Title: Need and Model of Telediagnosis The Manitoba Experience
1Need and Model of Telediagnosis -The Manitoba
Experience
- Albert E. Chudley
- Mary Cox-Millar
- Sally Longstaffe
- University of Manitoba
- 4th Annual Fetal Alcohol Canadian Expertise
(FACE) Research Roundtable Edmonton, AB - September 9th 2003
2Learning Objectives
- Demonstrate the need for telehealth
- Identify a process that will facilitate distant
diagnosis and meet the needs of the North - Recognize the need to partner with external
groups and communities - Discuss our experience in FAS diagnosis using
telehealth
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5CADEC Community Services/Partnerships
Direct Service For Children 0 to 7 Years of Age
Family Support
Government Support
Healthy Child Manitoba Manitoba Health/Child
Health
Interagency FAS/E Program Childrens Special
Services/FAS Outreach Team Society for Manitobans
with Disabilities Provincial Outreach Therapy
Services for Children Child and Family Services
Fetal Alcohol Family Association Child and Family
Services
School Age Children
FAS/FAE Support Services
Special Education Classrooms David Livingstone
School and Shaughnessy Park Child Guidance
Clinic Childrens Special Services Child
Psychiatry
Support for Pregnant Women
NorWest Mentor Program Aboriginal Health
Wellness/ FAS/E Prevention Program Mentorship
program The Pas and Norway House
Northern Manitoba Services for Families
Diagnostic Services
Adult Services
Clinic for Alcohol Drug Exposed Children Fetal
Alcohol Support Team - Thompson
Fetal Alcohol Support Team Thompson Interagency
Group The Pas / Flin Flon
6Reasons for and Benefits of Telehealth
- Canada has many distantly located low population
communities with limited access to specialty care - Reduced time and costs for travel
- Timeliness of access to care
- Reduced barriers to compliance with appointments
- Facilitates family involvement
- Enhances linkages amongst health professionals
and community agencies - Provides access of education and training to
rural areas
7MBTelehealth
- Partnering with the Prairie Provinces FAS
Initiative and CADEC, the first link was with
Thompson MB in 1999. - Following a 3M grant from the federal
government, technical capabilities were greatly
expanded in 2001. - Subsequent link to NorMan Region (The Pas and
Flin Flon) 2002-present.
8-
Intake
Assessment
Follow
-
up
9Paediatrics and Child Health Vol 7 March, 2002
Linked to 24 sites!
10Telehealth Equipment
- Province-wide LAN H.323 internet protocol
video-conferencing system - Uses multi-site control unit
- Portable equipment with document viewer
11Total Network Utilization Fiscal Year 2002-2003
Total Number of Sessions 2,031
FAS sessions represent27 encounters
12Utilization by Type of Session(shown by quarter
year for 02-03 fiscal year)
(All clinics including FAS)
13Clinical Utilization (Actual Number) Fiscal Year
2002-2003
(All clinics including FAS)
14Cost impacts, assumptions re patients
- Does not include indirect costs savings due to
time off work, child care while away etc - No distinction made between costs borne by
individual and those borne by health care system
15Technical success qualitative findings
- Users satisfied with training received
- Unanimous appreciation of technical support
- Technology easy to use
- Sites linked by satellite experience more
problems - Some would like to enlarge network to more sites,
have more drops, be available for emergent and
urgent use 24/7
16CADEC Telehealth Experience with FAS Diagnosis
- Total of 27 links since April 1/99
- 8 of 27 links planning/team meetings,
presentations and/or education sessions - 19 of 27 links assessment links
- 27 children were assessed (initial assessment,
consults and/or follow-up to initial assessment) - 4 of the 19 assessment links were training teams
in diagnosis
17Estimated travel savings (FAS-24 month period)
18Feedback From Users Following FAS Assessments
- Excellent it is almost like talking face to
face at your kitchen table with the doctors. - It should be in more communitiesbest thing that
could ever come to the North. - It is an opportunity to see how the medical
system works. - Bringing expertise to the community helps in
building a team that is working in the best
interests of the child.
19Feedback From Users Following FAS Assessments
- Travelling to Winnipeg is a stressor for many
people. - Using telelink allows the children to be
assessed with less disruption to their daily
routinea trip to Winnipeg would be 3 days from
home! - A birth mother would be more willing to
participate if she is supported through the
process by people who know her and the child in
the community.
20What Have We Learned?
- Importance of establishing external relationships
(CADEC team and the community) - Establish common and site-specific goals
- Provide training as needed
- Clarify process for referral
- Establish guidelines for communication and
clarify expectations
21What Have We Learned?
- Ask for feedback on experience
- Need to wait for camera before speaking
- Use close up mode when speaking
- Provide a warm-up period for children to become
accustomed to the interactive talking
television and the room - Allow privacy (limit numbers in the room at any
given time
22Summary
- Telehealth FAS Diagnosis has met the needs of
some families in a northern community in Manitoba - On site coordinator trained in preparing the
family for the diagnostic process and with good
community links is essential - Need to link with local professionals and
agencies
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24Thanks for not drinking, Mom