Abstract
Care at a distance (Telemedicine) is rapidly receiving acceptance across the globe courtesy of the new development in information and communication technology (ICT). This concept eliminates the traditional ways of seeking healthcare services where clinicians and patients had to establish physical contact for treatment.
Canada was among the first world nations to adopt the concept. As a result, the country has witnessed a myriad of benefits accompanied with some challenges. The discussion in this paper focuses on the state of care at a distance in Canada by considering its benefits, challenges, advances made in comparison to other countries, as well as its future in the country.
Introduction
The demography of Canadians is characterized by dispersed settlements with a great portion of the population residing in urban areas. This dispersed nature of the population complicates the process of delivering health services. Nonetheless, the goal of the health sector is to provide high-quality services as stipulated by the World Health Organization (WHO).
The traditional ways of accessing health whereby the patient and the physician have to meet physically has been the main hindrance for equitable provision of health services. However, the modern progress in ICT has provided the green light for medical practitioners to exploit several opportunities to ensure equitable provision of health services.
One such vibrant opportunity is telemedicine, which intertwines medicine and telecommunication technologies in the healthcare delivery process. This paper analyzes the contemporary state of telemedicine (care at a distance) in Canada, how other countries are implementing the concept and possible solutions to the challenges that concept is currently facing.
Telemedicine Defined
Telemedicine is a contemporary version of care at a distance, which entails doctors attending to patients in absentia. Telemedicine involves the provision of healthcare from a distance by incorporating medical expertise and telecommunication technology. It comprises all healthcare activities such as diagnosis, prescription of medicine, continuing medical studies, research, and examination (Ahmed et al., 2008).
Telecare refers to the provision nursing services to clients from a distance and it is closely associated with telemedicine. In addition, telehealth underscores the situation where individuals can receive public health services.
In a recap, telemedicine, telecare, and telehealth all involve the transmission of health-oriented matters without the clinician having a physical contact with the patient. This transmission is facilitated by telecommunication technology. Telemedicine is gaining popularity across the world and particularly in developed countries like Canada.
Current state of Telemedicine in Canada
Canada was among the initial countries to approve the use of telemedicine in their health sector. Most stakeholders see telemedicine as one of the key instruments for improving access to healthcare in rural as well as isolated regions characterized with few healthcare centers. Through the application of the concept, the marginalized communities can receive healthcare services based on major towns through communication technology.
The use of telemedicine is quickly developing as studies conducted in Canada have shown an increase in the number of telehealth programs across the country. Furthermore, the establishment of the Canadian Telehealth Society followed by the Telehealth Association of Ontario has affirmed the importance of telemedicine (Trudel, Paré, Têtu, & Sicotte, 2012).
Since the introduction of telemedicine in Canada, the country has witnessed several benefits in connection with health provision. This assertion is quite evident considering the great percentage of patients and institutions that the telehealth technology is helping to receive and deliver healthcare services respectively. Some of the major benefits include enhanced access, productivity, and quality as explained in the subsequent paragraphs.
Telemedicine offers an option for the classic treatment method where the patient has to be physically present for the medical services to be administered. It eliminates the problems of distance that limit some individuals from accessing health care. Residents of regions that have scarce population can get comparable care like those from urban areas who physically receive the assistance of specialists.
The basic goal and achievement of telemedicine is enabling access (Canada’s Health Informatics Association, 2013). The aboriginal Canadians and rural dwellers have been progressively getting equitable access to health service. Statistics show that by the end of 2010, there were over 5,710 telehealth structures established in about 1,175 communities (Canada’s Health Informatics Association, 2013).
Most clients who used these telehealth systems came from the bucolic areas and particularly most were Aboriginal Canadians (Canada’s Health Informatics Association, 2013). In a given instance, an aboriginal woman was involved in an accident after receiving inpatient services; however, physicians were able to communicate to the nearest telehealth system and the patient received treatment in the absence of her initial nurses.
Most organizations providing telemedicine clinics are largely based in rural areas and northern regions of Canada. In the telemedicine structures, it would be difficult for patients to cover long distances to specialist assistance, thus averting equitable health-care delivery (Ahmed et al., 2008).
Telehealth has also promoted patient-centered care since individuals can get services close to their residential areas. The provision of cancer care in northern and rural Canada is a great example of how telehealth is improving the lives of residents of the latter areas. Regional health institutions usually attract huge population of patients who have to cover long distances to reach the health centers.
These long distances make it difficult for cancer patients who have to visit the hospitals consistently during their follow-up care. Fortunately, as most health experts admit, the application of telemedicine in cancer treatment programs has enhanced how medical practitioners offer follow-up care to their patients irrespective of geographical challenges especially in Northeastern Ontario.
Researches indicate that most patients who received treatment through Telehealth found it more comfortable than traditional health care delivery system (Ahmed et al., 2008).
Telemedicine is a cheap and time conscious system. Since it brings health services closer to the patients, it relieves them of travel costs among other burdens. It relieves elderly patients, immobile Canadians, and those who are poor and cannot afford the transport costs. Studies show that rural patients save about 500 km of a return trip in every telehealth service they attend (Ahmed et al., 2008).
By saving such travel distance and time, they also save money that would be spent on travelling. Research conducted in one particular region with telehealth systems showed that about 66% of patients interviewed had saved money thanks to using telemedicine technology in seeking health services (Wesson & Kupperschmidt, 2013).
Furthermore, it has facilitated the provision of timely treatment, which in turn results in quality healthcare. Telehealth has enhanced the management of patients with chronic ailments and it includes various forms such as assistance via telephone calls and supervision technologies that can be accessed from home.
Furthermore, it helps in the delivery of leading practices like telestroke. In one particular instance, a nurse showed how to perform surgical drain through video conferencing to assist a patient who had gone home after a surgery. Notably, the several administrative and medical services that can be achieved through telemedicine make the concept the best facilitator for giving quality care in line with the best practices.
The money and time saved by medical institutions and patients can be used on other productive areas. Studies show that physicians save about 20 days yearly whenever they applied the concept of telemedicine (Canada’s Health Informatics Association, 2013). Telehealth minimizes the use of health travel funds and Canada has saved up to $34 million on transport funding thanks to the Telehealth programs (Canada’s Health Informatics Association, 2013).
Moreover, the Telehomecare programs across Canada have allowed the country to save about $915,000 that could have been used in the emergency department to attend to patients (Canada’s Health Informatics Association, 2013). Canada saves about $55 million annually due to its telemedicine structures.
Plans for future implementation
Currently, telemedicine has won the heart of many Canadian clinicians and patients. Nonetheless, even as Canadians celebrate the current benefits of telemedicine, it is important to consider its future in the country. It is anticipated that the concept will grow and expand to include other services due to the new technologies that develop daily.
Telemedicine will become a normal practice as the traditional form of treatment where patients have to seek assistance in person. Furthermore, it is likely that it will become invasive given the huge reception that experiences currently. Consequently, more systems will be introduced to serve urban patients.
The increased penetration as well as acceptance by Canadians will stir other stakeholders such as jurisdictional healthcare organizations, physicians, and pertinent providers.
The advancement in technology will create a real-time connectivity, which will attract extra groups to adopt the concept. Subsequently, the application of telemedicine will result in extra benefits whilst ensuring that best practices are achieved (Trudel, Paré, Têtu, & Sicotte, 2012).
According to Canada’s Health Informatics Association (2013), initiatives have been established to determine how the care at a distance can be applied whilst maintaining best practice.
The European Union developed a number of strategies to achieve best practices, which include improving the image of telemedicine in their countries by making sure they are cost-effective, creating clear legislations on telemedicine, and tackling all the challenges that might impede the process of accessing telemedicine services (Trudel et al., 2012).
The EU has been discussing the progress made towards achieving the latter goals and correcting any emerging errors. According to Wesson and Kupperschmidt (2013), the progress is quick and it has attracted several professionals and stakeholders.
The current state of pioneer countries in implementing the strategy
The United States has invested heavily on telemedicine, which is normally monitored by the American Telemedicine Association (ATA) (Zanaboni & Wootton, 2012). ATA has embarked on training programs that will facilitate the provision of telemedicine programs to all Americans.
As of February 2014, 40 states in the US had some coverage for telemental health, 18 states had coverage for home telehealth, and 12 states had embraced remote patient monitoring” (American Telemedicine Association, 2014, p.1). Australia adopted the concept in 2007, while Norway followed suit in 2010, but slightly over 25% of countries across the world are adopting, legislating, and implementing telemedicine.
The current state of telehealth relies on the technology and financial trends in the world and the investment that is being made in advancing this concept. As aforementioned, various countries have endorsed telemedicine, and thus they are investing to enhance its services.
For instance, Australia has vowed to invest AUS $400 million in Telehealth (Trudel, Paré, Têtu, & Sicotte, 2012). Due to financial challenges that most European countries are facing, leaders are devising ways to cut cost whilst providing quality services to citizens. In the health sector, one of those concepts considered as cost-effective is telehealth.
Problems faced and lessons learnt
Despite the numerous achievements made by the telemedicine concept, there are certain challenges that derail its growth. These challenges revolve around physician reimbursement, professional growth, technology execution, governance and regulations by the ruling party, licensing process, and benefits awareness, as well as measurement (Trudel et al., 2012).
The use of providers in telehealth systems has been high especially where they are given lucrative incentives for their extra work. However, some health practitioners have been claiming that they are not given enough payment for their job. Therefore, it is necessary for healthcare institutions to come up with extra incentives to pay providers who serve their patients through the telemedicine technology with best practices.
With advancements in telemedicine, the involved parties need to introduce professionalism and especially on how to interact with patients through care at a distance.
Indeed, there are several differences between a clinician being consulted through the traditional methods and another communicating with his/her patient through videoconferencing. Stakeholders must realize that this concept requires new skills and knowledge that can only be achieved through training.
How to implement the lessons learnt and prevent same problems
Technology keeps on changing and thus it is important for people to anticipate this change. In the case of telemedicine, new technologies have been introduced across the world such as home monitoring and tele-enabled diagnostic instruments that have made work more efficient than before whilst improving on healthcare quality.
Canada should always learn these new technologies and educate its providers in a bid to give their best. In the case of licensing, it is important for the government to provide operational licenses across jurisdictional boundaries, which will help in raising the number of patients who can be served through telehealth.
A good example is the province of New Brunswick that permits clinicians from different provinces to serve patients from the province (Canada’s Health Informatics Association, 2013). By introducing this idea, the country will enjoy the full benefits of Telemedicine.
Moreover, the method of governing ‘care at a distance’ should be altered to a central organization technique that is currently being applied in Ontario and Manitoba. Unlike decentralized organization, the adoption of central organization is simple and it attracts a large population.
It enables jurisdictions to manage capital investments and their employees share information and experiences easily. Nonetheless, the type of governance technique that is adopted should be in line with other technologies used by other healthcare organizations to simplify the work of the management and ensure transparency.
Conclusion
Telemedicine has become a household name in Canada. Since its adoption, it has helped many patients who had problems in accessing healthcare through physically meeting their doctors. It is a blessing especially where distance is involved and health care centers are not available. Moreover, it has helped clinicians to provide a myriad of health services whilst observing the best practices and guidelines.
Additionally, it has promoted the right of ensuring equitable healthcare delivery to all. Indeed, the future of telemedicine in Canada is bright. Nonetheless, a number of changes should be addressed for a promising future. New technologies, incentives, and method of governance should be reexamined to ensure effective and efficient operation of the concept.
References
Ahmed, S., Mann, C., Sinclair, D., Heino, A., Iskiw, B., Quigley, D., & Ohinmaa, A. (2008). Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient’s perspective. Epilepsia, 49(4), 573-585.
American Telemedicine Association: State Policy Tool kit, Improving Access to Covered Services for Telemedicine. (2014). Web.
Canada’s Health Informatics Association: 2013 Canadian Telehealth Report. (2013). Web.
Trudel, M., Paré, G., Têtu, B., & Sicotte, C. (2012). The effects of a regional telepathology project: a study protocol. BMC Health Services Research, 12(1), 64-74.
Wesson, J., B & Kupperschmidt, B. (2013). Rural Trauma Telemedicine. Journal of Trauma Nursing, 20(4), 199-202.
Zanaboni, P., & Wootton, R. (2012). Adoption of telemedicine: from pilot stage to routine delivery. BMC Medical Informatics and Decision Making, 12(1), 1-9.