Making e-health services Work for First Nations · Telehealth: Anatomy of a Killer App! Bandwidth intensive Integrated with existing service frameworks Open and interoperable standards

Nexus Tech 2003Nexus Tech 2003

Making eMaking e--health services Work health services Work for First Nations for First Nations

Using Information and Communications Technologies Using Information and Communications Technologies to Improve Local Access to Health Servicesto Improve Local Access to Health Services

Vancouver, BC Vancouver, BC 15 April, 200315 April, 2003

John Rowlandson John Rowlandson ConsultingConsulting


What is eWhat is e--Health?Health?

The ideal? Borderless, The ideal? Borderless, seamless. Accessible in all seamless. Accessible in all reaches of the country. reaches of the country. Delivering fast, accurate Delivering fast, accurate diagnosis and treatment. diagnosis and treatment. A system whereA system where……all all points of care (homes, points of care (homes, schools, family schools, family practitioners, community practitioners, community clinics and hospitals) are clinics and hospitals) are linked.linked.

William Pascal, DG, OHIH, January 2001William Pascal, DG, OHIH, January 2001


Why Now?Why Now?

ee--health tools work health tools work –– distributed technologies distributed technologies and networks are manageable and interoperable and networks are manageable and interoperable First Nations are demanding a more equitable First Nations are demanding a more equitable and effective allocation of health resourcesand effective allocation of health resourcesProvincial and Federal policies support eProvincial and Federal policies support e--health health implementation (implementation (RomanowRomanow, National Health , National Health Accord, PTC)Accord, PTC)ee--health supports evidencehealth supports evidence--based medicine and based medicine and health planninghealth planning


The eThe e--Health/Networking Health/Networking RelationshipRelationship

Health is an anchor tenant for Health is an anchor tenant for advanced networking. eadvanced networking. e--health health applications have the capacity applications have the capacity toto……

Aggregate demand across Aggregate demand across regional and national networks.regional and national networks.Sustain communitySustain community--based based networks.networks.Demonstrate the value of Demonstrate the value of network access for health care network access for health care providers and patients.providers and patients.Engage new partnerships.Engage new partnerships.Push network innovation.Push network innovation.


Demand Side for eDemand Side for e--health health applicationsapplications

More than 1,000,000 health care providers More than 1,000,000 health care providers in Canadain CanadaNursing shortfall of 20,000 today Nursing shortfall of 20,000 today –– up to up to 113,000 by 2010113,000 by 2010Physicians Physicians –– Client ratio to increase from Client ratio to increase from 1:548 to 1:718 by 2021.1:548 to 1:718 by 2021.Northern Medical Schools coming on Northern Medical Schools coming on stream in British Columbia and Ontario. stream in British Columbia and Ontario.


Two Ends of the eTwo Ends of the e--Health WorldHealth WorldConsumer eConsumer e--HealthHealth Institutional eInstitutional e--HealthHealth

Consumer e-Health

Institutional e-Health

H

CL

AC

PO

HU

CL

H


How long until we build a How long until we build a bridge between thembridge between them……??


EE--health Scopehealth Scope

Telehealth ServicesTelehealth ServicesTelemedicineTelemedicineTelecareTelecare

Health InformaticsHealth InformaticsEHR/PACSEHR/PACSHIS/Order EntryHIS/Order EntryPopulation Health/RegistriesPopulation Health/Registries

Health InfrastructureHealth InfrastructureStandardsStandardsRelationshipsRelationshipsSupport ServicesSupport ServicesNetworks/TechnologiesNetworks/Technologies


Telehealth: Anatomy of a Telehealth: Anatomy of a Killer App!Killer App!

Bandwidth intensiveBandwidth intensiveIntegrated with existing service Integrated with existing service frameworksframeworksOpen and interoperable standardsOpen and interoperable standardsDemonstrates immediate benefit to usersDemonstrates immediate benefit to usersGeneralizableGeneralizable and scalable across whole and scalable across whole populationspopulationsResponsive to community health needsResponsive to community health needs


Where Can Telehealth Make a Difference?Where Can Telehealth Make a Difference?

61%

11%6% 5% 3%

14%

Consultation & Follow-up Medevac Diagnostic ImagingSurgery Prenatal Confinement All Other

Reason for Patient Transfers - April 2001 to March 2002

15-20% of these kind of consults can be done by telehealth


What is Involved?What is Involved?

ModellingModelling: Developing and applying a : Developing and applying a working telehealth model working telehealth model –– training, training, scheduling, clinical referrals and protocolsscheduling, clinical referrals and protocols

Demonstration/EngagementDemonstration/Engagement: : Identifying telehealth expectations and Identifying telehealth expectations and prioritiespriorities

Partnership DevelopmentPartnership Development: Working : Working with local, regional, provincial and federal with local, regional, provincial and federal bodies to devise and implement sustainable bodies to devise and implement sustainable telehealth servicestelehealth services

MigrationMigration:: Supporting the regional Supporting the regional migration of telehealth services to other rural migration of telehealth services to other rural remote communitiesremote communities

Creating a Telehealth

Toolkit


Geographic ScopeGeographic Scope


Connectivity ModelConnectivity Model

Integrated, Secure Integrated, Secure and Reliableand Reliable

Advanced IP architectureAdvanced IP architecture

Encrypted VPN connectivityEncrypted VPN connectivity

Quality of ServiceQuality of Service(1M/sec (1M/sec –– terrestrial; terrestrial; 512/768 burst Satellite512/768 burst Satellite

24x7 Remedy 24x7 Remedy HelpDeskHelpDesk

Aggregated DemandAggregated Demand


Telehealth Services ModelTelehealth Services ModelCommunity-Based Regionally Supported

Local Coordination, Nursing Support & Promotion

Regional Management, Scheduling, Training & Technical Support


Moving from this… …to this too!

Coordinated Local Access to Comprehensive Health Services


• CME programming

• Nursing Issues & Practice

• Patient Education:

• Diabetes management

• Pre-Admission clinics

• Health Worker training

• Mental Health

• Healthy Babies,

• Home & Community Care…

Continuing Health Education


Teleradiology and Regional PACS


Screening and Non-Urgent Nurse/Physician Consultation


ResultsResults

Telemedicine Services successfully implementedTelemedicine Services successfully implementedCore Clinical and Administrative Staff trainedCore Clinical and Administrative Staff trainedCommunityCommunity--based Coordinators certifiedbased Coordinators certifiedInterInter--provincial scheduling service operationalprovincial scheduling service operationalRegional Community Network delivers secure QOS Regional Community Network delivers secure QOS connectivity across an aggregated networkconnectivity across an aggregated networkRegional buyRegional buy--in for migration of telehealth services to in for migration of telehealth services to an additional 23 communitiesan additional 23 communities


ChallengesChallenges

Capitalization and Capitalization and EvergreeningEvergreening costs costs (technological change)(technological change)Knowledge and skills transfer Knowledge and skills transfer –– turnover turnover among medical, nursing and community among medical, nursing and community health workershealth workersProvincial and federal policy developmentProvincial and federal policy developmentIntegration with primary care servicesIntegration with primary care services


OpportunitiesOpportunities

Improved community wellImproved community well--beingbeingImproved health statusImproved health statusCapacity building (jobs, knowledge, retention/recruitment)Capacity building (jobs, knowledge, retention/recruitment)

High Value network connectivityHigh Value network connectivityRegional Partnerships Regional Partnerships Decentralized help servicesDecentralized help services

Improved EffectivenessImproved EffectivenessReduced Patient Travel BurdenReduced Patient Travel BurdenMore effective use of limited health resourcesMore effective use of limited health resources


Lessons LearnedLessons Learned

Move in successful increments (baby steps)Move in successful increments (baby steps)Understand human relationships and how your Understand human relationships and how your project might change (enhance/eliminate?) themproject might change (enhance/eliminate?) themDonDon’’t start until you have Community Buyt start until you have Community Buy--in in Build Communication into every stepBuild Communication into every stepPlan for Comprehensive AccessPlan for Comprehensive AccessAggregate IT ServicesAggregate IT Services


What Can You Do to Make What Can You Do to Make telehealth services accessible?telehealth services accessible?

Determine where the gaps are in the existing service Determine where the gaps are in the existing service model?model?

Work with local and regional health partners to integrate Work with local and regional health partners to integrate telehealth into daytelehealth into day--toto--day standard of careday standard of care

Document community wellness needs and health Document community wellness needs and health prioritiespriorities

Encourage community leadership to formally support Encourage community leadership to formally support telehealth accesstelehealth access

Communicate your needs to federal and provincial health Communicate your needs to federal and provincial health service managers.service managers.


ee--healthhealth: Using Information and: Using Information andCommunications Technologies to Improve Communications Technologies to Improve

Local Access to Health ServicesLocal Access to Health Services

For more information contact:For more information contact:http://telehealth.knet.cahttp://telehealth.knet.caJohn RowlandsonJohn [email protected][email protected] 653 4049250 653 4049

Documents

Making e-health services Work for First Nations · Telehealth: Anatomy of a Killer App! Bandwidth intensive Integrated with existing service frameworks Open and interoperable standards