TeleHealth

• What is TeleHealth?
• What benefits does TeleHealth provide?
• What happens during a TeleHealth consultation?
• What is the role of the TeleHealth nurse?
• Where can I learn more about TeleHealth in Canada?
• Other related sources

What is TeleHealth?

For many First Nations and Inuit communities, the nearest hospital, doctor or nurse may be hundreds of kilometres away. In many cases, this gap can be bridged using TeleHealth - technology that allows patients, nurses and doctors to talk as if they were in the same room.

TeleHealth can be:

• Two physicians discussing a patient's problems by telephone;
• Medical information being transferred, safely and confidentially, between computers via high-speed telephone lines;
• A patient getting a face-to-face examination by a remotely located doctor, through interactive video-conferencing; and
• Medical images, previously photographed and stored on computers, being forwarded later to remotely located professionals.

In Canada, the TeleHealth strategy is to use information and communications technologies in order to improve access to our universal health care system.

TeleHealth technology comes in many forms

Some of the TeleHealth applications in use today include:

• Telemedicine - for delivering medical services at a distance;
• Tele-education - for meeting professional and patient education and research needs;
• Telecare or teletriage - for diagnosing medical problems through a call centre; and
• Telemonitoring and telehomecare - for treating patients in their homes.

TeleHealth is a partnership

TeleHealth is not just about technology and information. It's about people working together toward a common vision: the timely and appropriate access to essential health care and information, regardless of location. In Canada, TeleHealth is a partnership between:

• Health care providers;
• Health care consumers;
• Communications providers;
• Regulatory agencies;
• Professional groups; and
• The community at large.

What benefits does TeleHealth provide?

TeleHealth cannot replace clinicians or other health care staff. But it can - and does - improve access to health care for people in remote locations, or whose access is limited by culture, language or clinical resources.

For patients, TeleHealth means:

• Less time away from home;
• Less time away from work;
• Fewer travel-related expenses, such as gasoline, meals and overnight stays;
• Care in your own community, where you feel more comfortable and your family and the medical staff who know you best are close at hand;
• Local access to a far greater number of specialists to help your care provider manage your care;
• Faster response times for medical tests and consultations between your care provider and outside specialists; and
• The ability to participate in face-to-face conversations with a specialist and your care provider at the same time.

For communities, TeleHealth means:

• Improved health care quality, through the ability to access specialists when they're needed;
• Greater control to select and access the health care services needed;
• Wider and more timely access to appropriate health information; and
• Employment and training opportunities to develop the technical expertise of local health care providers.

For health care providers, TeleHealth means:

• Improved peer-to-peer communication among health care providers in remote areas;
• Better professional support, greatly reducing stress and improving career satisfaction, recruitment and retention;
• Continuing education and training, through videoconferencing and secure professional web portals; and
• Better integration of community and provincial health care systems, enabling seamless delivery of services.

What happens during a medical TeleHealth consultation?

Here's how a typical medical TeleHealth exam might proceed, with you as the patient.

Upon choosing to have a TeleHealth consultation, you are asked to sign a form that gives permission to send your medical information to the remote specialist or health professional who would be assisting with your health care. If you don't sign the form your information won't be forwarded, but you'll need to arrange a face-to-face consultation instead.

At the time of your medical TeleHealth appointment, a specially-trained staff member explains the process and prepares you for a clinical exam. This exam takes place in a private room, where you can either be by yourself or with others you choose to have with you - such as your own doctor, a family member, or anyone else you want there for support.

Through use of a TV or computer screen, a small camera, microphone and special telephone line, the exam begins with your picture, x-rays and other test results being transferred to the remote physician. Special hand-held cameras are sometimes used to zoom in for tight close-ups, providing a good view of the problem areas. Other electronic tools, like a fibre-optic otoscope and digital stethoscope, allow the physician to examine you as if he or she were there in person.

Everyone can talk freely back and forth during the examination - and you, as the patient, are encouraged to ask questions. The health professional, who is visible to you on the screen, is also sitting in a private room, so your information and any conversation between the two of you remains private and confidential - just as if you were having an appointment in person.

What is the role of the TeleHealth coordinator?

There's more to providing care through TeleHealth than simply installing cost-effective technology. TeleHealth operations must also fit into the organizational structure of the health care facility, have administrative and remote medical support, and have the operational infrastructure to allow the clinical applications to work.

But first and foremost, TeleHealth operations need to meet the clinical needs of the health care providers and their patients. This means keeping the meetings personal. And this is where a properly trained community health worker comes in.

The role of the TeleHealth coordinator is to facilitate the provider-patient relationship. Whereas cameras, monitors and other pieces of equipment can make the TeleHealth exam room seem cold and impersonal, the TeleHealth coordinator's job is to promote the "human factor". By keeping the use of technology to a minimum and focusing on ways to increase human contact, the TeleHealth coordinator prevents the technology from interfering with the relationship.

Before a TeleHealth service is implemented, the TeleHealth coordinator spends time at the consulting specialist's site of practice, in order to build their professional relationship. By observing the specialist's personal methods of practice, the TeleHealth coordinator is able to better recreate the experience of an in-person consultation during the subsequent TeleHealth exam. The TeleHealth coordinator also studies workflow patterns, in order to fit the TeleHealth consultation seamlessly into the provider's practice.

Additionally, meeting other support staff in person helps establish the interpersonal working relationships that lead to better cooperation, communication and staff satisfaction. When the TeleHealth coordinator is at the remote site, these enhanced professional relationships encourage personal relationships between the patient and provider.

Where can I learn more about TeleHealth in Canada?

Research on TeleHealth in First Nations and Inuit communities

Evidence obtained through a recent research project reveals that TeleHealth is an effective tool for providing health care to First Nations and Inuit communities in Canada. The National First Nations TeleHealth Research Project report shows how the related research was planned, implemented and evaluated, and also provides educational materials of potential interest to other First Nations and Inuit communities who may choose to launch their own TeleHealth projects.

TeleHealth in Alberta

The Alberta First Nations TeleHealth Program (AFNTP) is an initiative aimed at redefining health care service delivery to First Nations communities in the Alberta Region. The initiative's objectives include developing the technical infrastructure to support TeleHealth programs, installing videoconferencing equipment, providing continuing education for nurses in remote communities, and deploying an information portal that will enable on-line access to thousands of health-related documents.

Other related sources

These Web sites offer additional information related to TeleHealth.

Canadian TeleHealth associations

Canadian Society for TeleHealth - Through information and communication technology, the Canadian Society for TeleHealth (CST) enables optimal health and healthcare for anyone, anytime, anywhere.

Telemedicine

International Society for Telemedicine - The International Society for Telemedicine (ISfT) exists to facilitate the International dissemination of knowledge and experience in Telemedicine and e-Health, and to provide access to recognized experts in the field worldwide.

Telemedicine Information Exchange - The Telemedicine Information Exchange (TIE) is a comprehensive, international, quality-filtered resource for information about telemedicine, TeleHealth and telemedicine/TeleHealth related activities.

American Telemedicine Association - The American Telemedicine Association (ATA) is the leading resource and advocate promoting access to medical care for consumers and health professionals via telecommunications technology. ATA seeks to bring together diverse groups from traditional medicine, academic medical centers, technology and telecommunications companies, e-Health, medical societies, government and others to overcome barriers to the advancement of telemedicine through the professional, ethical and equitable improvement in health care delivery.