When he’s not attending to his regular duties as CEO of the Ontario Telemedicine Network (OTN), Dr. Ed Brown plays host to a steady stream of visitors from all over the world. “I think we have the largest and most active telemedicine network in the world,” he says. “People are very curious to see what we do.”
The OTN is a provincewide, two-way video conferencing network that provides patients with access to clinical services at health care locations across the province. In addition to clinical care, the network is also an important avenue for delivering distance education and enabling meetings between health care professionals and other partners.
Brown likens it to an “examination room over a distance,” where doctors and clinicians can see patients in their own communities without anyone having to travel any great distances. Last year alone, 102,000 patient “events” were conducted on the OTN. In addition, there were over 10,000 educational events with 360,000 health care providers. In some cases, educational sessions are held over multiple sites at the same time.
“The fundamental problem that led to the development of telemedicine in Ontario was that we have a big province where people traditionally have had to travel a lot to get access to health care … or they just didn’t access it at all,” Brown explains.
While the first pilot telemedicine projects were launched in 1998, it was around 2006 that technology improved to the point where telemedicine really started taking hold with health care providers and educational facilities, Brown says. “It has never been hard to set up video conferences. The key was doing it on a large scale in a way that was simple and reliable.”
Image quality was one of the major issues that kept some players on the sidelines, says Dr. Jack Kitts, president and CEO of The Ottawa Hospital. “The high definition and clarity of vision we see now compared to several years ago has taken away any naysayers. You can get a very good look at most things thanks to advancements in (video conferencing) technology.”
Clinical and lab hematologist Dr. Janis Bormanis at The Ottawa Hospital has been a proponent of using the OTN for patient consultations. “When we had heard about the success of telemedicine in places like Australia, where distance necessitated technology innovation, it was a very appealing prospect,” he says.
Bormanis is among a number of physicians at the hospital that provide regular OTN consultations to patients in distant areas within the Champlain Local Health Integration Network (LHIN). The hospital has a number of telemedicine rooms equipped with video conferencing tools. Co-ordinators set up appointments for patients to connect with doctors, who will switch between different sites to provide advice in such areas as respirology, geriatric care and hematology among others. Where required, nurses at the sites are trained on specific examination procedures to assist doctors during the video sessions.
Bormanis says the concept has proven extremely successful and popular with patients. He estimates that the OTN has been used to see 6,800 patients over the past three years at a rate of 200 patient visits per month on average. “It’s going all the time — and growing. Patients love it. In addition, there is simply no room to expand within The Ottawa Hospital, so this is good for everyone.”
The ability to consult in a virtual world also delivers considerable cost savings, Brown adds. “If all patients who had telemedicine travelled instead, that would translate into a total cost of about $18 million.”
Over the course of OTN’s evolution, it has received significant support from the federal, provincial and health care sectors. “The government has also supported the policy changes needed to make it work. For example, it can be billed through OHIP, which is a huge step forward,” Brown says.
The momentum for the OTN continues. It now has 1,200 sites and 2,000 video conferencing studios, and has expanded beyond hospitals to include family health teams, mental health agencies, associations and colleges. The next step is driving the same capabilities to patients at home. A recent pilot was conducted with 800 patients with serious chronic diseases who were paired with nurses who monitored their data and worked with them to set self-management goals.
Satisfaction rates from the pilot are at 98 per cent; emergency department visits were reduced by 75 per cent; and hospitalization rates for the group dropped by 65 per cent, Brown reports. “Not only are these patients healthier and happier, but it has reduced costs to the health system significantly.”
“We once had a horse and buggy health care system in which the only way to get help was to go there,” Brown says. “Now we have the technology to support high quality health care over distance and managed to find the right place for it. In doing that we are improving health care while reducing costs.”
The Ottawa Citizen