Visions Journal

Matthew Chow, MD, FRCPC

Reprinted from the "System Navigation" issue of Visions Journal, 2014, 10 (1), pp. 37-38

You can do almost anything online these days. One area that hasn’t caught up with the online revolution, however, is health care. 

Many Canadians wait months for care and some have to drive or fly hours to another community to get help. Canadians who are dealing with mental health problems often face even longer waits because of a shortage of professionals who are trained to deal with these issues. If you live in a small town or city, you likely face the longest waits.

This is where telehealth comes in. Telehealth is a word we use to describe health care services that are delivered at a distance. Telehealth used to be limited to telephone services, but in this age of the Internet, telehealth includes video calls (e.g., Skype), instant messaging, email and even technology such as wireless stethoscopes and portable ultrasound machines.

What, where, how?

A telehealth visit may look like this:

1. An individual talks to their family doctor about a mental health problem.

2. The family doctor refers the individual to see a mental health professional.

3. The mental health professional has telehealth available and offers a telehealth visit instead of a regular in-person visit.

4. The individual goes to a telehealth room (usually a special room in a local clinic or hospital that has a video camera, microphone and large screen). In the future, you will be able to do this from the privacy of your own home, school or place of work. Some private telehealth companies already offer this option.

5. The professional connects to the individual using a secure video link.

6. The professional writes a report, prescribes a treatment, orders any necessary tests and sends this information to the individual’s local health professional, such as a family physician, pediatrician or mental health clinician. This information is often sent by fax or mail. In the case of prescriptions, it’s often faxed or called directly into the pharmacy. Lab tests are often ordered by fax. In the future, much of this information may be sent electronically.

In British Columbia, we are seeing some exciting new options for people to get mental health care using telehealth. Many hospital clinics now have an option for telehealth visits rather than travelling to the clinic in person. For example, children and families who are referred to the mental health programs at BC Children’s Hospital are automatically offered a telehealth visit if they live in a community with a telehealth room and have a problem that doesn’t require an in-person visit. Between 2012 and 2013, children and families saved more than $400,000 in travel costs by using telehealth rather than travelling to see us at BC Children’s.

Some private companies are also getting in on the telehealth action. Livecare and Medeo, both headquartered in Vancouver, are two examples of new companies that offer telehealth services from family doctors and specialists all across BC. According to these companies, thousands of people have received care this way, and hundreds of doctors are participating.

With some of these new companies, seeing your doctor is becoming as easy as turning on your laptop or tablet. Some provide services to regular clinics, and using the service is as easy as walking into a participating clinic. Other companies require individuals to subscribe to the service. The advantage of a subscription service is that individuals can access the service from virtually anywhere they have Internet service and a device with a camera.

In general, people who choose one of these private companies do not have to pay for the service. This may change in the future.

Is telehealth for everyone?

Telehealth is not for everyone. Some problems are better solved when an individual travels to meet a health care professional in person, or the professional comes to the individual’s community to make a visit. For example, individuals with developmental disabilities such as autism are usually seen in person. Likewise for individuals with complicated medical problems that require a physical examination or special tests like a CT scan.

Common mental health problems such as depression and anxiety, however, can often be helped by telehealth visits. The Operational Stress Injury (OSI) clinic in BC makes hundreds of telehealth visits every year to military veterans and members of the RCMP who suffer from problems such as post-traumatic stress disorder (PTSD). Because of telehealth, the OSI clinic is able to reach many more people who need help.

Some people worry that telehealth may not be as good as a regular face-to-face visit. Others worry they will have trouble using the technology, especially if they aren’t used to using computers and smartphones. These are normal worries, and fortunately, we’ve found the experience of telehealth is better than what people expect. In fact, I’ve spoken to telehealth professionals who find that elderly people are some of the most grateful users of telehealth. Imagine an elderly person who needs to travel several hours away to see a medical specialist: this person is now able to see the specialist at a nearby clinic, or perhaps even from the comfort of their own home.

Ask about it!

The next time you need to see a mental health professional, or a friend or family member needs help, ask if telehealth is available. Check out your local mental health clinic, hospital or even one of the new telehealth companies.

Telehealth is a safe and effective way to provide care. We can expect to see the use of telehealth grow in the future as we keep trying to find ways of delivering care to people no matter where they are.