Canada’s newest territory recently became the first jurisdiction in the country to extend telehealth services to every community within its borders.
Nunavut has an advantage in having only 25 communities, but with a geographic territory one fifth the size of Canada, crossing three time zones
and lacking any terrestrial communications networks, it was a challenging project nonetheless.
It’s called the Ikajuruti Inungnik Ungasiktumi (IIU) Telehealth Network. The name comes from an Inuit phrase that means “”a tool to help people from far away.””
It actually started before Nunavut became a separate territory. In 1999, three communities in what was then the Northwest Territories were connected using dial-up videoconferencing technology. Because all phone service in the region is provided by satellite, this system operated over a satellite connection. Two more communities were later added to this original network. But the dial-up system didn’t work well, recalls Angela Butt-Constantine, acting manager of the telehealth project.
“”Because we’re satellite-based, if there was some bad data the call would drop.”” Starting in 2000, the original five sites were upgraded to a system using Internet Protocol (IP), which is less inclined to drop calls due to quality-of-service issues, and five more communities were added to the network, with funding from the Canadian Health Infrastructure Partnership Program (CHIPP).
In 2002, five more communities joined, bringing the network to 15 locations. In 2004, the territory obtained funding from the Primary Health Care Transition Fund to add seven more communities to the network, and then found private donations to pay for connecting the remaining three. The last communities were connected in the fall. Since the territory was created, Butt-Constantine says, Nunavut’s government has invested $18 million in the telehealth project.
Roberta Hildebrand, executive director of the Canadian Society of Telehealth, says telehealth networks can now be found in every Canadian province and territory. Telehealth has particular benefits for people in remote areas, she says. Having worked a year in health care in remote northern communities herself, Hildebrand remembers having to fly patients out frequently. Telehealth can help avoid that.
Ardicom Digital Communications Inc., which provides satellite transport for the network, is partially owned by NorthwesTel Inc. and uses the satellite technology that NorthwesTel already has in place to deliver phone service to northern communities. Some facilities needed upgrading to support the telehealth network, though, and getting technicians to the remote communities was difficult, says Carol Wrigglesworth, service co-ordinator at Ardicom.
Nunavut’s network can support connections to Iqaluit — the territorial capital and largest settlement — and four other communities at one time, says Butt-Constantine. This means individual communities can hold separate conferences with each other or points in the south, or up to five communities, including Iqaluit, can be linked together in a single conference.
The network’s single largest use is health-care education. Fewer than a dozen doctors live and practise full-time in Nunavut, most at the territory’s only hospital in Iqaluit. Most communities rely on doctors — largely from the south — who travel through the territory and visit each location at intervals. Nurse practitioners are the primary source of health care. Physicians can conduct training sessions with nurse practitioners, social workers and technicians in the communities using the telehealth network, Butt-Constantine says. Patient consultations done over the telehealth network are mainly follow-ups. After visiting a community, a physician can use the network to check on patients’ progress. Depending on where they are in Nunavut, patients are seen by doctors in the Northwest Territories, Alberta, Manitoba, Ontario or Quebec. Physicians who treat patients in Nunavut must be licensed in the territory, Butt-Constantine notes, so remote consultations are generally done by the same doctors who visit the territory.
If a patient does have to be transported to hospital, his or her family can communicate by videoconference. The network is also pressed into service occasionally for videoconferences on other government business, and Butt-Constantine says it could have broader uses in future. “”We’re going to be going back to the community to see what the community needs. If it’s shared, then it’s not just the health (care system) picking up the cost.””