Patient stories Sunnybrook Magazine – Spring 2017 Wellness

Telemedicine connects patients to their care teams in new ways

Patient who used telemedicine

Burn patient Everett Mullen, 78, (pictured above) is being treated by Dr. Marc Jeschke, director of Sunnybrook’s Ross Tilley Burn Centre in Toronto via a secure mobile-phone app. Mullen lives 400 kilometres away from Toronto in Sudbury, Ontario. (Photo by Gino Donato)

It’s been almost two years since Everett Mullen’s legs were burned from ankle to groin as he was burning leaves in the yard of his Sudbury home. That day in April 2015, Everett was flown by air ambulance to Sunnybrook, where doctors performed two operations – one to repair his legs and another to graft skin from his back onto his singed limbs. He was in hospital for about one month. Everett has never returned to Sunnybrook.

All his follow-up appointments with Dr. Marc Jeschke, director of Sunnybrook’s Ross Tilley Burn Centre, have happened via a secure mobile phone app at his local hospital, which is only 15 minutes away from his home. During these appointments, Everett puts on a hospital gown and sits in a room equipped with a big-screen television and small video camera.

Dr. Jeschke examines him through the camera, which a nurse holds and moves over his legs and back. This form of videoconferencing is known as telemedicine and allows for virtual screen-to-screen interactions between patients and their health-care providers.

“It’s an 800-kilometre round trip between here and Toronto. It’s a lot of driving and if I had to fly, it would be costly,” says Everett, a 78-year-old snow plow operator who returned to work just a few months after his injury.

“At the start especially, it would have been really hard for me to travel because [the doctors] took the skin off my back, from the top of my shoulders to my waist, to graft onto my legs.”

Dr. Jeschke says telemedicine enables close and continuous follow-up without the necessity of travelling. “It’s independent of the weather, saves huge amounts of time and can be done at all times of the day. Everett had access to specialized care 24-7 without being at the burn centre.”

Telemedicine’s roots in Ontario can be traced back to Sunnybrook, one of the four sites where telemedicine was launched in the province in April 1998. This virtual private network – set up to protect patient confidentiality – is operated by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the Ontario Ministry of Health and Long-Term Care. OTN now works with about 1,300 health-care organizations and more than 8,000 health-care providers in nearly 1,750 sites across Ontario.

It’s been a gift because everything happens close to home”

– Olive Climo, patient

Telemedicine is making a significant difference in health care, where patients who need access to medical specialists often have to travel long distances for diagnosis, treatment and follow-ups.

According to the OTN, more than 637,000 patients in the province received care and health education through telemedicine in 2016. This has saved patients almost 260 million kilometres in travel and significantly reduced appointment wait times, emergency room visits and hospital admissions.

“When I started in telemedicine in October of 2001, there were less than 20 communities with telemedicine in their local hospitals under the NORTH [Northern Ontario Remote Telehealth] Network telemedicine program, which had a home at Sunnybrook,” says Valerie Sutherland, Sunnybrook’s telemedicine clinical coordinator.

“At that time, there were two other telemedicine programs in the province providing health-care services to patients in the southwest and eastern areas. In 2006, the three programs came together to become OTN.”

“Looking at telemedicine today, more health-care professionals in many disciplines and programs have adopted it as a means to provide health-care services to patients,” she says. These professionals include specialists and other practitioners, such as family physicians, speech-language pathologists, occupational therapists, physiotherapists, nurses, communicative-device assistants, pressure garment therapists and social workers.

“On average each month, about 35 health-care professionals at Sunnybrook consult with patients through telemedicine,” says Sutherland. These professionals come from a wide range of programs at Sunnybrook, from cardiology and endocrinology to dermatology, urology and psychiatry, to name a few. “Telemedicine has allowed Sunnybrook’s specialists to help patients not only in Ontario but in other provinces as well,” she adds.

“From time to time, we provide very specialized health-care services to patients who live in other provinces in Canada, thanks to a national adoption of this medium for delivering care.” says Sutherland.

James Heap was one of those patients who needed specialized care for his essential tremor disorder. Sunnybrook was the first site in Canada to offer MRI-guided focused ultrasound – a non-invasive surgical treatment that uses heat to burn away the area of the brain that causes abnormal movements of the hands and arms.

James’ hands shook so badly that everyday tasks such as eating and drinking became difficult.

“I was dropping everything and couldn’t do simple things like cut my food,” says the 84-year-old Ottawa resident. “My local doctor gave me pills to control the shaking, but it didn’t really help.”

From diagnosis to treatment, telemedicine allowed Dr. Michael
Schwartz, right, a neurosurgon at Sunnybrook, to provide health care to Ottawa resident James Heap, left. (Photo by Kevin VanPaassen)

Everything changed last year after James was referred to Dr. Michael Schwartz, a neurosurgeon at Sunnybrook and principal investigator on the MRI-guided focused ultrasound trial to treat tremors.

James had his first consultation with Dr. Schwartz through telemedicine. Under the supervision of a nurse, he went through a series of tests that included drawing spirals, drinking water from a glass and pouring water from one glass to another.

“I have a large screen that allows me to see the patient easily,” says Dr. Schwartz, who does all his initial consultations with potential MRI-guided focused ultrasound patients through telemedicine for those who cannot easily travel to Sunnybrook. “I can see if their hands are trembling when they’re doing the various tests or even if their hands are just resting on the desk.”

Based on the telemedicine consultation, Dr. Schwartz concluded that James was a good candidate. Last September, James underwent the procedure to treat the tremors in his right hand. He now reports that he goes to restaurants, shaves with a blade and plays golf.

Thanks to telemedicine, James had to come to Sunnybrook only twice – for MRIs – before his procedure.

“Technology is at a point where the communication and tests via TV monitors are the same as if I had been in Dr. Schwartz’s office,” he says. “And in my mind, these tests were as important as the operation.”

The field of telemedicine is also opening up new avenues for cancer patients like Olive Climo. The first time she drove to Toronto to meet Dr. Natalie Coburn, a surgical oncologist at  Sunnybrook, she left her home in Port Hope at 5 a.m.

Olive Climo uses telemedicine to attend her appointments with her oncologist Dr. Natalie Coburn

Cancer patient Olive Climo of Port Hope, Ont., (seated, at right) used to leave home at 5 a.m. to get to appointments at Sunnybrook with surgical oncologist Dr. Natalie Coburn. Now, through telemedicine, her progress can be monitored from her local hospital with nurse Patricia Ley (at left) and Dr. Coburn (on screen), saving time, money and stress. (Photo by Kevin VanPaassen)

“It’s easy to be anxious on the highway,” says Olive, who was diagnosed last year, at the age of 69, with gallbladder cancer. “There’s all this construction and traffic, and when you’re worried about your health the drive is even more stressful.”

Thankfully, she hasn’t had to make that long drive very often since last August. Her initial consultation with Dr. Coburn and the operation that followed called for two trips to Sunnybrook. Since then, all other appointments with Dr. Coburn, including follow-up appointments to monitor the progress of her chemotherapy, have been through telemedicine.

“I go to a local hospital for chemo, and after 18 weeks of chemo, I’ll get a CAT scan there and then have a telemedicine appointment with Dr. Coburn to discuss results,” says Olive. “It’s been a gift because everything happens close to home.”

Dr. Coburn, who started using telemedicine about three years ago, says her “aha” moment came one snowy day in February when a patient who had come in for a 2 p.m. appointment told her that she had driven in from Temiskaming in northeastern Ontario, and the journey to Sunnybrook had started at 5 a.m.

“And I said to myself, ‘There’s got to be a better way to do this,’” Dr. Coburn recalls. “Often, people are coming in, feeling unwell, or just after a surgery, so the trip is really quite a burden.”

Telemedicine also keeps her schedule on track, notes Dr. Coburn. Given the complex web of sites involved, she may be seeing patients located in Timmins, Oshawa, Wiarton, Lindsay and Midland within the same hour. As each site has an assigned time to be linked with Sunnybrook, it is important to start appointments as scheduled.

“There are so many benefits to telemedicine,” says Dr. Coburn. “But in the end, it’s about offering better care for patients.”

How does telemedicine work?

Telemedicine uses videoconferencing technology – including tv screens and webcams at each end – to connect patients with health-care professionals through a secure virtual private network. Technologies such as digital stethoscopes, which allow doctors to hear a patient’s heartbeat across distances, and high-resolution patient examination cameras – for close-up images of conditions like rashes and burns – make it easier to gather and share information. In Ontario, telemedicine can happen in one of several ways, including the following:

    • Instead of travelling to see a specialist in another city, patients simply go to a telemedicine studio, usually in a hospital or a medical clinic, in or near their home community. In the studio, a health-care professional guides the patient through the telemedicine session.
    • Mobile applications, such as those developed and used by Sunnybrook’s Ross Tilley Burn Centre, enable secure communication and information sharing through an iPhone or iPad. In addition to patient follow-up appointments, the Ross Tilley Burn Centre is using this technology for initial assessment of a patient’s injuries at other hospitals to determine whether a transfer to Sunnybrook is needed.
    • In the future, the hope is to offer telemedicine to more patients at home through a software plug-in installed on their computers.