A telemedicine service linking health-care professionals with 26 First Nation communities across Northern Ontario is saving money and bringing improved health care to some of the most isolated communities in the province.
KO Telemedicine will co-ordinate more than 3,000 consultations this year, sparing patients in First Nation communities like Fort Severn, Peawanuck, Bearskin Lake and Webique from having to travel to Thunder Bay and other urban centres for medical care.
Telemedicine eliminates the hardship and expense of travel and allows patients to access health care in a supportive environment without having to worry about the cultural and linguistic barriers they would encounter in the city, said Nancy Muller, KO Telemedicine’s regional co-ordinator.
In the absence of telemedicine services, some members of First Nation communities wouldn’t even seek medical attention, she said.
Teleophthalmology
William Owen of Poplar Hill First Nation is a perfect example. Blind, but resigned to his fate, Owen was finally examined when a KO Telemedicine nurse flew into the community with a retinal camera as part of a teleophthalmology pilot program. The examination revealed that his condition was caused by cataracts and that a simple procedure would restore his vision.
“He just accepted that he was blind and that was his lot in life,” said Muller. Following an operation by Thunder Bay ophthalmologist Dr. Sanjay Gupta, Owen was able to see again.
The teleophthalmology pilot provides retinal screening for approximately 200 patients per year in seven of the 26 communities served by KO Telemedicine. The retinal images are uploaded onto a website and reviewed at a later date by ophthalmologists using store-forward technology.
“It takes one minute for an ophthalmologist to review an image and do a full report,” said Muller. “If there are anomalies, it takes five minutes.”
KO Telemedicine would like to extend the service to all 26 communities it serves, but hasn’t been funded to do so.
Retinopathy
Retinopathy is a common complication of diabetes that can cause blindness. Images taken by a retinal camera are able to reveal damage to the blood vessels.
“With retinopathy, two things can happen,” said Muller. “Either the blood vessels will get weak and start to leak or they’ll start to proliferate.”
People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely laser treatment and appropriate follow-up care.
The teleophthalmology pilot program is a great start, but should ideally be integrated into diabetes care or a total eye care service, said Muller. Electronic health records, she added, are also desperately needed because paper charts currently reside at both family physician practices and federal government nursing stations, but both are incomplete.
KO Telemedicine facilitates approximately 600 consultations per year for the Sioux Lookout Diabetes Program. Prior to the introduction of the service, patients may have been seen once a year. Now, there are consultations daily and, “if someone needs to start on insulin, they can get a consult quickly,” said Muller. Diabetics who are able to see physicians with greater frequency benefit from the coaching and follow-up offered through telemedicine consults, and can improve their A1C test results, she added.
Telemedicine has made a big difference, but providing quality health care to First Nation communities is still a struggle. According to Muller, there is a severe shortage of nurses, and not enough resources to provide everyone in a First Nation community with an annual physical exam.
“Ideally if you’re a physician responsible for a community of 500 people, you’d like to see each person at least once a year, but what you find when you get up there is you’re seeing the chronic disease clients and looking after the acute issues. If more chronic disease patients could be looked after using telemedicine technology, physicians would have more opportunity to see other patients on their visits to remote communities.”
Telerehab
KO Telemedicine’s newest service is a telerehab program offered in conjunction with St. Joseph’s Care Group in Thunder Bay. Patients recovering from strokes in remote First Nation communities are able to link up with a physiotherapist from the comfort of their home using portable videoconferencing equipment.
Without the service, patients would have had to extend their stay in Thunder Bay to participate in rehabilitation, or return home without any rehab care.
Muller would like to see more specialists equipped with videoconferencing equipment right in their offices.
“It’s still a hardship for them because they often have to leave their clinical practice and drive to Thunder Bay Regional Health Sciences Centre. They don’t have their secretary or their charts with them, and it’s frustrating because 20 per cent of scheduled encounters are failures. Half of them are no-shows. It’s a huge problem.”
KO Telemedicine’s office in Balmertown, just outside Red Lake, operates with a staff of 10, but there is also one full-time employee in each of the 26 communities served.
Additional communities will be brought on board as funding is made available and the necessary communication infrastructure is in place.
Aside from enabling clinical consultations, KO Telemedicine also facilitates training and educational events, elders’ gatherings and family visits. Group consultations are also held for maternity care, pain management, weight loss and diabetes education.
