Edward Pratt drives a tractor
and has chronic foot pain. But how far will he have to
travel from rural Alberta to find an orthopaedic surgeon?
Soon, he may not even have to put on his boots to get
treatment. The emerging field of telehealth and telemedicine
is beginning to change the face of medicine in Canada.
Instead of long journeys into urban centres, this technology
provides a new shortcut: long-distance consultations over
high-speed networks. Patients like Mr Pratt no longer
have to leave their region to have specialized care, but
instead can get a telehealth consult from the comfort
of their local doctor's office.
"I think it's really seen as a
potential tool to assist with some of the difficulties
we have in Canada in terms of access," says Dr Penny
Jennett, head of the University of Calgary Health Telematics
Unit and president of the Canadian Society of Telehealth.
"It certainly has a potential to assist with access,
in the way we deliver care and the way we follow up
with people."
THE
VIRTUAL REALITY
A typical telemedicine session is conducted via videoconference
between a specialist and a local doctor, who makes use
of stethoscopes, dermatoscopes and x-ray viewing equipment
as needed. Communication between the two offices is
handled either over the internet or ISDN, a high-speed
private data line.
In Canada, every province and territory
is in on the telehealth action. Alberta leads the pack
with nine health regions and a total of 235 active sites
hooked up with the technology. The longterm goal is
to integrate these services with Alberta's electronic
health record system. "Today we don't see total integration,"
says Dr Jennett. "It's still evolving, but eventually
issues relating to electronic health records and pharmacy
databases will all be integrated." The technology is
also shortening waiting times, she adds. Using a system
she calls tele-triage, patients can call ahead to a
hospital or clinic. Trained nurses, following agreed
upon prototypes and protocols, then direct them to the
appropriate doctors or departments.
THE
LINES ARE OPEN
Another bonus is that long-distance consultation opens
the lines of communication, so to speak, between healthcare
professionals, allowing specialists the chance to share
their knowledge with other doctors and vice versa. "It
provides the opportunity for us to meet each other and
talk over the diagnostic problems and essentially do
some continuing medical education on the spot," says
Dr Steve Edworthy, a rheumatologist and associate professor
of Medicine and Community Health Sciences at the University
of Calgary. "You don't get that otherwise because you
don't have that kind of face-to-face presentation of
the problem with the patient."
But what about concerns that telemedicine
might replace old-fashioned, in-the-flesh consultations?
Dr Jennett sees telemedicine becoming an adjunct rather
than a replacement. Dr Edworthy agrees. He finds he's
spending just as much time with telehealth patients
as he would during face-to-face consultations � perhaps
even more, as he has to make a special trip to a telehealth
centre each time.
Dr Edworthy also admits that there
are shortcomings inherent to the system. "When a diagnosis
is made and we discuss it in the office, there's a much
closer feeling with the patient � in other words you
can see what the emotional impact of a diagnosis might
be on the patient, and you can provide some comfort
to them," he says. "It can be extremely emotionally
upsetting for the patient and with telemedicine you
have no way of reaching out to them."
ROBO-DOC?
Although telehealth units can cost a prohibitive $70,000
at the moment, we should see the prices drop as expensive
ISDN lines are replaced by cheaper internet alternatives.
Future developments could make it possible to perform
surgery by remote control over long distances, with
advanced procedures carried out robotically under the
supervision of a local doctor.
"I think those more futuristic
things are here already," says Dr Jennett, "but I don't
think it's yet at the stage where every care centre
will be able to access them. There are types of telehealth
that are already just another option to consider. And
we're already there because technology's allowed us
to be there."
In our next issue: NRM will
investigate the futuristic world of telerobotics
and telesurgery.
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