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Scope of telehealth network broadens in North (8/02)

By Ian Ross Armelle Hope considers herself a walking and talking “miracle” of telemedicine. The 58-year-old Timmins resident attributes the NORTH Network to saving her life.

By Ian Ross

Armelle Hope considers herself a walking and talking “miracle” of telemedicine.

The 58-year-old Timmins resident attributes the NORTH Network to saving her life.

After suffering a broken leg in a serious car accident two years ago, an magnetic resonance imaging of her skull revealed she had emerged from the crash without any head trauma, but the results unexpectedly displayed a golf ball-sized brain tumour. Clearly not relishing the idea of having the top half of her cranium lifted off and probed by a Sudbury neurosurgeon, it was suggested she obtain a second opinion from Toronto.

Instead of waiting months just to secure an appointment while her condition potentially worsened, a two-way live videoconference was arranged through the NORTH Network between herself and her doctor, and a neurosurgeon at Sunnybrook Hospital in Toronto.

Out of the consultation came the recommendation for a less invasive approach that did not cut the skull or touch the brain, but employed a process that involved running a scope through her nose.

“There was no hesitation on my part,” says Hope, a French-language instructor at Collège Boréal. “I had absolutely no difficulty in making an informed choice.”

With her leg still healing in a cast, the procedure was carried out at Sunnybrook a little more than a month after the initial diagnosis, and the tumour lodged in her pituitary gland was removed.

Telemedicine has become so popular that daily scheduling conflicts have necessitated the addition of a second studio at the Timmins and District Hospital, now widely regarded as the hub of telemedicine in Ontario.

“With all the new sites we’re bringing in across the North, we’re just bursting at the seams,” says Dr. Rob Williams, the network’s clinical director and champion who is heading up an ambitious Phase 2 expansion program. The expansion is now underway in the northwest to improve health-care delivery to First Nations communities on the James Bay coast.

Since being launched in 1998, the Northern Ontario Remote Telecommunications Health Network (NORTH) has expanded from a meagre four sites in Timmins, Cochrane, Kirkland Lake and Sunnybrook Hospital to 63 sites this year.

From only doing two patient-doctor consults that first month in March, 1998, the network conducted 173 in May of this year, more than 2,500 consultations overall, involving more than 30 disciplines, including neurology, cardiology, dermatology, psychiatry and pediatrics.

“We anticipate by the end of this year to be doing 500 consultations a month,” says Williams.

Telemedicine is the practice of medicine over distance through the use of telecommunications equipment.

In the past, one physician simply phoned another for advice, but telemedicine brings a specialist located hundreds or even thousands of kilometres away into the actual examination room through a live interactive feed.

Though telemedicine is far from being the great equalizer in addressing the North’s doctor shortage, Williams says it does provide a degree of health-care equity, offering access to specialists for people who live hours away from advanced medical care, and in some cases delivers even the most basic medical services to remote nursing stations.

Though medical consults and post-operative follow-ups make up the bulk of the network’s volume, it is also used for continuing- and distance-education opportunities for doctors and rural medical students on placement.

But its real benefits is in saving the sick and the elderly from the aggravation of having to travel to Sudbury and Toronto for examinations and paying out of pocket an estimated $800 for residents in northeastern Ontario and about $1,700 for those in the northwest.

At each site, the network employs basic video workstations with a camera mounted above a large digital monitor for the patients and their family doctor to converse with a specialist over a distance. Their old dial-up system has now been replaced by a secure virtual private network supporting a whole array of diagnostic equipment, such as an electronic stethoscope, X-rays, ultrasound and CAT scans, as well as offering sharper imaging and voice, delivered in real time.

Hand-held cameras enable specialists in Toronto to detect the slightest hand tremors in a Parkinson’s patient, or closely examine a surgical scar.

“It’s nothing less than a miracle as far as we’re concerned,” says Anne Weiler, a clinical services leader and the network’s co-ordinator at the Kirkland Lake and District Hospital.

“We’re a largely poor community with a lot of unemployment, and it saves travel time in having to avoid a trip to Toronto or Sudbury.”

But for all the technology at their disposal, Williams and his support staff of 25 have, and still must overcome, many barriers. The network is expensive to operate. Run as a turnkey operation, there are substantial costs to buy and install equipment for new sites, to set up clinical examination studios, to train medical staff on how to act as video technical support personnel, as well as balance the complexities of accommodating everyone’s schedules.

To that end, the NORTH Network relies exclusively on a consortium of federal and provincial funding partners, health-care providers and businesses, such as Weyerhaeuser in Dryden, when drawing up their annual budget.

This year’s estimated budget with the expanded network comes in between $5.5 million and $6 million.

Even though telemedicine and telehealth networks are rapidly gaining worldwide acceptance in countries as far away as Malaysia, the provincial Ministry of Health (MOH) has been slow to accept the practice. The province does endorse telehealth technology, says Williams, but the MOH views it as a potentially very expensive service, despite the fact the network enjoys so much grassroots support.

As a result, the NORTH Network is forced to pay specialists out of their own budget - about 15 per cent - because current Ontario Health Insurance Plan rules do not recognize ‘virtual consultations’ requiring the physician be physically present with the patient.

In terms of future applications, Williams says performing surgeries over the Internet through the use of robotics combined with videoconferencing is most likely years away, but bringing back the house call through the use of technology is their next step.

Among their next projects is tele-home care, enabling health-care providers such as the Victorian Order of Nurses to be able to see and interact with patients in their home, using this technology. And this month, the NORTH Network will be selectively experimenting on a trial basis with remote-access service to link up their northern studios directly with a physician’s office personal computer in Toronto.