Transcript No Slide Title

An Overview of the History and Current
Status of Telehealth in Canada
INET MINI-CONFERENCE
June 20, 2007
Laurie Poole, BScN, MHSA, CHE
President, 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
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)
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Telehealth
Telehealth: the use of information & communication technology to exchange health information
and provide health care and wellness services
Telecommunication infrastructure is a pre-requisite
Telehealth 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 delivery
EHR Infostructures support telehealth applications as per any other Point-of-Service Application
Benefits of Telehealth
• Increase access to health care services
• Improve quality of care
• Reduce health care costs
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Telehealth in Action
Telehealth Consultations in a one year period:
Nova Scotia : 2,573 total telehealth sessions
1,170 clinical telehealth sessions
Manitoba:
Ontario:
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4,842 total telehealth sessions
3,149 clinical sessions
33,000 total telehealth sessions
25,000 clinical consults
Telehealth at Work
K-net Telehealth
•Grew from 5 FN communities in
2003 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%
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Telehealth at Work
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Canadian Telehealth Domains
Clinical Consultations and Follow-up (Examples)
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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
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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
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
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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
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What are the issues?
• Telehealth should not be an
additional silo of clinical
information
• Telehealth should not be an
isolated channel of service delivery
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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
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Technology and Data Integration
• Point of Service (POS) Systems
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Integrated workstations
Laptops and handhelds
Kiosks
Patient home access
• Network infrastructure
– Bandwidth management
– Wireless capability
– Home and office automation
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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
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Governance and Policy
• Licensure
– Legal, ethical responsibilities
– Cross jurisdictional issues
– Provincial-territorial response
• Credentialing
– Credentials for practitioners who provide remote
consultations
– CCHSA/NIFTE Guidelines
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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
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Type of consent required
Who should obtain the consent
Where is it stored
Specific needs regarding cross-jurisdiction
Service Planning, Delivery and
Performance Management
• Vision and goal setting
• Service design, resourcing and budgeting
• Change management and training
• Quality Improvement
• Accreditation
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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
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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)
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Source: Canada Health Infoway, 2005
Adoption and Change Management
• Quebec Legislation (November 2005)
• Technical Advancements
• Health Care Restructuring
• Move towards the development of
Electronic Health Records
• Consumer Demand & Expectations
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Why focus on ICT?
• Health care is a priority for Canadians
• A crucial economic sector
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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
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Source: Canada Health Infoway, StatCan
Opportunity for Integration
Electronic Health Records
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.
Public
Health
Primary
Health Care
Electronic health record systems
form the foundation for a health
information and communications
infostructure that can enable
modern health care delivery.
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Source: Canada Health Infoway, 2006
Drugs and
Patient
Safety
Information &
Communications
Technologies
Wait Times
Cancer
Chronic
Disease
Benefits of the EHR
Electronic
Health
Record*
Demographics
Diagnostic Images
Laboratory Results
Drug Profile
Clinical Reports
Immunizations
Telehealth
• 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
• 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
• 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
Source: Canada Health Infoway, 2006
Access
• Availability of Services
• Ability to Access Services
• Consumer Participation
Quality
• Safety
• Effectiveness
• Appropriateness
Productivity
• Efficiency
• Care Coordination
Disease Management
A system of coordinated health care
interventions and communications for
populations with conditions in which selfcare efforts are significant
Disease Management Association of America (DMAA)
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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
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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?
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Shared Vision
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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”
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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
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Join us in St. John’s for our 10th
Annual Conference
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Thank You
www.cst-sct.org
email: [email protected]
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