A few years ago, I was diagnosed with Generalized Anxiety Disorder. My doctor suggested counselling as part of my treatment. My workplace health benefits include access to counselling services. When I contacted our provider to book an appointment, I was given the option of doing online counselling with a practitioner based in Toronto (I’m in Saskatoon). I jumped at the chance. As a person with a hearing disability, I felt that online chat provided not just needed health care, but also suitable accommodations.
Telemedicine is not yet widely used in Canada, but it is gaining momentum. In Saskatchewan, we are still working with an advice-based model via a service called HealthLine. Staffed by nurses, this phone line offers advice on whether it is better to treat your own symptoms, wait to see your regular doctor, go to a clinic, or go to an emergency room.
Services like HealthLine only offer advice, and often require patients to seek in-person care. Telemedicine is different, directly connecting patients and licensed health care providers online. Telemedicine — also known as eHealth, telehealth, or virtual medicine — aims to cut down on in-person visits, making medical care more efficient for both patients and healthcare providers.
I chose telemedicine because it supported my disability, but there are numerous reasons why telehealth might be a good choice for a patient. People in remote communities, people with limited mobility or limited transportation options (including seniors), and people living in areas with shortages of family doctors and/or specialists could all benefit from telemedicine. But there are other reasons to choose telehealth too. Parents with young children may have difficulty arranging child care in order to visit a doctor; it may be difficult for some people to get time off work during regular office hours; and for others, just the chance to avoid germs at a walk-in clinic might be reason enough to choose a virtual appointment.
While urban dwellers might not use telehealth services very often, it has been practiced in remote communities for years. Pelican Narrows, in Saskatchewan, is a six hours’ drive northeast of Saskatoon. Since 2014, a robot has been instrumental in providing healthcare to the village of 2800 residents. Prior to the introduction of the robot, critical cases had to be airlifted to Saskatoon. This was problematic for patients, who were then isolated from their friends and family, and without community support in Saskatoon hospitals. Transportation delays due to weather or airport shutdowns could prove fatal. And the cost to the health care system is high, since the price of a round trip is about $10,000.
The Pelican Narrows robot has a stethoscope, ultrasound, dermatoscope (for a magnified view of the skin), ophthalmoscope (to look into the eye), and otoscope (to look into the ear). A nurse, trained in telemedicine, takes remote direction from a doctor to use the robot’s equipment. The images scanned by the equipment are sent via video in real time to a doctor, who can make diagnoses and determine treatment plans.
While not as impressively futuristic as Dr. Robot, there are a couple of other ways telemedicine services can be accessed. In urban areas where there are shortages of family doctors, telemedicine clinics could be the best way to ensure continuity of care. As this piece in the Victoria Times Columnist explains, MedViewMD, based in Chatham, Ontario, has set up telemedicine clinics within British Columbia pharmacies. Patients are first assessed by a nurse practitioner before meeting with a doctor via web conferencing.
Home health monitoring is another facet of telemedicine. A patient is loaned a tablet computer with various equipment hooked up to it (like a blood pressure monitor or blood glucose meter). Readings made by the equipment are uploaded and sent to the patient’s health care provider.
This system encourages accountability for the patient in terms of self-care. For example, failing to take medications or falling back into an unhealthy lifestyle after treatment will be reported immediately to the practitioner. The monitoring also provides an alert to the practitioner when the patient requires urgent care.
Despite its potential, and despite being widely used in the U.K., U.S.A., Australia, and New Zealand, telemedicine has not yet been widely adopted in Canada. One point of concern is the confidentiality of health records shared between various practitioners online; another is the worry that patients will not see continuity of care if a different practitioner is provided for each appointment. There are technological issues too. Apps need to be developed for different purposes; and, of course, any type of system glitch or failure can cause untold problems.
However, the digitization of healthcare is gaining momentum, and is impacting everything from online certification for healthcare professionals (such as Advanced Cardiovascular Life Support (ACLS) recertification) to the opening of Canada’s first fully digital hospital in Toronto. Despite the concerns about it, telemedicine is clearly forging forward.
Should you go ahead and embrace telemedicine now while it is still gaining a foothold? It’s important to remember that if you accept some types of telemedicine, not all your health-care services need to become digitized. And, in fact, just as I chose online counselling after having an in-person appointment with my family doctor, telemedicine is best used as a supplementary form of healthcare. Some in-person appointments will still be required.
But if telemedicine offers a choice that’s convenient and/or offers a service that’s otherwise unavailable to you, why not take it? Regardless of whether a non-urgent appointment is made with an in-person or online practitioner, that practitioner is still a licensed health care professional whose job is to keep you healthy and well.