1. Transforming Care: Improving Access Through Implementation of Store and Forward Technology in Manitoba “Information travel not patient travel”

2. MBTelehealth • Manitoba’s Telehealth Network • 2001 MBTelehealth is established with 28 sites: • Rural and Northern Manitoba - 21 • Winnipeg - 7 • Sites located in all 11 Manitoba Regional Health Authorities • 2010 – 97 sites and growing… • Rural and Northern Manitoba - 69 • Winnipeg - 28

3. Why Store and Forward • Manitoba has a low population density with 3.42 people per square mile (2008 estimates) • The Royal College of Physicians of Canada recommends 1:65,000 dermatologist to person ratio, Manitoba has 1:92,000 • Most Manitoba dermatologists practice in Winnipeg • Options for dermatology care are face to face or video conferencing • Notable increases in requests for specialist care identified an opportunity to explore innovative solutions to enhance access to specialist services

4. Store and Forward Store and Forward technology is defined as: “a system that allows for the collection of medical data such as digital images which are transmitted to a consultant for review in the future”

5. Benefits for Patients • Decreased wait time for specialist care • Reduced travel time for patients • Reduced cost for patients to receive care • The general practitioner remains the patient’s main care provider • Increased access to specialist care in medically underserviced areas

6. Benefits for Primary Care Clinics • Medical education and shared care opportunities for specialists and primary care providers • The general practitioner remains the patient’s main care provider • Uses existing clinic infrastructure (computer, internet connection and web based software) • Referring physicians can bill Manitoba Health directly which is not available for traditional referrals

7. Benefits for Specialist • Web based software that can be accessed anywhere in Canada • Ability to provide service during non-traditional hours • More efficient use of specialist time • Does not impact existing clinic times • Allows specialist to see more patients • Promotes shared care model between specialist and primary care provider

8. Comparison of Referral Timelines

9. How Store and Forward Works Step 1: Referring Primary Health Care Provider • The referring primary health care provider uses Store and Forward technology to input health information and capture digital images. Step 2: Documentation and Digital Images • The digital images and health information are “stored” on a secure server. Step 3: Specialist • A notification of newly ‘stored’ data is securely transmitted, or “forwarded”, to a dermatologist for assessment, diagnosis and/or treatment recommendations. Step 4: Follow Up • The primary health care provider is notified that the Store and Forward consult has been processed by the dermatologist and makes arrangements to follow up with the client.

10. Technology Involved • Existing internet connection and Internet Explorer • iScheduler Store and Forward Module • Store and Forward module included within iScheduler to be utilized for all Store and Forward referrals • Canon SX120IS Digital Camera • All digital images to be captured • 4 cameras purchased for this project

11. Video Link

12. Store and Forward at MBTelehealth • Demonstration project to demonstrate viability of Store and Forward technology in dermatological care • Started April 2010 • Demonstration project completed September 2010 • Evaluation to be completed

13. About the Clinics • Brandon Medical Clinic • 11 providers (all MD’s) • Niverville Medical Clinic • 4 providers (3 MD’s and one NP) • Access River East • 11 providers (6 MD’s and 5 NP’s)

14. By The Numbers 83 – Referrals sent between April 1 and September, 2010 2.83 – Average number of days to wait for a response from the specialist 4.6 – Average number of referrals sent by clinic per month 1– fewest hours to a response from a specialist 15 – most days to a response from the specialist (on vacation) 403 – Live interactive teledermatology appointments last year

15. Total Referrals by Clinic(April – September)

16. Store and Forward Referrals by Month

17. Average # of Days for a Store and Forward Response

18. Referral Response

23. Diagnosis Types

25. Distribution of Age to Diagnosis

26. Case Study • SAF referral for slow, enlarging, bleeding, crusty lump on scalp • Reviewed images, showed obvious sun damaged skin with a single 2 cm eroded nodule on scalp • Treatment – urgent biopsy completed, showed squamous cell carcinoma, allowed for proper surgical removal before spread to lymph nodes

27. Evaluation • Submitting to MPAN for support to conduct objective evaluation

28. Questions