October 17, 2012

Health Team expands video access to specialists

As published in The Erin Advocate

The East Wellington Family Health Team (EWFHT) is expanding its telemedicine services, making it easier for Erin patients to consult medical specialists.

Two new nurses, Paula McClintock and Shannon Leighton, started work at the Erin clinic recently. They are dedicated to helping more patients be "seen" by doctors at various locations, with videoconferencing technology provided by the Ontario Telemedicine Network (OTN).

"There is enough work to keep them in their primary role," said Michelle Karker, EWFHT Executive Director. The OTN equipment has been in place for about two years, but they didn't have the staff to operate it regularly. "We're trying to figure out how we're going to squeeze it all in, dealing with that pent-up demand that we've had."

Shannon Leighton and Paula McClintock with Michelle Karker

New provincial support has enabled the Waterloo-Wellington Local Health Integration Network (WWLHIN) to allocate dedicated annual base funding of $934,000, plus $250,000 in one-time funding, to expand telemedicine services in the region. Coordinated by St. Joseph's Health Centre in Guelph, funding has been distributed to care providers such as the East Wellington team.

The Erin clinic now has a full compliment of six doctors and is actively seeking new patients. Karker said the doctors and other team members are "fully on-board", and excited that patients will have quicker access to specialists.

"It has been in place for some time, but mainly in the Thunder Bay - Sudbury, very remote and rural areas," said McClintock. "They've perfected it, and they're finding other uses for it in these more southern rural areas, as another method of gaining access to health care."

One of the early barriers was web connectivity, but the Erin clinic now has access to a highly secure network. To protect the confidentiality of patient information, there is a dedicated Internet Service Provider (ISP) that does not handle other users.

Erin has offered geriatric psychiatry through OTN, but now there is potential to offer a wide range of specialties, including psychiatry for children, teens and adults, a field where medical resources are limited in rural communities.

EWFHT has a directory of physicians offering OTN service and may urge others to do so, especially since the setup is becoming easier and less costly – a desktop unit, instead of a large camera and monitor.

"It opens up the possibility of tapping into more resources," said Karker. EWFHT is currently making arrangements with a respirologist, and hoping to find a specialist to help patients with chronic pain.

"We're definitely looking into a physician who can diagnose fibromyalgia – there's a need for that," said Leighton. "And we've found that there are support groups on line as well."

Patients in a large city might attend a patient group for a particular illness, but in a small town, there may be no one else with the same condition. OTN enables them to attend the local clinic and participate in a support group through a video link. The system also allows staff to take courses or participate in meetings without having to travel.

EWFHT will also offer a service called Telederm, where a high quality digital photo of a skin condition is sent to a dermatologist, enabling a diagnosis or advice back within two weeks, instead of a patient staying on a waiting list for six months to see the doctor in person.

Some patients will still need to travel to see a specialist for certain procedures, but OTN can reduce the number of trips by allowing the preparatory consultation and follow-up to be done remotely – including arrangement of ongoing help through the Community Care Access Centre (CCAC).

Doctors will be able to review things like x-rays and blood test results before a session starts. Patients will arrive at the clinic early enough to have the nurse do any required assessments and equipment testing before going on-line.

An OTN session can involve much more than sitting in front of a camera and having a discussion. The nurse may operate a hand-held camera that can show the doctor a close-up view of a body part – for example, to show the severity of a hand tremour. It can also be used to follow a patient as they walk, so the doctor can see their gait.

Nurses will gather data and give assessments to the doctors. Information such as blood pressure, respiratory function and test results can be instantaneously transmitted. Nurses can use a digital stethoscope, while doctors can click on a picture to show where it should be placed on the patient, and hear the same audio as the nurses.

"They are their eyes and ears and hands on the other end of the camera," said Karker.

Matt Smith, previously the Manager of Rehabilitation and Ambulatory Services at St. Joe's, has been hired to provide coordination for the 67 OTN sites within the WWLHIN, enabling training and the sharing of ideas among the health professionals.

"This project will enable us to try some new ways to improve equity across the Waterloo Wellington LHIN and increase access to specialist care, especially in rural areas,” said Smith.

"By investing in this technology and the people who use it, we are providing residents with better health, better care, and better value for taxpayer dollars,” said Joan Fisk, WWLHIN Board Chair.

In 2011/12, the use of telemedicine in Ontario has resulted in an estimated $44 million in avoided travel costs. More than 3,000 health care professionals use OTN across more than 1400 sites in Ontario, including 67 in Waterloo-Wellington. This year, the system will deliver more than 200,000 patient visits.

"It's about the ability to get the care in a way that is easier and instant, so less wait time, and able to get to diagnostic equipment that you might not be able to get to," said Fisk, in an interview. "It's all about communication, more information to the patient. Also to get in front of a specialist, which you would have to drive to. There you are in a virtual situation, it's really quite impressive."

"For patients, it means greater peace of mind knowing that medical knowledge and expertise are easier to access with the help of this technology,” said Dr. Ed Brown, CEO for OTN, which is an independent, not-for-profit organization funded by the Ontario government.

Fisk said the LHIN is dedicated to "working hard with the hospitals, with the health service provision, to get more access to care – every minute that's what we're focused on. Ultimately it's about getting better care."

The WWLHIN administers almost $1 billion in health care funding for regional hospitals and community care, not including the costs of doctors or regular operations of family health teams.
Fisk said change often comes slowly in health care, due to habits engrained over many decades.

As an example, she said not all doctors are eager to put all of their files onto a different, shared system called Clinical Connect. It is a secure web portal delivering integrated electronic health records to thousands of health professionals from Niagara, Hamilton, Haldimand, Brant, Waterloo and Wellington areas.

That system will also consolidate patient information from hospitals and Community Care Access Centres (CCACs), and will connect with telemedicine initiatives, said Fisk.

"The idea is, you present yourself at an emergency department, they click on your OHIP number, and they'll know what diagnostic tests you've had, they'll know what your physician has had to say about you, what surgeries you've had. Especially for frail seniors, this is so important," she said.

"Trying to get there has been an unbelievably difficult process...Younger doctors are used to it. Ultimately, I think we have so much more opportunity in front of us – this is just the beginning."