BY NORM TOLLINSKY
Date Published | Sept. 20, 2007

The Ontario Telemedicine Network (OTN) has been given the green light to launch a Telehomecare pilot project that will allow health-care professionals to remotely monitor patients in
their homes.

The program will be administered by five or six family health teams across the province, each of which will select 120 patients with chronic diseases – predominantly congestive heart failure and chronic obstructive pulmonary disease.

“We will be putting telemetry equipment and, if needed, a videophone, into the patients’ homes to allow health-care providers to monitor things like blood pressure, pulse oximetry, weight and blood glucose, if appropriate,” said OTN Chief Medical Officer Dr. Rob Williams. “There will be a little black box next to the phone that is programmed to ask 10 questions every day. Are you more short of breath or less short of breath? Have you gained weight or lost weight? Are your ankles more swollen or less swollen?”

The answers will be uploaded onto a server and trended. Patients whose answers fall outside an acceptable range will be contacted by a family health team nurse for follow-up.

The early warning system will allow health-care providers to intervene before a patient’s condition deteriorates and results in hospitalization.

The White Oaks Family Health Team in Timmins is one of the family health teams selected for the pilot. The others have yet to be announced.

Scheduled to be up and running within the next six months, the Telehomecare project is an example of the evolution of telemedicine technology into the broader community.

Emergency triage

The OTN has also submitted a proposal to the Ministry of Health and Long-Term Care and the Canada Health Infoway for a pilot project linking health-care professionals in a hospital emergency department with 40 long-term care homes.

Nurses at long-term care homes tend to err on the side of caution and are quick to call 911 when residents fall ill.

“What we’re looking forward to is an emergency triage system so that when a resident becomes ill, and staff are worried, they can have an urgent video conference with a physician, who will review the case with them,” said Dr. Williams. “We believe that in a good number of cases, it will be possible to empower staff to manage the resident on site without a transfer.”

The OTN has looked at various models for such a service and has come to the conclusion that a dedicated site staffed by emergency physicians and nurses would work best.

“So, if Sudbury was doing it, they would do it for all of northeastern Ontario,” said Dr. Williams. “You would staff up the emergency department in Sudbury with a few extra nurses and maybe a physician and you would have a telemedicine studio there.”
Providing nurses in long-term care homes with such support would relieve the burden on ambulance services and emergency department staff, and spare residents the anxiety and distress of unnecessary trips to hospital.

The OTN started expanding telemedicine beyond the confines of hospitals about four years ago and now has studios in long-term care homes, prisons and physicians’ offices.

All but a few hospitals in the province are equipped with studios and, most hospitals in Northern Ontario have at least two. The Timmins & District Hospital has eight, said Dr. Williams.

“It’s a somewhat portable piece of equipment that can be moved from one location to another and, often, a hospital will hardwire two or three locations and move the equipment around.”

However, as health-care providers and hospital staff became more familiar with the technology and demand increased, additional studios were acquired.

Professional development

In addition to being used for clinical consultations, the technology facilitates professional development activities and allows hospital administrators in multiple sites to meet without having to waste time and money on travel.

The Ontario Telemedicine Network is the largest telemedicine program in North America and was driven primarily by the unique health-care needs in the North, said Dr. Williams.

“The amount of video consulting work in Northern Ontario is enormous compared to southern Ontario, but there’s the obvious need in the North. There’s a much greater incentive to use the technology in the region because of geography and distances.”
The health-care community in southern Ontario is catching on, but the applications are different, he noted.

“They’re using it a lot more for education and administrative support. They’re also doing case counselling between hospitals and targeting disabled people who have trouble moving from one end of the city to another.”

The OTN has also deployed telemedicine equipment in 25 physician offices, including specialists in Sudbury, Thunder Bay and Toronto who consult with patients in under-serviced areas.

The OTN provides the equipment free of charge to physicians who are heavy users of the technology in hospitals. It also covers the physician’s fees as long as they are unable to bill OHIP for consultations via teleconferencing technology, although that’s due to change by April 1, said Dr. Williams.

Typically, the studios at patient locations are equipped with a camera and monitor, a hand-held camera for close-up imaging, a digital stethoscope, an endoscopic light source to examine ears and throats and a document camera.

Also on the horizon is a new Store Forward service. Unlike conventional real-time telemedicine technology, Store Forward is a multimedia, secure email consisting of a video clip and text that can be reviewed by a consultant at a later date.

“If you have a rash or a wound that is being managed and needs to be monitored, the practitioner can record a video clip and forward it to a consultant. The next day, the consultant can look at the e-mail, assess the situation, make recommendations and reply,” said Dr. Williams.