Health Priorities Before the Pandemic

The COVID-19 pandemic is clearly a health crisis, but before it struck, most hospitals and health providers were ill equipped for a global crisis, let alone a local one. That was certainly the case at the Toronto East Health Network. Mark Fam , the Vice President of Clinical Programs, says that they are a partnership of “21 diverse communities,” encompassing different “cultures, racial and socio-economic backgrounds.” Within the 21 communities are five of the poorest neighborhoods and some of the richest in Toronto. Overall, the network supports “300,000 residents, and about 100,000 more that come into the community.”

For years, the diversity of the residents and communities within the partnership produced a lot of data, though for a long time it was not used to its fullest extent. Nonetheless, it has always been a “real tapestry that shapes a lot of how we think about data quality, and how we work with our community.” Though the network operates independently, it is obviously part of the city of Toronto and part of the province of Ontario. Thus the health teams within Ontario decided to look at all the data that was being collected “to understand where our patients were coming from.” Each part of the province created a series of profiles, and the avatar used within eastern Toronto is called ‘Rahul’. He is “not a real person but is representative of many of our patients.”

Rahul is a “67 year old widower who lives alone in one of the neighborhoods characterized by low socio-economic status.” He was recently diagnosed with Type Two Diabetes and high blood pressure. “He’s fortunate to have a family doctor,” but the doctor runs a small clinic and is overrun by a high number of patients. The doctor monitors Rahul but can’t really provide the necessary support. As such, Rahul is “unaware of the resources within the broader community and therefore doesn’t know where to turn for help.” On top of that, Rahul doesn’t have a car and has specific dietary needs, both of which make seeking help even more complicated.

Essentially, patients needed to navigate a fragmented system, and that was before the pandemic. Now I would say that the pandemic has only exacerbated those troubles even more.

Mark Fam, Vice President, Clinical Programs, Toronto East Health Network

Dealing with the Pandemic in a Holistic Way

Despite the obvious fragmentation and chaos of the way the system used to work, the coordinated response to the pandemic has actually turned things around and proved that there is a better way. When the pandemic struck, it was clear to all the hospitals in Toronto that data needed to be integrated with technology to “really intersect with how we improve care in a whole different way.” Though even before COVID-19 came along, it was known that winter is always characterized as a “busy respiratory season” and is often referred to as an “annual surge”. So working with data and technology was on the cards before the pandemic hit in order to manage the winter surge. For years, things like “population health hotspots” that identified respiratory issues and infections were recorded.

This data was very useful when the pandemic arrived. For instance, “proactive case finding” was one of the first actions. A few large testing hubs were set up, but for the most part, the partnership arranged a series of smaller “mobile pop-ups” because “we knew where there were likely to be greater barriers to access that might produce higher test positivity.” Social media was also mined to see what people were saying and where they wanted to be, so the testing and later the vaccinations, could come to them. People in “shelters or long-term care” were identified too, and through “secure messaging” (ie: Whatsapp) were told about “mobile outreach teams that were mobilized to support them.” For the most part, it wasn’t about “some new fancy tools.” It was generally about connecting with people using traditional tools like phones and messaging, but “in a different way.” The intention was simply to have a detailed and organized “case management process so we could see and identify every single positive case in our catchment area.” Then if the patients required hospital care or other medical assistance, they could be “triaged together with their community partners and put on a remote monitoring pathway as a new tool for self-management, where they would receive the same care irrespective of their socio-economic determinants or other factors.” From the health operator’s perspective, everyone was “connected to a common technology platform for central monitoring with one infrastructure.” Patients that required them were issued with “home pulse oximeters” and virtual nurses were also deployed, so all the data could be seen, assessed and analysed. Any patient that didn’t have the necessary technology to be monitored was also provided with a phone or other devices. As a “system-wide” approach across all of Toronto, the dashboards that were produced showed “the statistical modeling forecasts for bed demand, and even how we’re managing different cases within the hospital.”

Leveraging this Approach for the Future

The pandemic will surely disappear at some point but it would be a great shame if the integrated lessons of the pandemic also disappeared. So the Toronto East Health Network, along with other similar partnerships, are currently in the process of leveraging the lessons and ensuring they are embedded. For instance, the first lesson is to “use population health and data to design digital care.” This includes using the very rich data from hospitals but also from “medications, compensation and even social media” to better inform and design new approaches to healthcare. Another lesson is to use all the available digital technology to deliver the best possible care, and to “be where the people are at.” This means both physically as well as “online in order to understand what their needs are and how we can address them.” However, it doesn’t necessarily “require additional infrastructure, it simply requires understanding the people.” After all, even technology is not actually just about the technology itself; it is (or should be) always about how the technology can provide assistance. So it means “breaking down simple barriers and enabling strong, secure community providers.” From a technology perspective, it is really about “expanding the idea of care anywhere services, and constantly building on it.”

For a character like Rahul, it means “he won’t be on his own anymore” in terms of medical care and provision. For one thing, after his diagnosis he would receive “a remote device to monitor his health.” This of course would be connected to a central platform that would be regularly seen and analysed. Should anything ever change, he would be informed about further testing. Though rather than clog up the resources of a hospital, “he would come to a local community hub steps away from his house.” Any testing done there would “feed back into the central dashboard,” and if necessary, it would update his “primary care physician and his community support service team.” Were his condition to worsen, he would see a nephrologist, “but initially that work would happen virtually at home.” He would then be recommended Hemodialysis, which again would be fitted at the hospital but monitored at home. Were he to need a kidney transplant, he and his entire team would be informed and it would happen at a “coordinated partner hospital, and the premium post care would be delivered by the local team.”

This is not quite reality yet, but it “is not that far away, maybe only a few years away.” Through the pandemic “we now have to build on the momentum and accelerate how we use data to really advance quality of care and ultimately the patient experience.”