Virtual Care Research
Since 1998, CRaNHR has conducted research into virtual care services. Virtual care services (e.g., telemedicine, telehealth, teletriage, e-health, and digital health services) use technology to span distance and time to provide access to the best quality medical, social or health care. The importance of virtual care is recognized in Ontario’s Patients First: Action Plan for Health, with priorities to improve access, connect services, and support patients. CRaNHR’s ongoing research into virtual care programs and policies can help make “decisions based on value and quality, to sustain the health care system for generations to come”.
Current Research Streams
Age and Sex Patterns of Medical Care Utilization through the Ontario Telemedicine Network
This masters’ research project is calculating per capita utilization rates for Ontario Telemedicine Network (OTN) facilitated health care services to determine if these rates vary by age, sex or geography. The study uses record-level OHIP billing data for 2008/2009 to 2014/2015 from the Ontario Ministry of Health and Long-Term Care to compare rates by patient age, sex, and diagnosis, and along with rural-urban or north-south dimensions. Study findings could be used to improve delivery by identifying service gaps, as well as low and high demand services. Findings may help inform program development and policies governing the delivery and organization of virtual care services.
(data provided by the Ontario Ministry of Health and Long-Term Care, 2016 – 2018)
Northern Initiative for Social Action (NISA) Warm Line Evaluation
The Northern Initiative for Social Action’s (NISA) Regional Warm Line is a peer-led non-crisis telephone support service to support mental health services in both rural and urban communities. Callers incorporate the warm lines as part of their regular recovery support systems. This mixed-methods evaluation aims to explore which communities in the North are currently accessing the Warm Line, and
how access could be enhanced for diverse Northern populations, including older adults, Francophone, Indigenous and LGBTQ communities.
(funded by the Ontario SPOR Support Unit – Strategy for Patient-Oriented Research, 2016 – 2019)
Access to and Use of Ontario Telemedicine Network in Northern Ontario
The Ontario Telemedicine Network (OTN) is one of the world’s telemedicine networks facilitating medical, health and social services as well as educational programming and administrative connections to communities throughout Ontario. This study used aggregated data to describe access and use of the network for medical care services in Northern Ontario.
(funded by the Ministry of Health and Long-Term Care as an Applied Health Research Questions under the Health Systems Research Fund, 2013 – 2016)
Evaluating the Efficacy of Telehealth-delivered Opioid Agonist Therapy
Opioid addiction is a major health issue in Ontario and may be more common in northern communities. Opioid agonist treatment (OAT) is the most effective therapy and is typically managed by a trained physician in face-to-face sessions. Relative to urban centres, patients in northern and rural regions do not have the same access to services and must rely on alternate treatment modalities (e.g., telehealth). This study used de-identified individual level data to evaluate the efficacy of telehealth as a treatment modality for OAT and compared treatment retention rates for face-to-face and telehealth modalities.
(funded by the Ministry of Health and Long-Term Care under the Health Systems Research Fund and by the Northern Ontario Academic Medical Association, 2013 – 2016)
Examining the Experience and Impact of Distance Education Opportunities for Health Professionals in Rural, Remote, and Northern Communities and First Nations
L. Carter, W. Warry, and M. Hanna
This study examined the learning experience of health professionals, focusing on learning outcomes and practice impact. Using a participatory, multi-perspective, mixed methods framework, and including five case studies, study findings should contribute to improvement of continuing education offerings and outcomes for health professionals, particularly those in Northern, rural, remote, and First Nations communities in Ontario.
(funded by the Ministry of Health and Long-Term Care under the Health Systems Research Fund, 2013 – 2016)
The Store-and-Forward (Asynchronous Telepsychiatry) Pilot Project in Northeastern Ontario: Evaluation of the Service Providers’ Satisfaction
CRaNHR evaluated a Store and Forward (S&F) telepsychiatry project facilitated by the Ontario Telemedicine Network (OTN) in collaboration with the Northeast Local Health Integration Network (NE LHIN) and the Group Health Centre (GHC) in Sault Ste. Marie. In the pilot project, videotaped interviews with patients were securely shared with psychiatrists who later viewed the interviews and provided treatment options to the patient’s primary care provider (PCP). Researchers asked consulting psychiatrists, PCPs, interviewers and a coordinator for their perspectives on benefits and challenges to patients and providers. The study summarized recommendations to the OTN, NE LHIN, GHC, and PCPs on program logistics and delivery so as to improve participation, service quality, and patient outcomes.
(funded by the Ministry of Health and Long-Term Care as a Applied Health Research Question under the Health Systems Research Fund, 2013 – 2016)
Impact of the Ontario Telemedicine Network on Medical Services Utilization
J.C. Hogenbirk, L. Smith, L. Carter, M. Hanna, L.D. O'Gorman, and S.E. Barnett
Phase I of the research program adapted an index of access to primary care to the telemedicine context and developed the associated methodology. Phase II, currently on hold, will employ the methodology to assess the downstream impact of telemedicine on medical service utilization. Findings have the potential to inform policy on improving access to quality health care for all Ontarians.
(funded by the Ministry of Health and Long-Term Care as an Applied Health Research Question under CRaNHR’s research centre funding and later through the Health Systems Research Fund, 2011 – 2016)
Evaluation of the City of Lakes Family Health Team's Patient Portal Pilot Project
J.C. Hogenbirk, S.E. Barnett, and E.E. Rukholm
This study evaluated a pilot test of the mydoctor.ca Health Portal initiated by the City of Lakes Family Health Team in Sudbury. The portal provided patients with a way to track and share health information, communicate with their care team and schedule appointments electronically. This study assessed portal quality, ease of use, and utilization. In addition, the evaluation asked patients, clerks and physicians for their views on how the portal might affect physician-patient communication, patient behaviour and outcomes, as well as the workloads of physicians and clerks.
(funded by the City of Lakes Family Health Team with support from the Consumer eHealth Program, eHealth Ontario, 2012)
An Evaluation of the Keewaytinook Okimakanak Telehealth Network: An Update of the Economic Model
Development of Financial Indicators and Economic Modelling of Provincial/Federal Cost Drivers for Keewaytinook Okimakanak Telehealth
J.C. Hogenbirk, R.W. Pong, M.G. Delmege, and V.G. Guérin
Keewaytinook Okimakanak Telehealth (KOTH) facilitates clinical, educational and administrative sessions via telecommunications technology in 24 geographically remote First Nation communities located in Northwest Ontario. This project first collected new data and updated the economic model from an earlier evaluation of the KOTH / NORTH Network Expansion Project. CRaNHR then developed: (1) financial and economic indicators for a Balanced Scorecard; and (2) a redesigned economic model that separated cost drivers for the Government of Ontario and the First Nations and Inuit Health Branch (FNIHB). The revised model allowed KOTH to answer specific funding questions pertaining to sustainability as posed by the Government of Ontario and FNIHB.
(funded by Keewaytinook Okimakanak, 2007 – 2008)
Using Telehealth to Augment Delivery of Mental Health Services by Family Health Teams: Potential barriers and possible solutions
R.W. Pong, J.C. Hogenbirk, P. Montgomery, and K. Boydell
CRaNHR conducted a literature search and review, key informant interviews and focus group discussions to identify mental health care services that could be provided by Family Health Teams using telecommunications technology. The researchers reviewed successes/failures in tele-mental health service delivery – focusing on projects that had the highest relevance to Ontario and primary care. In addition, the researchers examined potential solutions to barriers such as readiness, integration, policies (e.g., remuneration, licensure, credentialing), client and provider willingness-to-use, etc. The report identified knowledge gaps and synthesized findings with implications for policy- and decision-makers.
(funded by Ontario Mental Health Foundation and Ontario Ministry of Health and Long-Term Care, 2005 – 2006)
Evaluation of the Keewaytinook Okimakanak Telehealth/NORTH Partnership Expansion Project
R.W. Pong, J.C. Hogenbirk, S. Hardy, B. Minore,* R. Ramirez, A. Lauzon, and A. Ibanez
CRaNHR, in collaboration with the University of Guelph's School of Environmental Design and Rural Development, evaluated the Keewaytinook Okimakanak Telehealth/NORTH Network Expansion Project in northwest Ontario. The research team worked closely with First Nations communities and organizations to ensure that these First Nation communities had the tools and expertise to collect, analyze and interpret data in the future. The evaluation also incorporated the needs of federal and provincial governments. The evaluation helped guide the expansion as the service sought to improve access to integrated health services in 24 geographically isolated First Nations communities.
(commissioned by Keewaytinook Okimakanak, 2004 – 2006)
Literature Review and Synthesis on Tele-homecare and Family Caregiving
R.W. Pong, J.C. Hogenbirk, N. Young, S. Lemieux, and L.J. Liboiron-Grenier*
CRaNHR, in collaboration with the Hospital for Sick Children, conducted a literature review and synthesis of tele-homecare, with a focus on its impact on family caregiving. The synthesis included a comprehensive description of tele-homecare projects in Canada and selected international tele-homecare projects. The research team examined the real and potential advantages/disadvantages of tele-homecare in support of family caregivers, with a view to helping determine new directions for homecare research and policy.
(funded by Health Canada, 2005)
Assessing Effects of Teletriage on Health Services Utilization of a Rostered Population in Northern Ontario
R.W. Pong, H. Lee, J.C. Hogenbirk, and D.R. Robinson
CRaNHR and the Group Health Centre (GHC) conducted a randomized controlled trial (RCT) of the impact of teletriage on the patients' use of medical services at GHC. Medical service use was obtained from the GHC electronic medical records for 1057 patients over 14 months. Results of the RCT showed a variable, but typically non-significant effect on medical services use.
(funded by the Richard Ivey Foundation, 2001 – 2004)
Environmental Scan for Developing Standards and Guidelines for Telehealth Accreditation
R.W. Pong, T. Cradduck, J. Finley, P. Jennett, P. Brockway, J.C. Hogenbirk, L.J. Liboiron-Grenier, M. Yeo, C. Szpilfogel, and K. Byrne
CRaNHR collaborated with the Alberta Research Council, the Health Telematics Unit (University of Calgary), and Dalhousie University to conduct an environmental scan of telehealth practice. The study provided recommendations to help inform the development of accreditation standards for telehealth practice. CRaNHR developed recommendations for telehealth human resources and coordinated research activities. Study findings and recommendations were consolidated into the National Initiative for Telehealth (NIFTE) guidelines, which were used by the Canadian Council of Health Service Accreditation (now called Accreditation Canada) in the development of telehealth accreditation standards.
(funded by the Richard Ivey Foundation, 2001 – 2003)
Evaluation of a Teletriage Pilot Project in Northern Ontario
J.C. Hogenbirk, R.W. Pong, B.T.B. Chan, D.R. Robinson, V. McFarland* , S. Lemieux, and L.J. Liboiron-Grenier
The study evaluated a teletriage pilot project, Direct Health/TéléSanté, to determine if the pilot project had met its intended objectives. Findings from the evaluation were used to inform the province-wide roll-out of the service, now known as Telehealth Ontario.
(funded by the Richard Ivey Foundation, 2001 – 2003)
Development of a Generic Framework for Evaluating Teletriage
R.W. Pong, S. Caty,* B. Chan, and J.C. Hogenbirk
CRaNHR developed a generic evaluation framework that could be used to evaluate a variety of telephone triage projects. The framework and tools were used by CRaNHR to evaluate Ontario’s teletriage pilot project, Direct Health/TéléSanté.
(commissioned by the Ontario Ministry of Health and Long-Term Care, 2000 – 2001)
Policy Issues in Relation to Telehealth in Canada
R.W. Pong, J.C. Hogenbirk, and D.A. Pearson
Two discussion papers were developed, one on licensing physicians for telehealth practice and the other on reimbursing physicians for telehealth practice. These papers discussed the nature of the issues and reviewed various options to help resolve policy issues that could hinder the wider adoption of telehealth in Canada.
(commissioned by the Advisory Council on Health Info-structure, Health Canada, 1999)
Evaluation of the HEARTT Demonstration Project and Addressing Major Policy Issues in Telehealth
R.W. Pong, K.V. Nagarajan, J.C. Hogenbirk and R Baigrie
CRaNHR conducted an economic evaluation of the University of Ottawa Heart institute’s Telecardiology program (Healthcare and Education Access for Remote Residents by Telecommunications: HEARRT). The study also critically examined three main policies pertaining to telehealth adoption in Canada.
(Funded by the University of Ottawa Heart Institute, 1998 – 2000)