Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System
Authors: Seto Emily , Smith Dallas , Jacques Matt , Morita Plinio Pelegrini 
Published: August 2019

Background
Telehealth has been shown to improve access to health care and to reduce costs to the patient and health care system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities.

Objective
The study aimed to explore the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities.

Methods
A mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders.

Results
Since 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06% [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth.

Conclusions
While clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth’s potential for providing efficient, safe, convenient, and cost-effective care delivery.