Telehealth in Canada: Challenges Present & Future

1. www.infotelmed.ca Telehealth in Canada: Challenges Present & Future Presentation by videoconference for the TELMED EDUC Congress, October 28th 2004 Sao Paulo – SP - Brasil by JOCELYNE PICOT, PhD Infotelmed Communications Inc (with the collaboration of LCE Communications Inc)

2. 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

3. 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 Canada ’s Health Care Sector www.infotelmed.ca

4. 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

5. 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

6. The five elements needed for telehealth to develop and survivewith 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

7. 1stthe 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

8. 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

9. 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

10. 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? 4th: need committed users, and5th: a sustainable program www.infotelmed.ca

11. 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 ? Funding and Sustaining Telehealth- the New Canadian Solution - www.infotelmed.ca

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14. Need for interoperability and standards across all Canadian jurisdictions Workflow and scheduling requirements Best practices Management models Business cases http://www.infoway-inforoute.ca Infoway’s Telehealth Strategic Investment Plan emphasizes: www.infotelmed.ca

15. Infoway’s Telehealth Strategy: Consulted jurisdictions, experts, stakeholders, and developed a strategy which aims to: • 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) www.infotelmed.ca

16. 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 technologywhich contributes to efficiency, saves time, gains access to just-in-time information • Many examplesof small Canadian companies developing innovative and creative e-solutions • Canadian telehealth suppliersno 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

17. *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

18. Telehealth fosters communication and collaboration: Canadian Aboriginals are also creating networks across the country • 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 www.infotelmed.ca

19. New emphasis onINTEGRATION with all clinical activities Technology suppliers must focus on SOLUTIONS rather than components The total health care enterprise mustEMBRACE, 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 Challenges facing the Canadian private & public telehealth industrythey are the same around the world www.infotelmed.ca

20. LCE LCE Communications Montreal . Canada 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 www.LCE.ca www.infotelmed.ca