Telemedicine, the next frontier: bringing care to where patients live
“On average, it costs the system $50 000 a year to provide dialysis treatment for one person with chronic kidney disease. If a patient is admitted to hospital for an acute illness and requires ‘crash’ dialysis, this admission alone can cost upwards of $20 000, excluding emergency and transport expenses. The impact that these numbers can have on our healthcare system is huge,” says Dr. Jonathan Thomas, a Family Physician in the rural community of Lion’s Head, Ontario.
But according to Dr. Thomas, patients with chronic diseases also bear the burdens associated with their illnesses in a variety of ways. “It would cost our patients around $500 in fuel and accommodations per year just to see a kidney doctor in London, Ontario, our nearest city. For the elderly, it can be really hard to drive the eight hours round-trip for appointments. Many tell me that because of their age, it isn’t worth it and it just isn’t safe.”
While working with the Peninsula Family Health Team in Ontario’s North Bruce Peninsula this month, I gained a better understanding of what these figures mean and how telemedicine, the next frontier in medicine, could potentially ease these burdens. Telemedicine is the use of innovative communications technologies (for example, videoconferencing, remote monitoring, image transmission) to bridge the distance of time and geography in order to deliver health care and or education. It is much broader than Telehealth Ontario, which is a service that patients can call to get general health advice over the phone from a Registered Nurse.
For Mr. B. Hadcock, an 80-year old retired maintenance worker who has lived in Lion’s Head for over twenty years and is a patient at the clinic, the path has not been easy since his diagnosis of Diabetes-related Chronic Kidney Disease. With only $2200 for him and his wife to live on per month in the form of old-age benefits and a pension, the costs of living can add up very quickly. In addition to this, Mr. Hadcock deals with the physical and mental fatigue associated with managing his co-morbid medical illnesses, including an early colon cancer that was surgically removed ten years ago, high blood pressure, high cholesterol and long-standing insulin-dependent diabetes. His wife, now 79 years of age, suffers from severe degenerative arthritis, the kind that has made moving about for simple activities, very difficult. “We do the best we can with what we have, although I know we live on the poverty line, if not below it,” he says.
“These are exactly the reasons why we established a connection with the nephrology group at the London Health Sciences Centre for our patients, via the Ontario Telemedicine Network (OTN),” says Dr. Thomas. With a single school, grocery store and four-bed hospital serving the local community’s 3900 people, cutting-edge technological advancements are not commonplace in these rural parts. And yet, Mr. Hadcock believes that the Peninsula Family Health Team’s commitment to providing him specialized care via the OTN is one of the best things that could have happened to patients like him. “The new video-link (telemedicine) technology will make it cheaper, easier and safer for me to see my kidney doctors. This is a huge bonus for me.”
Renowned as a cottage destination for its beautiful landscapes and water-front properties, Lion’s Head is a popular setting for retirees. Dr. Thomas estimates that seniors make up nearly half of his practice population. “This means that a significant and increasing subset of my population deals with the age-related complications of Diabetes, including Chronic Kidney Disease.”
To meet the need for his patients, Dr Thomas and his inter-disciplinary care team reached out to London Health Sciences nephrologist, Dr. Peter Blake, to establish a virtual clinic using the telemedicine technology provided by OTN. “Normally, I am not what you would consider a ‘techie’ person,” says Dr. Blake. “However, OTN is a simple technology, not more complicated than using a remote control for your TV at home.” In fact, when Dr Blake’s administrative assistant was running late for the first virtual clinic, he was able to operate the technology while seeing patients, with ease. “It takes a little while to wrap your head around the concept, but we have found that patients really like the clinics,” he says. Dr. Blake’s involvement with the project has sparked his interest in another pilot project that uses telemedicine as a supportive tool for patients starting home dialysis.
Interestingly, telemedicine technology is used by 74 Family Health Teams, 39 Community Health Centers and all public hospitals in Ontario. As a result, more than 200,000 patients benefitted from access to medical care last year via OTN. Once considered a barrier to use, cost will become even less of a concern next year when OTN rolls out a new, more cost-effective web-based software application for Telemedicine that can be accessed from a personal computer. Despite the impending savings, there are still barriers that prevent the medium from becoming a mainstay in everyday patient care. “While the technology is there, many healthcare organizations just don’t have the human resources to divert to telemedicine,” says Melody King-Smillie, Regional Manager at OTN. “For some, providing care via OTN can require changes in practice and alterations in workflow. For some physicians with busy schedules, this can be difficult,” she further states. To offset this barrier, a Ministry-sponsored initiative supported the hiring of 191 Telemedicine-dedicated nurses in organizations across the Province, all of whom go through OTN’s training course for nurses. OTN has even worked with the Ministry to establish special billing codes for physician remuneration to further encourage utilization.
Dr. Thomas hopes that his initiative can become a turn-key model, so other organizations don’t have to re-invent the wheel if they decide that such a program is beneficial to patients.
The Peninsula Family Health Team physician group has expanded their use of OTN to access rapid consultations with other specialists, including dermatologists, with demand likely to grow in the coming months for other specialist consultations. With all this said, Dr. Thomas and his colleagues are aware of the niche that OTN plays in patient care. “We are cognizant of the fact that telemedicine will not replace traditional consultations with specialists.” Along similar lines, Dr. Blake says that the key is to use the technology under the right circumstances. “I do believe in the value of face-to-face. However, there are some kidney-related pathologies that can at least initially, lend themselves to management that can be coordinated via OTN.”
In Lion’s Head, I witnessed first-hand, the way that the OTN offers an important and essential ‘value-add’ for patients and healthcare providers. It saves patients the associated costs of traveling, keeps them safe and provides them with the care they need, right where they live. With an aging population, telemedicine could prove to be a very useful tool in helping to monitor and manage chronic diseases.
“For the most part, patients appreciate that we are reducing barriers to access, even though we may be losing some of the in-person contact that they are used to,” says Dr. Thomas.
Mr. Hadcock could not agree more. “This is the way of the future for patients like me. The future is already here.”
While it is obvious that telemedicine will never replace the classical bed-side examination, it has surely played a role in providing world-class care for patients in this small town.
Naheed Dosani is a Family Medicine Resident with the Department of Community and Family Medicine at the University of Toronto and is training at St. Michael’s Hospital. Follow Naheed on Twitter @NaheedD