Need and Model of Telediagnosis -The

Manitoba Experience Albert E. Chudley

Mary Cox-Millar

Sally Longstaffe

University of Manitoba4th Annual Fetal Alcohol Canadian Expertise

(FACE) Research Roundtable Edmonton, AB

September 9th 2003

Learning Objectives

• Demonstrate the need for telehealth

• Identify a process that will facilitate distant diagnosis and meet the needs of the North

• Recognize the need to partner with external groups and communities

• Discuss our experience in FAS diagnosis using telehealth

CLINIC FOR ALCOHOL AND DRUG EXPOSED CHILDREN (CADEC)

Winnipeg

MISSION: To improve the lives of alcohol and drug exposed children and their families by:

MDT approach diagnosis, treatment recommendations

Support families as they move through process

Help families link community resources

Develop research strategies

CADEC Core Values

Multidisciplinary

Holistic approach

Recognize individuality

Attitude of respect

Recognize diversity

Research to increase knowledge and enhance lives of affected children

Participate in continuous learning

CADEC Community Services/Partnerships

FAS/FAE Support Services

Direct Service For Children0 to 7 Years of Age

Interagency FAS/E ProgramChildren’s Special Services/FAS Outreach TeamSociety for Manitobans with DisabilitiesProvincial Outreach Therapy Services for ChildrenChild and Family Services

Diagnostic Services

Fetal Alcohol Family Association

Child and Family Services

School Age Children

Special EducationClassrooms David Livingstone School and Shaughnessy Park

Child Guidance ClinicChildren’s Special Services

Child Psychiatry

Support for Pregnant Women

Northern Manitoba Services for Families

Family Support

Nor’West Mentor ProgramAboriginal Health &

Wellness/ FAS/E Prevention Program

Mentorship program The Pas and Norway House

Clinic for Alcohol & Drug Exposed Children

Fetal Alcohol Support Team - Thompson

Fetal Alcohol Support Team – Thompson

Interagency Group The Pas / Flin Flon

Government Support

Healthy Child ManitobaManitoba Health/Child

Health

Adult Services

Reasons for and Benefits of Telehealth

• Canada has many distantly located low population communities with limited access to specialty care

• Reduced time and costs for travel• Timeliness of access to care• Reduced barriers to compliance with appointments• Facilitates family involvement• Enhances linkages amongst health professionals and

community agencies• Provides access of education and training to rural

areas

MBTelehealth

• Partnering with the Prairie Provinces FAS Initiative and CADEC, the first link was with Thompson MB in 1999.

• Following a $3M grant from the federal government, technical capabilities were greatly expanded in 2001.

• Subsequent link to NorMan Region (The Pas and Flin Flon) 2002-present.

CADEC Intake Meeting

Document Review

Screening (optional)

Intake Meeting with parents,

school

Information Gathering

Referral

Model for Coordinated Assessment/Follow-up Service

refer elsewhere defer or on hold by parental request

unable to contact

M.C.Millar/T.Benoit Nov/00

Case Conference

Medical Assessment (Genetics,

Developmental)

Family Debriefing

(optional) Follow-up Planning

Final Report

Psychology

OT

Speech & Language

-

Intake

Follow-up

Asse

ssmen

t

Paediatrics and Child Health

Vol 7 March, 2002

Linked to 24 sites!

• Province-wide LAN H.323 internet protocol video-conferencing system

• Uses multi-site control unit

• Portable equipment with document viewer

Telehealth Equipment Telehealth Equipment

Total Network Utilization Fiscal Year 2002-2003

132 141

98 9575

123

190 196163

255271

292

0

50

100

150

200

250

300

350

Total Number of Sessions: 2,031

[FAS sessions represent~27 encounters]

Utilization by Type of Session(shown by quarter year for 02-03 fiscal year)

0

100

200

300

400

500

600

April-June

July-September

October-DecemberJanuary-March

(All clinics including FAS)

Clinical Utilization (Actual Number) Fiscal Year 2002-2003

172161

144

104111

83

4940

67

394548

0

20

40

60

80

100

120

140

160

180

200

April

May

June

July

Augus

t

Septe

mbe

r

Octob

er

Novem

ber

Decem

ber

Janu

ary

Febr

uary

Mar

ch

(All clinics including FAS)

Cost impacts, assumptions re: patients

• Does not include indirect costs savings due to time off work, child care while away etc

• No distinction made between costs borne by individual and those borne by health care system

Technical success: qualitative findings

• Users satisfied with training received• Unanimous appreciation of technical support• Technology easy to use• Sites linked by satellite experience more problems • Some would like to enlarge network to more sites,

have more drops, be available for emergent and urgent use 24/7

CADEC Telehealth Experience with FAS Diagnosis

• Total of 27 links since April 1/99• 8 of 27 links – planning/team meetings,

presentations and/or education sessions• 19 of 27 links –assessment links• 27 children were assessed (initial

assessment, consults and/or follow-up to initial assessment)

• 4 of the 19 assessment links were training teams in diagnosis

Estimated travel savings: (FAS-24 month period)

Average $ per session

Total $

Patient travel costs avoided 475 12825

Professional travel costs avoided 4800 38400

Total travel costs avoided 5275 51225

Feedback From Users Following FAS Assessments

• “Excellent… it is almost like talking face to face at your kitchen table with the doctors.”

• “It should be in more communities…best thing that could ever come to the North.”

• “It is an opportunity to see how the medical system works.”

• “Bringing expertise to the community helps in building a team that is working in the best interests of the child.”

Feedback From Users Following FAS Assessments

• “Travelling to Winnipeg is a stressor for many people.”

• “Using telelink allows the children to be assessed with less disruption to their daily routine…a trip to Winnipeg would be 3 days from home!”

• “A birth mother would be more willing to participate if she is supported through the process by people who know her and the child in the community.”

What Have We Learned?

• Importance of establishing external relationships (CADEC team and the community)

• Establish common and site-specific goals• Provide training as needed• Clarify process for referral• Establish guidelines for communication and

clarify expectations

What Have We Learned?

• Ask for feedback on experience• Need to wait for camera before speaking• Use close up mode when speaking• Provide a warm-up period for children to

become accustomed to the interactive “talking television” and the room

• Allow privacy (limit numbers in the room at any given time

Summary

• Telehealth FAS Diagnosis has met the needs of some families in a northern community in Manitoba

• On site coordinator trained in preparing the family for the diagnostic process and with good community links is essential

• Need to link with local professionals and agencies

Thanks for not drinking, Mom