In To uc h What is Telehealth?
N ational I ndian & I nuit C ommunity H ealth R epresentatives O rganization T ouch In 6"1ÊÎxÊÊUÊ /" Ê ÊEÊ 1/Ê "1 /9Ê/Ê,*,- //6-Ê", </" Ê 7-//,ÊÊUÊ7 /,ÊÓä£ä What is Telehealth? and to increase its usage, especially among First Nations. by Cecelia Talley Telehealth, eHealth, and telemedicine may be confusing terms to many Community Health Representatives (CHRs). A cursory search for health information on the Internet will turn up many articles written by academics, containing a lot of confusing jargon and information. One easily becomes intimidated by the wealth of new material that is available. The purpose of this article is to increase awareness at both the CHR and community levels of the benefits of telehealth services for patients TABLE OF CONTENTS What is Telehealth Telemedicine eHealth Telehealth Telehealth Technology IT Innovations Midwifery Background Clinical Administrative Educational Benefits Panaroma Aboriginal Telehealth Knowledge Circle What role can the CHR play? Limitations Patient Checklist NIICHRO Activities Road to Competency Canadian Red Cross Victorian Order of Nurses Canadian Paediatric Society Keeping In Touch Membership Form 2010-2011 Upcoming Events 1 1 2 2 4 5 6 9 10 11 11 13 14 15 17 18 19 19 19 20 21 22 23 24 For a free NIICHRO Resources Catalogue, Call 1 800 632-0892 There are currently three overlapping categories of electronic health care: telemedicine, eHealth and telehealth. The term telehealth is used more frequently than other terms, but usage is inconsistent, and it is often used interchangeably with eHealth and telemedicine. Even the spelling is inconsistent, with a varying mix of capitals and hyphens used in different sources. Telehealth eHealth Telemedicine TELEMEDICINE Health Canada defines telemedicine as a rapidly developing application of clinical medicine where medical information is transferred for the purpose of medical consultation. It is happening today, across wires or wirelessly, through videoconferencing systems, the Internet, or even by telephone and fax. It is a process of sharing patient or medical information electronically between two locations. The First Nations Health Council (FNHC) in B.C. describes telemedicine as an information and continued on next page... What is telehealth? ...continued from previous page communications technology-enabled approach to delivering health care from a distance (FNHC 2007). Put simply, telemedicine is viewed as an interaction between a patient and his or her doctor or nurse, using technology to conduct consultations from separate locations. An information package put out by Keewaytinook Okimakanak (KO) Telemedicine (2007) in Ontario states that it is the only telehealth agency owned and managed by First Nations in Canada. KO Telehealth is a provincial partner of NORTH Network, one the largest and most successful telehealth networks in Canada. (Muttitt, Vigneault and Lowen 2004) e/ “eHealth” differs from telemedicine mainly because it is used by non-professionals, and although it also uses technology, it is centered on an Internet-based health care delivery system. The First Nations Health Council describes eHealth as the health sector using digital data that is transmitted, stored, and retrieved electronically for clinical, educational and administrative purposes both at a local site and at a distance. eHealth requires collaboration between First Nations, and the federal and provincial governments. Aboriginal communities expect a culturally based approach and control of the design and delivery of eHealth services. (Marr, Seymour, Sanderson and Boesch 2000). // Telehealth uses information and communication technology to deliver health care across distance. Many view it as a means to improve access to health care services. The genesis of telehealth has often been attributed to NASA and space travel. NASA physicians needed to check the vital signs of astronauts as they travelled around the earth. (Prial 2006) Telehealth applications include assessment, diagnosis, interventions, supervision and group therapy. (Nickelson 1996). continued on next page... 2... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page The following table defines and illustrates the differences between Home Telehealth, Interactive Home Telehealth, Telemonitoring and Self-Monitoring, as outlined in the American Telemedicine Association’s Home Telehealth Clinical Guidelines. (2003) iÊ/ii i>Ì • Encompasses remote care delivery or monitoring between a health care provider and a patient outside of a clinical facility In their place of residence (home or assisted living residence) • ÌiÀ>VÌÛiÊiÊ • • • Includes the utilization of two-way interactive audio-video Involves the patient and a health care provider Provides remote care delivery (i.e. assessments, education and data collection) May include devices which collect clinical data from the patient and deliver it to the health care provider Telehealth • • Includes the collection of clinical data and the transmission of such data between a patient at a distant location and a health care provider through a remote interface so that the provider may conduct a clinical review of such data or provide a response relating to such data • Is the periodic and scheduled use of a device by the patient to obtain clinical data that is used by the patient to measure their own health status Commonly measured data include blood pressure, glucose, weight and temperature. /iiÌÀ} -ivÌÀ} • continued on next page... NIICHRO In Touch Winter 2010 sss 3 What is telehealth? ...continued from previous page The Canadian Health Act promises Canadians accessible and universal health care. Yet rural and remote areas are still underserviced in terms of acute disease care and primary health care, well-being, disease prevention, health promotion and community health care. As a result, there is a need for more acceptance of telehealth technologies. Dr. John Wooton, a special advisor on rural health in the Population Health and Public Health Branch of Health Canada, has said that, “If there is a two-tiered medicine in Canada, it’s not rich versus poor, it’s urban versus rural.” (Nagarajan 2004). Of the more than 600 First Nations communities located across Canada’s vast land mass, many are in rural areas and/or areas accessible only by air or boat. Despite this, even small, isolated Aboriginal communities usually have some form of access to the Internet. Increasing usage of technology such as computers, handheld devices and cell phones provide a feasible way to access these smaller, more remote communities. Telehealth is used by medical professionals and various communities to provide medical services more easily and faster. By using high speed broadband and satellite communication, care providers are able to provide real-time medical care to patients in remote locations that were difficult or impossible to reach in the past. This is important because approximately one-third of Aboriginal and Inuit communities in Canada are classified as remote, isolated or semi-isolated. (Dal Grande 2001). Telehealth can relieve some of the burden placed on family caregivers. Family members do not have to leave their jobs, lose wages and/or travel great distances. Telehealth equipment alleviates some of these burdens. First Nations communities place a high value on respecting the younger, future generations. A recommendation made by an interview participant in a National Aboriginal Health Organization (NAHO) study was to capitalize on how involved kids and teens are in the e-world. (NAHO Conference, 2009). They are growing up with technology. / "1 /" Ê/ ""9 Telecommunication technology in health care currently consists of an integrated system of same-time or real-time, and store-and-forward technologies. Store-and-forward technologies deal with the collection and storage of clinical data or images that are forwarded for interpretation. Real-time video is the use of live video to conduct a clinical encounter in real time. (Anonymous 2008) Both systems can deliver care for a patient at any given moment. Using telephones, the Internet, webcams, instant messaging, or other technologies that provide real-time audio and video services to gather or supply information to/from geographically separate sites are all examples of continued on next page... 4... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page telehealth in action. Today, technological advances such as videophones and PC teleconferencing are cost-effective means of telecommunications. (Jerome and Zalor 2000). The KO Telemedicine Program uses a broadband connection that supports clinical services, the Internet and online mental health counseling, as well as videoconference training. Most hospitals in Ontario’s North have never had a radiologist available on call or online, forcing them to ship the X-ray films from location to location. With telehealth technology a small number of radiologists in a centralized location can provide consultation to a vast region like Canada’s North. Three Corners Health Services Society in BC videoconferencing. /Ê "6/" - There are examples of IT innovation in each province and territory. The telehealth system in Canada has grown to the point where all provinces and territories now have some type of telehealth in place. (McBain, 2005). Some examples of telehealth included using videoconferencing to enhance health administration, utilizing wireless bedside to clinician desktop technology, telephone monitoring, telementoring, linking family health teams via telephone, and medical telephone consultations, to name just a few of the uses. A home-care project in Nova Scotia and New Brunswick is testing ways of transforming heart failure management across Canada through the use of home-based monitoring technologies and more proactive intervention. A person goes into the patient’s home and shows them how to use the equipment. Health Canada notes that the BC Telehealth program is made up of three discrete programs encompassing continuing medical and nursing education and 11 areas of clinical applications involving four provider organizations and 14 receiving organizations in 12 communities. (www. hc-sc.gc.ca, 2003). In BC, the Inter Tribal Health Authority and the Vancouver Island Health Authority are planning to set up retinal screening clinics that includes three fixed-site locations plus mobile clinics across Vancouver Island. A trained nurse photographer will do the screening. Retinal Image Packages will be downloaded to the Inter Tribal Health Authority server and a retinal specialist will review the images online and prepare an assessment report (www.fnhc.ca). The BC First Nations eHealth Centre of Excellence (CoE) Society is interested in developing clinical programs that initially focus on maternal health, mental health and diabetes (BC First Nations, 2009) The eHealth, CoE plans to provide new training opportunities for community members and health workers by making training opportunities accessible from within the community. Telehealth can reduce patient travel burden, especially for elderly people and those with young children who experience hardship if long distance travel is involved in accessing health care services. continued on next page... NIICHRO In Touch Winter 2010 sss 5 What is telehealth? Bringing WTPC to the community ...continued fromfrom previous page ...continued previous page 7,9 Since ancient times, there have been healers who advised and cared for women during childbirth. In the old days a “wise woman/man” would advise and help the expectant mother through her pregnancy and delivery, and help to ensure the baby and mother were fine afterwards. Today, the “wise ones” or midwifes have university degrees specializing in all stages of pregnancy and postpregnancy care. They are funded as part of the health care system in Canada, and follow Canadian health administration and territorial/provincial health regulations. There is a maternal and child health initiative in British Columbia through the First Nations Health Council that will improve maternal health services for First Nations women. It is hoped that the initiative will give women the choice to have their babies closer to home and put birthing back in the hands of women. One component of this program is an Aboriginal Doula project and training of Aboriginal midwives and the creation of a community toolkit and traditional birthing manual. The first step in this process is to create a First Nations Maternal and Child Health Advisory Committee to help enhance current provincial and federal streams in Aboriginal Perinatal, Maternal and Child health programs. (2008). In Ontario, the KO Telemedicine brochure features a testimonial from a patient who arrived at the Sioux Lookout Menoyawin Health Centre where the Telemedicine staff used a view camera that enabled a specialist located in another town to examine the patient and make a diagnosis that saved the man’s leg. He states that without the technology he would have been faced with amputation. He credits telemedicine with saving his leg. (Garrick 2007) KO has successfully partnered with the Sioux Lookout Health Authority and maintains that they have improved access to, and coordination of health services in their area. A Telehealth Coordinator from Deer Lake First Nation states: “If they have diabetes they have to fly to Sioux Lookout to get trained on using their needles and here they can see those nurses on the video conference unit. Some people are afraid to fly ... and they have to spend days out of the community, sometimes just for a simple test” (Ferreira, Ramirez, Walmark, 2004). A 2002 report by the Keewaytinook Okimakanak Tribal Council noted that certain Northern Ontario First Nations communities only had approximately 57 days of direct psychiatric care a year (KO, 2002). Costs for inperson visits were excessive and telemental health provided a viable alternative (Brassfield and Clement, 2007; KO, 2002). continued on next page... 6... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page Health Canada concluded that telehealth was capable of improving access to, and quality of mental health services at the local or community level. Health Canada notes that rural and remote communities have a serious shortage of health professionals so the expansion of telemental health is expected in the future. (2004). In May 2007, Grand Chief Stan Beardy, NishnawbeAski Nation, spoke via streaming video from Northern Ontario to the United Nations Conference on Indigenous Peoples Communication for Development in New York. He commented on the importance of videoconferencing and streaming video technologies for his remote First Nations communities. He remarked: My presentation to you today represents a remarkable achievement by our people to not only harness the power of information and communication technologies, but also adapt these technologies to address our political, social and economic agenda. (O’Donnell, Perley, Walmark, Burton, Beaton and Sark 2007) The same 2007 article describes a First Nations school in New Brunswick that produced a music video and shared it online as part of a program to address youth suicide. These two communities have expanded their use of video communications for community development activities other than telehealth and formal education. Telehealth in this capacity can be viewed as contributing to a more holistic interpretation of community health. In the past, First Nations children were born at home and KO Telehealth provides an opportunity to bring that back. Given are two examples of women in labour in two separate First Nations communities. One woman went into premature labour. It was easier to use the videoconferencing system through the Okimakanak Telemedicine system. A coordinator set up the system with a physician who was on call 24 hours a day for emergencies. The physician provided instructions to the nurses and aides through a camera and they delivered the babies. The physician helped deliver two First Nations babies on the same day, even though the mothers gave birth in different locations. In the Lakes District of British Columbia, full capability hospitals are located in Prince George and Smithers. Smaller villages like Burns Lake have medical clinics. However, the clinics usually refer the expectant mother to the main hospital facilities to give birth. The Burns Lake Medical Clinic is located in the centre of the Lakes District, approximately two hours from Smithers and three hours from Prince George. Currently the facility does not have telehealth and is conferencing with doctors in other areas over the telephone. The clinic is implementing patient record and lab result capability over the network in April of 2010. However, patients will still have to travel a minimum of an hour and a half to have advanced laboratory work done. This imposes considerable costs in both time and money for the patients and the six bands in the local area. Frequent heavy snowfall in the winter complicates continued on next page... NIICHRO In Touch Winter 2010 sss 7 What is telehealth? ...continued from previous page travel and makes getting to appointments dangerous and expensive. If a female patient goes into labour or has unexpected complications, she faces a long, painful, and dangerous ambulance ride to the nearest hospital facility if the situation is beyond the local clinic’s capabilities. If the situation is life threatening, the emergency air service can transport her if the weather permits. However, it is still 45 minutes to an hour before they can reach their destination. Prenatal care for a pregnant woman requires her to consult frequently with her health care provider. In the Lakes District, whether she chooses a midwife or an obstetrician, either she or the health care provider must travel long distances to appointments. This example is repeated hundreds of times across the country. There are two midwife practices in the Lakes District, located in Prince George and Smithers. These two practices cover an area of approximately 400 square kilometres. In B.C., a nurse line is available 24 hours a day, seven days a week. It is used for non-emergency health concerns, or to discuss symptoms and procedures and get a recommendation as to whether or not you should see a health care professional. Telehealth is increasingly used in North America to provide health services to very remote locations. For example, the State of Arizona has a large population of American Indians who live on remote reservations. Diabetic patients on Indian reserves in Arizona have their retinas remotely screened by specialists at eye-care facilities in larger centres. (McGee 2004) Alaska and Arizona reservations offer remote vision screening services to Indians with diabetes. (McGee 2004) It is predicted that this screening will reduce the incidence of diabetesrelated blindness to less than five per cent. In Boston, home health care nurses use digital cameras to take photos of patients’ skin wounds and surgery incisions. The nurses send the images over phone lines to wound-care specialists who compare earlier images to determine if a change in care is warranted. (McGee 2004) American cancer patients can obtain second opinions about their diagnosis from oncologists at leading cancer centres. Asthmatic children can use Webcams in their homes to send videos of themselves using their inhalers and airflow-measurement devices. Other examples of telehealth currently used include mammograms for women in rural areas. Digital images are sent to clinicians for review. An example from Alaska illustrates the advantage of having telehealth technology in emergency situations. Technicians in Noorvik, a small village approximately 200 miles from Kotzebue, were installing telehealth equipment when a woman who was about to give birth arrived. Severe weather conditions made it impossible to transport her to the regional facility in Kotzebue. Working quickly, the technicians set up the equipment and the local village health practitioners were able to contact doctors in the main facility 200 miles away. Using live two-way video and audio technology, the doctors were able to guide the clinic’s practitioners through the whole delivery process. (Anonymous 2004) These are only a few of the current telehealth initiatives occurring throughout Canada and North America. ,"1 Despite the delay in fully implementing telehealth, it is not a new idea. It has been around since the 1950s. The rising cost of providing health care to an aging population is currently a major incentive for the use of telehealth for service provision. The continued on next page... 8... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page Baby Boomer generation is placing increasing demands on the health care system due to issues associated with aging. Boomers know how to search the Internet for health information, and know more about their health than previous generations. On a positive note, each successive generation is increasingly more knowledgeable technologically. and Zalor 2000) Home health care products such as blood pressure devices are used increasingly, and in many First Nations communities videoconferencing is a way to provide essential services and communications in remote and rural areas. At this time, there is still a severe shortage of health professionals throughout North America. Conveniently, telehealth is viewed both as a way to deliver health care over distances, and as a mechanism for improving access to health services. It gives patients access to specialists and it provides a way to share limited health human resources. Home telehealth may be provided by a licensed health care provider, which includes, but is not limited to: Rankin Inlet, Nunavut Since the 1990s, First Nations have had more cost-effective information technology equipment available. (Nickelson 1998) More communities, including First Nations communities, now have better access to Internet connections. The major telecommunications companies entered into a $16 M partnership with the federal government’s SchoolNet program to build a network of satellite connectivity to many remote First Nations schools. (O’Donnell Beaton and McKelvey 2008) That initiative ensured that almost all rural and remote First Nations communities in Canada had access to a broadband connection. Keewaytinook Okimakanak (KO) and the Atlantic Policy Congress of First Nations Chiefs were two First Nations organizations engaged in this work. Today, technological advances such as videophones and PC teleconferencing are costeffective means of telecommunications. (Jerome NIICHRO In Touch Winter 2010 There are more home health care products such as blood pressure devices, video cams and webcams used increasingly in the home. Telehealth technologies can help to provide both basic and specialist health services and health promotion and disease prevention education to under-serviced areas, especially in Canada’s remote and rural areas. continued on next page... sss9 What is telehealth? ...continued from previous page Telemental health, known in the past as closedcircuit two-way television, has been in use for decades. Canada only started to use this technology in the mid-1990s (Health Canada, 2004). All provinces and territories use telemental health to some degree (2004). Telehealth uses electronic information and telecommunications technologies to support long-distance health care delivery and health education. Ê /The focus on communication and information technology is also used for clinical applications such as diagnostic, treatment and monitoring. There are three categories of clinical telehealth applications. The first, telemedicine, is often referred to as teleconsultation. A physician or a subspecialist at a larger centre provides a diagnosis and treatment plan based on conducting a remote interactive patient examination and interview or reviewing data from a store-andforward encounter. The second application is referred to as telecare. Telecare uses telehealth to communicate with a patient and/or caregiver. Follow-up related to diagnosis or to ensuring that the patient is complying with a treatment plan is an example of telecare. The third category includes physicians and specialists in different locations collaborating on one case. KO Telemedicine program uses a broadband connection that supports clinical services, the Internet and online mental health counseling, as well as videoconference training. by real-time or store-and-forward technologies. Telephone, fax machines, chat rooms, discussion boards, and audio and videoconferencing are examples of these applications. With the introduction of telehealth, teleconferencing with specialists or doctors in an emergency can and has saved patients’ lives, and has also saved doctors and communities considerable time and money. United States patients with chronic illnesses who received intervention noted that, “It is not important how the interaction happens, but that it happens.” (2008) Stroke patients normally wait between three to six months between appointments. In this case, the patients could interact with nurses on a daily basis. It is more cost effective to upgrade facility capabilities at a fraction of the cost of hiring more doctors and expanding their infrastructure. Even if the will and finances were available to hire more physicians, it is unrealistic because there is a severe shortage of physicians in Canada and North America generally. A Clinical Telehealth Coordinator would be the main liaison between a patient and a clinician using technology for developing and implementing telehealth clinical applications such as teleconsultations. These applications are provided continued on next page... 10... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page -/,/6 /Administrative applications include the recording and sharing of billing summaries, electronic connections to pharmacies for prescription ordering and crosschecking for conflict between prescription drugs, checking medical records for inconsistencies between past and current treatments, research and public health record keeping and administration. The British Columbia Interior Health Administration developed a mobile care system that allows health care workers to access patient records, perform assessments and input updated patient information. (Sibley 2005) For a complete list of all electronic health record projects in Canada, visit Infoway’s website at www. infoway-inforoute.ca. Click on each province and territory and you will see the projects that have been initiated and completed. From Infoway’s website, a sample comprehensive view of a patient’s medical history is available at http://www.infowayinforoute.ca/images/ehr.html. The comprehensive view includes: • • • • • • • • Patient Details: Photo of patient with Name, Address, Phone number, Sex and DOB Patient Record: Alerts, Diagnosis GP Details: Name, Address, Phone number Other Health Care Providers: Name, Dept., Last encounter, Next encounter, Right of access Medications: Date, Medications, Prescriptions, Last filled Encounter History: Date, Facility, Specialty, Clinician, Reason, Type Immunizations: Type, Most recent, Number received Diabetic indices: Type, Value, Most recent 1 /" Ê /-Ê The 11th Annual Conference of the Canadian Society of Telehealth held in October, 2008 highlighted the breadth of active models, educational programs and delivery of one of the three categories of electronic health care. Educational applications include continuing medical education for professionals, educational resources for patients and self-monitoring devices for patients to help cue them for agreed upon behavioural changes. We already use telecommunications and information technology for educational purposes and for training, as well as to provide access to health assessment, diagnosis, intervention, and consultation supervision, across distances (Nickelson, 1998). It is also used in universities for many courses. Professors and continued on next page... NIICHRO In Touch Winter 2010 sss 11 What is telehealth? ...continued from previous page students have access to discussion and questions after class. Students use chat boards for peer to peer communications. Ideally a graduate of an approved school of nursing is preferred to coordinate a telehealth program. National Research Council Canada encouraged participants to join live events by multi-site videoconference, or watch the event live on their computer via a video and audio webstream. Participants can post comments and questions that will be answered during the event. A telehealth coordinator would also scope, plan, train, and implement and evaluate all clinical telehealth initiatives. The 2009 Gathering Wisdom Conference held in Vancouver, B.C. provided sessions on eHealth. Part of the sessions included an electronic interactive participant polling component which helped focus feedback and input from all participants in the sessions. Part of that feedback included a strong indication that participants viewed telehealth as an important requirement for the development of effective community health services. Participants noted the lack of trained people to maintain telehealth and to foster greater interorganizational collaboration. Health Canada’s Health Infostructure Support Program piloted an electronic distance delivery program for skill development training for Alberta CHRs who worked in isolated or semi-isolated communities. (Parker and Froehler 2000) CHRs required computer skills training in order to access online training opportunities. They needed ongoing support along with training opportunities. One of the services expected of a CHR is to research health issues. In some communities the CHR did not even have a computer in her office. Many CHRs require skill development opportunities. This includes computer skills training. Lack of basic technological literacy and work and family constraints present challenges to CHRs, who are mostly female. Many CHRs are still afraid of using computers. If CHRs experience technical problems, many would simply abandon their computers rather than seek technical assistance. (Portage College 2000). continued on next page... 12... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page * ", Canada Infoway comments that the SARS outbreak in 2003 highlighted the impediments of our antiquated system. (www.infoway-inforoute.ca) When the SARS outbreak hit the world, Canada was using an obsolete system called RDIS, which stands for Reportable Disease Information System. Canada Infoway states that, “The lessons of the SARS crisis have been taken to heart. A Public Health Surveillance IT application called Panorama is in the works to address information technology gaps.” (www.infoway-inforoute.ca) Panorama is a new public health monitoring system that began in 2007. The B.C.- Yukon Public Health Information Project at the B.C. Ministry of Health began working in collaboration with Health Canada, the First Nations Chiefs Health Committee and the B.C. First Nations eHealth Centre of Excellence to develop a strategy for including First Nations in B.C.’s implementation of a new public health surveillance system. The First Nations Health Council brochure entitled “A Year in Review 2007 - 2008” states that, manage and control infectious outbreaks that pose a threat to the public’s health. Infoway’s goal is that by 2010 every Canadian will benefit from the public health surveillance system. The historical record of pandemics includes the 1918-1919 flu epidemic. The public needs an early warning system to provide information about an impending pandemic. In 1997, the public had to deal with H5N1, a new variety of human influenza. The strain jumped from poultry to humans. First Nations communities in Northern Ontario used videoconferencing to coordinate Chiefs, community members, and service providers for planning the H1N1 Pandemic response. Panorama is being developed with funding from Canada Health Infoway and will be used in jurisdictions across Canada to improve information management for public health programs related to communicable disease and immunization. In B.C., Panorama is a component of the overall eHealth initiative and as such it will ultimately enhance public health surveillance, information sharing and electronic health records in the province. Infoway supports the implementation of a panCanadian public health surveillance system called Panorama. Panorama will facilitate, identify, continued on next page... NIICHRO In Touch Winter 2010 sss 13 What is telehealth? ...continued from previous page ", Ê //Ê "7Ê , Ê / ® ATKC is the national centre of excellence for Aboriginal telehealth. It was formed in 2003 at the annual conference of the Canadian Society for Telehealth. The ATKC portal was created as a focal point for those interested in Aboriginal telehealth. Registration to the portal is free. To inquire about membership in ATKC write to: Aboriginal Telehealth Knowledge Circle C/o CST Secretariat Office #310 – 4 Cataraqui Street Kingston, Ontario, K7K 1Z7 Telephone: 613 531-9476 Fax: 613 531-0626 Email: [email protected] Website: www.cst-sct.org LÀ}>Ê/ii i>Ì ÊÜi`}iÊ ÀViÊ/ ® Purpose / Mandate: To improve the health of Indigenous people by expanding the use of Telehealth and supporting Indigenous health providers through: • • • • ATKC joined the Canadian Telehealth Society (CTS) as a Special Interest Group on October 15, 2006. ATKC makes the following announcement which is posted on the CTS website (www.cst-sct.org). Information and knowledge transfer and sharing; Promotion and professional development; Change management and Implementation tools; and Advocacy and strategic alliances. >À\Ê-ÌiÛiÊ,>« >iÊ Brenda, a proud Aboriginal woman, wife, mother and g Brenda, a proud Aboriginal woman, wife, mother and grandmother, is also the randmother, is also the past chair of the Aboriginal past Chair of the Aboriginal Telehealth Knowledge Circle (ATKC), a Special Telehealth Knowledge Circle (ATKC), a Special Interest Interest Group of the Canadian Society of Telehealth. Brenda started with Group of the Canadian Society of Telehealth. Brenda the Manitoba Telehealth Program in 2001 and is currently the Telehealth started with the Manitoba Telehealth program in 2001 Coordinator – Aboriginal Program. She is completing her fourth year with the and is currently the Telehealth Coordinator – Aboriginal Matootoo Lake Medicine Lodge. Brenda brings to this position many years Program. She is completing her fourth year with the of nursing experience in northern and urban settings both in management Matootoo Lake Medicine Lodge. Brenda brings to and non management roles. Recently she was the Project Manager for the this position many years of nursing experience in First Nations Expansion Project which deployed telehealth into ten isolated, northern and urban settings both in management and northern, Manitoba First Nations communities which was a great opportunity non management roles. Recently she was the Project and challenge that gathered many diverse groups together to work collectively Manager for the First Nations Expansion Project which toward a common goal. deployed telehealth into ten isolated, northern, Manitoba continued on next page... 14... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page 7/Ê,"Ê Ê/Ê ,Ê*9¶ Brenda worked for nine years on Telehealth. During a recent interview Brenda commented on the important and unique role of CHRs. They work with patients and many different health care providers. They are in a good position to inform their community members about the alternative health care services available to them through telehealth. There are different levels of programs currently set up in First Nations communities. Some are just beginning to set up programs. Most of our communities are struggling with very limited resources. One of the benefits of telehealth is to link up with other CHRs in your area to hold meetings via teleconferencing to share strategies to improve programs. Linking up with other CHRs can also provide an added resource. CHRs can share their knowledge with each other and identify strategies that have worked well for them. The same principle can apply to any community health worker such as Mental Health and Drug and Alcohol workers. Brenda noted the example of linking up NIICHRO In Touch Winter 2010 with a group of people who were meeting in Winnipeg recently. This same principle can be used for educational forums. Dieticians and nurses could link up with CHRs to provide, for example, educational material that focuses on the preventative aspects of diabetes. In turn, CHRs could share this material with community members who are living with diabetes. Brenda also pointed out that CHRs can act as advocates for their clients by informing community members that telehealth is one of the options available in many communities. For most First Nations or Aboriginal communities, connectivity to the Internet is no longer a barrier. It is now time to start supporting First Nations who want to expand their knowledge and use of telehealth. Many of their clients are quiet and/or shy and would not feel comfortable talking to a doctor or nurse. CHRs on the other hand are very comfortable being a link between the community members and their health care providers. CHRs can ensure that patients have someone with them who could speak on their behalf to ensure continued on next page... s s s 15 What is telehealth? ...continued from previous page that medical referral, that Telehealth is an option. Many First Nations and Aboriginal people do not like to leave their communities. Telehealth offers an affordable option. Telehealth can also provide televisitation between family members who are receiving health care away from their home communities and family members who remain at home. a member of ATKC is that CHRs would have access to the research portal as well as networking opportunities. They can connect to a very valuable peer group. CHRs can find new ways to share information, collaborate, identify priorities, and generate knowledge in regards to eHealth. If you choose to join ATKC after considering the benefits of becoming a member, you can do so by contacting the following email address: CHRs would explain to community members that [email protected]. You can also use any search there is a process to follow if they choose to use engine such as Google, Yahoo, MSN, or ASK to telehealth options. When a patient is referred to find more information on telehealth. Simply type facilities using telehealth, they are referred to a in “telehealth” and the name of your area and the main scheduler. The main search engine will generate scheduler will provide all the a list for you to review. It is “At the same time, we look details on how to access another way to learn about forward to working with the CST telehealth, and identify which telehealth in your area. to raise the profile, value and facilities are available in their “The ATKC is excited about professionalism of telehealth area. CHRs are in a position our new relationship with the overall.” to not only give support but CST as it directly supports also to ensure that the patient our mission to improve the BRENDA SANDERSON, INTERIM PRESIDENT gets the quality of care they health of Indigenous people OF THE ATKC BOARD OF DIRECTORS AND need. by expanding the use of CHAIR OF THE ATKC SIG telehealth and supporting Brenda also discussed the Indigenous health care ATKC, which is made up mostly of Aboriginal providers,” said Brenda Sanderson, interim people, or non-Aboriginal people who work in President of the ATKC Board of Directors and Aboriginal communities. While it is a national Chair of the ATKC SIG. “As we move forward in group with representatives from across the country, spreading the good news of telehealth within our ATKC members are the grassroots people working communities, we will work closely with the CST on telehealth. The group is even expanding with to raise the visibility and understanding of the networks in the USA. It was noted that ATKC Aboriginal telehealth community within the broader does not currently have any CHRs as members Canadian telehealth community.” She added, “At and it would be nice to have some CHRs join their the same time, we look forward to working with the group. CST to raise the profile, value and professionalism of telehealth overall.” The ATKC is in a position ATKC works on a capacity building principle. It is to conduct consultations to create and advocate made up of volunteers. The group acts as a home for an Aboriginal eHealth research agenda. (Maar, base for all Aboriginal people who currently work Seymour, Sanderson and Boesch 2009) The ATKC with telehealth. One of the benefits of becoming consensus process places less emphasis on continued on next page... 16... NIICHRO In Touch Winter 2010 What is telehealth? ...continued from previous page the knowledge of experts and more on the perspective of those who are affected by eHealth. (2009) Aboriginal people have had outsiders devalue their knowledge for over a century. The ATKC approach focuses on the lived experience of Aboriginal people. //" It is important to note that ideally telehealth should only supplement face-to-face clinical consultations; it cannot replace them. One issue is that the medical care sector has lagged well behind other sectors in its implementation and use of information technologies. Most of us do our banking online, we book our air travel online and some of us even attend court online (telecourt). A major area of concern to First Nations in Canada is ensuring that there are initiatives developed regarding standards of practice for telehealth. Standards must ensure good practice, privacy, confidentiality and competence while using telehealth. The cost of equipment for telehealth is a major limitation for many First Nations communities. In the past many telehealth initiatives were short-term or pilot projects. NIICHRO In Touch Winter 2010 sss 17 Patient Checklist ÌÀ`ÕVÌ\ For First Nation and Inuit community members, this patient checklist provided by the nurse, CHR or homecare worker is to assist you in being better prepared to take a lead on their own health care and what options are available (if any) in relation to Telehealth technology. 1. Check with the Health Centre or Nursing Station to find out if there are Telehealth technology is available in your area: q Yes, we have telehealth capabilities: Local Contact Person ________________________________________________________________________ Contact Number ( ) _________________________________________ q No, we do not have telehealth technology available in my community yet. 2. Where is the Telehealth Coordinator/Scheduler located? City: _______________________________ Telephone: ( FAX: ( Facility ____________________________________________ ) _________________________________________________ ) _______________________________________________________ Email: ________________________________________________________________ 3. What Telehealth services are available for you in your area? qTeleconsultation qTelevisitation qEducational qMental Health qClinical qElectronic Health Records qOther _________________________________________________________ 4. Ask your doctor if he can provide you Telehealth options? q Yes, my doctor can q No, my doctor cannot 5. Is there a Nurse Line or health information phone line available in your area? q Yes Telephone q No ( ) ______________________________________ 6 Confirm with your doctor if the medication prescribed is covered by the Non-Insured Health Benefits (NIHB). q Covered by NIHB q No, (alternative that is covered) ___________________________ Suggestion: It’s a good idea to prepare a list of questions to ask you health provider. That way, you will not forget to cover an important topic. 18... NIICHRO In Touch Winter 2010 NIICHRO Activities ,"Ê/"Ê "*/ 9 While no funding has been accessed to support this initiative since March 2007, NIICHRO has been doing its best to maintain some momentum. In May 2009, it was a discussion item at the Annual General Assembly. The CHRs gave overwhelming support to the core competencies and at the same time aired some of the concerns they face on a daily basis. In July 2009, Ms. DedamMontour did a Road to Competency presentation to Health Canada’s Working Group on Chronic Disease Core Competencies. Then in November 2009, NIICHRO attended the National Aboriginal Health Organization’s conference and had a Road to Competency poster presentation on the core competencies for a CHR. For more information or the list of competencies, go to http://www.niichro. com/2004/?page=reports&lang=en Ê,Ê ,"-In September 2009, the Canadian Red Cross invited NIICHRO and other organizations involved with the RespectED Program to come to Ottawa for an information sharing session on their respective programs and services. It was very impressive that the program has been in existence for 25 years and NIICHO was very pleased to participate in this important celebration. As for information sharing, NIICHRO’s presentation was on the role of CHRs and their scope of duties as well as on the organization and how we work on developing culturally appropriate educational resources for First Nation and Inuit communities. NIICHRO In Touch Winter 2010 Celebrates 25 years! sss 19 NIICHRO Activities ...continued from previous page 6 /", Ê",,Ê"Ê 1,-Since September 2009, NIICHRO sits as an Advisory Committee member of the Victorian Order of Nurses – Aboriginal Health Initiative. This First Nations initiative has three components, all of which could impact the work of CHRs. The role of the First Nations Advisory Committee is to guide the process and development of resources for each of the components: Home Visiting Resource Guide Framework • • • Assist in the development of the home visiting framework so that it can provide a bridge for an overall outline of skill sets and behaviours needed in home visiting. The goal is to provide supports and identify gaps in training in regards to home visiting standards. To provide culturally-safe care to First Nation’s families in home visiting practice. Chronic Disease Prevention and Management Toolkit • • • Assist in the development of a toolkit to provide resources for chronic disease prevention and management programming. The toolkit is to provide information on the Expanded Chronic Care Model that is being used by provincial health departments and health regions across Canada to guide the changes in health care provision to prevent and manage chronic conditions. The goal was to identify what resources are required to compliment and assist with current chronic disease initiatives in communities. Integrated Quality Management Framework • • • Receive update on the 8 First Nation site visits that were undertaken to provide a baseline to ensure resources created were relevant and meaningful. Participate in committee meetings and provide input on resource development. The goal is for the resource to assist communities to have Quality Management and Continuous Quality Improvement Process applied to daily operations and health services ands program. The vision of this initiative is to support program and service providers in First Nations communities with useful and reliable frameworks; resources, and expertise to enhance core competencies, standards of practice, knowledge base, integration of evidence-informed practice and alignment with national and provincial level approaches. continued on next page... 20... NIICHRO In Touch Winter 2010 NIICHRO Activities ...continued from previous page ÊÊ*/, Ê-" /9 NIICHRO sits as a Liaison member of the Canadian Paediatric Society, First Nations, Inuit and Metis Health Committee. Each year the committee combines one of its meetings with a site visit to a First Nation community, Inuit hamlet or Métis settlement. The goal is to see the community, meet its health workers, elders and community members to understand their issues and challenges as well as successes in regards to children and youth. In October 2009, the committee went to the Inuit community of Nain, NL which is located on the NIICHRO In Touch Winter 2010 north coast of Labrador in Nunatsiavut. The visit to the Child Protection/Welfare office resulted in health staff noting their concern with FASD. The FASD coordinator who is situated in Goose Bay works on intervention and developing programs at schools. At the time of the visit, there was no FASD program within the community. They have also adopted a behavioral aid idea from Alaska. A supper was held where community members are invited to join the committee and discuss any issue pertaining to children & youth. The highlight of that evening was a local youth group how did some Inuit drumming. sss 21 Keeping In Touch Form KEEPING IN TOUCH... NIICHRO is reviewing its mailing list and we need you to indicate whether you wish to continue receiving NIICHRO’s In Touch Newsletter. Our goal is to serve you better. To facilitate this process, please return the completed form below or complete the 2010 -2011 Membership form by June 30, 2010. YES, keep me subscribed Unsubscribe Preferred means to receive “In Touch” PDF version (via e-mail) Hard copy (via mail) Mailing address (please print) Name: Title: Organization: Address: City: Province: Postal Code: Telephone: Fax: Email: Please return via Fax: (450) 632-2111 22... NIICHRO In Touch Winter 2010 National Indian & Inuit 2010-2011 MEMBERSHIP FORM Community Health Representatives Organization (NIICHRO) I. Membership Information First name: Last Name: Title: Organization/Health Care: Address: Community: Prov: Postal Code: Tel: Fax: Email: II. Membership Fee (one form for each membership) CHR $75.00 Trained: Untrained: Include copies of certificates/diplomas Associates $100.00 III. Method of Payment Cheque (enclosed) Cheque (to follow)** Purchase Order # ** Please make cheque payable to: NIICHRO ** Print name and contact information of person authorizing payment: Name: Title: Phone #: Credit Card: Cardholder Name: Card Number: Expiry Date: Cardholder Signature: Office Use Only NIICHRO In Touch VISA Master Card Authorization #: Winter 2010 sss 23 Upcoming Events >>`>Ê*ÕLVÊi>Ì ÊÃÃV>Ì *ÕLVÊi>Ì ÊÊ >>`>\Ê- >«}ÊÌ iÊÕÌÕÀiÊ /}iÌ iÀ *Pre-conference session: The Future of Community Health Workers/Lay Health Workers in Canada and Internationally: Opportunities, Challenges and Risks June 13-16, 2010 Toronto, ON Telephone: (613) 725-3769, ext 126 Email: [email protected] Website: www.cpha.ca/en/conferences/conf2010.aspx >>`>ÊLÀ}>Ê-Ê iÌÜÀ June 14-18, 2010 Enoch, AB Tel: (604) 266-7616 Fax: (604) 266-7612 Website: www.caan.ca/ i>}Ê"ÕÀÊ-«ÀÌÊ7À`Ü`i]ÊÌ iÊÈÌ Ê>Ì iÀ} September 3 - 10, 2010 Hawaii Convention Center, Honolulu, Hawaii Phone: (808) 597.6550 Fax: (808) 597.6551 Website: www.papaolalokahi.org/coconut/events/pdf/ HOSW_1pgr.pdf 24... Ì Ê viÀiViÊvÊÌ iÊ >>`>Ê,ÕÀ>Êi>Ì Ê ,iÃi>ÀV Ê-ViÌÞ “Rural Life: Connecting Research and Policy” September 23-25, 2010 Fredericton, NB Phone: (306) 966-7888 Fax: (306) 966-8799 E-mail: [email protected] Web site: www.crhrs-scrsr.usask.ca/fredericton2010/ {Ì ÊÌiÀ>Ì>Ê viÀiViÊÊiÌ>ÊV Ê -«iVÌÀÕÊÃÀ`iÀ The Power of Knowledge: Integrating Research, Policy and Promising Practices Around the World March 2 – 5, 2011 Vancouver, BC E-mail: [email protected] Website: www.interprofessional.ubc.ca {Ì ÊÌiÀ>Ì>ÊiiÌ}ÊÊ`}iÕÃÊ `Êi>Ì Securing Our Future: Advancing Circles of Caring March 4 - 6, 2011 Vancouver, BC Website: www.cps.ca/English/ProEdu/IMICH.htm NATIONAL INDIAN & INUIT COMMUNITY HEALTH REPRESENTATIVES ORGANIZATION (NIICHRO) PUBLICATION P. O . BOX 1 0 1 9 • K A H N AWAK E • Q U EBE C • J 0 L 1 B 0 • CA N A DA #40069101 NIICHRO REGISTRATION In Touch Winter 2010
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