Seminar Health Telematics Unit U. of Calgary

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Seminar Health Telematics Unit U. of Calgary
The Evolution of Telehealth Where From Here?

• Jean-Paul Fortin md
• Laval University, Cau-CSSS
• Quebec
• January 18th 2008

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Topic

• From a Key note address on
• Where telehealth is in Quebec and why
• Where to go and how
• To an opportunity for sharing on why and how
  elsewhere in Canada

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Data Sources

• Field observation, experimentation, research, and
  evaluation
• Collaborative work with WHIC, HTU
• Occasional advisor for Infoway
• RQT Med coordinator, CST Board member
• CHIPPS projects study for change management and
  telehealth integration in HC services

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Telehealth in Quebec

• Quick and impressive start
• From a few field clinical, managerial, and
  technical champions initiatives
• And central support
• Followed by slowing progress in
• Use of telehealth
• New initiatives, projects or
• Studies to learn about best practices, conditions
  on implementation, adoption, sustainability,
  diffusion.

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In between

• Transformation of HC system
• 4 Supra regional advisory boards
• Integrated Health University network (RUIS)
• A leverage for one of the Ministerial silos
• RUIS-telehealth for developing and leading
  telehealth with Ministerial coordination
• No field project central funding for more than 5
  years
• Less collective action
• Building on hope from Infoway
• No evidence of telehealth being a priority

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Elsewhere

• CST recognizes need for promoting telehealth
• Central decision makers rarely building on
  telehealth
• Neither are the media
• More and more convivial and convergent
  technologies for integrated daily use
• Prevention, intersectoral projects
• Used by social services and communities for less
  social loneliness, for consolidating social
  networks in remote area and large cities
• Alliances between municipalities, communities and
  many other sectors influencing health

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Why

• Is there a lack of pertinent information for
  decision makers ??
• And for the population??
• Did DM choose to prioritize EHR?
• Is telehealth seen as being only a technological
  challenge?
• Is there opportunuity for innovation in our
  systems? Is there too much centralization?
• Is technology solely IT leadership dependant?
• Is there a PPP gap?
• Is Infoway part of the solution or the problem?

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Infoway ?

• Some interesting projects
• scheduler, business case, convergence, group
  bying.
• But transferred from telehealth to EHR?
• Small part of provincial need, mostly technology
• No real change management funding, nor formative
  evaluation
• Is funding influenced by health being a
  provincial jurisdiction?
• Important influence as a leverage.
• How far on provincial development plans?
• Infoway contribution is not to be seen as a
  finality but a means to support provincial
  strategic choices for HC services organisation.

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But

• Telehealth is a must
• Evidence - more and more numerous
• We need a shift

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Factors

• Telehealth is a  care technology  not only a
  tool
• Implies clinical processes revisited, roles and
  responsibilities renegotiated and services
  reorganised
• Conditions of adoption linked to field
  requirements
• Clinical leadership driven

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Need to manage

• Impact on md distribution in the province
• Consequences of non telehealth related decisions
  (cardiologists training internists for
  echocardiograph examination)
• Adjustments between md and nurses in remote
  areas, other professionals in specific programs
  (retinal screening program)
• Organisational change related to telehomecare

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Need to remember

• Innovation, adaptation and evolution start
• Where real experts are (field experts)
• Where clinical processes change and integration
  conditions are
• Need to rely on settings with innovation culture
  so to initiate

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No unique solutions

• Need for systematic formative evaluation
• Capitalise on alliances with researchers and
  evaluators with much field experience

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Decentralized governance

• To much centralisation to much bureaucracy and
  less field adapted solutions
• Centralisation barriers to quick operational
  decision making process
• So
• Is a good definition of innovation  a
  delinquency that has succeeded (Sériex)?
• Is it more appropriate  to ask pardon to the
  central decision makers than ask permission? 

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More health field experience leaders are needed

• Expertise balanced direction and management team
• Common vision of telehealth
• Knowing characteristics and conditions of
  clinical and managerial processes to change
• Large experience in managing multiple interfaces
  required in telehealth
• Clinicians and care teams
• Specializes and primary care institutions,
• Regions

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Need to recognize central roles

• Publicise strategic orientations in telehealth
• Laws and regulation adapting to applications
  conditions
• Optimal functioning of major common interest
  infrastructures
• Technical norms and standards
• Guiding principles for
• Win-win and incentive oriented HC system
  financing,
• Md remuneration
• PPP partnerships

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A must

• Capitalising on between levels of interventions
  synergy
• Recognition and respect of everyone strength
  (local, regional, and central).
• Have users involved more than only occasionally
  consulted

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Where to go

• Better known added values, best practices,
  conditions of uses
• Inputs for needed definition from requesters,
  regions, and PC.
• More networked and available research and
  evaluation expertise
• Target setting well known for innovation culture
• Develop more capacity to learn from projects
• Ensure at local and regional level
• Balanced and decentralised governance
• Clinical services oriented team
• Have planners and programmers included in mandate
  to look for how telehealth could influence health
  objectives and how to integrate into practices
  and services and in the transformation strategy
  of HC system

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MOBILISATION

• Need to have all those who believe in telehealth
  to mobilise so to influence decision makers at
  all levels, colleagues potential partners
  stakeholders
• Even if a bit delinquent there must be
• Telehealth initiatives with primary stakeholders
• Forum for open discussion
• Channel of communication to update and harmonise
  the messages

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RQT Role

• Drivers for recognition of teleheath as an
  essential strategy for better heath and social
  care for the population
• Symposium
• The most important activity to contribute for
   change management 
• Opportunity to share experiences and expertise
  without barriers that some of our structure and
  functioning bring along
• Initiate and participate in community of practice
  building (coordinators and research evaluators),
• Support dialogue with industry, patients, and
  population
• Alliances and partnership with societies with
  same objectives in Quebec, Canada and elsewhere
• Soqibs, SCT with two directors as CST elected
  board members, Catel in France..

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Key individual and collective action Winners
patients and population

• 1) Lamothe, L., Fortin, J-P.,  Gestion du
  changement  et  Lintégration des technologies
  dans le continuum de soins , CHIPPS projects,
  Santé Canada. March 2007.
• 2)  Telehealth- What the Future Holds, White
  paper produced by the Canadian Society of
  Telehealth (2007) (soon available on web sites
• 3) Telehealth Change Management Repository,
  http//www.cst-sct.org/cm/.
• 5) Home_Telehealth_Business_Case_Report, Infoway
  2007. http//www.infoway-inforoute.ca/fr/pdf/_FR.p
  df