Re­mote pa­tients can now get help

Psy­chi­a­trists use telemedicine

Ottawa Citizen - - CITY - KELLY EGAN

Of all the fields in health care, psy­chi­a­try seems the least suited to telemedicine.

Se­ri­ously. Would pa­tients will­ingly un­bur­den them­selves about a pro­found men­tal prob­lem while sit­ting alone in a room, in front of a cam­era, miles from the shrink’s couch? Yes, it turns out. Whether a sign of our evolv­ing sen­si­bil­i­ties in this dig­i­tal age or just ev­i­dence of a huge prac­ti­cal ad­van­tage, re­mote psy­chi­a­try is boom­ing at the Royal Ot­tawa Men­tal Health Cen­tre.

At an un­veil­ing Tues­day, the hospi­tal re­vealed it did about 900 clin­i­cal con­sul­ta­tions by re­mote video in 2012, an in­crease of roughly 80 per cent from the year be­fore.

There are now 40 or so doc­tors at the Royal us­ing the tool, which con­nects them to pa­tients in smaller places like Barry’s Bay, Deep River, Tim­mins and Cornwall.

Backed by a $1-mil­lion do­na­tion from Bell Canada, the hospi­tal un­veiled two fancy suites that are equipped with se­cure video lines, high-end cam­eras and pairs of large mon­i­tors, about 40 inches wide.

Doc­tors can use the main­floor suites — kid­dingly com­pared to the “Star­ship En­ter­prise” — or mo­bile tech­nol­ogy that lets them video­con­fer­ence right from their of­fices.

Chief psy­chi­a­trist Dr. Ra­jiv Bhatla demon­strated the tech­nol­ogy by tap­ping a few keys on a lap­top and land­ing in con­ver­sa­tion with Su­san Coulas, a nurse and telemedicine co-or­di­na­tor at St. Fran­cis Me­mo­rial Hospi­tal, about 180 kilo­me­tres west in Barry’s Bay.

“The pa­tients are very com­fort­able with the tech­nol­ogy,” said Coulas, who pointed out that ac­cess, travel time and un­pre­dictable weather can be big bar­ri­ers to good health care in re­mote com­mu­ni­ties.

“Peo­ple are sur­prised at how ef­fec­tive it is and how well they can in­ter­act,” said Dr. Bhatla. “Peo­ple are more com­fort­able with TVs, screens. Es­pe­cially young peo­ple.”

He said the real “cul­tural shift” was with doc­tors, who tended to be con­ser­va­tive minded in their ap­proach to the tech­nol­ogy.

Psy­chi­a­trists are in short sup­ply in On­tario — a short­age that might reach 300 within 20 years, one study pre­dicts — par­tic­u­larly in smaller com­mu­ni­ties. There are only two, for in­stance, in all of Ren­frew County, both based in Pem­broke. This cre­ates gen­uine prob­lems in small com­mu­ni­ties like Barry’s Bay, said Coulas, in­clud­ing res­i­dents who might go years with­out get­ting a proper psy­chi­atric di­ag­no­sis.

The 20-bed hospi­tal is now us­ing the Royal’s tele-ac­cess about twice a month. On those days, three or four pa­tients will spend roughly 30 to 45 min­utes each speak­ing to a psy­chi­a­trist in Ot­tawa. With the help of the fam­ily physi­cian, changes in treat­ment or med­i­ca­tion can be made. If nec­es­sary, face-to-face meet­ings can be ar­ranged.

Dr. Bhatla said an­other ad­van­tage of the sys­tem is that gen­eral prac­ti­tion­ers can get more reg­u­lar ad­vice from the spe­cial­ist, thus build­ing their own ex­per­tise.

It is not, how­ever, a cure-all for un­der­ser­viced ar­eas.

“I would say telemedicine is not for ab­so­lutely ev­ery­one in ev­ery cir­cum­stance. But it lends it­self to more op­por­tu­ni­ties, in terms of pa­tient care, than one would think,” said Dr. Bhatla.

Dr. Ed Brown is chief ex­ec­u­tive of the On­tario Telemedicine Net­work and called the changes in de­liv­ery “a huge trans­for­ma­tion” in health care.

He told the small crowd at the Car­ling Av­enue hospi­tal that the net­work now has 3,000 “plat­forms” at about 1,600 lo­ca­tions, mak­ing it one of the largest such net­works in North Amer­ica.

Of the 200,000 pa­tients who are an­nu­ally served by the net­work, the fastest grow­ing spe­cialty is men­tal health, he said. “It’s like you and me talk­ing with a screen around your head,” Dr. Brown said in an in­ter­view later. “Peo­ple just for­get there is tech­nol­ogy be­tween them.”

Lianne Wheeler, chief nurs­ing of­fi­cer at the 16-bed Deep River hospi­tal, said avoid­ing the four-hour trip to Ot­tawa, the pos­si­ble overnight stay, the ex­pense of meals and park­ing, is a huge ad­van­tage in their ser­vice area.

Psy­chi­atric care with a Royal doc­tor is now de­liv­ered one day a month by telemedicine, in blocks of two or three hours. A pi­lot project that be­gan last year now looks to be per­ma­nent.

It is ev­i­dence of the de­creased stigma at­tached to men­tal ill­ness that a cor­po­ra­tion like Bell would hap­pily at­tach its name to a high-pro­file cam­paign in­tended to spread aware­ness and spark dis­cus­sion about the men­tally ill.

The tele­com gi­ant has com­mit­ted $50 mil­lion as a long-term goal and is gear­ing up for its “Let’s Talk Day” on Feb. 12, dur­ing which funds are raised for ev­ery text and long-dis­tance call. In­deed, not only is Olympian Clara Hughes in­volved in the high-pro­file cam­paign but Ot­tawa Sen­a­tors cap­tain Daniel Al­freds­son was a pres­ence at Tues­day’s gath­er­ing, the blue-eyed Swede loom­ing from a 10-foot-tall poster.

WATCH a video report on this story at



Dr. Ra­jiv Bhatla demon­strates the Royal Ot­tawa Hospi­tal’s live video con­nec­tion of the telemedicine pro­gram.

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