020406080100120140160180Canada Inuit Nunangat Inuvialuit Region Nunavut Nunavik NunatsiavutSuiciderateper100.000pop.Inuit regions of Canada1994/19981999/20032004/2008Ref: Statistics Canada. 2012 July.Suicides in Nunangat 1994-2008
**Differences in mortality across the urban–ruralcontinuum are mainly amongst the under 45years, and are particularly due to deaths caused byinjury and poisoning, motor vehicle accident (MVA)and suicide.*The proportion of excess deaths relative to urbanplaces for those under 45 years increases withdecreasing age.*Remote places have the highest excess in mortalityfor suicide, MV A, injury and poisoning, relative tourban places.
**First Nations men and women live 7.4 and 5.2 years less thanthe average Canadian.*Deaths from circulatory diseases (23% of all deaths) andinjury (22% of all deaths) accounting for a near staggering50% of all deaths.*For ages 1 to 44, the most common cause of death was injuryand poisoning.*Suicide rates for Aboriginal youth range from 5-7 times higherthan the national average.Ref:1. http://www.ainc-inac.gc.ca/pr/info/fnsocec/abhl_e.html - Factsheet on Aboriginal Health.2. CMAJ, Sept 18, 2001; 165 (6).
**The potential years of life lost frominjury alone was more than all othercauses of death and was almost 3.5 timesthat of the general Canadian population.
**Providing safe and effectivecare*Information systems*Continuity of standards*Legislation*Monitoring indicators*Evaluating care*Evidence-Informed Practices
**Health system sustainability*Cost drivers –*New technologies*Health Human Resources*Incidence of chronic disease*Expectations re access to care
**Health human resources*Availability*Turnover rates*Time / workload demands*Skill mix*Educational opportunities
**Health system structure*Delivering healthcare to large anddispersed populations*Information systems*Determining basic levels of service*Location of health infrastructure*Governance
**Health services equity*Quality of care*Lack of specialty care*‘Generalist’ role of the rural clinician
Health Technology and Evidence ChallengesOur Story
*Telehealth Defined:*The delivery of health-relatedservices and information viatelecommunications technologies.*Can be as simple as two healthprofessionals discussing a case overthe telephone or as sophisticated asdoing robotic surgery betweenfacilities at different ends of theglobe.
**Telehealth – broad range of applications*Tele-psychiatry*Tele-cardiology – stroke care, rehab*Tele-dermatology*Tele-radiology*Nephrology consultations*Various other specialist services –Oncology, Ophthalmology, WoundCare, Endocrinology, etc.
**Portable technologies*Ultrasound*Mammography*Home Hemodialysis*Implications – improvedaccess*Challenges – quality/accuracycompared to clinic/hospital-based care
**Point-of-care testing*Defined as ‘medical testing at or near the site ofpatient care, without sending the sample to alaboratory setting’*Examples include - blood glucose testing, coagulationtesting, blood gas analysis, cardiac testing, completeblood count, and electrolytes analysis*Implications – improved access, potentially lessinvasive, reduced costs*Challenges – quality compared to lab-based testing?
**Health Technology Management*Defining process*Opportunities for early adoption*Need for evidence contextualization*Need for whatever evidence is available*Understanding context
What does the Future Hold?Challenge:*Geography*Demographic tilt*Burden of illness*Socio-cultural drivers*Human resources*Governance*CostSustainability?
Purpose of HealthcareProvide Quality Care to:*Individuals and PopulationsDefinition of Quality (IOM)*Patient Centered*Safe*Equitable*Effective*Efficient*Timely
Problem & Solution*Problem has been identified:Delivering Care in North*The Goal has been articulatedQuality Care*The Solution?*Health information technology?Is there a Value Proposition?
Health Information Technology:Improve the Quality Quotient?*CommunicationThe ability of Health care providers to function asdistributed teamsNetworked Health*DataThe ability to measure point of care data toestablish if quality care is being delivered
Northern SolutionQuality Care*Patient Centered*Safe*Equitable*Effective*Efficient*TimelyCommunication= distributed teamsDataThe ability tomeasure point ofcare data toestablish if qualitycare is beingdelivered
The Way ForwardWorking*Technology*The patientNot Working*Health CareIndustry*Teams*Data
The Way ForwardCultural Shift*CommunicationAgree to work on common imperfectplatformform teams = circle of care for eachpatient*Embrace the fundamental value of DataBoth will drive Quality