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An experience using Telehealth Ontario July 27, 2005

Posted by Hans in : analysis, opinion, reviews , 10comments

Ontario’s Ministry of Health has a “free, confidential telephone service you can call to get health advice or general health information from a registered nurse” called Telehealth Ontario. I don’t know about you, but as someone who works and studies in the ehealth domain, I find the name of the service somewhat confusing. I can understand the rationale for naming the program as such: telephone + health + Ontario = telehealth Ontario. But, the name makes things somewhat confusing for people who are familiar with the terms telemedicine and telehealth. Perhaps something like “health phone” or “health line” would have been better.

In any case, I’m not writing about the name of the program. A few days ago, I had an opportunity to use the service. While out for his evening walk, my dad got bitten by a neighbourhood dog (I hesitate to use the word “attacked” because I wasn’t there to witness it). Anyway, by the time my dad got home, he had a nice rip in his shorts and a matching bite mark on his thigh. He wasn’t in any pain, but you could see several puncture and cut marks and some blood. After making sure he was (relatively) okay, my first thought was “does he need to go to the ER for some sort of shot?”. I had no clue, so my sister and looked up “animal bites” in a home health reference book we had as well as the Internet. The answers that we found weren’t too comforting and as our family tried to figure out what to do, I remembered Telehealth Ontario. So, we called the number (1-800-797-0000).

An operator answered fairly quickly and asked a few questions and then said to expect a call from a nurse within 20 minutes. Some of the questions asked about any existing health conditions (he has diabetes) and any medications he may be taking (we mentioned the drug types and why, but no specific names). Whoa - didn’t realize that the person on the other end of the line wasn’t a nurse. I guess there’s some sort of triage system in place to direct calls. Basically, all we wanted to know was if a dog bite is serious enough to go to the ER or if we could wait till the morning to visit our family physician.

Anyway, we were surprised that after only about one minute, we received a call-back. The nurse asked us to describe the wound and to see if my dad was experiencing any symptoms. We had to describe the size and nature of the wound(s) (was blood oozing or not). The nurse gave us some instructions as to what to do next and said that if stitches were required to go to the local ER. The nurse didn’t answer the question we wanted, so we asked: does he need to get a shot right away? Since the dog was a domesticated animal, probably not. Great - gotta love the definitive answer. So, my dad waited till the next morning to go see our family physician - our neighbour dropped off a copy of the dog’s shot history from the veterinarian to take to the physician.

Overall, I think the 24 hour service seems to be pretty useful. My guess is that the objective of the service is to keep people from going to the ER unnecessarily. By having a health professional give advice is comforting for people (like me) who don’t know if something can wait “till the morning”. I was pleasantly surprised to learn that the nurse has access to any previous calls we have made, although I wonder how the privacy issues work out for the initial operator taking our call. Does this person need to see the entire call history if they are only collecting information on the behalf of the nurse?

I can’t say if the costs of the program are offset by decreasing demand to the ER because I don’t have that data, but it is an interesting question to ask. I’m also curious to know how many people and how often the service is used. Honestly, I’m not sure if I’m comfortable having the nurse call back. Why can’t the nurse be the one answering the call right away? But, overall, I think the program works and is a pretty low-tech example of telehealth in action.

In the future, I wonder if these types of interactions can take place over the Internet using real-time chatting or using some sort of VOIP service. Since we have a digital camera, we could have easily photographed the wound and uploaded the image to the nurse to view.

Popularity: 29% [?]

Podcasting in Health - A look at Apple iTunes v4.9 for health podcasts July 13, 2005

Posted by Hans in : analysis, opinion , 2comments

A short while ago, I wrote a post about some of the challenges of podcasting in health care. I came across a statistic about the seeming popularity of podcasting because of Apple Computer’s iTunes software (version 4.9 supports podcasting). So, I decided to check out the iTunes music store to see what I could find.

At the time of writing (Wednesday July 13, 2005 at 1245 Eastern Standard Time), I searched for health-related podcasts. I’ve summarized my findings below.

Table 1: Searches for health/medical related podcasts on iTunes4.9

What I found interesting is that if you just view the podcasts using the iTunes categories (health - all subcategories), there are 89 podcasts listed. I just took a quick look, and it’s pretty much the same.

Maybe I’ll keep checking to see what happens in this category. I’m surprised that there aren’t any patient podcasts sharing their experiences. Based on past examples of patients using the Internet, I would have expected at least one or two patient podcasts. Maybe I’m not using the right search terms. So far, I’m still not convinced that podcasting will be that big in health settings.

Popularity: 12% [?]

Blood, bytes, and being a good neighbour July 12, 2005

Posted by Hans in : opinion , add a comment

Wow - it’s been almost a month since my last post. My apologies for being tardy. I’m going through a bout of writer’s block, which isn’t a good thing for a doctoral student who wants to graduate :) Regardless, I’m just going to write about my recent experience with the Canadian Blood Service (CBS).

This past weekend, I was in a local shopping mall and noticed a Canadian Blood Services booth. For reasons not completely apparent even to myself, I decided to donate blood. The experience itself was actually quite revealing. For one, the blood donating process is more technologically advanced than I had anticipated. Maybe it shouldn’t be considering the tainted-blood scandal of the 1990s (you can read a CBC.ca special on the tainted blood scandal).

Here are some things I noted:

Okay, those are some of the things I noticed right away. I’m actually interested to see how my “information” is used. One of the nurses with whom I spoke mentioned that the Canadian Blood Service has a national system (except for Quebec which has its own system), so that I can go anywhere in Canada and donate blood. I’m supposed to receive some sort of identification package in the mail in a few weeks identifying my blood type and some other details I can’t recall.

One thing that I intrigued me was the level of complexity of the consent form as well as the intake questionnaire. I can’t understand how someone who has difficulty with English could possibly understand the form. Maybe that’s why a nurse verbally confirms all of the responses before allowing someone to proceed. I was mildly surprised to note that all donors have an opportunity to voluntarily withdraw just prior to donating blood using a “yes/no” sticker system while alone in the “room”. The nurse said that this procedure gives the donor a final “out” if the donor has any reservations about donating - either because they are afraid of the procedure or have concerns about their own eligibility for donating blood.

In terms of the actual blood collection itself, it wasn’t so bad. I was shocked to learn that 450mL of blood is collected (about two small cups). The blood collection only took about 15 minutes, but I spent about 50 minutes for the entire process. I was a bit disappointed because I was initially led to believe that I would only need 15 minutes, but maybe I didn’t ask the right question - how long before I can leave versus how long does it take to donate blood?

As I was lying on the cot with the tube sticking out of my arm, I was wondering if there was any opportunities to automate the process further. The only thing I can think about is having an electronic intake form. But, an electronic form means significant investments in technology with what may be very little gain. The form itself isn’t the problem. It’s having some hardware that donors can use to enter the information. Could a handheld computer be used here? I’m sure that using electronic tools could provide multi-lingual support for non-native English speakers. Part of the challenge is that much of the blood collection takes place outside of the CBS offices (e.g., malls, schools, and community centres). What type of infrastructure support would be needed to make an electronic solution work? I saw a few laptop computers that the desk clerks were using, but very little by the nurses/phlebotomists themselves.

I think the nurse is right to note that asking people in person and observing their responses is a good human check to make sure that potential donors are being truthful in their responses. Being from a research background, I was mildly interested to see that CBS encourages donors to participate in research (by collecting a small portion of their blood for testing and research projects).

Oh yeah, one last thing. One of the “experienced” donors waiting beside me commented how the entire process seems to be getting longer each year. He thinks that the time will only increase because of the increased bio-terror threats. I was shocked to hear this idea, but after some thought, I realized that attacking the health system maybe a natural escalation of terrorists with the blood supply only one just insidious method. Scary thoughts…

Well, I’ll write more in two months during my next blood donation. I’m curious to see if the information they collected from me will be used. Hopefully there will not be as much demographic data collection.

Popularity: 9% [?]