OTN AND THE ABORIGINAL COMPLEX Page 1 of 12

Major Assignment:

OTN and the Aboriginal Complex

Melissa Pavao

6972517

INFO71750

Krizia Mae Francisco

November 30, 2016

OTN AND THE ABORIGINAL COMPLEX Page 2 of 12

Introduction and BackgroundCanada has a vast dispersion of land with a juxtaposition of urban sprawl against

remote, rural locations. Many of these isolated areas are populated with people of

Aboriginal descent. ‘Aboriginal identity’ is a collective term used to reference First

Nations, Métis, Inuit, and/or Registered or Treaty Indian peoples of Canada. (1) These

people exist as a unique entity, engaging in culturally appropriate lifestyles, within a

modernized society. Aboriginals make up 4.3% of the total Canadian population. (1) The

province of Ontario is home to the highest concentration of Aboriginal peoples in the

country, accounting for one fifth of their entire population. (1) This population is

governed by a, “complicated ‘patchwork’ of policies, legislation and agreements that

delegate responsibility between federal, provincial, municipal and Aboriginal

governments in different ways in different parts of the country.” (2)

Health outcomes of the Aboriginal populations have been a longstanding and

reoccurring theme amongst national surveys and public health research. Although their

health has been reportedly improving over recent years, they continue to endure

considerably lower health outcomes than that of the non-Aboriginal populations of

Canada. (2) While access to care is a crucial consideration, these outcomes are also

largely attributed, “to the social, cultural and political factors that have shaped, and

continue to shape, their lives.” (3) This phenomenon has been referred to as the ‘social

determinants of health’ and has come to the forefront of understanding the influences of

Canadian health inequities. (2) Canadian Aboriginals face significant barriers to

appropriate access to quality care.

The Aboriginal peoples are the fastest growing Canadian population and yet the

chair of the Royal College of Physicians and Surgeon’s Aboriginal Health Advisory

Committee argues that, “the state of Aboriginal health is a national embarrassment and

leadership is needed now more than ever.” (14) Aboriginal peoples are disadvantaged,

underserved and will continue to fall through the cracks of the health care system

unless change is harnessed. There needs to be a coordinated effort in addressing the

inequities in health care delivery in order to narrow the gap between Aboriginal and non-

Aboriginal populations in Canada.

OTN AND THE ABORIGINAL COMPLEX Page 3 of 12

Current SituationCurrently, the status of Aboriginal health is extremely complex and the list of

predominant health issues is long. Some of these issues include high infant mortality;

malnutrition and stunted growth; shortened life expectancy; diseases and death

associated with cigarette smoking; alcohol and drug misuse; interpersonal violence,

homicide and suicide; obesity; diabetes; and cardiovascular disease. (2) One of the

biggest demographic pressures on the Aboriginal population is an overrepresentation of

the youth. (4) Table 1 below illustrates the age distribution from 2011. These

disproportions are a direct result of low life expectancy and high fertility rates. (1)

Table 1. Canadian Aboriginal Age Distribution from 2011 (1)

The United Nations Committee on the Rights of the Child has raised concerns

regarding these disproportions and what risks these children are bound to face. (4)

Provincial and municipal ministries estimate that Aboriginal youth, who make up less

than 5% of Canada’s total child population, are representing 40% of the foster care

system. (4) On top of already being considered a disadvantaged population, children

who live in foster care are at a much higher risk for health and behavioural disorders. (5)

The Canadian Pediatrics Society maintains that foster care children reported higher

rates of learning disabilities; ADHD; behavioural and emotional problems; dental

OTN AND THE ABORIGINAL COMPLEX Page 4 of 12

neglect; respiratory disorders; asthma; cerebral palsy; congenital abnormalities;

dermatological disorders; growth disorders; as well as hematological disorders. (5)

Aboriginal children entering the foster care system are a high-risk, special needs

population who face unique barriers to optimal health care. (5)

SolutionTelemedicine has been identified as a key mechanism in improving access to

health services, especially for those who are underserved or living in rural and remote

locations. (6) It is a tool that allows information and communication technologies to

share a variety of health services, information, and expertise over geographical

distance, time, cultural and social barriers. (6) The University of Texas Medical Branch

argues that it holds the potential for not only targeting health care to individual patients

but also targeting health care to specific populations. (7) The challenges facing the

Aboriginals, and more specifically the Aboriginal youth, are not unsurmountable and a

telehealth network promises to tackle many of these obstacles head on.

There are a variety of clinical services that are offered at different jurisdictions via

telemedicine. The Canadian Telehealth Report identifies, “89 distinct areas of clinical

service [that] were reported in 2015.” (8) Some of the most common clinical services

being delivered are mental health and addictions; psychiatry and psychology; pediatrics;

neurology; oncology; dermatology; and diabetes. (8) It also allows for the availability of

education. Telemedicine offers an opportunity for the transfer of information and

knowledge which becomes essential to the wellbeing of the patient as well as the

ongoing competence of health care providers in remote locations. (8) Pediatrics is

actually one of the most common types of telehealth care educational services in the

country. (8) Ontario had to most number of education sessions involving healthcare

providers in 2015. (8) A survey done in the US revealed that children who had access to

telehealth reported positive changes in their overall health and function. (8)

The funding for Aboriginal clinical services is blurred between two government

bodies. First Nations peoples receiving health services on-reserve receive Federal

funding. (6) Otherwise, those who receive specialty care off-reserve are under

Provincial/Territorial jurisdiction. (6) Telemedicine holds the capacity to “virtually”

OTN AND THE ABORIGINAL COMPLEX Page 5 of 12

connect First Nations communities to any health care professional without having to

physically leave the reserve. (6) This could potentially streamline funding. It offers real-

time access to all types of care under one jurisdiction. It also holds the potential for a

number of other benefits including:

Improved access to care

Improved efficiency and productivity

Improved care coordination

Improved access to specialists

Increased patient satisfaction with care

Cost savings

Improved clinical outcomes

Reduction in emergency room use (6)

Telemedicine has been quietly growing across Canada with the volume of

telehealth sessions growing by 120% between 2010 and 2014. (8) The Ministry of

Health estimates that Ontario’s programs have been growing at approximately 30%

annually over the past several years. (9) However, the Ontario initiative is only receiving

0.1% of the health budget and still requires significant start-up capital and operational

funding. (8,9) Funding is critical to the expansion and sustainability of telehealth in

Canada, especially in some if it’s neediest areas. (6) In contrast, as the number of

telehealth sites increases, the cost related to connecting and supporting additional sites

decreases. (6) Sharing infrastructure costs between possible network users, education,

justice, government, could be extremely influential in viability of a telehealth project. (6)

Other provinces, including BC, Alberta, Saskatchewan and Manitoba, have all

made major strides towards telemedicine adoption. Across Canada, there are a number

of regional Telehealth programs that have gained momentum in the past couple years.

(8) The dispersion of these programs’ websites can be seen in Image 1 below. There is

also evidence of the Aboriginal communities taking on initiatives of their own. By 2015,

there were three reporting First Nations Telehealth networks in Canada; KOeTS in

Ontario, FNHA in BC, and FNIH in Alberta. (8) But these projects are very small-scaled,

lack funding and none of them have acquired accreditation yet. (8) While these sorts of

developments are positive in nature, it does increase fragmentation across the country

OTN AND THE ABORIGINAL COMPLEX Page 6 of 12

and makes it difficult for the federal government to focus its attention, and more

importantly their funding.

Image 1. Telehealth Program Websites across Canada (8)

However, Canada needs to focus its effort on regional success, “to serve as a

blueprint for a national strategy for Aboriginal telehealth.” (6) Ontario has shown some

of the greatest progress and according to David Jensen, spokesperson for the Ministry

of Health, “has one of the largest telemedicine programs in the world.” (9) “I believe that

telemedicine is an essential service for the people of Northern Ontario,” said Laura

Kokocinski, CEO of the North West LHIN. (10) “This technology ensures that residents

can continue to receive care as quickly, efficiently, and as close to home as possible.”

(10) Ontario’s current initiative is being monopolized by the vendor Ontario

Telemedicine Network (OTN).

About OTNOTN, which was established in 1993, is a private and secure network that allows

health care professionals in Ontario to provide remote patient care across a variety of

telecommunication devices. (11) It is the most widely used tool in Ontario whose

network and services span across the province. Their vision is, “to be a mainstream

channel for health care delivery and education.” (11) OTN is a trusted provider and a

OTN AND THE ABORIGINAL COMPLEX Page 7 of 12

made-in-Ontario solution that is already integrated into the public health care system.

(11) They represent an independent, not-for-profit organization that is predominately

funded by the Ontario government. (11) OTN has managed to help avoid 25M

kilometers of travel and 27M litres of fuel since 2002, appearing to be a major

opportunity for the remote and isolated Northern regions of Ontario. (10)

OTN usage spans across the majority of the province and is one of the largest

networks of its kind in the world. (10) Northern Ontario accounted for 49% of the

province’s total telemedicine activity. (10) By the end of last year, OTNhub

had 21,390 subscribed users which are made up of physicians, nurses, specialists,

allied health professionals and others. (11) The network currently consists of a total

of 1,652 sites with 3,413 systems across the 14 LHINs. (11) Image 2 below maps out

the locations that are serviced by the OTN. (11) The northern regions of Ontario, where

Aboriginal populations are more concentrated, experience a much wider dispersion of

OTN serviced locations. This is something that OTN and the Ontario government should

seek to address if they wish actually implement change in the health outcomes of the

Aboriginal populations.

Image 2. OTN Service Locations (11)

OTN AND THE ABORIGINAL COMPLEX Page 8 of 12

OTN is using the Internet to allow health care professionals access the network

from their offices using personal computers. (12) They felt they had to leverage the

internet to keep costs down. (12) The existing network is based on core and endpoint

technology from Polycom Inc., Cisco Systems Inc. and Tandberg SA (now a division of

Cisco). (12) In 2011, OTN underwent a cost-effective expansion of its network through a

partnership with Vidyo Inc., a New Jersey company. (13) Vidyo Inc. is a software-based

communication and collaboration platform that is highly flexible and can be easily

customized for individual enterprise needs. (13) This requires a simple software

download on the user end. (12) New technologies and opportunities are going to

continue to push OTN forward in technological development.

OTN offers a number of key functionalities for its users. Below is a

comprehensive list of some these features (11):

eConsult: immediately connects referring physicians and nurse practitioners to

specialists. (11) See Image 3 below to understand how this interaction works.

Image 3. The Process of an eConsult (11)

eVisits: health care professionals can have real-time video visits with patients

and peers through three different methods; PC/MAC, mobile app or room-based

system in a health organization. (11)

telehomecare services: management of a patient’s condition through remote

home monitoring and health coaching. (11)

OTNhub: a one stop shop to access all levels of health care delivery; primary

care, specialists and healthcare organizations. (11)

OTN AND THE ABORIGINAL COMPLEX Page 9 of 12

Education services: videoconference learning, webcast events plus a forum for

the exchange of information. (8)

The capacity to monitor and record a patient’s daily vitals anywhere and at any

time. (8)

OTN Personal Video Conferencing (PCVC): a mobile software-based service

offered for these devices; PC, MAC, and iOS devices. (11)

Monitor user experience: monitor service quality and employ satisfaction

surveys. (8)

Use of an electronic scheduling system to coordinate appointments. (8)

PHIPA compliant: OTN uses a variety of physical, administrative and technical

methods to protect your personal health information. (11)

Future BarriersOTN has already made so much progress in organization and operability, becoming

one of the largest and most successful telehealth networks in the world. Yet there is

great potential for future expansion. There are a number of barriers that may impede on

this development in the future. It is important for OTN to understand and address these

key issues in order to expand virtual-based care to the underserviced populations. (8)

Some of these limitations are examined below:

Lack of a single and coherent government/management structure which has a

major impact on funding responsibilities. (8)

Limited or no interoperability with EMRs, EHRs and other digital solutions. (8)

Lack of coordination across (and sometimes within) the network/program. (8)

Internet performance and availability of bandwidth are important extremely

important factors in getting the Telehealth up in the northern regions (8).

However, there are programs aimed at providing broadband solutions to these

northern, isolated regions like Broadband for Rural and Northern Development

(BRAND). (6)

Uncertainty about which organizations should take on a lead role in supporting

and serving Aboriginals. (8)

OTN AND THE ABORIGINAL COMPLEX Page 10 of 12

Convincing health practitioners of the benefits of trying this new mode of health

care delivery. (9) Especially since the Ministry of Health of Ontario cut the

telemedicine consulting fee to 60% of that of an in-person. (9)

Meeting funding needs for equipment and mass training of health workers. (9)

Readiness of the communities for adoption of the telehealth technologies. (6)

ConclusionCurrently, there is an overwhelming overrepresentation of a high-risk population

that exists within an already disadvantaged segment of Canadian society. The

overrepresentation of the Aboriginal youth is a direct result of the poor health outcomes

of their overall population. Aboriginal children represent a unique portion of the

population whose health care needs require special attention. As previously mentioned

within this report, initiatives that are targeted towards improving their access to quality

care could potentially bridge some of these gaps in health care availability.

Telemedicine has already made major progress in appropriate access across the

country and Ontario has stepped up as a world leader in these developments. Ontario

Telemedicine Network (OTN) shows great promise in addressing some of the key

barriers facing these people. Although there are a number of obstacles the program will

have to face in the future, by already having such a strong presence across the

province, this network could serve as a blueprint for a national initiative. By investing in

a focus on pediatrics, education and family planning in isolated and remote regions of

the province, the OTN program could be met with major successes in Aboriginal youth

health outcomes. OTN has all the tools needed to revolutionize the way that Canada

delivers health care. It is time to finally meet the needs of these people and invest in a

program that will bring about change for current and future generations. After all, these

children are the future of this nation.

OTN AND THE ABORIGINAL COMPLEX Page 11 of 12

Reference List1. Statistics Canada. Aboriginal Peoples in Canada: First Nations People, Métis and

Inuit [Internet]. 2016 [cited 2016 Nov 28]. Available from:

http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-

eng.pdf

2. National Collaborating Centre for Aboriginal Health. An Overview of Aboriginal

Health in Canada [Internet]. 2013 [cited 2016 Nov 28]. Available from:

http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/101/

abororiginal_health_web.pdf

3. National Collaborating Centre for Aboriginal Health. The State of Knowledge of

Aboriginal Health: A Review of Aboriginal Public Health in Canada [Internet].

2012 [cited 2016 Nov 28]. Available from:

http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/52/

SOK_report_EN_web.pdf

4. Gough P, Trocme N, Brown I, Knoke D, Blackstock C. Pathways to the

Overrepresentation of Aboriginal Children in Care. Centre of Excellence for Child

Welfare. 2005; 23E: 1-3.

5. Ponti M. Special Considerations for the Health Supervision of Children and Youth

in Foster Care. Canadian Pediatric Society. 2008; 13(2) 129-32.

6. Muttitt S, Vigneault R, Loewen L. Integrating Telehealth into Aboriginal

Healthcare: The Canadian Experience. International Journal of Circumpolar

Health. 2004; 63(4) 401-414.

7. Vo A, Brooks GB, Farr R, Raimer B. Benefits of Telemedicine in Remote

Communities & Use of Wireless Platforms in Healthcare [Internet]. [cited 2016

Nov 29]. Available from:

https://telehealth.utmb.edu/presentations/Benefits_Of_Telemedicine.pdf

8. Canada’s Health Informatics Association. 2015 Canadian Telehealth Report

[Internet]. 2015 [cited 2016 Nov 29]. Available from: https://www.lecsct.ca/wp-

content/uploads/2012/10/2015-TeleHealth-Public-eBook-Final-10-9-15-

secured.pdf

OTN AND THE ABORIGINAL COMPLEX Page 12 of 12

9. Glauser W, Nolan M, Remfry A. Telemedicine on the Rise across Canada

[Internet]. 2015 June 25 [cited 2016 Nov 29]. Available from:

http://healthydebate.ca/2015/06/topic/telemedicine-across-canada

10.Ontario Ministry of Health and Long-Term Care. Telemedicine- Improving Access

to Care through Technology [Internet]. 2008 [updated 2014; cited 2016 Nov 29].

Available from:

http://www.health.gov.on.ca/en/pro/programs/ecfa/action/primary/pri_telemedecin

e.aspx

11.OTN [Internet]. 2016 [cited 2016 Nov 28]. Available from: https://otn.ca/

12.Solomon H. Huge Expansion of Ontario Telehealth Network [Internet]. 2011

[cited 2016 Nov 29]. Available from: http://www.itworldcanada.com/article/huge-

expansion-for-ontario-telehealth-network/44661

13.Hackensack NJ. Vidyo Selected By Ontario Telemedicine Network to Expand

Home Care and Telehealth Services Using Video Conferencing Solutions

[Internet]. 2011 Aug 2 [cited 2016 Nov 29]. Available from:

http://www.vidyo.com/company/news-and-events/press-releases/vidyo-selected-

by-ontario-telemedicine-network-to-expand-home-care-and-telehealth-services-

using-video-conferencing-solutions/

14.Reading J, Farber B. Why is Canada ignoring the health of aboriginal peoples?

[Internet]. 2015 April 9 [cited 2016 Nov 30]. Available from:

http://www.theglobeandmail.com/opinion/why-is-canada-ignoring-the-health-of-

aboriginal-peoples/article23856403/