Project: Southwestern Ontario Telehealth Network (SWOT-N)

Canada Health Infostructure Partnerships Program

Project Description

The Southwestern Ontario Telehealth Network (SWOT-N) project (now known as VideoCare) involved the deployment of a 43-site videoconferencing-based network. The Network was designed to extend existing and proposed clinical programs across the entire southwestern Ontario region through tele-consultation, while enabling tele-education and tele-administration . The clinical programs cluded geriatrics, renal dialysis, oncology, paediatrics, stroke, radiology and ophthalmology.

Outcomes

The SWOT-N initiative resulted in the development of a regionally managed, sustainable network that enabled physicians and consultants to case conference through a private, secure system. The Network also allowed allied health professionals such as nurses, dieticians and social workers to build and support relationships with their peers through case management activities as well as through distance learning opportunities.

In addition, the SWOT-N project has noted the following:

• Overall usage of the network has increased steadily over time;
• The use of tele-administration was greatest for Departmental or Team meetings and administrative meetings;
• Tele-administration and tele-education have removed the barriers (time constraints, weather conditions, or distance) that could prevent participants from attending sessions in person; and
• Improved access to services has enabled care closer to home.

Policy Implications

• National standards are needed for telehealth equipment in order to support future RFP processes with telehealth vendors, and to create more consistent and compatible equipment and policies, both provincially and nationally;
• A national consensus must be reached around patient consent;
• Mechanisms for adequate remuneration for clinician use of telehealth need to be established, particularly appropriate billing codes for physicians; and
• A consensus around the terminology used to describe videoconferencing healthcare delivery that will mitigate the public's confusion between phone-based services and others must be established.

Lessons Learned

The SWOT-N project reported multiple lessons learned, some of which have been summarized into the following four concepts:

• Good communication, education, technical support, commitment from key decision-makers, regional governance, and clinical and technological areas working together, are the primary factors that contributed to the development of the network;
• Leadership from program "champions" and clinical coordinators in each clinical area and at each telehealth site are essential for continued development and optimal implementation; there is an ongoing need to identify and support these clinical champions;
• The size of the network can hamper its implementation. A strategy may be to limit initial implementation to fewer sites but those with strong commitment and leadership; and then increase the network size;
• Telehealth projects should not be developed and implemented in isolation of other related projects within the province.

The Future

SWOT-N undertook a proactive approach to ensure the ongoing sustainability of telehealth through the development of a regionally endorsed Sustainability Plan. The plan addresses the technical infrastructure requirements of the region as well as the ongoing clinical coordination and centralized support roles provided during the implementation phase of the initiative.

In addition:

• There are significant opportunities for wider dissemination of the technology and for increased patient and health care provider access to telehealth. These applications would also serve to enhance integration of health services;
• More equipment and improved clinician access to equipment are essential for increased use of telehealth;
• Continued efforts are needed to increase organizational and clinical support, especially to overcome hesitation around its use for direct patient care;
• Mechanisms for adequate remuneration for clinical use of telehealth need to be established;
• Ongoing efforts to provide training and technological support are required;
• Mechanisms are needed to ensure effective communication and information sharing within the network, and to increase public awareness and acceptance; and
• More consistent and compatible equipment and policies, provincially and nationally are required.

As well, additional evaluation is desirable to explore reasons for inconsistent levels of usage across the region, to identify strategies to increase direct clinical applications, to identify solutions to any new challenges, and to identify and explore health impacts of telehealth.

Appendix A: Documents or Products Generated

Document/Product Name

Template for vendor RFP

User Guide and/or Training Manual

Policy and Procedure Manual

• Under development

Job Descriptions

Software Applications:

• Telehealth Scheduling Software
  • purchased from First Virtual Corp.

Clinical Program Protocol

• Service Design Manual

Video Conference Protocols and Etiquette Guide

• Service Design Manual

Confidentiality and Privacy Documents

Sustainability Plan

For additional information, please contact Neil MacLean at 519-685-8500, Ext.77772 or at neil.maclean@lhsc.on.ca.