The Virtual Health Hub - Saskatchewan, Canada

In this episode with hear from the team of the Virtual Health Hub in Saskatchewan, Canada: Dr Ivar Mendez, Dr John Michael Stevens, Dr Victoria Sparrow-Downes and Joey Deason. Episode summary: 01.25  Our guest introduce themselves and tell us about their professional background and their interest in rural health   05.26  They share what they most enjoy about living and working in a rural area, and what they find most challenging. 10.15  What is Saskatchewan like? 13.08  What is the Virtual Health Hub? 15.12  How does th Indigenous perspective and culture impact the work of the VHH? 20.17  What does the VHH do? 23.11  How are new technologies used to provide care and support local healthcare teams? 29.15   Are there challenges with connectivity or maintenance of the equipment? 21.10  What other benefits does remote virtual care provide? 37.10  What kind of training is provided to clinicians engaging with the VHH? 40.43  What has the community response been to this new way of working? 49.08  What are some of the lessons that they have learned from working on the VHH? 55.35  What are the first steps to move towards developing virtual care?   Key messages: Saskatchewan is the size of France with 30% of the population being rural and remote. There are many opportunities to leverage technology to improve care for rural and remote populations. Some of the challenges are: lack of resources, being away from family can be difficult, access to patients or patients accessing care, harsh climate, logistical challenges. Most enjoyable part of working in rural and remote areas is being part of a tight knit community and healthcare team.   The climate is harsh, especially in the winter with temperatures up to -60C.  Many of the communities are not accessible by road and can only be accessed by plane.  Due to isolation there are other challenges such as access to food, some communities may only have one small general store with limited access to fresh produce.  Some of the communities are 900 km away from tertiary care centres, it can be a three hour flight to reach them.  This can be a barrier to healthcare provision. The Virtual Health Hub is an Indigenous led project as most of the communities it serves are Indigenous.  It is a purpose built building which will have access to state of the art technology to allow clinicians to assess patients in real time and help them make a decision on the triage and treatment of patients.  It is a project supported by the governments.  It aims to serve about 90 communities.  The Indigenous perspective is crucial in the development of the work of the Virtual Health Hub.    Indigenous culture plays a role in how clinicians approach care and there is great value in having people who are familiar with the different cultures providing care through the virtual system.   Projects of the VHH are primarily informed by each community's needs. They are looking to harness the strengths of local community members and seeing how they can be involved in providing care. Developed an applied certificate course which is designed to train healthcare workers from the community on how to work with new virtual care technologies.  This enables them to work better with clinicians that are providing virtual care.   VHH has been working with remote communities and a number of issues are clear from this work: Accessibility to timely care. Local healthcare workers can feel like they have to practice beyond their scope of practice Challenges to recruitment and retention Advanced technologies allow clinicians to support the local team and the triage of patients when it is needed.  The virtual system has been able to save lives.   They have very high quality video and audio connection to other clinicians which is useful for critical cases where specialist input may be required. Clinical services are provided from a distance, a remote clinic can be performed entirely via video link where patients can connect with a clinician. VHH is piloting some new technologies to see if they work in rural and clinical settings.   Telerobotical ultrasonography is a project that makes ultrasound available to rural and remote communities. The ultrasonographer is in a central location, on the other side there is a robotic arm with an ultrasound probe allowing them to perform scans remotely.  This has been crucial for prenatal ultrasounds. They have developed a partnership with the local telecommunications provider to ensure that they have the required connectivity and bandwidth for their service.   Most of the systems being used can be maintained remotely, are reliable and can function well for long periods of time. There is a bolstering effect for recruitment and retention in these communities, the availability of remote support helps to build confidence and reassurance knowing that acute cases can be managed with a shared responsibility model. There is a large gap between telephone support and having the possibility of having an specialist see what is happening and the situation in the room and have your hands free to take action. One of the challenges of virtual care is the inability to perform a physical exam.  This has been addressed by developing a virtual health hub assistant training course. These assistants would be based in the community and be able to perform some guided physical examinations.  Virtual care done in the right way  has the ability to increase accessibility, continuity and quality of care. They encourage a team based approach to virtual care with sharing of expertise and responsibility which builds trust and capacity. They have been working to understand patient pathways and how this can be integrated into the workflow of different clinicians.   Part of their role is to make a system that is easy to use for the patients and communities as well as the clinicians and care providers.  They have a technical team that provides training to support them in working with the VHH.   Virtual care is about building trust and relationships.  When communities receive access to healthcare they embrace the technology.   They are looking to see how to incorporate translator services as different communities use different languages.  Another challenge is enabling the use of virtual care for people with hearing impairment or other disabilities.   Lessons learned: The importance of building solutions with the community. You have to be flexible and malleable in your vision - be willing to change what your project is or what you think you are working towards.  Focus on the needs of the communities rather than fitting your ideas into the communities. Remain open minded to all possibilities.  Some technologies may have been piloted in very different circumstances than they might be being used in a rural or remote setting.  Trust and relationships with the community really drive successful projects. Virtual care is a new frontier and there is an underdevelopment of protocols or guidance.  This development needs to be done. Advice for First steps: Understand the community and their needs. Do not underestimate the challenge of bringing virtual care into the workflow of clinicians. Be prepared for a huge project. Research is important, backing up your work with scientific evidence is important when you are trying to take new technologies and mainstream them.  Collect evidence, identify what is and is not valid.   Virtual Health Hub: https://virtualhealthhub.ca/  Contact VHH: [email protected]     Thank you for listening to the Rural Road to Health! Rural Health Compass