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Project: WestNet Tele-Ophthalmology Project

Canada Health Infostructure Partnerships Program

Synopsis

The goal of the WestNet Tele-Ophthalmology Project was to cost effectively reduce the risk of loss of vision for diabetic patients in remote communities through the early detection and treatment of diabetic retinopathy. The rationale for the project included the Canadian Diabetes Association's recommendation to provide annual eye exams for diabetic patients, combined with the increasing number of individuals with diabetes in the NWT, especially within the Aboriginal population. During the project, two different eye services were evaluated: Still image exams and video indirect exams. Both of these were new services, not previously provided by the GNWT, and required an eye technician to travel to the remote communities to perform the exams.

To achieve this objective, trained Certified Ophthalmic Medical Technicians and Technologists equipped with a Digital Retinal Fundus camera, a laptop computer and specialized software, took diagnostic images of the retinas of one hundred and eighteen persons living with diabetes in remote communities in the NWT. These images were then transmitted to the Retinal Specialists at the University of Alberta's Department of Ophthalmology in Edmonton where the images were assessed.

Outcomes

Prior to starting the project the quality of service provided to patients was acceptable. Patients with diabetes were routinely examined in their community by an ophthalmic technician. If there was any pathology found that required further investigation, patients were sent to Yellowknife to see the ophthalmologist. If the patients needed any treatment for the problem they were then sent to Edmonton to see the retinal specialist. With the project's technology, the ophthalmologists in Yellowknife and Edmonton were able to assess patients without them having to leave their home communities. If treatments were required, then patients would be flown to Edmonton. Decreasing the amount of travel the patients had to do allowed them to avoid the stress of travel to the big city therefore increasing patient compliance and interest in continuing proper eye and health care.

Research Implications

The set up in the north is very unique. Having only one ophthalmologist servicing the entire territory the technicians have more responsibilities compared to their counterparts down south. When this type of service is not available the set up represented by this project could be quite feasible. The camera worked as a good screening tool for diabetic retinopathy but having knowledgeable staff operating it helps with patient education and understanding. The Zeiss camera provides excellent optics and very clear pictures but is fairly big and cumbersome for traveling, a more compact camera might be worthwhile considering. The software used with the project did what was required but a more user-friendly version would facilitate the picture converting process.

Lessons Learned

Outreach:

develop a telehealth education package; disseminate to those potentially affected by telehealth in order to educate them and prepare them for the Needs Assessment questionnaire;
review, establish and formalize relationships with potential telehealth sites (referral and remote).

Background:

review the previous telehealth activities that have occurred in the region and other similar locations. Learned from their success/mistakes;
conduct a resource inventory including any current telehealth technologies and telecommunications; people resources (those involved in telehealth and those interested in participating.

Planning:

conduct a needs assessment of all sites potentially affected by telehealth. The results will help determine what clinical, educational and administrative needs have priority, and will help identify those interested in telehealth including 'champions';
match identified needs to the ability to meet these needs via telehealth (this ability includes having health professionals who want to use telehealth).
review types of telehealth technology and telecommunications links at all potential sites; ensure new technology is interoperable with the referral centers, meets the technical requirements including security, is compatible with the referral sites, and meets the needs of the community;
identify the telecommunications options and work with vendors to test then implement the preferred option.

Project Management:

establish a team that develops a strategic plan for the design, implementation and evaluation of the telehealth network; this team will oversee the project including budget management;
choose a well qualified Coordinator;
issue an RFP for purchasing the technology;
contract the vendors to install the technology at all sites;
educate and train potential users (including support staff) about the telehealth system and how to use it;
educate and train potential eye technicians to trouble shoot and repair the technology.

The Future

At the moment there are no plans to continue the project. The main barrier for its continuation is financing. If the project were to continue the ophthalmic technicians would travel more often to each community in order to conduct still image retinal exams. This increase in travel would require another ophthalmic technician at the eye clinic. These changes mean there would need to be an increase in the travel budget and the salary budget. At present time the Stanton Territorial Health Board does not have such funding.

Another barrier would be access to some of the remote communities. The equipment that the technicians traveled with is quite large. Some of the communities are only accessible by small plane and they have restrictions on the size and weight of their cargo. A more feasible plan to get around this issue might be to travel to the larger communities with the digital imaging system and if need be fly the few patients from surrounding communities. Although there would be some travel for those patients living in smaller communities they would not have to travel as far or for as long yet they still get the benefits of the still imaging system.