# Presentation: 111819

**Responding to the Needs of Northern Ontario Communities**
**Dr. Robert Williams**
- Medical Director
- NORTH Network

## Slide 2

## Health Care Concerns - Northern Ontario 

- Decreased access to specialty care
- Physician recruitment / retention
- Discontinuity of care
- Hospitalization rates 25% higher than provincial average
- High cost of patient/physician travel

##   Reasons for Patient Transfers in Northern Ontario       1993 - 1994  

**Northern Health Travel Grants Program****  **

**94,706 Patient Transfers**

**Procedure/ **

**Surgery**

**23.2%**

**Consultation**

**32.2%**

**Follow-up**

**40.2%**

**Hospital**

**4.4%**

## Tele-health Challenges

- Costs
- Organization and scheduling
- Physician remuneration
- Local concerns
-  referral patterns
-  efficacy of tele-consultation
- Communications incompatibilities
- Duplication of efforts

**Tele-health Challenges**

## NORTH Network Objectives

- Improve access to specialty care
- Increase access to CME and reduce professional isolation
- Reduce costs associated with long distance travel
- Program evaluation to aid in planning provincial tele-health network

## NORTH Network Technology

**NORTH Network Technology**

**Existing communication infrastructure**
- 336/384 kilobytes/second (ISDN + SW 56)
- Standards-based
**Peripherals**** **
- Patient camera
- Light source with otoscope
- X-ray scanner
- Teleradiology station
- Stethoscope

## NORTH Network Organization

**NORTH Network Organization**

- Local staffing to ensure grass-roots support
- Communication strategies
- Physician reimbursement
- Existing referral patterns respected

## NORTH Network CME

**NORTH Network CME**

- Weekly adult / pediatric medicine
- Monthly Grand Rounds
- Accreditation from CFP(C)
- Links to other sites for additional CME
- ie. Mayo Clinic series

## NORTH Network Consultations March 25, 1998 - March 31, 2000 

**NORTH Network Consultations**** ****March 25, 1998 - March 31, 2000**** **

**n = 756**
**PT/OT/ST/PsT: Physiotherapy, Occupational Therapy, Speech Therapy, Psychotherapy**
**Other:Gastroenterology, Geriatrics, Radiology, Pain, Respirology, Surgery, Neurosurg**
**           **

## Number of Consultations per MonthMarch 1998 - April 2000

## SATISFACTION

**SATISFACTION**

**Specialists**
-  Ability to provide adequate dx/rx plan **94%** (n=426)
-  Overall satisfaction **94%** (n=431)
**Patients**
- Satisfaction with telehealth consult **94%** (n=342)
- Choose tele-health again **92%** (n=341)
**Referring Physicians**
- Met needs of family doctor** ****98%**** **(n=206)
- Met needs of patient** ****99%**** **(n=211)

## Tele-medicine vs. Face-to-face 	

**Tele-medicine ****vs****. Face-to-face ****	**

**% of telemedicine consults that replaced face-to-face 147/155 = 92%**
**% of telemedicine consults requiring face-to-face**
**	****8/155 = 8%**
**Reasons given:**
**Telemedicine consult inadequate****	****	****0**
**Routine follow-up****	****	****	****	****2**
**For procedure****	****	****	****	****1**
**Needed consult in different specialty****	****1**
**Other****	****	****	****	****	****4**
**	****(medico-legal / admission / sports clinic / group session)****	****	****	****	****	****	****	****	**
**	****	****	**

## Cost of Tele-Consultation

**Cost of Tele-Consultation**

**	****	****	****	****         ****	**
**Specialist (mean, n=391)****	****	****	****   $57.09**
**Referring MD (mean, n=109) ***if present***	****   $34.73**
**Average Time (n=395)     16.6 min.****	****	****        - **
**Communication    $0.095 x 6 lines x 16.6  =   $9.46**
**TOTAL COST****	****    ****$101.28**

## Estimated Travel Grant Savings (@ $0.305/km)

**Cochrane to**:			   	      # patients	            Cost
- Timmins   		< 90 km		  	  49		      -
- Toronto		  720 km			141	          $	30,964
- Sudbury		  380 km		  	    2	_	_     232
**Kirkland Lake to:**
- Timmins		   140 km		163		  6,960
- Toronto		   590 km		113	             	20,334
- Sudbury		   315 km		    4		     384
**Timmins to:**
- Toronto		    680 km		  50		10,370
- Sudbury		    290 km		    7		     619
**Sudbury to:**
- Toronto		    400 km		  11_	_	 1,342
**TOTAL ESTIMATED TRAVEL GRANT SAVINGS:  ****$ 71,205**

## 	    Assumptions:
	1. Core costs already paid (equipment, phone lines, staff)
	2. Doctors would be paid anyway
	3. Marginal savings per patient = $135.56
	    $71,205 travel grant /491patients = $145.02 - $9.46 (avg.LD cost)

**	****1.** **Core costs already paid (equipment, phone lines, staff)**
- 	**2.** **Doctors would be paid anyway**
- 	**3.** **Marginal savings per patient = ****$135.56**
- 	    **$71,205 travel grant /491patients = $145.02 - $9.46 (avg.LD cost)**

**Estimated Cost Savings**

## NORTH Network OUTCOMES

- One of busiest tele-consultation programs in Canada
- Specialists able to do assessments
- Increased collegiality among rural physicians
- Excellent attendance for CME
- 6 telephone lines are effective

## NORTH Network - FUTURE

**NORTH Network - FUTURE**

- Province-wide tele-health network
- Additional specialties
- Extended programming