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An Overview of the History and Current Status of Telehealth in Canada
INET MINI-CONFERENCE June 20, 2007
Laurie Poole, BScN, MHSA, CHEPresident, Canadian Society of Telehealth
Outline
• The Canadian Society of Telehealth
• What is Telehealth?
• Update on Telehealth Activities in Canada
• Barriers to Success
• Requirements for a Shared Vision
• Questions and discussion
Slide #: 3
The Canadian Society of Telehealth
• The National Voice of Telehealth in Canada
• Affiliated with other e-health organizations (Collaboration Agreement with COACH)
• Leadership, Advocacy, Policy & Education
• Forum for exchange of ideas and knowledge
• Subject Matter Expertise (e.g. Canada Health Infoway)
Telehealth
Telehealth: the use of information & communication technology to exchange health informationand provide health care and wellness servicesTelecommunication infrastructure is a pre-requisiteTelehealth solutions enable health service delivery channels:
Tele-Consultations
Videoconferencing stations,
communication enabled
medical devices
Tele-Education
Videoconferencing stations
used for training/education
Home Telehealth
Active or passive monitoring
of remote patients for pre/post-op procedures,
CDM etc.
Tele-triage
Centralized health call centers to offer first line delivery of service to clients as part of primary care
and emergency response
Scheduling Solutions – a key enabler required for the effective use of telehealth service deliveryEHR Infostructures support telehealth applications as per any other Point-of-Service Application
Slide #: 5
Benefits of Telehealth
• Increase access to health care services
• Improve quality of care
• Reduce health care costs
Slide #: 6
Telehealth in Action
Nova Scotia : 2,573 total telehealth sessions 1,170 clinical telehealth sessions
Manitoba: 4,842 total telehealth sessions 3,149 clinical sessions
Ontario: 33,000 total telehealth sessions 25,000 clinical consults
Telehealth Consultations in a one year period:
Slide #: 7
Telehealth at Work
K-net Telehealth•Grew from 5 FN communities in2003 to 24 communities in 2006•Vast land mass (average community population 700)•Estimated program costs: $2.8 million/year•Estimated travel savings: $4.2 million/year•Patient satisfaction > 90%
Slide #: 8
Telehealth at Work
Slide #: 9
Canadian Telehealth DomainsClinical Consultations and Follow-up (Examples)
• thoracic• psychiatry (adult, geriatric and
pediatric)• forensic mental health
assessments• orthopedic• ophthalmology • pathology• live fetal ultrasound interpretation, • live paediatric cardiac echo• paediatric swallow assessments• Oncology - cancer care• Dietary (e.g. eating disorders), • endocrinology• anesthesiology• radiology – digital imaging
• chronic disease mgt (diabetes etc) • cardiology• pre-op, post Op• general surgery• gastroenterology• physio therapy• nephrology• neurology• wound management and
dermatology• rheumatology• speech and language• genetic counseling family visits• ergonomic assessments• Home Telehealth • 24/7 Tele-nurse Lines
Slide #: 10
Telehealth Myths
• Build it and they will come
• All practitioners like it
• Training one person is all you need to do
• Broadband is everywhere
• One size fits all and it’s plug and play
Slide #: 11
Telehealth Myths
• If something goes wrong with a group of physicians, you will get another chance
• The government is here to help• New equipment is always backward
compatible
• Networks never fail
• It’s just wires and doctors
Slide #: 12
What are the issues?
• Telehealth should not be an additional silo of clinical information
• Telehealth should not be an isolated channel of service delivery
Slide #: 13
What are the issues?• The core issue is the scope and
complexity of telehealth integration:– Technology– Data– Governance and policy– Service planning, delivery and performance
measurement– Clinician workflow– Consumer participation
Slide #: 14
Technology and Data Integration
• Point of Service (POS) Systems– Integrated workstations– Laptops and handhelds– Kiosks– Patient home access
• Network infrastructure– Bandwidth management– Wireless capability– Home and office automation
Slide #: 15
Technology and Data Integration
• Privacy and security– Secure access– Consent management– Secondary use of data
• Data capture and exchange– Standards to support technical and semantic
interoperability– Comprehensive information to support decision
making at the point of care– Minimum data set for longitudinal storage
Slide #: 16
Governance and Policy
• Licensure– Legal, ethical responsibilities
– Cross jurisdictional issues
– Provincial-territorial response
• Credentialing– Credentials for practitioners who provide remote
consultations
– CCHSA/NIFTE Guidelines
Slide #: 17
Governance and Policy
• Reimbursement – Absence of policies impacting telehealth adoption
– Coverage is neither consistent nor complete
– Being addressed by P/T jurisdictions (e.g. Alberta)
• Consent– Type of consent required
– Who should obtain the consent
– Where is it stored
– Specific needs regarding cross-jurisdiction
Slide #: 18
Service Planning, Delivery and Performance Management
• Vision and goal setting
• Service design, resourcing and budgeting
• Change management and training
• Quality Improvement
• Accreditation
Slide #: 19
Clinical Adoption & Consumer Participation
• Clinician Adoption and Workflow– Early exposure and demonstration of ‘best
practices’– Physician automation
• Consumer participation– Building confidence and competence– Link to providers– Human Factors
Slide #: 20
Physicians not integrating ICTs in workflow
• Physicians in general early adopters of ICTs, but have difficulty integrating into workflow and patient care
• 88% of Canadians use internet, but 1 out of 2 users access it from home, not the office
• Demographics are changing use: 53% of Canadians physicians under 35 are using PDAs (compared to less than 33% of physicians over 55). (CMA)
• GP offices face the same challenges are other SMEs in using ICTs (lack of time and expertise, transforming business processes)
Source: Canada Health Infoway, 2005
Slide #: 21
Adoption and Change Management
• Quebec Legislation (November 2005)
• Technical Advancements
• Health Care Restructuring
• Move towards the development of Electronic Health Records
• Consumer Demand & Expectations
Slide #: 22
Why focus on ICT?• Health care is a priority for Canadians• A crucial economic sector
– 13% of Canada’s GDP (est. 2006)– Estimated $142 B spending in 2005– Close to 40% of P/T expenditures– Employs over 1.5 million people (2006)– Responsible for estimated 34% of business R&D (2004)
• Health care sector is a heavy user of technology for diagnostics, but less for business process efficiency
Source: Canada Health Infoway, StatCan
Slide #: 23
Electronic Health Records
Primary Health Care
Public Health Drugs and
Patient Safety
Chronic Disease
CancerWait Times
Information &
Communications
Technologies
Electronic health record systems can help improve patient health outcomes, decrease duplication, error and costs; and reduce waits. Without electronic health records, national directions to improve primary health care, public health, drugs drug and patient safety, chronic diseases, cancer and wait times will not be successful.
Electronic health record systems form the foundation for a health information and communications infostructure that can enable modern health care delivery.
Opportunity for Integration
Source: Canada Health Infoway, 2006
Benefits of the EHR
Access• Availability of Services
• Ability to Access Services
• Consumer Participation
Access• Availability of Services
• Ability to Access Services
• Consumer Participation
Quality• Safety
• Effectiveness
• Appropriateness
Quality• Safety
• Effectiveness
• Appropriateness
Productivity• Efficiency
• Care Coordination
Productivity• Efficiency
• Care Coordination
• Increased interpretations by remote specialists• Improved wait-times for diagnostic imaging services• Improved availability of community based health services• Reduced patient travel time and cost to access services• Increased patient participation in home care• Increased patient access and use of their health record
• Increased interpretations by remote specialists• Improved wait-times for diagnostic imaging services• Improved availability of community based health services• Reduced patient travel time and cost to access services• Increased patient participation in home care• Increased patient access and use of their health record
• Increased access to integrated patient information • Reduced duplicate tests and prescriptions• Reduced physician prescription call-backs• Reduced patient and provider travel costs• Improved vaccine management• Improved information management resulting in reduced costs
• Increased access to integrated patient information • Reduced duplicate tests and prescriptions• Reduced physician prescription call-backs• Reduced patient and provider travel costs• Improved vaccine management• Improved information management resulting in reduced costs
Electronic Health
Record*
Demographics Diagnostic Images Laboratory Results
Drug Profile Clinical Reports Immunizations
Telehealth
• Decreased medical errors• Improved interpretation of diagnostic and laboratory results• Decreased adverse drug events• Decreased prescription errors• Improved prescribing practice • Increased speed and accuracy in detecting infectious disease outbreaks
• Decreased medical errors• Improved interpretation of diagnostic and laboratory results• Decreased adverse drug events• Decreased prescription errors• Improved prescribing practice • Increased speed and accuracy in detecting infectious disease outbreaks
Source: Canada Health Infoway, 2006
Slide #: 26
Disease ManagementDisease Management
A system of coordinated health care interventions and communications for populations with conditions in which self-care efforts are significant
Disease Management Association of America (DMAA)
Slide #: 27
Value Created by Telehealth & EHR
• Healthcare professionals make clinical decisions based on knowledge
• Better knowledge translates to better care
• Knowledge starts with accurate, relevant clinical information
• The EHR creates the capability to share relevant clinical information
• The 5 Rs of the EHR:– The right information– About the right client– Available to the right person– In the right place– At the right time
Slide #: 28
In Summary…
• Telehealth can’t exist in a vacuum
• Technology continues to outpace governance, policies and
legislation
• It’s main principle is more about people and relationships than
technology
• How will we know when we’re there?
Slide #: 29
Shared Vision • Enabler in achieving healthcare goals
• Standards Development
• Political Will
• Integration with the EHR
• When we no longer use the prefix ‘tele”
OR
• When we no longer have to ask “what is telehealth”
Slide #: 30
Telehealth Vision
Telehealth is a service delivery component within the larger e-health domain and has applicability across the whole continuum of health care delivery. It is a mode of delivery for health care and health education that is becoming more integrated with the overall delivery of health care services.
Source: CST White Paper, Telehealth- What the Future Holds, May 2007
Slide #: 31
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