THROUGH THE CROSS-JURISDICTIONAL
LOOKING GLASS: MEASURING CONSUMER,
PROVIDER, AND HEALTH SYSTEM IMPACTS OF EHEALTH IN REMOTE AND ISOLATED FIRST
NATIONS
PR ES E NTATION TO COACH
OT TAWA , O N TA R IO
M AY 2 8 , 2 0 1 3
PE N N Y C A R PE NTER A N D O R PA H M CK ENZIE
INTRODUCTION
PURPOSE OF PRESENTATION
to describe KO
eHealth’s efforts
to measure and
report
telemedicine
impacts to diverse
partners
• First Nations
• OTN
• Provincial governmentMOHLTC/NW LHIN
14/province health services
• Federal government-FNIHB
OVERVIEW OF PRESENTATION
• First Nations in Northern Ontario
• KO/Knet (Kuh ke Nuh) Network
• KO eHealth Services and the role of the
Community Telemedicine Coordinator
• Methodology/Approach
• Findings/Results
• Recommendations and Conclusions
FIRST NATIONS IN NORTHERN ONTARIO
Section 1
REMOTE AND RURAL FIRST NATIONS
IN THE SIOUX LOOKOUT AREA
• 25 First Nations are either
remote or rural
• Limited access to health
• Limited access to educational
services
• Limited access to
opportunities
First Nations members
who need medical
procedures or higher
education are often
required to leave their
communities to have
access to schools and
medical facilities in urban
centres
In the Beginning…….
• In the early 1990’s, Sioux Lookout area First Nations
(SLAFN) had no broadband connection and had to rely
on slow dial up systems via telephone lines to receive
any email both in the health centre and the community.
• The Keewaytinook Okimakanak Chiefs, identified
broadband as a need for their 5 communities and by
2000 received funding from a IC SMART Communities
project to build broadband.
• One objective of the SMART project was to develop
telemedicine in 5 remote First Nations, by 2004 and
after the end of the project, telemedicine expanded to
25 remote First Nations in Northern Ontario
BROADBAND
IN THE SIOUX LOOKOUT AREA
• All the First Nation communities in the Sioux Lookout
area are connected to KO-KNET’s broadband services
• 25 sites have access to KO Telemedicine (health and
wellness services delivered via videoconference)
• Keewaytinook Internet High School, among other
broadband-enabled services.
KO-KNET BROADBAND SITES
KNET TECHNICIANS
KO TELEMEDICINE SITES
PARTNER CONTRIBUTIONSFIRST NATIONS
Each FN has an agreement with KO to provide
office space in the health clinic/nursing station
FN is responsible for hiring a Community
Telemedicine Coordinator
KO eHealth also supports 10 off-reserve First
Nations provider sites, e.g. the Sioux Lookout
Diabetes Program, Sioux Lookout First Nations
Health Authority, Shibogama FN Council to name
a few
PARTNER CONTRIBUTIONS-OTN
KO eHealth maintains a partnering agreement
with the Ontario Telemedicine Network, is fully
integrated with the provincial telemedicine
service management system and maintains
linkages to more than 500 additional points-ofcare
PARTNER CONTRIBUTIONS-FNIHB
Health Canada’s First Nations and Inuit Health
Branch provides approximately $2.9M annually
to support KO eHealth operations
Funding provides salaries, broadband
connectivity and program costs
COMMUNITY TELEMEDICINE COORDINATOR
• The CTC is the person in the
community responsible for
ensuring that telemedicine
events are conducted from
the initial referral stage to
the completion of the event
• CTCs also are the point of
contact in the community for
telemedicine
TELEBABIES
• CTCs also have leveraged telemedicine to
assist in emergency deliveries.
CURRENT KO TELEMEDICINE ACTIVITY
WHY STUDY THE IMPACTS OF
KO TELEMEDICINE?
• It is important to document how users of
telemedicine use this service
• If designed to meet the needs of First
Nations, impacts should teach First Nations
about community health needs for health
planning.
• Provides evidence to funders for future
program development and funding
METHODOLOGY AND APPROACH
OTN data collection process:
All appointments are entered into the Telemedicine
Service Manager (TSM) by the Schedulers
Monthly reports are produced by OTN and sent to KO
eHealth for our review and assessment
KO eHealth keeps track of the clinical activity of all sites
and provides information to each site as requested or
needed
This information also helps us determine which sites are
in need of assistance
METHODOLOGY AND APPROACH
FNIHB data collection process:
Handwritten activity logs are faxed by the CTC to the main
office after a consult is completed
The logs are faxed to the NIHB office to be assessed as to
whether the consult has saved $ in travel and to assess the
value of the saving
The form is considered ineligible if it has missing information
or if it is not eligible under NIHB
This information is also entered into a spreadsheet by our
staff and used as a backup to confirm assessments by NIHB
office
RESULTS/FINDINGS
1. Internal Audit 2012 - As part of a strategic
service review, an audit of how eligible
consult data was collected, processed and
interpreted
2. FNIHB 2007/08 – 2011/12 five year
evaluation plan
RESULTS/FINDINGS
 During the five year evaluation period KOeHealth
o Annually delivered access to more than 70 therapeutic areas of
care
o Coordinated 26,661 telemedicine events
 70% of all events resulted in the delivery of a clinical
service at a First Nation point-of-care
 more than 8,000 events supported a health education or
administrative function
o Engaged more than 400 unique health professionals
o Delivered a valued community-based health service
o Provided timely access. Wait times compare favorably to
national and provincial standards; the average elapsed time
from placing a referral to a telemedicine appointment was less
than 48 days
RECOMMENDATIONS
• Specific recommendations to streamline business
processes
• Introduce a more collaborative and managed
approach with health service providers
• Five years of historical consult data has shown us how
to adapt specific business processes and to more
effectively assess the impact of the eligibility metrics
e.g. more than 60% of our consults are considered
ineligible by NIHB
RECOMMENDATIONS
• The need to identify a source of capital funding to
support telemedicine technology upgrades and
replacement
• Development of a virtual trauma care service for
Isolated First Nations in the Sioux Lookout Zone
• Expansion of the KO eHealth Telemedicine service
model to all isolated and remote First Nations in
Ontario
Referral and Data Collection
Processes Challenges
• A recent analysis of this manual logging process has identified a
number of pain points at which productivity (staff time) and data
integrity (incomplete, missing or erroneous information) are impacted.
• Errors are introduced by faxing, correcting, and refaxing logging sheets
• Automated error checking and quality control processes are not
possible because KOTM & NIHB staff must complete and review logging
sheets by hand
• KOTM and NIHB staff each manually transfer the same hand-written
information from the logging sheets to Excel workbooks.
• Results of the NIHB event tracking, eligibility assessment and financial
valuation process do not accurately represent services delivered
Referral and Data Collection
Processes Challenges
• The logging/referral sheet is the primary tool by which
service volumes are documented by KOTM and
assessed for eligibility and financial value by NIHB (non
insured health branch)
• Logging is a wholly manual process, with as many as
5000 sheets being faxed and re-faxed in a given fiscal
year
E-FORM DEVELOPMENT –PAIN
POINTS
1. Loss of productivity – staff time for manual
systems – staff from both NIHB and KOTM
reviewing forms and logging sheets by hand to
excel spreedsheet
2. Data Integrity – incomplete forms, missing or
erroneous information
3. Non standard eligibility assessment and financial
valuation process
E-FORM DEVELOPMENT
FUTURE STATE
• KOTM is proposing an eHealth-enabled logging/referral template and
workflow
• The e-logging project has 3 objectives:
 Integration – NIHB logging e-Form will be part and parcel of KOTM’s
scheduling workflow
 Efficiency – NIHB logging e-Form will reduce staff time required to
complete, check, track and transfer information
 Scalability – NIHB logging e-Form will be scalable to other point of care
telemedicine services
CONCLUSIONS
• Concluded that KO eHealth provides a highly valued
and cost effective service and directly contributes
to improved access to health and wellness services
for remote and isolated First Nations in Ontario.
• KO eHealth will continue to work with First Nations
to develop ehealth solutions to complement
community health services.
THANKS! MERCI! MIIKWEHC!
Acknowledgment to the communities and people
of the
KO Telemedicine served First Nation Communities
For further information, please contact
orpahmckenzie@knet.ca
pennycarpenter@knet.ca