Monday, 29 February 2016

The state of Telehealth in Canada

Telehealth services in Canada have been on the rise in recent years to help address the gap between traditional healthcare service demand and capacity. By providing health services through video conference, telephone, online, or accessing information remotely, healthcare workers are able to assist more patients using less resources. The technology gives patients living in remote areas access to health professionals and provides health workers with ways to deliver care outside the traditional confines of clinic and hospital walls.

The potential for Telehealth is enormous and it is slowly catching on in Canada, according to the 2015 Canadian Telehealth Report published by Canada’s Health Informatics Association (COACH). The report looked at Telehealth in 12 provinces and territories (excluding Nunavut). Information for the report was also received from the national First Nations and Inuit Health Branch. In total, 13 jurisdictions provided information from 26 various contributors regarding the state of Telehealth in their regions (a complete list of the program contributors can be found on pg. 8 of the report).

The increase in Canadian Telehealth services

Telehealth endpoints

The amount of hospital-based and community Telehealth endpoints grew in all jurisdictions, expanding by 41.5% from 2012 (7,297) to 2014 (10,351) across the country.

Clinical sessions and clinical service areas

The number of clinical Telehealth sessions have also grown, according to COACH. There is an increase of approximately 195% between 2006 and 2012. From 2012 to 2014, there is an aggregate growth of 47.5%, from 282,529 sessions in 2012 to 411,778 sessions in 2014.

An increase in clinical service areas is seen across the jurisdictions as well, with 393 operating in 2010 and an 123 being added by 2012, a 31% increase, according to the 2013 Canadian Telehealth Report. The most common services being delivered by Telehealth are in psychiatry and psychology, cardiology, diabetes, genetics, oncology, and chronic pain, neurology, pediatrics, occupational therapy, and physiotherapy specialties.

Telehomecare and remote patient monitoring

Home Telehealth monitoring endpoints also saw an increase in British Columbia, Ontario, New Brunswick, Quebec, and the Yukon, rising by 18% from 2010 (2,095) to 2012 (2,465). An increase of 54% in patient numbers occurred between 2012 and 2014 (3,802). The most monitored conditions are congestive heart failure and chronic obstructive pulmonary disease.

Although there has been an increase in home Telehealth monitoring, the growth rate is lower than expected, potentially due to inconsistent research results and the amount of capital required to establish remote patient monitoring services.

Educational service areas

Educational service areas are areas in which distance education regarding health care is provided via Telehealth. In the 2015 report, the distinction was made between provider educational services and patient educational services. The report’s glossary defines the two as:

Patient Educational Service: A Telehealth service where distance education is provided to the patient (or the patient’s family) towards their care or wellness. (Appendix A: Glossary, pg. 69)

Provider Educational Service: A Telehealth service where distance education is provided to a clinician or related Telehealth staff, e.g. continuing medical education (CME), clinical rounds, technology in-services etc. (Appendix A: Glossary, pg. 69)

In 2012, there were 90 distinct educational service areas in Canada for clinicians, patients, and families. The jurisdictions reported an aggregate increase of 28% between 2010 (208) and 2012 (266), providing education services in more areas. Ontario’s Telemedicine Network (OTN) provided all 90 identified educational areas via Telehealth.

In 2014, the 90 distinct educational services remain for healthcare providers, with 64 services being available for patients and families. Oncology, pediatrics, and pharmacy are the top educational services, available for providers in 10 jurisdictions. Dietetics is the leading area of education for patients and their families, with 8 jurisdictions offering services.

Medical peripherals

A variety of medical peripheral devices are used across the jurisdictions to conduct clinical assessments using Telehealth. These peripherals include exam cameras, digital stethoscopes, digital ophthalmoscopes, digital otoscopes, ocular and retinal cameras, dermatology cameras, and ultrasound scanners. There has been an overall increase in the number of these devices used across the jurisdictions.

Desktop and mobile videoconferencing

Out of 12 reporting jurisdictions in 2014, 10 reported to have some form of desktop or mobile video conferencing technology available. All 10 of these use the technology for administrative purposes and clinical consultations, while 9 of them also use it for patient education.

Electronic scheduling services

All 13 jurisdictions used electronic scheduling in 2012, an increase from the 10 that reported to be using e-scheduling in 2010.

Conclusion

The increase in Canadian Telehealth services suggest that Canada’s health care providers and patients are starting to adopt these new technologies at a faster pace, providing better access to health care services across the country. Another positive benefit of the expansion in Telehealth services come from the increase in engagement and education on the part of the patient in their own care and well-being.

By providing healthcare services to patients across the country in both urban and rural areas, Telehealth has the potential to revolutionize the healthcare industry by facilitating the evolution of a more patient-centric model of healthcare access.