Pioneering telehealth for BC’s rural and remote First Nations communities

Dr. John Pawlovich using a telehealth-enabled ENT camera to examine a patient during a videoconferenced appointment in the remote community of Takla Landing Dr. John Pawlovich using a telehealth-enabled ENT camera to examine a patient during a videoconferenced appointment in the remote community of Takla Landing

Dr. John Pawlovich, a family physician living in Abbotsford, BC, has a thriving practice in Takla Landing, a rural and remote aboriginal community located approximately 400 km north of Prince George, BC. Like many physicians providing rural and remote healthcare, he flies or drives by 4X4 into Takla Landing once a month for a week to meet face-to-face with patients. Unlike many physicians, however, Pawlovich regularly meets with and examines these patients, and consults with Takla Landing clinic nursing staff on a daily basis from his home office via videoconference for the other three weeks of the month.

Pawlovich and Takla Landing are part of a pilot project initiated by Carrier Sekani Family Services to explore how telehealth technologies can be used to provide primary care support to isolated aboriginal communities. The project, which started in 2010, is an unmitigated success. After installing state-of-the-art videoconferencing equipment that included peripheral examination tools such as a stethoscope, an ENT camera, and a general exam camera, the Takla Landing healthcare team developed new processes and competencies to integrate the new technology into their daily services.

Telehealth enables nurses and physicans who are off-site to collaborate in an unconventional manner. Nurses often lead much of the care at Takla Landing and use the telehealth system to consult with Pawlovich via iPad, smartphone, or HD desktop screen and camera when a complex health issue requires a consult. Caroline Alger, an RN who has worked at Takla Landing, notes that it is amazing to have a physician listen via telehealth to heart, lung, and bowel sounds, examine wounds, and talk to the patient to explain their symptoms and diagnosis. “It takes away the guesswork that occurs when a physician prescribes on the basis of the examining nurse’s description of symptoms and findings,” says Alger, and she notes that telehealth also helps her learn new skills and review existing competencies in patient examination and treatment. Support of healthcare services through telehealth has enabled care workers to manage more patients in-community and reduces the number of patient transfers to acute care facilities elsewhere, saving money and reducing patient stress.

In addition to enhancing acute healthcare provision, telehealth also enables much more optimal management of chronic diseases, allowing patients to receive proactive and preventative care from a familiar healthcare provider. “The ability to continue to directly work with a patient despite not being physically present in the community is a game changer,” says Pawlovich.

The success of the Takla Landing pilot project has led to further investigation about the effectiveness of telehealth in supporting specialist care. “We’re now offering several specialties within Takla Landing, including general surgery, thoracic surgery, infectious disease care, nephrology, addictions, HIV and AIDS, dermatology, and cardiology,” notes Pawlovich. While complex treatments may not take place at the community health clinic, local healthcare staff and telehealth both play a key role in managing and supporting the patient through the process. For example, Pawlovich and clinic nurses have managed simple surgical pre- and post-operative exams in-community by videoconferencing with the specialist.

The emerging First Nations Health Authority is very interested in the outcomes of the Takla Landing pilot project and has initiated a Telehealth Expansion Project that plans to fully launch by the end of 2013. This project will create the opportunity for a large number of aboriginal communities to get involved with telehealth when they’re able and ready to do so. Pawlovich is cautious about referring to telehealth as a cure-all for addressing gaps in aboriginal health. He notes that communities should assess what services are currently available and explore how telehealth will be able to improve those services. “You need to have a model of service delivery before you can bring in telehealth equipment,” he observes. “If there is no care available in the community, the technology won’t be able to miraculously create it.”

There are other challenges facing remote and rural aboriginal communities wishing to augment their healthcare programs with telehealth technologies. Telehealth is heavily reliant on internet connectivity and requires a great deal of bandwidth to function properly. In regions of BC that do not have access to high speed connectivity, acquiring this bandwidth (usually through satellite internet connections) can be difficult and costly. Videoconferencing equipment, too, can also be expensive. However, Pawlovich feels that the rapid evolution of mobile technologies will likely bring such barriers down over time.

Takla Landing residents have embraced new technology in a brave and collaborative manner and are at the forefront of a new, emerging paradigm of healthcare. Pawlovich speculates that in the future, all patients will have the ability to access their healthcare provider virtually, and that virtual care will compliment in-person care for remote and rural patients. Web-based delivery of healthcare and telehealth will significantly impact overall access to and cost of healthcare, physician licensure, and billing – issues which have not yet been examined. Pawlovich concludes, “Telehealth is going to lead us into areas we can’t imagine presently. It wasn’t that long ago that the local Takla Landing care aid was calling for urgent help over a VHF radio. Now with the click of a mouse the physician arrives at the bedside. Stay tuned!”

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