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Orpah McKenzie



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    OS01 - It's All About the Patient Outcomes! (ID 1)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 1
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      OS01.02 - Virtual Emergency Support Service. "I've Got Eyes on the Patient" (ID 272)

      Orpah McKenzie, KO eHealth Telemedicine Services, Keewaytinook Okimakanak "Northern Chiefs"; Balmertown/CA

      • Abstract

      Purpose/Objectives:
      The Virtual Emergency Support (VES) project is a First Nations, Federal & Provincial partnership. Its goal is to enhance support to nurses and clients in emergent & urgent situations in remote and isolated Sioux Lookout nursing stations by using an appropriate and accessible combination of smart technologies and accessing necessary expertise in a timely manner. VES has been implemented in eight First Nations Nursing Stations in Sioux Lookout Zone. Emergency rooms in each facility are linked to a dedicated province-wide emergency telemedicine system. The system allows physicians to directly access these emergency rooms using hand-held, laptop and stand-alone room-based videoconferencing systems.The objective of the final evaluation is to determine if the VES service model is an effective means for enhancing urgent and emergent care in isolated nursing stations.


      Methodology/Approach:
      The evaluation is based on a limited production roll-out in the Deer Lake, Mishkeegogamang, Pikangikum, and Sandy Lake First Nations and reflects service-level data and provider feedback collected between 16 March and 31 December 2017. VES Data Sources and Collection Approach: A. Nursing Feedback · Nurses summarized VES encounters by filling out a record of event · KOeHealth staff conducted short interviews with Nurses-in-Charge (NICs) on a weekly basis. · Face-to-face interviews with NICs B. Physician feedback · Eight physicians were interviewed or provided written responses about their experiences with the VES. · Three ORNGE Transport Medicine Physicians (TMPs) provided feedback about their experiences. · ORNGE shared results of post-VES surveys C. Service-level data · Nursing records of event · Logging files from OTN’s videoconferencing application for Emergency Medicine · Provincial air ambulance transport logs · Monthly VES Implementation Team meetings · Promising Practices Workshop – 4 October 2017, Thunder Bay. D. Direct engagement and observation: · Site visits to four First Nations communities.


      Finding/Results:
      Between mid-March and end of December 2017, VES resources were mobilized to manage 10.4% of the 666 medical evacuations that originated from one of the four VES First Nations. Feedback by nurses, ORNGE TMPs and Regional Critical Response Program (RCCR) confirm that VES is an effective means for enhancing urgent and emergent care in isolated nursing stations. With VES, patients living in Ontario’s most remote communities have access to the same level of clinical expertise as any other resident in the North West LHIN


      Conclusion/Implications/Recommendations:
      VES is an advanced, integrated and scalable urgent/emergent service model that is effectively supporting nurses and patient care in isolated First Nations nursing stations. Provider feedback and service-level data show promising results. Nearly three-quarters of the ORNGE TMP workforce (17 of 23) have used VES one or more times to support nurses and MDs in isolated nursing stations. Regional Critical Care Response teams have used VES multiple times to stabilize critically ill patients prior to transport, coach nurses in the optimal use of life-saving equipment, and counsel family members about the imminent death of a loved one. Service-level data and provider feedback signal successful completion of the VES pilot project and anticipate its expansion to additional isolated First Nations in the Sioux Lookout Zone.


      140 Character Summary:
      VES is urgent/emergent service model that support nurses and patient care in remote and isolated First Nations nursing stations in Sioux Lookout Zone.

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    OS23 - Looking Through the Data Lens (ID 38)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
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      OS23.04 - Managed Service Model: Accessing Healthcare Through a Different Lens (ID 459)

      Orpah McKenzie, KO eHealth Telemedicine Services, Keewaytinook Okimakanak "Northern Chiefs"; Balmertown/CA

      • Abstract

      Purpose/Objectives:
      The Managed Service Model (MSM) project provides access to timely and culturally safe health care services to First Nations communities throughout Ontario. Keewaytinook Okimakanak eHealth Telemedicine Services (KOeTS) and Ontario Telemedicine Network (OTN) invited remote First Nations communities across Ontario to participate in the MSM project. The project is facilitated using OTNinvite, a videoconferencing feature that allows individuals external to OTN’s network, to participate in real-time video visits.


      Methodology/Approach:
      OTN and KOeTS piloted a new model for First Nations communities with a simpler and more convenient alternative to purchasing a room-based videoconferencing system. First Nations on-reserve communities with adequate internet connectivity applied to receive a secure desktop computer with videoconferencing devices (high definition web camera and an echo cancelling speakerphone) so that they could participate in video consults. Consults are enabled through a private and secure web link. In March 2017, the participating First Nations communities attended an engagement session in Kenora where they received equipment and process training. In all, 40 OTNinvite systems were distributed to the participating communities. Community engagement is continuously provided by a Regional Telemedicine Navigator (RTN), located in Balmertown. The RTN identifies and schedules healthcare providers and services to meet the needs of the community members. Funding for this project is provided through Ontario’s First Nations Health Action Plan. While the project was designed to facilitate the connection between patients and providers using OTNinvite, the feature was also leveraged as a teaching device to familiarize providers with the project. This ensured that providers and communities were comfortable with the technology and processes prior to patient engagement.


      Finding/Results:
      Communities within the project identified a demand for healthcare in areas such as mental health, oncology, and diabetes. Mental health presents the area of most potential to expand utilization within the community health centres. Awareness and partnership development with mental health partners is ongoing. Based on the identified needs, engagement sessions were held with Misaway (diabetes management centre), Waypoint Centre, SickKids Telepsychiatry program, as well as St. Michael’s Hospital and Thunder Bay Regional oncology departments. To date, the project has discovered: -There exists a knowledge gap among providers who are unfamiliar with OTNinvite and accustomed to traditional room-based telemedicine services. -Despite the connectivity available throughout the province, First Nations communities are still challenged with bandwidth issues. -The communities selected for the MSM project had no prior experience with telemedicine and so require a higher level of support.


      Conclusion/Implications/Recommendations:
      -The RTN continues to mitigate the provider knowledge gap through ongoing outreach and working with Telemedicine Coordinators (TMC). To keep their skills sharp, TMCs are encouraged to participate in OTNinvite test calls. -Where bandwidth issues are not resolvable, systems will be re-allocated to other communities. -The frequency of contact and engagement with these communities will be increased to better support their participation in the project. By encouraging health care providers and patients to use MSM, First Nations communities have access to a low-cost alternative to purchasing a video clinical system which requires OTN membership, management, and staffing resources.


      140 Character Summary:
      The KOeTS and OTN lead MSM project provides timely access to culturally safe health care for harder-to-reach Ontario First Nations communities using OTNinvite.