Projets de Recherche>En Cours>Évaluation du Réseau IIU
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Évaluation du réseau IIU (Nunavut Telehealth Network)
janvier 2002 – juin 2003

The Nunavut Telehealth Network plan calls for an effective network that will eventually support 15 sites located in very small communities widely scattered over a very large territory. Most sites will act to both receive and send data, using a combination of store and forward and real time or live mode. This breadth and diversity of services to be offered using telehealth tools are likely to produce system-wide impacts on health service utilization within the territory. This project will assess the overall, system-wide implications of the telehealth network for the Nunavut health system. Our evaluation report will be designed to provide a framework and methodology for continuous self-evaluation in future phases of network utilization.

The project also has a more specific mission : to provide answers to a number of questions related to the implementation of the project within the time-frames specified, as well as the appropriateness of the design of the network and its effectiveness in meeting the needs of the Nunavut population. Questions that need to be answered in this part of the evaluation relate to timeliness and ease of use. We have developed a methodology for systematically and qualitatively documenting the process of implementation, as well as the reasons for transformations or deviations from the initial plan and their expected results. The methodology is based on the project vita method developed by Smith and Florini (1993) which provides a structured format for tracking important developments in multi-level and multi-site and multi-actor projects. This information may be used to explain across-site variations in functionality, uptake and effectiveness.

Our overall approach is stakeholder-driven. It seeks to maximize the responsiveness and relevance of the both the evaluation process and its outcomes by involving stakeholders as fully as possible in the design and conduct of the evaluation and in the interpretation of results, the formulation of recommendations and implementation of solutions. Our approach is also flexible. The Canadian Coordinating Office for Health Technology Assessment’s (CCOHTA) recent review of videoconferencing in telehealth in Canada suggests that once telehealth networks are in place, the number of uses for the equipment often diversifies and leads to the adoption of new applications for the systems. Our experience has taught us that implementation of complex telehealth networks can often undergo significant transformations in timelines, technologies, applications and personnel as the implementation proceeds, due to various interacting factors and the local, inter-agency, supplier, and coordinating levels. Such transformations and changes are often critical to implementation effectiveness and the capacity for telehealth systems to achieve their goals.

Multiple methods of data collection are being used to assess changes over time from the perspectives of patients, personnel, communities and other stakeholders. Telehealth usage is tracked using online forms completed by personnel at the participating sites, and through the analysis of health system utilization data for patients in the Nunavut communities where telehealth will be implemented, in relation to non-telehealth communities. Another aspect of our methodology is to follow a sample of patient trajectories over time, assessing their utilization of all health services, both with and without telehealth during the study period. Patients’ views are being obtained through questionnaires measuring perceived quality of and satisfaction with service and care. Provider views are being gathered primarily in interviews. The suitability of the technology in meeting the needs of the clients and users will be assessed through questions about technical matters on the online forms and a checklist developed for that purpose, to be completed by managers, vendors and users. Methods for measuring cost-avoidance and identifying key financial indicators will be explored with project managers and other stakeholders and will include indirect cost efficiencies and the impact of telehealth on costs to patients. We will use qualitative content analysis (computer-based) to identify emerging themes and lessons learned. Means taken to ensure patient privacy and to improve health system security will be documented through interviews with health information systems managers in Nunavut and the remote sites and through the use of standardized test cases.