The First Nations Health Authority Telehealth Expansion Project

FNHA’s eHealth, Information Management and Privacy Director, David Huh FNHA’s eHealth, Information Management and Privacy Director, David Huh

Telehealth as a tool has been a part of British Columbia’s healthcare system for nearly two decades. Recent forays into telehealth such as Health Canada’s successful pilot project in Takla Landing, BC with Dr. John Pawlovich – are garnering new and much deserved attention from physicians and rural residents alike. Current telehealth technologies – which include videoconferencing, secured internet connections, and satellite communications systems – enable physicians to deliver both primary care and specialist services directly to patients living in remote and rural communities, without necessarily having to meet the patient in person.

The First Nations Health Authority (FNHA) has carefully observed the outcomes of the Takla Landing telehealth pilot, and is committed to delivering a fully-integrated telehealth clinical network – in fact, such a network is one of the action items listed in the Transformative Change Accord: First Nations Health Plan, a document which underlies and guides the work of FNHA. In a province as challenged by geography as British Columbia, delivering a telehealth network is a monumental challenge. The FNHA’s eHealth, Information Management and Privacy Director, David Huh, notes that some First Nations communities in BC do not yet have persistent connectivity. “How does one layer a robust and immersive videoconferencing or telehealth experience onto that?” The answer is simple – one doesn’t– at least not without some preliminary exploration to discover what a community truly needs and wants. “For communities that don’t have robust connectivity, we would undertake upgrades through the Health Connectivity Project – another FNHA initiative – so that the community can have reliable and secure access to network services. From there, higher level services from telehealth would follow.”

Before Huh or his team even discuss the installation of any technology into the communities, however, he first looks at the health story of the community, to see what’s driving the requirements for telehealth. “If there is a strong need for, for instance, access to a mental health program,” he explains, “then we start to do service mapping and matching with providers within the region, or within the province. We provide a roadmap to get a community to the desired endpoint.” The FNHA does not work in isolation, nor does it build new infrastructure in each instance. “We tap into partnerships within our Regional Health Authorities with deep collaboration with their Aboriginal health programs,” says Huh, “If we are smart in the way we leverage existing investments made by the province, we can make a dollar stretch a long way.”

Although the impetus to support clinical telehealth throughout BC First Nations communities is part of the FNHA’s mandate, Huh and his team recognize that not every community is immediately ready or able to implement telehealth as part of their community health and wellness plan. A key element of the First Nations Health Authority approach is to leave no community behind. Rather than selecting a list of communities for telehealth support, thus dividing BC First Nations into ‘have’ and ‘have-not’ communities, FNHA recently issued an open call for participation in the initial phase of the Telehealth Expansion Project to all 203 BC First Nations. 38 responses (representing 65 First Nations) to the call were received. An open process, says Huh, “is fair by having a very transparent and clear selection criteria” and provides opportunity for communities willing to undertake the work. The 38 health organizations have different levels of readiness, measured in terms of operational, technical and clinical capacity, which means that the FNHA will need to carefully work with each group to identify areas of support. In the end, however, the groups will advance in their ability to take on basic or full modal telehealth services. “The outcome of the project is to provide equitable access to primary care and health and wellness services, so that both ‘have’ and ‘have-not’ communities all have access to the project.”

Huh’s portfolio for eHealth encompasses more than telehealth expansion. The FNHA’s eHealth,  Information Management and Privacy group is also currently working on:

  • providing private, secure, reliable and robust connectivity to all BC First Nations health service organizations, with the ultimate goal of integrating these groups fully into the provincial health environment and/or eHealth space.
  • implementing and supporting Panorama, a pan-Canadian public health information project that focuses on the surveillance and management of communicable diseases. BC First Nations are leading the way in the adaptation and use of Panorama, with several BC health service organizations currently participating in the project.
  • implementing community EMRs into jurisdictions that currently don’t use any time of charting or case management tools. These community EMRs will be more patient-centered than their traditional EMR counterparts, which will align with the health and wellness perspective adopted by most First Nations health centres.

Despite the focus on technology, Huh remains clear that the focus of his work is the patient. Dr. Pawlovich’s work on the pilot in Takla Landing, he observes, successfully demonstrated that a physician can build relationships with First Nations patients in the community through monthly visits, and then continue maintaining those relationships via telehealth services. “At the end of the day, it’s about the patient.”

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