Report to Romanow Commission
by the Canadian Society of Telehealth

The purpose of this submission by the Canadian Society of Telehealth is to detail the important benefits to the health of Canadians by the comprehensive application of Information and Communication Technologies (ICTs) to our Healthcare System. As background, The Canadian Society of Telehealth is comprised of more that 200 members across Canada. The membership includes healthcare providers, academics, individuals from the private sector, and professionals from federal, provincial, and territorial Ministries of Health. Our vision "is to be the nation's leader in the promotion of Telehealth and an advocate for its integration into the healthcare system to improve the health of all Canadians". Our definition of "Telehealth" is broad and consists of 5 components: A. Medical treatment and diagnosis at a distance (Telemedicine), which generally means real time interactive videoconferencing between a patient receiving advice from a consultant at a distant site. Participants are connected over high-speed phone lines (e.g. ISDN) and high-speed private networks. Examples include Telepsychiatry, Teledermatology, Telecardiology, and Teleradiology.

The entire range and volume of Telehealth activities has increased remarkably especially in the last year aided by significant grants and other investments by all levels of government, most notably Health Canada. Telehealth activities now occur in all Canadian Provinces and Territories. As the Romanow Commission is aware, the Premiers' meeting on health in Winnipeg in August 2000 was an important milestone for the Canadian Health Care System. Agreement was reached on the principles of what is needed to sustain our publicly funded system. In addition to a Vision Statement, the Premiers published a plan for Priorities for Action on Renewal and Innovation. In the Paragraphs below, I have listed the Premier's 11 Priorities and indicate how Telehealth applications will aid in achieving success for each.

1. Access to Care
The Premiers agreed that access to health services is of highest priority to all citizens. There is now ample experience in Canada and elsewhere that Telehealth can provide quality health care for a great variety of medical conditions, involving all specialties of medicine, nursing, and other health disciplines. Telehealth is obviously most important for Canadians in remote locations or where an appropriate specialist is unavailable, but there is much to be gained in urban settings as well. Examples of how Telehealth and electronic links can increase and provide better provide access in less remote areas include: access by individuals who cannot leave their home or community; efficient connections between local emergency rooms and specialists at central better equipped sites; development of "a virtual intensive care units" in a region minimizing transfers between units. With the advent of robots and other new technologies it is already possible i to perform surgery and other diagnostic and treatment procedures remotely, adding an entire new dimension to distance consultations.

2. Health Promotion and Wellness
The Premiers recognized that all provinces and territories are already engaged in strategies to promote health and prevent illness. Increased Internet access for Canadians is improving our ability to provide health and wellness knowledge to our entire population. Strategies that are outlined by Industry Canada's National Broadband Taskforce are supported by the Canadian Society of Telehealth for they will further improve the quality of information that can be delivered, and expand the number of communities and homes that will have access to health information.

3. Appropriate Health Care Services- Primary Care
The Premiers recognized that improvements to primary care are crucial to Canadian health systems' renewal. Wide deployment of Telehealth will ensure that the goal of having health care as close to home as possible by the most appropriate provider will be met. By providing expertise directly to local primary care providers and minimizing travel, Telehealth will improve the efficiency of care through more timely diagnosis and treatment, less need for repeat studies, fewer inappropriate referrals, and a decreased number of patient transfers.

4. Action on Health Human Resources
The Premiers directed the Ministers of Health to identify approaches to improve the education, training, recruitment, and retention of the health work force. Experience in several Canadian Provinces has already shown that the scheduled and impromptu education and training programs by videoconferencing can be of great benefit to professionals in communities in which these activities were never previously available. These electronic meetings have been shown to reduce feelings of professional isolation especially for providers in the more remote communities. When coupled with the upgrading of skills that these sessions afford, a positive effect on recruitment and retention in under-serviced areas can be expected.

5. Home Care and Community Care
The Premiers noted that home care and community care are the fastest growing health Services in Canada. At the same time, care in the home and community is also identified as one of the weak points of our current system. The provision of nursing services by tele-homecare using video phones over ordinary telephone lines is now undergoing extensive trials in Ontario, New Brunswick, the United States, and elsewhere. A related use can be seen in
the innovative PACE 2000 project in Ontario that uses videophones to provide social and medical links for a community of seniors in the Ottawa region. Early results indicate that these Telehealth strategies should have enormous impact over the next several years in many homes and communities. This application of Telehealth in home and community care deserves very strong consideration in future plans in light of our aging population needing more medical and social services as close to home as possible.

6. Action on Pharmaceutical Management
The Premiers identified a need for Canadians to have access to new, appropriate, and cost effective drugs and have pledged to work to together to develop strategies to assess and evaluate prescription drugs. Sharing of drug data that relate to effectiveness, adverse affects, cost, and best practices will be facilitated by new electronic data systems for communication between medical professionals, consumers and the pharmaceutical industry.

7. Health Information and Communications Technology
In this section of their report the Premiers focused on Telehealth and information and communications technology.. They fully recognize that investments in these technologies will lead to a more integrated and coordinated delivery of health care services. By linking the various elements of our health system, and making an individual's health record simultaneously available to all involved medical providers, Telehealth technologies have the potential to eliminate much of the "chaos in care" now experienced. A single Electronic Health Record will be an important component of a renewed health care system. 8. Health Infrastructure The Premiers reiterated their commitment to ongoing investment in new equipment, technologies and facilities for sustaining and renewing the modern health system. Investment in Telehealth applications is consistent with this pledge.

9. Sustaining Health Care Services - Ongoing Health Renewal and Innovation
The Premiers appealed for increased federal aid to health care. Telehealth promises to maximize the dollar investments in health care services through greater access, reduced delivery and travel costs, reduced number of health interventions and tests, faster treatment, and improved efficiencies. Because of this potential for cost savings and increased health benefits, appropriate funding should be directed toward Telehealth in the future. The economic impact and health benefits of Telehealth have not yet been fully evaluated, and economic data are often inconclusive. Studies often focus on short-term economic benefits to governments, and ignore cost savings to private citizens and long-term health benefits to society. New investments in evaluation of Telehealth's health and economic advantages are clearly indicated.

10. Clear Accountability- Reporting to Citizens
The Premiers recognized a responsibility to provide regular status reports on health to all citizens. Electronic systems will be important tools to disseminate this information on such items as: health status of Canadians, health outcomes and quality of service.

11. Working Together
The Premiers identified the need for various levels of government, health care institutions, health care providers, and communities to work together to meet the health care needs of the 21st Century. The proper and widespread use of information and telecommunications technologies is essential to overcome many of the current obstacles to success. In conclusion, the Canadian Society of Telehealth hopes that the Romanow Commission appreciates the enormous power of Telehealth as an enabler of many of the important changes that will be necessary for the evolution and renewal of our health care system. Telehealth applications should have a prominent role in the Commission's final recommendations.

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