Hospitals plugged into Telemedicine

When lung transplant patient Lauren Childerhose needs to check in with her Toronto-based physicians, she and her family don’t have to worry about fighting traffic on Highway 401 for hours at a time.

Instead, the 21-year-old Kingston resident simply visits a local hospital, where she connects with her doctor via telemedicine technology to speak in real-time. That’s what happened in July at Kingston General Hospital, when Childerhose was on hand to help mark Toronto General Hospital’s 1,000th telemedicine lung consultation.

Telemedicine technology brings patients and health-care providers face-to-face, regardless of geographic location, via two-way videoconferencing and the latest tele-diagnostic instruments, such as digital stethoscopes. The region’s three university hospitals - Hotel Dieu Hospital, KGH and Providence Care - are members of the Ontario Telemedicine Network (OTN), which offers shared technology that allows hospitals to provide follow-up care to patients from afar.

Childerhose received a double lung transplant in 2007 at Toronto General Hospital, but much of her care before and after the transplant actually took place in Kingston, at Providence Care. The technology available at each of Kingston’s hospitals offers patients like Childerhose significant savings in terms of cost and time. Those savings also apply to clinicians, says Trish Lundstrom, KGH’s telemedicine coordinator.

“Telemedicine is fast becoming a cost effective and efficient mode of delivering health care in Ontario,” says Lundstrom. “At KGH, clinical consultations as well as education events and meetings are occurring frequently using telemedicine technology.”

KGH’s telemedicine resources include four Interactive Doctor on Call (IDOC) portable videoconference units, three Smart-Steth digital stethoscopes, a hand-held camera and meeting rooms (two with permanently mounted videoconference equipment). Last year, KGH’s telemedicine activity included 49 clinical consultations and 231 educational events.

Childerhose points out that telemedicine not only offers her family convenience, but the technology allows for more than just a brief chat. The digital stethoscope, for example, allows her physicians to monitor her breathing in real-time.

“I think the digital stethoscope technology is great,” she says. “You still want to actually experience a checkup, and not simply talk to the doctor, so I think that’s really a useful piece of technology to offer.”

While the telemedicine process may look effortless to patients, it’s actually quite complex. For the video link to work, Eddy Lloyd, a registered nurse and Providence’s telemedicine specialis, has to hook up some pretty technologically advanced equipment at Providence Care’s Mental Health Services site – including two 42-inch plasma video monitors and a Polycom FX system. The high-end technology provides top-of-the line picture and sound quality, far surpassing images and audio on webcams and cell phones. The more accurate the picture, Lloyd points out, the more clearly the doctor can assess the patient visually. The system can also tap into more than one location at once, linking multiple hospital sites on one call.

Lloyd says a typical call uses 384 kilobytes per second of bandwidth, which is industry standard for a videoconference. He admits he’s learned a lot about videoconferencing since taking over Telemedicine and Telepsychiatry at Providence Care, which itself has been providing consultation across the South East Local Health Integration Network for ten years.

Meanwhile, Hotel Dieu Hospital sponsors The Heads Up! Program, a specialized outpatient mental health program that serves clients and families in Belleville, Napanee, Kingston, Brockville and Smiths Falls.

It’s a large service region with a relatively small team. But Hotel Dieu’s multidisciplinary program team gets the job done, says Peter Coughlin, manager of Heads Up.

“We focus on early psychosis intervention,” says Coughlin. “Our client population is between the ages of 14 and 35. Many are in school or beginning jobs or job training. Client treatment goals are often focused on being successful in education or vocational areas – and videoconferencing makes sense in use of time, gas and less disruption in daily responsibilities.

The team completes follow-up psychiatric interviews with clients via OTN, while case managers and team members meet every Thursday morning via OTN for psychiatric consultation rounds. This not only comes in handy during poor weather, but also provides an efficient way to meet, review urgent client needs, and gather input from the other team members.

Not surprisingly, as the three hospitals have learned, it’s the younger clients who are naturally adept at getting used to the technology.

“We find that our younger clients, who are very familiar with current technology, understand the sound and video connections very quickly and are adept at managing the remote control and using the technology effectively,” says Coughlin. “One has to adapt to the voice activated switch of cameras during an interview or multi-point conference, but with practice and good listening skills, it can be very helpful.”