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:
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:
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:
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:
For communities, TeleHealth means:
For health care providers, TeleHealth means:
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.
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.
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.
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.
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.