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Tuesday, 3 April 2012

Telehealth: A real public health contribution - or at least a major convenience

Telehealth has come to Canada in a big way.  One success of the Canada Health Infoway, a future blog will speak to the relative failure of other initiatives. 

 Gone should be the day long excursions of rural residents to the specialist for a 15 minute consultation. From the comfort of a telehealth unit, dermatologists and psychiatrists can examine and assess a patient and even begin treatment.  Specialists can do assessments and follow-up visits remotely saving both patient and physician time and effort.   Surgeons can complete pre-surgery work without the patient ever needing to leave their home community until time for the surgery.  Even some physical examination can be done remotely as sound, look and touch can be digitalized.

Of course many diagnostic images can be obtained in one city and interpreted almost instanteously in another.  Pathology specimens can be batched together for specialized interpretation anywhere.   Electronic impulse recordings (ECD, EEG etc.) digitalized, and sometimes even interpreted electronically.  Photos of wounds, ulcers, rashes and other skin disorders can be channeled to health care providers overseeing care to diagnose and to monitor treatment progress .

In the most forward thinking of interventions, surgery can be done remotely using robotic tools managed by the artist in a different location.  

Consolidation of experts has significant advantages for provider groups and will improve efficiency.  Convenience for residents is greatly improved.  Medical transportation costs can be reduced where these are subsidized.   And for a relatively paltry cost that many communities can afford.  Most of the major obstacle of payment has been overcome.  Oddly, a good portion of current telehealth consultations could likely be achieved over the telephone and adequate compensation for such service is lacking expect in payments for full episodic care. 

Of course evaluations speak to the convenience of the service more than health impacts which demonstrate “no inferiority” to the service.   In a health system struggling to find dollars, its perhaps ironic that telehealth has received so much investment and praise.  It is tangible demand of the consumer for service oriented functions that has driven the improvements – a message that health consumers can and do have a voice that can be expressed and heard.  

Within larger communities, home monitoring of patients with congestive heart failure and chronic obstructive pulmonary disease are being trialed with real successes in reducing emergency and hospital care – all through the telephone or Internet.

There are advantages to telehealth for rural communities that lack health care facilities.  Such access is integral to community growth.   The next step will be trying to bring primary health care services to telehealth, and that has been only marginally undertaken in the most remote of regions. 

Expansion of urban (and rural) chronic disease remote (home) monitoring seems to be an impending reality and an added benefit if there is a good way to link the service to primary care provision. 

Star Trek views of electronified health providers are still fictional, however telemedicine has been piloted specifically for space exploration – and the benefits of this technology are being applied for the convenience of this expansive country.  

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