2014

1

“In offering a patient and his family a tiny

roadmap of the last part of their lives

together, and assuring safety along the

way, the health care worker may allow

them a peace and final serenity which has

no price.” (Doyle-Brown, 2000.)

2

Acknowledgements

Robin Cano, RN, Telemedicine Coordinator

Lisa Kirk, RN, Telemedicine Coordinator

Dr. Geoff Davis

Dr. Kevin Miller

JJ Hupka, OTN

Anish Shah, OTN

3

The Idea

The negative consequences of

isolation and fear are added

burdens to clients and families

coping with life-limiting illness in the

home environment.

Planned physician appointments

into the home allows patients and

families to ease fears through video

connection with a health care

professional.

4

Questions

Would patients and providers feel that this

service was of value

Would this service produce system value

Does the type of technology matter

5

Inclusion Criteria Patients identified by Palliative Care

Physician (PCP)

Patients who are terminally ill

Arrangements may be in place for

planned death at home

Patients who require symptom

management in the home at end of life

Community Care Access Centre

(CCAC) Palliative Nurse Practitioner

may be involved in care

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Exclusion Criteria

o Patients who lack support to help

deal with the technology in cases

where the patient is unable to do so

o Patients that do not have wireless

internet in their home

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The Technology

• The PCP has a desktop computer with

webcam and speaker/microphone

• Samsung Galaxy or Ipad Tablet

• Icon leading to a generic email address

• The HPC nurse has a desktop computer

• Software loaded Vidyo Desktop - a

confidential audio/video link to a “virtual

room” (Ontario Telemedicine Network,

2014)

• 4 digit passcode on tablet

8

9

Value - Client Perspective

• Saves energy: at end of life, clients

have little to no energy to get ready,

wait in the waiting room, be

assessed and then go home

• Decreases stress levels of patient

and perceived stress of caregiver

• Client able to use time and energy

for living life

10

Value - PCP Perspective

• Able to see the client at home (time

savings)

• Able to visit the client at their home

more often than they would by

making conventional house calls

• Able to connect with and support

clients at end of life

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System Value

• Increases access to specialized care

• Smooth transitions

• Client’s who choose to remain in the

home for end of life are well supported

• Cost avoidance (ER)

• Time for in person appointments (for

family members)

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Project at 6 months

6 Clients

25 appointments

TRAVEL

12 hrs physician travel saved

3 hrs RN travel spent

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Preliminary Findings…

• 5/6 patients would rather use the tablet

than go in to the physician’s office,

given their condition

• 5/6 patients were woman aged 55-64

who identified that they were not “tech

savvy”

• 4/6 patients had difficult pain and

symptom management issues and

transferred from home to the Hospice

Unit

• The technology works!

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Answers

Do patients/providers feel that this

service was of value - YES

Does this service produce system

value - YES

Does the type of technology matter

– YES

YES YES!! YES!!!!

15

Next Steps

• Engagement

• Propose larger project to include more

providers and partners

– Community tool

– Nurse Practitioners

– Region

• Business case for system performance

16

“I am enjoying being able to see the

doctor this way. My life is better as I

don’t have to wait in the doctor’s

office…”

17

“this technology should be available

to every family”