Canada is a unique launchpad for virtual healthcare as it combines a modern, nationalized health system with incredibly remote towns and villages. One program in Ontario has had significant success and may serve as a model for other provinces.
The baby was coming – but much earlier than expected. Karina Beavis was 30-weeks pregnant and in early labor when she rushed to the emergency room at rural Espanola Regional Hospital and Health Centre in Espanola, Ontario. The problem? Espanola had no OB-GYN on staff, and the transfer hospital was an hour away in Sudbury.
Dr. Sean Mahoney, the family physician on staff at Espanola, had no obstetric expertise and was desperate to have the laboring woman transported to Health Sciences North, the large regional hospital in Sudbury.
“[Mahoney] called the obstetrician on the phone. He said there’s no way the mother’s going to get here on time,” says Dr. Derek Manchuk, Medical Director of the Virtual Critical Care (VCC) Unit at Health Sciences North (HSN), the regional hospital in Sudbury. “They’re going to deliver in the ambulance, so it’s better to keep them in the hospital emergency room.” Mahoney then asked if he could have the obstetrician help him via telemedicine using VCC.
A nurse set up the connection, and by consulting directly with specialists in Sudbury via the dedicated video conferencing system, Mahoney successfully delivered Beavis’ daughter, Leah, who weighed in at four pounds. “We were able to involve the VCC nurse, the obstetrician and the pediatrician, who helped deliver and resuscitate the baby, who was then transferred to HSN and did very well,” Manchuk says. “The mother was very happy with what had happened and the care that she could receive.”
Happy, but pleasantly surprised, she said after Leah’s delivery. “It was a little weird having people in another hospital watch me give birth,” Beavis told the local newspaper. “But it made a huge difference for the delivery. We feel very blessed that everything came together and that Virtual Critical Care unit was available.”
According to Manchuk, without VCC, Leah’s birth likely would have gone much differently.
“One of two things would have happened. They would have tried to muddle through on the phone giving advice without seeing what was going on, or they would have just said, ‘Best of luck to you, get them here when they’re stable,’ and hung up the phone,” he says. “I think it’s a quantum leap in terms of the care that can be provided.”
Putting Practitioners and Patients Together
Leah’s birth, which took place in September of 2016, is just one dramatic example of how the province is leveraging the power of telemedicine to provide first-class care to patients at remote hospitals throughout northeastern Ontario. The system, launched in 2014, is the first of its kind in Canada. Through the program, HSN maintains a group of doctors, nurses and specialists on call to respond to emergency and critical care situations at remote hospitals throughout the Canadian province.
For Americans, it’s sometimes hard to grasp the geographical challenges facing patients in farther-flung areas of Canada who need help beyond what their local doctors can provide.
Within northeastern Ontario, for instance, many communities maintain hospitals like Espanola’s, with a staff of primarily nurses and family physicians. Others are even smaller and more distant, and their lack of healthcare providers is compounded by their geographic inaccessibility. It’s in these circumstances that VCC is invaluable, Manchuk says.
Recently, VCC was used to assist a patient in the town of Hearst, which has a population of 5,000 and is an eight-hour drive away from Sudbury and two hours away from its next closest community.
“We had a patient that was in their emergency room for well over a day because the air ambulance couldn’t get there because of weather,” Manchuk says. “[Using VCC] we could maintain that patient in Hearst for almost two days, a critically ill patient on life support with the family physician there and a nurse – and they have very little experience in terms of managing critically ill patients. They see maybe a handful a year at most.”
And then there are spots such as the remote town of Moose Factory, a native community of 1,700 on the Moose River near the southern tip of James Bay. Moose Factory is more than 300 miles away from Sudbury and completely inaccessible by car during spring, summer and fall because it depends on ice roads for surface travel.
Bridging Geography, Saving Money
The foundation of the Canadian health system, known there as Medicare, is ensuring that every Canadian citizen will receive health care, regardless of their ability to pay. What results is a system that would, to Americans, be somewhat familiar in the way services are provided, but is entirely different when it comes to payment.
For standard procedures, doctors bill each provincial health care system directly and are compensated accordingly using funds collected through taxation. There are no insurance company middle men, a limited amount of red tape, and zero costs – such as deductibles or copayments – passed along to the patient. However, costs associated with pharmaceuticals, dental and vision are not covered through the national health plan. Canadians pay those out-of-pocket or have them covered through private insurance companies.
On the upside, because there are no costs to the patient, there are fewer roadblocks to preventative treatment and early detection, which results in lower per capita spending on health care by Canadian residents. In 2015, the per capita rate of health care spending for a U.S. resident was $9,451 (U.S.), compared to $4,608 (U.S.) for a Canadian. On the downside, Canadian healthcare maintains a documented reputation for long delays – some up to 10 months or a year – in scheduling elective or non-emergency surgeries and procedures compared to those for providers in the U.S.
Because of the limitations to healthcare access in areas like north eastern Ontario, many patients wouldn’t have the opportunity to see specialists or receive advanced care at all were it not for telemedicine allowing doctors to provide care from a distance with the least amount of technical interference, Manchuk says.
“The whole benefit of the video conference is not the technology. The technology should be easy to use and almost transparent in terms of its presence,” he says. “It’s about the discussion of the patient and involving the team members on each end of the connection.”
That’s not to say, however, that the system doesn’t also save Canadian healthcare money. Manchuk notes that because of the differences in their system and that of the United States, it’s difficult for Canada to track costs and savings per procedure the way we do here. However, just in the realm of transportation, he estimates that Ontario saves up to $16,000 (Canadian) per round trip with each air ambulance it doesn’t have to dispatch to transport a patient. That adds up to $1.4 million (Canadian) in just transportation savings since VCC was launched in 2014.
But cost savings aren’t foremost among VCC’s goals, he notes, and should the U.S. expand its use of telemedicine in emergency and critical care situations, he says it shouldn’t be here, either, whether it’s used for something as major as assisting a remote hospital with advanced procedures or as ordinary as helping someone decide if a cut needs stitches.
“At the end of the day the goal should always be to improve patient care, because if we do that we’ll save money,” he says.