Technology overcomes geography
One of the largest of those initiatives, the Ontario Telemedicine Network (OTN), delivers clinical, educational and administrative services to more than 441 health care sites throughout the province. Ed Brown, OTN's CEO, says, "Last year, we supported over 32,000 patient consultations, nearly 7,000 educational events and an equal number of administrative sessions across the province. (This is) one of the most active telemedicine networks in the world. Health professionals can actually 'see' a patient and manage his or her care without the patient having to travel or wait as long. It is a very exciting development."
The network uses live, two–way video–conferencing with medical devices such as digital stethoscopes and hand–held exam cameras to reproduce the health provider patient interaction over a distance. Launched in 2006, the program was initially provided through hospitals and has expanded into community settings such as primary care and mental health facilities. "The next great step for us," says Dr. Brown, "is to move right into the patient's home. That's really where telemedicine is going.
"Tele–homecare is very powerful technology in terms of improving patient outcomes and reducing health care costs, because it empowers patients to manage their own illnesses. We improve care – and patients are making fewer trips to the emergency department and being admitted to hospital less often. When you improve patient outcomes, improve satisfaction with the health care system and reduce system costs, that's very powerful technology."
In Eastern Canada, similarly advanced technology is making an equally enormous difference in patient outcomes and treatments costs. Mike Silver, a radiologist at St. Martha's Regional Hospital in Antigonish, says, "As technology evolved, we had the ability to ensure that all of our images were digital, but the real challenge was to store and distribute all that information to wherever it was needed in a secure manner.
"In Nova Scotia, the tele–health community put together a provincewide Picture Archiving and Communication System (PACS). Every hospital is linked via a fibre optic network within one firewall, and we have security officers in Halifax protecting the entire network. That approach made it easier to have a central archive. Now no matter where you are in the province, you're able to access the required images."
While all of that sounds very technical in nature, the impact it has had in human terms is immeasurable. "A week after the system was set up, I was on call and my coverage included rural Cape Breton," says Dr. Silver. "Near Neal's Harbour, a rugged area that is often impassable during winter storms, there was a car accident. A young girl of about six was involved, and the physician in Neil's Harbour identified what might have been a neck fracture. But in kids, there are growth centres that can look like fractures."
Dr. Silver was able to examine the digital image of the girl's neck and reassure the physician that the finding was normal. "Prior to the implementation of the system, she would have been put on a backboard in a cervical collar and transferred by air ambulance to Sydney or Halifax. It would have cost the province somewhere in the range of $10,000 – and cost her parents a lot of anguish and worry. It all happened during a terrible snow storm, so there is also always the chance of potential disaster – losing the air ambulance. With the system in place, the referring physician got the information he needed in a timely manner, they took the cervical collar off and sent her home. She was fine." "Telemedicine is a very important enabling tool," says Dr. Brown. "If you look at each of the big issues today – access to care, quality of care, primary care, wait time strategies, chronic disease management, patient safety – there is a role for telemedicine. The question is, 'How do we leverage this technology to really improve outcomes and create a better, more sustainable health care system?'"