Personal Health Navigator

Remote-monitoring homecare is reducing ER visits

Vital signs

QUESTION: My mother has been hospitalized several times for congestive heart failure. Each time the same thing happens. After her condition is stable, the hospital sends her home. But my mother has a hard time managing her illness and she ends up back in the ER.  Is there any type of medical help she can get at home? She lives in Ontario.

ANSWER:  There actually is a program that’s aimed at patients just like your mother.  It’s called Telehomecare and it was developed by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the provincial government and Canada Health Infoway.

Patients are supplied with equipment so they can take daily measurements of their own blood pressure, weight, pulse and the oxygen levels in their blood.  They are also given a tablet device to answer a few questions about how they are feeling. A technician comes to the home to set everything up.

All this information is automatically transmitted to a data centre where it is monitored daily. If the data suggest a patient is having a problem, a specially trained nurse will call the home. The family doctor may also be notified. With a bit of guidance from the nurse, the patient can hopefully get back on track and avoid another trip to the hospital.  Weekly telephone coaching sessions are also arranged with each patient.

“The goal of the program is to motivate and educate patients on how to look after themselves,” explains OTN’s CEO Dr. Ed Brown.

He notes that patients with congestive heart failure have trouble circulating fluids in their bodies. Fluid will sometimes build up in the lungs. They often feel short of breath and may need to be readmitted to hospital. There is no cure for the condition, but the symptoms can sometimes be managed through lifestyle changes such as eating a healthy diet and keeping weight under control.

The daily monitoring and feedback gives patients a better understanding of how their activities have a direct impact on their health. “They begin to learn what sorts of things – like eating salty fish and chips – will get them into trouble,” explains Dr. Brown. “Then suddenly, it’s not worth it any more having salty fish and chips when they know that they are going to up end up in the hospital.”

The program lasts for six months, at the end of which the equipment is returned. “Data show that the effect lasts well beyond the six months,” says Dr. Brown. Many patients buy their own blood pressure cuffs and weight scales “and they continue to monitor on their own – which is a great advance in self-management.”

The program, started in 2012, has helped to reduce hospitalizations by 60 per cent among the patients who got Telehomecare, says Dr. Brown.

It also provides remote monitoring and health coaching for patients suffering from a lung ailment known as Chronic Obstructive Pulmonary Disease or COPD.

Heart failure and COPD are among the leading causes for re-hospitalizations in Canada.

Telehomecare is now available for these two conditions in most of Ontario. The service is usually delivered through local Community Care Access Centres (CCAC) or hospitals.

There is just one catch – many doctors don’t know about it.  That means a lot of patients like your mother are missing a chance to benefit from the program.

Dr. Brown says OTN has been working with hospitals to make sure more patients are referred to Telehomecare.

At Sunnybrook Health Sciences Centre, for instance, consideration of Telehomecare has been integrated into regular discharge planning. “We are promoting it as best we can,” says Lois Fillion, Sunnybrook’s director of operations for the community and brain sciences programs.

Patients are assessed to determine what services they may need once they leave the hospital and this process helps identify those who could potentially benefit from Telehomecare. “The referral is automatic,” she explains.

But, even if patients are at hospitals where the referral isn’t automatic, they can still hook up with the program on their own.

Patients, or their family members, can go to the website of OntarioTelehomecare.ca to find the program in their area.   They just need to type in their postal code – and up pops the contact information.

Or, if they don’t have a computer, they can phone OTN at 1-855-991-8191.

Other provinces also have various forms of “telemedicine,” but Ontario has one of the most extensively developed systems in North America.

Indeed, OTN has been at the forefront of using new technology to put patients in touch with health-care providers.

OTN was formed in 2006 to make it easier for people in remote parts of the province to access health services. In particular, OTN made it possible for patients to have appointments with physicians and specialists through “video conferencing,” instead of travelling hundreds of kilometers to a medical centre in a distant city.

“Originally, the patients would go to a local hospital or medical office that had the [video-conferencing] equipment,” explains Dr. Brown. The doctors, in turn, would go to video-conferencing studios near where they practice.

Some of the earliest Telemedicine pilot projects were carried out using Sunnybrook’s studio as a base for medical specialists who provided care to people living far from Toronto. And that service continues to this day.

With the latest Internet advances, however, it’s now possible for a growing number of patients and doctors to connect directly without having to go to a studio.

OTN has created a secure video-to-home network that allows doctors to do “virtual” house calls.  It’s being used for a wide range of purposes, including palliative care in some parts of Ontario. “People who have limited time left don’t want to spend it in the emergency department, hospital or doctor’s waiting room– they want to be at home. So, it is hugely valuable for end-of-life care.”

Meanwhile, OTN is now turning its attention to smartphone apps. “There are probably 100,000 apps related to health-care,” says Dr. Brown. “We’re looking for the ones that have demonstrated real value to patients and we’re trying to figure out a way of implementing them into the health-care system.”

It’s possible that some of these apps eventually will be able to help patients like your mother who are living with chronic and debilitating illnesses.

For now, though, OTN’s Telehomecare appears to be her best-available option.

About the author

Paul Taylor

Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskPaul@sunnybrook.ca
and follow me on Twitter @epaultaylor