Telemedicine

For many Métis communities, the nearest hospital, doctor or nurse may be hundreds of kilometers away. In many cases, this gap can be bridged using telemedicine – a technological tool that allows patients, nurses and doctors to talk as if they were in the same room.

Telemedicine can be:

• Two health professionals discussing a patient’s problems by telephone;
• Medical information being transferred, safely and confidentially, between computers via high-speed telephone lines;
• A patient getting a face-to-face consultation or examination by a remotely located doctor, through interactive video-conferencing; and
• Medical images previously photographed and stored on computers, being forwarded later to remotely located professionals.

Telemedicine technology comes in many forms. Some telemedicine applications in use today:

• Telemedicine – for delivering medical services at a distance;
• Tele-education – for meeting professional and patient education and research needs;
• Telecare or teletriage – for diagnosing medical problems through a call centre; and
• Telemonitoring and telehomecare – for treating patients in their homes.

Telemedicine is a Partnership

MNO Telemedicine is not just about technology and information. It is about working together toward ensuring timely and culturally appropriate access for our people to essential health care and information, regardless of their location. It is a partnership between:

• Health care providers
• Health care consumers
• Communications providers;
• Professional groups; and
• The Métis community

What Benefits does Telemedicine Provide?

Telemedicine cannot replace clinicians or other health care staff. But it can – and does – improve access to health care for people in remote locations, or whose access is limited by culture, language or clinical resources.

For patients, Telemedicine means:

• Less time away from home;
• Less time away from work;
• Fewer travel-related expenses, including gasoline, meals and overnight stays;
• Care in your own community, where you feel more comfortable and your family and the health staff who know you best are close at hand;
• Local access to a greater number of specialists to help your care provider manage your care;
• Faster response times for medical tests and consultations between your care provider and outside specialists; and
• The ability to participate in face-to-face conversations with a specialist and your care provider at the same time.
  

For the Métis community, Telemedicine means:

• Improved health care quality, through the ability to access specialists when they are needed;
• Greater control to select and access the health care services needed;
• Wider and more timely access to appropriate health information; and
• Employment and training opportunities to develop the technical expertise of local health care providers.
  

For health care providers, Telemedicine means:

• Improved communication among health care providers in different areas;
• Better professional support, greatly reducing stress and improving career satisfaction, recruitment and retention;
• Continuing education and training, through videoconferencing and secure professional web portals; and
• Better integration of community and provincial health care systems, enabling seamless delivery of services.

What happens during a medical telemedicine consultation?

Here’s how a typical medical telemedicine exam might proceed - Upon choosing to have a telemedicine consultation, the patient is asked to sign consent forms that provides permission to send his/her medical information to the remote specialist or health professional who will be assisting with his/her health care. If the client does not sign the form the information will not be forwarded, and a face-to-face consultation will have to be arranged instead.

At the time of the medical appointment or consultation session, the MNO trained staff member (called the Community Telemedicine Coordinator) explains the process and prepares the client. This appointment takes place in a private room, where the client can either be by his/her self or with others chosen by the client to have in the room – such as a family member, or anyone the client wants or needs there for support. If it is a visit with a specialist the client may want to have the referring physician in the consultation.

For diagnostic appointments at the sites that have iDOC units, with the use of a TV or computer screen, a small camera, microphone and special internet line, the exam begins with the pertinent client information, pictures, x-rays and other test results being transferred to the remote physician. Special hand-held cameras are sometimes used to zoom in for tight close-ups, providing a good view of the problem areas. Other electronic tools, like a fiber-optic otoscope and digital stethoscope, allow the physician to exam the client as if he or she was with the client in person.

Everyone can talk freely back and forth during the appointment. The patient is encouraged to ask questions. The health professional, who is visible to the client on the screen, is also sitting in a private room, so the client’s information and any conversation between the client and the health professional remains private and confidential – just as if the appointment were being held in person.

What is the Role of the Community Telemedicine Coordinator?

There is more to providing care through telemedicine than simply installing cost-effective technology. Telemedicine operations must also fit into the organizational structure of the health care facility, have administrative and remote medical support, and have the operational infrastructure to allow the clinical applications to work.

First and foremost, telemedicine operations must meet the clinical needs of the clients. This means keeping the meetings personal. And this is where a properly trained health worker (Community Telemedicine Coordinator) comes in.

The role of the Community Telemedicine Coordinator is to facilitate the provider-client relationship. Whereas cameras, monitors and other pieces of equipment can make the teleconference exam room seem cold and impersonal, the telemedicine coordinator’s job is to promote the “the human factor”. This is particularly important for the Métis. By keeping the use of technology to a minimum and focusing on ways to increase human contact, the Community Telemedicine Coordinator prevents the technology from interfering with the relationship.

MNO Plans for Telemedicine

Presently, the MNO has placed videoconferencing equipment for telemedicine in 13 of our Metis community health offices. In addition two iDOCs (Interactive Doctor On Call units) have been placed in Timmins and Thunder Bay. We are planning to include the communities of Brampton, Owen Sound and Welland, with installations complete in 2008.

The MNO has a partnership with the Providence Care Centre (PCC) in Kingston Ontario. PCC is a mental health institution that offers outreach programs. It is affiliated with Queen’s University. The Chief Psychiatrist at Queen’s University holds the dual position of Chief Psychiatrist with PCC as well. This partnership provides MNO with continuing education programs for our staff through videoconferencing and deployment of an information web portal with on line access. The partnership will also provide MNO clients with access to sessions with psychiatrists based at the Providence Care Center. In addition the Queen’s University health research and policy department is working with MNO to develop a Métis Nation of Ontario health surveillance system.

The future will bring development of more telemedicine programs that are identified by MNO health staff and clients. There are many possibilities and ways to use this technology efficiently and effectively to ensure culturally appropriate access to health care for the Métis. The existing iDOC will enable the MNO to move forward with provision of primary health care by providing access to physicians from our existing health centres. Telemedicine and the iDOC will be key in the Métis Mobile Primary Health Care Units.