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Krisan Palmer



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    OS03 - Secured Communication in Circle of Care (ID 4)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Area 2
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      OS03.03 - Digital Health: Evolving and Disrupting the Boundaries of Traditional Healthcare (ID 166)

      Krisan Palmer, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract

      Purpose/Objectives:
      Horizon Health Network is New Brunswick’s (NB) largest Regional Health Authority and is a recognized leader in implementing and sustaining innovative telehealth solutions across all levels of the healthcare system. Horizon’s Stan Cassidy Center for Rehabilitation (SCCR) has recently celebrated 60 years as a North American leader in neurological rehabilitation. SCCR’s newest initiative is another example of empowerment of patients and clinicians to facilitate timely access to scarce clinical resources via telehealth. The purpose for the development of this application was to provide secure capture, delivery and storage of videos taken of those pediatric patients referred to SCCR with significant neurological impairments. These videos obtained by families, as well as established community partners, in various non clinical settings, are critical tools through which rehab professionals at this tertiary center can now provide more timely access, recommendations, treatment and follow-up.


      Methodology/Approach:
      Horizon embraces the philosophy that technology is an enabler. The key to success is to ensure the design and selection of technology to be used is driven by clinical needs. Two clinical needs were identified by SCCR when asked to formally outline the challenges they regularly encounter while providing care to patients throughout rural NB. The first, that situational behavior cannot be appropriately assessed for treatment recommendations unless witnessed by the attending MD or therapist. Secondly, ensuring that assistive/supportive equipment prescribed is safely and correctly applied. Up to this point any attempt to send pictures or videos to the clinicians demonstrating either of these, had been fraught with barriers regarding privacy, security, size and storage. In frustration, many families found their own work around and posted them on u-tube to provide clinicians access. Using Horizon’s established telehealth browser based portal, a mobile app was developed specifically to address SCCR’s need. Patients now use their own devices to download the app from Google Play or Apple store to record and upload videos to their individual patient folder. Clinicians are immediately notified via text and / or email that something new has been added for review and can then communicate their treatment recommendations. Innovative clinical processes and technical architecture are imperative to success in any sustainable telehealth initiative and will be shared specific to this application during the presentation.


      Finding/Results:
      Early intervention by way of increased accessibility permits clinicians to be proactive versus reactive in the detection of safety and treatment requirements for this vulnerable patient population; positively impacting quality of life and overall clinical outcomes.


      Conclusion/Implications/Recommendations:
      Improved access to services that would otherwise not be available in rural or remote communities continues to be seen as the primary contribution of telehealth. However, there is evidence that telehealth can enhance quality of care by better supporting application of best practices, improvement of knowledge and skill development in local care providers, and improvement of care coordination, with decreased costs for payers. Furthermore, telehealth can improve patient/caregiver engagement and enable them to become more active participants in their own care and well-being often from the convenience of their own home, wherever that may be.


      140 Character Summary:
      Provision of a collaborative approach to patient centric rehabilitative care via the use of a Health Authority custom designed mobile app on patients own devices.

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    OS16 - Unleashing Telehealth (ID 26)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Area 4
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      OS16.03 - Telenephrology and the Elimination of Geography for Hemodialysis Patients (ID 532)

      Krisan Palmer, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract

      Purpose/Objectives:
      Telehealth promotes access to those scarce clinical resources most often located in more urban settings to which patients must travel large distances to receive treatment. Prior to the establishment of Horizon Health Network’s first satellite hemodialysis unit, patients requiring this life sustaining care had to do just that three times every week. The goal in establishing satelitte hemodialysis units was to ensure safe, comprehensive and evidence based local care for this vulnerable patient population by eliminating the geography between them and their nephrologist using Telehealth processes and technology.


      Methodology/Approach:
      In order for a satelitte unit to be established, the physical, technical and clinical environment must be replicated to match those of the main Dialysis center. The same clinical standards of care that are adhered to by the Nephrology Program clinicians in the main dialysis unit must be operationalized and maintained in the satelitte unit. This includes the weekly patient rounds conducted by the nephrologist in conjunction with the nurses at the patient’s chair side or treatment station while undergoing dialysis. In order for this to occur at a distance, Telehealth must be employed. The Nephrologist at the main unit connects to the satelitte unit via a real-time interactive audio and video telehealth modality and is able to discuss the patient’s treatment plan with both the patient and the nurse together, just as it would occur if the patient was being treated in the same building as the Nephrologist. This is what has become known as Telenephrology.


      Finding/Results:
      Currently there are four satellite units established and they treat 94 patients per week. Three of them are open six days a week and one operates three days each week. This eliminates 158 round trips per patient each year.


      Conclusion/Implications/Recommendations:
      Teledialysis is a safe and patient centric healthcare delivery mechanism that should be explored by all Regional Health Authorities currently offering Nephrology services.


      140 Character Summary:
      Elimination of geography thrice weekly for Dialysis patients.

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    OS26 - Telehealth in Action (ID 42)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Area 2
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      OS26.02 - A Comprehensive Telestroke Solution for New Brunswick (ID 521)

      Krisan Palmer, Telehealth, Horizon Health Network; Saint John/CA

      • Abstract

      Purpose/Objectives:
      The goal of the provincial Telestroke program is to provide a solution that allows every New Brunswick (NB) citizen experiencing an acute stroke the potential to receive leading edge stroke care for this emergency event as well as thrombolysis therapy; specifically a medication known as TPA. The real issues arise with correctly identifying candidates who would benefit from TPA, as well as having a system that is equipped to respond in the rapid manner required and with the additional opportunity to provide this treatment at remote or rural locations and centers that do not ready access to stroke specialists.


      Methodology/Approach:
      Telestroke NB is built upon NB's existing Telehealth capacities, for which we have been previously recognized as a leader in using innovative technologies to provide high-quality intervention, prevention, follow-up, and educational resources to patients throughout our province. Telestroke NB links every 24 hour emergency room, which has computed tomography (CT) access, in the province to an on-demand stroke specialist in real time, regardless of the location of the patient or specialist. Neurologists connect to the hospital network using a virtual private network (VPN) from their home or office to review the CT image within seconds of the scan being completed. This system also allows them capacity to view older CT scans performed on that patient from additional NB sites. They document the necessary clinical assessment performed while connected in real time via interactive audio and video to the emergency room where the patient has presented. In this manner, benefits and risks are communicated to the patient, family and staff at the referring site who also receive advice and support for thrombolysis decisions.


      Finding/Results:
      Telestroke NB is a system that was developed cooperatively between two provincial health authorities (Horizon and Vitalité), Ambulance NB, and Heart and Stroke Foundation of NB with the support of the government of NB. This sustainable system was built to align within existing programs and all partners worked collaboratively. It is an innovative, province-wide system for delivering evidence-based acute stroke care and thrombolytic therapy. Each health authority supported the development of consistent guidelines and processes to ensure patients receive care in both official languages as mandated in a bilingual province. Emergency room staffs were integral to the program success as they developed ways to support the remote specialist with performing needed clinical assessments and dialogue with patients and their families.


      Conclusion/Implications/Recommendations:
      Telestroke NB is a sustainable program; improving health by increasing access to quality, evidence-based stroke care in the hyperacute setting. This results in better health outcomes by directly reducing disability caused by stroke. It results in cost-savings by reducing the burden of care for patients who might otherwise require longer hospital stays and long-term nursing care. It also reduces unnecessary transfers and demonstrates the power of cross regional program collaboration. Telestroke NB is one step of a truly comprehensive stroke system; moving towards using Telehealth for primary and secondary stroke prevention. It was launched in collaboration with every facet of the New Brunswick health care system.


      140 Character Summary:
      A province wide innovative technological solution to provision of hyperacute healthcare services.