2015 - 2016Year End Report

First NationsTelehealth Network

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Message From Our CEOExecuve SummaryFunding SourcesTSAG and the First Naons Telehealth NetworkFirst Naons Telehealth Network Staffing Telehealth Posions Cross TrainingNew Sites and New Endpoints on the First Naons Telehealth NetworkVirtual and Soware Accounts Mhealth Accounts Virtual Meeng Rooms (VMR)Videoconference Equipment and Clicical Peripherals Videoconference Equipment Clinical Peripherals New Clinical Peripherals Exisng Clinical PeripheralsTelelhealth Network Maintenance and Upgrades Distributed Media Applicaon (DMA) Resource Manager RealPresence Access Director (RPAD) Media Suite Web Suite RMXInventory Management and Internal Tracking Soluons TSAG Tickeng System Tickeng Within Telehealth Types of Tickets Technician Checklist Inventory Management Systems Historical Knowledge BaseKey Telehealth Sessions and New Partnerships Educaon 2015-2016 Year End Educaonal Stascs New Partnerships Exisng Relaonships Videoconference Recordings

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TABLE OF CONTENTS

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Clinical 2015-2016 Year End Clinical Stascs New Partnerships Exisng PartnershipsTelehealth Training Program Training Documentaon Training Opportunies First Naons Health Centre Training FNIHB Training RealPresence Training Training Plan for Handheld CameraFirst Naons Telehealth Portal New Upgrades and Features Series Page Email Us and Subscribe Features Surveys and Evaluaons Home Page Updates Upgrades on Stats and Automated Reporng Funcons Quarterly Videoconference Usage ReportsFirst Naons Telehealth Network Communicaon Strategies Telehealth Newsleer Supporng Growth of Telehealth Through Community Connecons Creaon of Telehealth Session Posters for Health Centres Manuals and Other Documentaon Centralized Help Desk and Support NumberFirst Naons Telehealth Network Strategic Plan 2015-2020ConclusionAppendix 1Appendix 1Appendix 2Appendix 3Appendix 4Appendix 5Appendix 6Appendix 7Appendix 8Appendix 8Appendix 9Appendix 10Appendix 11Appendix 12Appendix 13Appendix 14Appendix 15Appendix 15Appendix 16

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This year marked the full transion of the Telehealth Program to First Naons Technical Services Advisory Group. This transion allowed for the development and execuon of a cohesive vision for the program and future offerings. The goal has always been and will connue to be community focused. All progress made is as a result of the idenfied needs of the community and any opportunity to have them included is taken.

The connuing partnerships, both new and old, have been essenal in the building of Telehealth. The connuing partnerships, both new and old, have been essenal in the building of Telehealth. These partnerships have allowed for the expansion of clinical services and educaonal offerings. They have allowed for experse to become accessible, despite the distance between. The hopes are to connue with these partnerships and explore new opportunies.

This year has proven to be a busy one. Equipment has been upgraded, new clinical programs have This year has proven to be a busy one. Equipment has been upgraded, new clinical programs have been developed and educaonal offerings have increased. The plans for next year are to build upon the successes of this year. Have a look at the progress and be sure to contact the team if you see an opportunity for expansion in your community or program area.

Vaughn PaulTSAG CEO

MESSAGE FROM OUR CEO

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This 2015/16 Telehealth Year End Report summarizes the extensive range of acvity that occurred to keep the First Naons Telehealth Network operaonal and expanding. The primary client connues to be the First Naon individual using the Health Center on reserve. Several new opportunies were explored in 2015/16 and the First Naons Inuit Health Branch (FNIHB) is now fully transferred to First Naons Technical Services Advisory Group (TSAG). First Naons Telehealth Network ensures that there is a highly qualified team of technical and program staff. These staff keep the network operaonal, provide support to the communies, and work with telehealth providers and subject maer experts to develop programs. The telehealth experience connues to be providers and subject maer experts to develop programs. The telehealth experience connues to be of a high standard, and stable funding ensures that it has long term sustainability.

Increasingly, First Naons Telehealth Network has a role in supporng Telehealth content, largely at the request of communies. The new training program implemented in 2015/16 is designed to increase the user confidence and allow them to get over the common hurdles that users of new technology face. New telehealth endpoints have been added and there is now a plan in place to ensure evergreening and Inventory Management is acvely occurring. The network is connuously monitored and technical support is available throughout business hours. New capacies have been added to the telehealth bridge to ensure a robust network. Upgrades and expansion to the Telehealth Portal allow for a “one-stop” website for all things telehealth. Educaon sessions are Telehealth Portal allow for a “one-stop” website for all things telehealth. Educaon sessions are being recorded and accessed as a resource when needed. All of these changes are monitored and reported on to the funder (FNIHB) as well as the HCOM subcommiee Operaons and Support.

In 2015/16, the First Naons Telehealth Network connued to move beyond hardware based videoconferencing and in to soware based videoconferencing with the Real Presence soware. In addion, Virtual Meeng Rooms allow for non-scheduled sessions and are increasing videoconferencing access. Clinical telehealth focus has been on ensuring peripherals are available to enhance the clinical experience, and that staff are trained in their use and maintenance. There is a connued focus on ensuring support is mely and professional.

All this work has led to a robust and stable network that hosts numerous sessions and is increasingly All this work has led to a robust and stable network that hosts numerous sessions and is increasingly being accessed by First Naons. Last year’s top clinical uses were in the Prescripon Drug program, Mental Health , and General Prac oner. First Naons Telehealth Network will connue to support new programming as requested by the communies and work to ensure the network will connue to expand in a thoughul and planned out manner.

EXECUTIVE SUMMARY

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Funding for First Naons Telehealth Network (FNTN) comes from Health Canada. The past several years have seen a transfer of services from Health Canada to First Naons service delivery companies such as TSAG. TSAG connues to demonstrate excellent value for the services delivered and clear fiscal responsibility with the funding provided.responsibility with the funding provided.

Telehealth was a part of eHealth services within First Naons Inuit Health Branch (FNIHB). The transion of the program began in 2013 with the transion of bridging services to TSAG. The transion of the scheduling and support posion was made in January 2015. The final posion to complete the full transion was made in July 2015 with the transfer of the was made in July 2015 with the transfer of the Project Officer posion. Telehealth received a new name: First Naons Telehealth Network. Even though the program was transferred out of FNIHB, there will always be a close working relaonship with the program areas at FNIHB especially with eHealth.

FUNDING SOURCES

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The First Naons Telehealth Network exists under the program area of Informaon Technology at First Naons Technical Services Advisory Group (TSAG). There is a small team of individuals dedicated to support, manage and develop the First Naons Telehealth Network. TSAG contracts technicians from Arrow Technology Group (ATG) to support and Technology Group (ATG) to support and maintain connecvity which is essenal to the delivery of Telehealth services.

The First Naons Telehealth Network supports videoconference connecvity to First Naons Health Centres and various other First Naons organizaons. See Appendix 1 for a detailed map of sites on the First Naons Telehealth Network. At the me of this report, the First Naons Telehealth Network has the following videoconference enabled organizaons on the videoconference enabled organizaons on the network:

• 52 Health Centres, Nursing Staons and Treatment Centres • 3 FNIHB NP on Call • 1 Mental Health Therapist • 3 Doctors • Health Canada • Real Presence/ Mhealth Accounts (Soware based videoconferencing, see below for more informaon)

ATG is an internet service provider with a presence in 42 First Naons Communies. TSAG owns 51% of ATG. The ATG profits that TSAG receives are reinvested back to First Naons in Alberta yearly through decisions made at the TSAG Chief’s Steering Commiee.

TSAG AND THE FIRST NATIONS TELEHEALTH NETWORK

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The TSAG Informaon Technology Manager is responsible for all the IT staff at TSAG. This posion will manage the budget and ensure work plan acvies are assigned to the appropriate area and are completed as required. The IT Manager will report to the TSAG Management Team.

The Health Canada FNIHB contributes two The Health Canada FNIHB contributes two advisory roles for the First Naons Telehealth Network. The roles are held by a System Analyst for eHealth and Physician in Public Health and Prevenve Medicine. The First Naons Telehealth Network collaborates new iniaves, exisng relaonships and reporng

FIRST NATIONS TELEHEALTH NETWORK STAFFING

TELEHEALTH POSITIONS

funcons with these individuals. Their experse in the area of Telehealth is a valuable resource for the First Naons Telehealth Network.

January 2015 the Telehealth Scheduling and Support posion transioned from FNIHB to TSAG. January 2015 the Telehealth Scheduling and Support posion transioned from FNIHB to TSAG. This posion is the primary contact for all of the Health Centres, Nursing Staons, Treatment Centres and AHS. The posion primarily is responsible the day to day operaons of the First Naons Telehealth Network. However, the posion has evolved since it has been at TSAG. The posion has taken on a communicaon role, backend infrastructure support, reporng and database management. It is very posive to see the growth of the program.

In July 2015 the Telehealth Project Officer Posion came to TSAG. This was the final posion of In July 2015 the Telehealth Project Officer Posion came to TSAG. This was the final posion of Telehealth within FNIHB to transfer to TSAG. This posion is primarily responsible to develop and work with FNIHB program areas and external partners to broadcast educaonal sessions. The other major role within this posion was stascs and reporng. The responsibilies include the development of policies, First Naons Telehealth Network Portal improvements, evaluaon and video eding to menon a few.

The First Naons Telehealth Network has Videoconference and eBusiness Soluon Analyst to guide The First Naons Telehealth Network has Videoconference and eBusiness Soluon Analyst to guide the direcon of the team and development of the network. This posion has been at TSAG since November 2008. In partnership with the FNIHB Medical Advisor, the Videoconference and eBusiness Soluon Analyst has a liaison role with First Naons communies and Clinical Providers to facilitate development of Clinical Telehealth Services within First Naons communies. This posion is responsible for reporng to eHealth FNIHB and HCOM subcommiee Operaons and Support.

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ATG Technicians are responsible for the day to day connecvity of the network. There are two Bridge Technician Posions/Helpdesk that support the bridging funcon on the First Naons Telehealth Bridge. These roles do the technical troubleshoong of the units, monthly checklists of all the sites on the network and recording of sessions when required.

ATG Senior Network Engineer is responsible for the network connecvity to all sites and is the third ATG Senior Network Engineer is responsible for the network connecvity to all sites and is the third level of support for all troubleshoong. This role is highly specialized to maintain all the backend infrastructure and database management of the First Naons Telehealth Network.

See Appendix 2 for the First Naons Telehealth Network Organizaon Chart.

CROSS TRAININGCross training is crical when you have a small team. Each member plays a vital role in the everyday funcon of the team. The First Naons Telehealth Network did have some Bridge Technician staff turnover this past year that did have an effect on the team, so to minimize the effects a decision was made to cross train. The job funcon between the bridge support and scheduling is very different but they do use similar tools to do their job funcon. In the cross training of staff, the Bridge Technicians were shown how to effecvely schedule, while the Scheduling team was shown how to schedule, monitor and troubleshoot bridged sessions.

To support successful cross training specific tools were put into place. The ckeng system, detailed To support successful cross training specific tools were put into place. The ckeng system, detailed in a secon above, allows for issues to be captured and dealt with, regardless if the individual tasked was present or not. The other piece was the knowledge base was created to store site specific infor-maon or procedures on how to complete a task. Training on system tools took place so everyone has the informaon and ability to troubleshoot. Not only was this valuable from an organizaonal point of view and supporve to our users but it also demonstrated an appreciaon of all tasks and funcons the individual completes for the team. It allowed for staff members to learn new job skills.funcons the individual completes for the team. It allowed for staff members to learn new job skills.

Benefits

• Everyday tasks can be completed when a team member is absent without compromising quality of service. • Increases skill set and knowledge for each staff member. • Ability to troubleshoot issues that are presented by the Telehealth users. • Extra coverage is available when required.

Challenges

• Staff knowledge retenon of training provided. • Not all issues presented can be dealt with by the cross trained staff, specialized skills are required for some tasks and more appropriate for senior level support. • Staff turnover requires connuous retraining. • Budget to compensate employees for addional workload is not provided.

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Funding became available and it was used to improve and expand the First Naons Telehealth Network. The network expanded to include two brand new sites, Lubicon and South Tallcree. Both sites were excited to receive the new equipment and have started to use the systems for some educaonal sessions.

Three sites received addional systems due to Three sites received addional systems due to acvity increasing. Fort Chipewyan received a Telehealth system for their boardroom, which allows for staff to comfortably aend an educaon session. Dripile and Swan River received Clinical Telehealth systems. These new addions allow for paents to aend their clinical sessions in a clinical space instead of the clinical sessions in a clinical space instead of the large boardrooms. Both sites have seen a significant increase in clinical sessions over the past couple years.

Stan Mlynczak is a Mental Health Therapist that is privately contracted by Bigstone Health Commission and Kapown Treatment Centre. Stan Mlynczak was experiencing difficules with his RealPresence account and tablet soluon so there was a decision made to replace his soware version with a hardware soluon. The desktop unit was installed with a soluon. The desktop unit was installed with a special network router to direct the videoconferencing traffic onto our First Naons Telehealth Network. This site has improved and usage has increased to include 124 paents seen over the year. However, there are mes when weather or area traffic affects the usage of the network to the locaon from the ISP of the network to the locaon from the ISP provider.

NEW SITES AND NEW ENDPOINTS ON THE FIRST NATIONS TELEHEALTH NETWORK

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Metro City is a group of physicians that facilitate addicons consultaons both in person and through videoconference with paents located in urban, rural and remote communies. General treatment is in the area of Suboxone Maintenance. First Naons Telehealth Network is being used to support the treatment of paents at Apple Drugs in Slave Lake. Future expansions are expected in the next fiscal year. This year, a total of 44 paents were seen on the First Naons Telehealth Network by Metro City Physicians.

Benefits

• New sites bring Telehealth into the community. The community members have an opon to aend medical appointments from a distance and aend educaon sessions. • Staff can use the equipment for meeng and educaon. • Addional systems allow for clinical events to occur in a clinical space without moving the large system into a clinical space. • An opportunity to establish new relaonships and respond to the community needs.

Challenges

• Lack of dedicated funds limits the degree to which upgrades and new sites can be completed. • There is considerable turnover and not always staff person dedicated to Telehealth, and it can be hard to reach someone when needed. • Deciding on which sites should have an increase to the number of Telehealth systems. • Outside influences such as connecvity may be a factor that is out of the FNTN’s control.

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Benefits

• No scheduling is required as users have the ability to log on and dial as needed. • Provides users with independence in scheduling meengs, sessions and other events. • Both VMR and RPD services are always available and can be accessed out of regular office hours. • Provides flexibility to all users.

Challenges

• Difficult to report on type of usage as this is not oen reported. • RealPresence installaon can be difficult at mes due to mulple factors including, age of computer, user error or lack of technology experience. • Different plaorms make it difficult to create specific manuals for all versions of soware and types of equipment RealPresence is installed on (PC, MAC, Tablet). • Troubleshoong for various devices can be complicated due to the various types of devices as well as soware versions. A user’s technical knowledge also may pose an issue in troubleshoong services. • Impedes the ability to schedule and perform network maintenance as the First Naons Telehealth Network staff are not informed of VMR or RPD usage.

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This was the first year of the evergreen process for the First Naons Telehealth Network. The overall goal was to replace as many systems as possible with the funding provided. The evergreen process consisted of replacing the current Polycom HDX Videoconference systems with the newer GroupSeries. The inial step was a meeng with the vendor to see what systems opons were available and decide on the new standard equipment for the network. The vendor was able to assist in determining which systems were the priority systems to replace due to age and soware version. The next step was to compile stascal reports to know which systems and health centres had high usage. The decision to replace the videoconference units was based on a combinaon of age, usage, usage. The decision to replace the videoconference units was based on a combinaon of age, usage, condion of exisng equipment and soware version. Approximately 60% of the videoconference equipment on the First Naons Telehealth Network has been a part of the evergreen process. The evergreening processes will occur over the next few years unl all of the HDX systems have been replaced.

This was a team effort in partnership with ATG. The technicians from ATG were able to install the This was a team effort in partnership with ATG. The technicians from ATG were able to install the new equipment while on one of their regularly scheduled site visits. This dramacally reduced the cost of shipping and special site visits from the budget. The First Naons Telehealth Network created a detailed manual on how to replace the HDX unit with a new Group Series unit. In December of 2015, The First Naons Telehealth Network presented to the ATG Technicians at the Annual Meeng and received noce of work ahead and a manual. Tickets were created to track all of the steps of the process from receiving the equipment into inventory, system configuraon, packaging the unit for shipping, transit of the system, installaon and final tesng.packaging the unit for shipping, transit of the system, installaon and final tesng.

The other major change in the network was the standardizaon of end point names and alias numbers. The exisng alias numbers were assigned to the unit when the network was much smaller, as the First Naons Telehealth Network connues to grow it was important to keep a consistent and organized alias scheme. There was a clear procedure created and documented, this tool was created to support the First Naons Telehealth Network in compleng the changes. In addion, standardizaon of names was made with the new naming convenon. The updates were gradual as we changed units but a decision was made to change the enre network in the next fiscal year early in the summer. This process involves changing the current alias and system names located in all the in the summer. This process involves changing the current alias and system names located in all the back end infrastructure devices and concluded with updang the First Naons Telehealth Portal Directory as well as the scheduling system used with Alberta Health Services (AHS). The biggest challenge was changing the alias within the AHS system.

Benefits

• The newest technology allows for improved videoconference quality. • Some of the problem units were replaced and the sites do not have any more issues. • Newer units integrate beer with the upgraded back end infrastructure. • Fewer buons on the remote makes it is easier to use, especially for first me users.

VIDEOCONFERENCE EQUIPMENT AND CLINICAL PERIPHERALS

VIDEOCONFERENCE EQUIPMENT

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Challenges

• Addional work was necessary as the new equipment had a major soware upgrade which changed the user interface. All of the new manuals and training had to be changed as well as the previously deployed units needed to be upgraded. • The training of staff on the new units is difficult to arrange. • AHS did not refresh all of their exisng directories with the new alias number so some scheduled sessions failed. To avoid this in the future the First Naons Telehealth Network watches each connecon and ensures that each session connects. • Limited funding did not allow us to upgrade the enre network so we now have a mixed system type network.

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The need for clinical peripherals has been growing over the past couple years. Telehealth providers including NPs, Specialists and Family physicians have increasing comfort with the equipment and are asking to expand their capacity to improve the clinical possibilies. The First Naons Telehealth Network was able to receive a few demonstraon units from various vendors to test with exisng equipment and some FNIHB nurses. Two sessions were arranged to have all the equipment set up and available for the nurses to demonstrate and provide feedback. There was a clear leader in the clinical handheld camera and stethoscope. First Naons Telehealth Network met with a few addional clinicians and decided to deploy the stethoscope in the Kee Tas Kee Now Tribal Council addional clinicians and decided to deploy the stethoscope in the Kee Tas Kee Now Tribal Council (KTC) communies and to deploy the handheld camera with two lenses (one for general exam and one for otoscope) to the Lile Red Communies. The First Naons Telehealth Network provisioned funding to purchase the equipment.

The request was specific for Fox Lake Nursing Staon to receive a stethoscope for

A er assessing the stascal data of clinical sessions, the decision was made to equip one general prac oner and four communies (Loon River, Peerless Trout, Whitefish Lake 459, and Woodland Cree) with a stethoscope. There are two addional units at TSAG unl addional clinical needs can be idenfied. Fortunately, AHS requested to borrow one of the AHS requested to borrow one of the stethoscopes so a Nurse Prac oner at Slave Lake could set up a Telehealth clinic with Peerless Trout. The unit that remained at TSAG is used to test with the community on a monthly basis to ensure the equipment is funconing. The stethoscope expansion connued following a request from the FNIHB On-Call Nurse a request from the FNIHB On-Call Nurse Prac oner.treatment expansion. However, the stethoscopes work in pairs so two addional stethoscopes were ordered. There has been a request from AHS for a handheld camera to be installed at Peerless to support the Nurse Prac oner clinic. The First Naons Telehealth Network will review the budget in the next fiscal year to see if this is possible. Ideally, there would be specific targeted annual funding to ensure First Naons prac oners have clinical peripherals that are up to date with changing technology.

Handheld cameras were also deployed to the Lile Red Communies of John D’Or, Fox Lake and Handheld cameras were also deployed to the Lile Red Communies of John D’Or, Fox Lake and Garden River. These handheld cameras were deployed in an effort to improve the images sent to prac oners during a clinical assessment without having to move the paent unnecessarily. In addion, the images from the handheld cameras can be shared with anyone connected to the call, within or outside of the First Naons Telehealth Network. Feedback received to date have been posive, parcularly from the FNIHB On-Call Nurse Prac oner providing service to those areas.

CLINICAL PERIPHERALS

NEW CLINICAL PERIPHERALS

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Benefits

• Allows the clinician to complete a more thorough physical examinaon of the paent themselves without relying on the eyes and ears of a supporng nurse. • Allows for beer clinical decision making and improved quality of care. • Takes the responsibility for reporng physical exam findings away from the community based staff, who may not be able to adequately describe findings (e.g. describe a rash in detail or heart and lung sounds). • Images and sounds are transmied in real me so nothing is stored. • A new partnership was established with a vendor.

Challenges

• High staff turnover and difficulty scheduling training of staff in community. • Finding a safe place to store the clinical peripheral equipment that is accessible to the staff. • Clinical peripherals need to be set up prior to each use. • Unable to track usage of clinical peripheral in a clinical consultaon and compile stascs. • Potenal cost concerns as new technology is always being developed and there is a need to evergreen what is currently being used.

Prior to the deployment of the clinical peripherals detailed above, clinical peripherals were being used in community. Only a select group of communies originally received clinical peripherals from FNIHB Telehealth. The exisng clinical peripherals included AMD General Examinaon Camera, AMD 400’s Camera and Illumaon Source as well as 2 document cameras. The first of the document cameras is an Elmo, which was used to demonstrate new equipment, share documents or x-ray film. The second is a Wolf Vision Document Camera, which is exclusively used in the Lile Red Community Pharmacies to provide a high definion image for pharmacy preparaon.

EXISTING CLINICAL PERIPHERALS

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In August of 2015, the First Naons Telehealth Network underwent major upgrades to the exisng Telehealth infrastructure. These upgrades were required to ensure the network connues to operate with enterprise security and reliability as the former equipment was reaching end of life (both in terms of soware and hardware support from our vendor Polycom). See Appendix 3 for the complete network diagram of the First Naons Telehealth Network. The following pieces of network equipment were upgraded and integrated into the network:

• Distributed Media Applicaon (DMA) • Resource Manager (RM) • RealPresence Account Director (RPAD) • Media Suite • Web Suite • RM

The Resource Manager (RM) is the front-end of what the CMA used to be. It is the interface used for day-to-day management. It is a valuable tool that the team uses to maintain the equipment on the First Naons Telehealth Network. This lets the in-office First Naons Telehealth Network staff know which units are online and if there are any connecon issues. As menoned above, some troubleshoong of equipment is available through this applicaon. The RM is also implemented as a virtual appliance.

Prior to the implementaon of the DMA, the Converged Management Applicaon (CMA) did everything in one piece of technology. Polycom has now split funconality into a backend (DMA) and a front-end (RM) that the First Naons Telehealth Network uses for day-to-day management.

The DMA is now a virtual appliance, meaning there is no longer dedicated physical hardware in house, thereby reducing maintenance and power expenditures.

TELEHEALTH NETWORK MAINTENANCE AND UPGRADES

DISTRIBUTED MEDIA APPLICATION (DMA)

RESOURCE MANAGER

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The RealPresence Access Director (RPAD) is the gateway between the internal protected network (the Axia Supernet network connecng to all the Health Centres) and the public Internet. The RPAD allows videoconference units as well as RealPresence Desktop users to connect in via the Internet. This includes sites such as Nurse Prac oners home offices and Health Centres that aren’t connected to the Supernet. By registering to the RPAD they appear to Supernet connected sites to be “on the inside” and can be managed by the Resource Manager and staff the same as any other end point.

This is also mostly a hands-off device that requires no day-to-day interacon. It acts like a router and This is also mostly a hands-off device that requires no day-to-day interacon. It acts like a router and firewall much like the DMA does except this one faces the public Internet whereas the DMA is on our protected internal network

Media Suite replaced the Recording and Streaming Server (RSS) which also was a hardware appliance that reached end of life. Media Suite allows the First Naons Telehealth Network sessions to be recorded and make them available on our website.

Our Media Suite implementaon also allows for Our Media Suite implementaon also allows for Live Streaming so people who do not have access to a videoconference unit or RealPresence Desktop setup can watch a session using any web browser. These live streams can also be made accessible to the public Internet and protected with passwords if required.required.

The Media Suite is implemented as a virtual appliance and requires lile to no technical interacon. Everything is automated. The starng and stopping of recordings is controlled via the RMX Bridge. Once the recording is finished, technicians simply log into the Media Suite to download the generated video files that are then edited and uploaded to our website.are then edited and uploaded to our website.

Media Suite also allows for channels to be created that are similar in funconality to YouTube channels. For example, training videos can be made available for anybody to watch at their discreon (and they can be password protected as well to control who exactly can watch what).

REALPRESENCE ACCESS DIRECTOR (RPAD)

MEDIA SUITE

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Web Suite is a new addion to our equipment and as such didn’t replace anything that existed before. It is implemented as a virtual appliance as well.

Web Suite allows users to join a session, or dial into a VMR room, using nothing but their web browser. They don’t need access to a videoconference unit nor do they need to install RealPresence Desktop soware. It also works on all major types of mobile phones and tablets.

The RMX bridge brings together all our equipment when it comes to mul-point calls. As soon as three or more parcipants need to meet, a bridge device is required. It also is required when interfacing with a third-party bridge or network such as Alberta Health Services (AHS) equipment.The RMX was not upgraded from hardware and as such remains a hardware appliance. There is a The RMX was not upgraded from hardware and as such remains a hardware appliance. There is a virtual edion available but it would require too many virtual resources and an upgrade did not make sense. The RMX is the heaviest consumer of compung resources so a dedicated hardware appliance makes the most sense to guarantee resources and speed. We did upgrade to the latest firmware version to remain up-to-date with Polycom support requirements.

Benefits

• The virtual edions of the new equipment make for very easy and faster backups and restores. • Allows for tesng before upgrades. • Increased upme of the network. The First Naons Telehealth Network was able to deliver greater than 99.99% upme now. • These upgrades allow for easy integrang with modern technologies such as smartphones. Anybody can connect from just about anywhere in the world provided they at least have a reliable Internet connecon.

Challenges

• Implementaon from vendor was not sasfactory and brought forward several challenges that required more me and staff resources to address. • Inaccurate descripon of Web Suite capabilies by vendor lead to unnecessary purchase of this soware. • Updates to the virtual appliances need to be scheduled so the First Naons Telehealth Network can be unavailable during the updates. • Difficult to receive high level support from Polycom when unique problems arise despite purchasing support contracts.

WEB SUITE

RMX

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In order to properly track and resolve reported user issues, those issues need to be properly categorized. The First Naons Telehealth Network has created unique and specific areas in which ckets can be labelled, these areas are known as Issue Types. This includes the following areas: • Administraon • Alberta Health Services Issues • Clinical Peripherals • First Naons Bridge • Polycom Endpoint • RealPresence Account Management • Technician Checklist • Telehealth Infrastructure Maintenance • Telehealth Portal

Tickeng Within TelehealthIn summer of 2015, a decision was made to In summer of 2015, a decision was made to offer the best support to communies and Telehealth users by implemenng a ckeng system. Jira, is a customizable and interacve ckeng soware. This soware has been built to maximize the efforts put forward for troubleshoong and working with equipment. The expectaon on using Jira is that every The expectaon on using Jira is that every phone call through the Help Desk receives a cket. This cket includes the name and contact informaon of the person calling, site locaon, type of issue that is occurring and other details needed to provide the best technical support. This cket is then assigned to an ATG technician either on-site at the Health Centre or in the either on-site at the Health Centre or in the TSAG offices. Once an issue has been resolved the cket is closed however the data will sll remain in the system, allowing for historical data to be accessed. Jira has been used by the First Naons Telehealth Network since August 2015. There have been significant revisions in the data recorded and reported at the end of the month. recorded and reported at the end of the month. Review of issues each month can reveal trends and recurring issues and allow for appropriate acon. See Appendix 4 for a detailed look at some of stats derived from the ckeng system.

INVENTORY MANAGEMENT AND INTERNAL TRACKING SOLUTIONS

TSAG TICKETING SYSTEM

TYPES OF TICKETS

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The ckeng system has allowed for consistent tracking of equipment in all Health Centres on the First Naons Telehealth Network. When an ATG technician is on-site at a Health Centre, they are asked to complete a “Technician Checklist”. This checklist is a connecon test and physical examinaon of the Telehealth equipment. The on-site ATG technician will complete a videoconference call with a member of the First Naons Telehealth Network Team. From here the funcons of the system are tested including: camera movement, remote control baery charging, audio tests and verify other internal se ngs. The Technician Checklist should be completed during each visit or once per month per piece of Telehealth equipment. The purpose of these checklists is to each visit or once per month per piece of Telehealth equipment. The purpose of these checklists is to ensure that all equipment is performing at the opmal level and there are no concerns. If the results of the Technician Checklist reveal damages or parts that need to be replaced, a cket will be created and resolved as soon as possible. See Appendix 5 for stascal data on some of the checklists created. Benefits

• Tickeng system allows for a beer system then “last in, first helped”. • Historical data is stored and can be accessed if issues were to occur again. • Allows for more accurate reporng of stascs. • Technician Checklists ensure that all equipment is performing at the opmal level.

Challenges

• Inconsistent creaon of ckets with each phone call. • Confusion surrounding which issues require ckets. • First Naons Telehealth Network updang ckets in a mely manner. • Some ckets stay open for lengthy periods of me due to delays in contacng users.

TECHNICIAN CHECKLIST

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Along with the implementaon of the ckeng soware, there is a new inventory management system. Each piece of equipment is tagged with an asset tag number. The First Naons Telehealth Network is able to pull up an asset number and see all of the details about the equipment. This includes: equipment type, serial number, warranty informaon, troubleshoong types, where the equipment is located and last known user (if applicable) see Appendix 6. Since August 2015, nearly 400 new assets have been entered into the Inventory system. All new Telehealth equipment, clinical peripherals and some network equipment have been tagged and entered in the inventory system. There are ongoing plans to include other Telehealth equipment and various Health Centre assets in There are ongoing plans to include other Telehealth equipment and various Health Centre assets in the inventory system. A staff member will be able to idenfy if the equipment is entered in the inventory system by locang the asset number, as seen below.

Benefits

• The asset numbers assist with troubleshoong remotely. The large sckers are easily idenfiable. • Warranty informaon is stored and can be easily pulled for record management. • Serial numbers are stored within the inventory management system in case the equipment is lost or stolen. • Asset management is a priority with large amounts of equipment across numerous locaons.

Challenges

• Creaon of a work plan to enter the legacy equipment in the inventory system. • The sckers are removable. Users can peel off the sckers, not realizing what they are for. • Accurate tracking of the asset over me is difficult. • Limited budget prevents enhancing funconality and/or usability.

INVENTORY MANAGEMENT SYSTEM

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In fall of 2015, First Naons Telehealth Network was given the opportunity to create a centralized knowledge base for the First Naons Health Centres. These programs have been created to hold all informaon on a specific site. Anywhere from open, closed and inventory ckets to narrave and site informaon that would not be found elsewhere. This allows for quicker and accurate troubleshoong; if a user calls with a queson the First Naons Telehealth Network is able to search pictures and specific informaon that will allow for remote troubleshoong see Appendix 7.

Benefits

• All informaon on a site is stored in one system. • First Naons Telehealth Network can access open, closed and inventory ckets within this site. • Provides a space for ongoing narraves for a site this includes network, videoconferencing, phone and other areas of the health centre. • Contains specific instrucons on most equipment in the health centre. This includes equipment set up, maintenance, upgrade instrucons or special operang procedures.

Challenges

• No singular person appointed to maintain the Knowledge Base, thus organizaon is not always in the best form. • Infrequent maintenance and up keep from First Naons Telehealth Network. • Challenges ge ng pictures of all of the sites from the ATG technicians. • There is informaon located in mulple secons of the database.

HISTORICAL KNOWLEDGE BASE

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The educaonal sessions offered by the First Naons Telehealth Network are either classified as FNIHB Training, FNIHB Program or AHS/Other. A session is categorized by who the presenng site is (either FNIHB or AHS/Other) and is further classified if it is a FNIHB session. FNIHB sessions that relay/teach on a specific topic or skill are classified as FNIHB Training while all other sessions are classified as FNIHB Program. In 2015-2016 the number of educaonal sessions adversed decreased by 17% overall. The number of sites who registered for sessions remained stagnant with 747 sites registering in 2014-2015 and 746 sites registering in 2015-2016. See Appendix 8 for a detailed descripon of types of sessions registered for.descripon of types of sessions registered for.

KEY TELEHEALTH SESSIONS AND NEW PARTNERSHIPS

EDUCATION 2015-2016 YEAR END EDUCATIONAL STATISTICS

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A concerted effort has been made this year in building new and strengthening exisng partnerships. One new partnership has been between FNIHB Nursing and CARNA Nursing. FNIHB Nursing Educators expressed an interest in having CARNA present for nursing staff on reserve. CARNA was able to fulfill this request and presented 1 session with 11 sites in aendance. Addional sessions have been planned for the upcoming fiscal year and will include sessions related to the history of nursing and recerficaon.

First Naons Telehealth Network Portal. This Speaker series was originally slated to have 8 sessions but conflicts with a speaker prevented 1 of the sessions from taking place.

A partnership was also built with AHS to deliver Mental Health Act educaon sessions tailored for individuals working in First Naons Health Centres. This partnership was formed as a result of a request from FNIHB to access Mental Health Act sessions, similar to those being offered to AHS staff. The result of this partnership was 2 sessions and 24 parcipang sites. The presenter also expressed interest in presenng further educaon sessions in the future.

In past years, the Lupus Society of Alberta has presented educaon sessions for the First Naons In past years, the Lupus Society of Alberta has presented educaon sessions for the First Naons Telehealth Network. The sessions were successful and provided registrants with informaon specific to First Naons. This year the partnership was rebuilt and the Lupus Society of Alberta was invited to present. The Lupus Society was able to present 1 session to 6 registered sites.

Lile Warriors emerged as a strong partner during this fiscal year. In exploring the organizaon’s Lile Warriors emerged as a strong partner during this fiscal year. In exploring the organizaon’s mandate and training opportunies, it was clear that sessions presented by them would generate interest. Lile Warriors presented 2 sessions to 17 registered sites. This partnership will connue as Lile Warriors has indicated interest in offering further group and one on one sessions to those who express interest.

Overall the partnerships built with the above organizaons resulted in high quality educaon Overall the partnerships built with the above organizaons resulted in high quality educaon sessions being made available to First Naons Health Centres on reserve. Through acve efforts to solicit feedback, these sessions are very well received. FNTN has increasingly played a moderator role in telehealth sessions and has been able to improve the quality of the presentaons

This year marked the 7th year of the Telehealth Speaker Series. This year’s iteraon was tled the “Four Elements” and focused on delivering sessions centered on the four elements of fire, water, earth and wind. Each of the “elements” had 2 sessions focused on cultural, safety or health related topics. Through the creaon of the Speaker series, a variety of new partnerships were Speaker series, a variety of new partnerships were built. Speakers from organizaons such as the University of Alberta Centre for Injury Prevenon, Alberta Health Services and FNIHB presented while expressing an interest in working together again in the future. The series was very successful with 7 sessions taking place with 59 sites in aendance and 5 sessions being recorded for theaendance and 5 sessions being recorded for the

NEW PARTNERSHIPS

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by working with partner organizaons and ensuring sessions provide opportunies for parcipants to interact with the subject maer experts. As these partnerships have proven to be successful, the hope is to maintain and strengthen these relaonships so that telehealth sessions meet First Naons needs and are delivered effecvely to the maximum number of aendees that is possible.There are ongoing plans for First Naons Telehealth Network staff to connue to work with subject There are ongoing plans for First Naons Telehealth Network staff to connue to work with subject maer experts to develop and support Telehealth Educaon Sessions. In the Spring of 2016 a new Fentanyl Learning Series will be delivered to communies. This series is created in partnership with the Alberta Fentanyl Response Team, First Naons Telehealth Network and several other organizaons that have been dedicang resources to combat this province wide crisis.

First Naons Telehealth Network has the ability to record and post educaon sessions to the First Naons Telehealth Network Portal. Educaon Sessions are only recorded with the expressed permission of the presenter and with the knowledge of all parcipants. Each video is reviewed with minor edits before posng to First Naons Telehealth Network Portal. These recordings serve as a compliment to posted handouts submied by presenters.

During the reporng period, there were 17 recorded educaon sessions posted to the First Naons Telehealth Network Portal. Of these 17 videos;

• 4 Nurse Educaon • 3 Well Being • 2 Aboriginal/Culture • 3 Public Health • 1 Communicaon • 1 Miscellaneous • 3 FNIHB Programming All 17 videos were viewed a total of 992 mes. A ached in Appendix 9 is a full breakdown of views per video.

In addion to building new partnerships, exisng relaonships have been maintained and strengthened. These relaonships include partnerships with;

• FNIHB Nursing • FNIHB Communicable Disease Control • FNIHB Nutrion • FNIHB Homecare • FNIHB Zone • Aboriginal Affairs and Northern Development Canada • Alberta Health Services

EXISTING RELATIONSHIPS

VIDEOCONFERENCE RECORDINGS

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Benefits

• Increased educaonal opportunies and diverse subject maer available for First Naons Telehealth Network Portal users. • Subject maer presented by individuals with experse. • First Naons Telehealth Network is able to deliver essenal informaon to a large group at once. • Ability to record sessions and post handouts allows for First Naons Telehealth Network Portal users to view recorded/posted content at any me.

Challenges

• Limited feedback from users makes planning sessions of interest difficult. • Finding cultural speakers, comfortable with the technology, is problemac. • Coordinang locaons for remote presenters is onerous as oen onsite technical support is not available. • Speakers oen would like an idea of how many parcipants will be in aendance, this is not possible too far in advance.

CLINICAL 2015-2016 YEAR END CLINICAL STATISTICS

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The majority of Clinical Acvity on the First Naons Telehealth Network occurs between an AHS site, the prac oner site, and First Naons community, paent site, on the First Naons Telehealth Network. Some Clinical sessions occur between Prac oner sites, outside AHS, and First Naons communies including Telepharmacy and Mental Health Therapy. In 2015-2016 the number of sessions increased by 28% while the number of paents decreased by 8%. See Appendix 10 for a detailed descripon of types of clinical services accessed.

This year has been a slow and steady year of growth with strengthening exisng partnerships and expanding into some new relaonships. As is to be expected, two General Prac oners have moved on to new areas but other prac oners are now providing health services through the First Naons Telehealth Network. It is encouraging to see the new clinical programs grow as the word spreads in the community.

A unique opportunity presented itself early in the fiscal year when Nurse Prac oner, Alison Ross, A unique opportunity presented itself early in the fiscal year when Nurse Prac oner, Alison Ross, out of the Family Care Clinic in Slave Lake presented a new clinical program plan to provide a clinic to Peerless & Trout every week in the aernoon of Tuesday, Wednesday and Thursday. The clinic provided an opportunity for the First Naon, First Naons Telehealth Network and AHS to work together. The First Naon had Telehealth equipment in a clinical area available to use. First Naons Telehealth Network tested all the Telehealth equipment, trained staff on how to use the Telehealth equipment, installed a stethoscope peripheral to the telehealth clinical cart and loaned a stethoscope to the AHS Family Care unit to support this clinic. First Naons Telehealth Network also ensures to the AHS Family Care unit to support this clinic. First Naons Telehealth Network also ensures opmal performance of the stethoscope by compleng monthly tesng when the ATG technician is on-site. AHS installed the stethoscope and made sure training was provided to the Nurse Prac oner. There were 60 paents seen during the inial me period from September 17 to December 17, 2015. This clinic is connuing to support Peerless & Trout and as of March 2016, services has expanded to support Kapown Treatment Centre. Discussions are occurring to expand services in to more communies.

NEW PARTNERSHIPS

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A Mental Health Therapist, Briany Travis, joined the First Naon Telehealth Network by RealPresence to provide clinical consultaon with paents in North Tallcree and Beaver First Naon. This therapist is registered with Non Insured Health Benefits (NIHB). There were 46 paent consultaons booked and were successful but unfortunately like many mental health appointments, there were many no shows for a variety of reasons. A concerted effort will be made with the community to assist this therapist to build this clinic.

The Kee Tas Kee Now Tribal Council and Bigstone Cree Naon opened Slave Lake Apple Drugs in The Kee Tas Kee Now Tribal Council and Bigstone Cree Naon opened Slave Lake Apple Drugs in the Town of Slave Lake in April of 2014. This partnership was inially idenfied as a local need to address opioid dependency in the BCN and KTC communies, it was redefined so that the goal is to provide access and service to a broad populaon in the geographic area who is in need of this service. In the 2015-16 fiscal year, a total of 44 paents were seen in this clinic via videoconference.

There is a new General Prac oner, Dr. Cardinal, in Saddle Lake providing services over telehealth There is a new General Prac oner, Dr. Cardinal, in Saddle Lake providing services over telehealth either using a clinical cart in Saddle Lake or using her RealPresence Account to provide clinical consultaons to Fort Chipewyan and possibly expanding to other communies in the future. Dr. Cardinal saw 27 paents over telehealth. Dr. Cardinal is a member of the Aboriginal Alternate Relaonship Plan (ARP) . It is ancipated that more ARP Physicians will sign up to provide videoconferencing clinics to addional communies.

The last of the new relaonships is with Sally Barkwell who is supporng KKECH Elders Lodge in Fort Chipewyan. This is a community driven iniave where they were having Nutrional Paent consultaons over the phone with Sally and were wondering if it would be possible to use the videoconferencing system in their lodge. There were many steps involved since both sites were not on the First Naons Telehealth Network and these are not supported sites. A er thorough tesng with the KKECH Elders Lodge and training on scheduling sessions, the First Naons Telehealth Network was able to support this connecon. Sally is able to schedule sessions via the First Naons Telehealth Portal and can dial direct to the KKECH Elders Lodge when desired. The First Naons Telehealth Portal and can dial direct to the KKECH Elders Lodge when desired. The First Naons Telehealth Network has some strong clinical Telehealth champions that connue to support and provide their services over the First Naons Telehealth Network. The relaonship with Alberta Health Services is ongoing and connued communicaon between the two networks is vital.

A clearly defined process to receive Nutrional A clearly defined process to receive Nutrional Consultaons on reserve in Northern Alberta from an AHS Die an is being developed with the Aboriginal Wellness Program. This is planned to start in the next fiscal year. This program will inially involve a die an from Fort McMurray that will provide telehealth consultaons with paents from Fort consultaons with paents from Fort Chipewyan and Peerless Trout. The communies are involved with AHS and are raising awareness of this exisng service that will be available. Once these sites are well managed the program can be expanded to addional communies. This program has learned from the established Calgary Zone learned from the established Calgary Zone Nutrional program.

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As The First Naons Telehealth Network’s roll grows, more and more organizaons and First Naons are asking for support. This includes clinical providers that want to provide services to First Naons. Efforts are made to ensure all clinical sessions are of a high standard and usage stascs reported accurately.

Benefits

• With the increase of clinical consultaons the First Naons Telehealth Network is meeng the goal of increasing services to First Naons Communies. • Creaon of new relaonships allows for addional services to be made available. • Requests are being received from communies to build new Telehealth services. • Increase in a variety of different clinical services, not already present in community.

ChallengesChallenges

• Difficult to adverse new Telehealth services to community members who don’t frequent the Health Centre. • Health Centre staff turnover is difficult to manage since First Naons Telehealth Network is not aware of the changes, this affects the clinics as new staff may not be made aware of exisng clinical roles. • “Paent No Shows” are discouraging to clinicians and it does make them queson if it is worth the effort to try Telehealth again. • Many of the Health Centres need to rely solely on First Naon Band employed staff to support primary care and somemes they are quite stretched for me within their own job descripon without adding addional tasks.

• Pharmacy • Nutrion Group Educaon • Dr. Butcher • NP on call • AHS Expansion

Telehealth stascs reveal that clinical numbers Telehealth stascs reveal that clinical numbers fluctuate month to month and there is a lot of geographical variability. FNTN connues to work with partners to connect communies to providers and to support exisng communies with retaining their current providers. Consistently across Alberta, clinical telehealth is well received and a priority area of expansion in well received and a priority area of expansion in many communies. It is a priority to ensure the support offered clinical providers is mely and responsive, with the ulmate goal of expanding the number of high quality clinical telehealth providers and ensuring the acvity is incorporated into the communies’ Health Plan.

EXISTING PARTNERSHIPS

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A new training program has been created for all Telehealth users. This training program is flexible and provides users firsthand experience using the equipment. The First Naons Telehealth Network contacts the Health Center and/or users to see if they would like training and what me would work for their schedules. Once a me is selected, training materials are sent out (prior to the session) via email. There have also been training sessions that are open to all Health Centres at once; Health Centres were free to register as they wish. Training sessions are also adversed on the front page of the First Naons Telehealth Network Portal, newsleer and email reminders. A training session the First Naons Telehealth Network Portal, newsleer and email reminders. A training session generally runs 25- 30 minutes in length, depending on the number of parcipants. All training offered is remote and goes over the following:

• How to make a call • Use the remote • Turn the unit on and off • Types of sessions • Types of calls • How to dial and connect to a call • First hand use of the equipment • Moving the camera (le, right, up, down, zoom) • Overview of the First Naons Telehealth Network Portal

Telehealth users are encouraged to contact First Naons Telehealth Network directly if and when Telehealth users are encouraged to contact First Naons Telehealth Network directly if and when they want training. Regular reminders are sent out via the monthly Telehealth newsleer as well as on the First Naons Telehealth Network Portal.

Several addions and improvements have been made to the training documentaon. There are training manuals created for:

• HDX User Guide • Group Series User Guide • RealPresence Users Guides for Mac and PC

Training documentaon for both the Group Training documentaon for both the Group Series and HDX equipment is available for public access on the First Naons Telehealth Network Portal (www.firstnaonsth.ca).

TELEHEALTH TRAINING PROGRAM

TRAINING DOCUMENTATION

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First Naons Health Centre Training

During this reporng period training has been offered to 30 communies with evergreened Telehealth equipment. Overall, 6 communies declined training, 8 communies successfully completed training and 16 communies did not respond to the training request. Training is scheduled by calling the Health Centre directly and speaking with the Health Director or the Nurse in Charge.

FNIHB Training 12 training sessions were organized throughout the year for FNIHB staff located in Canada Place. During these 12 sessions, 42 parcipants were trained on how to use videoconference equipment and the First Naons Telehealth Network Portal.

RealPresence Training

RealPresence training is generally offered at the me of soware installaon. There have been RealPresence training is generally offered at the me of soware installaon. There have been mulple mes that First Naons Telehealth Network has been on-site to install and walk users through RealPresence. The First Naons Telehealth Network was onsite during a large KTC Staff meeng where over 20 people were trained on the equipment. The First Naons Telehealth Network was also onsite to install and train Treatment Centre Directors on the use of RealPresence for their program areas.

Benefits

• The remote training allows for staff to get hands on experience in using it and being a part of a videoconference. • Large groups of people can be trained at once. • The First Naons Telehealth Network is flexible with schedules and can work around the hours of the trainees. • There are various ways that the First Naons Telehealth Network adverses training to the Health Centres and to Canada Place. This allows for a wider area of coverage in case they are not on the subscriber mailing list.

Challenges

• Having sites aend their scheduled training. There are frequent no shows to scheduled calls despite a calendar invite and reminder phone calls. • Having sites return the training calls. Several voicemails and emails will be le with no contact from the designated person. • Not knowing who to contact at the Health Centre. O en the scheduling team contacts the Health Director or the Nurse in Charge however, these posions are oen busy and/or on a rotaon bases. • First Naons Telehealth Network has tried to make strong contacts at the Health Centres but this is a challenge as staff turnover is great and the First Naons Telehealth Network is oen uninformed of said changes.

TRAINING OPPORTUNITIES

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Training Plan for Handheld Camera

Handheld cameras were deployed to the Lile Red Communies of Fox Lake, John D’Or and Garden River. Prior to deployment, a training plan was developed to train the nurses on how to set up and use the handheld cameras in delivering care. The training program required the use of the training manual, created by the First Naons Telehealth Network. The training manual was step by step and included a variety of pictures, to limit confusion when interacng with the technology. In an effort to further prevent confusion, FNIHB nurses were invited to complete the training In an effort to further prevent confusion, FNIHB nurses were invited to complete the training program. The goal was to have the FNIHB nurses act as a resource and provide hands on training in community. To replicate the experience of the nurses in community and test the training program, the FNIHB nurses were provided with the training manual and the equipment. No addional instrucon was provided to the nurses as they set up and used the handheld cameras. The FNIHB nurses were successful and provided feedback that the manual was straighorward and easy to use.

Successes

• New nurses/users can be trained without need for a dedicated trainer. • Step by step instrucons allow users to address common issues with handheld cameras without needing to call support. • Training for the handheld camera can be provided in person at the Health Centre or remotely by the FNIHB Nurses. • Innovave technology is being brought in and used in the Health Centre.

Challenges

• FNIHB nurses would be best able to address how the handheld camera can be used in a clinical se ng but are oen difficult to access. • Some Health Centres/Nursing Staons use the handheld cameras on a regular basis while others do not, making retenon of skills gained difficult. • Feedback was received from the FNIHB nurses on the training program but no feedback was received from the nurses in community. • Inconsistent communicaon within the Health Centre regarding use and storage of camera, which leads to missing equipment.

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First Naons Telehealth Network Portal is a publically accessible website that is the central hub for all videoconferencing on the First Naons Telehealth Network. The website has an up to date calendar, library to view past recordings, an updated First Naons Telehealth Directory and many other features that provide an exceponal Telehealth experience. an exceponal Telehealth experience.

Series Page

The Series Page was created as a space that has The Series Page was created as a space that has all informaon regarding a Telehealth Series. All handouts, recordings and session informaon that are a part of a series can now be found under the series tab. Before the creaon of the Series Page, users would have to search the calendar to locate individual sessions within a series. There are currently four Telehealth series series. There are currently four Telehealth series that users can view under the Series Page. More series will be added to the Series Page as they occur.

Email Us and Subscribe Features

A new “Email Us” buon has been created which allows users to quickly contact First Naons Telehealth Network. All emails are directed to (vchelp@firstnaonsth.ca). The Subscribe Buon now allows for users to The Subscribe Buon now allows for users to not only subscribe to Telehealth Portal adversements and session reminders, but also the First Naons Telehealth Network monthly newsleer. In compliance with recent legislave changes, the First Naons Telehealth Network Newsleer and other communicaons are only sent to individuals who have subscribed. sent to individuals who have subscribed.

FIRST NATIONS TELEHEALTH PORTAL

NEW UPGRADES AND FEATURES

35

The second survey is a larger quesonnaire, see Appendix 12. In this survey more detailed informaon and feedback on the presentaon itself is collected. We hope that with all the feedback from each detailed survey, we can connue to coordinate and provide meaningful educaon sessions to community members. If parcipants have any quesons or any feedback for the presenters, parcipants can include this in If parcipants have any quesons or any feedback for the presenters, parcipants can include this in the evaluaon. All feedback will remain confidenal and will not be shared outside of the First Naons Telehealth Network.

Home Page Updates

There are several new addions to the Home Page on the First Naons Telehealth Network Portal. These addions include the following:

• Unavailable Site Secon- This secon lists all sites that are unavailable for videoconference due to technical difficules. This secon was created to let users know when booking sessions which sites should not be booked. • Monthly Newsleer Secon- This secon provides a brief descripon, a direct link to view and how to receive the newsleer. This secon was created to bring focus to the newsleer and provide a quick means of access. • Adversements Secon - Important sessions are now highlighted here with direct links to register, view handouts and complete surveys. Upgrades on Stats and Automated Reporng Funcons

The First Naons Telehealth Portal also has an extensive reporng feature built in. This reporng The First Naons Telehealth Portal also has an extensive reporng feature built in. This reporng feature captures stascs related to educaon session adversement/registraon, clinical events and meengs. This reporng feature allows for immediate collecon of data that can be used in the Telehealth program planning process.

Surveys and Evaluaons

The First Naons Telehealth Network The First Naons Telehealth Network purchased and customized survey soware that now allows for the collecon, analysis and storage of feedback received from First Naons Telehealth Network parcipants. A er every First Naons Telehealth Network session, there are two different evaluaons that get sent out electronically to each registered parcipant. electronically to each registered parcipant. The first evaluaon is made up of two quesons: which site you are aending and was your connecon was successful, see Appendix 11. The purpose of this evaluaon is to get accurate numbers for each site; which allow for proper stascal reporng.

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In addion to reporng on sessions, the First Naons Telehealth Portal captures data related to portal usage. Data captured includes daily data traffic, daily page hits and daily visitor hits. A new feature, recently installed, was a views counter on the VC Recordings Archive page. This has proven to be invaluable in the planning of new sessions, as it allows for the First Naons Telehealth Network to gauge interest in certain subject areas.

Benefits

• The Series page allows easier access to all sessions within a series. • Evaluaons give parcipants and community members opportunity to provide feedback. • Reporng feature allows for more informed decision making in the planning of next year’s acvies • Allows for immediate access to informaon related to videoconferencing and past sessions.

Challenges

• There are limited responses from users with the large evaluaons despite several reminders during sessions. • It’s a challenge to reach out and generate new users and have them register for First Naons Telehealth Network sessions. • Many opportunies for interacon exist on the First Naons Telehealth Network Portal and Newsleer but few Telehealth users have ulized them. • The interface of the Portal appears outdated compared to other websites.

On a quarterly basis videoconference usage reports are compiled for Health Directors. These videoconference reports include informaon about clinical, educaonal and meeng videoconferences that have taken place in the me span. The reporng quarters span the following me frames; April to June, July to September, October to December and January to September, October to December and January to March. These reports can be used to monitor usage of Telehealth, plan upcoming acvies and view opportunies of expansion. Along with community specific reports, Health Directors are provided with an overview of Telehealth usage throughout the First Naons Telehealth Network. Health Directors are encouraged to contact the Health Directors are encouraged to contact the First Naons Telehealth Network with any quesons they may have or discuss opportunies to improve offerings for their community.

QUARTERLY VIDEOCONFERENCE USAGE REPORTS

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Successes

• Transparency surrounding Telehealth usage allows for informaon to be available to decision makers when needed • Various methods of communicaon allow for individuals to access informaon in a way that works best for them. • Encourages Health Directors to examine their Telehealth priories and assess and idenfy any needs. • Creates opportunity to engage with Health Directors on a quarterly basis.

Challenges

• Communicaon from users has been lacking. Communicaon has been going out on a consistent basis but it’s been difficult to gauge the effecveness of each method. • Feedback regarding Quarterly Videoconference Usage Reports has been limited. Whether lack of feedback is due to method of transmission, lack of interest or other reason has yet to be determined. • Receiving up to date contact informaon for the Health Directors makes sending reports to the correct person troublesome. • Lack of usage is consistently reported and seems to persist despite being approached to assist in planning or providing support.

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The inaugural First Naons Telehealth Newsleer was distributed in September 2015. The reason behind the newsleer is to provide all upcoming Telehealth informaon to users in a fun and creave way. The newsleer is sent out the first working day of every month; excluding the months of December, July and August. Each addion provides a recap of the August. Each addion provides a recap of the previous month, upcoming sessions, and spotlight on the First Naons Telehealth Network Portal as well as other unique features. The newsleer is a dynamic document that changes throughout the month; most recently we have added a Telehealth Games secon.

The newsleer is sent out to all the First Naons Telehealth Portal Subscribers. At the me of this report, there are over 540 subscribers to the First Naons Telehealth Portal. Once the newsleer is sent out, the First Naons Telehealth Network is provided with up-to-date analycs that lists how many views, how many links were clicked, who has views, how many links were clicked, who has opened the newsleer as well as top clicks. All newsleers are posted to the First Naons Telehealth Portal in PDF form the same day the newsleer is sent to Subscribers. Users can access the newsleers via the Library Page or by clicking on the newsleer link on the Home Page. A full copy of the First Naons Telehealth Page. A full copy of the First Naons Telehealth Network Newsleer is included in Appendix 13.

FIRST NATIONS TELEHEALTH NETWORK COMMUNICATION STRATEGIES

TELEHEALTH NEWSLETTER

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This document captures historical and current events of Telehealth. It is meant to provide context on how Telehealth started and how it has impacted communies. First Naons Telehealth Network is searching for community feedback and stories to include in this document. Community highlights are crical not only to emphasise the importance of Telehealth but to also bring forward community successes and showcase the forward thinking of communies. Several Telehealth programs and iniaves will be featured along with some stascs and user narraves.

“Supporng Growth of Telehealth through Community Connecons” is expected to be completed “Supporng Growth of Telehealth through Community Connecons” is expected to be completed and printed by winter of 2016. This document will be available online PDF on the First Naons Telehealth Portal. A few printed copies will be distributed to HCoM Sub-Commiee members.

Benefits

• Having the newsleer allows for a unique and creave way to share informaon to Telehealth Subscribers. • There are analycs and reports for each newsleer that is sent out. These analycs track top clicks, most viewed sites and the overall number of opens. • The newsleer is sent out via email inially as well as posted as a PDF on the First Naons Telehealth Network Portal which allows for people who are not subscribers to view the newsleer. • The email newsleer is interacve. Links and surveys can be created that allow for readers to access more informaon at the click of a buon.

Challenges

• Each newsleer contains a Community Highlight secon. Although it’s important to highlight the posive ways that Telehealth supports users however, it’s been a struggle receive a response from community. • Each month readers are encouraged to provide feedback but no responses have been received • The number of users reading the email has steadily declined. • Creang unique content every month without contribuon from communies and FNIHB staff.

SUPPORTING GROWTH OF TELEHEALTH THROUGH COMMUNITY CONNECTIONS

40

In an effort to increase reach outside of frequent users of Telehealth, session posters have been created and circulated. Posters are created specific to each session and includes informaon about the session, speaker and learning outcomes. These posters are aached to session details on the portal as well as in email reminders. The email reminders include a note for users to print and circulate the posters as they see fit. See Appendix 14 for a sample of session posters.

There have been manuals created for both internal and external use. For Telehealth users, there are documents and training manuals that are available on the First Naons Telehealth Network Portal, as menoned in the Training Documentaon secon of this report. There are mulple PowerPoints created for training purposes as well.

New documentaon has been created for internal employee use. It was important to the First New documentaon has been created for internal employee use. It was important to the First Naons Telehealth Network to streamline beer working processes. This guarantees connuity of care and constancy of troubleshoong. These documents vary in length and topic. They provide informaon from installing equipment to day to day job dues. Lots of care and due diligence were

Benefits

• Encourages user parcipaon and feedback as it allows for communies to have their own voice. • Includes informaon that users may or may not have known about Telehealth and the First Naons Telehealth Network. • Includes historical informaon that will put Telehealth in context to newer users. • Will be publicly accessible for all stakeholders, staff and users to view.

ChallengesChallenges

• It is challenging to get communies to respond to requests to provide content. • Ge ng pictures of users who are using the equipment first hand is near impossible. • Large numbers of people providing content for the document, this means that more me will go into eding and preparing the document. • Finding a unique format for the finalized document and dedicang me has taken longer than expected.

CREATION OF TELEHEALTH SESSION POSTERS FOR HEALTH CENTRES

MANUALS AND OTHER DOCUMENTATION

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were used in creang these documents as there was lile to no documentaon prior to this year. It is the hope that these manuals provide an ongoing up to date resource to staff. See Appendix 15 for a full list of internal and external documentaon.

A single toll free number was created to assist clients with accessing the Help Desk as well as First Naons Telehealth Network support. This one number provides a single point of access to a variety of support mechanisms and features. This system allows for the possibility of stascs to be gathered and analysed on usage. Overall feedback from users has been very posive and well received. A poster has been created and circulated to highlight the centralized number, see Appendix 16. Each Health Centre has received mulple versions of the posters to place throughout their Health Centres.

First Naons Telehealth Network Strategic Plan 2015-2020 was approved in the fall of 2015 by the HCOM Subcommiee Operaons and Support. The goals of the Strategic Plan are:

1. Expand use of Telehealth in clinical, educaon and administrave capacies. 2. Enhance partnerships between First Naons and key partners including health professionals, telehealth programs, and Alberta Health Services.

The Strategic Plan has five Strategies:

1. Increase communicaon and awareness with key stakeholders. 2. Enhance the First Naons Telehealth Network. 3. Facilitate clinical and educaon opportunies in First Naons Communies. 4. Enhance infrastructure and support. 5. Strengthen AHS engagement.

This year proved to be one of growth and improvement for the First Naons Telehealth Network. From the growth of relaonships, expansion of exisng services and upgrading of technical equipment, the First Naons Telehealth Network connues to thrive in the ever-changing landscape of health services. The common thread that remains is its focus. The First Naons Telehealth Network has always been and connues to be community focused. It is through feedback from community and support from partners that the First Naons Telehealth Network can connue on its trajectory towards innovaon and success.

CENTRALIZED HELP DESK AND SUPPORT NUMBER

FIRST NATIONS TELEHEALTH NETWORK STRATEGIC PLAN 2015 - 2020

CONCLUSION

phone: 1-888-999-3386email: vchelp@firstnaonsth.caweb: www.firstnaonsth.ca

PROGRAM CONTACT INFORMATION

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YEAR END REPORT APPENDIX

Map of First Naons Telehealth Network Sites

APPENDIX 1

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First Naons Telehealth Network Diagram

First Naons Telehealth Network Organizaon Chart APPENDIX 2

APPENDIX 3

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Technician Checklist

Telehealth Tickeng BreakdownAPPENDIX 4

APPENDIX 5

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Example of a First Naons Telehealth Network Inventory Ticket

Site X Knowledge Base Page

APPENDIX 6

APPENDIX 7

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Clinical Stascs

Videoconference Recording Views

APPENDIX 8

APPENDIX 9

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Educaon Stascs

Short Evaluaon

APPENDIX 10

APPENDIX 11

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Long survey APPENDIX 12

First Naons Telehealth Network April 2016 Newsleer APPENDIX 13

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APPENDIX 14Sample Session Posters

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Documentaon list for First Naons Telehealth Network APPENDIX 15

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Sample Poster of Centralized Number and Videoconference Support APPENDIX 16