JMIR Publications

ABSTRACT

Background:

Telehealth has been shown to improve access to healthcare and to reduce costs to the patient and healthcare system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities.

Objective:

The objectives of this evaluation were to understand the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this case study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities.

Methods:

A mixed-methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. In addition, online questionnaires were administered to nurses in each of the 14 Yukon community health centres outside of Whitehorse, and patients who had used telehealth were also asked to complete a questionnaire. Qualitative data included focus groups and semi-structured interviews with a total of 36 telehealth stakeholders.

Results:

Since 2008, there have been a consistent total number of telehealth sessions of about 1000 per year, with the main use being for clinical care (70% of all sessions in 2015). From the questionnaire data (11 community nurses, 10 patients) and interview data, there was a consensus among the clinicians and patients that the System provided timely access and cost savings from reduced travel. However, they believed that it was underutilized and the equipment was outdated. The challenges and opportunities discovered led to the identification of four factors that should be considered when trying to advance and expand a telehealth program. 1) Patient and clinician buy-in: Past telehealth experiences should be considered when advancing the system, such as negative clinician experiences with outdated technology. Expansion of services in orthopaedics, dermatology, and psychiatry were found to have particular benefit in Yukon by clinicians specializing in these areas. 2) Workflow: The use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon Telehealth Coordinator. 3) Access to telehealth technology: Clinicians and patients should have easy access to telehealth technology, whether it is telehealth units or alternative desktop applications. The use of consumer products, such as mobile technology, should be leveraged as appropriate. 4) Infrastructure: The required human resources and technology need to be established when expanding and advancing telehealth.

Conclusions:

While clinicians and patients have generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to significantly expand the types of telehealth services and the number of telehealth sessions. The lessons learned from this evaluation can be applied to other remote communities to realize telehealth’s potential as a means for efficient, safe, convenient, and cost-effective care delivery.