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Telemedicine: The ER & Beyond

No longer relegated to just back office roles or for secondary education, telemedicine has increasingly become an integral part of a healthcare provider�s practice even reaching into the field of emergency medicine.


By Robert Liu

 

TORONTO � In the remote town of Marathon, Ontario, a three-year-old boy named Callum sat in his bed with a fever, coughing and suffering badly from symptoms of pneumonia. In the dead of winter, the small child was brought in and admitted to the local hospital of his rural town, which is located over 600 miles (1,000 km) to the north of this bustling metropolis. Callum�s parents and his family practitioner knew he desperately needed the medical attention of a pediatrician but the closest specialist was over 180 miles (300 km) to the west in the city of Thunder Bay. Even on a warm summer day, it was a four-hour ambulance ride. In the unrelenting snow of January, it was a hazardous race against time that exposed Callum not only to the elements but also to the very real dangers of slamming into a moose.

Today, Callum is a healthy boy still living in Marathon. He never needed that ambulance ride in January 2004; he was able to stay in his local community. Instead, the pediatrician came to him through an IP-based video link that tapped into a tele-health network operated by the Northern Ontario Remote Telecommunications Health (NORTH) Network, a membership-based program that receives funding from the Ontario and Canadian governments.

�There�s a huge shortage of health professionals in Ontario and this technology is dramatically improving access to care for our rural population,� said Dr. Ed Brown, an emergency room physician who was the founder and now is executive director at NORTH Network.

What started as an experimental partnership among four hospitals in 1998 has now blossomed into a wide-area network of 170 sites (hospitals, universities, long-term care facilities, nursing stations, public health and ambulance units) in 105 communities that spans across the 460,000 square miles of the province of Ontario. Callum�s case was NORTH Network�s 10,000th consult. By May, 31, 2005, the program already hit the 25,000 mark and is expected to reach 50,000 consults by the end of next year.

The concept of telemedicine (or tele-health � the terms are synonymous) may lend itself well for the Canadian market, where healthcare is public and land is vast. Of the 12 million people that reside in Ontario, nearly 30 percent live like Callum in rural areas where healthcare professionals are less likely to set up practice. But the growing importance of telemedicine on the healthcare world isn�t just isolated north of the U.S. border. Whereas in previous years, two-way IP-based communications only served healthcare professionals with basic corporate video conferencing needs or secondary education (i.e., teaching sessions), companies like Polycom or Tandberg have refocused their efforts on the actual practices of healthcare providers.

In its simplest form, telemedicine is essentially video conferencing with a few extra bells and whistles. Those bells and whistles may include digital stethoscopes, sphygmomanometer (blood pressure), handheld patient examination camera, pulse oximeter, etc., in addition to two-way television transmission. With a combination of tools to examine vital signs, eyes, ears, nose and throat, a doctor or nurse could gather enough information to diagnose the patient.

�If there�s a growth area, it�s in the practice of telemedicine itself,� said Tim O�Neil, Acting Global Director of Polycom�s Healthcare practice. �The doctor has a certain amount of budget to treat you and those dollars aren�t increasing.�

In practice, if a patient can avoid hospitalization, then those added resources could be reinvested back into the entire healthcare system to everyone�s benefit. That�s exactly what has happened in the field of palliative medicine. After establishing a tele-homecare practice to monitor patients suffering congestive heart failure, NORTH realized reduced hospitalization rates of 30 to 80 percent. �Very, very dramatic numbers,� Dr. Brown said during a recent on-site tour sponsored by Cisco Systems Canada Co. (NORTH has built its network infrastructure entirely on Cisco 7200 series routers with dual-power supplies and other redundancies.)

The reliability of its network as well as its own success has led NORTH to even roll out telemedicine initiatives in the areas of emergency care. For example, if a stroke is detected early, a victim can be administered clot-busting drugs to reverse the process. In addition, NORTH received funding from its local utility for an emergency telemedicine program for electrical burn victims. Other areas include clinical care, dermatology, allied health professions like speech therapy, and rehab specialists.

Of course, not everyone is convinced that telemedicine has reached the threshold of critical mass. Earlier this summer, the Canadian Supreme Court in a ground-breaking 4-3 decision ruled that denying a citizen the right to purchase private health insurance plans was unconstitutional and jeopardized the well-being of Canadians. But that alone isn�t likely to thrust telemedicine into the spotlight.

�The remote solutions make great press but my guess is the numbers are not that big,� said Tom Astle, senior vice president at National Bank Financial�s Technology Group.

While the NBF analyst currently stands correct, a confluence of other factors has changed the face of telemedicine. For example, ten years ago in the field of homecare, Medicare only reimbursed healthcare professionals if they actually paid the patient an on-site visit. But since the enactment of the Home Health Prospective Payment System (PPS) on October 1, 2000, Medicare began reimbursing healthcare providers between $2,000 and $6,000 per 60-day term depending on the level of care that the patient required.

�For the first time, that allowed us to consider employing telehealth as an adjunct to face-to-face visits. Up until October of 2000, there was no economic imperative,� said Marcia Reissig, president of Boston-based Partners Home Care, which cares for some 3,000 patients on any given day. Of its total base, approximately 150 patients are receiving telemedicine monitoring services.

In June, lawmakers in Congress introduced the Medicare Tele-health Enhancement Act of 2005. If enacted into law, the legislation would provide $30 million in funds for tele-health programs.

�The majority of U.S.-based telemedicine initiatives were cost-reducing. That�s turned into revenue-generating,� Polycom�s O�Neil added. IT

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