Canada and State-Run Telemedicine

June 6, 2012
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Canada recognized years ago that it simply didn’t have enough practitioners spread out over its vast territory to provide quality person-to-person healthcare.  The Province of Ontario was one of the first to implement a telemedicine program to deliver healthcare.

Canada recognized years ago that it simply didn’t have enough practitioners spread out over its vast territory to provide quality person-to-person healthcare.  The Province of Ontario was one of the first to implement a telemedicine program to deliver healthcare.

The Health Council of Canada has released its “Progress Report 2012: Health care renewal in Canada.”  Overall, most of the provinces and territories have done what was expected of them in home and community care, health human resources, telehealth, access to care in the North, and comparable health indicators since the signing of the 2003 health accord.

Since 2005, the use of telehealth (what we call telemedicine in the U.S.) has increased by 35% annually.  The federal government’s investment in Canada Health Infoway included $108 million for telehealth projects, to be cost-shared with provinces and territories.  In 2010, the latest year reporting, close to 1,200 communities across Canada were using more than 5,700 telehealth sites.  This infrastructure has allowed nearly 260,000 telemedicine encounters, including an estimated 94,000 visits between doctors and patients in rural areas.  That looks good on the surface, but because the healthcare system is run by the provincial and territorial governments, most of the emphasis has been on parity between jurisdictions – not on improvements in healthcare delivery.  Also, these telemedicine encounters are the sum of numerous “pilot projects” – not sustained initiatives.  Despite the commitment to telemedicine, no one really knows how many Canadians now have access to healthcare via technology.  The provinces and territories have each done their own thing so there is no clear and consistent information about healthcare performance to make comparisons.

What the report calls encouraging, however, are the innovative telemedicine services now in place for the First Nations in Manitoba.  These are the native tribes in Canada.  They’ve worked together in partnering with various stakeholders to overcome many telemedicine challenges for which the rest of Canada has yet to find answers.   John G. Abbott, the CEO of the Health Council of Canada, believes that once these practices are adopted more widely, they could improve healthcare delivery and access.

I understand why the Canadians want to have healthcare equity among the provinces and territories (because taxpayer dollars are being spent), but there will always be discrepancies because each province is different – different population centers, different geography, etc. Even with adequate Internet access everywhere, no government healthcare system relying on telemedicine can ever be perfect or perfectly comparable.

I hope the Canadians think beyond primary care because a major benefit of telemedicine is improved access to specialists.  That’s why I think the evolving U.S. model of specialty telemedicine groups will be superior to anything a central government like Washington or Ottawa could run.  No offense to the medium size neurology practices, but I foresee a day when the Mayo Clinic, for example, is the national provider of telestroke service here in the United States.   Mayo could expand its services beyond Arizona, Minnesota and Florida now, but the cost of medical licenses for each specialist in 50 states is expensive.   So they need a mechanism that allows a licensed healthcare professional to do telestroke care wherever it is required in the country with perhaps only one license fee.  One proposal has been the “tandem” license proposal that Senator Tom Udall of New Mexico has been working on.  Still no word on when he will introduce the bill in the Senate, but it’s already overdue from February.

Having the right specialists available at the right time for the right patient is only one half of the pie though.  For these programs to be  cost-effective, Mayo or some other nationally known healthcare institution would have to make arrangements with emergency departments at small hospitals in each state with the appropriate telemedicine equipment ready for use in them.  (The majority of small acute care critical access hospitals on the Mayo Telestroke Network in Arizona use GlobalMed mobile telemedicine stations.) This calls for an advanced business model based on what Mayo has learned from its smaller programs within the borders of one state.

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