THIS PRIORTY AREA IS ADMINISTERED BY AN ACTIVE WORKING GROUP
The First Nations eHealth Working Group (FNeWG) is mandated by Resolution 09/14 which states that:
- "The Chiefs of Ontario engage in the development of a comprehensive eHealth Strategy with both Ontario and Canada to define roles and responsibilities necessary to facilitate a coordinated strategy for eHealth and connectivity to all First Nations in Ontario."
- "The Chiefs in Assembly direct COO to establish a working group of First Nations and health technicians to develop an integrated strategy
of eHealth and broadband connectivity for all First Nations in Ontario."
eHealth describes the secure transfer of health resources and healthcare by electronic means. It includes the electronic collection, management, use, storage and sharing of healthcare information. Examples of health information are your personal health number, a referral from your physician or nurse practitioner, the number of children being treated for asthma at your community health centre, discharge summaries, vaccination and medication history and courses of treatment.
Personal health information is accessible to health care professionals linked to private networks like eHealth Ontario. Whether you are getting a prescription filled, having a CT scan interpreted, participating in a telemedicine clinic or making a medical appointment, chances are that some or all of that information is being carried, stored and shared on a secure eHealth network.
eHealth touches most people in Ontario in a very direct way. Like the health system, eHealth is enormous and complex. Unlike the health system most eHealth tools are hard to see. They exist in the background and are designed to meet a growing demand for medical evidence at the point-of-care. Some examples of everyday eHealth tools are:
- The mobile phone app that reminds diabetics when it’s time to test their blood sugar
- the PDA that helps the foot care nurse choose and order the right type of pressurized dressing
- the keyboard that the receptionist uses to schedule your next appointment, and;
- the transmitter in the ambulance that sends vital signs to physicians preparing for a patient’s arrival in the emergency room
eHealth is in the early stages of its development. eHealth growth depends on its acceptance by the public and by healthcare professionals, its integration with complementary services – such as laboratory information systems, and its adoption by all health service providers at all points-of-care.
Acceptance by the public and healthcare professionals will leverage public funds to expand services. Integration with stand alone systems will enhance the value and impact of eHealth services, and adoption by all providers at all points-of-care defines an accessible and affordable service, where all citizens equally benefit, and the cost of delivery is distributed across many payers.
Most Ontario First Nations are not linked to a secure eHealth network. While the majority of community members regularly interact with stand alone and integrated eHealth systems – in hospitals, at pubic health units, with their Family Health Team – most community-based health care still relies on paper records, despite the fact that distributed eHealth services are particularly well-suited to the remote and rural contexts that define many of Ontario’s First Nations. Specifically,
- distributed eHealth services have the capacity to make medical evidence available at the point-of-care. This capacity contributes to continuity of care and improved decision-making. Unlike a paper record, an electronic record brings together multiple pieces of health information, some of which reside in the local healthcare setting and others outside of it. In the handful of First Nations that have installed clinical information systems, Health Directors are now able to demonstrate who is using their facility each month and for what reasons. Their ability to sort anonymous health information helps them to adjust Health Centre services to their client needs.
- a key aspect of eHealth development has been its capacity to make more effective use of health and human resources. While it is always difficult to staff clinics and upgrade staff skills in rural and isolated places, eHealth decision support tools both increase local access to health knowledge and make it easier to reach out to other providers when help is needed. In some Ontario communities, for instance, elders who have had knee and hip replacement surgeries have scheduled their follow-up appointment by Telemedicine. This saves them the painful trip out and allows their homecare worker and a local nurse to participate with the surgeon in the healing process. At the same time, tools such as automated alerts for chronic disease sufferers reduce the health care professional’s time spent completing clerical tasks and increase the time available for providing direct and indirect care.
- distributed systems provide secure small footprint storage. If a fire or a flood strikes at a health centre the entire health history of the community is placed at risk. eHealth systems safeguard local records by backing up files in separate locations. Local systems also have the ability to link with centralized systems where pieces of personal health information may be sent, received and stored offsite. Importantly, eHealth also increases space availability in community health centres. The contents of an entire room of local paper records can be stored in the same footprint as a DVD player.
The inaccessibility of eHealth for Ontario First Nations can be traced to a short-list of common challenges: the perceived cost of buying-into and maintaining community systems, community-based capacity gaps, jurisdictional uncertainty and fragmentation and competing local and regional priorities.
eHealth systems are designed to address the conditions and circumstances that often define and limit health service delivery for First Nations. While Canada and Ontario have crafted unique and overlapping business cases and policies to guide eHealth development, a First Nations value proposition and community-based priorities for eHealth development have yet to be developed.