REACH

Status

Completed
Status date

2014-12-09
Activity Code

8-.007

Objectives

Create a cost effective, commercially viable, satellite based, medical home care solution (including teleconference, remote vital sign monitoring, and satellite telecommunications technologies),
Create a solution that meets the treatment needs of Assertive Community Treatment (ACT) teams and their patients/clients,
Determine whether the solution can substantially reduce the treatment costs of ACT teams by enabling the teams to substitute many "travel visits" for "virtual visits",
Assess the solution by establishing a pilot project that treats 20 patients.

Until relatively recently, most people experiencing severe mental illness were destined to spend much of their lives in residential treatment hospitals. Today, modern pharmaceuticals and ACT teams enable many patients to reside at home, in the community. An ACT staff member must travel to each patient's home to observe the patient taking his or her medication and monitor the patient's response to treatment. Patients/clients who are most in need of ACT homecare services are visited twice daily, everyday for treatment purposes. Extensive travel requirements make the ACT treatment approach expensive, but less expensive and more effective than the alternative of hospitalization. Currently, there are more than 60 Assertive Community Treatment (ACT) teams in the Province of Ontario, funded by the province. The number is growing. Thirty of the teams are treating, on average, 50 patients per team, for a total of 1,500 patients.

The REACH telehealth based home care solution will not replace the conventional travel based home care system that currently works well. It will enhance the quality of care and reduce the cost per patient so the dollars saved can serve more patients. Instead of the team members physically travelling to the home of each patient as many as 14 times per week in serious cases, many of those visits will be made virtual under this pilot proje

Challenges

The key issues to be addressed within the project include:

Installation and operations of interactive satellite systems in homes,
Acceptability of a home care solution by clinicians and severely mentally ill patients living at home,
Integration of a home care solution with a satellite infrastructure and its overall performance,
Available for medical purposes, 24 hours a day, seven days a week,
Designed to meet the ergonomic needs of vulnerable patients.

Benefits

The benefits that would accrue to ACT teams would include the ability to:

Substitute a significant number of travel visits to severely mentally ill patients living at home, for teleconference visits:

Reduced time require for travel,
Reduced cost of travel,
Reduced risk of travelling in inclement weather,
More productive use of available clinicians.

Monitor vital signs at a distance,
Alert clinicians at an earlier stage when patient's mental status and/or vital signs exceed accepted standards,
Deliver health and wellness educational content.

Features

Clinical treatment services:

Clinicians (including, nurses, social workers, occupational therapists, and other professions),
Psychiatrists, family practitioners, and other specialties.

Work stations:

Interactive, audio/visual communication of nurses to patients,
Vital sign monitoring,
Medical records,
Health and wellness educational content.

Connectivity:

Satellite and terrestrial hybrid infrastructure,
Bandwidth on demand.

Remote operational and maintenance:

Reduced downtime,
Proactive monitoring of system performance.

The REACH project will implement a TDM/MF-TDMA STAR network architecture to provide the primary network connectivity for the project. An adjunct terrestrial facility will be implemented to extend the satellite-based traffic from the Calgary HUB to the LHRI and the Nursing Station in Woodstock.

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Plan

Evaluate and select a home care solution suitable for the patients living at home,
Evaluate and select satellite architecture for patients living at home in remote and under serviced areas,
Integrate and optimize the aforementioned technologies,
Define and develop protocols and procedures to conduct virtual visits to augment conventional travel visits,
Run and monitor the system on a pilot basis to: a) refine the system, and b) optimize protocols and procedures,
Evaluate the ability of the system to provide care at a distance that is at least as good as conventional travel visits,
Promote the system as a turn-key solution.

Current status

The Telesat lead consortium of partners designed, developed and implemented a satellite and terrestrial hybrid infrastructure in Southern Ontario, Canada to conduct a homecare trial over a three year period. The trial focused upon severely mentally ill people of both genders permitted by their caregivers to live at home under clinical supervision. Their care givers were a multidisciplinary Assertive Community Treatment (ACT) team of health care professionals including psychiatrists, nurses, social workers, occupational therapists and other health and social workers operating from a centralized hub facility in Woodstock, Ontario, Canada.

The trial allowed Telesat to optimize the hybrid infrastructure to reduce cost and increase the reliability of the infrastructure. The daily interaction between the patients and the professionals identified features and functions missing in the commercial homecare platform provided by project partner VaaSah. The VaaSah platform was further developed to incorporate functionalities found to be needed. Now the feature rich platform is suitable for other clinical practices beyond psychiatry.

The mental patients readily adapted to the homecare platform and the virtual mode of receiving care at a distance. To them, it does not matter how care is provided via terrestrial, satellite or the hybrid of the two.

The professionals increasingly accepted the virtual mode of providing care at a distance. They found that this tool allows them to provide care in time and to many more patients by reducing travel time and by increasing the efficiency of communication with the patients and their peers. To them, satellite provides an extended reach beyond where terrestrial facilities are available.

The REACH project met its objectives fully to optimize the network infrastructure and provide care at a distance. The resulting network costs less than conventional visits and provides reliable and secure care to the patients in time. The project demonstrates that the number of expensive hospital beds needed can be reduced.

The REACH team is now attempting selling this solution to the health system funding agencies. Hospital administrators, local and provincial government health agencies and the federal government are listening. Pharmaceutical and insurance companies continue to show interest. The huge multi-years funding commitment is required from any government agency or a company anywhere in North America; this would be the same in other parts of the world. Where the workers are involved, the fear that the technology will replace them has to be over come; REACH replaces no workers but allows them to perform their responsibilities more efficiently, it enhances the existing human network. The REACH solution cannot be selectively sprinkled across the country, it has to be part of an overall health care system; it makes sense that where terrestrial facilities provide care, these facilities are extended by providing satellite communications to reach patients living in under-served and rural communities.

The REACH team is persevering to market the solution in the belief that positive government decisions will be made in the foreseeable future and the Pharmaceutical and insurance companies will adapt the solution to provide care in time and save costs to the healthcare systems. The Pilot project has allowed to compile the following cost savings by reducing travel time & preventing hospital days.