Citizen and stakeholder perspectives about using remote-monitoring technology for older adults
And thank you all for joining us today. For those of you who may not have I've...For those of you who I have may not have had the pleasure of meeting my name is Brenda Vrkljan and I'm the collaborative co-lead of the McMaster Collaborative for Health and Aging alongside my colleague Dr. Rebecca Ganann who is currently on sabbatical. And we call sabbatical a gift in our particular uh profession because it just gives you some time to focus on uh work that you might not have been able to focus on as well as some new opportunities um that are leading edge and and Dr. Ganann certainly is known for her leading edge approaches in all kinds of different ways so what a pleasure I have to co-lead the collaborative with her. So we're very excited to be hosting our first collaborative conversation of this academic year. I usually like to wish people happy new year
uh in our world in September but uh I'd like to welcome all of you including our presenters and they're going to introduce themselves in a few moments but just bear with us here as we open the conversation. Today we are gathering on Zoom and I'd like to begin by acknowledging that the land on which McMaster is built and where I've signed on uh from from my home are the traditional territories of the Mississauga and Haudenosaunee nations and within the lands protected by the Dish with One Spoon Wampum agreement. We acknowledge the importance of the land which we each call home in part to reaffirm our commitment and responsibility to improve relationships between nations and to improve our understanding of local Indigenous peoples and their cultures. And certainly this past weekend was one of reflection and an opportunity to hear and listen to the voices of those with lived experience of Indigenous cultures and others. And certainly listening to those voices so important every day but an opportunity and I thought I turned on the radio, I turned on other media, and I thought the stories that were being told were really important and uh and certainly helped to broaden my perspective as well so we're always learning and growing and that certainly is our approach here at the collaborative. So I take this moment too to invite you to join me to remind ourselves of our commitment to equity and fairness in our work and beyond and improving fairness includes acknowledging and addressing those structural barriers and inequities which continue to exist in part due to the Colonial history of Canada. So before we get started I have just a few housekeeping items the webinar webinar portion of
this event is being recorded and it will be shared with you and posted with other past conversations on our website so please feel free to disable your video if you don't want to be recorded on camera. And we will however stop recording before our Reflecting Together time that begins at 1 pm and I'll talk a little bit more about that reflecting together time in a moment. So questions and conversation are always welcome and encouraged at the end of the formal presentation but please feel free to use the Zoom chat function throughout our conversation. So for those of you who are new
or newer to the collaborative we have one quick slide here to encourage you to follow up and learn more about what we do um and you can connect with us through all kinds of different ways. We are a coalition of researchers, trainees, older adults caregivers, and others working to improve the health and well-being of older Canadians by advancing patient oriented research on aging. And we aim to achieve this by providing research and engagement consultations and support, promoting training mentorship, and facilitating partnerships and knowledge translation for patient-oriented research on aging. And we use the term "patient" here but we know it's about partnership at the end of the day and I think our health system and others are learning a great deal about the words uh and choosing our words carefully. So again, you can connect with us through email, X, which is formally known as Twitter, Youtube, or LinkedIn, and you can find past collaborative conversations on our YouTube channel um and website. So I want to mention uh
just before I turn it over to our speakers um that the Partnership in Research Fellowship is now open to trainees across Ontario...very exciting. PhD students and postdoc fellows who are registered in an Ontario accredited university and engaged in aging-focused research are eligible to apply so tell all your friends. You do not need to have prior experience in patient-oriented research or training and mentorship and isn't that what it's all about is learning and growing. If you are
interested in this opportunity or know someone who might be we ask that you contact the collaborative before you get started on the application and uh our friendly team will uh will certainly be in touch to help any way we can. We've had some fantastic projects...our older adult partners have been amazing, as always, in terms of working as part of the team and uh providing feedback and helping uh in any way we can, of course, to help advance strategic patient-oriented research in Canada. I'm going to come back to our presenters in a moment but I just want to uh just talk about Reflecting Together and that comes at the end of our uh of our hour with our presenters and we hope that you'll be able to stay and continue the conversation and we're really fortunate um that Dr. Michael Wilson and Ron Beleno will uh be sharing their knowledge and experience that are are uh...in terms of their presentation today...but we sometimes like to go a little deeper and we're able to do that in the follow up conversation. So uh thanks to Michael Kirk who uh
is one of our older adult partners who will help uh support that conversation and uh and we'll work through there so hopefully um you can stay on for a little bit longer in that Reflecting Together. I promised I'd come back to the slide. I know for people who are new to the series this is where we bring together researchers and people with lived experiences to share their journeys and lessons learned in patient-oriented research and today our guest will be speaking on the the perspectives of citizens and stakeholders regarding the use of remote monitoring technology for older adults who want to remain in their homes and ultimately maintain their current level of function and care. And I'm so pleased to introduce our guest speakers who elaborate on these introductions as we move through the presentation today so Dr. Michael Wilson is the scientific director of the McMaster Health Forum and associate professor in the Department of Health (Research Methods), Evidence and Impact at McMaster University. Ron Beleno a community partner, caregiver, and board member in
the Ontario strategy in patient-oriented research unit, which we refer to as OSSU uh which leads Ontario's strategy for patient-oriented research and we use the term SPOR. So all kinds of acronyms in this space, right Ron uh and Michael, and and we we're looking forward to hearing more about uh about the work you do uh together in partnership. So I will stop sharing and uh hand it off to our our speakers for today so thanks very much everyone. Great thank you, Brenda, uh I'll be brief I think Brenda shared my roles at McMaster uh what my work really focuses on is on increasingly timely and demand driven evidence support for government decision makers and system organizational and professional leaders as well as citizens. And sometimes that means
doing really quick evidence syntheses within very short periods of time and sometimes it means also pairing that with uh deliberate processes with citizens and with system leaders where we can um have discussions and hear about values and preferences from citizens about how to address challenges and then also from system leaders about what they think can and should be done. So that's where this project comes from uh it was funded but what I'm going to be talking about was funded by AGE-WELL uh through a platform grant uh that I hold from them that's focused broadly on supporting rapid learning health systems and we've tackled a number of topics one of which is remote monitoring technologies and we have another one that's uh in play right now that I'll speak to towards the end of my uh presentation about integrated health innovation systems that kind of pulls together threads of some of the things we found in the deliberative processes about remote monitoring technologies that we did. And with that, I've worked with Ron actually through the AGE-WELL process on a previous project with my colleague Rosalie Wang and now also on a couple of ones from this current fund project and I'm excited that he's able to join us here today. He's always very dynamic and has lots of great perspectives to share so with that I
can hand it over to him to introduce himself. Thanks uh there, Michael, um I think Michael when we connected was probably like the second year AGE-WELL was around so I'm guessing 2016, 2017. This is the first time I'm actually, I think, even in a presentation with you like this is like eight years later so I'm excited to be here with Michael and everyone else. Greetings everyone, I'm Ron Beleno. I was a caregiver to a father that lived with Alzheimer's and Dementia and he since passed in 2018. I'll share some of my slides here in a second uh but I also care for mom
who is about 20, 30 minutes away from me. And I say that 20, 30, 40 minutes depending how fast I drive on the highway. There's a reason I say that because it's technically it's a remote distance but when my dad was around and we were having a let's say an emergency, you're kind of panicking, you're driving, you're not thinking and I could get there probably in 15 minutes if I really broke the rules, which that wasn't the goal, but it is one of those just something to to consider when you are someone who is a caregiver um and you're trying to provide distance care. So I'll share a
little bit about that in a second as well. I'm also part of AGE-WELL with Michael. Michael has said AGE-WELL, which is Canada's technology and aging network and with AGE-WELL I co-chair the older adult and caregiver advisory committee across Canada. I'll share later as well that we do have a conference coming up - so if you are in the Toronto area this is the best time to try and make it to this conference. First time in uh Toronto and uh it is a great event specifically for not just researchers and trainees but also for older adults and caregivers. Like you get to touch
things you get to touch VR you get to touch camera sensors all that stuff so and hopefully Michael will be there as well and I'll be there as well. So you can meet us in person so I will start my presentation here and uh gonna bring in a little technology. That's me and I think I will just be spotlighted for a second here so everyone should be able to see me fully here with my presentation. And uh so this is a citizen and stakeholder perspectives about using remote monitoring uh technology for older adults. For myself I'll share my story a little bit of what I was using, okay during this time. My contact details are there uh if you want to reach me. And uh back in
the day some of my caregiving back in the day uh when my dad was diagnosed from 2007 to 2018 okay. He passed away at home uh he aged in place as best as we could uh that was quite a challenge um being an only child uh also being the parent favourite, you know out of all the kids um uh that was one of the challenges that I had to go through there. So let's see here...got that going...oh sorry, I actually uh started from the very end. I'm gonna rewind this because it was at the, there we go... Okay so being a caregiver I'm just want so this is more of a story that I'm going to tell you here and then we can discuss later for those that can stay after one uh um more of this in detail. I was a caregiver okay we have different names we have carers, care partner, uh some will just say sister, brother, son, child, whatever that is okay. So there's different words -today I'm going to use the word caregiver okay just like patient partner, citizen, uh it really depends. Words do matter to some people and uh for me it is a caregiver. And
apologize if you hear some drilling - that is the condominium above me right now doing this okay. A little background - mom and dad - oh before I forget this presentation I'm going to squeeze this in about 10 minutes which is usually a 30 minute presentation so I will go fast, I will skip some slides, but you'll get the point of some of my uh messaging here. Mom and dad being Filipino they like to combine their names when they have a kid my mom's name is Ronses, dad's name is Raynaldo. They got the Ron on the Aldo I'm Ronaldo - that's my name. Good thing my dad didn't go first - if he did they would have got the Ray and the cess I would have been called racist okay, so I'm glad I'm not called racist. I'm glad my mom went first okay. There's a cat on the care
team - that's Lucky okay. Lucky was part of our care team. Lucky will be seeing in a video in a few minutes during some remote caregiving okay. A little bit of the challenges we are dealing with okay...so to understand remote care, you also kind of need to know what are you solving for? Why are we going to bring remote care in our lives? Is it of value? Is setting up a camera system okay so that I could see my dad uh, you know, a great return but the expense or the risk could be is that some privacy will be lost okay my dad and my mom will have someone watching them so we have to do all those calculations when it comes to caring for someone uh so remote care this was some of the challenges we were dealing with okay you could see Dad with dementia of course there's memory loss okay uh we're dealing with Falls so Mobility challenges okay so that's some of the stuff my dad uh was known as a Wanderer someone who would leave the house and go missing that was a big safety concern that we had okay that was the first time I brought in some remote caregiving tools okay without realizing I was remotely carry in okay so those are a few just to share and this was the te that we had for one person with dementia here in Scarboro where I live um I live by the Toronto Zoo if anyone knows that uh know where the Toronto Zoo is I don't live in it but I live right by it and my parents again are 20 minutes away those were some of the people that we needed to care for my dad okay during his uh nine ten years of diagnosis or 10 plus years sorry of his diagnosis okay so this you don't need to understand fully but this is kind of related to me as a caregiver okay a slide I've been using from the very beginning back eight years ago always have worked on this here where as a caregiver these are some of the reasons why we are solving uh or creating Solutions whether it is high-tech low te uh the community helping out he this is what I've been solving for for my work which was I'm dealing with emotions okay so fear of my dad going missing okay uh the stress okay that my mom has that she can't go to sleep because he might secretly walk out of the house uh in the middle of the night in the winter okay known as a silent accent okay those are some of the emotions uh creating the confidence okay it's also building up confidence in caregivers okay uh we're dealing with variables such as finances the time okay uh energy how much sleep do I get how much time am I traveling just to see my dad for let's say 15 minutes and I have to drive back home again okay so those are a few um of the things I want you guys to kind of understand as to why we bring remote care uh and other care tools and strategies into the mix uh very quickly something I like to talk about is the calculating character I'm always looking at ways to bring in confidence to improve uh the chances of success for care these are my slides again I'm not an academic I'm not a researcher by those means and it's one where I say what are the returns okay for bringing in some solutions is that really loud can you guys hear that Michael not you can't hear that drill I can't hear the drill at all runs so I think you're good so you you probably have to deal with it but the rest of us are good oh good okay so I will just work on that there like this okay so return on investment okay if I buy a technology such as as a sensor okay this is one of the sensors that agw well supports okay uh from uh sorry who is this game um caire 2 altim view right okay this is a sensor that converts you into a stick figure okay deals with privacy okay something like that okay how much does this $200 camera cost well we had cameras back in the day for 50 to100 $50 to $100 that I still use 10 years later now with my mom okay which she's fine with that was a high return okay on that so I could check in on them caring from a distance caring while not being there okay so that is I call it the return on the numbers okay there's all numbers here and it just so happens return on numbers by accident spelled out the Rons okay I did plan that but if you ever try and figure that out I'm always calculating as to what is the benefits and the disadvantages let's see okay technology as a tool okay I'd like people to think that specifically specifically those that um say Ron I've done talks and right away they say I don't like technology I don't want technology don't push technology on me and I remind people I'm not here to push technology I say if you don't want it don't use it it's your choice okay but I said if you've gone to the bathroom this morning if you've turned on the tap if you've uh used the dishwasher you've used technology okay to support your life in some way okay I always remind people Plumbing is an old form of Technology okay that still today we haven't succeeded in okay there's many places that don't have Plumbing okay here in Canada as well but if you can get technology you get these Solutions okay you get uh you can clean you know in the house you could keep the community safe with a fire hydrant or a sprinkler system okay you could grow food in places you can't grow so it adds to the quality of life for many of us by using the plumbing system consider the internet okay to support remote care and here are some examples and I know Michael will have a great slide that shows these examples as well he talks about that the internet so these are just some examples of a camera okay to be able to monitor someone from a distance okay uh computer we've used it already we're doing it right now to get information be educated okay to learn more to get that one idea that can help when it comes to aging when it helps to caregiving let's say uh we have a the smart devices which I'll show in a second here like a Google home or Google or an Amazon device okay I remotely play music uh for my dad back in the day before those devices came in when he was a little stressed or when I knew that he needed a little more energy I could control that from my house or anywhere around the world right so those are examples where technology can support some of these challenges that I'm working on or that we are all working on okay um and that is uh just a few that you can see right there let's keep going on um and I said technolog is simply a tool okay to connect us okay and if my dad at point B is 20 minutes away and I'm at Point a can I find a way to care for him remotely from a distance can I have let's say my aunt in California caregiving for Dad from a distance okay so that's what we were doing uh back in the day pre- pandemic um and that was just something I uh appreciated um uh that I had at this time of where we're at in life of having tools and Technology okay and as I'll finish off here just some of uh Ron's remote care back in the day okay uh I will show one video here uh and let's see see if you guys give me a few seconds here share screen um share sound okay so this is a video again back around I don't know I think it was 201 oh it's 2014 here when this thing called Skype was still in okay so Skype uh with that's used for a business tool back then to do a video chat I was using it for caregiving actually um and you will see me you know with permission from my mom with my dad who knew we had cameras back then uh that's another conversation the ethical conversation around privacy uh the risk of having remote tools of monitoring someone but this is one where my mom could go and do some activities while I would be right here uh at home monitoring him caring for him okay especially when he was at the risk of going out missing when he shouldn't be walking out of the house okay so we were having that period where we were challenged with that so uh here's the screen here and um you guys should see that and you'll see him about to leave I was able to care for him I'm only going to play maybe two minutes here to relax him and you'll even see lucky the cat hi Dad how are you I'm over here come here you just relax okay okay you stay home okay okay but you have to stay there okay Dad okay okay you just relax okay how's lucky how's lucky lucky yeah where's lucky you lucky yeah [Music] luy okay who's that right there on the floor that's lucky oh it's the brother of Lucky okay so I will stop that there and I'll come back to zoom here and think I've lost you all on Zoom where did you guys go hang on Zoom I am lost on Zoom here if I can get assistance to exit Zoom oh here it is sorry am I yeah I am okay so anyways that is just an example of uh uh how I was using remote care back then some tools right now that people might want to know about is I showed the camera there okay you know this sensor this one that actually converts someone into a stick figure so you don't see my dad like that um these devices these alexas Google home High return in my opinion for 40 50 bucks depending uh Amazon's have having prime day soon as well in a few days so those are the times I tell caregivers you know save 50% okay I could remotely play music for my dad from a distance okay or my mom currently right now okay I could have family photos that I can control from a distance so those are the things uh that I just wanted you guys to see um I will be AG well I'm working with a team called uh we TR and um silver and we're going to be creating a tracking insoles that go into shoes okay that can waigh yourself things like that from a distance so those are some of the things that you could be doing okay just I'm dumping everything to you guys here okay we have all these uh tracking devices that you can have but there are reasons why you don't go this route as well okay there's pros and cons but it depends on who you are and that's kind of the work we did uh with Michael um the rech the great research he's done so um anyways that's uh what I'd like to share for now and I will pass it over to Michael to discuss the work that was done around all of this thank you Ron that was great gave such a great perspective on some specific uh Technologies and how they're used and some stories so I really appreciate you doing that um I'm going to pull up my slides if I can find them give me one moment sorry okay so hopefully everyone can see my slides so I'm going to starting at the end for some reason okay here we are um so I'm going to give kind of an additional perspective to remote monitoring technology so Ron and gave lots of great examples and how you can use it role of caregivers in a way our project o overall and for this specific one is really trying to think through some system level policy challenges and and ways to think about integrating things like like remote monitoring Technologies at a system level so that's the perspective we came out with this um so I'm going to give you just a bit of a sense of our timeline and where it intersects with some other work that we've done um along with a very quick snapshot of our process and inputs with more focus on our key findings from the citizen panels and the dialogue that we ran and I'm going to end with kind of where we are now with our last phase of our age well project around uh this effort or thinking around an Integrated Health Innovation system in which many ways this remote monitoring project led us towards um so in terms of our timeline this started back in May October 2022 May from May to October uh 2022 engag in our planning process with our steering committee we can in addition to that a separate process that we worked with the BC government on we convened a series of four what we called Horizon scanning panels to identify and refine uh and prioritize Innovations in health system governance financial and delivery Arrangements that could be considered for piloting and scaling up uh in provincial and territorial health systems for the remote monitoring piece in November we convene four virtual citizen panels with 35 citizens with one of those being in French That Was Then followed by a national virtual stakeholder dialogue with 19 system leaders in April of this year we wrapped up our last Horizon scanning panel which led us to this bigger picture thinking about Integrated Health Innovation systems um and then from that project we're now planning in February our last series of four citizen panels about Innovation systems which is going to be followed by a national dialogue in March so that's our overall project trajectory um if you're interested in this project about remote monitoring Technologies our products are always available Open Access online on the nickmas health forms website so the link is here I can put it into uh the chat when I'm done as well so you have it handy um and just because I'm going to cover kind of the the highlights of this and there's much more really detailed information in the documents that we have available that if you're interested you could have a read um so I thought Ron's overview of Technologies was fantastic I just have a few figures from the brief that we wrote to inform our deliberative processes around remote monitoring Technologies so thinking about who are the potential users could be healthy older adults to maintain their active life lifestyle older adults with one or more chronic conditions where the technology could help monitor uh specific indicators that could be helpful for example to a primary care provider a caregiver and whoever for older adults where there's much more complex information that might need to be tracked and um ident ified and help people stay as independent as possible uh Ron talked a lot about older adults with dementia and then also the caregivers in their role in this they can be used to monitor things like Health and Wellness in one's home environment which means that they can stay in that home environment for longer periods of time could be more non-invasive and patient and engage patients in it or could be non-invasive and very much automated which requires little um little effort from the from the patient or their caring give her um I won't go through the examples of remote monitoring I think that Ron covered all these anything from sensors to blood pressure monitors online portals and they could be used across all sectors in our health systems so we usually think of our sectors as Home and Community Care Primary Care Hospital hospitals and Specialist Care Rehab long-term care and public health and ideally they could be integrated across all those to help coordinate uh care and help people stay at home as long as possible um they could they could monitor many different types of things like heart rate or breathing body temperature oxygen saturation or blood pressure blood glucose to name a few and they can also monitor parts of someone's home so there's many examples here whether it's detecting abnormal behaviors toensure safety speech patterns to identify any emerging health issues that could be happening wandering behaviors which uh Ron pointed to in his really in his video um among many others so that's kind of what we're thinking for remote monitoring Technologies to ground you in what we mean by that so when we thought of this in terms of what are the system level challenges that we have to face around using remote monitoring Technologies effectively and to help people stay at their homes and live independently we identified a number of things through our interviews with key informant and then as we looked at the data and the evidence one is to it's hard to identify those who could benefit from different types of remote monitoring Technologies so there are so many Technologies out there sometimes people have S have given us the sense that it's very hard to figure out whether and how they should be using and what they should be using there's also a lot of varies of uncertainty regarding remote monitoring Technologies so and it's hard to reconcile some of the uncertainty with what again what should be used um are there limits for what should be remotely monitored the privacy concerns that Ron also pointed to um and then combine that with a number of different challenges at the system level where existing programs for remote monitoring Technologies or just in general the use of remote monitoring Technologies don't necessarily uh leverage our existing governance financial and delivery arrangements so we don't have an overarching regulatory framework for remote monitoring Technologies it's not a core part of the health system yet um there's challenges in scaling and spreading the use of Technologies when there's so many and primary care physicians offices aren't necessarily set up to routinely use them and it's hard for them to take on yet another role in the types of things that they do which then speaks to also in a siloed budgeting and and challenges and how people are paid not to mention the interoperability of where the data goes who tracks it and where does it go into your health records um and then a lot of the what we heard also is that programs aren't currently complemented with behavioral implementation strategies to help ensure the Technologies get to the people who need them so more of an implementation consideration um and so here's some things that we also heard from citizens once we put this in front of them and I say 10 challenges here but I actually combined a few this morning and I forgot to change the number in the header so it should say eight challenges my apologies for that and one of it was lack of public awareness about remote monitoring Technologies but also I think people told us during the panels that we convene that you know they know these things are out there but they're not really sure about how they can help uh support them as the agent place or help their parents or loved ones or others um so there's a kind of a disjointed sense between what's out there and how it can actually be used in their life um the also the idea of remotely monitoring people could raise concerns and fears some noted you know this notion of being under surveillance and privacy concerns and protection and ownership of data more generally either not small concerns and there are things that we continue to Grapple with with things like electronic health records um and access to them there's also there was also some talk around the costs associated with remote monitoring and Associated Technologies and that it could reinforce this notion of a two-tiered system of care that people who have an ability to pay are going to get access to newer and better forms of care and that's going to reinforce a two-tiered system so how do we help Advance this in a way that adheres to sense of universality within the health system and address those Equity concerns um and whether there's a threshold for where remote monitoring Technologies are no longer cost effective when does it become a huge burden on a healthc care provider that means that can't also be doing other things um so there I think we have to find the right balance um which ones are publicly funded and when and for whom was another concern um some concern that Technologies could replace human contexts a lot of emphasis on using them strategically alongside human context to more generally optimize care and also to ensure the validity and reliability of the Technologies being used and that those attitudinal barriers can make it harder to innovate so this will unwillingness generally in our health system sometimes to step outside of the box and do something new um so in addition to the challenges we put in front of both citizens and our system leaders um three elements of approach uh to that could be used to address some of these challenges to inform those deliberations the first was around supporting people in their caregivers and families to use and adopt remote monitoring technology so in other words how can we help people identify what they could benefit from and to use them in meaningful ways so ways working with primary care or other parts of the sector to proactively identify people who could benefit from it how can we financially support people to use and ensure the maintenance of the Technologies and to sometimes just you know people already have these Technologies on a phone or something else in their house how do we then just hook them up and to be able to do that sometimes it's not the technology itself it's actually getting things hooked up and us and usable for their specific context in life and needs and that's part of that implementation strategy piece at the bottom as well the second one is around enabling organizations and providers to use and adopt remote monitoring Associated technology so it's not just on the uh patient client caregivers side but also helping providers do this and a lot of this was fr the need to do this with trained around co-designing programs and services together to make sure those Technologies are usable from both sides um and adopting more organizational targeted implementation strategies and provider targeted strategies the last piece was around adopting a rapid Learning System to support the development implementation and evaluation of these Technologies and by that I mean this ongoing cycle of identifying where challenges are how technology how remote monitoring Technologies or others could help um address those challenges build the business case around it design The Innovation implement the plan evaluate and then continue to adjust and disseminate results so instead of thinking oh we have a solution and it's going we're and we're going to put it in then just assume it's going to work instead this is you know we've got something that sounds really promising and we're going to give it a try but we know we're not going to get it right the first time and just be very clear about that commitment that you know nothing's going to be perfect when we first started but we're going to adjust as we go and trying to do this the best we can and that's going to put us ahead of the curve in terms of our thinking and ability to integrate Innovations in our system so when we put this in front of citizens what we heard was that the sequ they thought the sequencing of those elements should actually be revised so they thought grounded in a rapid learning model to address those system level challenges make sure that users are guiding the development evaluation implementation support the imple implementation of robust pilot projects across many different groups of people with an emphasis on Rural and remote and vulnerable communities and in real world context there were many people who pointed the fact that you know it's great some of these Technologies work well in a lab or an academic setting but we need to know if they work in the real world and to build evidence from that so that we can build a business case for their system wide scale and spread um and then also this this notion of network of regional hugs that could support collaboration um on the organizational side they were very supportive of this co-design idea some concern about it potentially slowing down Innovation processes I think there's ways to work through that um and then supporting people really many people emphasize the need to access remote monitoring Technologies based on needs and not the ability to pay that came out very strongly across all the panels um and also having people be proactively engaged in care planning conversations to be able to match that technology to the needs and context of their unique situation as well as need for that onboarding and additional training and taking an empowerment empowerment approach about how this can help them and really engage them in their own care uh when we talk to system leaders about this we also put the findings from the panels in front of them and their brief so they heard what the citizen panel said and they throughout the deliberations point to the need to address using this to address long-standing challenges facing Health Systems and as a way to modernize our Circle of Care um and speaking about um this one participant said older older adults often cover up that they're suffering and providers are often making decisions about without reliable information and this technology can be really a GameChanger for that um the key priorities that they underscored here were using it to be considered as a core Health System function F thinking about it differently and reframing to get clients and families excited about using it using conducting person centered empowerment based assessments and you're really framing it as a fun and engaging lifestyle technology perspective and also using it to proactively drive those modernized approaches of of care and teams and Pathways um and really F they were also keen on the rapid learning and Improvement Cycles uh some additional priorities from system leader is kind of speaking to the specific AG well link here really TW to examine how the mission and priorities of age well linked up with some of the things that we're talking about and that's what we're linking up with with our final phase of the project trying to create some space to engage stakeholders to work towards a unified agenda which is what I'm really hoping comes out of this Innovation System work um using things like technology accelerators and incubators to kind of pair that supply side with the demand of what's needed in systems and empowering the public and providers to drive this narrative and continually and update uh that evidence base all alongside using Ane Equity lens uh in this process some few additional key insights and I'll turn to some questions uh for us uh four factors that we found that were related to um influencing remote monitoring success were one the intervention design so co-designing with the target population making it easy and simple using accurate measurements some customizability and focusing on self-management also having it be interpersonal identification of patients with high risk of admission motivation to use it and routine data entry and frequent follow-ups also interpersonal so two-way communication self-management support using data to personalize care and then collaboration across teams and then the organizational level important to have Central monitoring unit or a dedicated Personnel or somehow integrated into existing workflows and incentives so these are kind of big system level things that need to be in place for to be successful we also saw from some the literature we looked at that three levers uh as being influential for scaling and support and um adoption and scaling of remote monitoring so the need for contextual research to understand the catchment area and the infrastructure is needed targeting a combination of local diseases to increase reach and access accessibility and then adopting that user and patient center design uh and then I think I have yeah so I have two more slides and then I will wrap up so for some key informant feedback when we did these Horizon scanning panels I found it really informative to talk to a number of people really engaged in this work and they said that you know the uptake has been great for some conditions like cop and chronic Health heart failure but slower and more challenging and almost everywhere else there's a lot of scalability challenges in primary care where monic care is typically managed as it's not set up for Primary Care clinicians to do this monitoring is this not part of their core function and their job and in alongside that there's this challenging with procurement of Technologies at a system level who pays for this and how should primary care physicians be paid differently and the lack of availability of interoperable electronic health record backbone for the all of these to hook into and coordinate with um it also needs to be we heard that it needs to be paired with personalized M Ms that identify the role that an rmt can play in achieving goals determining the right technologies that are compatible with the systems that are available and providing that support for the hookup so this is not just an individual but allowing this to operate at a system level and this is our preliminary thinking about this Innovation System so I I won't go through this in detail but just give you a sense that in thinking about Innovation and how do we support scale and spread of um these types of Innovations we've heard very strongly that there's this on the demand side what we need is for policy makers and decision makers to identify the purpose for the Innovation whether is it to lessen the capital intensity of healthcare build a business case about it but also provide this Innovation backbone to let suppliers on the bottom part of this figure to plug into the system and start testing and so the need to be able to test identify what's working what's not adjust and then the system uh leaders need to be able to figure out which are we going to scale um at a system level uh and whether it's system being a region or a province or whatever it may be so this is just some preliminary thinking and I can come back to this if you want but I will end there because I feel like I've probably talked for a while and it's be good to hear some questions so thanks everyone so I can stop sharing but I can come back to it if it's needed thanks Michael Ron for handling this technology so well uh in terms of our Zoom technology but uh yeah and thanks for that that overview and it was it was really great Ron to have you contextualize with your experiences I I I I will speak for myself in terms of I really appreciate you sharing your personal uh footage with us um I know that must be difficult given uh that your your Dad's passing uh however it does help us understand uh some of the complexities that Michael then dove into on the other side right with um with what we really need to be thinking about and I think Liz one of the participants asking uh you know some questions in the chat about how do we uh yeah how do we Implement how do we pay for some of these Technologies right and and Ron using you using Skype way back when right uh for that so all of that to say I mean so many important points uh raised today in terms of the conversation and I'd like to open it up uh for questions we will again break for the reflecting together at at one o'clock but uh we have some time and thanks Mike for giving us some time and Ron as well um so I'll try to hold the awkward pause here no well well while some people are gonna put something in the chat which we're hoping for um I will address lizz's comment in a little more detail uh because Liz was asking about funding right and again Michael talked about it I call it my rois you know um so uh my goal okay that I keep pushing that I would like to see is that how could we have let say the Healthcare Community prescrib Technology okay so there's prescribing pharmacological Solutions right we got the farm industry there there's a part of me that says well why can't my dad's doctor if I say hey my dad is at risk of going missing instead of giving him a pharmacological solution to knock him out and not you know not my biggest My First Choice said we want him out there we'll prescribe a GPS technology one company I mentioned them earlier we Track full disclosure I do advise with them you track based out of Pickering I challenged them and they actually got their their technology of tracking solution as a class two or class one medical device okay so that is technology that a doctor can say we're going to prescribe you this okay technology your insurance recovery are we there yet no but this is why the work that Michael has done is quite important to show um and this is last comment of that here's an example in the west coast you probably some people would have heard uh that there was social prescribing so doctors prescribing park passes to someone okay here's your park pass it doesn't have to be all pharmacological okay but however they got that program going that's what I'd love to see for technology so Liz great question we just need to come up with more Creative Solutions and move the work forward yeah as Michael well know sometimes the system has to play catchup uh right but it helps to know what they should be catching up on in terms of priorities and and so the citizen engagement part Michael uh so critical right and showcased here today with you and Ron of course Rebecca has raised her Zoom hand doesn't she have great Zoom etiquette uh yeah so Rebecca kindly unmute yourself which she just has done and go for it thanks so much um thank you both for a really excellent presentation and uh and Ron you've heard me say before because I for those of you that don't know I've had the pleasure of partnering with Ron in a number of initi shs but whenever we meet patient Partners in a in another conversation we're always learning new things or different aspects of their experience so thank you for sharing your experience with all of us in this conversation and I learned some more things today so that was a pleasure for me um one of the things that I wonder about and I and I appreciate your comments that you just made Ron about you know where do we go from here and thinking about these nonpharmacological approaches and thinking about and and so it sort of ties with what I was going to ask maybe the two of you um uh and so maybe I'll direct it to Mike but maybe Ron you're I'm happy to hear from you as well but I'm wondering from the panels and the deliberations um like because there these are these big system issues so I wonder if there were any quick wins like where do we start how do we start moving forward on some of these agenda items so I'll just leave it broadly and happy to hear your thoughts yeah I mean that's the question of the day right um so when it's a good one and a hard one uh to answer definitively so when we did these Horizon scanning panels for example we had we had a number of you know provincial decision makers in that panel and we were trying to identify things that they could try now and you know they were really hoping for we could give them here's three things that are ready to go it was not that easy um to do unfortunately and so we remote monitoring was one of them and there were some core examples um in there I have to go back to some of the specifics but they I think they were they were excited about um the potential of testing out remote monitoring along with what Len in the chat pointed to about using AI to integrate some of the integrate and analyze some of the data so things like early warning systems that can help use the remote monitoring data and to provide an alert or something to a caregiver or a care provider to be able to say something isn't quite right here we need to now pay attention like you know alert to someone needing an intervention or support and so I think there's some opportunity to start trying out things like that especially as AI becomes more refined and accurate in his ability to do this but for me what it comes back to is that last figure I had which was kind of pointing to the decision makers really having to point to clearly what is the system challenge or challenges that they want to address and then building the business case and then it's the suppliers that come in and are able to say look we can we have stuff that is almost ready to go for this and we can adapt and then we can try and evaluate if you give us a chance to actually roll this out in a meaningful pilot so I think that's for me where the disjuncture happens is that there isn't enough opportunity for helping some of the innovators and businesses to then Connect into the system in a meaningful way so that one we can strengthen the system but then two can also strengthen our Innovation System which many have pointed to as kind of being small and could be uh really improved if given this type of opportunity so it's a bit of a non-answer but uh also I think some bigger system implications there Rebecca Michael you actually uh it's it's a great answer that's actually what I was goingon to say it's coming from The Innovation side sometimes we always wait from the policy the healthcare for me the caregiver the families we don't have time to wait for that right if we're in the fire right now I will go to best bu I will look at Home Depot what are the things I could grab right now and figure out but that was back then now we have all the innovators spe across Canada especially coming up with all their Solutions but they can't get in okay for some reason they're not getting enough pilot test coming in aell is helping with that research is allowing to to have that but working with some of these organizations okay so I'm going to pick again the examples I gave with dementia Alzheimer societies okay so the Alzheimer's say hey get a pilot project get the research person together we have three Innovations ready to go okay get that to your community home care providers okay Home Care Services the Aging place so it is that who gets to the table is the quick wins for me but the innovators are there waiting okay um and some of them as Michael said they're coming up with these Solutions developing them but some of them are ready ready okay that have been already ready they just can't uh get into this community because no one's getting getting them to the table and they have to spend the money on marketing getting it to Best by whatever so um Michael that was kind of my answer as well is that Innovation side they're ready um yeah yeah thanks Ron and uh I think we have a you know everybody's can take a look at the chat uh and Vanessa has made a comment I think Ron um some of the yeah some of the uh coordination you demonstrated right and listed and I can like it's one thing to list it linear uh I can only imagine what's happening behind the scenes right in terms of that coordination so I don't know if you want to comment so so Michael used a word which I don't know how many people know this word interrup ability okay so that is a big long word I don't even know how many syllables maybe 10 okay but interop ability to me that maybe doesn't know that word of saying oh I have to bring something to the doctor okay it's on this device it's on this uh it's on as well this and I got some paper notes okay so all that coordinating gets messy okay I'm pretty good at putting it together at the end of the day here doc here is a one-page print out of this update okay can we do that better can we do that faster do I need to spend five minutes with my dad's doctor at the appointment showing him all the data that we have versus remotely now the two what's happening it's shifting where Primary Care can get some of that data possibly ahead of time so it's uh I don't even have to go to the appointment it's going to FL and your dad doesn't have to come we saw his weight we saw this these Health details details um so as we were saying this is not directly the caregiver and my dad this could be my dad directly with his health care Primary Care team let's say so um when you're talking about coordinating care between all these providers yes it's messy Vanessa it's going to be messy for a while I'm gonna let you know it's not going to go away anytime soon uh but we can get better okay caregivers on our side we could make it easier you know we can make our coordination easier with all these tools as well so um won't tell you how to do that yet too long for that but that's where technology comes in yeah and and yeah not surprisingly you know we have suggestions in the chat as well from Len right trying to think about different ways that we can uh yeah those opportunities for Innovation and uh I know it's a it's as as Ron said it's hard to get in there um I think in terms of the way our system is set up go ahead Brenda but I I got to mention like I'm I'm respecting what Len's doing here like to find a len to find a Ron there's not that many as well right like how many Len Callins lend your names out here so I have to call you out there okay yeah we'll know this information okay that also has to be moved up as well as Michael's saying you know we have to find ways so that people can get educated cricker can like again I used a plumbing example all of you can promote a dishwasher a washing machine a sprinkler system by now right you understand how it works we need to get the the general population comfortable to have these conversations um that it's not new but it'll still take some time but yeah we need more lens in the world say and and Liz uh Michael has you know noted I know the health Forum works with many countries and globally as well and she's just made a comment about what you know what are other countries doing um uh Canada is quite unique in terms of how large it is right when we look at some of our Scandinavian uh Scandinavian counterparts uh yeah the size of Canada is a bit a bit more of a challenge but I don't know if you have any comments about this the approaches used by other countries I'd be curious from Michael's side as that academic who gets us go up to all this conferences uh yeah I don't go to all that many conferences but yeah um in terms of other countries um I'll come back to the Horizon scanning panel because one of the things we did was try and do a big scan of kind of new and different innovations that were coming up that were kind of being tried in uh small numbers of other countries or essentially that we weren't doing here so Innovative Tas not always necessarily Innovative to others um and so that was kind of the initial thinking behind some of those uh panels I'm putting the link to that Horizon scanning piece in there and that led us to things like um I'm just refreshing my memory of these kinds of things like the types of remote monitoring um programs that are used in other countries but are enabled by and I'll come back to that word interoperability so you have the Kaiser perentes of the world you know in the US who essentially have an interoperable system with you know health records connected across an entire system for a large population we do not have that here so the challenge for us is that we need to play so much catchup on the system side to even get to to the point of being able to use some of those Innovations so part of the reason why we see some remote monitoring companies going to the US after they started in Canada is because they have a population base that they can then scale up and spread and use because of the system backbone that's in place that lets them test rapidly but then also adjust and scale up and we just don't have that level of interoperability here and it's challenging for making that work so there are some examples in that Horizon scanning piece I I'd actually have to go and refresh myself for some of the very specific examples for you but we do you know this type of work and others routinely do things like jurisdictional scanning to find out not only what the evidence is saying but what also some experiences are with some of the uh jurisdictions thank you Michael and with that I want to thank both you and Ron for sharing your expertise with our with our group um and I think as these conversations go we sometimes they just feel like we're just getting started but luckily we have the reflecting Together part which get you know can extend our conversation and provide a bit more depth and so I will hand the proverbial mic over to our older adult partner uh
2023-10-10 11:19
