“Information travel not patient travel”

Transforming Care: Improving Access Through Implementation of Store and

Forward Technology in Manitoba

MBTelehealth• Manitoba’s Telehealth Network

– 2001 MBTelehealth is established with 28 sites:

• Rural and Northern Manitoba - 21• Winnipeg - 7• Sites located in all 11 Manitoba

Regional Health Authorities

– 2010 – 97 sites and growing…• Rural and Northern Manitoba - 69• Winnipeg - 28

Why Store and Forward

• Manitoba has a low population density with 3.42 people per square mile (2008 estimates) • The Royal College of Physicians of Canada recommends 1:65,000 dermatologist to person ratio, Manitoba has 1:92,000• Most Manitoba dermatologists practice in Winnipeg• Options for dermatology care are face to face or video conferencing• Notable increases in requests for specialist care identified an opportunity to explore innovative solutions to enhance access to specialist services

Store and Forward

Store and Forward technology is defined as:

“a system that allows for the collection of medical data such as digital

images which are transmitted to a consultant for review in the future”

Benefits for Patients

• Decreased wait time for specialist care • Reduced travel time for patients• Reduced cost for patients to receive care• The general practitioner remains the patient’s

main care provider• Increased access to specialist care in medically

underserviced areas

Benefits for Primary Care Clinics Medical education and shared care

opportunities for specialists and primary care providers

• The general practitioner remains the patient’s main care provider

Uses existing clinic infrastructure (computer, internet connection and web based software)

Referring physicians can bill Manitoba Health directly which is not available for traditional referrals

Benefits for Specialist• Web based software that can be accessed

anywhere in Canada• Ability to provide service during non-traditional

hours • More efficient use of specialist time• Does not impact existing clinic times• Allows specialist to see more patients• Promotes shared care model between

specialist and primary care provider

Face to Face Consult

The patient has a face to face appointment with Primary Care Provider

The patient has a face to face appointment with Primary Care Provider

Primary Care Provider creates a referral to a specialist

Referral is sent to a specialist

Specialist reviews referral and schedules an in person appointment with the patient

Patient is notified of appointment with specialist

Patient has appointment with specialist

Specialist sends report letter to Primary Care Provider

Store and Forward referral is generated and uploaded to specialist

Specialist reviews store and forward referral and sends report to Primary Care Provider Primary Care

Provider reviews report and schedules follow up appointment with the patient

The patient has a follow up appointment with the Primary Care Provider to review specialist recommendations

Day

1D

ay 1

Day

2

Day

1

Day

3

Day

4

Day

8

Day

5

Day

12

Day

21

Day

123 D

ay 1

24

Store and Forward Consult Total Time to Receive Specialist Care:

Face to Face = up to 124 days

Store and Forward = up to 12 days

Comparison of Referral Timelines

How Store and Forward WorksStep 1: Referring Primary Health Care Provider

– The referring primary health care provider uses Store and Forward technology to input health information and capture digital images.

Step 2: Documentation and Digital Images– The digital images and health information are “stored” on a secure server.

Step 3: Specialist– A notification of newly ‘stored’ data is securely transmitted, or “forwarded”, to a

dermatologist for assessment, diagnosis and/or treatment recommendations.

Step 4: Follow Up– The primary health care provider is notified that the Store and Forward consult

has been processed by the dermatologist and makes arrangements to follow up with the client.

Technology Involved• Existing internet connection and Internet Explorer• iScheduler Store and Forward Module

– Store and Forward module included within iScheduler to be utilized for all Store and Forward referrals

• Canon SX120IS Digital Camera– All digital images to be captured– 4 cameras purchased for this project

• Video Link

Store and Forward at MBTelehealth• Demonstration project to demonstrate viability

of Store and Forward technology in dermatological care

• Started April 2010• Demonstration project completed September

2010• Evaluation to be completed

About the Clinics

• Brandon Medical Clinic– 11 providers (all MD’s)

• Niverville Medical Clinic– 4 providers (3 MD’s and one NP)

• Access River East– 11 providers (6 MD’s and 5 NP’s)

By The Numbers

83 – Referrals sent between April 1 and September, 2010 2.83 – Average number of days to wait for a response from the specialist4.6 – Average number of referrals sent by clinic per month1 – fewest hours to a response from a specialist15 – most days to a response from the specialist (on vacation)403 – Live interactive teledermatology appointments last year

Total Referrals by Clinic(April – September)

Store and Forward Referrals by Month

Average # of Days for a Store and Forward Response

Referral Response

Urgency of Treatment Implementation

73%

4%

13%

1%9%

N/A Urgent Soon Routine Other

Recommendation to Primary Care Provider for Follow Up

85%

7%

8%

See Treatment Plan Provide the following information or results No action required

Diagnosis Types

Distribution of Age to Diagnosis

Case Study

• SAF referral for slow, enlarging, bleeding, crusty lump on scalp

• Reviewed images, showed obvious sun damaged skin with a single 2 cm eroded nodule on scalp

• Treatment – urgent biopsy completed, showed squamous cell carcinoma, allowed for proper surgical removal before spread to lymph nodes

Evaluation

• Submitting to MPAN for support to conduct objective evaluation

Questions