Rivers on computer-based doctor-patient interface - he likes it.

Rivers 100x100By Ray Rivers

May 23, 2019

BURLINGTON, ON

 

Seven in ten Canadians say they’d rather speak to their doctor over the internet than have to truck on down to one of those disease-laden offices where one spends more time in the waiting room than with your doctor. Health monitoring technology, most of which is delivered in a laboratory or specialty clinic (ultrasound, X-ray, MRI, etc.), has virtually obviated the need for the traditional annual physical examination.

This doesn’t mean one shouldn’t ever have, and see, a family doctor. But should we stop progress? There was a time when we only read the news in a newspaper. Today anyone reading my column has transitioned to reading on-line. So why can’t we also make the transition from the physical doctor’s visit to a more virtual reality?

Not to diminish the value of front line medicine, but increasingly the family GP has become a gate keeper and medical tour guide. Once a potential health issue has been identified the patient is typically off to a specialist.

So the Canadian Medical Association (CMA), the Royal College of Physicians and Surgeons of Canada (Royal College) and the College of Family Physicians of Canada (CFPC) are launching a task force to examine virtual care technology and how it can improve access and quality of care for patients from coast-to-coast-to-coast.

Virtual demo

Demonstration of a computer-based doctor-patient interface.

Hamilton’s own Dr Richard Tytus, a CMA board member, Past President of Hamilton Academy of Medicine and resident physician at Steel City Medical clinic is leading a virtual care project using a computer-based doctor-patient interface. With the assistance of local health support staff, Dr. Tytus conducts limited medical exams for his patients, then diagnoses and prescribes on-line as needed.

Dr. Tytus has largely been focusing on those with mobility challenges, for example patients in nursing homes who can’t easily make the journey to his office. And while he has been successful working with that sub-group of the public, he also sees the potential to generalize this approach for a broader cliental including those with mental health issues, where accessibility and the benefits of immediate attention may be even more valuable.

Still, CMA president Dr. Gigi Osler says one big hold up is the matter of privacy. On-line data is thought to be less secure than files in a doctor’s office or the (hopefully) more protected E-health patient files . It’s one of the reasons your doc may not allow you to schedule an appointment directly over the internet. Dr. Tytus gets around the privacy issue in using his Skype-like appointments by obtaining permissions from the patient at the outset.

Another big hold up is government support. Governments may not simply be convinced of the cost/benefits of Telehealth yet. Ontario has actually slashed e-health spending in its latest budget. And besides the province still has its own, so-called Telehealth phone-in line, which generally defaults to directing you to your local emergency ward, because liability prevents real diagnosis.

Health care is primarily a provincial responsibility operating within the Canada Health Act. But, most provinces don’t even fund real telemedicine, so entrepreneurial medical practitioners and companies like the Maple group, are starting to fill the gap, offering private services.

Even after a century and a half of living together Canada’s provinces still dwell in silos of parochialism, limiting our progress as a nation vis-a-vis the rest of the world. And health care is no exception. One of the promises of Telehealth is the ability to bring the best health care professionals to your screen no matter where you live. But that would mean tearing down artificial provincial barriers.

A medical licence, for example, in one province does not transfer to another. Each province and territory has its own regulatory college and its own set of standards to license its doctors. And yet 9 out of 10 physicians support either a national licensing regime or universal recognition of provincial/territorial license.

It is expected that the joint medical task force will conclude to call on governments to implement a real Telehealth strategy with inter-provincial portability at the heart of any subsequently hatched program. Clearly Telehealth has a future beyond Dr. Tytus’ experiments among senior citizens in Hamilton. The challenge for governments, as always, is to work together to make it happen.

Rivers hand to faceRay Rivers writes on both federal and provincial politics, applying his more than 25 years as a federal bureaucrat to his thinking.  Rivers was a candidate for provincial office in Burlington where he ran against Cam Jackson in 1995, the year Mike Harris and the Common Sense Revolution swept the province. He developed the current policy process for the Ontario Liberal Party.

 

Background links:

The Annual Exam

Virtual Care

Ontario Telehealth

Telehealth Task Force

Canada Falling Behind

CMA Sees Hope

Maple Telehealth

Ontario Cuts E-health

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4 comments to Rivers on computer-based doctor-patient interface – he likes it.

  • Mike

    Ray, they don’t publish a lot of accomplishments as they leave that to MOHLTC but have a couple under their stories section. There has been good stuff happening with them for over decade. Not sure why more is not communicated by the government. OTN develops, deploys, trains and supports the technology to enable Tele-medicine services. They don’t deliver any medical services.

  • Ray Rivers

    Mike Thanks for your comment – I had reviewed this site but there was no indication that they are actually delivering virtual care so left it off my linkages. There is a lot of discussion of the potential but no indication that they have actually done anything to help patients. Sorry if I missed it.

  • Mike

    Unfortunately it seems there is a lack of knowledge that Ontario has been a leader in this type of digital consult for many years. Review Ontario Telemedicine Network’s (https://otn.ca/) info and accomplishments. What you mentioned was Telehealth Ontario which is the call in service where you get to speak to a nurse. I know, I know, healthcare like to make things confusing.

    OTN have consulted with many other jurisdictions in Canada and internationally, providing insight and assistance in others starting their own capability. The service here was started to support geographically challenged areas of the province but has become broader. We have already dealt with and developed the governance and protocols to enable this service so these can be leveraged to support rolling this out on a broader basis. Obviously there is difference to full blown telemedicine and booking an online appointment but we have the know how, it just needs support and buy-in to scale up.

  • Well written and well thought out. I completely agree, for several reasons. But I do stand by, or bend over for, the “Gold Standard” of digital prostate exam and would rather not have a machine do it.

    Records privacy is an issue, but it would be naive to think a physician’s office is secure.

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