Telemedicine has been promised for over two decades. It has been practiced for some time in the remote regions of Canada, due to the lack of access to specialists. Many specialized equipment setups were developed for these purposes, which allows a physician to direct a nurse or medical practitioner at the patient’s side to provide certain treatment, examination, or counsel.

A conventional telemedicine setup for the remote side.
Photo: iDOCSWeb

Challenges in these remote locations were access to broadband, funding for the equipment setups and maintaining IT stability during the consults – a rather considerable challenge if no one else is doing it elsewhere, as there are few lessons learned from anywhere to implement.

But due to the COVID-19 pandemic, telemedicine is now spreading to the urban environment and is being used for ordinary consultations, as well as supporting more challenging consults. The general lifting of these restrictions took place in Manitoba on March 15th, allowing doctors to bill when using telemedicine.

Telemedicine practice during COVID-19 Pandemic,
Photo by ABC News

During the COVID-19 pandemic, our medical practitioners are avoiding unnecessary contact with patients due to the risk of social transmission. Patients are being seen virtually, using the simple technology of either mobile phone or the laptop.  Prior to these recent changes (billings and approval to use), telemedicine results were very poor.

Prior to these circumstances, the UK had conducted 14% of 23 million general practice appointments by phone, while only .5% (115,000) of the appointments were conducted by video. In the US, one service provider indicated that half of their patient contacts in 2017 were virtual. The majority of these virtual contacts were by phone, with an almost equal amount by messaging, with a small amount by video. The Canadian Telehealth Report indicated that in 2015 there were about 410,000 telehealth clinical sessions, which represents .15% of the 270 million billable services, as reported by the Canadian Institute for Health Information. Realizing that some medical services can be delivered in a challenging environment, our physicians are now making their appointments virtual.

You  no longer have to take an hour to get to the clinic, spend money on some exorbitant parking fees (and you know that the parking enforcement officer is watching closely) and wait for your appointment – which is going to be late, because the doctor is fully booked and some patients have a more challenge case than a simple consult can resolve, finally have your 15-minute consult and proceed to drive home.

This “Ceremony of the Doctor’s Appointment” takes the better part of half a day, and easily $20 in parking and gas – unless the parking enforcement officer tags for a further $70, because you did not estimate well enough how late your appointment would run. You feel in these cases that you are Snake Plissken and your challenge is to “Escape from New York!”  Thanks, telemedicine, for giving me back my half-day.

“Snake Plissken” thankful for getting back his half-day
Photo by Pixilart

When telemedicine was first indicated, the wrist-wringers and technophobes were all concerned about patient confidentiality, data security, health protocols etc. However the US Congress passed the Health Insurance Portability and Accountability Act (HIPPA in 1996). In Canada there is not yet a national framework for telemedicine and as a result, each territory and province have their own set of licensing requirements that physicians must abide by. The medical regulatory authorities in British Columbia, Alberta, Manitoba, Saskatchewan, Ontario, Québec, New Brunswick, Nova Scotia, and Newfoundland and Labrador have more recently published telemedicine bylaws or policies.

In the past most part many non-contact consultations are taking place via mobile phone. This regime is referred to as “Doctor in a Pocket”. However other setups are also available for patients requiring higher degrees of intervention and these are built specifically for certain applications. Given that in urban areas, broadband is widespread, these systems are easy to deploy.

From the patient surveys which have been conducted on telemedicine, patients want this type of service, and if the doctor is running late they can multitask and do something else until the doctor is available. For patients with chronic conditions or more challenging circumstances mobile phone apps and devices may be able to pitch in and provide the doctor with the information that they require. As a result, the in-clinic visitation can be significantly reduced, post-pandemic. Lets encourage our medical system to stay with this approach.

Bottom line, why did it take the COVID-19 pandemic to mobilize our telemedicine system to serve the patients better?  We have had 25 years of run up to this time to figure out an staged and progressive implementation and instead we are doing this in a rush.