Project: Eastern Ontario Telehealth Network

Canada Health Infostructure Partnerships Program

Synopsis

The Eastern Ontario Telehealth Network (EOTN) Project (now known as CareConnect) was implemented over a 18-month period to deliver health care in 19 hospitals in Eastern Ontario via specialized telecommunication technologies. The goal was to support the primary care providers in rural areas through distance access to clinical consultations and specialty services located in three Ottawa hospitals.

The primary focus of the project was to provide a (full) range of clinical consultation services:

• Cardiology
• Paediatric care including mental health, respiratory and clinical genetics,
• Dermatology
• Care of the elderly
• Geriatric rehab
• Palliative care.

Outcomes

• Enhanced access to specialty care by patients in rural areas of Eastern Ontario. This has decreased waiting lists for some specialties and improvement in the utilization of geriatric rehabilitation beds;
• Enhanced access to rounds, Continuing Medical Education (CME), and continuing education by health care professionals;
• Increased collaboration and relationship building amongst the partner hospitals;
• Decreased traveling time and expenses for patients, families, physicians and other health care professionals;
• Fewer unnecessary transfers to tertiary care centres;
• Increased contact and improved working relationship between rural and consulting hospitals;
• Increased access to specialty consultations and education sessions for rural areas;
• Integration of telehealth clinics into the mainstream of health care; and
• Access to sessions through the EOTN increased considerably at little cost to participants and their organizations;

Policy Implications

Further study is recommended regarding:

• Physician reimbursement, provincial funding formulas and set fee schedules;
• Physician credentialing; and
• A provincial patient consent process.

Research Implications

• The impact of telehealth on physician referral patterns; and
• Costs and cost savings achieved through telehealth.

Lessons Learned

The EOTN project reported numerous lessons learned which are included in their evaluation report. Many of them revolved around the importance of proper planning and preparation, the need to address organizational change management, and logistic/process issues, which are summarized below:

• A formal management structure should be in place at the onset of the program;
• The willingness of consulting physicians to provide telehealth consultations should be ascertained before beginning a needs assessment survey;
• Ideally, each site should have medical, clinical, and administrative 'champions' to promote telehealth within the hospital setting;
• A telehealth program is very complex and represents major organizational change, especially for providers. Involvement of the consulting and referring physicians in all aspects of telehealth, attention to ease of access and use, and appropriate incentive utilization mechanisms are requirements for success; and
• Logistically, patient management is enhanced at the referral sites if a designated examining/consultation telehealth room is available.
• Common understanding and training clinical protocols is required for successful clinical consultations.
• More opportunities to meet with other CHIPP projects doing similar work would have been ideal to share experiences, ideas, and best practices. This could have been facilitated by CHIPP project staff.

The Future

The EOTN was built on a sound plan that established a centralized focus and positive environment from which to proceed. The Project Manager was strongly supported by the Management Committee, Steering Committee and Advisory Council, and this facilitated the relatively smooth functioning of major planning and management activities throughout the 18-month project. All of this was reinforced by strong executive commitment and support, and the informal and formal alliances that existed prior to the start of the EOTN.

The time frame for the EOTN pilot was too short. In the case of the EOTN almost two-thirds of the 18 months were used in just getting things effectively up and running, which left very little time to generate extensive clinical and educational sessions throughout the partner sites and, hence, to realize some of the intended objectives of the project. Additional time would have allowed the EOTN to develop champions (at all levels), and to establish the depth of support for the major organizational change that is implied by telehealth.

Priorities for the Future

• Short Term
  
  
  • Establishment of adequate operational funding for the EOTN;
  • Development of clear policy directions for the next phase of the EOTN;
  • Identification of champions at all key levels ;
  • Establishment of appropriate reimbursement and credentialing mechanisms;
  • Establishment of full-time site coordinators; and
  • Creation and establishment of a governance structure representative of currently active EOTN partnerships.
• Medium to Long Term
  
  
  • Increase the number of telehealth rooms in each hospital;
  • To engage all hospitals in Ontario referral area (Southeast Region, Champlain District)
  • Expansion in the number of clinical services offered to patients and providers;
  • Dedication of one educational service telehealth platform;
  • Development of training programs for clinical and educational activities;
  • Realistic targets for the expansion of partner organizations; and
  • Completion of an economic evaluation
  • Expansion in the number of consulting sites providing bilingual services.

Appendix A: Documents or Products Generated

Nom du document/produit

Policy and Procedure/Operational Manual

Job Descriptions and /or recruitment manual

Clinical Program(s) Protocols:

• Cardiac
• Dermatology
• Mental Health
• Nephrology
• Paediatric Respiratory and Urology
• Pre-admission Assessment

Video Conference Protocols and Etiquette Guide

• Multi-point Etiquette
• Presentation Tips

Consent Forms

Sustainability Plan

For additional information, please contact:

Kathryn Crone, Executive Director, CareConnect at 613-562-6075 kcrone@careconnect.org or at www.careconnect.org