Expanding telehealth requires better promotion and more rural broadband

Telehealth services in Canada are getting results, providing care to Canadians who don't live in close proximity to medical facilities, but there is still a long way to go before it is integrated into the Canadian healthcare system. Advocates say what's needed is better marketing of telehealth's benefits, and greater broadband availability in rural and remote areas."I think we are making fantastic inroads in Canada in driving out telehealth to rural areas across the country," says Edward Brown, CEO of the Ontario Telemedicine Network, the country's largest telemedicine network. OTN sees 2,600 patients and provides 450 educational events per month."We are reducing the hardships of travel for people and their families, and really providing access to care to rural areas across the country," he said in an interview at the annual meeting of the Canadian Society of Telehealth in Ottawa last week. Data from the provinces and territories indicate that about 1,700 communities in Canada have accessed telehealth services.Agencies like Canada Health Infoway (CHI), a federally funded, not-for-profit organization whose mandate is to push the use of electronic information systems and electronic health records in Canada, has provided nearly $100 million for telehealth projects since its inception.Across the country, telehealth is various stages of development and use. Alberta and Ontario have the largest telehealth networks with Ontario having 600 end points and Alberta with 350. Both provinces will likely be first in having a fully functional electronic health record as well.More work to be doneSome of the more difficult challenges in delivering telehealth have been overcome, such as inadequate fee schedules to compensate doctors who participate in telehealth projects and coordination between sites that practice telehealth.Despite the progress, telehealth is far from becoming a fixture in Canadian healthcare. That may be the fault of telehealth advocates who have failed to convey the advantages to policymakers and healthcare practitioners, according to Jane O'Heir, a group program director with CHI who is responsible for the telehealth, drug, and public health surveillance programs."We have not marketed the benefits of telehealth well enough to people who fund healthcare to help them understand the role it plays," she said "We need to look at the benefits and document them, so they have a better understanding."Until there is documented evidence of the pros of telehealth, funders will not get on board to address the remaining challenges, such as insufficient broadband infrastructure in the territories and other northern communities, O'Heir added.The Broadband for Rural and Northern Development program brought broadband to about 900 communities before it closed, leaving as many as 2,000 other small communities continuing to rely on dial-up access.Expanding telehealth in Alberta is less of an issue, where the province's pan-provincial SuperNet offers universal high-speed service to 4,200 learning and health facilities across the province.Jason Murphy, lead system architect at CHI, says high bandwidth speeds are required to perform real-time medical consultations, but where broadband connectivity is an issue, northern communities are using satellite systems and telephone lines to transmit data.One method of sending information is store and forward, meaning the information is saved and transmitted for review at a later date and not for simultaneous communication with another site."We can still send vital signs or pictures, such as x-rays, over a satellite link, but not in real time. This avoids the bandwidth challenges," explained Murphy. "We have to be creative in our solutions, and look at how we deal with low bandwidth connectivity. We know there is low bandwidth, high-latency satellite networks in place in northern communities. The question is how do we make sure that the applications in place work well over those connections."Despite the ongoing challenges, the past president of the Canadian Society of Telehealth is optimistic. Richard Scott describes Canada as "way ahead" in telehealth compared to other countries, with the United Kingdom being perceived as the global leader."E-health is a well-kept secret, and if the population knew more about it, they would demand access to it, and it would allow things to mature more quickly. It's surprising how little people know about it, and that is in part due to lack of promotion of it," said Scott, assistant professor at the global e-health and training program at the University of Calgary.Federal Election on Telehealth: What do the parties say?Healthcare-related issues such as doctor and nurse shortages and wait times garnered significant headlines during the election campaign. The federal political parties addressed healthcare in their party platforms, but telehealth was not a talking point. Here's what the parties had to say.The Liberals pledged a doctors and nurses fund of $420 billion that is a "flexible tool" designed to respond to improving access to health care professionals and that the fund could support technology and telehealth projects, according to party spokesperson Marc Roy. The Conservative Party has indicated that it has increased health-funding transfers to the provinces since it formed a minority government, and that provinces can use that additional funding for the delivery of services like telehealth if they choose, said Deirdra McCracken, a spokesperson for the Conservative Party. The Conservatives also recently announced that they would provide up to $500 million in funding for broadband over a five-year period beginning in 2010/2011. The federal money would have to be matched by equal commitments from the provinces and municipalities as well as the private sector, bringing the potential total up to $1.5 billion. The Bloc Québécois has indicated that healthcare is a provincial responsibility and has not made any pronouncements on healthcare in general and telehealth in particular.Blake Poland, a health promotion critic with the Green Party of Canada, noted telehealth has been held out a solution for inadequate access to healthcare services in underserviced areas of Canada. "Telehealth has advantages for getting care to remote and rural areas," said Poland, but noted that the party has not made specific commitments about telehealth services in the country. An integrated healthcare system is the goal for the New Democrats. "As an integrated part of a planned public health care system, telehealth has become a valuable tool in serving remote areas. It has improved access to care and reduced delays and costs in treatment," read an email from party spokesperson Bob Gallagher.

Expanding telehealth requires better promotion and more rural broadband

News | 10/14/2008 7:00 pm EDT

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