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Last week all the First Nation Community Telehealth Coordinators (27 coordinators) working in their home communities gathered in Balmertown to complete their certification process as CTCs working with the Keewaytinook Okimakanak Telehealth initiative. The training workshop provided all the CTCs with the opportunity to share their stories and experiences as well as learn new skills.

Click here to view some pictures from the training workshop.

Cal Kenny, K-Net's Multimedia Producer, video taped a various parts of this workshop. He has posted some of the video clips online for the CTCs to use in their communities to help explain their work.

Click here to see the video clips from this Certification workshop

KO Telehealth is pleased to announce that the program is reaching all time highs for clinical, educational and training events...

October saw clinical events hitting over 100 for the second time in 2005 with November seeing the highest results yet. November consisted of 111 clinical events and 88 public health and wellness education events. Please click to review the detailed utilization statistics 'KOTH Utilization Statistics'.

The record setting clinical events utilization is the direct result of KO Telehealth's Community Telehealth Coordinators (CTCs)facilitating scheduled events from 8:00-4:30. Emergency after hours support is also provided by the CTCs, as required.

In order for the community telehealth programs to manage the available bandwidth for the video conferencing needs of the communities, full time coordinators are required to ensure the doctors can see patients in their home communities. This dedication towards the improvement and enhancement to health care services in the communities is the direct result of the community members acceptance to incorporate new technologies into their local health integration initiatives.

These locally owned and operated telehealth programs need to be sustained with the reinvestment of savings into local priorities. Local priorities ranging from educating and training community members into certified telehealth coordinators to ensure community human resource development.

Please visit the KO Telehealth Website for up-to-date news and information surrounding the program.

from http://telehealth.knet.ca News items - KOTH Furthers CTC Certification  - Posted by: Donna Williams

The Keewaytinook Okimakanak Telehealth team is excited to announce the first ever comprehensive certification training for Community Telehealth Coordinators (CTCs).  Commencing January 16, a total of 27 CTCs will be coming to Balmertown to participate in this training program. 

Until now, most CTC training is done on-line via videoconference however due to the large success of First Nation uptake, a comprehensive training process is the solution to ensure full certification for all KOTH CTC's.

There has been a large number of CTC's hired in the last year.  This face-to-face training will allow the KOTH team to meet each other and confirm their knowledge through demonstration and hands-on training. CTCs will receive training on the following modules.

• Privacy and Confidentiality
• Technical Training on the Telemedicine Workstation
• Education Session Coordination
• Computer Skills
• Clinical Protocols
• Community Promotion
• Mock Session

Certifying CTCs in Telehealth Coordination ensures CTCs have the skills to successfully implement community-based Telehealth to meet the health care needs of First Nations.

The Certification training will be followed by a gala dinner and graduation ceremony.  First Nations representatives and other organizations have been invited to share in this celebration.

Vytas Mickevicius, Executive Lead, Telemedicine, e-Health Office with the Ministry of Health and Long-Term Care arrived in Sioux Lookout on Thursday, Nov 24. He met with Robert Thomas, KO Health Director and Brian Beaton, K-Net Coordinator to discuss First Nation e-health strategies. The meeting was arranged by Robert Vigneault of Canada Health Infoway who ended up missing his connections to Sioux Lookout and joined the discussions by telephone.

Vytas is  working with the three provincially funded telehealth networks developing the Ontario Health Transformation Strategy. Plans are being developed to integrate these three network into one by April 1, 2006. Ensuring that First Nations and the KO Telehealth service will be able to access these provincial services is an important component of their plans.

Tours of the network, teleradiology at Menoyawin, meetings with KO Telehealth, SSHA and FedNor were part of these discussions.

In May of 2005, Keewaytinook Okimakanak and Canada Health Infoway initiated a project to codify and document the processes and systems developed as part of the KO Telehealth implementation process and to summarize lessons learned and emerging best practices in delivering telehealth services – the use of secure videoconferencing to improve and enhance access to clinical and health education and training services – in isolated First Nations.

As Canada’s largest and busiest First Nation governed telehealth network, this work anticipates widespread roll-out of Aboriginal and First Nations telehealth initiatives and supports shared objectives of improving telehealth coverage in isolated Aboriginal communities, increasing clinical utilization of telehealth services and supporting the adoption and diffusion of telehealth innovations by health service providers and First Nations and Aboriginal people in Canada.

The project was led by the Keewaytinook Okimakanak Research Institute (KORI – http://research.knet.ca) and supported by KO Telehealth and K-Net managers and approved by the Keewaytinook executive. Brian Walmark led the project team at KORI and Krista Balenko at Canada Health Infoway. Products were developed by Jesse Fiddler, Cal Kenny, Wes McKay, Franz Siebel, John Rowlandson, Florence Woolner and Jennifer Morrow. KORI would like to thank community members in Sandy Lake and Keewaywin First Nation for their participation in focus group interviews and Community Telehealth Coordinators Ida Fiddler and Joshane Fiddler for their guidance and assistance during the community engagement sessions. ... Click here to read the entire PDF document (144 pages)

Table of Contents

PREFACE .... 1
PRODUCTS .... 1

PART 1: SUMMARY OF KO TELEHEALTH BUSINESS PROCESSES .... 2

SECTION A: ORGANIZATIONAL STRUCTURE AND HUMAN RESOURCES .... 3

• KO Telehealth Organizational structure .... 3
• KO Telehealth Job Descriptions .... 5
• KO Telehealth Start-up Roles and Responsibilities .... 16
• Major Human Resource Lessons Learned .... 25

SECTION B: COMMUNITY OUTREACH AND TRAINING .... 29

• Lessons Learned: Community Telehealth Coordinator Outreach .... 29
• Community Telehealth Coordinator Remote Training Plan .... 33

SECTION C: HEALTH SERVICE PARTNERSHIPS, DEPENDENCIES AND RISKS .... 40

• First Nations Partnership Development .... 40
• Effects of Nurse/Physician Turnover on Telehealth Service Delivery .... 46
• Telehealth Service Development Risk Mitigation .... 48

SECTION D: MANAGEMENT SYSTEMS .... 57

• KO Telehealth Governance Structure .... 57
• KO Telehealth Business Practices .... 59
• KO Telehealth Annotated Policies and Procedures .... 62

PART 2: FIRST NATIONS TELEHEALTH ENGAGEMENT .... 70

SECTION A: FIRST NATIONS ENGAGEMENT STRUCTURES, STRATEGIES AND COMPETENCIES .... 71

• Annotated Engagement Diagram .... 71
• Communication Tools and Approaches .... 75

SECTION B: EVALUATING EFFECTIVENESS AND COMMUNITY SATISFACTION .... 82

• Timeline and Diagrammatic Summary of Evaluation Framework Design .... 82
• Keewaytinook Okimakanak Indicators, Milestones and Benchmarks for Success.... 85
• Matrix of Evaluation Requirements .... 89
• Process Diagrams and Summary of Community Feedback .... 91

SECTION C: MIGRATING TELEHEALTH SOLUTIONS .... 92

• Migration Requirements with Lessons Learned and Considerations .... 92
• Overcoming Health Service Provider Barriers .... 103
• Observed Benefits of a Wellness Service Model .... 108
• Matrix of Community Health Needs and How Telehealth Addresses Needs .... 112
• KO Telehealth Development Summary .... 116
• First Nations Telehealth Development Glossary .... 120

SECTION D: Community Telehealth Coordinator Vignettes .... 123

PART 3: FIRST NATIONS TELEHEALTH NETWORK SERVICES MODEL .... 124

SECTION A: TELEHEALTH NETWORKING TOOLS AND SERVICES IN REMOTE FIRST NATIONS HEALTH CENTRES .... 125

• Interactive Multi-Media Flash Presentation .... 125

SECTION B: IMPLEMENTING AND SUSTAINING NETWORK SERVICES .... 126

• Sustainability Challenges and Lessons Learned .... 126
• Inventory of Network Services Delivered .... 130
• Partnerships Between KO Telehelath and First Nations Communities .... 133
• Network Security Measures .... 137
• K-Net/KO Telehealth Historical Development Timeline .... 138

KO Telehealth (KOTH) received funding from Canada Health Infoway (CHI) to document its operations and management structure as a model for other First Nations telehealth projects in the country. 

The documents and reference material will be archived by CHI on their database that everyone is invited to use when they sign on as a member. There is already a large collection of valuable resource material on their searchable database. Click here to complete the registration to access the e-Health KnowledgeWay Portal. 

An animated presentation showing how the various communication tools used in the delivery of telehealth share information is available online. Everyone is invited to guide the patient throughout an ideal telehealth office where they can see all the different telemedicine tools being used by the Community Telehealth Coordinators, the doctors and the nurses to share and access patient information. By clicking on each of these different devices, the viewer will then see how the information is transmitted within a secure and safe network. Jesse Fiddler, in Sandy Lake First Nation, was contracted to produce this Flash presentation.

The animation requires the latest version of Macromedia Flash to display properly on your computer. Click here to check out the Flash presentation providing you with a digital tour of a community telehealth station.

The critical role that the Community Telehealth Coordinators (CTCs) perform in the development and delivery of community-based telehealth is captured in a 17 minute DVD video. This production, lead by Cal Kenny - K-Net's Multi-media Producer, is broken up into smaller chapters that are available on-line. Click here for the KOTH web page with links to these videos.

The project management for the production of this telehealth documentation initiative was lead by the folks at the KO Research Institute.

On Wednesday, October 19, the Keewaytinook Okimakanak Telehealth (KOTH) Sustainability Committee and the Evaluation Committee met together to review the findings from the KOTH Interim Report. Click here to see the news story about the release of the Interim Report for links to the entire report.

After the powerpoint presentation by Dr. John Hogenbirk, Dr. David Robinson from the Department of Economics at Laurentian University highlighted the value of this report with the statement, "We have done a very limited evaluation here ... The gold standard for evaluating something economically is cost benefit and that takes into account every benefit, every cost. What this evaluation has shown really is that if you just consider the travel costs, it pays the cost of setting up and running the system! ... The program is very justified at this point" .... Click here to see Dr. Robinson's comments.

Dr. John C. Hogenbirk, Centre for Rural and Northern Health Research (CRaNHR), Laurentain University presented the powerpoint presentation describing the findings of the evaluation to date. Click here to watch this presentation.

Dr. Ricardo Ramirez, School of Environmental Design and Rural Development (SEDRD), University of Guelph, another lead researcher and author of this report also commented about the Interim evaluation report. Click here to hear his comments.

Andres Ibanez, the Masters graduate candidate who did a lot of the field work and data collection for this report also made some important observations. Andres is studying at the School of Environmental Design and Rural Development (SEDRD) at the University of Guelph. Click here to see his comments.

Click here to see the web page that contains links to this important meeting.

KO Telehealth is pleased to make the Interim Report available to partners and stakeholders. Key messages from the Interim Report are summarized in the areas of Access, Acceptability, Integration, Quality and Financial Impact.

“Our lives have been completely changed by the services we now receive over the network. Having telehealth care and also having secondary education services available in our communities is making us stronger as a people.”

- Geordi Kakepetum, Executive Director

• Interim Report
• Appendix 1- Evaluation Framework
• Appendix 2- Evaluation Manual 
• Appendix 3- Economic Model
• Appendix 4- Figures and Tables
• Appendix 5- Focus Group Integration

Main Messages

The Keewaytinook Okimakanak Telehealth/NORTH Network Expansion Project began with 5 First Nations communities and has since expanded to 22 First Nations communities located in the Sioux Lookout Health Zone. Geographically isolated and culturally distinct communities such as these have lower access rates to health services and lower health status relative to the rest of Ontario. The Expansion Project used  telecommunications technology compared to travel to span geographic distance. This evaluation represented a comprehensive effort to measure short-term changes in access and sets the stage to measure the potential long-term health effects.

Access: KOTH usage varied from 66 to 224 telehealth sessions/month (average=122/month). First Nations communities averaged 12 sessions/month. Clinical consultations comprised 42% of the 2926 sessions, followed by training (19%), education (17%), meetings (13%) and demonstrations/tests/family visits (8%). The number of medical specialties, educational events and health programs offered via telehealth also increased. The stories and the statistics suggest that telehealth has "virtually" decreased the geographic distances that have, in the past, restricted access to health information and health services.

Acceptability: Over 90% of the 73 patients said that they found the telehealth session helpful, 96% would repeat the same appointment by telehealth and 89% would recommend telehealth to another person. These sentiments were echoed by many health providers. A frequent qualification was that flying patients or providers in and out of a community was still needed as a viable, workable option, should it be required by the situation.

Integration: Many stakeholders recognized the potential and need for telehealth to integrate the programs and the people involved in health education, prevention, early diagnosis, treatment and follow-up (e.g., diabetes). The benefits of improved continuity of care and greater family involvement were also emphasized.

Quality: Many physicians felt comfortable with using telehealth for most follow-up and also for initial consultations provided that face-to-face was available should it be required by the situation. Many stakeholders concluded independently that the role of locally recruited, fulltime Community Telehealth Coordinators (CTCs) was of paramount importance to telehealth success and had implications not only for quality of service, but for access, acceptability and integration. Stakeholders advocated for ongoing efforts to educate and retain qualified personnel.

Financial Impact: The Pilot Project provided proof of concept as the telehealth service was rolled-out to 22 First Nations communities and provided cost and utilization data that were used to model a fully operational and sustainable telehealth program. Different estimates and monetary values were assigned to telehealth sessions that averted travel versus those that were in addition to travel ("new" telehealth). Costs for the Sustainable Program were estimated at $2.81M/year. Estimated savings were $4.16M/year for averted travel and $6.09M/year if “new” telehealth was assigned a dollar value. Estimates were based on 1346 averted trips for 4810 telehealth sessions/year. The breakeven point occurred when there were 915 averted trips for 3271 telehealth sessions/year.

Conclusions: The preliminary findings of the evaluation suggest that the KOTH/NORTH Network Expansion Project has increased utilization. The Sustainable Program has the ability to become a financial success in the near future. Feedback from stakeholders in the communities and in support centres testified to emerging benefits and significant potential for the future.

Keewaytinook Okimakanak telehealth information video series describing the work of the Community Telehealth Coordinators. Produced by Cal Kenny, K-Net's Multi-media Producer as part of the KO Telehealth information package being prepared for a Canada Health Infoway initiative.

Part 1.  Overview of the community-based Keewaytinook Okimakanak Telehealth initiative View here Length:2:47 Part 2.   Introducing and Supporting Telehealth in First Nations View here Length:3:22 Part 3. Sample Consult Session View here Length:4:47 Part 4. The Roles and Responsibilities of the First Natin CTCs View here Length:2:11 Part 5.     Public Health Education View here Length:2:54 Part 6.     Conclusion  View here Length:1:46

Click here for the telehealth web page with these videos

Keewaytinook Okimakanak's Telehealth (KOTH) initiative was highlighted at last week's AFN Telehealth Summit. The KOTH project involves the expansion of the telehealth services to include all twenty-five First Nations across the Sioux Lookout zone. The project is  funded by Health Canada's Health Transition fund and FNIHB along with other partners including the First Nations, Industry Canada FedNor, Northern Ontario Heritage Fund and NORTH Network.

At the gathering, the KOTH booth was set up to demonstrate the various tools involved in operating this telehealth service in these remote communities. The booth was maintained by the Community Telehealth Coordinators (CTCs) who were able to attend this summit in Winnipeg. As well, the KOTH team delivered a number of presentations about their work during the various conference sessions. Click here to view some pictures from this gathering and the team involved in putting it together.

The new video production about the CTCs' work in each First Nation was premired at the booth, with parts of it being shown during the presentations. Cal Kenny, K-Net's Multi-media Producer, is working with his team to complete this video as part of a Canada Health Infoway initiative. Click here to watch this 17 minute video. (requires windows media player) 

More updates on this video will  be posted on the KOTH web site at http://telehealth.knet.ca