 |
= |  |
I recently had an experience with Telehealth Ontario. This is a service which is supposed to increase access to health information and reduce unnecessary visits to the emergency room. Anecdotal evidence in discussions with colleagues and friends suggest that almost all calls end in a suggestion to go to the emergency room. I fail to understand how anyone, except someone infected with bureaucratic thinking, could think the result would be otherwise?
First of all, calls are initially handled by triage agents, not necessarily registered nurses. If and when you get in touch with a registered nurse, the registered nurse does not have access to your physical person to even assess your vital signs or see the wound or complaint in question. You are never asked for your Health Card Number so the information available to the nurse is extremely limited. (Let’s not forget that Ontario is millions of kilometres away from an electronic health record so even with a Health Card Number, the nurse would have very little information about you.)
The nurse goes through what appears to be a computer guided list of questions to ask. They gather information about your situation in a call that lasts around 20 minutes in my case. During this time, why not just head down to the emergency room that the nurse will eventually advise in the end anyways? Discussions with nurses and doctors during my visit to the ER confirmed my theory that they found the Telehealth Ontario service useless and that virtually all calls ended in a referral to the emergency room. ‘20 Questions’ is a fun game a parties, but much less so when a person’s life may be on the line.
The biggest flaw in the system is obvious . A patient needs to be seen by a doctor. Physical examination is the cornerstone to medical practice. While it is true that some new technologies allow for video conferencing and devices that would transmit vital signs and medical test results to the remote attending physician Telehealth Ontario relies on a simple voice call. The mere idea that a registered nurse could provide a meaningful triage of a patient over the phone is sheer lunacy.
If The Ontario Ministry of Health seeks to reduce unnecessary emergency room visits, then the triage process upon entry to the emergency room must be altered to be performed by both a nurse and a doctor. Currently only a triage nurse assesses the patient for priority and then a multi-hour wait to see a doctor ensues. Patients who have unnecessarily visited the emergency room could be assessed promptly by a triage physician and be advised to have their condition (deemed professionally not to be an emergency) addressed in a community clinic or by their family doctor.
Ontario citizens looking for medical advice for an issue they consider an emergency issue will call Telehealth Ontario only to find that ‘no one [useful] is home’. After wasting precious time answering a list of computer generated questions, they will go to the emergency room, where they deserve to go, and hopefully, but unlikely, receive prompt medical assessment by a nurse and a physician. As for Telehealth Ontario being a measure to improve access to health care in Ontario and reduce emergency room wait times, the politicians have dialled the wrong number.
Interesting facts
- Each Telehealth call costs $39.
- Most other provinces with similar services have a call cost of $20/call.
- In 2008/2009 fiscal year there were 905,000 calls totalling just over $39 million (based on 905,000 x $39/call).
- Telehealth Ontario recently ran ad campaigns at unknown costs but during expensive prime time television.
- Telehealth Ontario had 905,000 calls out of a population of 12.2 million. Compare this to Quebec’s Info Santé which received 2 million calls from a population of 7.4 million. From this we can infer that either Ontarians are less aware of our Telehealth service than Quebecers or Ontarians find the service less useful.
[Source: http://www.auditor.on.ca/en/reports_en/en09/313en09.pdf]
