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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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      OS26.01 - Digital Health Enhances the Continuum of care for Oncology Patients (ID 539)

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

      • Abstract

      Purpose/Objectives:
      The overall driving factor for provision of Teleoncology in New Brunswick is the concentration of clinical oncology specialists in the southeastern and southwestern regions of the province. Patients not in these locales, with their families or caregivers, must travel in order to interact with their clinicians. The goal of Teleoncology is to provide safe, evidence based practice in the nearest community to where the patient resides.Thus eliminating exhaustive travel for those patients already in a weakened physical and emotinal state.


      Methodology/Approach:
      Oncology referral patterns were analysed and in conjunction with the established satelitte chemotherapy clinic locations, Oncologists were approached to explore the potential use of Telehealth for patient follow-up appointments. Inclusion and exclusion criteria were established based on the clinical presentation of patients. The was determined during this exercise that Teleoncology provides the ability to deploy a wide range of services including clinical consultation, diagnostic services, knowledge exchange in the form of clinician and patient education, peer support and professional development. Exploration of access to required information electronically, such as electronic health records,was also explored to ensure that all of the required information was available, irrespective of geography. Technology plays a supportive role in that clinical needs are what drive the selection. Innovative clinical processes are the key to success in any sustainable Telehealth initiative and will be outlined specific to this application during the presentation. For example, the engagement of primary care physicians in performing the physical assessment for the specialist prior to each visit has definitely been a positive force in enhancing the patient care continuum, and physician knowledge transfer.


      Finding/Results:
      Teleoncology has facilitated the national clinical standard of patients being seen by an oncologist or a general practitioner in oncology (GPO) prior to each cycle of chemotherapy. This method of care delivery has greatly diminished the need for oncologists to visit outlying areas on a rotating basis, giving oncologists the opportunity to follow up on their own patients. As well, it now provides the opportunity for many patients to become engaged in clinical trials whereas prior to Telehealth, distance and access eliminated them as recruitment candidates. One very real challenge for the remote hospital sites is that of nursing resources. This is net new activity and must be taken into consideration. Other care delivery impacts, challenges and lessons learned will also be discussed.


      Conclusion/Implications/Recommendations:
      Teleoncology offers the potential for improved access to a wide variety of cancer support services, leading to benefits for patients and their families closer to home. It can provide wider scale access to cancer related educational programs. The provision of opportunities for patients to receive clinical and support services much closer to their home community will reduce the cost to them and their families in terms of time and finances, as well as reduce the costs to our provincial healthcare system. Currently one group of Oncologists within one urban center in New Brunswick visit over 30 sites virtually on a regular basis to facilitate their patient care delivery.


      140 Character Summary:
      Engagement of primary care physicians in teleoncology delivery.