Health care delivery revolution
Mendez is the Fred H. Wigmore professor and unified head of the department of surgery at the University of Saskatchewan and Saskatoon Health Region.
Delivering effective health care to underserviced areas is a major issue in both developing and developed nations.
The perennial challenge of recruiting and retaining physicians in rural communities seriously hinders access to medical care for the most vulnerable populations in Saskatchewan, where one-third of the population lives in a rural setting.
Distance and time are significant barriers for adequate health-care provision in remote northern communities, where patients need to be transported to regional centres even for routine diagnostic tests. The cost of health transportation is staggering, in the range of $50 million a year, and consumes a huge proportion of the health budgets of those regions where health needs remain unmet. This results in health indicators that are well below the Canadian average.
Rapid advances in telecommunication technologies have opened the door for the development of solutions that could help address these issues. Increasingly, consumer cellphones and tablets are being used to transmit medical information.
However, the large-scale application of mobile telemedicine applications likely will require dedicated medical devices that are capable of providing a range of remote presence capabilities, combined with secure, reliable and stable connectivity.
Saskatchewan is an ideal setting to implement this mobile health-care technology as it has a large territory with many remote and underserviced communities, most of them First Nations. We have been pioneering such mobile technology that would allow the point-of-care diagnosis and treatment that could be used to effectively triage patients in their own communities.
These patients otherwise would end up in the emergency rooms of major referral centres in Saskatoon or Regina, increasing the workload burden on their services. Saskatchewan has, by far, the highest emergency admission rate in Canada, with 10,609 admissions per 100,000 people compared to an average of 7,600 emergency admissions for the rest of the country.
A switch from the current model of centralized diagnosis in large medical facilities to point-of-care diagnosis could dramatically increase medical efficacy by removing the barriers of time and distance, reducing wait times, and decreasing the cost of delivering health care.
Portable, remote presence devices for telemedicine have the potential to change the way health care is delivered in developed and developing nations. The availability of a global cell signal network that already covers 95 per cent of the world’s population, and rapidly increasing bandwidth will provide the telecommunication platform for a wide range of mobile telemedicine applications.
The use of low-cost dedicated remote presence medical devices will increase access to medical expertise to anybody who lives in a geographical area with access to a cellphone signal. This access will be especially beneficial to individuals in rural or remote communities such as the Canadian North, or in developing countries where medical expertise is insufficient or lacking.
Canada’s experience with the use of a remote presence device in the Inuit community of Nain in northern Labrador has shown improved patient care associated with high levels of satisfaction by patients, nurses and physicians, as well as a 60 per cent reduction in air transport to the regional health centre.
As this technology continues to advance at an accelerated pace, its implementation in health-care delivery will be unstoppable. We can expect an increase in sophistication and capabilities of portable remote presence devices and diagnostic peripheral attachments.
Real-time blood chemistry analyses, portable imaging systems, electrophysiological assessment tools and rapid diagnostic tests for infectious diseases are being developed, and will increase our ability to perform point-of-care diagnoses.
Although applications of portable telemedicine may initially be directed to emergency situations, remote locations and the developing world, perhaps its major impact could be in the delivery of primary health care. We can envision the use of portable remote presence devices by allied health personnel in a wide range of scenarios, from home care visits to mental health care follow-up sessions, where access to medical expertise in real time would be just a phone call away.