Health Telematics Unit Global e-Health Research and Training Program The Alberta SuperNet – Impact on Health Services Delivery Dr. Penny Jennett – Principle Investigator Co-Investigators: Dr. M. Yeo, Dr. R. Scott American Telemedicine Association 2004 Annual Meeting & Exposition Tampa, Florida May 2-5, 2004

PJ - ATA Tampa, Florida May 2-5, Overview Background Purpose Methods Results Impact Readiness Challenges Conclusions Next Steps

4700 linkages 422 communities Federally funded Multi-sectored 14 multi-disciplinary researchers from 4 universities Broadband – ISPs - 10 times dial-up kb What is the Alberta SuperNet?

PJ - ATA Tampa, Florida May 2-5, Background Eight sub-projects 1. Public consultation 2. Distance learning 3. Disaster emergency 4. Health 5. Discrete choice 6. Virtual clusters 7. In home/community 8. Libraries

PJ - ATA Tampa, Florida May 2-5, Purpose To determine the Key Informant views of:  Healthcare organizations/care sites (e.g. CEOs, administrators);  Healthcare practitioners (e.g. physicians, nurses, rehabilitation therapists); and  Consumers (e.g. Patients/clients, public) on the impact of the SuperNet as a transmission mode for e-health applications/solutions.

PJ - ATA Tampa, Florida May 2-5, Questions What is the perceived or actual impact of using the SuperNet to deliver health services? How will the delivery of health services affect the status quo? How ready are the various stakeholder groups to use the SuperNet? What indicators can be used to measure the impact of the SuperNet? How might the delivery of health services via the SuperNet affect patient safety and confidentiality? How do project findings impact the various strategic policy levels?

PJ - ATA Tampa, Florida May 2-5, Method Selection of Participants Key Informants  Representative sample of 14 key health sector informants was selected from the participating communities, in consultation with the Provincial Telehealth Director.  6 organizational/administrators 4 health care providers 2 patients/consumers 2 provincial telehealth program  All 14 key informants selected were interviewed (100% response rate)

PJ - ATA Tampa, Florida May 2-5, Results Impact (Positive and Negative) on: Usual Care Current Telehealth Services Readiness

PJ - ATA Tampa, Florida May 2-5, Results Impact on Usual Care Positive:  Provide greater access to care, particularly for elderly and physically disabled.  Improve the quality of care; timeliness of care; and appropriateness of care.  Better use of resources; more appropriate use hospital beds and providers of care.  Capacity building for rural health care providers.  Provide greater continuity of care from tertiary level facilities to care in rural communities.

PJ - ATA Tampa, Florida May 2-5, Results Impact on Usual Care (Cont’d) Negative:  Fear that providers and services will be lost in rural communities.  Disruption of patient-provider relationship / Impersonal.  Change in processes and way healthcare is delivered.  Pushing the system harder at both provider and community ends.  Rural communities caring for more acute patients.  Redundancy will need to be built into the system.

PJ - ATA Tampa, Florida May 2-5, Results (cont’d) Impact on Current Telehealth Services Positive :  Possible to reach Alberta Communities that could not be reached before, via telehealth.  Increase in telehealth consultations.  Higher bandwidth will make more, higher quality, e- health services available.  Increased flexibility will facilitate the use of telehealth as a tool in clinical practice.  Sharing of diagnostic information will be immediate.  Can be cost-effective if done within context of all other IT requirements.

PJ - ATA Tampa, Florida May 2-5, Results (cont’d) Impact Current Telehealth Services Negative:  Telehealth services currently in place are ISDN and will require transition to IP.  Need for infrastructure changes – gateways, gatekeepers, bridges, etc. requires significant up front planning in collaboration with IT/IS.  Going to have to learn to do things differently.  If telehealth, via IP is not reliable, could impact patient outcomes, and telehealth services negatively.  Privacy and confidentiality issues, particularly with wireless and EHRs.  Lack of experience with providing telehealth via the SuperNet.

PJ - ATA Tampa, Florida May 2-5, Results (Cont’d) Readiness to Use SuperNet (n=14) GroupNot Ready Partially Ready ReadyUncertain Organizations/ Senior Administrators 3 (20%) 8 (53%) 2 (13%) 1 (7%) Health Care Providers 4 (27%) 5 (33%) 4 (27%) 1 (7%) Patients/Public4 (27%) 8 (53%) 2 (13%)

PJ - ATA Tampa, Florida May 2-5, Challenges Informed Awareness Costs Sustainability Business Case Technical Infrastructure Reliability Gateway; bridge; interface Security/Privacy People Staffing Education Support Readiness

PJ - ATA Tampa, Florida May 2-5, Conclusions Converging high capacity Internet health services with usual and current telehealth services has both positive and negative implications, including potential socio-economic impact (e.g. capacity building, and more efficient use of resources) across several levels. Key Informants have varied views as to the state of readiness.

PJ - ATA Tampa, Florida May 2-5, Next Steps NEXT STEPS:  Triangulation of results: household telephone interviews, town halls, symposium, and health questionnaire results  Dissemination of e-Health Sector Sub-Project findings.  Integration of findings of e-health sub-project with other sub-projects.

PJ - ATA Tampa, Florida May 2-5, Summary Background Purpose Methods Results Impact Readiness Challenges Conclusions Next Steps

Health Telematics Unit Global e-Health Research and Training Program Thank You! Dr. Penny Jennett Health Telematics Unit Global e-Health Research and Training Program