The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
LOCATION:
London, Ontario, CA

YEAR:
2007

STATUS:
Laureate

CATEGORY:
Healthcare

NOMINATING COMPANY:
Polycom

ORGANIZATION:
Ontario Telemedicine Network

PROJECT NAME:
OTN

Short Summary
The Ontario Telemedicine Network (OTN), a comprehensive, province-wide telemedicine network, is an independent, not-for-profit organization funded by the Ontario Ministry of Health and Long-Term Care. OTN uses advanced information and video collaboration technologies and electronic medical devices to support the delivery of clinical care, professional education and health-related administrative services. With a presence at more than 360 sites across Ontario, OTN is one of the busiest and most comprehensive telemedicine programs in Canada.

Telemedicine has the potential to be a key enabler in the transformation of health care delivery, supporting a patient-focused, results-driven, integrated and sustainable health care system. By overcoming barriers in distance and time, telemedicine is an effective and efficient system to access and/or deliver health care services, health education, and health system management. OTN provides a provincial standard to support and enable telemedicine in a variety of settings across the province.

The benefits of telemedicine are obvious. It reduces time, cost and risk of travel for patients, families and health care providers, minimizing the disruption of their daily lives. It enables the inclusion of family and local clinical supports, wherever they may be. Telemedicine provides access to specialists and to emergency care that would otherwise be unavailable in some communities. It facilitates improved coordination of care, reducing the need for patient transfers between health care facilities and improving continuity of care across the health care system.

Telemedicine supports health care professionals’ development, skills transfer, recruitment and retention. OTN partners with local, regional and provincial health care providers to provide a comprehensive set of services that ensure telemedicine is easy to use, reliable, adaptable and cost-effective.

Introductory Overview
The Province of Ontario (Canada) is an ideal region for implementing a video telemedicine network because of the significant demographic and geographic challenges it presents. Winter weather makes access to rural and remote communities very difficult. The population is aging. Many communities are under-serviced by physicians and other health care professionals. Attracting doctors to practice in rural communities can be difficult due to professional isolation and the lack of continuing education opportunities.

The Ontario Telemedicine Network (OTN) is the result of the April 2006 merger of three award-winning, provincially-funded telemedicine networks: CareConnect in Eastern Ontario, NORTH Network in Central and Northern Ontario, and VideoCare in Southwestern Ontario. OTN’s mandate is to support clinical, educational and administrative telemedicine services for the province of Ontario.

Using advanced information communication and video collaboration technologies from Polycom, as well as electronic medical devices, OTN supports the delivery of clinical care, professional education and health-related administrative services at more than 360 urban and rural sites across the province. OTN is an independent, not-for-profit organization funded by the Ontario Ministry of Health and Long-Term Care. OTN offers telemedicine solutions to every hospital in the province, and is expanding activities to other sectors such as public health, long-term care, private homes, and community care.

Telemedicine is a key component of Ontario’s e-health strategy. Facilitated by OTN, telemedicine improves access to doctors, nurses and allied health professionals. It reduces the time, cost and risk of travel for patients, their families and providers and supports health care professional development.

OTN Telemedicine Champions:

Sandra Whittle is a nurse in the Medical Day Clinic at Leamington District Memorial Hospital:
“The Network has a profound impact on the access to, and the quality of, health care for our community. Outcomes can only improve when patients can connect with physicians or specialists without the expense of travel time, lost work and the costs and stresses of going to an appointment far from home.”

Dr. Stephen Bagg is a physiatrist at Providence Continuing Care Centre’s St. Mary’s of the Lake Hospital in Kingston. He recently began conducting pre-admission assessments for stroke patients and provided this feedback after a virtual examination of a patient in Napanee:
“Everything went well. It was great to see the patient and talk to him, observe him moving his paretic limbs and stand up. It’s much easier to be certain this man is appropriate for the stroke rehab program after seeing him, compared to the old system that involved the written summary and phone conversation. I plan to continue to take advantage of this technology!”

Dr. Denise Coulas at St. Francis Memorial Hospital in Barry’s Bay is a Telemedicine Physician champion and also speaks positively about the services provided via OTN:
“Thank you for giving me this opportunity. I will actively promote telemedicine services in our rural community and be a resource to develop new areas of clinical consultations. My experience has been that the services provided by the Network have no limits.”

OTN will continue its efforts to support timely access to specialist and emergency care, enhance educational opportunities for health professionals and make quality health care available to patients and their families across the province.

Benefits
Has your project helped those it was designed to help?   Yes

What new advantage or opportunity does your project provide to people?
OTN’s goal is the seamless integration of telemedicine into the provincial health care system. Working collaboratively with its partners, OTN makes it possible to enhance and expand services initially provided in hospitals, and to connect effortlessly with organizations across the continuum of care. Already, more than 2000 specialists, physicians and other health professionals are using the Network to provide care for their patients. In 2005/06, OTN facilitated more than 23,000 patient consultations for health providers.

When surveyed, health care providers identify access to multidisciplinary care teams, real-time discussion and improved continuity of care with less travel and cost as the benefits of telemedicine for patients and their families.

Has your project fundamentally changed how tasks are performed?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
OTN was pleased to support the Canadian Space Agency Haughton-Mars Mission 2006. OTN provided the infrastructure for an emergency telemedicine pilot project to support physicians and researchers on their remote field mission to Devon Island, Nunavut. Located 180 km north east of Resolute Bay in the Arctic Circle, Devon Island is the largest uninhabited island in the world with terrain resembling Mars. The mission - where astronauts train for a mission to Mars – ran throughout the summer of 2006. Through the hard work and dedication of the Devon Island Project Team, the members of the field mission were been able to access trauma surgeons in Vancouver and internists in Ontario via telehealth on an emergency basis. Possible reasons for emergency consultation included misadventures with polar bears and ATV accidents.

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
Ontario Telemedicine Network's (OTN's) technical standards and guidelines ensure secure, manageable connectivity between videoconferencing end-points. This is accomplished using OTN-owned and managed hardware, VPN devices deployed at member sites, and centralized communications devices located at OTN data centres. Together, this hub-and-spoke architecture constitutes a network overlay which integrates Smart Systems for Health Agency (SSHA), ORION, community-based networks (such as K-Net and Larg*Net), and the public Internet. OTN's architecture is designed to support not only telemedicine applications, but also to co-exist securely and reliably with most other IP traffic in and out of the SSHA MPN.

Interactive video conferencing technology from Polycom is one of the key enablers of the provincial telemedicine network. The key to diagnosing and treating patients at a distance is being able to see and evaluate them in real time. Combined with medical peripherals, video conferencing is a powerful tool for facilitating telemedicine.

The telemedicine equipment is designed to ensure ease of use. Depending on the needs of the user, videoconferencing calls can be reserved and expedited through a scheduling service or by the Members themselves using a web-based call centre portal provided by OTN. The portal also allows Members to learn about and register for educational and professional development events. Many educational and administrative events are also viewable on Member PCs through OTN’s webcasting service.

OTN's network overlay equipment and network operations centre ensure telemedicine sessions are reliable, secure, and fully interoperable with other members. OTN sets a variety of equipment, network, software, and operating standards that all members agree to adhere to. The Network proactively monitors and responds to service issues levering strategic relationships with network providers and equipment vendors.

By mid-2007, OTN will complete the integration of the three legacy networks resulting in a single network, complete interoperability, and the infrastructure to grow and scale telemedicine to new levels in Ontario.

Originality
What are the exceptional aspects of your project?
Telemedicine is an electronic channel for health service delivery which makes use of videoconferencing, data sharing and workflow tools. Telemedicine is no long a “future technology” – over the last decade, it has emerged to become a real and dynamic field of healthcare. Videoconferencing-based telemedicine services not only provide access to healthcare providers for citizens living in rural and remote communities, but also have shown themselves has having enormous potential to transform healthcare for urban citizens.

OTN is one of North American's most successful videoconferencing-based telemedicine services. Using state-of-the-art IP-based videoconferencing systems running on interconnected high-speed networks, hundreds of physicians, nurses and allied health professionals in hundreds disciplines treat more than 30,000 patients a year. OTN conducts more than 2,500 clinical videoconferences and 450 multipoint educational events in Ontario each month.

Delivering remote healthcare service to urban, rural and remote areas of the Province of Ontario presents a unique challenge, especially given that healthcare is a sector with some of the most stringent patient privacy, security and reliability requirements. OTN has overcome these challenges by creating its service which doesn’t push complex technologies at users, but rather creates easy-to-use turn-key systems which fit into the existing operational and clinical processes of the healthcare sector. Support services for end-users include a custom-developed web-portal for self-scheduling of encounters, centralized multipoint control units and off-network gateways, centralized asset management and parts-pools, and a 7/24 technical support desk.

With patient and physician satisfaction ratings over 95%, OTN has broken through the acceptance barriers that have limited the impact of other similar initiatives.


How is it original?
OTN is one of the largest telemedicine networks in the world with 194 partnering organizations; more than 23,000 patient consultations annually; 210 therapeutic care areas and unique programs and services; 1500 participating healthcare professionals, 4910 annual education events; and 360 hospital and community sites.

The commitment and innovation of the Ontario Telemedicine Network’s Member organizations and the health care professionals of Ontario have made the province a world leader in the field of telemedicine and have provided a strong foundation on which to build. Through OTN, they are leading the way in the transformation of our health care system to the next level of access, quality and sustainability.


Is it the first, the only, the best or the most effective application of its kind?   Most effective

Success
Has your project achieved or exceeded its goals?   Achieved

Is it fully operational?   Yes

How many people benefit from it?   23,472

If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
Telestroke initiatives throughout the province illustrate the benefits of collaborating to optimize stroke care. Telestroke programs span the continuum of care: stroke recognition, prevention, pre-hospital, Emergency, acute, transition, rehabilitation and community.

In 2005 at 12:08 pm, an 84-year-old woman from Chatham, Ontario experienced the signs and symptoms of stroke. At 12:13, an ambulance was dispatched, and at 12:20, paramedics picked her up. As part of the telestroke protocol, the ambulance attendants called the Chatham-Kent Health Alliance (CKHA) Emergency Department and gave notice of a possible stroke patient on the way. CKHA nurses immediately set up the videoconferencing system and a call was connected with the stroke neurologists at London Health Sciences Centre, 60 km away. The physicians at CKHA and LHSC jointly assessed the patient at 12:40. CT Images taken in Chatham were auto-forwarded to the LHSC PACS system at 12:46 and the stroke team at both ends reviewed the images together. Labs were back at 12:56 and the patient was admitted to CKHA later that afternoon for follow up care. Within 38 minutes of the onset of symptoms, Chatham-Kent emergency room physicians received support and mentorship regarding assessment of the CT images and the possible administration of tPA (a powerful clot-busing drug) from the London neurologists. Distance as a barrier to care and professional mentorship was eliminated. Unnecessary, costly and stressful patient transfer was avoided.

Says Gloria Mervin, a senior who was one of the first stroke patients through the LHSC/CKHA telestroke project, “This [telestroke] saves a trip to London – being flown to London. It puts your family in an awful position if they have to go to London, when you can stay in your local hospital and still get the connection with the specialists in the larger hospitals."

How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
In 2005, more than 600 patients from Northern and Central Ontario were survey about their telemedicine experiences. Survey respondents ranged in age from 19 – 84 years. The vast majority had experienced one or two telemedicine appointments. More than 95 percent responded that the visibility and audibility was good or excellent. Almost everyone surveyed agreed that it is easier to get to the telemedicine studio than to see a health care provider in person – and best of all, most survey participants agree that their telemedicine visit was just as good, or better, than a face-to-face visit. Ninety-nine-percent of respondents were very or reasonably sure that they would recommend telemedicine to others.

In 2006, more than 150 consulting health care providers (specialists, allied health and primary care) were surveyed about the experiences with telemedicine in the province of Ontario. The results? 91 percent would recommend telemedicine to their colleagues for clinical consultation and 88 percent would use telemedicine again in the future.

Difficulty
What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
The challenge over the past year has been to integrate three distinct organizations with distinct business practices, processes and systems of technology. CareConnect, NORTH Network and VideoCare were all successful in the delivery of telemedicine services, but they were completely unique organizations. Organizational leadership from each of the three legacy networks worked to create a shared corporate culture, common business practices, and technical and security standards that would allow and support exponential telemedicine growth in the Province of Ontario. At the same time, the Network’s practices needed to support the regional differences of Ontario’s vast geography – it was recognized that a one size fits all telemedicine solution was not possible and that OTN services had to respond to regional needs and priorities.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
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