It’s Time to Tear Down Telehealth Barriers on Remote First Nations

When it comes to health care, remote First Nations face serious challenges. Access to services is one of the biggest. Right now, telehealth has the potential to help – but there are major obstacles in the way.

Currently, most patients in First Nations communities experience poor continuity of care. Many face health complications due to insufficient follow-up with caregivers and medical professionals. Access to specialist expertise may also be limited – or non-existent.

A lot of the factors that contribute to this state of affairs are social and historical. Working through them will take time. But logistical barriers also play a role, and the steps required to tear these down are more straightforward. Take, for example, the implementation of telehealth.

One of the biggest barriers to contemporary telehealth is poor wifi and cellular networks. On remote First Nations, there’s been a lot of recent progress on these fronts. But there are still communities that don’t have reliable access.
Given all of the benefits that telehealth provides, isn’t it time to find a solution?

Access to Health Care: Still a Unique Challenge

It’s no secret. In many rural and remote communities, residents have difficulty accessing the health care services they need. Living far away from medical specialists and leading health care facilities poses obvious challenges. But in remote First Nation communities, geography isn’t the only consideration.

In a talk to a parliamentary committee, Dr. Michael Kirlew noted that services on First Nations are “far inferior” to what most people in Canada receive. He highlighted the role that systemic discrimination has played in creating unequal access to care.

One of the many issues Kirlew delved into was access to specialist expertise. Speaking of his work in northern communities, he noted that mental health care was “virtually non-existent”.

A recent auditor general’s report was just as eye-opening. Findings indicate that clinical services and medical transportation are far from guaranteed on First Nations. Not only that, but many nurses working in the North were found to have inadequate training.

These issues are complex. And given the many social factors at play, addressing them won’t be easy. But Government and service providers can’t forget about logistical considerations, which are just as critical. Taking concrete steps toward improving access will go a long way.

Telehealth Revisited – the Potential Value for Remote Health Care

When it comes to providing better health care services in remote First Nations, feasibility is key. Because in many communities, the need is urgent.

There’s no doubt that strategies to attract and retain care practitioners are important. But what can community leaders, care providers, and policymakers do to help right now?

In many cases, adopting telehealth is the answer. Of course, this care delivery model has been around for a couple of decades. But now, thanks to major technological developments, it’s making a comeback. And it’s going to be especially beneficial in remote communities.

In the past, telehealth technology enabled remote patients to check in with health care providers from a distance. In many cases, it helped them connect with specialists they would never otherwise have had access to. Technology also made it possible for providers to share patient information, improving care overall.

Telehealth will continue to fill these functions – but in even more beneficial ways. Right now, improved videoconferencing and information-sharing technologies are changing health care for the better.

And because these capabilities are now available through mobile devices, they’ve become more accessible and convenient. They’re also easier to use than ever before – even for those who don’t possess high-level technical skills.

If telehealth technology were properly harnessed, health care in remote First Nations could quickly improve.

High-quality follow-up care would result from better patient-practitioner communication. Unprecedented continuity of care would occur if care plans were shared easily, and in real time. And major service gaps – such as the lack of mental health support identified by Dr. Kirlew – could be closed.

Ongoing Telecommunications Barriers

In recent years, there’s been a push from First Nations communities to expand cellular and wifi coverage. A desire for better access to health care is one of the reasons many advocates have championed the cause.

There are First Nations projects like First Mile, which encourages communities to control their broadband networks. There’s also K-Net Mobile – an Ontario cellular service provider that began with the leadership of the Keewaytinook Okimakanak tribal council.

These kinds of information and communication technology projects have the potential to greatly improve health care.

K-Net clearly understands. The company introduced DiabeTEXT, a program that enables diabetes workers in participating communities to send self-care reminders to patients on their phones.

In partnership with First Nations, advanced telehealth apps could take improving care to the next level. And communities with reliable cellular and wifi networks will see the biggest benefits.

Improved coverage would allow more patients to connect with caregivers and engage with their health information via mobile devices.

Crucially, it would also enable medical practitioners and care providers to connect with one another over long distances. Imagine the difference these connections could make in situations where patients urgently need treatment.

Let’s say a nurse working in a remote First Nation has to treat someone experiencing a health emergency. The procedure that could help the patient isn’t particularly difficult to perform. But the nurse has never done it before.

Using a telehealth app with videoconferencing capabilities, the nurse could receive coaching from a qualified specialist.

But the absence of cell towers or wifi service could make this process difficult, if not impossible. The same is true of circumstances where caregivers, health care practitioners, or patients need immediate access to health information.

The Value is Clear

In recent years, telecommunications infrastructure has improved significantly in remote First Nations communities. But the fact that some regions are still without coverage is unacceptable.

Consider this story. Recently, a car and a half-ton truck collided between the northern Saskatchewan communities of Black Lake and Stony Rapids. The accident occurred just weeks after cell service became available in the region.

A passerby was able to call for help, and the injured party received the treatment he needed to recover. Without cell coverage, this scenario could have played out very differently.

These events illustrate just how important digital connectivity can be. And when it comes to health care delivery, there’s no shortage of potential problems that can occur without it.

Feature image courtesy of Blue Coat Photos

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COPD Education – Onboarding


To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Patient, Educator (Nurse, RT, the Physician could also be the educator)

One 60-90 min session with the Educator

  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
COPD Education – Continuous Maintenance


To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Patient, Educator (Nurse, RT or Physician)

A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
COPD Respiratory Status Follow-up


Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Patient, Educator (Nurse, RT or Physician)

Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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