Transcript Document

Need and Model of
Telediagnosis -The
Manitoba Experience
Albert E. Chudley
Mary Cox-Millar
Sally Longstaffe
University of Manitoba
4th Annual Fetal Alcohol Canadian Expertise
(FACE) Research Roundtable Edmonton, AB
September 9th 2003
Learning Objectives
• Demonstrate the need for telehealth
• Identify a process that will facilitate distant
diagnosis and meet the needs of the North
• Recognize the need to partner with external
groups and communities
• Discuss our experience in FAS diagnosis
using telehealth
CADEC Community
Services/Partnerships
Family Support
Fetal Alcohol Family Association
Child and Family Services
Direct Service For Children
0 to 7 Years of Age
Government
Support
Healthy Child Manitoba
Manitoba Health/Child Health
Interagency FAS/E Program
Children’s Special Services/FAS Outreach Team
Society for Manitobans with Disabilities
Provincial Outreach Therapy Services for Children
Child and Family Services
School Age Children
Special Education
Classrooms David Livingstone
School and Shaughnessy Park
Child Guidance Clinic
Children’s Special Services
Child Psychiatry
Adult Services
FAS/FAE
Support Services
Northern Manitoba
Services for Families
Fetal Alcohol Support Team – Thompson
Interagency Group The Pas / Flin Flon
Support for Pregnant
Women
Diagnostic
Services
Nor’West Mentor Program
Aboriginal Health & Wellness/
FAS/E Prevention Program
Mentorship program The Pas
and Norway House
Clinic for Alcohol & Drug Exposed
Children
Fetal Alcohol Support Team - Thompson
Reasons for and Benefits of
Telehealth
• Canada has many distantly located low population
communities with limited access to specialty care
• Reduced time and costs for travel
• Timeliness of access to care
• Reduced barriers to compliance with appointments
• Facilitates family involvement
• Enhances linkages amongst health professionals
and community agencies
• Provides access of education and training to rural
areas
MBTelehealth
• Partnering with the Prairie Provinces FAS
Initiative and CADEC, the first link was
with Thompson MB in 1999.
• Following a $3M grant from the federal
government, technical capabilities were
greatly expanded in 2001.
• Subsequent link to NorMan Region (The
Pas and Flin Flon) 2002-present.
Model for Coordinated Assessment/
Follow-up Service
-
Intake
(optional)
Referral
Screening
Information
Gathering
Document
Review
CADEC Intake
Meeting
Psychology
refer elsewhere
defer or on hold by parental request
unable to contact
OT
Speech &
Language
Final
Report
(optional)
Follow-up
Planning
Family
Debriefing
Case
Conference
Medical
Assessment
(Genetics,
Developmental)
Follow-up
M.C.Millar/T.Benoit
Nov/00
Assessment
Intake Meeting
with parents,
school
Paediatrics and Child Health
Vol 7 March, 2002
Linked to 24 sites!
Telehealth Equipment
• Province-wide LAN
H.323 internet
protocol videoconferencing
system
• Uses multi-site
control unit
• Portable equipment
with document
viewer
Total Network Utilization
Fiscal Year 2002-2003
350
300
255
250
190
200
150 132
141
98
100
292
271
196
163
123
95
75
50
Total Number of Sessions: 2,031
[FAS sessions represent~27
encounters]
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Ju
ly
Ju
ne
M
ay
A
pr
il
0
Utilization by Type of Session
(shown by quarter year for 02-03 fiscal year)
600
500
Apr il-June
400
July-Se pte m be r
300
Octobe r De ce m be r
Januar y-M ar ch
200
100
M
B
(All clinics including FAS)
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0
Clinical Utilization (Actual Number)
Fiscal Year 2002-2003
200
180
144
160
140
111
120
172
161
104
83
100
67
80
45
48
60
49
40
39
40
20
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(All clinics including FAS)
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Cost impacts, assumptions re: patients
• Does not include indirect costs savings due to time off
work, child care while away etc
• No distinction made between costs borne by individual
and those borne by health care system
Technical success: qualitative findings
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Users satisfied with training received
Unanimous appreciation of technical support
Technology easy to use
Sites linked by satellite experience more problems
Some would like to enlarge network to more sites,
have more drops, be available for emergent and
urgent use 24/7
CADEC Telehealth Experience
with FAS Diagnosis
• Total of 27 links since April 1/99
• 8 of 27 links – planning/team meetings,
presentations and/or education sessions
• 19 of 27 links –assessment links
• 27 children were assessed (initial
assessment, consults and/or follow-up to
initial assessment)
• 4 of the 19 assessment links were training
teams in diagnosis
Estimated travel savings:
(FAS-24 month period)
Patient travel costs avoided
Professional travel costs avoided
Total travel costs avoided
Average $
per session
475
Total $
4800
38400
5275
51225
12825
Feedback From Users Following
FAS Assessments
• “Excellent… it is almost like talking face to face
at your kitchen table with the doctors.”
• “It should be in more communities…best thing
that could ever come to the North.”
• “It is an opportunity to see how the medical
system works.”
• “Bringing expertise to the community helps in
building a team that is working in the best
interests of the child.”
Feedback From Users Following
FAS Assessments
• “Travelling to Winnipeg is a stressor for many
people.”
• “Using telelink allows the children to be assessed
with less disruption to their daily routine…a trip to
Winnipeg would be 3 days from home!”
• “A birth mother would be more willing to
participate if she is supported through the process
by people who know her and the child in the
community.”
What Have We Learned?
• Importance of establishing external
relationships (CADEC team and the
community)
• Establish common and site-specific goals
• Provide training as needed
• Clarify process for referral
• Establish guidelines for communication and
clarify expectations
What Have We Learned?
•
•
•
•
Ask for feedback on experience
Need to wait for camera before speaking
Use close up mode when speaking
Provide a warm-up period for children to
become accustomed to the interactive
“talking television” and the room
• Allow privacy (limit numbers in the room at
any given time
Summary
• Telehealth FAS Diagnosis has met the needs
of some families in a northern community
in Manitoba
• On site coordinator trained in preparing the
family for the diagnostic process and with
good community links is essential
• Need to link with local professionals and
agencies
Thanks for not drinking,
Mom