eHealth, the use of information management and communication technologies in health services, is an area of development that offers potential tools and strategies to improve effectiveness of health services for First Nations in British Columbia. While community based Health Centres excel at shaping appropriate and effective services for their members, they also continue to work to overcome a number of unique challenges stemming from a variety of factors, including economies of scale, isolation, funding limitations, infrastructure and capacity challenges, and jurisdictional barriers. eHealth is seen as an important effort that can contribute to empowering Health Centres to overcome these service challenges.
The First Nations eHealth Strategy Council, has produced a Strategic Planning Framework, a Developing Community eHealth: First Nations eHealth Discussion document, and a Health Centre Challenges in an eHealth Context Feedback Report.
NEW PUBLICATION: Developing Community eHealth
Developing Community eHealth - Starting the eHealth discussion with BC First Nations | pdf download |
Community level services are self-directing, each with their own planning processes and cycles, and with accountabilities to their Health Board and/or Chief’s and Councils, and members. As such this document is not intended as an eHealth plan.
Rather, its purpose is to identify viable and relevant entry points through which communities can pursue their developmental paths with respect to eHealth.
While First Nations Health organizations and departments share many commonalities, they are also unique in many ways. Therefore, the answer to the questions of if-where- how eHealth can add value and be of assistance to these services, will vary across communities.
By creating a dynamic and non-linear picture of eHealth development areas, we hope that this document will continue to be of value for communities in different ways at different points in their journey as health service providers.
Developing Community eHealth was produced with the generous input of BC First Nations Health Directors, the technical team would like to extend a big THANK YOU to all of the Health Directors that took part in informing this document.
Health Centre Challenges and eHealth Survey Results
FNHDA / FNHC Health Centre Challenges and eHealth - Feedback Report | pdf download |
BC First Nations Health Directors and Senior Health Leads were asked by the First Nations Health Directors Association to provide feedback on draft identification and description of six Health Centre challenges that would inform a discussion document regarding eHealth opportunities for Health Centres. The document was distributed to one hundred and sixty-three (163) Health Directors / Senior Health Leads. An online survey instrument was used to facilitate feedback.
Fifty-eight (58) feedback responses were submitted. The majority of responses were from Health Directors (70%). There was a good distribution of responses from across each of the Health Authority regions, approximating actual geographic distribution of communities (+/-10%).
The Health Centre Challenges in an eHealth Context Feedback Report, drew on some key issues relevant to First Nations eHealth obtained from a variety of sources, including the First Nations Health Blue Print for British Columbia 2005; Gathering Wisdom for a Shared Journey (2007, 2008 & 2009); Health Director’s Forum (2008); and other direct engagements. These issues and challenges were vetted and revised by the FNHDA, and then circulated to Senior Health Leads for First Nations across the province.
eHealth Challenges as identified by the First Nations Health Directors Association
The FNHDA and the Senior Health Leads have confirmed six core challenge areas particularly relevant to First Nations eHealth:
- Access to Services – It is well documented that impeded access to the range of primary health care services adversely impacts health status. A number of BC First Nations communities are very remote, making accessibility to primary health care service centres difficult and costly.
- Fragmented Health Record – The current paper based charting an records systems, used by most Health Centres, is not conducive to holistic health. Client information becomes fragmented by service provider, with each provider keeping isolated case notes, leading to a provider-centric record rather than a client-centred record.
- Accountability-Reporting Burden – First Nations Health Services currently carries a substantial reporting burden to funders (predominantly FNIH). There has been little to no investment at a community operational level to establish or sustain the capacity and tools to make the execution of this reporting burden reasonably manageable, and to mitigate the impact of reduced client services that it results in.
- Service Referrals – The continuity of relevant health information across organizations in the referral process is limited and inconsistent. Existing referral processes, where known, are often burdensome requiring significant administrative overhead. Ineffective management of client continuity of care through the referral process creates additional safety/risk factors for clients.
- Connectivity & Infrastructure - Often communities that would benefit the most from solutions like telehealth are usually the mot remote and isolated. Implementing sufficient connectivity to support eHealth in these remote communities is challenging and expensive. Infrastructure developments, and associated implications, need to be developed and managed in a way that supports local control and protections for community. There are significant gaps in even the most basic infrastructure and associated maintenance requirements for many community Health Centres.
- Interoperability – these refers essentially for the need for alignment to occur between service providers and jurisdictions at the service provider, organizational, technical and cultural levels. In particular, there is a need for a policy environment that enables the sharing and transmission of electronic health information between First Nations Health Centres and provincial health authority providers.
In conclusion, possible strategies for the partners to adopt to address these issues are:
- Increased First Nations access to health services through eHealth-enabled solutions
- First Nations Health Centres with efficient and effective eHealth-enabled clinical and operational information management capacities
- Efficient & effective eHealth enabled Health Centre accountability-reporting capacities
- First Nations Health Centres leveraging eHealth Solutions to support continuity of care across agencies
- Robust and sustainable IT/Network infrastructure and related capacities at the local Health Centre, regional and provincial levels
- First Nations Health inclusion as integrated sector with BC Provincial eHealth Framework