Access to Health Services in the Northwest Territories of Canada through Telehealth Expansion

Abstract

The Northwest Territories Health and Social Services system faces the challenging task of delivering health services to a population that 1) is split between urban and extremely rural settings and 2) is approximately 50% Indigenous and faces inequality rooted in historical discrimination. In an era marked by technological innovation, technology plays an increasingly important role in healthcare, especially in rural settings.

In the past decade, Project ECHO (Extension for Community Healthcare Outcomes), a telehealth model that connects primary care clinicians with medical specialists, has been developed to address a worldwide specialist shortage and the need for specialist knowledge in remote and underserved areas. The ECHO model serves as a workforce amplifier by using technology, shared best practices, and case-based learning through hub-and-spoke networks to train and support primary care clinicians in rural areas. Because this model seeks to address disparities in healthcare, rising healthcare costs, and health system inefficiencies, it has the potential to strengthen the Northwest Territories Health and Social Services system by improving the delivery of health services in remote communities.

This thesis evaluates the need for improvements in access to health services for residents of the Northwest Territories through an overview of the unique health challenges that Northern communities face and factors important to the delivery of health services in the Northwest Territories. Once establishing this need, I analyze the current operation of the ECHO model in terms of implementation successes and challenges and the Northwest Territories’ commitment to the use of telehealth for improving the delivery of health services to its residents. Finally, I determine the feasibility of Project ECHO expansion for mental health in the Northwest Territories with respect to 1) technical implementation, 2) administrative support, 3) community support, 4) available funding, 5) political will, and 6) the cost-effectiveness of the model.

My analysis found that the ECHO model would address current gaps in the territory’s delivery of health services and aligns with territorial goals of strengthening primary care, increasing attention to mental health, and expanding its use of telehealth to reach more patients. I conclude that the model is currently feasible in the Northwest Territories but that further investigation is needed to determine how best to implement it with regard to technical implementation, funding, and cost-effectiveness. Overall, Project ECHO’s potential for success in the Northwest Territories indicates that the Government of the Northwest Territories should strongly consider implementation of the model and further investigate its feasibility and effectiveness.