2013 Canadian Telehealth Report

C A N A D I A N TELEHEALTH R E P O R T

www.coachorg.com

BASED ON THE 2012 TELEHEALTH SURVEY

2013

Public Version

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without permission in writing from the publisher.

© 2013 COACH: Canada’s Health Informatics Association (Revised June 2013)

ISBN 978-0-9879573-8-2

National Office 250 Consumers Road Suite 301 Toronto, Ontario M2J 4V6

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Produced in Canada

32013 CANADIAN TELEHEALTH REPORT | | © COACH: Canada’s Health Informatics Association

Acknowledgements ......................................................... 6

Executive Summary ........................................................ 8

Preface .......................................................................... 12

Program Volume Overview .......................................... 15

Delivery of Clinical Sessions ..........................................18

Clinical Services Overview ............................................ 20

Home Telehealth ........................................................... 24

Delivery of Healthcare Educational Sessions .............. 27

Educational Service Areas Overview ............................ 30

Telehealth Technology Supporting Administrative Events ................................ 34

Accreditation Of Telehealth Programs ......................... 35

Teletriage Nurse Call Lines .......................................... 36

Telehealth Program Specific Websites ......................... 37

Medical Peripherals ...................................................... 39

Desktop And Mobile Video Conferencing ...................... 40

Electronic Scheduling ................................................... 43

First Nations ................................................................. 45

Next Steps ..................................................................... 50

Appendix A: Glossary .....................................................51

Contents


TAbLE 1: Program Volume Details ................................16

TAbLE 2: Available Clinical Services ............................21

TAbLE 3: Home Telehealth Monitoring Devices .......... 26

TAbLE 4: Home Telehealth Monitoring Data ............... 26

TAbLE 5: Available Educational Service Areas .............31

TAbLE 6: Teletriage Services ....................................... 36

TAbLE 7: Medical Peripherals ..................................... 39

TAbLE 8: Desktop and Mobile Video Conferencing ...... 40

TAbLE 9: Technology Used for Peer to Peer Video Conferencing & Associated Use Policies ......................41

TAbLE 10: Program Volume Details in First Nation Regions ................................................. 46

TAbLE 11: Available Clinical Services in First Nation Regions ................................................. 47

TAbLE 12: Available Educational Service Areas in First Nation Regions ................................................. 48

TAbLE 13: Availability of Public Websites and Tools in First Nation Regions ................................................. 48

Tables


FiGURE 1. Percentage Growth of Clinical Sessions Since 2002 as Reported by Four Jurisdictions ...............14

FiGURE 2. Number of Hospital-based and Community Endpoints in 2010 and 2012 Across Jurisdictions ........... 17

FiGURE 3. Total Number of Clinical Sessions in a 12 Month Period Per 25,000 Population .................18

FiGURE 4. Total Number of Clinical Sessions Provided in the Last 12 Months ......................................19

FiGURE 5. Jurisdictional Home Telehealth Monitoring Endpoints in 2010 and 2012 ......................... 24

FiGURE 6. Three Jurisdictions that Added Home Telehealth Monitoring Endpoints in the Last 12 Months .................................................... 24

FiGURE 7. Total Number of Educational Sessions Provided in the Last 12 Months ..................... 28

FiGURE 8. Total Number of Educational Sessions in a 12 Month Period per 25,000 Population.................. 29

FiGURE 9. Total Number of Administrative Events Using Videoconferencing in a 12 Month Period Per 25,000 Population ................................................... 34

FiGURE 10. Accreditation of Telehealth Programs ....... 35

FiGURE 11. Telehealth Program Specific Websites Available to the Public................................................... 37

FiGURE 12. internal Websites Accessible to Staff and Authorized individuals ............................................ 38

FiGURE 13: Electronic Scheduling Systems.................. 43

FiGURE 14: internal and Provider Use of Electronic Scheduling .............................................. 44

FiGURE 15. Electronic Scheduling of Appointments Across Telehealth Programs ....................................... 44

FiGURE 16. Accreditation of Telehealth Programs in First Nation Regions ................................................. 47

FiGURE 17. Electronic Scheduling Systems in First Nation Regions ................................................ 49

FiGURE 18. internal, Provider and Patient Use of Electronic Scheduling in First Nation Regions ............. 49

Figures


The development of this 3rd Canadian Telehealth Report and the supportive participation from so many across Canada speaks to the depth, commitment, transparency and leadership of the telehealth community. The strength of this community can be seen in the enthusiastic and fervent contributions of the staff and management of the many telehealth programs, clinics, teletriage services and other facility or home based telehealth services in every jurisdiction and every remote, rural or urban health organization. The patients and providers receive the benefit of the great work of so many in the telehealth community.

On behalf of the COACH Board of Directors and all users of this Report, both nationally and internationally, I would like to thank the many contributors to the 2013 production of the Canadian Telehealth Report. In particular I would note the work of John Schinbein, the outgoing Executive Director, Canadian Telehealth Forum for his continued leadership in the development of this bi-annual report and a special thanks to Grant Gillis, the incoming Executive Director of CTF, Annabelle Sumenap, Sarah Jiwa, other COACH staff and Alex Hennig who supported the editing, design and production of this report.

I would also like to thank the Ministries of Health of every jurisdiction, the telehealth networks, eHealth programs and numerous staff in each organization that contributed their data to this Report. Without your enormous support, there would be no Canadian Telehealth Report.

Finally, a thank you to Canada Health Infoway for their strong interest, specific use and promotion of this Report.

Please enjoy your read of this fine Report.

Don Newsham, BSc, BAdmin, CPHIMS-CA Chief Executive Officer COACH: Canada’s Health Informatics Association

Acknowledgements


Acknowledgements

TELEHEALTH PROGRAM CONTRIBUTORS

British ColumbiaProvincial Telehealth Office

Jane London

Vancouver Island Health Authority (VIHA)

Margarita Loyola

Interior Health Authority (IHA)Loretta ZilmDon Fletcher

Fraser Health Authority (FHA)Laura Caron

Provincial Health Services Authority (PHSA)

Valerie AshworthIgor Marusech

Northern Health Authority (NHA)Frank FloodValerie HartDana Stephen

Vancouver Coastal Telehealth (VCH)

Ian LeylandBrian BootsmanLiz Santos

First Nations Health Authority Telehealth Office

Sean Taylor Stephen Prevost Dr. Shannon Waters

AlbertaAlberta Health Services

Josephine Amelio

Jason L. Kettle

First Nation Inuit Health Branch Alberta Region Telehealth

Michelle HoeberBrendan Lee

SaskatchewanTelehealth Saskatchewan

Dr. Gary MorrisNeil Olynick

First Nation Inuit Health Branch eHealth Saskatchewan Region

Suzanne FedorowichTrevor EnnisDeborah Kupchanko

ManitobaManitoba Telehealth

Gwendolyne NyhofMike Heise

OntarioOntario Telemedicine Network

Neil MacLeanFrank van Heeswyk

Keewaytinook Okimakanak (KO) eHealth Telemedicine (First Nations)

Orpah McKenziePenny CarpenterDonna Roberts

First Nation Inuit Health Branch Ontario Region Telehealth

Deborah Potvin-Mask

QuébecTélésanté Québec (RUIS McGill Virtual Health and Social Services Centre (CvSSS)); Télésanté RUIS de l’Université de Montréal; Télésanté RUIS de l’université Laval; Télésanté RUIS de l’université de Sherbrooke

Christian-Marc Lanouette

New BrunswickNew Brunswick Regional Health Authorities

Sam FieldingDarren McKinnon

Horizon Health Network Krisan Palmer

Vitalité Health NetworkSilvana BoscaNicole Chevarie

Nova ScotiaNova Scotia Telehealth

Sandra CascaddenLeigh Whalen

Newfoundland and Labrador Newfoundland and Labrador Telehealth Program

Joanne Reid

Prince Edward IslandQueen Elizabeth Hospital Telehealth & Videoconferencing Services

Julie Cole

Yukon TerritoryYukon Territory Telehealth Project

Dagmar Borchardt

Northwest TerritoriesNWT Telehealth

Jason Doiron

NunavutNunavut Telehealth

Tracy MacDonaldDarryl Smith

First Nations and Inuit Health Branch (National)

Guy MacLaren


Healthcare in Canada continues to face increasing demands for services, generated by many factors including an aging population (patients and care providers), and the increased availability of new, but costly diagnostic testing technology and drug therapies. While current healthcare resources continue to struggle to meet these demands, service delivery alternatives such as telehealth are continuing to augment resources and address the growing gap between demand and capacity.

As they play an expanding role in meeting healthcare service demands, telehealth and other eHealth initiatives such as the Electronic Health Record are increasingly appreciated as key tools in bridging the gap and moving towards patient centric care. The particular contribution of telehealth involves the elimination of distance barriers, improving equity of access to services that often would otherwise not be available in remote and rural communities. Fundamentally, telehealth connects providers with patients and clients, through the digital transmission of voice, data, images, and clinical information rather than physically moving patients or health practitioners and educators. Access, timeliness, productivity, quality, convenience are all improved, and travel costs are reduced if not avoided.

Telehealth also provides the added benefit of patients becoming active participants in their own care and well-being, including receiving education aimed at fostering their health and wellness from the comfort, convenience and safety of their own homes and communities.

In 2011 Canada Health Infoway commissioned a study by Praxia and Gartner to document the benefits accruing to patients, providers and the health system through the appropriate use of telehealth. Leveraging data from the 2011 Canadian Telehealth Report, the Infoway commissioned study’s resulting report - Telehealth Benefits

and Adoption Connecting People and Providers Across Canada1 - clearly shows that telehealth continues to have a positive impact in the areas of access to care, quality, productivity and reduced cost.

As a service to the telehealth community, since 2008, the CTF (Canadian Telehealth Forum) of COACH: Canada’s Health Informatics Association has conducted a bi-annual survey and developed a report of telehealth services across Canada. The report is intended to provide in-depth information on a jurisdiction-specific basis for telehealth services being provided in Canada.

It must be stressed that the collection and comparison of the data between jurisdictions is challenging as the structure of the telehealth programs and networks in Canada varies significantly between jurisdictions, as does the taxonomy and scope of data they collect. For the purpose of this report, in order to provide a provincial and territorial level comparison, where the telehealth programs are regionally, authority or hospital based, those data were aggregated. As a result of the variation in data collected, the authors of this report have made significant attempts to validate and standardize the reporting of data for comparison purposes within the report. For accuracy, the specific service data provided by the jurisdictions is provided within the appendices of the Comprehensive Version of the Report.

The data contained in this report represents a consecutive 12-month period, taken at respective points in time selected by each of the jurisdictions between 2010 and 2012. Therefore, any comparison of this report’s data with other publications should be viewed with caution as the time frame and thus the reported data may be at variance amongst the reporting jurisdictions. It is also important to note that during their respective chosen reporting periods, the jurisdictions’ telehealth programs could continue to add new clinical

1 Gartner & Praxia. (2011). Telehealth benefits and adoption: Connecting people and providers across Canada. Retrieved from: https://www.infoway-inforoute.ca/.

Executive Summary


ExEcutivE Summary

and educational sessions as well as expand the number of end points, thus this report should only be considered accurate at the time the data was submitted by the jurisdictions. It is intended as a snapshot in time and a comparison between the data reported by the jurisdictions in 2010 and 2012.

The structure of the various programs and networks also impacts the comparability of some of the data. As an example, in Alberta there is one health region for the entire province, and all desktop video conferencing data for administrative purposes are captured across the organization by its central information technology department, not just for the telehealth program. In comparison, due to their multiple structures, the other jurisdictions have only been able to provide data for the administrative use of desk-top video conferencing used by the telehealth program, thus the significant variation in reported volume in this particular use of telehealth.

For the first time the regional (provincial) offices of the First Nations and Inuit Health Branch (FNIHB) provided the First Nations’ Data, but not all regional offices were able to respond to the survey so a complete national picture is not currently available. The data presented on First Nation’s telehealth services is a subset of the data reported by the jurisdictions. There might be overlap in the data for the First Nation regions with the data provided by the corresponding jurisdictions. The data collected is still very useful to capture the types and volume of services being provided by several jurisdictions to First Nations communities, which are typically located in isolated and remote areas, thus making access to traditional health services difficult. Improvements to the communications infrastructure for isolated and remote communities, along with advances in technology, bode well for the expansion of services to First Nations communities.

Results

Telehealth Endpoints

All jurisdictions reported some expansion in the number of hospital-based and community telehealth endpoints. The aggregate reported national expansion of hospital-based and community telehealth endpoints between 2010 (6,460) and 2012 (7,297) was 13%.

Clinical Sessions

All jurisdictions reported an increase in the number of clinical telehealth sessions between 2010 (187,385) and 2012 (289,747). The aggregate growth in volume (2012) was 54.6% over that reported in 2010. In its 2011 report2, Praxia and Gartner reported the growth in clinical events through telehealth at a rate of 35% per annum between 2006 and 2010. With inclusion of the data from 2010-2012, the number of clinical telehealth sessions have grown by approximately 195% from 2006-2012.

Clinical Service Areas

Over 79 distinct areas of clinical services were reported. In 2012, six new clinical service areas were added to the survey: Cardiac Rehab/Atrial Fibrillation, Homecare Monitoring – COPD, Homecare Monitoring-Dementia, Genetics – HCP (Hereditary Cancer Program), Occupational Stress Injury and Emergency Medicine. In the 2011 Canadian Telehealth Report, ICU/Emergency Medicine was reported as one type of telehealth clinical service. This year, ICU and Emergency Medicine are two distinct telehealth clinical services that are reported separately.

2 ibid.


ExEcutivE Summary

In 2010, the aggregate number of clinical service areas across all the jurisdictions was 393. In 2012, an additional 123 clinical service areas were added which results in a 31% increase since 2010.

The most commonly reported services being delivered by telehealth are:

• Mental Health (Psychiatry & Psychology) (13 jurisdictions)

• Cardiology, Diabetes, Genetics, Oncology (12 jurisdictions)

• Chronic Pain, Neurology, Rehabilitation (Occupational Therapy), Rehabilitation (Physiotherapy) (11 jurisdictions)

Home Telehealth Monitoring Endpoints

British Columbia, Ontario, New Brunswick, Québec, and the Yukon Territory reported home telehealth programs were in place and expanding. The number of endpoints increased by 18% between 2010 (2,095) and 2012 (2,465). CHF (congestive heart failure) and COPD (chronic obstructive pulmonary disease) dominate the conditions being monitored. Only Québec reported providing monitoring services for diabetes.

The rate of growth in home telehealth (monitoring) is well below the overall growth of telehealth services. This was not expected. It was anticipated that given the significant growth rate of chronic disease in the Canadian population, and its particular impact on the health system utilization, that fairly rapid growth would be seen in this area. A number of studies and growing program experience have already shown that regular monitoring and timely intervention reduces hospital admission rates, health system costs and in many cases has a positive impact on the long-term health implications for those suffering from chronic diseases such as diabetes, hypertension, CHF

and COPD.3 4 The reasons for this slower than expected growth are not currently fully known and will likely vary by jurisdiction, however, the Canadian Telehealth Forum has established a Community of Interest of Home Telehealth and this will be one of the first areas of discussion. It is speculated that one reason for the slower than expected growth is the lack of research and consistent evidence. In the last year or so, a number of seemingly contradictory studies, some indicating benefits and others indicating little or no benefit have been published. 3,4,5 . As well, some jurisdictions are currently evaluating their pilot programs, in which the results will determine the future program structure and rate of expansion.

Educational Service Areas

The jurisdictions continue to use telehealth to deliver educational services. Telehealth is currently covering a total of 90 distinct educational service areas across the country for clinicians, patients and families. In 2010 the jurisdictions in aggregate, reported providing education in 208 areas, this has expanded to 266 educational areas in 2012, a growth rate of 28% between 2010 and 2012. As a jurisdiction, the Ontario Telemedicine Network (OTN) provides the broadest range of educational areas via telehealth, covering all 90 identified educational areas.

3 Noel, H.C., Vogel, D.C., Erdos, J.J., Cornwell, D., Levin, F. (2004). Home telehealth reduces healthcare costs. Telemed J E Health, 10(2): 170-83.

4 Dinesen, B., et al. (2012). Using preventive home monitoring to reduce hospital admission rates and reduce costs: A case study of telehealth among chronic obstructive pulmonary disease patients. J Telemed Telecare, 18(4): 221-5.

5 Cartwright, M., et al. (2013). Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator elehealth questionnaire study): Nested study of patient reported outcomes in a pragmatic, cluster randomized controlled trial. BMJ, 346: f653.


ExEcutivE Summary

Medical Peripherals

A range of medical peripheral devices is used in support of clinical assessments conducted by telehealth. Exam cameras are used in all jurisdictions except Prince Edward Island and the Northwest Territories. Digital stethoscopes are used in nine jurisdictions; digital ophthalmoscopes in two jurisdictions; ocular cameras in three jurisdictions; and digital endoscope in two jurisdictions. More detail is available in the body of the report.

Desktop and Mobile Video Conferencing

This area continues to expand in use as the technology becomes more affordable and ubiquitous. Of the thirteen jurisdictions, eight provide for some form of desktop or mobile video conferencing and all eight of these jurisdictions use this technology for clinical consultations, while only half or four of the jurisdictions use it for patient education purposes.

Electronic Scheduling Services

All thirteen jurisdictions reported using some form of electronic scheduling to support telehealth services in 2012; this is an improvement over 2010, when ten jurisdictions reported use of e-scheduling. The main body of the report identifies which jurisdiction is using what scheduling system. A number of jurisdictions (7 of

13) support online schedule viewing by providers (not the act of scheduling, but the ability to view a scheduled appointment); no jurisdiction currently permits online viewing of the telehealth program service schedule by patients. Online scheduling by providers is currently available in six of the thirteen jurisdictions; no jurisdiction provides for online scheduling by patients.

Conclusion

Telehealth continues to be an area of rapid expansion both in the volume and types of services provided for healthcare and health education delivery in Canada. Praxia and Gartner state that the rate of growth continues to outpace many other areas of eHealth with respect to adoption and impact on service delivery to the patients and providers. Between 2006 and 2010, the rate of growth equaled 35% per year; growth in telehealth services continued between 2010 and 2012, with the volume of clinical services reported increasing by almost 54.6%, this is an approximately 195% growth in clinical service provision by telehealth in the last six years. This is an amazing rate of growth and clearly speaks to the adoption and acceptance of telehealth by patients and providers as an increasingly mainstream method of delivering many health care services in Canada.


“TELEHEALTH – ELIMINATING DISTANCE IN THE

PRACTICE OF HEALTHCARE AND WELLNESS

UTILIZING INFORMATION COMMUNICATION

TECHNOLOGIES”6

BACKGROUND

This is the third in a series of bi-annual reports (2008, 2011, 2013) developed by the CTF (Canadian Telehealth Forum), a forum of COACH: Canada’s Health Informatics Association. The 2008 report was developed by the CST (Canadian Society of Telehealth). The reports are based on the responses to a survey sent to all jurisdictions (provinces and territories). The reports build on each other and are intended to provide in-depth information on a jurisdiction-specific basis for the expansion of telehealth services being provided in Canada. The comprehensiveness of the data reported has also increased in the 2012 survey in response to requests from the jurisdictions and Canada Health Infoway.

METHODOLOGY

A standard form survey was developed for 2012 based on the 2010 survey and input received from stakeholders between September and October 2012. Several new clinical services areas have been added and others deleted based on the input from stakeholders. In November 2012 the survey was sent to all jurisdictional (provincial and territorial) telehealth programs and networks. All jurisdictions were able to respond to the survey and provide data for the report by the end of January 2013.

6 Canadian Society of Telehealth. (2008). 2008 Strategic Plan.

The collection and comparison of the data between jurisdictions is challenging as the structure of the telehealth programs and networks in Canada varies significantly between jurisdictions, as does the scope of data they collect and the taxonomy they use. In Ontario, Manitoba, Newfoundland and Labrador, telehealth is coordinated or delivered by a single provincial program, whereas in other provinces such as British Columbia, New Brunswick and Nova Scotia the programs are regionally or health authority based and in Prince Edward Island, telehealth programs are hospital based. For the purpose of this report, in order to provide a provincial and territorial level comparison, where the telehealth programs are regionally, authority or hospital based, the data were aggregated.

The type of service data collected by the programs and the service taxonomy also varies across the country. As a result of the variation in data collected, the authors of this report have undertaken significant efforts to validate and standardize the reporting of data for comparison purposes within the report; these efforts notwithstanding, the authors anticipate that the data still reflects some variation within and between the jurisdictions. For accuracy, the actual service data provided by the jurisdictions is provided within the appendices of the comprehensive report.

Preface

Throughout the report, this document will be referred to as the 2013

CANADIAN TELEHEALTH REPORT. Survey data for this report was

collected in 2012 and will be referenced as such. As the report is

published bi-annually, references to the previous report will made as the

2011 CANADIAN TELEHEALTH REPORT with survey data from 2010.


Preface

LIMITATIONS

The data contained in this report represents a consecutive 12-month period and were taken at a point in time selected by the jurisdictions between 2010 and 2012. Therefore, any comparison with other publications should be viewed with caution as the time frame and thus the reported data may be at variance. Programs also continue to add new clinical and educational service areas as well as expand the number of end points.

As noted earlier, the service data collected varies between jurisdictions. It is also recognized that some data may not be available, e.g. data from private clinics that are not part of the jurisdiction’s telehealth program. Each jurisdiction also varies in its capacity to collect data, in some it is collected manually and others electronically through operational and scheduling systems. This is the first time non-program volume data was submitted for Québec to the Canadian Telehealth Report. This is also the first time that representation is seen from Prince Edward Island, but it is important to note that the data captured is only from one hospital: Queen Elizabeth Hospital.

The structure of the various programs and networks also impacts the comparability of some of the data. As an example, in Alberta there is one health region and all desk-top video conferencing for administrative purposes is captured across the organization by its central information technology department not just for the telehealth program. In comparison, due to their multiple structures the other jurisdictions have only been able to provide data for the

administrative use of desk-top video conferencing used by the telehealth program, thus the significant variation in reported volume.

The regional (provincial) offices of the First Nations and Inuit Health Branch provided the First Nations’ data. Not all regional offices were able to respond to the survey so a national picture is not currently available. The data presented is a subset of the data reported by the jurisdictions. There might be overlap in the data for the First Nation regions with the data provided by the corresponding jurisdictions.

OVERVIEW

Telehealth is an important strategy in healthcare as it benefits health professionals, patients and communities. Health professionals are able to continue professional development through educational learning and training via video conferencing and secure professional portals. Travel time and distance barriers are virtually eliminated for patients who live in remote areas where access to a hospital or clinician is limited. Communities can stay connected to health professionals and have greater control and access to information and services. It is recognized that telehealth may not be appropriate or available in all circumstances. Where it is available and appropriate costs are reduced for patients and travel assistance programs as there is no need for travel expenses.

Figure 1 shows the percentage growth in clinical sessions via

telehealth since 2002 in select provinces. This figure shows that

telehealth services in small, medium and large jurisdictions are

growing at a reasonable rate. Although Ontario provides the greatest


Preface

number of clinical sessions, it did not report the highest percentage

growth in clinical session. Instead, Alberta and Manitoba which

provide a medium capacity of clinical sessions showed the greatest

percentage of growth via telehealth. It is important to note that

the Yukon Territory which provides a smaller capacity of clinical

sessions had a significant growth percentage for clinical sessions via

telehealth. This suggests that there is an improvement in the use

and implementation of telehealth programs in more remote areas of

Canada since 2002.

Figure 1. Percentage Growth of Clinical Sessions Since 2002 as Reported by Four Jurisdictions

Figure 1. Percentage Growth of Clinical Sessions Since 2002 as Reported by Four Jurisdictions

0% 200% 400% 600% 800% 1000% 1200%

Yukon

Ontario

Manitoba

Alberta

Percentage Growth of Clinical Sessions Via Telehealth Between 2002 to 2012

JurisdicPon

s

A SERvICE or SERvICE AREA (clinical or educational) is a TyPE of

service provided by a jurisdiction (e.g. Cardiology) whereas a SESSION

(clinical, educational, other) represents a single OCCURRENCE within a

service area (e.g. 16 Cardiology sessions)


Each jurisdiction was asked to describe the broad capacity of their telehealth program by providing volume details (Table 1) that can be compared across jurisdictions. In 2010, Ontario reported 305 communities served via telehealth, but in 2012, Ontario only stated that telehealth services were provided to communities across Ontario. Québec did not provide the number of communities served for 2010 or for this year’s report. Number of Communities Added in the Last 12 Months, Number of Health Facility / Hospital Based Endpoints Added in the Last 12 Months and Number of Community/Shared Facility Endpoints Added in the Last 12 Months are new telehealth program indicators added to the 2013 Canadian Telehealth Report to reveal any expansion in telehealth endpoints since the release of the 2011 Canadian Telehealth Report. It is important to acknowledge Québec’s first time reporting on the number of health facility/hospital based endpoints. Many jurisdictions saw an increase in the number of health facility / hospital based endpoints when compared against the 2011 Canadian Telehealth Report. Four out of the eleven jurisdictions reporting data in both 2010 and 2012 [Northwest Territories (2010: 38, 2012: 34), Nova Scotia (2010: 120, 2012: 78), New Brunswick (2010: 286, 2012: 138) and Manitoba (2010: 155, 2012: 64)] reported a decrease in the number of health facility/hospital based endpoints in their jurisdictions. Ontario is the only jurisdiction reporting an increase in the number of community/shared facility endpoints since 2010. Additional investigation is warranted as to why the numbers are not consistent across jurisdictions. Although Saskatchewan, Québec and Newfoundland and Labrador did not submit data on the number

of community/shared facility endpoints, only Québec explained that their jurisdiction does not report this as a telehealth program indicator. Alberta also explained that it does not differentiate between the number of community/shared facility endpoints and the number of health facility / hospital based endpoints.

New Brunswick is the only jurisdiction that was unable to provide volumes of clinical and educational sessions, in addition to the number of administrative events using videoconference. Alberta reported the greatest number of total number of other events / services (i.e. legal assessments) across jurisdictions and reported that this number was attributed to unique audio conferences using telehealth services. Telehealth Program contacts at Alberta Health Services have confirmed this data point (545,606 total number of other events / services). The Canadian Telehealth Forum and COACH are continuing to determine how total number of other events / services is reported across jurisdictions.

Program volume Overview

The largest increases in the NUMBER OF FACILITy/HOSPITAL BASED

ENDPOINTS from 2010 to 2012 were found in:

British Columbia - 241% (2010: 233, 2012: 794) Newfoundland and Labrador - 26% (2010: 50, 2012: 63) Ontario - 24% (2010: 1,740, 2012: 2,154)


Program Volume oVerView

Table 1: Program Volume Details

BC AB SK MB ON QC NB NS NL PE YT NT NU

Total Population (thousands)1 4,622.6 3,873.7 1,080.0 1,267.0 13,505.9 8,054.8 756.0 948.7 512.7 146.1 36.1 43.3 33.7

Number of Communities Served 119 120 76 72 — — 40 54 61 ** 14 32 25

Number of Communities Added in the Last 12 Months 9 — 13 4 — — 1 0 2 0 2 0 0

Number of Health Facility / Hospital Based Endpoints 794 1,152 162 64 2,154 659 138 78 63 2 48 34 36

Number of Health Facility / Hospital Based Endpoints Added in the Last 12 Months 68 320 29 6 421 162 4 0 2 0 14 0 2

Number of Community/Shared Facility Endpoints 87 1,152 — 121 480 — 0 5 — 0 18 39 11

Number of Community/Shared Facility Endpoints Added in the Last 12 Months 4 320 — 26 105 — 0 0 — 0 0 0 1

Total Number of Clinical Sessions in the Last 12 Months 25,846 11,737 3,832 12,367 204,058 6,790 — 1,666 10,784 82 855 2,757 1,755

Total Number of Educational Sessions Involving Patients/Families in the Last 12 Months

470 694 132 103 *** 700 — 262 13 13 0 0 108

Total Number of Educational Sessions Involving Clinicians in the Last 12 Months (i.e. CNE/CME, Rounds)

6,264 1,116 1,683 2,009 13,965 7,960 — 1,192 198 463 611 1,087 900

Total Number of Administrative Events Using Videoconferencing in the Last 12 Months 3,521 109,664 1,307 1,687 16,523 5,700 — 870 *** 46 275 537 173

Total Number of Other Events / Sessions (i.e. legal assessments) 271 545,606* 0 35 — 153 — 9 0 — 0 1,057 180

Site Coordinators for Each Agency/Hospital YES YES YES NO YES YES YES YES NO YES YES NO NO

1.Statistics Canada. Table 051-0001 - Estimates of population, by age group and sex for July 1 2012, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database).

LEgENd:— Jurisdiction did not provide data * Alberta Health Services has confirmed this data point** Available across Queen’s County*** Utilized but not tracked


Program Volume oVerView

Figure 2 reveals that the total number of health facility / hospital based endpoints and the number of community/shared facility endpoints have increased since 2010 by 13%. The overall increase in the total number of endpoints is largely due to an increase in the number of health facility / hospital based endpoints since 2010 (2010: 3932, 2012: 5382).

Figure 2. Number of Hospital-Based and Community Endpoints in 2010 and 2012 Across JurisdictionsFigure 2. Number of Total Endpoints in 2010 and 2012 Across Jurisdictions

6460

7297

6000

6200

6400

6600

6800

7000

7200

7400

2010 2012

Total N

umbe

r of End

points


A clinical session is any event involving the care of a patient including any clinician - patient consults or clinician - clinician consults for case management purposes.

In telehealth, the change in the volume of sessions provided is often used as a proxy for adoption. As the populations and demographic distribution vary across the jurisdictions, it is suggested that absolute volume numbers between jurisdictions should not be compared as an indication of adoption rates between jurisdictions. In order to view the data for comparability, the number of sessions provided per 25,000 population were calculated. This shows the heavier reliance on telehealth in the remote and isolated regions of Canada.

All jurisdictions with the exception of Nova Scotia reported an increase in the total number of clinical sessions in the last 12 months as compared to the 2011 Canadian Telehealth Report (Figure 4). This is the first time that Prince Edward Island is submitting data to the Canadian Telehealth Report. New Brunswick did not provide data for the total number of clinical sessions in this year’s survey.

Delivery of Clinical Sessions

The largest percentage increases in the TOTAL NUMBER OF CLINICAL

SESSIONS PROvIDED IN THE LAST 12 MONTHS since 2010 were found in:

Northwest Territories - 256% (2010: 771, 2012: 2,757)

Yukon Territory - 81% (2010: 472, 2012: 855)

Manitoba - 78% (2010: 6,959, 2012: 12,367)

Figure 4. Total Number of Clinical Sessions in a 12 Month Period Per 25,000 Population

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800


Num

ber of Clin

ical Ses

sion

s Prov

ided

P

er 25,00

0 Po

pulaPo

n

JurisdicPon

2010

2012

Ontarioalth

ofpulation

Figure 3. Total Number of Clinical Sessions in a 12 Month Period Per 25,000 Population


Delivery of CliniCal SeSSionS

Figure 4. Total Number of Clinical Sessions Provided in the Last 12 Months

25,846

21,747 11,737

9,129

3,832

2,584

855

472 2,757

7711,755

12,367

6,959204,058

122,029

6,790

5,060

-

7,128

1,666

1,694

82

-

10,784

8,528

# 2012

# 2010

direction of growth

BRITISH COLUMBIA

ALBERTA

SASKATCHEWAN

MANITOBA

ONTARIO

QUEBEC

NEW BRUNSWICK

NOVA SCOTIA

NEWFOUNDLAND AND LABRADOR

PRINCE EDWARD ISLAND

YUKON TERRITORY

NORTHWEST TERRITORIES

NUNAVUT

1,284


Clinical Services OverviewTable 2 indicates which clinical services are generally available within a jurisdiction. The services are provided either by the jurisdiction directly or by another jurisdiction. In jurisdictions with more than one telehealth network or program, the data have been aggregated so that the clinical service might not be available in all health regions or authorities within that jurisdiction. Each jurisdiction has its own naming convention so it is possible that additional services are available but not reported separately. This information is intended to provide a general overview of the depth and breadth of clinical telehealth services being provided across the country. Individual jurisdictional responses are available in the appendices of the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

This is the first time Prince Edward Island and Québec are submitting clinical services data to the Canadian Telehealth Report so all clinical services for Prince Edward Island and Québec are considered new for this report. Based on the survey’s pre-release validation process with the jurisdictions, new clinical services were tracked in the 2013 Canadian Telehealth Report including Cardiac Rehab/Atrial Fibrillation, Homecare Monitoring – COPD, Homecare Monitoring-Dementia, Genetics – HCP (Hereditary Cancer Program) and Occupational Stress Injury. The following clinical services were not tracked in this

year’s report based on input from the jurisdictions: Autism, Blood Disorders, Public Health and Pulmonary/Respirology, but they may be re-added in the future. In the 2011 Canadian Telehealth Report, ICU/Emergency Medicine was reported as one type of telehealth clinical service. This year, ICU and Emergency Medicine are two distinct telehealth clinical services that are reported separately. Across jurisdictions, Alberta has added the greatest number of new clinical services to its telehealth program since 2010. British Columbia has also added a considerable number of new clinical telehealth services to its telehealth program.

The most common types of CLINICAL SERvICES offered by jurisdictional

telehealth programs are:

• Mental Health/Psychiatry -13 jurisdictions report offering this service

• diabetes, Oncology, Cardiology and genetics -12 jurisdictions report

offering this service

• Rehabilitation (Physiotherapy), Rehabilitation (Occupational Therapy),

Chronic Pain, Neurology -11 jurisdictions report offering this service


CliniCal ServiCeS Overview

Table 2: Available Clinical Services

Clinical Service BC AB SK MB ON QC NB NS NL PE YT NT NUAddictions Amputee/Prosthetic ConsultAnesthesiologyArthritisAudiologyCardiac Rehab/Atrial FibrillationCardiac SurgeryCardiologyCdR (Child development and Rehab)Chronic PainCOPd (Chronic Obstructive Pulmonary disease)/Asthma dBS (deep Brain Stimulators)deaf Well-Beingdermatologydiabetesdialysis discharge Planningdown SyndromeEating disordersEchocardiogramEmergency MedicineEndocrinologyEnterostomal Therapy EpilepsyFamily MedicineFamily PlanningFamily VisitationsForensic Psychiatrygastroenterologygeneral SurgeryLEGEND:

• Service reported by jurisdiction for the 2013 Canadian Telehealth Report (based on 2012 Telehealth Survey)

• Service was added by jurisdiction after release of 2011 Canadian Telehealth Report (based on 2010-2011 Telehealth Survey)

• New service area tracked in the 2013 Canadian Telehealth Report



Clinical Service BC AB SK MB ON QC NB NS NL PE YT NT NUgeneticsgenetics – HCP (Hereditary Cancer Program)geriatricsgynaecologyHaemophilia

Health EducationHomecare Monitoring – CHF (Congestive Heart Failure)Homecare Monitoring – COPdHomecare Monitoring – dementiaHomecare Monitoring – diabetesHomecare Monitoring – HypertensionICU (Intensive Care Unit)Infectious diseasesInternal MedicineLung TransplantMental Health / PsychiatryNephrology (general)Nephrology (Renal)Neurology (general)Neurology (Stroke Emergent)ObstetricsOccupational Stress InjuryOncologyOphthalmologyOrthopaedicsPaediatricsPalliative CarePathologyPharmacyPlastic SurgeryLEGEND:




Table 2: Available Clinical Services (continued)



Clinical Service BC AB SK MB ON QC NB NS NL PE YT NT NUPreoperativePsychiatryPsychology RadiologyRehabilitation (Occupational Therapy)Rehabilitation (Physiotherapy)RenalRheumatologyRoundsSexual MedicineSleep disordersSocial ServicesSpeech LanguageStrokeThoracicsTrauma AssessmentUltrasoundUrologyWound ManagementLEGEND:




Table 2: Available Clinical Services (continued)


Home TelehealthHome telehealth is the use of home-based equipment to monitor a patient’s medical condition. The home-based monitoring devices may include fixed equipment, tablets or smart-phones. These devices are used to monitor vital signs such as pulse, blood pressure, blood sugar and weight and to transmit the data securely for review and assessment by a clinician. Most assessments take only minutes, while the time it takes to reach the clinic, doctor’s office, hospital or other facility for the assessment could be well over an hour. Additionally, some patients may have difficulties or challenges with the travel itself. This is why home telehealth is convenient for many patients as it eliminates the travel time and distance for simple assessments which can be done in the comfort and privacy of one’s home. It is also more reflective of the patient’s current state as more data is collected over time vs. in a single office visit and it can help reduce the white coat syndrome (office based anxiety) which might skew the data.

Five jurisdictions reported home telehealth programs at the time of this report: British Columbia, Ontario, Québec, New Brunswick and Yukon Territory. Other jurisdictions are in the process of establishing home telehealth monitoring programs for chronic disease. These programs are generally used to support patients with CHF (congestive heart failure) COPD (chronic obstructive pulmonary disease) and diabetes. In Figure 5, it is evident that, save for Québec, the number of home telehealth endpoints has increased since 2010 for the jurisdictions that reported use of these endpoints. The number of home telehealth endpoints increased by 18% between 2010 (2,095) and 2012 (2,465).7

7 Nova Scotia reported 50 endpoints in 2010 but none in 2012. Therefore, this data point has been removed from the calculation.

Figure 5. Jurisdictional Home Telehealth Monitoring Endpoints in 2010 and 2012

Figure 6 shows the three jurisdictions that have added home telehealth monitoring endpoints since 2010. It isn’t too surprising to see the addition of new endpoints in British Columbia and Ontario as these two jurisdictions have the larger populations.

Figure 6. Three Jurisdictions that Added Home Telehealth Monitoring Endpoints in the Last 12 Months

ON43

BC112

NB130

YK2010: 0

2012: 18

NB2010: 1052012: 192

BC2010: 1772012: 399

ON2010: 8132012: 856

QC2010: 10002012: 1000

YT


Home TeleHealTH

The rate of growth in home telehealth monitoring is well below the overall growth of telehealth services. This was not expected. It was anticipated that given the significant growth rate of chronic disease in the Canadian population, and its particular impact on the health system utilization, that fairly rapid growth would be seen in this area. A number of studies and growing programs have shown that regular monitoring and timely intervention reduces hospital admission rates, health system costs and in many cases has a positive impact on the long-term health implications for those suffering from chronic diseases such as diabetes, hypertension, CHF and COPD (Noel et al., 2004 & Dinesen et al., 2012). The reasons for this slower than expected growth are not currently fully known and will likely vary by jurisdiction, however, the Canadian Telehealth Forum has established a Community of Interest for Home Telehealth and this will be one of the first areas of discussion. Cartwright and colleagues speculate that one reason for the slower than expected growth is the lack of research and consistent evidence. In the last year or so, a number of seemingly contradictory studies, some indicating benefits and others indicating little or no benefit have been published. As well, some jurisdictions are currently evaluating their pilot programs. The results of these evaluations will determine the future structure of programs and their respective rates of expansion.

This is the first time that home telehealth devices and monitoring data were tracked as seen in Tables 3 and 4. Table 3 shows that Québec is the only jurisdiction to report home telehealth monitoring for diabetes and maternal care. Although Ontario has the second largest number of home telehealth endpoints, it reports monitoring of only two conditions: CHF and COPD. Both these conditions dominate the conditions being monitored by home telehealth devices across jurisdictions.

Table 4 shows that Québec reports collecting the largest number of vital signs for home telehealth monitoring. Québec is also the only jurisdiction to monitor glucose levels and respirometry. New Brunswick is the only jurisdiction to monitor ECG (echocardiogram). The vital signs that show the greatest amount of home telehealth monitoring are SpO2 (oxygen saturation), weight and heart rate as reported by four jurisdictions for each category.


Home TeleHealTH

Table 3: Home Telehealth Monitoring Devices

Jurisdiction CHF COPD Diabetes Renal Depression Dementia Maternal CareOther Chronic

Diseases

Other Technologies in the Home

BC *

ON

QC ** ***

NB

* Post-Acute/Early Discharge

** Ventilated Patients

*** Audio/video for ventilated patient with saturometer, blood pressure The following jurisdictions do not have home telehealth monitoring devices: AB, SK, MB, NS, NL, PE, YT, NT, NU

Jurisdiction NIBP1 SpO22 WeightHeart Rate

Glucose Questions ECG3 RespirometryFetal Heart

RateOther

BC

ON

QC *

NB **

1 Non-Invasive Blood Pressure 2 Oxygen Saturation3. Echocardiogram* Accelerometer** VideoThe following jurisdictions do not have home telehealth monitoring devices: AB, SK, MB, NS, NL, PE, YT, NT, NU

Table 4: Home Telehealth Monitoring Data


Delivery of Healthcare Educational Sessions Telehealth programs in Canada generally provide both continuing education to health care providers using telehealth technology as well as providing primary and supportive education to patients and their families in support of care plans and health and wellness.

Some jurisdictions were able to segregate the data into provider or patient education, others were not. For the purpose of this report, Total Number of Educational Sessions Involving Patients/Families in the Last 12 Months and Total Number of Educational Sessions Areas Involving Clinicians in the Last 12 Months (i.e. CNE8/CME9, Rounds10) have been summed to represent the Total Number of Educational Sessions in the Last 12 Months. An educational session for clinicians is any event where distance education is provided to clinicians (CME, clinical rounds, mortality/morbidity rounds) using audio and/or video technology. An educational session for patients/families is any event where distance education is provided to patients and families using audio and/or video technology; it does not include patient / family access to the network website. Six out of eleven jurisdictions reporting data in both 2010 and 2012 (Ontario, Yukon Territory, Northwest Territories, Nunavut, Manitoba, Québec), reported an

8 CNE- Continuing Nursing Education9 CME- Continuing Medical Education10 Rounds- A teaching conference or a meeting in which the clinical problems

encountered in the practice of nursing, medicine or other clinical service are discussed

The largest increases in the TOTAL NUMBER OF EDUCATIONAL

SESSIONS IN THE LAST 12 MONTHS since 2010 were found in:

• Québec - 3493% (2010: 241, 2012: 8660)• Northwest Territories - 52% (2010: 715, 2012: 1087)• Yukon Territory - 49% (2010: 419, 2012: 611)

increase in the total number of educational sessions in the last 12 months (Figure 7). Saskatchewan is the only jurisdiction in which no change was observed with regard to the number of telehealth educational sessions provided since 2010. This is the first time that Prince Edward Island (in the form of a single hospital, the Queen Elizabeth Hospital) is submitting data to the Canadian Telehealth Report. Comparisons could not be made between the 2010 and 2012 educational sessions data for British Columbia and Newfoundland and Labrador as these two jurisdictions have decided to to remove their 2010 data from this edition of the Canadian Telehealth Report based on concerns they have with the validity of the data originally submitted. In addition, New Brunswick did not provide data for the total number of educational sessions in this year’s survey.


Delivery of HealtHcare eDucational SeSSionS

6,734

-1,810

3,7861,815

1,815

611

419 1,087

715883

2,112

1,653 13,965

10,492

8,660

241

-

2,451

1,454

1,693

476

-

211

-

=

# 2012

# 2010

direction of growth

BRITISH COLUMBIA

ALBERTA

SASKATCHEWAN

MANITOBA

ONTARIO

QUEBEC

NEW BRUNSWICK

NOVA SCOTIA

NEWFOUNDLAND AND LABRADOR

PRINCE EDWARD ISLAND

YUKON TERRITORY

NORTHWEST TERRITORIES

NUNAVUT

1,008

Figure 7. Total Number of Educational Sessions Provided in the Last 12 Months


Delivery of HealtHcare eDucational SeSSionS

Figure 8. Total Number of Educational Sessions in a 12 Month Period per 25,000 Population

0

100

200

300

400

500

600

700

800


Num

ber of Edu

caPon

al Session

s Pe

r 25

,000

Po

pulaPon

JurisdicPon

2010

2012

In order to view the data for comparability, calculations of the number of sessions per 25,000 population were performed. This shows the heavier reliance on telehealth in the remote and isolated regions of Canada.

Figure 8. Total Number of Educational Sessions in a 12 Month Period per 25,000 Population


Educational Service Areas OverviewTable 5 lists the educational service areas covered as reported by each jurisdiction. This is the first time Prince Edward Island and Québec have submitted educational service area data to the Canadian Telehealth Report so all educational service areas for Prince Edward Island and Québec are considered new for this report. It is worth mentioning that in Nunavut, most educational service areas are provided by Children’s Hospital of Eastern Ontario, Ottawa. Based on input from the jurisdictions, Thrombolytics was not tracked in this year’s report. In the 2011 Canadian Telehealth Report, ICU/Emergency Medicine was reported as one type of telehealth educational service area. This year, ICU and Emergency Medicine are two distinct telehealth educational service areas that are reported separately. Across jurisdictions, Yukon Territory has added the greatest number of new educational service areas to its telehealth program since the 2011 Canadian Telehealth Report. On the other hand, many jurisdictions appear to have decreased the number of educational service areas offered in their telehealth programs. For example, in the 2011 Canadian Telehealth Report, Nova Scotia listed offering 38 types of educational service areas; in this report, Nova

Scotia lists offering only one type of educational service area. This finding warrants further investigation as to the possible causes of the shrinking telehealth educational program in Nova Scotia and the overall decrease in educational service areas offered across some jurisdictions. Individual jurisdictional responses are available in the appendices of the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

The most common types of EDUCATIONAL SERvICE areas offered by

jurisdictional telehealth programs are:

• Palliative Care, Paediatrics, Psychiatry - 10 jurisdictions report offering this service

• Obstetrics, Oncology, Rehabilitation (OT) - 9 jurisdictions report offering this service.


Educational SErvicE arEaS ovErviEw

Educational Service Areas BC AB SK MB ON QC NB NS NL PE YT NT NU

Addictions

Amputee/Prosthetic Consult

Arthritis

Audiology

Cardiac Surgery

Cardiology

CdR (Child development and Rehab)

Chronic Pain

COPd/Asthma

dBS (deep Brain Stimulators)

deaf Well-Being

dermatology

diabetes

dialysis

discharge Planning

down Syndrome

Eating disorders

Echocardiogram

Emergency Medicine

Endocrinology

Enterostomal Therapy

Epilepsy

Family Medicine

Family Planning

Family Visitations

Forensic Psychiatry

gastroenterology

general Surgery

LEGEND:




Table 5: Available Educational Service Areas




genetics

genetics- Hereditary Cancer Program

geriatrics

gynaecology

Haemophilia

Health Education

Homecare Monitoring – CHF

Homecare Monitoring – diabetes

Homecare Monitoring – Hypertension

ICU — Intensive Care Unit

Infectious diseases

Internal Medicine

Lung Transplant

Mental Health / Psychiatry

Nephrology (general)

Nephrology (Renal)

Neurology (general)

Neurology (Stroke Emergent)

Obstetrics

Oncology

Ophthalmology

Orthopaedics

Paediatrics

Palliative Care

Pathology

Pharmacy

Plastic Surgery

Preoperative

LEGEND:




Table 5: Available Educational Service Areas (continued)




Psychiatry

Psychology

Radiology

Rehabilitation (Occupational Therapy)

Rehabilitation (Physiotherapy)

Renal

Rheumatology

Rounds

Sexual Medicine

Sleep disorders

Social Services

Speech Language

Stroke

Thoracics

Trauma Assessment

Ultrasound

Urology

Wound Management

LEGEND:




Table 5: Available Educational Service Areas (continued)


Telehealth Technology Supporting Administrative Events

An administrative event is any non-clinical or non-educational use of video conferencing equipment for program management purposes. It is appreciated that desk top video events / sessions may not be counted by some jurisdictions. Jurisdictions were asked to provide data on the total number of administrative events using videoconferencing in the last 12 months. This is the first year that Prince Edward Island is submitting data to the Canadian Telehealth Report. Since the release of the 2011 Canadian Telehealth Report, Québec has introduced the reporting of videoconferencing in administrative events. New Brunswick did not submit data for this indicator in this year’s survey. Similar to the previous survey, Newfoundland and Labrador did not provide data for this indicator. In order to view the data for comparability, calculations of the number of events per 25,000 population were performed (Figure 9). This shows the heavier reliance on telehealth technologies in the remote and isolated regions

of Canada and in Alberta which includes desktop conferencing across the province. In the 2011 Canadian Telehealth Report, Yukon Territory reported the greatest number of administrative events held using videoconferencing whereas this year, Alberta is the leader in the use of videoconferencing in administrative events.. With the exception of British Columbia and Nunavut, most jurisdictions have increased the use of videoconferencing in administrative events since 2010. This is the first year Alberta has submitted data on the use of telehealth technologies to the Canadian Telehealth Report and telehealth program contacts at Alberta Health Services have confirmed this data point (109,664 administrative events using videoconferencing in the last 12 months).The Canadian Telehealth Forum and COACH are continuing to determine how total number of administrative events using videoconferencing in the last 12 months is reported across jurisdictions.

Figure 9. Total Number of Administrative Events Using Videoconferencing in a 12 Month Period Per 25,000 Population

Figure 9. Total Number of Administrative Events Using Videoconferencing in a 12 Month Period Per 25,000 Population

0

100

200

300

400

500

600

700

800


Num

ber of Adm

inistraP

ve Eve

nts Pe

r 25

,000

Po

pulaPon

JurisdicPon

2010

2012


Telehealth programs can voluntarily seek to be reviewed and accredited either separately or as a component of a hospital, health authority or health region accreditation. Accreditation Canada (AC) is a non-profit, independent organization that provides health organizations with an external peer review to assess the quality of their services based on standards of excellence. AC standards are based upon five key elements of service excellence: clinical leadership, people, process, information, and performance.

Figure 10 identifies the telehealth programs that are accredited and indicates those planning accreditation. Five out of thirteen jurisdictions reported that at least one of their hospitals, health authorities or health regions are accredited. Out of the eight remaining jurisdictions, only Newfoundland and Labrador reported planning accreditation in the near future. Many of the jurisdictions currently accredited reported plans for renewed accreditation (British Columbia, Québec, New Brunswick). Telehealth programs that pursue standards of excellence warrant accreditation. Further investigation may be required to determine why many jurisdictions are currently not accredited or pursuing accreditation to meet these standards. For more detailed information on jurisdictional accreditation, view the comprehensive 2013 Canadian Telehealth Report at http://www.coachorg.com

Accreditation Of Telehealth Programs

Figure 10. Accreditation of Telehealth Programs

ACCREDITED « PLANNING « NOT ACCREDITED

ABMB

NBBCQC

NLYTNTSK

ONPE

NU

NS


Teletriage Nurse Call LinesThe majority of jurisdictions have implemented teletriage or nurse call lines. Specially trained nurses who provide trusted health information and advice to callers staff these 24/7 call centers. In some provinces just three numbers - 8-1-1 - on the phone or online (e.g. Nova Scotia) means facilitated access to non-emergency health information and services. Translation services are also available. For example, in British Columbia patients can access information in over 130 languages on request. For those patients or clients who are deaf and hearing-impaired, assistance via TTY (text telephone) is also available in many jurisdictions. Individuals can talk with a nurse about their symptoms; in some jurisdictions they can consult

with a pharmacist about their medication questions, or get healthy eating advice from a dietitian. Ten out of the thirteen jurisdictions offer teletriage services to its residents (Table 6). With the exception of Yukon Territory, whose teletriage service is provided by an out of province organization (British Columbia), all teletriage services are provided by in-province organizations. Jurisdictional teletriage services are not generally provided directly by the jurisdictional telehealth programs, but by other organizations as listed in Table 6.

Table 6: Teletriage Services

Jurisdiction Teletriage Website URLsTeletriage Services

Organization Providing Teletriage Services

BC http://www.healthlinkbc.ca/ YES HealthLinkBC

AB http://www.albertahealthservices.ca/223.asp YESRAAPId (Referral, Access, Advice, Placement, Information & destination)

SK http://www.health.gov.sk.ca/healthline YES SaskHealthLine through Ministry of Health

MB http://www.wrha.mb.ca/healthinfo/healthlinks/index.php YES Winnipeg Regional Health Authority

ON http://www.health.gov.on.ca/en/public/programs/telehealth/ YES Clinidata

QC http://wpp01.msss.gouv.qc.ca/appl/m02/M02RechInfoSante.asp YES Infosanté

NB http://www.gnb.ca/0217/Tele-Care-e.asp YES department of Health

NS http://811.novascotia.ca/ YES 811 Health Link

NL http://yourhealthline.ca/en/index.html YES Health Line

PE — NO —

YT http://www.healthlinkbc.ca/ YES HealthLinkBC

NT — NO —

NU — NO —

Legend: — Teletriage service is not available


Telehealth Program Specific WebsitesFigure 11 identifies the jurisdictions that offer public telehealth program specific websites. These websites provide information about current telehealth initiatives, updated services, facility locations, relevant articles amongst other essential telehealth information to the public. The availability of interactive tools on the websites such as encounter scheduling, PHR (personal health records) and CDM (chronic disease management) assessment for public use are limited at this time.

Manitoba and Québec are the only jurisdictions that offer interactive tools on their public websites in the form of satisfaction surveys. This is the first year that the Canadian Telehealth Report is measuring the availability of satisfaction surveys as interactive public tools. Future advances in improving public experience of telehealth programs may involve increasing the number and types of interactive public tools.

BC

http://www.health.gov.bc.ca/ehealth/telehealth.htmlhttp://www.viha.ca/telehealth/

http://www.interiorhealth.ca/YourCare/telehealth

http://www.phsa.ca/AgenciesAndServices/Services/telehealth/default.htm

ABhttp://www.albertahealthservices.ca/services.

asp?pid=service&rid=7371

SKwww.health.gov.sk.ca/telehealth

MBwww.mbtelehealth.ca

ONwww.otn.ca QC

RUIS Montréal: http://ccr.ruis.umontreal.ca/telesante

RUIS Laval: http://www.lecsct.ca

RUIS Sherbrooke : http://www.chus.qc.ca/volet-academique-ruis/telesante/

NB—

NShttp://www.gov.ns.ca/health/telehealth

NLwww.nlchi.nl.ca/telehealth

PE—

yT—

NThttp://www.hss.gov.nt.ca/health/nwt-healthnet/

NU—

LEGEND:

— Public website URL does not exist

Figure 11. Telehealth Program Specific Websites Available to the Public

http://www.health.gov.bc.ca/ehealth/telehealth.html

http://www.viha.ca/telehealth/

http://www.interiorhealth.ca/YourCare/telehealth

http://www.phsa.ca/AgenciesAndServices/Services/Telehealth/default.htm

http://www.phsa.ca/AgenciesAndServices/Services/Telehealth/default.htm

http://www.albertahealthservices.ca/services.asp?pid=service&rid=7371

http://www.albertahealthservices.ca/services.asp?pid=service&rid=7371

http://www.health.gov.sk.ca/telehealth

http://www.mbtelehealth.ca

http://www.otn.ca

http://ccr.ruis.umontreal.ca/telesante_

http://www.lecsct.ca

http://www.gov.ns.ca/health/telehealth

http://www.nlchi.nl.ca/telehealth


TelehealTh Program SPecific WebSiTeS

Figure 12 identifies the jurisdictions that offer telehealth program specific websites to staff and authorized individuals. The services available to staff through their website vary by jurisdiction. Eight out of thirteen jurisdictions have a specific internal website that is accessible to staff and authorized individuals. The availability of interactive tools such as encounter and consult scheduling, CDM assessments and satisfaction surveys are available to a larger degree for internal staff than to the public. British Columbia, Québec and New Brunswick offer encounter and consult scheduling tools, Québec was the only jurisdiction that reported offering CDM assessments and Manitoba was the only jurisdiction that reported offering satisfaction survey as an interactive tool on the internal website. This is the first time the Canadian Telehealth Report asked jurisdictions to provide data on telehealth program specific websites and associated internal interactive tools for staff and authorized individuals. For a more detailed look at the types of interactive tools available to telehealth program staff, view the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

Figure 12. Internal Websites Accessible to Staff and Authorized Individuals

Figure 11. Internal Websites Accessible to Staff and Authorized Individuals

Specific Internal Website

Accessible to Staff and Authorized Individuals

BC

AB

MB

ON

QC

NB

NS

NL


Medical PeripheralsMedical peripherals are devices that are used to support clinical assessments conducted by telehealth. An exam camera is used in all jurisdictions except Prince Edward Island and the Northwest Territories. The largest growth in medical peripherals since 2010 is the digital stethoscope which is used by three more jurisdictions: Québec, Prince Edward Island and Nunavut. As seen in Table 7,

three other peripherals were tracked for this year’s report: ophthalmoscopes, endoscopes and home telehealth monitors. These three peripherals are used by a few of the jurisdictions. This is the first time that Québec and Prince Edward Island submitted medical peripheral data for the Canadian Telehealth Report so all medical peripherals for these jurisdictions are considered new for this report.

Table 7: Medical Peripherals

Jurisdiction Exam Camera Stethoscope Otoscope Ophthalmo-scope Ocular Camera Endoscope

Home Telehealth Monitors

Other

BC *

AB **

SK

MB

ON

QC ***

NB

NS

NL

PE

YT

NT

NU* VIHA – Spirometer, IHA – Digital Cameras, FHA – BP Cuffs, Oximeters, PHSA – Microscope

** High End Document Camera (Pharmacy), Retinal Camera (Diabetic Retinal Exam)

*** Videoconference equipment at home for ventilated patient: Accelerometer, spirometer, personal health scale, tensiometer, oximeter, oral thermometer, glucometer, echography.

LEGEND:

• Medical peripheral reported by jurisdiction for the 2013 Canadian Telehealth Report (based on 2012 Telehealth Survey)

• Medical peripheral was added by jurisdiction after release of 2011 Canadian Telehealth Report (based on 2010-2011 Telehealth Survey)

• New medical peripheral tracked in the 2013 Canadian Telehealth Report


Desktop And Mobile video ConferencingDesktop and mobile video conferencing are increasingly affordable and dependable methods of communication. Video conferencing allows health professionals to perform consultations that do not require in-person interactions. Desk-top and mobile video conferencing technology is also much less expensive than traditional videoconference equipment that was facility based due to is large size and support requirements. This method of communication still allows for a personal relationship and trust to be established as there is still the face-to-face interaction between patient and the provider of care.

In Table 8, eight of the thirteen jurisdictions provide for some form of desktop or mobile video conferencing and all eight of these jurisdictions use these technologies for clinical consultations. Only four of the thirteen jurisdictions use desktop and mobile video for patient education purposes. Compared to 2010, there is a significant increase in the use of desktop and mobile video between staff and with patients. In 2010, only three jurisdictions (British Columbia, Alberta and Northwest Territories) reported use of video conferencing between staff for telehealth purposes, while in 2012, there are currently six jurisdictions (British Columbia, Alberta, Ontario, Québec, New Brunswick and Nova Scotia) that are using video conferencing between staff. In 2010, only British Columbia reported use of video conferencing with patients for education. In 2012, three more jurisdictions reported use of video conferencing. In 2010, Alberta, Newfoundland and Labrador and Yukon Territory reported use of video conferencing with patients for clinical consultations. There are now eight jurisdictions that support the use of these technologies with patients for consultations.

Northwest Territories reported the use of desktop and mobile video between staff in 2010 but not in 2012. Similarly, Yukon Territory reported the use of desktop and mobile video with patients for clinical consultation in 2010 but not in 2012.

Table 8: Desktop and Mobile Video Conferencing

Juri

sdic

tion


Between Staff Only

With Patients for Education

With Patients for Clinical

ConsultationOther

BC *

AB

SK

MB **

ON ***

QC ****

NB

NS

NL

PE

YT

NT

NU

* Access to meetings, training/testing of VC equipment** Telehealth staff for administrative and education purposes, providers

for admin, education, and clinical purposes *** By consultant for patient care**** Staff training

LEGEND:

• desktop and mobile video service was reported by jurisdiction for the 2013 Canadian Telehealth Report (based on the 2012 Telehealth Survey).

• desktop and mobile service was added by jurisdiction after release of the 2011 Canadian Telehealth Report (based on the 2010-2011 Telehealth Survey)


Desktop AnD Mobile ViDeo ConferenCing

Table 9 shows the different technologies used for video conferencing. This is the first time the Canadian Telehealth Report is reporting on the types of video conferencing technologies. HDX400 and Movi/Jabber are the most popular technologies used and implemented in four jurisdictions: British Columbia, Alberta, Ontario and Newfoundland and Labrador for HDX400 and British Columbia,

Manitoba, Québec and New Brunswick for Movi/Jabber. British Columbia and Alberta use iPads for videoconferencing and Nova Scotia is in the pilot phase with this device. British Columbia is the only jurisdiction that uses iPhone for videoconferencing and none of the jurisdictions reported use of an Android device or Cisco Cius for videoconferencing.

Table 9: Technology Used for Peer to Peer Video Conferencing & Associated Use Policies

Juri

sdic

tion

Technology Used For Peer to Peer Video ConferencingUse Policies (Privacy and

Security)

Use Policies Available to Other

NetworksHdX 4000 iPad iPhone Android Polycom Movi/Jabber Skype

Microsoft Communicator

Cisco Cius Other

BC *

AB NO

SK

MB NO

ON NO

QC **

NB ***

NS NO PILOT NO NO NO NO NO NO NO

NL NO NO NO NO

PE

YT ****

NT

NU

* UBC - Cisco Tandberg, XXMP Instant Messaging, PHSA - MS Lync, Cisco E20 and EX90** Cisco EX60*** Tandberg, Cisco, Sony, All H323, Webex **** Tandberg, Cisco Telepresence

LEGEND:• Video conferencing technology was reported by jurisdiction for the 2013 Canadian Telehealth Report


Desktop AnD Mobile ViDeo ConferenCing

Delivering telehealth services by video conferencing introduces numerous privacy and security aspects that are not present in a one on one – face to face consultation in a clinician’s office. These include areas like network security, the number of individuals involved in the consultation process from support staff with the patient during the consultation, to technology staff required to trouble shoot technology difficulties. Each area requires specific policies and procedures to ensure the patient’s and clinician’s privacy is protected.

Some of these policies ensure that:

• The session is secure from non-authorized viewing

• Each participant is familiar with their role

• There is correct use and operation of the technology

Nine jurisdictions (British Columbia, Alberta, Manitoba, Ontario, Québec, New Brunswick, Nova Scotia, Newfoundland and Labrador and Yukon Territory) all have use policies for video conferencing. Of these nine jurisdictions, British Columbia, Alberta, Manitoba, Ontario, Québec, New Brunswick and Nova Scotia have their use policies available to other networks.


Electronic SchedulingElectronic scheduling is the use of an application to schedule meetings, consultations and appointments. All thirteen jurisdictions reported using some form of electronic scheduling to support public telehealth services in 2012 which is an improvement compared to 2010 where only ten jurisdictions reported use of e-scheduling. In 2010, electronic scheduling was used internally by program staff in six of the jurisdictions. In 2012, there was an increase to nine of the jurisdictions using e-scheduling internally.

The advantages of electronic scheduling are many:

• Most electronic scheduling programs allow a search for available slots by first available appointment, by provider, by day of the week, by date and month, by evening hours, by length of slot and more. Each search can be done with just a few keystrokes. Many also have a week at a glance feature. Turning pages in a book is not that fast.

• It allows multiple people in different geographical locations to access and schedule appointments at the same time.

• Patient names can be checked off as they are seen, technicians can identify the people they worked with and doctors can keep an eye on who is coming in order to stay on time.

• The scheduling system can interact with a recall system and will remove recall notices (or lists) for patients who have already scheduled appointments. It can also send a second notice or place follow-up phone calls to patients who were recalled, but have not yet scheduled.

• The main screen for each patient record also shows the next appointment scheduled. This is also very helpful with every patient interaction.

• It’s easy to make sweeping schedule changes in the future - such as closing off lunch periods or taking certain days of the week off.

• An electronic scheduling system can provide an interactive feature for patients on a website, this can avoid numerous telephone calls.

• Not all slots need be available or visible to the user.

• Future appointments can be viewed from any remote location, such as home, on vacation, from a laptop, tablet or smart-phone, or from one office to another.

• Utilization data is easy to access and analyze.

Figure 13 shows the different systems used for e-scheduling. All jurisdictions reported use of e-scheduling. VC Scheduler is the most common system used for e-scheduling as reported by six of the jurisdictions. Ontario and Québec have their own custom made scheduler for meetings and appointments.

Figure 13: Electronic Scheduling Systems

iSchedulerBC, MB, NL

VC SchedulerAB, SK, NS, YT, NT, NU

MS OutlookBC, AB, QC, NB, YT

Custom Made SchedulerON, QC

Electronic Scheduler

OtherBC, QC, PE, YT


ElEctronic SchEduling

In Figure 14, the jurisdictions in dark blue are the ones in which internal and provider use is new since 2010. The jurisdictions in light blue have already reported these uses in the 2011 Canadian Telehealth Report. Seven of the thirteen jurisdictions support online schedule viewing by providers, which is an improvement from 2010 in which four jurisdictions reported this function (Ontario and Yukon Territory did not report this data this year). Online scheduling by providers is currently available in six of the thirteen jurisdictions which is also an improvement from 2010 in which three of the jurisdictions reported this function. No jurisdiction provides for online viewing or online scheduling by patients as of the time of this latest survey.

Figure 14: Internal and Provider Use of Electronic Scheduling

Figure 15 shows e-scheduling across telehealth programs. This is the first time that e-scheduling across programs was tracked. Six jurisdictions (British Columbia, Alberta, Québec, New Brunswick, Nova Scotia and Newfoundland and Labrador) reported e-scheduling between different regions. Of these six jurisdictions, three of them (Alberta, Nova Scotia and Newfoundland and Labrador) also reported interprovincial e-scheduling. Saskatchewan also reported interprovincial e-scheduling.

For a more detailed look on electronic scheduling, view the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

Figure 15. Electronic Scheduling of Appointments Across Telehealth Programs

Figure 14: Internal and Provider Use of Electronic Scheduling

•BC |AB | SK | MB | QC |NB | NS | PE | NU Internal Use by Telehealth Program Staff

•BC | AB | MB | QC | NB | NS | NLProvider Use -‐ Online Viewing

•BC | MB | ON | QC | NS | NTProvider Use -‐ Online Scheduling


First NationsThe gap between health status and health services available to First Nations versus non-First Nations is already very wide. If eHealth initiatives advance at the current pace within the provincial/territorial systems without serious consideration for First Nations communities the gap may grow even wider. Compared to the general Canadian population, First Nations adults have a higher frequency of arthritis/rheumatism, high blood pressure, diabetes, asthma, heart disease, cataracts, chronic bronchitis, and cancer. The prevalence of diabetes among First Nations adults is nearly four times as great as the general Canadian population. Nearly one in five First Nations adults has no doctor or nurse available in their area (18.5%).11

In the words of Richard Jock – Chief Executive Officer of the Assembly of First Nations, “Reciting these troubling statistics is not meant to stigmatize First Nations people; rather, they should be understood as a call to action. Given these stark realities coupled with the proliferation of technology, inaction is no longer acceptable. First Nations people deserve the same access to quality comprehensive health care as all other Canadians. Technology offers a remarkable opportunity to make serious improvements in the health of First Nations people in Canada.12“

11 First Nations Information Governance Session. (2010). Quick Facts- Regional Health Survey. Retrieved from: http://www.rhs-ers.ca/facts.

12 COACH: Canada’s Health Informatics Association. (2012). First Nations and the Jurisdictions eHealth Convergence Forum Summary Report. Retrieved from: www.coachorg.com.

Health care for First Nations is complex for a number of reasons: multiple levels of government having some level of responsibility, lack of coordination of services across the multitude of care providers, culture, only a few clinicians living in First Nations Communities, and lack of sufficient network capacity due to the isolated and remote locations of most First Nations communities. On a positive note, increasingly the federal government, jurisdictional governments and First Nations are collaborating to improve health services for First Nations.

For the first time, several of the regional (provincial) offices of the First Nations and Inuit Health Branch (FNIHB) provided the First Nations’ Data, but not all regional offices were able to respond to the survey so a complete national picture is not currently available. The data presented on First Nation’s telehealth services is a subset of the data reported by the Jurisdictions.

Many First Nations communities reside in more rural and remote locations with the nearest hospital, doctor or nurse a hundreds of kilometers away. This is why telehealth is beneficial to the First Nations as technology can be used to eliminate the barriers in distance between a health provider and the patient. Telehealth eliminates travel barriers and reduces costs of appointments that are significant to small communities in which access to healthcare services is limited. Although there aren’t as many telehealth programs provided to First Nations, it is important to note that the services being provided are being used and are increasing in volume.


First NatioNs

Table 10: Program Volume Details in First Nation Regions

BC AB SK ON

Total Population 6,000 125,000 66,378 15,500 – 16,000

Number of Communities Served 5 44 79 26

Number of Communities Added in the Last 12 Months 3 11 0 0

Number of Health Facility / Hospital Based Endpoints 5 5 36 27

Number of Health Facility / Hospital Based Endpoints Added in the Last 12 Months 3 1 5 0

Number of Community/Shared Facility Endpoints 0 55 0 15

Number of Community/Shared Facility Endpoints Added in the Last 12 Months

0 7 0 0

Total Number of Clinical Sessions in the Last 12 Months 2,000 771 25 3,401

Total Number of Educational Sessions Involving Patients/Families in the Last 12 Months 0 — 40 462

Total Number of Educational Sessions Involving Clinicians in the Last 12 Months (i.e. CNE/CME, Rounds) 0 647 — —

Total Number of Administrative Events Using Videoconferencing in the Last 12 Months 300 — — 522

Total Number of Other Events / Sessions (i.e. legal assessments) 15 — 0 0

Site Coordinators for Each Agency/Hospital NO NO NO YES

LEGEND — Jurisdiction did not provide data


First NatioNs

Home Telehealth

Home telehealth hasn’t been implemented in many First Nations communities. However, there is use in Ontario, with four home telehealth monitoring endpoints reported. This is a promising in advancing telehealth for First Nations as assessments and consultations can be conducted in the comforts of the First Nations homes.

Accreditation of Telehealth Programs

None of the First Nation regions have accredited telehealth programs. In Figure 16, British Columbia and Ontario are planning accreditation in the next two to three years.

Figure 16. Accreditation of Telehealth Programs in First Nation Regions

Clinical Service Areas

British Columbia and Saskatchewan were invited to report the number and type of clinical services and educational service areas provided to First Nation regions, but these haven’t been tracked separately and were incorporated into the jurisdictional data. Table 11 shows the clinical services that are provided to First Nation communities as tracked separately by Alberta and Ontario.

ACCREDITED « PLANNING « NOT ACCREDITED

ABBC1

SKON2

1. 24 months2. 36 months

Table 11: Available Clinical Services in First Nation Regions

Clinical Service AB ON

Addictions Amputee/Prosthetic ConsultAnesthesiologyCardiologydermatologydiabetesdischarge PlanningEmergency MedicineEndocrinologyEpilepsyFamily MedicineFamily Visitationsgastroenterologygeneral SurgerygeneticsgeriatricsInfectious diseasesInternal MedicineMental Health / PsychiatryNephrology (general)Neurology (general)Neurology (Stroke Emergent)ObstetricsOncologyOrthopaedicsPaediatricsPathologyPharmacyPlastic SurgeryRehabilitation (Physiotherapy)RheumatologySpeech LanguageUrologyWound ManagementOther – UnspecifiedOther – Community Medicine Public HealthOther – Hematology Other- HemodialysisOther – Immunology/AllergyOther – OtolaryngologyOther – Respirology

LEGEND• Service was reported by jurisdiction for the 2013 Canadian

Telehealth Report (based on the 2012 Canadian Telehealth Survey)


First NatioNs

Educational Service Areas

Table 12 shows the educational service areas that are provided to First Nation communities as tracked separately by Alberta and Ontario. There aren’t many educational service areas provided, but it is important to note that there are some and First Nation regions in Alberta focus on similar educational service areas as the jurisdictions, showing that although these regions are in more isolated areas, professional development is still an important topic.

Educational Service Area AB ONArthritisCOPd/Asthma diabetesEmergency MedicinegastroenterologygeriatricsgynaecologyHomecare Monitoring – CHFICU – Intensive Care UnitInfectious diseasesMental Health / PsychiatryObstetricsOncologyPaediatricsPalliative CarePsychiatrySpeech LanguageStrokeOther – UnspecifiedOther – Allied HealthOther – Community Medicine/Public HealthOther – Educational/TrainingOther – Surgery

Telehealth Public Websites

In Table 13, Alberta and Ontario have public websites for telehealth in First Nation regions. Similar to the jurisdictional public websites, these sites provide information on educational service areas, clinical services and events. Alberta even reports the availability of several interactive tools (scheduling, CDM assessments, satisfaction survey and PHR). Alberta and KO (Keewaytinook Okimakanak) Telemedicine in Ontario provide a web portal specifically for First Nations. It provides information about the availability of both clinical and eductional services that are available, this includes a calendar for scheduled events by community and the ability to register for the event. The site also provides an archive of previously presented and available material such as information about disease, what to expect from a telehealth consultation and policies and procedures.

Jurisdiction Public Website URL

Public Interactive Tools

Encounter/ Consult

SchedulingCdM

AssessmentsSatisfaction

Survey PHR Other

BC — — — — — —

AB www.firstnationsTH.ca *

SK — — — — — —

ON www.telemedicine.knet.ca

* Handout and video recording library and calendar of eventsLEGEND: — Public website URL does not exist

Table 12: Available Educational Service Areas in First Nation Regions

Table 13: Availability of Public Websites and Tools in First Nation Regions

http://www.firstnationsTH.ca

http://www.telemedicine.knet.ca


First NatioNs

Medical Peripherals

The medical peripherals that are used in First Nation regions for telehealth are exam cameras, stethoscopes, otoscopes and ophthalmoscopes. Exam cameras and otoscopes are used in First Nation regions of British Columbia, Alberta and Ontario. Saskatchewan does not currently use medical peripherals for telehealth in the First Nations communities.


Video conferencing is used between staff in British Columbia, Alberta and Ontario First Nation regions. Alberta is the only First Nation region that has video conferencing with patients for clinical

consultation.

The First Nations communities in British Columbia use HDX 4000 and Microsoft Communicator for video conferencing. First Nation Regions in Alberta also use HDX4000 for video conferencing, in addition to Polycom. The technology that Ontario uses for video conferencing is Polycom.

For a more detailed look on video conferencing, view the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

VC SchedulerAB, SK

Custom Made SchedulerAB

Electronic Scheduler

OtherON

Figure 17. Electronic Scheduling Systems in First Nation Regions

Figure 18. Internal, Provider and Patient Use of Electronic Scheduling in First Nation Regions

Electronic Scheduling Services

In Figure 17, Alberta, Ontario and Saskatchwan reported use of an electronic scheduler to provide scheduling for First Nations. The most common electronic scheduling system used by the telehealth programs to schedule appointments and consultations to First Nation communities is the VC Scheduler. This reflects the data reported from the jurisdictional telehealth programs as VC scheduler was reported as the most dominant e-scheduler. British Columbia did not report use of an e-scheduler.

Figure 18 shows uses of e-scheduling between staff and providers in First Nation regions. Alberta, Ontario and Saskatchewan report internal use of an e-scheduler. Alberta and Ontario also report online-viewing of schedules for providers. Ontario has online scheduling for providers and Alberta has patient viewing of schedules.

Inter-regional and interprovincial e-scheduling is provided by Alberta and Ontario only as seen in Table 18. Saskatchewan did not report data for e-scheduling across telehealth programs.

Figure 17. Internal and Provider Use of Electronic Scheduling in First Nation Regions

• AB | ON | SK Internal Use by Telehealth Program Staff

• AB | ONProvider Use -‐ Online Viewing

• ONProvider Use -‐ Online Scheduling

• ABPatent Use -‐ Online Viewing


Next StepsFuture Priorities of Telehealth Programs

All jurisdictions were invited to identify upcoming priorities for their respective telehealth programs. Priorities were identified through both closed and open ended responses in the 2012 Canadian Telehealth Survey. The highlights of those priorities that were shared included the following:

• Expanding/upgrading telehealth network and technology infrastructure to better serve more communities,

• Introducing or increasing the use of digital stethoscopes, cameras and other medical peripherals,

• Developing policy and procedures to further improve and support clinical and educational activities,

• On-boarding of telehealth services to provincial scheduling systems where these are in place, and

• Expanding the use of desktop videoconferencing in such clinical areas as audiology, dermatology, eating disorders gastroenterology as well as to serve the educational needs of patients and clients in the areas of general health and mental wellbeing, elder health and wellness, rheumatology and stroke.

Not all of the jurisdictions revealed upcoming plans for their telehealth programs, but the ones that did are listed in the comprehensive 2013 Canadian Telehealth Report at www.coachorg.com.

What’s Next for the Canadian Telehealth Report

Moving forward, COACH and the Canadian Telehealth Forum (CTF) will continue to consult with the jurisdictions and First Nations to improve the value of the Canadian Telehealth Report by:

• revising and clarifying existing questions as required,

• working with stakeholders towards a more consistent telehealth taxonomy to improve comparability of data, and

• adding new indicators/questions to ensure the survey is contemporary with Canadian telehealth practices as these continue to grow, evolve and mature.

The next Canadian Telehealth Report is scheduled for publication in the spring of 2015; the survey process will begin in the fall of 2014.


Appendix A: GlossaryAccreditationA process in which certification of competency and credibility is presented.

Administrative Events Any non-clinical or non-educational use of video conferencing equipment for program management purposes. It is appreciated that desk top video events / sessions may not be counted.

Clinical SessionsAny event involving the care of a patient including: clinician - patient consult, clinician - clinician consult for case management purposes.

CommunityA recognized city, town or village.

Community / Shared FacilityA facility, normally in a small community, with telehealth capability and where health care and other non-health related public services such as education or justice are delivered.

Education Sessions for CliniciansAll events where distance education is provided to clinicians (CME, clinical rounds, mortality/morbidity rounds) using audio and/or video technology.

Education Sessions for Patients/FamiliesAll events where distance education is provided to patients and families using audio and/or video technology; it does not include patient / family access to the network website.

Health FacilityAny publically funded/administered facility where health care is provided using telehealth technology. Does not include private clinics or physician offices.

JurisdictionA province, territory or federal government.

Medical PeripheralA device that is used to support clinical assessments conducted by telehealth.

SessionsThere are no universally accepted clear definitions for sessions; for the purpose of this survey, a session is single occurrence regardless of the number of end points involved.

Tele-Triage Program

A program that provides unscheduled primary assessment, first aid and other health related advice to the general public by nurses usually via a published call in number e.g. 1.800.XXX.XXXX or 811. These programs are normally provided at the jurisdictional level.

Telehealth – Eliminating Distance in the Practice of Healthcare and Wellness Utilizing Information Communication Technologies13

While succinct, this description fails to adequately articulate the myriad variety of technologies that may be brought into play from the least sophisticated “plain old telephone system” (POTS) to highly sophisticated technologies using a combination of video, store and

13 Canadian Society of Telehealth. (2008). 2008 Strategic Plan.


Appendix A: GlossAry

forward, web portals and data messaging. telehealth helps eliminate distance barriers and improve equity of access to services that often would otherwise not be available in remote and rural communities. It is about transmitting voice, data, images, and information rather than physically moving patients or health practitioners and educators thereby improving access, timeliness, productivity, quality, convenience and reducing travel costs. It also has the added benefit that the patients can more easily become active participants in their own wellbeing and are able to engage in educational programs aimed at fostering wellness from the comfort, convenience and safety of their own homes and communities.

Home Telehealth Monitoring EndpointsNormally part of defined home telehealth program using home based equipment (may include fixed equipment, tablets or smart-phones) used to measure vital signs (pulse, blood pressure, weight, blood sugar etc) and transmit the data for review and assessment by a clinician. This does not include email exchanges.

About COACH

COACH: Canada’s Health Informatics Association is the voice of health informatics (HI) in Canada, promoting the adoption, practice and professionalism of HI. COACH represents a diverse community of accomplished, influential professionals who work passionately to make a difference in advancing healthcare through information technology. HI is the intersection of clinical, IM/IT and management practices. Members are dedicated to realizing their full potential as professionals and advancing HI through access to information, talent, credentials, recognition, programs and a broad range of services and specialized resources. www.coachorg.com

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©2013 COACH: Canada’s Health informatics Association

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Documents

2013 Canadian Telehealth Report