Device interoperability, lack of inter-network business processes and disparate laws across provinces and territories top the list of barriers to inter-provincial telehealth in Canada, according to national telemedicine program, North Network.
inhibitors include physician payment, privacy and security and IP interoperability issues. Most health-care institutions today use integrated digital service network (ISDN) videoconferencing. IP also requires a common set of protocols.
“Does it offend you that we do not have inter-provincial telehealth?” Ed Brown, executive director, North Network, asked health-care professionals attending a session on the pros and cons of telehealth at this week’s e-health 2005 conference in Toronto. “If you’re from Saskatchewan and attending this conference in Toronto, you can’t get health care from a doctor in another province under the Canada Health Act.”
Telehealth or telemedicine refers to the use of communications and information technologies such as videoconferencing to examine and treat remote patients, enabling them to “visit” an out-of-town specialist from their home rather than travel, according to North Network’s Web site.
With telemedicine clinics in more than 100 sites across the country, North Network is a membership-based program of Sunnybrook and Women’s Health Sciences Centre in Toronto. The University Health Network, (UHN) for example, is one of more than 100 Ontario members that uses North Network’s technical and operational services.
The No. 1 reason why people go to another province to get health care is referral patterns across provincial lines, said Brown. Other factors include the fact that centres of excellence are scattered around the country, follow-up visits and outbreaks such as SARS. Residents of Nunavut or Yukon, for example, need to get a lot of health care from the south, whereas people in northern B.C. go to Alberta, said Brown, pointing to a map of referral patterns in Canada.
Based on North Network data, 771 out of 3,956, or 20 per cent of consults in northwestern Ontario go outside the region, while 403 or 12 per cent go to Manitoba specialists. Though both provinces’ medical colleges in this case have agreed to let physicians do this, many provincial governments, including Ontario, do not acknowledge telehealth.
This is why health-care experts like Sharon McGonigle, telehealth program coordinator at UHN — which is comprised of Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital — are advocating for legislation of telehealth services. “We are building an artificial barrier,” said McGonigle, who attended the above session. “If a doctor here is licensed by the College of Physicians and Surgeons, isn’t that enough?”
Telehealth can improve access to care and reduce wait times for surgery, added McGonigle, giving the example of a referral patient from the North who was scheduled for bypass surgery in Toronto. The patient’s angiogram was sent down to Toronto for the triage nurse to look at so that the patient could go straight to the operating room upon arrival, she said.
But in order for inter-provincial telehealth to succeed, the government’s role needs to be cut back, said David Zitner, director, medical informatics, Dalhousie Faculty of Medicine in Halifax, N.S. “Governance has intruded on the action of health care,” said Zitner, adding that board members of Canada Health Infoway, for example, are provincially appointed. “To have inter-provincial telehealth now, we have to do something to reduce the government’s role as administrator and regulator.”
Medical errors kill one to three people for every 200 people admitted to Canadian hospitals each year, according to a Baker and Norton study that was published in the Canadian Medical Association journal. “We have intolerable waiting times and unacceptable errors,” said Zitner in reference to the above statistic. “If we had a system in place that punishes instances that are intolerable, we wouldn’t have these problems that exist.”
Playing the role of the Devil’s advocate, Richard Scott, president, Canadian Society of Telehealth argued that, for the most part, telehealth is the province’s responsibility to provide and as such is an intra-provincial issue. This includes increased access to education, information and services, for example. “(Telehealth) is opening up the floodgates to every health-care institution communicating with every other institution,” said Scott, who, in real life, is an advocate of telehealth. “Hell would have to freeze over to have the capabilities to do that.”
Scott added that most of the health care provided in Canada is within three miles of where a person lives or works. “Just because we have the capability doesn’t mean that need to do it,” he said. “Unless we have a national strategy and acceptance on these issues, inter-provincial telehealth will not happen.”