Need and Model of Telediagnosis The Manitoba Experience

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Need and Model of Telediagnosis -The Manitoba
Experience

• Albert E. Chudley
• Mary Cox-Millar
• Sally Longstaffe
• University of Manitoba
• 4th Annual Fetal Alcohol Canadian Expertise
  (FACE) Research Roundtable Edmonton, AB
• September 9th 2003

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Learning Objectives

• Demonstrate the need for telehealth
• Identify a process that will facilitate distant
  diagnosis and meet the needs of the North
• Recognize the need to partner with external
  groups and communities
• Discuss our experience in FAS diagnosis using
  telehealth

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CADEC Community Services/Partnerships
Direct Service For Children 0 to 7 Years of Age
Family Support
Government Support
Healthy Child Manitoba Manitoba Health/Child
Health
Interagency FAS/E Program Childrens Special
Services/FAS Outreach Team Society for Manitobans
with Disabilities Provincial Outreach Therapy
Services for Children Child and Family Services
Fetal Alcohol Family Association Child and Family
Services
School Age Children
FAS/FAE Support Services
Special Education Classrooms David Livingstone
School and Shaughnessy Park Child Guidance
Clinic Childrens Special Services Child
Psychiatry
Support for Pregnant Women
NorWest Mentor Program Aboriginal Health
Wellness/ FAS/E Prevention Program Mentorship
program The Pas and Norway House
Northern Manitoba Services for Families
Diagnostic Services
Adult Services
Clinic for Alcohol Drug Exposed Children Fetal
Alcohol Support Team - Thompson
Fetal Alcohol Support Team Thompson Interagency
Group The Pas / Flin Flon
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Reasons for and Benefits of Telehealth

• Canada has many distantly located low population
  communities with limited access to specialty care
• Reduced time and costs for travel
• Timeliness of access to care
• Reduced barriers to compliance with appointments
• Facilitates family involvement
• Enhances linkages amongst health professionals
  and community agencies
• Provides access of education and training to
  rural areas

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MBTelehealth

• Partnering with the Prairie Provinces FAS
  Initiative and CADEC, the first link was with
  Thompson MB in 1999.
• Following a 3M grant from the federal
  government, technical capabilities were greatly
  expanded in 2001.
• Subsequent link to NorMan Region (The Pas and
  Flin Flon) 2002-present.

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-
Intake

Assessment
Follow
-
up

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Paediatrics and Child Health Vol 7 March, 2002
Linked to 24 sites!
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Telehealth Equipment

• Province-wide LAN H.323 internet protocol
  video-conferencing system
• Uses multi-site control unit
• Portable equipment with document viewer

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Total Network Utilization Fiscal Year 2002-2003
Total Number of Sessions 2,031
FAS sessions represent27 encounters
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Utilization by Type of Session(shown by quarter
year for 02-03 fiscal year)
(All clinics including FAS)
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Clinical Utilization (Actual Number) Fiscal Year
2002-2003
(All clinics including FAS)
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Cost impacts, assumptions re patients

• Does not include indirect costs savings due to
  time off work, child care while away etc
• No distinction made between costs borne by
  individual and those borne by health care system

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Technical success qualitative findings

• Users satisfied with training received
• Unanimous appreciation of technical support
• Technology easy to use
• Sites linked by satellite experience more
  problems
• Some would like to enlarge network to more sites,
  have more drops, be available for emergent and
  urgent use 24/7

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CADEC Telehealth Experience with FAS Diagnosis

• Total of 27 links since April 1/99
• 8 of 27 links planning/team meetings,
  presentations and/or education sessions
• 19 of 27 links assessment links
• 27 children were assessed (initial assessment,
  consults and/or follow-up to initial assessment)
• 4 of the 19 assessment links were training teams
  in diagnosis

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Estimated travel savings (FAS-24 month period)
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Feedback From Users Following FAS Assessments

• Excellent it is almost like talking face to
  face at your kitchen table with the doctors.
• It should be in more communitiesbest thing that
  could ever come to the North.
• It is an opportunity to see how the medical
  system works.
• Bringing expertise to the community helps in
  building a team that is working in the best
  interests of the child.

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Feedback From Users Following FAS Assessments

• Travelling to Winnipeg is a stressor for many
  people.
• Using telelink allows the children to be
  assessed with less disruption to their daily
  routinea trip to Winnipeg would be 3 days from
  home!
• A birth mother would be more willing to
  participate if she is supported through the
  process by people who know her and the child in
  the community.

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What Have We Learned?

• Importance of establishing external relationships
  (CADEC team and the community)
• Establish common and site-specific goals
• Provide training as needed
• Clarify process for referral
• Establish guidelines for communication and
  clarify expectations

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What Have We Learned?

• Ask for feedback on experience
• Need to wait for camera before speaking
• Use close up mode when speaking
• Provide a warm-up period for children to become
  accustomed to the interactive talking
  television and the room
• Allow privacy (limit numbers in the room at any
  given time

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Summary

• Telehealth FAS Diagnosis has met the needs of
  some families in a northern community in Manitoba
• On site coordinator trained in preparing the
  family for the diagnostic process and with good
  community links is essential
• Need to link with local professionals and
  agencies

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Thanks for not drinking, Mom