THE OTTAWA TELEHEALTH PROJECT

Objective: To examine the telehealth system as a means of improving ac cess to cardiac consultations and specialized health services in remot e areas of Ontario. Methods: The University of Ottawa Heart Institute has set up a telehealth test program, Healthcare and Education Access for Remote Residents by Telecommunications (HEARRT), in collaboration with industry and the provincial and federal government, as well as se veral remote clinical test sites. The program makes off-site cardiolog y consultations possible. History taking and physical examinations are conducted by video and electronic stethoscope. Laboratory results and echocardiograms are transmitted by document camera and VCR. The techn ology is being tested in both stable outpatient and emergency situatio ns. Various telecommunications bandwidths and encoding systems are bei ng 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 usin g H.320 encoders to 40 Mbps using digital transport of NTSC video sign als have been evaluated. Although lower bandwidths are sufficient for sending echocardiographic and electrocardiogram data, bandwidths with transport speeds of 4 to 6 Mbps appear necessary to capture the nuance s of the cardiac physical examination. A preliminary satisfaction surv ey of 19 patients noted that all felt that they could communicate effe ctively with the cardiologist by video, and each had confidence in the advice offered. None reported that he or she would rather have travel ed to the doctor in person. Initial and projected examination of the c osts suggested that telehealth will effectively reduce overall health care spending while decreasing travel expenses for rural patients. Con clusion: Telehealth technology is sufficiently sophisticated to allow off-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 clo sely with government and industry, we will develop a marketing and com mercialization plan to support the use of this technology throughout O ntario and expand application to patient education and continuing medi cal education.