Dialling up the future of consulting your doctor

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This is part of The Globe's months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from staff.

I am a downtown person, so the trek to Sunnybrook Health Sciences Centre in North York involves a transit trifecta of streetcar, subway and bus – an hour of travelling time each way unless something goes wrong, as it frequently does. Then, my commute can double or even triple in length.

That's why whenever I look around at the people waiting in chairs at the Odette Cancer Clinic, I wonder almost as much about their transit woes as their medical issues. Turns out I am not alone. Colorectal surgeon Dr. Andy Smith, Sunnybrook's Executive Vice President & Chief Medical Executive, believes that eradicating travelling time is one of the necessary shifts in transforming the overburdened health-care system.

A lot of what happens in the 100,000 plus ambulatory visits to Sunnybrook's Odette Cancer Clinic every year, could be done just as easily elsewhere, says Smith, listing blood tests and other routine medical procedures. We have to get rid of "the notion" that somebody should drive 35 miles in bad Toronto traffic, pay exorbitant parking fees and wait hours, if a clinic is running behind, he says, in order to have a doctor tell you "that your blood work is okay and come back in three months."

Modern technology allows doctors to consult, diagnose, and in some cases treat patients in their own homes whether that is across town or in the High Arctic. Alas, the compensation system tends to pay doctors by the visit. Until that administrative process is changed, patients will continue to be asked to show up in clinics and medical offices to have their prescriptions renewed and to hear their test results, adding unnecessary costs to healthcare's bottom line and digging an expensive and frustrating hole in a patient's day.

Sunnybrook was an innovator in helping to develop what is now called the Ontario Telemedicine Network (OTN) a web of healthcare providers and services originally set up for patients in remote locations in northern Ontario. "We used to think that we need that in Ontario because how are we going to take care of somebody up in Hudson's Bay or in Marathon Ontario, but we are now recognizing that we were wrong," says Smith. What we should also be using it for, he says is Telehomecare. "We are only in the infancy to do that, but at least the concept is out there."

Smith's transformative moment about the benefits of practising telemedicine on a local level came in a conversation with a nurse practitioner at the Odette Clinic. "I have been amazed," she told him, "that people think the only way to have a personal, important and meaningful connection with a patient and their family is face to face with them in the clinic." On the contrary, the nurse practitioner felt she could build better relationships over the phone because her patients were at home and in their own comfortable environment. "It is not that I am trying to be as good as when they are here," she said. "I actually think I can do it better."

Nobody would agree with that sentiment more than Stacey Daub, the CEO of the Toronto Central Community Care Access Centre (CCAC), the organization that provides homecare. Sitting in her mid-town Toronto office, she describes many of the ways the physicians, nurse practitioners and other healthcare workers can provide medical help at home to patients suffering from say Chronic Obstructive Pulmonary Disease (often called emphysema) and Congestive Heart Failure (CHS), "Instead of sending a nurse in to check monitors," says Daub, "we do coaching on the phone and remote monitoring."

What they are learning, though, is that telemedicine can be a boon for patients with mobility issues and children with chronic and debilitating conditions. Daub tells me about a mother who struggled to bring her child, who has myriad health issues, across Toronto to appointments with specialists. Her daughter has a severe and potentially life-threatening drooling problem, which is exacerbated by the jostling and movement that is an inevitable by-product of navigating city traffic. Either the mother had to pull over and stop the car several times on each journey to the hospital to suction her daughter's excess saliva, or she had to find a helper who could sit in the car and monitor her daughter's drooling.

Instead, CCAC nurse practitioner Arlene Chaves proposed that the mother and her daughter participate in an Urban Telemedicine pilot project that will enable them to stay at home and videoconference with doctors and nurses involved in the little girl's care. "They are all talking together and nobody is travelling," explains Daub.

Back at Sunnybrook, I contemplate the possibilities of telejournalism as I say goodbye to Smith, walk past rows of patients and family members waiting to see specialists in the hospital, and head outside to catch a bus that will take me to the subway and then the streetcar for my trek back downtown. Good thing I brought my e-reader.

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