Dr. Ed Brown asked how many people in the audience were able to e-mail their family doctor? A small handful in the Mount Sinai hospital auditorium raised their hand. When asked who would like the ability to e-mail their doctor, everyone in the room raised their hands.
The situation is likely to change much sooner than we think. The question is, are health care providers ready, will the public participate, and will quality be more than an “acceptable second best?”
Brown, CEO of the non-profit Ontario Telemedicine Network, says Ontario is already one of the most advanced telemedicine environments in the world. Last year there were 204,058 telemedicine “events” in the province – a staggering 52 per cent growth over the previous year. There are slightly over a thousand regular users – this in a doctor population of 25,000.
Brown and Will Falk, a health care “leader” with PwC Canada, spoke at Longwood’s Breakfast With The Chiefs this morning on the growing virtualization of health care.
By conducting health care consultations virtually, Brown says that Ontarians have been spared travelling the equivalent of 275 trips to the moon and back. In Northern Ontario it has saved 108 million miles of travel. Given northern travel grants are available for citizens to access health care mostly in the south, that represents about $45 million in savings had all those trips actually taken place (likely not all would have).
Brown said it was a bit embarrassing winning a green award for their service given their objective was to increase access to care. They weren’t necessarily focused on the environment.
While access to a vast array of specialists is possible through virtualization, what is called “asynchronous” consultations are becoming more common particularly among dermatologists. Asynchronous refers to consultations that happen in a different time and space. For a dermatologist, that could mean a family doctor taking pictures of a patient’s skin condition and sending them over virtually.
Not only does this take place much faster than simply referring the patient on, but it saves the dermatologist time as well. And if time is being saved, so too are dollars. The latest Ontario Medical Association deal with the province includes “more virtual connections between family doctors and specialists, and an expansion of telemedicine services.” Clearly if it takes less time for the docs, the province is likely looking for a percentage of the savings.
Falk says virtual health care has done a lot of catching up in quality over the last 10-15 years and in some situations has been shown to actually improve health outcomes.
Psychiatrists argue, for example, that group therapy among certain groups – such as bulimics – actually works better virtually than face-to-face.
One psychiatrist present said that “machine intelligence” is improving the prescribing accuracy for his patients. Whereas there was a time when getting a prescription correct the first time was twice as likely to be wrong as right, now prescriptions are made with 85 per cent confidence. In a discipline that lacks many objective measures, this is a major step forward.
Brown recognizes that there are studies critical of the quality of virtual health care. He says that this is ultimately just a tool, but the content still remains paramount.
Virtual health also makes possible a series of small interactions with someone managing their chronic care rather than engaging fewer longer interactions in person. Where this has worked it has reduced hospital admissions among this group by two-thirds.
And how many times have we had to make an appointment with our doctors simply to ask a question? Wouldn’t we all want to have the ability to do an e-consultation with a qualified physician? How many primary care visits would this stem and at the same time provide answers far sooner?
Falk calls this all a “radical shift in production” that has many implications, including allocation of the labour force and physical space requirements.
With tablet and personal computers, more Ontarians have the means right at home to teleconference on their health care. They don’t necessarily have to seek out a teleconference studio, although the Ontario Telemedicine Network notes on their website where such studios are located as well as telling doctors which specialists are doing virtual consultations.
The question is: will the patients accept it? One doctor in the audience revealed that he had offered an e-mail service to his 12,000 patients. Only 1,200 signed up. As part of this new virtual service, patients are e-mailed test results automatically. The doctor said only 22 per cent actually open these messages. He says his office still has to call patients by phone when test results come back abnormal. When asked about the age range of those who are participating, surprisingly he said those who had signed up reflected all ages and conditions.
The Ontario Telemedicine Network is working with three Local Health Integration Networks to roll out virtual health care in “a much larger way.”
Brown says the immediate future includes providing patients with access to their health records and improving provider-to-provider interactions.
“If you send a question,” says Brown, “somebody has to make a commitment to answer.”
Falk says the method of payment for docs impacts on the adoption rate for this new technology. Doctors in capitated practices – rather than fee for service – are much more likely to be early adopters of this technology.
It is also possible that doctors may provide electronic information to patients in ways that will help them better manage their condition, such as downloading an APP on a iPad or iPhone.
Falk says that many of his own visits to the family doctor would benefit from a record of that interaction to review. With more virtualization, it is possible to actually record such virtual visits, which benefits the patient, but may make the doctor somewhat more anxious about what they have to say.
Brown says the challenges are no longer the technology. (The latest includes a stethoscope with Bluetooth technology that allows a doctor to listen remotely).
It’s about the way we all work together. “It can’t be ad hoc.”
“This is the moment for primary care,” he says.
More on this issue to come.