TELEHEALTH: P3
DELIVERS HEALTHCARE
AT CYBERSPEED
by John Chenery
In a remote Nova Scotia
fishing village late one spring evening, a copiously refreshed resident
emerged from a waterfront bar, took a long walk on a short pier and ended
up in the Atlantic jammed between the pier and a fishing boat. Badly
banged up, he was taken to local hospital where the two family doctors
called to attend him were concerned that he might have sustained broken
ribs, internal injuries, maybe even a broken neck or a fractured skull.
All the victim could tell them was that it hurt - a lot. Just a few years
ago, the doctors' first move would have been to stabilize the patient and
get him to the trauma center in Halifax as quickly as possible, involving
either a lengthy road journey or an expensive flight on the air ambulance.
Today, thanks to a pioneering public-private partnership (P3) between the
provincial health department and TecKnowledge Healthcare Systems Inc.,
things are simpler, with benefits to the patient, the physician and, not
least, to the province's cash-strapped health system. TecKnowledge is a
leader in the burgeoning field of telehealth - the use of communications
and information technology to deliver healthcare services and information
over large and small distances. Telehealth is quickly emerging as one of
the fastest growing segments of Canada's multi-billion-dollar healthcare
industry. An estimated 400 Canadian companies are now active in the
business - projected to top $1 billion in sales this year. In the case of
the accidental swimmer from Nova Scotia, the province's advanced
telehealth network, the most comprehensive in Canada, allowed the local
doctors to rapidly send x-rays and other test results to radiologists and
trauma specialists in Halifax. The expert diagnosis: no serious injuries,
no need for an emergency dash to the city; have him spend the night and
sleep it off. Long distance diagnosis is now an everyday occurrence in
Nova Scotia. All healthcare facilities with inpatient beds - 41 in all -
are linked in a network that is costing the province $8 million to install
and operate for three years. "We've surprised a lot of people,"
said Linda Weaver, TecKnowledge's co-founder and Chief Technical Officer.
"Nova Scotia isn't exactly famous for being progressive." The
system allows doctors in remote areas to refer difficult cases to any
physician in the provincial healthcare system, including specialists at
the principal teaching hospital in Halifax. Physicians can see and speak
with the faraway patient through videoconferencing while x-rays, photos,
video clips and other relevant materials are digitized and transmitted.
The telehealth unit can also be hooked up to devices such as ultrasound
monitors to complete the diagnostic package. Weaver said that the
project was born four years ago in response to growing problems among the
province's rural physicians. "They were overworked, overwhelmed and
they were leaving their practices. It was clear to the decision-makers in
the provincial health department that something had to be done and
telehealth was one component of the plan." Instead of trying to
establish and operate the network itself, the department went looking for
a private sector partner. They discovered TecKnowledge. Founded in 1993 by
Weaver and Dorothy Spence, former clinical engineers in the provincial
health system, the small Dartmouth-based company provides telehealth
solutions to the healthcare community. "It came down to some
forward-thinking people within the public sector as well as political
leaders realizing that something needed to be done and they didn't have
the expertise to do it," said Weaver. "They were willing to
break down the barriers between the public and private sectors to make it
happen." Weaver firmly believes that telehealth is one activity that
must be undertaken as a partnership because of its complexity and the need
to consider the requirements of all the parties. Nova Scotia has installed
a governance structure that is led by the health department and brings
users - physicians and hospitals - to the table with the operators before
decisions are made and implemented. Weaver feels that there is still
strong resistance in some parts of the public health sector to the growing
involvement of private companies in providing services. "There is a
very real fear that the private company brings with it a different set of
objectives, which is true, of course. Businesses want to stay in business;
they have to be profitable. But that doesn't have to be the only driving
force." Ten years ago, most telehealth activity was funded almost
exclusively from the public purse. But as the industry has grown, so have
the involvement, participation and investment from the private sector.
The main driver fueling the ongoing telehealth boom has been the
explosion of information technology and telecommunications at a time when
the healthcare industry was increasing its use of computers and
telecommunications. But much of the recent growth and even stronger
prospects for the industry arise from its potential to maintain quality
healthcare in an environment where federal and provincial healthcare
spending has been stagnant or declining. Add to that an aging population,
increasing demand for equitable access to healthcare services for
residents of isolated communities and the increasing demand among the
general population for health information of all kinds. In a detailed
analysis of the telehealth industry, Industry Canada said remote
consultation needs (telemedicine) or distance health and continuing
medical education drove early projects. Today, fewer than 30 percent of
projects are based on telemedicine. Most startups now focus on integrated
health networks, of which telemedicine may be a component. One of the
major features of the current telehealth scene in Canada is the growing
involvement of private companies. Continued growth would require close
partnerships between the customer/purchaser/user and system or service
providers. "…In many countries like Canada, these entities are
located in separate public and private domains, but good working examples
exist where the best of both sectors partner successfully," the
analysis noted. "The best telehealth projects combine the expertise
of health users with the best suppliers of technological
innovations." Dr. Mamoru "Mo" Watanabe, president of the
Canadian Society of Telehealth, agrees that, if telehealth is going to
proceed and achieve its potential, the public and private sectors are
going to have to learn how to work together in partnerships. "It's
a relationship that is still difficult because the partners are so
different in their philosophies and their approach," he said.
"The private company will always tell you that they want to make a
profit but that it is not the driving force, but it really is. They are
driven by quite different objectives. And because there is a difference in
culture, there is a different understanding of how the sectors work. You
need to spend a lot of time just working out what people mean when they
say certain things. We're all speaking English and using the same words
but you soon find out that the words mean very different things in the
different sectors." Adding to the tension is the long-running and
increasingly heated debate over private firms offering clinical services -
a development seen by many as the beginning of the end of Canada's public
health system. "Admittedly, this is not a very well considered
reaction because in Canada at this time private delivery of clinical
services through telehealth is not what is driving its development,"
said Watanabe. "But these days anything that involves a
public-private partnership in the health field tends to make people
wary." There are problems enough without that kind of
misunderstanding. Watanabe said that with the notable exception of Nova
Scotia, the record of health departments and private firms working
together on telehealth projects is not good. "Virtually all the
provinces have experienced problems, sometimes serious problems in making
these partnerships work," he said. "It certainly has not been an
easy relationship and there are still a lot of difficult transitions to be
made if we are to overcome the culture clash at work
here." Nevertheless, most provinces have telehealth networks in
greater or lesser stages of development. Alberta's we//net resulted from a
strategic alliance of Alberta Health with IBM and Ernst and Young to
provide project development and quality assurance services. The
partnership ensures that alberta we//net is primarily private-sector built
with appropriate advice and guidance from government and the public sector
health authorities, with additional input from medical professional
associations and healthcare providers. In Quebec, development of the
Interregional Telemedicine Network would not have been possible without
input from the private sector, said Dr. Andre Lacroix, an expert on
telehealth at the University of Montreal. Toronto's Hospital for Sick
Children has pioneered many different telehealth applications working with
a range of companies including Bell Canada, Adcom Electronics, Teleglobe
and Sony. Ask Linda Weaver the secret of TecKnowledge's success in Nova
Scotia and she doesn't hesitate. "An awful lot of telehealth projects
that have been started in Canada and elsewhere have been straight
technology-push. That means companies coming in with complex and expensive
technology that doesn't match what needs to be accomplished. We came at
the problem from the opposite direction, co-developing and co-designing
the system with the clinical people who would be using it. So you arrive
at solutions based on what is needed, not what is technically possible.
And you iron out potential areas of conflict as you go along."
John
Chenery has worked as a journalist and editor for national newspapers in
Australia and the UK. Before moving to Toronto from Costa Rica, he was
Director of Communications with the Earth Council.
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