Project: Telemedicine in a rural environment

2004
Canada health infostructure partnerships program (CHIPP)

Synopsis

The Témiscamingue primary care telemedicine project was designed for the Centre de santé de Sainte-Famille (CSSF) [Sainte-Famille health centre] in West Quebec, with a view to providing four rural and isolated communities with primary health services. The Témiscamingue CSSF, in partnership with the Université du Québec en Abitibi-Témiscamingue, the Winneway First Nations and private-sector technology providers (Abbott Laboratories, Tanberg Canada and Télébec) developed an interactive videoconferencing network that links patients in remote locations and at the residential centre with physicians in the centre's emergency department. This new technology made it possible to develop the new real-time "virtual examination" methods, which give physicians the possibility of choosing to treat the condition from a distance, sparing the patient the inconvenience, discomfort and expense of travel to a health centre.

Results

The Témiscamingue telemedicine project has yielded a number of results, despite external factors that caused a major slowdown. Overall, the project results were as follows:

• The main telemedicine equipment was developed, a functional work station was designed and data were transmitted between the points of service and the centre, thanks to the technical support provided by the computer analysis team.
• Simplified, French-language summary tables and instruction manuals were produced for use as reference documents by the nurses.
• The Winneway Aboriginal community was served from a telemedicine station through which primary care service could be provided. The involvement of the band council from the start of the project was a key element in the project's success.
• The project led to development of networking with the Ordre des infirmières et infirmiers du Québec [Quebec Order of Nurses] and the Collège des médecins du Québec [Quebec College of Physicians].
• Research was encouraged in the field of organizational change--that is, management of change among employees and acceptance of new technologies among patients, in order to ensure better acceptance of the project by the stakeholders.
• Documentation and materials--i.e. equipment utilization guides more suited to use in the field, with summarizing of the instructions, and consent forms--were generated.

Impact on Policy

• This project is intended to improve health services in the Témiscamingue area, which is considered a remote region in Quebec. It is indisputable that a technological conversion is taking place at the CSSF. However, it is too soon to tell about the impact on policy, since the changes are just beginning.

Impact on Research

• As far as the impact on human resources is concerned, there have been significant improvements in the staff's competencies. However, if there is a desire to increase the availability of the sites and to offer services 24 hours a day, 7 days a week, it will be necessary to increase the staff on site.
• The recording of the telemedicine sessions to facilitate staff training affected the reliability of the information and data collected from patients. The experience showed that most of the patients felt psychological pressure at the time to sign the consent forms allowing the sessions to be recorded. The problem is that patients hid personal information, knowing that they were being recorded and fearing that the information would be disclosed. It is believed that the recording of the telemedicine sessions ought to be limited to cases where there is no risk that the veracity of the information given by the patients will be compromised.

Lessons Learned

Many lessons were learned from the rural telemedicine project. The lessons have to do with the organization of and approach to implementation, delivery of health care and continuous professional training. The following is a summary of some of the lessons learned:

• The technical aspects--i.e. the ordering, receiving and installation of the equipment--must be reasonably mastered before one starts providing services. The main obstacle in the project was the lack of integration of the telemedicine equipment, a situation that led to development of integrated software reflecting specific needs.
• Ample use must be made of all the assistance available, be it from financial backers, suppliers, professional corporations, other projects or some other source, in order that the project may achieve its objectives.
• Considerable delays do not necessarily mean that the project is not moving forward. In an innovative project, the smallest step is a giant step. It is only by recognizing forward movement that determination of new needs is possible.
• It is necessary to allocate effort carefully--i.e. to ease up on parts of the project that cannot develop quickly and to apply more effort for the parts of the project that are succeeding the best.

The Future

Health Canada's support under the Canada Health Infostructure Partnerships Program (CHIPP) made possible the project's deployment. However, it is necessary to think about how the project can survive once that financial assistance has ended. It has been pointed out that most of the expenditures were for transmission line costs. It is believed that better management of the transmission costs could result in a significant reduction. Emergency consultation services for the Winneway community will be deployed in the near future. The Winneway clinic will have to be able to put in place emergency services available 24 hours a day, 7 days a week. Also, it is hoped that the same services can be started up for the Rémigny and Belleterre community.¹ Finally, it is thought to be unlikely that telemedicine services can be adopted in the near future at Pavillon Duhamel.

If such services are to be deployed in future, the following must happen:

• the shortage of physicians in Témiscamingue must be eliminated;
• responsibility for the telemedicine project must devolve to a program head, and this means that a position of nurse in charge of the project must be created; and
• an individual must be given the responsibility of negotiating agreements with the secondary and tertiary centres, in order to accelerate the contracts process with those institutions.

It is possible to launch new projects in addition to the above-namely, primary teleconsultation and tele-emergency services. These projects are expected to be viable, given the experience acquired, including in operating in a context of being short on resources, and the skills acquired for developing a training program that reflects tele-emergency services needs.

For more information, please contact:

Jacynthe Berube, at jacynthe_berube@ssss.gouv.qc.ca or (819) 622-2773, ext. 4433.