Seminar Health Telematics Unit U. of Calgary

1. Seminar Health Telematics Unit U. of Calgary The Evolution of Telehealth: “Where From Here?” Jean-Paul Fortin md Laval University, Cau-CSSS Quebec January 18th 2008

2. Topic • From a Key note address on : • Where telehealth is in Quebec and why • Where to go and how • To an opportunity for sharing on why and how elsewhere in Canada

3. Data Sources • Field observation, experimentation, research, and evaluation • Collaborative work with WHIC, HTU • Occasional advisor for Infoway • RQT Med coordinator, CST Board member • CHIPPS projects study for change management and telehealth integration in HC services

4. Telehealth in Quebec • Quick and impressive start: • From a few field clinical, managerial, and technical champions initiatives • And central support • Followed by slowing progress in: • Use of telehealth • New initiatives, projects or • Studies to learn about best practices, conditions on implementation, adoption, sustainability, diffusion.

5. In between • Transformation of HC system • 4 Supra regional advisory boards • Integrated Health University network (RUIS) • A leverage for one of the Ministerial silos • RUIS-telehealth: for developing and leading telehealth … with Ministerial coordination • No field project central funding for more than 5 years • Less collective action • Building on hope from Infoway • No evidence of telehealth being a priority

6. Elsewhere • CST recognizes need for promoting telehealth • Central decision makers rarely “building on telehealth” • Neither are the media… • More and more convivial and convergent technologies for integrated daily use • Prevention, intersectoral projects • Used by social services and communities for less social loneliness, for consolidating social networks in remote area and … large cities • Alliances between municipalities, communities and many other sectors influencing health

7. Why : • Is there a lack of pertinent information for decision makers ?? • And for the population?? • Did DM choose to prioritize EHR? • Is telehealth seen as being only a technological challenge? • Is there opportunuity for innovation in our systems? Is there too much centralization? • Is technology solely IT leadership dependant? • Is there a PPP gap? • Is Infoway part of the solution or the problem?

8. Infoway ? • Some interesting projects • scheduler, business case, convergence, group bying. • But $$$ transferred from telehealth to EHR? • Small part of provincial need, …mostly technology • No real change management funding, nor formative evaluation • Is funding influenced by health being a provincial jurisdiction? • Important influence as a leverage. • How far on provincial development plans? • Infoway contribution is not to be seen as a finality but a means to support provincial strategic choices for HC services organisation.

9. But • Telehealth is a must • Evidence - more and more numerous • We need a shift

10. Factors • Telehealth is a « care technology » not only a tool • Implies clinical processes revisited, roles and responsibilities renegotiated and services reorganised • Conditions of adoption linked to field requirements • Clinical leadership driven

11. Need to manage • Impact on md distribution in the province • Consequences of non telehealth related decisions (cardiologists training internists for echocardiograph examination) • Adjustments between md and nurses in remote areas, other professionals in specific programs (retinal screening program) • Organisational change related to telehomecare

12. Need to remember • Innovation, adaptation and evolution start • Where real experts are (field experts) • Where clinical processes change and integration conditions are • Need to rely on settings with innovation culture so to initiate

13. No unique solutions • Need for systematic formative evaluation • Capitalise on alliances with researchers and evaluators with much field experience

14. Decentralized governance • To much centralisation = to much bureaucracy and less field adapted solutions • Centralisation = barriers to quick operational decision making process • So : • Is a good definition of innovation: « a delinquency that has succeeded »(Sériex)? • Is it more appropriate « to ask pardon to the central decision makers than ask permission? »

15. More health field experience leaders are needed • Expertise balanced direction and management team • Common vision of telehealth • Knowing characteristics and conditions of clinical and managerial processes to change • Large experience in managing multiple interfaces required in telehealth • Clinicians and care teams • Specializes and primary care institutions, • Regions

16. Need to recognize central roles • Publicise strategic orientations in telehealth • Laws and regulation adapting to applications conditions • Optimal functioning of major common interest infrastructures • Technical norms and standards • Guiding principles for • Win-win and incentive oriented HC system financing, • Md remuneration • PPP partnerships

17. A must • Capitalising on between levels of interventions synergy • Recognition and respect of everyone strength (local, regional, and central). • Have users involved more than only occasionally consulted

18. Where to go • Better known added values, best practices, conditions of uses • Inputs for needed definition from requesters, regions, and PC. • More networked and available research and evaluation expertise • Target setting well known for innovation culture • Develop more capacity to learn from projects • Ensure at local and regional level : • Balanced and decentralised governance • Clinical services oriented team • Have planners and programmers included in mandate to look for how telehealth could influence health objectives and how to integrate into practices and services and in the transformation strategy of HC system …

19. MOBILISATION • Need to have all those who believe in telehealth to mobilise so to influence decision makers at all levels, colleagues potential partners stakeholders • Even if a bit delinquent there must be : • Telehealth initiatives with primary stakeholders • Forum for open discussion • Channel of communication to update and harmonise the messages

20. RQT Role • Drivers for recognition of teleheath as an essential strategy for better heath and social care for the population • Symposium: • The most important activity to contribute for « change management » • Opportunity to share experiences and expertise without barriers that some of our structure and functioning bring along • Initiate and participate in community of practice building (coordinators and research evaluators), • Support dialogue with industry, patients, and population • Alliances and partnership with societies with same objectives in Quebec, Canada and elsewhere • Soqibs, SCT with two directors as CST elected board members, Catel in France..

21. Key: individual and collective action Winners : patients and population • 1) Lamothe, L., Fortin, J-P., « Gestion du changement » et « L’intégration des technologies dans le continuum de soins », CHIPPS projects, Santé Canada. March 2007. • 2) « Telehealth- What the Future Holds”, White paper produced by the Canadian Society of Telehealth (2007) (soon available on web sites • 3) Telehealth Change Management Repository, http://www.cst-sct.org/cm/. • 5) Home_Telehealth_Business_Case_Report, Infoway 2007. http://www.infoway-inforoute.ca/fr/pdf/_FR.pdf