Using Telehealth to expand our reach: What works

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Using Telehealth to expand our reach What works
whats available?

• GF Strong Rehab Centre
• December, 2006

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What is Tele-health?

• TH broadly refers to the use of information and
  telecommunication technology to assist with the
  delivery of health information and services by
  facilitating the transmission of images, voices,
  and other data over large and small distances BC
  Ministry of Health Planning
• Other terms Tele-medicine, e-health

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Benefits of Tele-health

• Research has shown care to be effective
• Increases family involvement
• Cost-effective and time-efficient for both
  practitioners and clients
• Improved access to specialty services
• Improve continuity of patient care
• Can incorporate culturally-appropriate care
• Can lead to capacity-building

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Types of TH Applications

• Reviewing the literature I have found examples of
  TH as applied to physical therapy, occupational
  therapy, nursing, social work, psychiatry,
  rehabilitation, and many others

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TH Processes

• TH has been used for patient assessment,
  consultation, case management, exercise
  monitoring, pre-screening for treatment options,
  post-program follow-up, case conference, and
  patient education

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TH Modes of Delivery

• Store and Forward transmission of information
  (e.g., fax machines, e-mail)
• Real Time transmission (e.g., telephone,
  video-teleconferencing)
• Combination of Store and Forward Real Time
  transmission

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TH Telecommunications and Network Links

• Plain Old Telephone System (POTS)
• Dial-up Digital Telephone Lines (ISDN)
• Asymmetric Digital Subscriber Line (ADSL)
• World Wide Web Internet

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Rural Stroke Rehab Project

• Typical problems encountered when patients
  discharged from rehab hospital to home
• Medication non-adherence, isolation, limited
  access to specialists, difficulty coordinating
  home-based services, inadequate supervision,
  minimal communication between hospital
  community care providers re patient history and
  discharge plans
• Technology home Internet videoconferencing
  units
• Strengths early identification resolution of
  problems, ?patient isolation, ?continuity of care
• Barriers complexity of equipment

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Multidisciplinary approach to treating eating
disorders

• Study of 12 patients
• Patients received CBT nutrition education
• After 1st session 50 would prefer
  videoconferencing to physical visits
• Reasons for preference convenience, feel more
  in control, less intimidating

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Trauma centre case management

• Pre-identified a subset of complex patients who
  were high service utilizers
• Interactive home telehealth equipment
• 18 of 30 patients received TH intervention
• Advanced nurse practitioner did case management
• 6 months prior to intervention vs. month of
  intervention - ?admissions, ? LOS, ? ED visits,
  and ? GP visits

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Use of TH by Social Work

• Mental health earliest most frequent users
• Use of videoconferencing slow to catch on
• E-mail or interactive e-mail (real time chat)
• Issues privacy/confidentiality/security/informed
  consent, impact on therapeutic relationship,
  charting

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MPAP First Nations TH Project

• Carrier Sekani First Nations Band
• Combination of physical clinics and TH follow-up
  clinics
• Rheumatology, PT, OT, nursing
• Partnership of Band, MPAP, TAS, ARC
• Benefits cost-effective, improved continuity of
  care, better care to more people
• Issues community readiness (assess promote),
  division of roles, ongoing evaluation, how to
  facilitate culturally- appropriate care

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British Columbia Communities with Telehealth
Facilities
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Provincial Status of TH

• Psychiatry uses TH for assessment and Rx
• Provincial site - BC Womens Childrens
  Hospital
• Each health authority has own network, and First
  Nations network
• Most sites are located in community health
  centres or hospitals, do not have paid staff, and
  typically have one or two cameras and two
  television sets
• Larger sites have peripherals for education
  (Leslie Gordon Diamond Centre)

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First Nations TH Sites

• Fort Nelson, Gitxsan (Hazelton), ITHA (Nanaimo),
  KDC Health (Campbell River), Kispiox (Hazelton),
  Kitkatla, NTC (Port Alberni), Old Massett, Sea
  Bird Island (Aggasiz), Shulhe-tun (Ladysmith),
  Skidegate, Sliammon (Powell River), Snuneymuxw
  (Nanaimo), StoLo (Chilliwack), Three Corners
  (Williams Lake), Tse-shaht (Port Alberni)

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The future is now

• Role of TH for GFS?
• Role of TH for social work?