Title: 3rd Annual Telehealth Research Summer Institute July 21-23, 2002
Investigator Name: Dr. Marilynne Hebert
Project Completion Date: December 2002
Research Category :Workshop
Institution:University of Calgary
Project Number: 6795-12-2002/4430021
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Summary
Introduction
The Health Telematics Unit at the University of Calgary hosted
the first Telehealth Research Summer Institute (TRSI) in
July 2000. It has become an annual event focusing on research and
evaluation of telehealth programs and telelearning initiatives
in health care. The third annual TRSI was
held on July 21 to 23, 2002. Participants included members of the
public, professional, academic, and private sectors interested
in telehealth implementation and sustainability. They were actively
engaged in discussions of telehealth impact and recommendations
to advance policy and research. Three themes underscored TRSI 2002:
socio-economic, technical and policy impact of telehealth.
The discussion document is a compilation of the TRSI 2002
presentations and small group discussions as well as key references
that provide additional insights. Supplementary material such as
the discussion group notes and presentation slides will be posted
on the HTU website early in 2003 at  www.ucalgary.ca/telehealth.
The TRSI 2002
discussion document is being widely circulated to colleagues with
an interest in telehealth and e-health, including TRSI participants
and speakers (all 3 years), Telehealth Coordinators, Canadian Society
of Telehealth and COACH Board Members, University departments with
health informatics programs, Assistant Deputy Ministers of Health,
Industry leaders and others.
Issues related to the socio-economic, policy and technical impact
of telehealth initiatives provided the focus for presentations
and small group discussions throughout the TRSI 2002.
Key ideas from the literature rounded out this thinking. Advancing
the field of telehealth/e-health requires further discussion around
priorities in three areas: research, evaluation and policy development.
Research Priority Areas
Research activities in telehealth and e-health have been gaining
momentum in the past 5-10 years as more researchers enter the field
and funds are allocated to this area of research. Research activities
focus on developing conceptual thinking and theoretical frameworks
necessary to advance the field. Clearly there have been many developments
in the area of socio-economic factors that influence determinants
of health as well as health indicators. Both the presentations
and discussion highlighted a more recent focus on understanding
the population health impact of interventions rather than solely
focusing in the short term on the local project participants.
Research into the socio-economic impact of telehealth can advance
in a number of areas, particularly around conceptualization of
the contribution of telehealth initiatives to health and health
care. This may include design of new health service models that
seamlessly incorporate e-health or appropriate economic models
to determine benefits. Within the context of determinants of health,
this research could also determine appropriate indicators and measures
that reflect the contribution of telehealth, including development
of reliable and valid instruments for capturing data in these areas.
Not only does the research need to focus on health outcomes, but
also extend into the impacts of introducing organizational change.
Results of recent studies should be extended to inter-organizational
changes when services cross local and international jurisdictions.
Adoption of telehealth technology requires attention to a number
of important research areas, including policy software, further
advancing the telehealth interoperability process and human resources
requirements.
Researchers must also attend and respond to the need for policy-driven
research. As noted in the discussions around policy, or lack thereof,
there is a continued need for framework development around e-policy
research. Once policies have been established and implemented,
for example policies to ensure EHR security, its implications need
to be re-visited.
In an area of rapid change and development, research around 3rd
wave, intelligent technologies, including digital remains critical.
As demonstrated by the work completed to date on interoperability
and standards on many levels, collaboration among partners in industry,
government, research and practice is required.
Evaluation Priority Areas
Evaluation activities are an important aspect of applied research and require a sound conceptual basis for the selection and use of tools. Frameworks that are valid and reliable as well as used consistently in the field are needed to provide useful, comparative data. The "knowledge translation" activities that move research results into practice are an important aspect of evaluation. These could be strengthened through adopting practical mechanisms to apply research findings in evaluation framework development and data collection tools. In much the same way as common health indicators have been adopted, policy intervention may be required for the consistent use of e-health indicators. Funding programs such as CHIPP illustrate that this strategy is possible on a national level.
As the small group discussion on Day 3 illustrated, it was challenging
to consider the unanticipated and potentially undesirable effects
of implementing telehealth/e-health initiatives. This is partly
because those involved in implementation tend to be champions who
see the benefits. Evaluation can play an important role in determining
the unintended consequences of adopting this technology. Questions
that might be asked include: Is there an optimal mix of face-to-face
and technology mediated services in a community? If so, how do
we determine it? While a balance of services may be sought based
on financial issues (e.g. it is more cost effective to provide
video-consultation to members of a community than to financially
support a specialist to live in the community), the unintended
consequences may be the destruction of services in a small community
as physicians do not see enough patients to stay in business.
Evaluation should extend to organizational factors including human resource implications in program implementation. This includes training for health care professionals who deliver e-health services, as well as for telehealth coordinators, researchers, policy makers, and decision makers. A broader training base may also increase awareness of the "glocal" aspect of policy, i.e. the local and global implications, as well as the need for policy interrelationships at multiple levels.
Evaluation should also include continued testing of interoperability
standards in practice. This includes an active, continued awareness
of interoperability testing being communicated at national and
international venues.
Policy Development Priority Areas
While the importance of policy and resulting policy issues have
been recognized as part of the development of telehealth initiatives,
integrating e-health services into the traditional delivery system
requires broader thinking than that required to ensure a local
project or program is successful. Policy is both necessary to support
integration as well as itself must be integrated at regional, national
and international levels of decision making. It is necessary to
establish globally acceptable policy principles and domestic policy.
Sound evidence of the socio-economic benefits of e-health initiatives
is needed prior to the move to implementation and integration.
Translation of these research and evaluation findings into policy
is a critical factor in moving this agenda forward. Clearly there
needs to be champions in all sectors: academia, government, industry
and practice for this to occur. Achieving this will require taking
advantage of opportunities for increased participation across groups,
for example, including more policy developers in planning and implementation.
Overall Recommendations
A number of issues were common to all three themes of the TRSI and
recommendations for their resolution, include:
- Sound policies related to the human resource implications resulting
from e-health initiatives are required. These should include
results of research and evaluation into the changes in professional
roles, organizational change management and stakeholder readiness
to accept the change.
- Participants agree that telehealth sustainability depends on integration into existing services rather than initiatives being seen as "adjuncts." A number of policy considerations arise from this and require attention from funding bodies, researchers, policy makers and professional organizations (e.g. Canadian Medical Association, Canadian Nurses' Association). These include:
- Policy implications related to remuneration and licensure
are slowly being resolved. While the need for integration will
continue to challenge policy development, it must remain a
core tenant.
- Policy considerations must support integration of e-health
with traditional services, as well as with the Electronic Health
Record.
- Policy development must consider both the local and global
impact.
- While participants generally recognized there are benefits
to developing consensus on standards and evaluation tools/methods,
implementation challenges remain. Leaders in research and evaluation
need to take a greater role in the translation and dissemination
of results to support a consensus building approach.
Summary
The annual TRSI provides
a forum for interested participants from industry, government,
academia and practice to actively discuss current ideas in e-health.
The TRSI 2002
themes - socio-economic, technical and policy impact of telehealth
- provided a framework for discussion and recommendations for future
directions.
Dissemination of this discussion document will provide additional
opportunities to not only stimulate discussion and debate around
relevant issues, but also engage a wider audience in influencing
e-health policy, practice, and research. Continued discussion and
debate of relevant issues will continue at TRSI 2003
on June 25-27.
The views expressed herein do not
necessarily represent the views of Health Canada
In addition to the above Summary, the full report can be accessed
in the following ways:
- The print version of the full report can be obtained in the
language of submission from the Health Canada Library through
inter-library loan.
- An electronic version of the report in the language of submission is available upon request from Health Canada by contacting the Research Management and Dissemination Division.
This research has been conducted with a financial contribution
from Health Canada's Health Policy Research Program. For permission
to reproduce all or part of the research report, please contact
the Principal Investigator directly at the following address: hebert@ucalgary.ca.
The Health Policy Research Program (HPRP)
funds research that provides an evidence base for health Canada's
policy decisions. The HPRP is
a strategic and targeted program with a broad socio-economic orientation
and connections to national and international endeavours. The research
can be primary, secondary or synthesis research, a one-time contribution
to a developing research endeavour, or a workshop, seminar or conference.
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