This is the feature article I wrote on Telemedicine and the advancements of E-Visits for Scribe magazine, Humber’s leading source for tech trends.




In Canada, access to healthcare can be limited due to basic geography. New technologies are making a big difference for patients unable to travel long distances to medical facilities. Today, patients can see a heart surgeon who is located 500 kilometres away without having to leave town. These virtual visits can save them time, money and stress involved in getting to important medical appointments.

In 2006, the Ontario Telemedicine Network (OTN) was founded. The OTN is one of the largest telemedicine networks in the world. It uses two-way videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations across the province. It is responsible for developing the technological advancement of telemedicine, which are now being referred to as E-Visits. according to the OTN.

E-Visits have been available in Ontario since 2006, but they became more common in 2011 when the Appletree Medical Group (Canada’s most progressive family practice and multi- disciplinary medical group) committed to a one- year pilot project with the provincially-funded OTN.  Patients in Toronto and ottawa were offered the choice of seeing a doctor face-to-face in a clinic or seeing a doctor by telemedicine.  Toronto patients who opted for telemedicine care were seen by doctors in Ottawa, and vice versa.  OTN’s case studies showed that all Appletree Medical Group trial cases were concluded with positive feedback from both doctors and patients, according to the online case study.

According to the OTN, virtual doctor visits could become as common as face-to-face appointments because health insurers, hospital systems and employers view it as a way to clamp down on rising medical costs.  They hope that giving patients easy access to a primary care physician will discourage them from visiting costly emergency rooms or overcrowded public clinics when they get sick.

At the start of this year, Deloitte, one of Canada’s leading professional consulting firms, announced their top technology innovations for 2014 and virtual doctor visits made it onto their top ten.

David Denov is the co-writer of the Deloitte prediction and senior manager of National Health Services, which is the national practice that serves across the country.  He was responsible for delivering everything from non-technical to technical consulting work for hospitals, governments and small and large organizations in the public and private health sector.

Prior to working for Deloitte, Denov spent three-and-a half years working with an Ontario based telemedicine delivery organization, so he is very familiar with the concepts and benefits of what E-Visits can do.

Deloitte’s yearly prediction stated, “The global health market will be driven by E-Visits, which are an alternative to face-to-face appointments.  Virtual doctor visits offer savings to the public and private health systems, opportunities for improved patient experiences and access to care; as well as reduced wait times.”

“As video gets better and requires less and less bandwith and more, and more bandwith is availabe, it makes sense that telemedicine can play a key role,” says Denov.

In 2012 there were more than 13,000 health applications available on the Apple app store.  He predicts that in the future there should be more smartphones on the planet available than people to use them.  “We believe this because you can see the growth patterns with cellular technology,” says Denov.

“If you are in North Bay and you have a stroke, the closest Neurologist could be 1,000 Kilometers away,” Says Denov.

When first hearing about E-Visits, Torontonian, Rachel Olson was very skeptical about the entire process.  “I don’t understand how sitting in front of a computer to talk with your doctor or physician could give you the same results as an in person checkup.”

Despite being given the opportunity to watch an online trial demonstration on virtual doctor visits, Olson’s opinions remained the same.  “I wasn’t eligible to actually participate in the online trial, but the entire process did seem quite simple.  The video explained, step-by-step what patients needed to do and explained the entire process quite thoroughly.  However, if I am still feeling sick I would prefer an in person visit, as opposed to online.  I just don’t feel being diagnosed over the computer seems completely accurate,” she says.

Of course virtual visits cant do everything that a doctor can do in person, but with the right technology, E-Visits could change medical history.

So how does an E-Visit actually work? The technology is a key factor to its success.  If a patient is interested, they will have to visit an OTN facilitated clinic for an initial meeting.  First, the video monitors deliver crisp images of doctor and patient on a secure network connection.

Electronic medical record (EMR) tablets allow all pertinent health information on the patient to be collected quickly and stored with previous data.  A camera provides high-resolution photos of bruises, cuts, burns, rashes and other visible conditions, which are readily transmitted to the online physician.  There are even electronic stethoscopes that allow doctors to listen to a patients heartbeat and breathing.  If a patient agrees to an online link, he or she first meets with a telemedicine assistant; usually a doctor still in residency or a nurse.

Various questions pertaining to the suspected illness, the symptoms and the patient’s health history are asked and recorded on the EMR tablet.  The information is transmitted simultaneously to the online doctor’s EMR as it is being gathered.  A patient may be checked for fever, blood pressure could be taken, ears, nose and eyes might be checked, and even a throat swab may be taken and sent to a lab.

When the assistant completes the prep work, the physician is contacted and the telemedicine visit begins.  The physician goes over the patient’s information and more questions are asked.  After the doctor makes a diagnosis, a prescription may be issued and printed at the clinic.

If an illness is deemed serious, the patient may be referred to a hospital emergency room.  Patients are referred to a doctor at the clinic if sensitive tests are required, such as pap smears.

Denov says that patient access to care is a big problem.  “If you are in North Bay and you have a stroke, the closest neurologist could be 1,000 kilometers away.”  E-Visits would allow that patient to connect that much faster to their doctor.

“In more rural areas of Canada, let alone other areas of the world, there is always a shortage of doctors, it is a lot easier to bring the technology to the patient, then the doctor,” says Denov.

E-Visits would also allow the patient to have decreased costs, as the patient wouldn’t have to travel quite a distance to see their doctor.  E-Visits also improve patient experience, as well as provide patients increased efficiency sine E-Visits provide patients with more instant access to doctors and specialists.

“I think most patients are sold, but the cost of infrastructure, pace of technology, lack of resources and physician resistance could be some potential disadvantages to E-Visits.  The docs themselves already have a full waiting room.  There is a physician shortage.  And if they already have a full waiting room, what is motivating them to change the way they care?” Denov says.

Kelsey Lee is a personal trainer who has recently moved to Toronto from British Columbia.  Kelsey was in a serious car accident and requires frequent checkups with her family doctor.  When she first moved to Toronto,  she decided she was not going to find a new doctor and would only have her checkups done when she would go back for visits in B.C.

“I would definitely be interested in trying out E-Visits, because I like my current doctor and I don’t want to find a new one.  I trust my doctor– I have been seeing him since I was five-years-old.  He is the only doctor I feel comfortable discussing my health and medical issues with.”

There is currently an organization that is developing telemedicine in British Columbia as well.

Kelsey suffered from a serious head injury and was required to visit her doctor weekly.  She has since improved from her accident, but still stays in constant contact with her doctor.  According to Appletree Medical Groups’ list of telemedicine condition requirements, Kelsey would be eligible for E-Visits.

The future for telemedicine and E-Visits is looking bright.  As patient and doctor feedback continues to stay positive, they will continue to gain popularity as a new way to deliver health care.


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