Remote patients can now get help
Psychiatrists use telemedicine
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.
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Dr. Rajiv Bhatla demonstrates the Royal Ottawa Hospital’s live video connection of the telemedicine program.