Appletree clinics expand telemedicine in Toronto and Ottawa

By Rosie Lombardi

Virtual online doctors are beginning to play a bigger role in urban centres where medical clinics, including walk-ins, are the new frontier. Telemedicine received a big boost in Ottawa about six months ago from the Appletree Medical Group. The Ottawa-based company, which operates clinics across Ontario, has committed to a one-year pilot project with the provincially-funded Ontario Telemedicine Network (OTN).

Appletree spokesperson Alison Green says the company, which charges physicians to operate out of its clinics while the doctors bill OHIP directly for the patients they treat, is pleased with the program.

The program has been very well-received by patients at the four Appletree Ottawa clinics and the five in Toronto where telemedicine is offered, adds Dr. Tim Bell (pictured), medical director at Appletree.

The OTN says 94 per cent of telemedicine patients using its network like the service. Last year, 134,000 patients were treated in the vast network, which includes hospitals and other healthcare facilities.

Douglas Angus, a professor with the University of Ottawa’s Tefler School of Management, isn’t surprised by the positive response. The federal government was involved in a number of telemedicine pilot projects about 12 years ago. Angus helped evaluate one involving a number of Eastern Ontario hospitals and health centres. Patients in small communities such as Deep River, Pembroke and Renfrew were connected from hospitals there to either the University of Ottawa Heart Institute, the Elisabeth Bruyère Health Centre or the Children’s Hospital of Eastern Ontario. A survey of patients, doctors and nurses showed the 18-month project was well received, says Angus.

“The patients absolutely adored it because they didn’t have to travel into the city. It was a godsend (because) they didn’t have to travel. Family members didn’t have to take a day off work (to drive the patients to Ottawa).”

But that’s not the same as being given the choice between telemedicine or a doctor in the flesh.

Says Angus, jokingly, “I guess the analogy would be: Why would I be texting someone right next door to me when I can go next door and talk to the person?”
Sometimes though, as was the case recently at the new Appletree clinic in Bells Corners, the only doctor available is by video link, and that can mean longer waits. Says Green: “This technology is not meant to replace the traditional physician-patient relationship. Rather, we see it as another tool in a growing tool box of ways the doctor can connect to a patient, and another way to increase patients’ access to good medical care.”

OTN supplied the electronic equipment and training at the nine Appletree clinics in Ottawa and Toronto that provide the service. Appletree will also be hooking up soon with a clinic in the North Bay area.

The OTN, which now receives $22.5 million annually from the province, is one of the largest telemedicine networks in the world.

About 3,000 doctors and other healthcare providers are used in about 1,200 sites across the province, which include hospitals, nursing homes, addiction treatment facilities and public health centres.

A health ministry spokesman says telemedicine, which was introduced in Ontario in the late 1990s, is “designed to increase efficiencies in the healthcare system, improve access to care, promote the effective utilization of healthcare resources and reduce the burden of waiting for and travelling to appointments for all patients across Ontario, regardless of where they live.”

While remote and rural areas are the major concern, “even patients in major urban centres can experience long waits for appointments.”

So how does telemedicine in a clinic work? The technology is a key factor to its success.

Angus says the technology was great 10 years ago when he was helping evaluate the federal pilot project, and it has grown by leaps and bounds since then.

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. Devices such as cameras provide high-resolution photos of bruises, cuts, burns, rashes and other visible conditions, and are readily transmitted to the online physician. There are even electronic stethoscopes that allow doctors to listen to a patient’s 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, as it is being gathered, is transmitted simultaneously to the online doctor’s EMR. A patient may be checked for fever. Blood pressure could be taken. Ears, nose and eyes might be checked. 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. More questions are asked. After the doctor makes a diagnosis, a prescription may be issued and electronically printed at the clinic. If an illness is deemed serious, the patient may be referred to a hospital emergency room. The patient would also be referred to a doctor at the clinic if sensitive tests are required, such as pap smears.

Posted March 15, 2012