Telemedicine a natural fit for health care

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Before he became a telemedicine patient, 64-year-old Kingston resident Gary Todd says his doctor would have to prescribe him medication for anxiety attacks each time Todd was scheduled to make the trip to Toronto to see his lung specialist.

“I was thinking I have to go to Toronto and find a place to stay overnight. Last winter they wanted me to drive in that ice storm – it was freezing rain and I said I can’t make that one, I’m not going to take a chance on the 401,” recalls Todd. “And with that stress, everything – my lungs – would tighten up and effect my breathing.”

Todd had a double lung reduction last June when doctors took off half of his left lung and a quarter of his right lung. The surgery was to help Todd combat emphysema, which made his breathing extremely difficult. Todd says the surgery became more feasible once he started having his appointments via videolink from Kingston. “Rather than driving five hours on the highway when you can sit down and do exactly the same thing by telemedicine, it saved a lot of time on my part and it’s easier for me,” Todd says.

Lloyd, a registered nurse at Kingston-based Providence Care, is also the telemedicine specialist for the health-care organization, which provides non-acute care to patients across southeastern Ontario. He says before Providence Care offered videoconferencing between patients and their specialists in other cities, local residents had a much harder time getting on waiting lists for particular surgeries.

“To be eligible for urgent transplants, patients were at one time required to set up temporary residence within a certain driving distance from Toronto,” Lloyd says. “Because telemedicine services at Providence Care have established easy and more frequent visits via videoconference with transplant teams, this distance has actually been increased to include families living in the Kingston area.”

That telemedicine is not used more often surprises Lauren Childerhose, who at 19 years old sports bright pink hair and is at ease with anything high-tech. Childerhose had a double-lung transplant in September, and for a year prior to her surgery she had most of her check-ups with her doctor in Toronto via telemedicine at Providence Care. She says in the age of Internet cameras and cellphone videos, videoconferencing between hospitals sounds simple.

“My appointments [via telemedicine] were interesting,” Childerhose says. “I didn’t have problems with it – I mean, I’ve used webcams and stuff before, so it’s pretty normal for me.” Her parents, Brian and Sue Childerhose, can’t help but laugh and attribute their daughter’s comfort with the high-tech videoconference to her youth. “I thought the technology was really great – although I didn’t think it would be such a big deal,” Brian Childerhose says. “It’s mind-boggling how complicated videoconferencing is but it wasn’t really a part of our consciousness when we talked about Lauren’s health. It was just, ‘boy, we’re sure glad we can do this’.”

The Childerhoses say it’s a positive sign they weren’t fazed when so many of Lauren’s pre-surgery appointments were through telemedicine and think it shows how the technology is a “natural fit” in the health-care system.

But Lloyd says what may look effortless to patients – is actually quite complex. For the videolink to happen, Lloyd has to hook up equipment worth thousands of dollars – including two 42-inch plasma video monitors and a Polycom FX system. The high-end technology provides top-of-the line picture and sound quality, far surpassing images and audio on webcams and cellphones. The more accurate the picture, Lloyd points out, the more clearly the doctor can assess the patient visually. The system can also tap into more than one location at once, linking multiple hospital sites on one call.

Lloyd says a typical call uses 384 kilobites per second of bandwith, which is industry standard for videoconference. He admits he’s learned a lot about videoconferencing since taking over telemedicine and telepsychiatry at Providence Care. “I’m a jack of all trades,” Lloyd laughs. “I consider myself lucky to be involved in this area of nursing. I have learned how to look after the technology, event management and scheduling, besides the essential clinical components and responsibilities as well. It’s useful for me to have all of these skills standing by.”

Todd says one of the biggest benefits of Telemedicine is having extra nursing support. For each telemedicine appointment with Todd’s specialist; Lloyd was in the room not only to make sure the equipment worked, but also to be a second set of ears. He says having Lloyd go through all the appointments with him prior to the operation put him at ease as he contemplated the serious risks of surgery.

“Being relaxed it’s easier to do stuff,” Todd adds, wiping his eyes. “The doctors couldn’t believe how fast I recuperated. In six days everything was starting to heal really well and it was in part because I was more relaxed and I just wasn’t nervous before the surgery.”

The Childerhoses, meanwhile, are thankful Lauren’s transplant was also successful. She’s planning to resume her university studies in psychology and Japanese this year and also has plans to travel. “The only word to say is unbelievable,” says Sue Childerhose. “This is a girl who had to be on oxygen 24-seven and who was having trouble getting up the stairs. Now she’s better than I am on the treadmill and the bike at the gym.”

Lauren Childerhose says looking back on her telemedicine experience she can imagine how the same type of technology could help other patients – and not just those facing major surgery like she was. “It could get bigger, you know,” she says. “There are a lot of different times it would be good to see a top-of-the line specialist, and be able to have that meeting scheduled for you in your hometown.”