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The virtues of virtual healthcare

By Mary Teresa Bitti | May 21, 2013

Virtual healthcare represents a fundamental shift in the delivery of healthcare. It promises more convenience and access for patients and relief for strained healthcare systems globally. It affects all aspects of the healthcare value chain, giving patients more control and better care and allowing health professionals to be more efficient and effective—at least that’s the hope.

The technology and its impact on traditional healthcare is certainly game-changing. For example, remote monitoring tools allow patients with chronic disease to transmit data such as blood pressure, glucose and oxygen levels to their health team without leaving home. Palm-sized, portable ultrasound units are being used on a trial basis at hospitals across Ontario. Tens of thousands of Canadians are wearing personal fitness monitors. More healthcare tools and apps are being developed every day. In a recent count there were more than 18,000 healthcare apps in the Apple app store.

But technology is just one aspect of virtual healthcare. 

“At its core, virtual healthcare is about the way people work together”, says Dr. Ed Brown, CEO of the Ontario Telemedicine Network (OTN), one of the largest and busiest telemedicine networks in the world, connecting some 1,000 organizations and providing services to every hospital in Ontario. “Virtual healthcare is clinical collaboration. It’s about being able to deliver care with communications tools across the entire healthcare system to create a holistic, collaborative approach to care. The really exciting part of what we do at OTN is not the technology. It’s getting people to think about what they do and using technology to enable new, more effective processes and business models. The key is to find those places where we improve quality and reduce costs at the same time. For example, more than 1 million people in Ontario have diabetes but they are not all having the required interventions, such as eye exams and other screening. If we can use technology to conduct those interventions and make it more convenient and efficient for patients and doctors, then we can avoid health complications and added costs to the system.”

This is particularly important when you consider the shift taking place in healthcare to meet the demands of a population that is living longer. The goal is to keep people out of hospital and help them to manage chronic conditions from their homes. The challenge is getting the many different care providers to collaborate. “To do that you need processes and tools that enable these folks to work together,” says Dr. Brown.  “If you can share data, build a care plan together, tell each other when the patient is admitted to hospital--all the simple things you need to do to support these patients--we will be way ahead.”

OTN was early to virtual care and remains a global leader in the space. A little background:  OTN was born out of the merger of three regional Ontario networks in 2006. At that time the objective was to provide rural telemedicine services and deliver healthcare over a distance. Dr. Brown puts the distance challenges in context, “Ontario is the size of California plus Texas plus Maryland. The far north, which represents one third of the province, has no roads. There are only fly-in communities. There is no question that telemedicine, which allows rural patients to see healthcare professionals from their home communities via videoconferencing  and uses tools such as handheld stethoscopes and digital patient cameras, was the ideal solution.”

Today, OTN supports 3,000 videoconferencing platforms at 1,600 sites and facilitates 300,000-plus patient events annually. That number has been growing on average 50% a year over the past two years. It started using private networks and is now migrating to public networks and the Internet. In many ways, OTN’s growth mirrors the typical trajectory for a new technology. It starts off in a niche with a particular application and that niche quickly expands and the applications multiply. What started with videoconferencing is now morphing into virtual care, and OTN has moved beyond a service provider to a facilitator, helping drive collaboration in order to take these technologies into mainstream healthcare.

To that end OTN has also evolved to facilitate e-consult services for specialties such as dermatology and ophthalmology with the ultimate goal of expanding into all specialties. For example, today, at 140 primary care practices, a health professional can take a picture of a patient’s skin condition, send data to a dermatologist electronically and they will send back their diagnosis and management plan in less than five days.  In the traditional system, wait times for an appointment with a dermatologist can take anywhere from six months to a year. Since April 1, fee codes for dermatological e-consults and retinal scans have been established—a key step in driving adoption and a challenging one as it requires both policy change and acceptance by different groups within the healthcare system.  In the U.S., 16 states have drafted legislation to include virtual care in payment schedules.

Dr. Brown expects that e-consult will be part of every specialty practice and could easily lead to a 25% reduction in face-to-face office visits. He points out that studies by leading healthcare systems such as Kaiser Permanente have seen similar  results at that level in primary care. Making that happen will require policy changes and a governance structure that will allow the many diverse providers to come together to not only create and share data but to extract the most value from that data and use it in a way that leads to better patient outcomes. 

“From OTN’s perspective, we had a unique opportunity. We started out many years ago in a green field and we created a governance structure so that everyone could play on the same field. All of our partners know the standards, how to respect each others’ privacy and security and they all agreed to use the business processes that we developed, which has given us a head start in being able to create a larger, collaborative network,” says Dr. Brown.  “That is probably our biggest value. In a way it won’t matter where the technology is hosted or what it does. It’s going to be how we approach that as a healthcare system that will make the difference. We need a seamless infrastructure in order for it to work. OTN wants to be in the room supporting and driving the development of that virtual system.”

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