Sto:Lo Health Conference

Mark Sommerfeld – First Nations Health Council Jeffrey Yu – First Nations and Inuit Health

J ff Aitk Mi i t f H lth S i Jeff Aitken - Ministry of Health Services February 12, 2009

Presentation ObjectivesPresentation Objectives

Provide an overview and status update regarding:Provide an overview and status update regarding:1. Provincial eHealth & Telehealth project activities in BC

2 T i tit C it t t Fi t N ti H lth & T l h lth2. Tripartite Commitment to First Nations eHealth & Telehealth

3. Tripartite First Nations eHealth and Telehealth project activities

eHealth Projects

Jeff AitkenJeff AitkenDirector

First Nations eHealth, EMR, Provincial Telehealth OfficeMinistry of Health Services

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I ti i H lth d I ti t Investing in eHealth and Innovation to Ensure Sustainabilityy

eHealth Vision“An integrated interoperable eHealth system in which healthAn integrated, interoperable eHealth system in which health

care information is accessible, when and where it is needed, to support personal health, health care decision making andto support personal health, health care decision making and health system sustainability.”

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eHealth Will SupporteHealth Will Support

Access to clinical information about individualsAccess to clinical information about individuals– At the point of care

• Demographic informationDrug information• Drug information

• Lab test result information• Diagnostic imaging results information• Public health information (immunization data)• Public health information (immunization data)

– By health professionals who have the need, ability and appropriate security to access this informationA th i– Across the province

• As and when health professionals are ready to use it

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Benefits

– Health care providers will be able to make more timely clinical decisions concerning patient care and public health protectionPatients will benefit from better quality care and reduced treatment delays– Patients will benefit from better quality care and reduced treatment delays

– Patients will enjoy better access to specialized services and care– Patients will not be subjected to duplicate, sometimes risky medical test j p , y

procedures

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eHealth Project EnvironmenteHealth Project Environment

AUTHORIZED eHEALTH USERS

Health Information Access Layer (HIAL)• Integration• Disclosure Directives & Audit Trail

• Authorization & Authentication• Standards-based

Health Information Access Layer (HIAL)

DrugInformationViewer Provider

Information

PatientDemographicInformation

Lab TestResults

Information

DiagnosticImaging

Public HealthInformation

Electronic Health Record

7CITIZEN ACCESS

Future State

BC eHealth Project O er ie sBC eHealth Project Overviews The goal is to implement world class excellence in the protection of

privacy and the assurance of security in patient-centred provider-privacy and the assurance of security in patient-centred, provider-supported eHealth systems in British Columbia

iEHR Project iEHR Project– iEHR will deliver a private and secure Electronic Health Record

service for BC that will enable sharing of electronic health record data across the continuum of caredata across the continuum of care

Provincial Laboratory Information Solution (PLIS) ProjectPLIS will provide a province wide repository of all patient lab test – PLIS will provide a province-wide repository of all patient lab test results, from public and private labs, accessible at any authorized point of care

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BC eHealth Project Overviews - continued

BC Yukon Public Health Information Project– Support public health service delivery by improving public health

information management and public health surveillance technology in British Columbia and the Yukon.

eDrug ProjecteDrug Project– Building on the success of BC’s existing PharmaNet system, the

eDrug project will introduce the next generation system (PharmaNet eRx) improving medication profile content from both community and acute care settings, special authority processing, and eventually providing electronic prescribing

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y p g p g

BC H lth P j t O i BC eHealth Project Overviews - continued

Connecting Diagnostic Imaging Project– CDI will provide better access to digital (filmless) diagnostic CDI will provide better access to digital (filmless) diagnostic

images and reports produced by both public and private radiology labs

Ph i i I f i T h l Offi (PITO) P Physician Information Technology Office (PITO) Program– The PITO Program will provide electronic medical record (EMR)

and practice management systems for physicians’ offices and practice management systems for physicians offices, replacing today’s largely paper-based health records and enabling staff to access BC’s electronic health record

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EHR Activity – beyond June 09 (tentative)EHR Activity – beyond June 09 (tentative)Apr – Jun 2009 Jul – Sept 2009 Oct – Dec 2009 Jan – Mar 2010Jan – Mar 2009 Apr – Jun 2009 Jul – Sept 2009 Oct – Dec 2009 Jan – Mar 2010Jan – Mar 2009

Production Prototype

Release 1.1 1.1Schedules to be confirmed

Ele

Prototype

Full ProductionRelease 1.2 1.2

ectronic Health

PharmaNet1 Integration

PHIP Integrationh Record R

ele

PLIS Deployment• 5 EMR vendors conformance tested• 1,000 physicians registered• PPN implementedeases

Philips DI Viewer across VHC & FHA Extend DI Viewer to IHA & NHA, then VIHA & PHSA

Continued PITO Physician Registration & EMR Installation (not integrated with EHR)

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across VHC & FHA(not integrated with HIAL)

Telehealth in BCTelehealth in BC

Mi i t f H lth S iMinistry of Health ServicesProvincial Telehealth Office

February 2009

T l h lth i BC Hi hli ht Telehealth in BC - Highlights Telehealth services are currently available in approximately 20 clinical program y y g

areas, including oncology, mental health/psychiatry, pharmacy, thoracic surgery, homecare, renal, rheumatology and wound care, as well as special services for children.

The capacity for two way live videoconferencing clinical administrative and health The capacity for two-way, live videoconferencing, clinical, administrative and health related educational encounters exist in more than 100 communities throughout the province.

There are approximately 200 Telehealth facilities providing access to approximately There are approximately 200 Telehealth facilities providing access to approximately 500 videoconferencing end points.

Telehealth facilities supported approximately 18,000 Telehealth consults through videoconferencing in 2007 with anticipated annual growth of 25% per annum.

Health education and training are being provided to approximately 30 First Nations communities via videoconferencing technologies in BC.

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BC Telehealth BenefitsThe Provincial Telehealth initiatives will improve access to health care for all BC citizens, especially for those in rural, remote and First

f fNation communities, by increasing the use of videoconferencing technology for clinical and professional encounters. Telehealth will:

Deliver faster, more efficient health care by using technology to remove the distance barrier;

Reduce patient travel burden particularly benefiting elderly people and those Reduce patient travel burden, particularly benefiting elderly people and those with young children who currently have to travel long distances to access health care services;

Provide access to wider range of specialist advice and services, by increasing the range of clinical services available through Telehealth;

Improve health professional retention and productivity in isolated communities by mitigating distance barriers, resulting in less isolation, and provide more opportunities for professional development leading to greater

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provide more opportunities for professional development, leading to greater job satisfaction;

TeleHomeCare - OverviewObjective: To improve care and reduce hospital readmissions of patients with CHF (Congestive

Heart Failure) through early detection and self monitoring of patients.

TeleHomeCare - Overview

) g y g pPartners: VIHA (Lead), IHA

Monitor in patient’s home - uses text & voice prompts Patient guided through taking vital signs (weight blood pressure heart rate oxygen Patient guided through taking vital signs (weight, blood pressure, heart rate, oxygen

saturation levels) Vital signs and answers to subjective questions are encrypted and transmitted to Health

Authority server Software on server triages patient data, recommends actions such as home visits, Software on server triages patient data, recommends actions such as home visits,

physician referral Nurse monitors alerts through dedicated workstation

(VIHA = Vancouver Island Health Authority)(IHA = Interior Health Authority)

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Objective: To improve access for patients and their families in remote and rural areas of

TeleOncology - Overview

Objective: To improve access for patients and their families in remote and rural areas of the province to specialized oncology services provided by regional cancer centres

Partners: PHSA (Lead), VIHA, IHA, NHA, FHA

Building on existing services Five Cancer Centres (Vancouver, Victoria, Surrey, Kelowna, Abbotsford ) providing

services to all of province New centre Prince George (2010) Oncology specialists provide initial and/or follow up consults to patient remotely

through VC technology

(PHSA = Provincial Health Services Authority)

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(PHSA = Provincial Health Services Authority)(NHA = Northern Health Authority)(FHA = Fraser Health Authority)

T l W dC O i

Objective: To implement community-based wound care services throughout NHA with

TeleWoundCare - Overview

j p y gprimary focus to support Home Care Nurses and staff in FN communities providing wound care

Partners: NHA

2004 pilot in Quesnel and FN Community Tache to support improved woundcare in northern & aboriginal communities

Home Care Nurses and health care staff in First Nations communities to use digital d i li d li i l li ti t d t & t k d i th cameras and specialized clinical application to document & track wounds in the

home care setting Woundcare specialist to review and provide consultative advice Ongoing education to nurses regarding difficult or special cases Ongoing education to nurses regarding difficult or special cases Implement in 21 communities plus 3 or more FN communities

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Objective: To provide access to quality thoracic surgical care to residents of BC and the

TeleThoracic - Overviewj p q y g

Yukon through videoconferencing technology. Partners: PHSA (Lead), VIHA, VCH (NHA, FHA, IHA, Yukon)

Thoracic surgeons provide comprehensive care to patients with non cardiac Thoracic surgeons provide comprehensive care to patients with non-cardiac thoracic conditions (e.g. lung and esophageal cancer)

Thoracic services provided through four Centres of Excellence – Vancouver, Victoria, Surrey, Kelowna

Dec 2003 – Kelowna began providing TeleThoracic services (initial assessment and post-operative follow-up) to communities in interior and north

Same model to be implement in 21 additional communities to receive services through Telehealth technology (ex. Gold River, Abbotsford, Fort St John, Sechelt)g gy ( , , , )

(VCH = Vancouver Coastal Health Authority)

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Objective: To improve retinal screening service access for populations at high risk of

TeleOphthalmology - OverviewObjective: To improve retinal screening service access for populations at high risk of

retinopathies (i.e. diabetics) living in rural and remote communities including First Nations

Partners: ITHA (Lead), VIHAPartners: ITHA (Lead), VIHA

Retinal screening clinics – 3 Fixed-site locations plus mobile clinics across Vancouver IslandVancouver Island

Screening by trained Nurse photographer ‘Retinal Image Packages’ downloaded to Inter Tribal Health Authority Server Retinal specialist will review online and prepare assessment report Retinal specialist will review online and prepare assessment report

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Provincial Telehealth Project TimelineProvincial Telehealth Project Timeline

Jul – Sept 2009 Oct – Dec 2009 Jan – Mar 2010Jan – Mar 2009 Apr – Jun 2009 Apr – Jun 2010

Phase 2 Phase 1

TeleHomeCare Rollout Completed

VIHA

Rollout Completed

IHA

Phase 1 Rollout Phase 2

TeleThoracic Completed

VIHA,VCH, FHA,NHA

Rollout Completed

PHSA

Phase 1 Rollout Completed

Phase 2 Rollout Completed

Phase 3 Rollout TeleOncology

TeleWoundCare

Completed

VIHA,PHSA, FHA,NHA

Completed

VIHA,PHSA, IHA,NHA

Rollout Completed

NHA, VIHA

Phase 1 Rollout

Phase 2 Rollout TeleWoundCare

TeleOphthalmology

Rollout Completed

NHA

Rollout Completed

NHA

Rollout Completed

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TeleOphthalmologyVIHA, ITHA

First Nations eHealth & Telehealth

Mark Sommerfeld, eHealth Consultant, FNHC

Jeffrey Yu, Jeffrey Yu, Manager eSolutions Unit, FNIH, Health Canada

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eHealthHEA

“The combined use of electronic communication & information technology in health sector. The use in the health sector of digital data – transmitted stored and

LTHTELhealth sector of digital data transmitted, stored and

retrieved electronically – for clinical, educational, and administrative purposes, both at the local site and at a di t ” (Mit h ll 2000)

INF

LEHE

distance.” (Mitchell, 2000)ORMA

ALTH

HEALTH INFORMATICS

TELEHEALTH

ATIC

H

E‐HEALTHS

E‐HEALTH

eHealth e ea t

• eHealth, by its very nature, requires a high degree of ll b ti (Fi t N ti F d l P i i l)collaboration (First Nation-Federal-Provincial)

• In a First Nations context, eHealth is an early innovatorIn a First Nations context, eHealth is an early innovator and integrator in reshaping relationships between (and amongst) First Nations and provincial and federal governmentsgovernments

• Firmly establishing these relationships at all levels is a y g pcritical success factor for the ultimate success and sustainability of First Nations eHealth at all levels.

Current Tripartite CollaborationCu e t pa t te Co abo at o

First Nations

P i i lTripartite

Provincial Health Services

Federal Health

Services

pFirst

Nations Health Plan*

Communities

*Tripartite First Nations Health Plan is Tripartite First Nations Health Plan is implemented by First Nations Health Council on behalf of BC First Nations

Health TransformationHealth TransformationTransformative Change Accord: Fi t N ti H lth PlFirst Nations Health Plan – Ten‐year Plan includes twenty‐nine key action items 

in four areas of: Governance, Relationships &Accountability, Health Promotion/ Disease & Injury Prevention, Health Services, Performance Tracking

Action Item # 23 –“Create a fully integrated clinical telehealth network” 

First Nations eHealth Governance Structure d E t and Engagement

Tripartite Strategy Council for First Nations eHealth– will establish the strategic direction for BC First Nations ehealth, and will contribute

to the alignment with the BC Ministry of Health’s eHealth Strategy Council, First Nations, and federal eHealth strategic planning

Tripartite Technical Working Group for First Nations eHealth– analysis and planning of non strategic issues for First Nations eHealth– operates as extension of Tripartite Strategy Council for First Nations eHealth– provides support to the Tripartite Strategy Council for First Nations eHealth

First Nations eHealth Centre of Excellence SocietyKey First Nations eHealth operational entity– Key First Nations eHealth operational entity

– effectively manage the First Nations Telehealth Network and apply information technology to facilitate the creation and use of health related data, information, and knowledge for purposes of improving health outcomes

Relationship Diagram Relationship Diagram

BC eHealth Strategy CouncilMinistry, Health Authorities, Ophysician

& Pharmmacist Community

BC Leadership Council

Medical eHealth Deployment Task Group

Health CIO Council

Medical Integration

Working Group

RegistriesPLIS (Lab)-iEHR(HIAL)eDrug EMR-PITO Telehealth Public Health

InformationConnecting Diagnosticg

Steering Committee

iEHR(HIAL)Steering

Committee

gSteering

CommitteeSteering

CommitteeSteering

Committee

InformationSteering

Committee

Diagnostic Imaging

Steering Committee

Clinical Advisory Groups

BC First Nations – Telehealth ExpansionBC First Nations Telehealth Expansion Objective: To build and expand Telehealth capacity within First Nations

communities; to ultimately integrate a First Nations Telehealth Network with the provincial Telehealth and eHealth networks.p s

First Nations TeleHealth Expansion Projectst at o s e e ea t pa s o oject Lead Organization: First Nations eHealth Centre of Excellence (CoE) Society Project Timeline: October 2008 - September 2011Project Timeline: October 2008 September 2011 Scope:

– Integration of First Nations Telehealth Network with eHealth Network Gateway – Enabling 57 endpoint sites (51 FN Communities – 6 HA endpoints)g p ( p )– Each site outfitted standard equipment to enable inclusion in emerging network– Building community capacity (including engagement, education, training)– Expansion of existing wellness & education services through videoconferencingExpansion of existing wellness & education services through videoconferencing– Development of clinical programs (initial focus: Maternal Health, Mental Health,

Diabetes/CDM) and services in alignment with First Nations Health Plan– Establishment of First Nations Telehealth Shared Service OperationsEstablishment of First Nations Telehealth Shared Service Operations– Development of Telehealth-specific capacity within the COE and its resources

First Nations Telehealth –Benefits to Community New training opportunities for community members and health workers - made accessible from within the community

Enable easy and cost-efficient way for health workers andEnable easy and cost efficient way for health workers andadministrators to meet and collaborate with other health centres and health organizations

Reduce patient travel burden, particularly benefiting elderly people and those with young hild h tl h t t l l di t t h lth ichildren who currently have to travel long distances to access health care services

Reducing health professional isolation through enhanced opportunities for peer support and professional development. Improved retention of professional staff in remote work settings

Establishment of a First Nations health network infrastructure that will enable other eHealth and communications solutions for First Nations Health CentreseHealth and communications solutions for First Nations Health Centres

Connectivity update, including federal f di tfunding support First Nations/Federal/Provincial stakeholders have partnered to

bridge the digital divide Investment of $35 M over the next 3 years

– Health Canada First Nation Inuit Health (FNIH) $17.5 M( )– BC Ministry of Labour & Citizen Services (LCS) $17.5 M

All 203 FN Communities will have access to Consumer Grade connectivityy

Approximately 20 FN communities will have access to Industrial Grade connectivity

Planning FN Health Network to integrate with the provincePlanning FN Health Network to integrate with the province

eHealth / Telehealth Next Steps and Planse ea t / e e ea t e t Steps a d a s Continue to support efforts of First Nations eHealth Centre of

E ll S i t d Fi t N ti H lth St t C ilExcellence Society and First Nations eHealth Strategy Council

Support First Nations Telehealth Expansion project team as they begin to execute their project plan

Continue to support planning and design efforts for the Health pp p g gAuthority Network initiative and First Nations Network initiative

Continue to build First Nation eHealth capacity to help advance Continue to build First Nation eHealth capacity to help advance 29 Tripartite Health Plan action items

Thank youThank you