The Ottawa telehealth project

Objective: To examine the telehealth system as a means of improving access to cardiac consultations and specialized health services in remote areas of Ontario. Methods: The University of Ottawa Heart Institute has set up a telehealth t est program, Healthcare and Education Access for Remote Residents by Teleco mmunications (HEARRT), in collaboration with industry and the provincial an d federal government, as well as several remote clinical test sites. The pr ogram makes off-site cardiology consultations possible. History taking and physical examinations are conducted by video and electronic stethoscope. La boratory results and echocardiograms are transmitted by document camera and VCR. The technology is being tested in both stable outpatient and emergenc y situations. Various telecommunications bandwidths and encoding systems ar e being evaluated, including satellite and terrestrial-based asynchronous t ransfer-mode circuits. Patient satisfaction and cost-effectiveness are also being assessed. Results: Bandwidths from as low as 384 kbps using H.320 encoders to 40 Mbps using digital transport of NTSC video signals have been evaluated. Althoug h lower bandwidths are sufficient for sending echocardiographic and electro cardiogram data, bandwidths with transport speeds of 4 to 6 Mbps appear nec essary to capture the nuances of the cardiac physical examination. A prelim inary satisfaction survey of 19 patients noted that all felt that they coul d communicate effectively with the cardiologist by video, and each had conf idence in the advice offered. None reported that he or she would rather hav e traveled to the doctor in person. Initial and projected examination of th e costs suggested that telehealth will effectively reduce overall health ca re spending while decreasing travel expenses for rural patients. Conclusion: Telehealth technology is sufficiently sophisticated to allow of f-site cardiology assessments. Preliminary results suggest there is a sound business case for the implementation of telehealth technology to meet the needs of remote residents in northern Ontario. Working closely with governm ent and industry, we will develop a marketing and commercialization plan to support the use of this technology throughout Ontario and expand applicati on to patient education and continuing medical education.