Project: NORTH Network

Canada Health Infostructure Partnerships Program

Synopsis

The NORTH (Northern Ontario Remote Telecommunications Health) Network is a telemedicine program that has been providing patient consultations and continuing professional education to northern and rural communities in Ontario via two-way television, electronic medical devices and other advanced technologies since 1998. NORTH Network and its partner, Keewaytinook Okimakanak Telehealth have collaborated with 75 member and funding organizations, to expand telehealth services from 14 to 78 sites, to deploy advanced technologies, to further develop and refine the service framework and to build significant capacity to deliver services.

Outcomes

The NORTH Network project has demonstrated that it had an impact on healthcare service delivery as well as the healthcare stakeholders perceptions of telemedicine across the regions served:

• Telemedicine dramatically improved access to physicians and allied health care professionals. In addition, First Nations groups felt that more attention is being paid to their community with respect to delivery of healthcare;
• Reduction in travel costs for patients was demonstrated;
• Physicians and allied health professionals reported increased access and a high degree of satisfaction with the continuing professional development and education opportunities;
• Improvements in quality of care were noted most particularly in the tele-stroke project which was NORTH Network's first emergency application. This project provided potentially lifesaving treatment which simply would not have been available in the communities in northern Ontario without this technology;
• This project has stimulated many public sector organizations to think about how they can use telemedicine to improve their services;
• North Network's use has extended beyond the physician/medical model to many other health professionals, as well as case conferences, mental health workers and diabetic education in First Nations communities, tele-visitation, nurse practitioner support and tele-mentoring applications;
• The Network stimulated the first deployment of Smart Systems for Health in Ontario. This allowed NORTH Network to reallocate resources to service delivery while aligning with the province's vision;
• The project has provided a best practice approach to change management which has served to sustain support levels in the communities throughout the project; and
• North Network has played a role in bringing diverse groups together. One of the best examples of this is NORTH Network's activities in bringing fourteen hospitals and two First Nations communities from across northwestern Ontario together to develop a tele-radiology network for their region.

Policy Implications

The following items have possible policy implications:

• The mainstreaming of telemedicine such that telemedicine is simply a tool to achieve health or program objectives. It is proposed that all government and public sector organizations who are planning to deliver healthcare programs consider whether telehealth should be part of their business plan; and
• The development of recommendations and policies which would assist in overcoming the following barriers to telehealth:
  
  
  • Physician remuneration
  • Credentialing of physicians
  • Interprovincial licensure
  • Hospital charting and MIS guidelines.

Research Implications

• Evaluation -The initiation of research programs in telehealth to fully assess the impact of telehealth on health services utilization and on health outcomes; and
• New Applications - The applicability of a telemedicine pilot project or programs in areas such as remote support for rural nurse practitioners and the development of virtual intensive care unit environments; and continued development of emergency applications such that telemedicine would play an active role in emergency preparedness.

Lessons Learned

The NORTH Network Project reported multiple lessons in the categories of Service Framework, Health Care Delivery, and Continuing Professional Development. A selection of the lessons learned is summarized below:

• Implementation must be driven by and sensitive to local needs, cultures and resources;
• Scheduling a telemedicine appointment must be as easy as scheduling a face-to-face consultation and the referral process should be automated;
• Physicians must be appropriately reimbursed and credentialed by appropriate licensing bodies to deliver telemedicine services;
• Multiple communication strategies and mechanisms are required, both internally and externally, to facilitate decision-making, information-sharing, promotion and accountability; and
• Telemedicine programs can actively participate in research and special projects to identify opportunities to expand the scope of services provided (e.g., emergency services).

The Future

Along with the two other CHIPP funded telehealth initiatives in Ontario, The Eastern Ontario Telehealth Network and the Southwestern Ontario Telehealth Network, the NORTH network has been provided with ongoing base funding by the Ontario Ministry of Health and Long Term Care. The level of funding did not allow for growth into new areas, but will sustain the existing infrastructure and the capacity that has been developed.

In addition, the three CHIPP funded initiatives in Ontario have begun collaborating more extensively. The projects have already joined together to launch a single web portal called "Telemedicine Networks of Ontario" to represent all three programs. Work continues towards creating a single telemedicine initiative for the province which will retain regional autonomy. Interoperability among many sites on the three networks has already occurred and more are in progress.

In addition to these projects, a number of new applications and special projects will be undertaken based on user needs as well as based on some of the health system priorities which have emerged as a result of the SARS situation in Canada. Other important initiatives include enhancing NORTH Network's role in stimulating research, collaboration with the two other telehealth networks in Ontario, continued work on network and network inter-operability, improved opportunities for training and the revitalization of our web portal as a customer service centre.

Appendix A: Documents or Products Generated

Document/Product Name

Templates for Vendor RFP

• RFI Evaluation Sheet
• RFI Scoring Evaluation Spreadsheet
• RFI Package
• Tele-radiology
  • RFP
  • Cost Summary Form
  • Site Hardware Needs Form
  • Summary Evaluation Chart
  • NORTH Network Tele-radiology Final Report

Templates for Vendor Contracts:

• KNET Service Level Agreement
• Stethoscope Rollout Project

User Guides and/or Training Manuals

• ABC Manual
• Patient Examination Camera - Guidelines/Use
• Smartsteth User's Guide
• Smartsteth Quick Reference Card for Patients/Physicians
• Smartsteth TopCon Retinal Camera
• Documentation Guide
• Connecting to Laptops:
  • To Polycom HCs
  • To Polycom View Station
  • To Tandberg 6000
  • To Tandberg HSCVIII
• Global Address Book:
  • FAQs
  • NORTH Network Global Address Book Entries
• Protocol for Videotransmission Requirements for Telehealth Consultations on Tandberg Telemedicine Workstation
• Polycom Telemedicine Workstation Training Manual
• Tandberg Workstation Training Manual
• Keewaytinook Okimakanak (KO) Training Manual for Telehealth Coordinators
• Telehealth Coordinator Training Package
• Regional Telehealth Coordinators Training Plan
• Tele-strike
  • Telehealth Coordinator Training Package
  • Forms
  • Patient Information Brochure
  • Neurologist Information Package
  • Northern Physician Information Package
  • Self-Directed Learning Package
• Medical Peripheral Training Material
• Non-medical Peripheral Training Material Framework

KO Training Workbook for CTC/Backups

Policy and Procedure Manuals:

• NORTH Network Policy/Procedure/Guideline Toolkit
• NORTH Network Policies and Procedures Manual:
  • Documentation for Tele-consultations
  • Out-of-Province Tele-consultations
  • Consents for Tele-consultations
  • Physician Remuneration
  • Elective Patient Referrals
  • In-Kind Contributions
  • Faxing Prescriptions
  • Interpreters
• Clinical Guidelines:
  • Credentialing of Consultants
  • Participating in Telehealth Consultations
  • Scheduling Consultations with Manitoba Specialists
• Committee Terms of Reference

Software Applications

• Other
  • Health Canada Medical Device Licensing
    • Device System Requirements
    • Healthcare System Certification Statement

Standards:

• Other
  • NORTH Network Point of presence Proposal
  • NN Integration Sites Infrastructure
  • SSH "Meet Me Point" Infrastructure
  • Teleradiology Sites

Clinical Training Protocols

KO Training Workbook for CTC/Backups

Sustainability:

• Master Work Plan - New Business;
• Business Process Flow for North Management Team;
• Impact Analysis June 27/03;
• Steps to Implement New Requests
• Final Strategic Planning Document - Jan./03
• NORTH Network Strategic Planning Session Follow-up April 11/03
• New Business Process
  • Business Process Flow
  • Considerations for Interview
  • Impact Analysis June/03
  • Master Work Plan
  • Membership Application
  • Request Form
  • Steps to Implement New Business
• Report on First Nations Telehealth Workshop - Oct./02
• KO Proposal for Expansion
• Patient Questionnaire;
• KO Store Forward Report;
• KO Tele-psychiatry Report, 2002

For additional information, please contact:

Dr. Edward Brown at ebrown@northnetwork.com or at 416-850-9092