Telehealth in Canada: Challenges Present & Future

Presentation by videoconference for the

TELMED EDUC Congress, October 28th 2004

Sao Paulo – SP - Brasilby

JOCELYNE PICOT, PhD

Infotelmed Communications Inc (with the collaboration of LCE Communications Inc)

www.infotelmed.ca

www.infotelmed.ca

Canada, like Brazil, has health care challenges

• 9 million km2 (Brazil 8 million km2)

• North & West vast expanses

•14 jurisdictions: federal, provincial, territorial

• 4,300+ rural/remote communities:

•5% have broadband coverage

• Time differences of +41/2 hours

• 35 million population, avg 3.3 inhabitants / km2

• some areas - densities < 1/ km2 (like Brazil)

• concentration along US border (Brazil, along coastline cities)

Canada

www.infotelmed.ca

Canada ’s Health Care Sector

• Universally accessible, publicly administered system

• Provincial health insurance plans provide health-care coverage without direct charges.

• Some services not covered by public insurance plans

• Geographically, not everyone has «equal» access

• Increasing age of population, increasing cost

• Innovations : telehealth, telepharma, electronic health records, home telecare, interconnected PACS

www.infotelmed.ca

What is telehealth ?

• A Canadian definition:

« the use of information and communications technology (ICT) to deliver health and healthcare services and information over large and

small distances » (Picot 1998)

www.infotelmed.ca

Telehealth in Canada• Telehealth networks in all 14 provinces and territories• All networks engaged in three categories of applications:

• Clinical, educational, administrative• The largest networks are

• In Alberta: 245 locations with 23 First Nations sites – • In Ontario: NORTHnetwork – over 100 active sites, most are northern, remote, on a “membership”model

• Most common clinical applications:• Telepsychiatry• Tele-dermatology• Tele-pediatrics

• Most include tele-imaging: radiology and ultrasonography • Moving towards more 1) integrated solutions 2) home telecare

www.infotelmed.ca

The five elements needed for telehealth to develop and survive

with examples from Canada

Based on real, identified needs

Adequate infrastructure, technical and organizational

Integrated in the health care system

Commited users

Sustained ongoing support / funding

www.infotelmed.ca

1st the need for telehealth exists in Canada!

Example, in Nunavut: Canada’s newest & largest territory

• 30,000 people over 2 million km²

• 4 different languages spoken

• 26 communities - one hospital

• no roads, air travel very costly

• physicians travel to different villages

• patients often travel to obtain care

• extreme climate causes cancellations, delays

• telehealth network connects 25 tiny communities widely dispersed

www.infotelmed.ca

2nd need adequate technical infrastructure and organizational readiness!

• Telehealth is ICT intensive- it needs:

– connectivity

– adequate bandwidth

– stable source of electricity

– technical support

– backup for emergencies

• Appropriate facilities for telehealth

sessions (privacy, lighting, soundproofing)

• Informed, interested, committed users• Organizational leadership• Adequately trained personnel

www.infotelmed.ca

3rd telehealth needs to be integrated in the health care system!

• It changes organization and workflow: scheduling, registration, consulting, access to care

• Must work with clinical information systems

• Licensing, compensation for providers must be in place

• Many aspects involved –see: National Initiative for Telehealth Guidelines or NIFTE: • WWW.NIFTE.CA

www.infotelmed.ca

4th: need committed users, and 5th: a sustainable program

• Commitment goes beyond « the champion »

• Who needs it – who wants it ?

• Are users willing to change their current way of doing things ?

• Will providers use

the system regularly?

• Are administrators committed

to telehealth ?

• Will the project become a program?

• Pilot projects raise expectations!

• Is funding available to continue after pilot phase is over ?

• Is there a long-term plan for modifying, expanding or upgrading?

• Will providers continue to provide services over telehealth?

www.infotelmed.ca

Funding and Sustaining Telehealth- the New Canadian Solution -

Before: government offered grants for one-time pilots.

Recently: government creating partnership programs: (e.g. CHIPP – Health Canada program ended in 2003)

– $80 million, funded 50% of 19 telehealth and 10 EHR projects

– Other 50% from provincial and territorial partners with commitment from partners to sustain program if successful

Now: CANADA HEALTH INFOWAY: STRATEGIC INVESTMENTS

• independent, not-for-profit corporation, accountable to the 14 federal, provincial and territorial governments

• How is this different from previous funding programs ?

www.infotelmed.ca

www.infotelmed.ca

www.infotelmed.ca

Infoway’s Telehealth Strategic Investment Plan emphasizes:

• Need for interoperability and standards across all Canadian jurisdictions

• Workflow and scheduling requirements• Best practices• Management models• Business cases

http://www.infoway-inforoute.ca

www.infotelmed.ca

Infoway’s Telehealth Strategy:

• increase coverage of telehealth in aboriginal, language minority, northern, remote and rural communities

• increase clinical utilisation and sustainability• increase integration into mainstream

healthcare service• increase telehealth link to EHR (crucial)

Consulted jurisdictions, experts, stakeholders, and developed a strategy which aims to:

www.infotelmed.ca

Telehealth now reaches people: in their homes, in workplaces, in offices, in outposts far away

• It’s here to stay: patients love it, remote communities need it, doctors are using it.

• Emphasis on technology which contributes to efficiency, saves

time, gains access to just-in-time information

• Many examples of small Canadian companies developing innovative

and creative e-solutions

• Canadian telehealth suppliers no longer developing large

hardware components but implementing small scale solutions

• Encourages private-public partnerships to break down

barriers to the free flow of information.*

www.infotelmed.ca

*Example: the Integrated Healthcare enterprise (IHE) Canada

• Part of a worldwide movement working to eliminate incompatiblity barriers to information flow

• Gathers industry and professional associations

• Open, not-for-profit organization promotes and facilitates the adoption of IT standards among Canada’s healthcare community

• Includes vendors, academics, professionals. All members are volunteers.

www.infotelmed.ca

Telehealth fosters communication and collaboration:

• Many live in remote, rural communities• Need to travel long distances for specialist care• May have language barriers• Have important health problems, for example, diabetes• Telehealth leaders recently created the Aboriginal

Telehealth Knowledge Circle (ATKC)• Are ready to engage in knowledge transfer activities with

other countries like Brazil

Canadian Aboriginals are also creating networks across the country

www.infotelmed.ca

Challenges facing the Canadian private & public telehealth industry

they are the same around the world

New emphasis on INTEGRATION with all clinical activities

Technology suppliers must focus on SOLUTIONS rather than components

The total health care enterprise must EMBRACE, NOT REJECT, appropriate, tested ICT solutions

… to get the right information,

into the right hands,

at the right time,

to support healthcare service delivery,

health care decision -making, and

health system sustainability

Thank you sincerely for your attention!

Jocelyne Picot M.A., PhD President, Infotelmed Communications Inc

This presentation was prepared with the assistance of:

LCE Communications

LCELCE Communications

Montreal . Canada

www.infotelmed.cawww.LCE.ca