Citizen and stakeholder perspectives about using remote-monitoring technology for older adults

Citizen and stakeholder perspectives about using remote-monitoring technology for older adults

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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 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 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 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

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