An experience using Telehealth Ontario

by Hans on 2005/07/27

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.

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{ 18 comments… read them below or add one }

DocX August 13, 2005 at 3:44 pm

Being an Emergency Doctor in Toronto I can say that Telehealth is not just a waste of money but a waste of effort.

The crap that they send Emergency Departments is unreal.

If I had a penny for the number of times a patient has said: “I wouldn’t have come to the ER but Telehealth told me to rush in right away!”

The millions of dollars spent on this Private American company called Telehealth would be better spent on more hospital beds, nurses and doctors.

Hans August 16, 2005 at 8:39 am

I’m sorry to hear that the telehealth program doesn’t seem to be of much benefit to the ER docs (and nurses). Guess the lay public doesn’t get to see the impact on the ERs. I also didn’t realize that this was a service provided by a private American company. I wonder why a similar service couldn’t be provided either by the ministry itself (maybe that’s a bad idea), a hospital (or group of hospitals), or a Canadian company.

I don’t disagree that if the telehealth program is a waste of money, then spending those funds on other necessary services like physicians and nurses would be a good thing.

Anonymous September 15, 2005 at 7:29 pm

I’m certainly not going to argue with an ER doc about how more money should be put into beds, nurses, and doctors, but as the father of a child with a fever, you kinda want some guidance right away, and I found this service provided it to my satisfaction. And I don’t recall the nationality of the person helping me to help my child being a big issue for me at the time. I was advised to treat at home, and it allowed me to do just that with more peace of mind than I had previous to the call, or that I might have gained having gone to the ER and waiting hours to see a doc frustrated with the system. Sorry his experience is different, but as a consumer of the system, I found the Tele-Health thing to be beneficial.

Hans September 16, 2005 at 1:05 am

Dear Anonymous – thank you for sharing your experience using the Ontario Telehealth program. I would have to say that my experience using the program was very similar to yours – providing a peace of mind that it’s okay to treat at home and not go to the ER.

Anonymous January 30, 2006 at 1:13 pm

I think the ER doc is being close-minded. Giving advice over the telephone is very difficult. Some people are very clear about describing their symptoms, however others are very vague. The nurses always have to err on the side of caution. I believe the public would not want it otherwise. Legal implications are also very important.

If someone says they have chest pain, many possibilities exist. However, only through a physical assessment can it be determined if it is heart-related or not. Thus a 911 or ER referral is warranted, depending on how severe the symptoms are. It may be nothing, but that cannot be determined over the telephone.

On the other hand, many people go to ER for viruses that could be treated at home. Telehealth is there to give advice on how to treat these symptoms and keep them away from the ER. When asking these callers what they would have done if they had not called Telehealth, many say they would have gone to ER. Some even say they would have called 911!

One final point, the service is also there to help answer any health-related questions. Parents love the service, especially when it relates to newborns, what is normal/not normal, breastfeeding questions, etc.

Overall, this 24-hr service provides great comfort to many people. If some people go to ER and have no significant issues, then all the better for them. But I don’t think they would want to take the chance that it could be something serious.

Sorry for the long message. I hope I explained my points clearly.

Anonymous February 22, 2006 at 6:11 pm

I am an RN who actually works for Telehealth Ontario. This is an extremely valuable service that is working within the health system to try and relieve the pressure on the ER’s, empowering the pulic to take charge of their own health by making decisions, and an enormous amount of education. Who educates the first time mum when she has had her baby and is discharged from hospital the same/next day?Unfortunately, what the callers tell us is extremely subjective, that is why a caller is asked a rigorous amount of questions, including medical/surgical history, many people do not realise that presenting symptoms may be related! For those of you in the ER’s and related fields, find out what we are all about before you start slamming the system, and let’s all cooperate together to try and make this a better health system!

Hans February 22, 2006 at 8:08 pm

Thank you for the past two comments – it’s always good to get opinions from different perspectives.

I don’t have a clinical background, but I can appreciate how people generally have difficulty articulating and describing a situation or symptoms – adding to the complexity is the fact that lay people may not have the appropriate technical knowledge to accurately describe what they are experiencing.

My apologies if you felt that I was critizing the work of Telehealth Ontario. Overall, I’m pretty happy with the program and what it can do for people in the middle of the night.

I can’t speak on behalf of health professionals working in the ER, but I think that in order to improve the system, we need to examine the consequences on all aspects of the system and not just one or two parts.

Discussion is good.

dazed January 12, 2007 at 3:10 pm

Disastrous.

We have a 6 week old daughter. Last night she was crying in a higher pitch than normal, and had not urinated in about 6 hours. My wife asked me to call telehealth for the first time. The “nurse” who answered started with questions about my daughter who essentially stopped crying about a minute into the call. She asked a question, I would give an answer and she would ask again. It became pretty apparent to myself my daughter was ok as she really didn’t have any symptoms. However the nurse kept asking similar questions. She then asked how often my daughter was feeding and I replied every hour or two. The nurse then about 5 times said every few minutes is too much. She wouldn’t listen to me. Eventually I grew frustrated and basically let her answer her own questions. Eventually she came to the conclusion my daughter was dehydrated. (Even after I had explained she had fed normally and had a dr. checkup 3 days previous and my daughter had been putting on weight very well). The nurse came back and said that I needed to get her to a hospital. I was a bit exhausted of her and frankly my daughter seemed ok just a bit cranky. To get off the call I finally said I would take her to an emergency centre.

This is where it gets bad. The phone rang about 3 minutes later, my wife answered and the nurse asked if we were taking my daughter to the hospital. We had spoken after I got off the phone, and we felt she was ok but would watch her. My wife said no to the nurse. The nurse immediately started asking about the welfare of the child, and why we were not going if I had said I was going to emergency. This went on for about 5 minutes when my wife, again to get off the call said we would visit a hospital.

My daughter calmed down, had a wet diaper and a stool movement and fell asleep.

2 hours later at 12:30 in the morning we get a call from CHILD SERVICES stating they had been contacted from Telehealth nurses and were fearful for my daughters safety. That we needed to report to an emergency room immediately and have a hospital official contact Child services that we had indeed arrived. We argued slightly but really just wanted this nightmare to go away. We asked for the nurses names and headed to the emergency room. Upon arrival we explained ourselves to the triage nurse who upon examing our daughter said this is a waste of time, that our daughter was fine, she said we seem like nice people and she called the Child services number. At first nobody answered. We had to wait 30 minutes (In the emergency room of a large Toronto hospital with a 6 week old infant-germs apparently had not entered the telehealth’s nurses thoughts) for a child care rep to call back. The triage nurse said “what is telehealth doing, this child does not need to be here.” The child services basically said the nurse at telehealth said the baby was in danger. The triage nurse said we were free to go, that if we wanted to we could see a doctor but it wasn’t necessary. By this time feeling we were awful parents, we stayed for 2 hours waiting to see a doctor just to be sure. By this time we scared to take off my daughter diaper, just to “prove” she had now urinated, nothing seemed wrong. The doctor finally arrived, we explained our evening. He laughed and said telehealth and child services do this alot. He inspectect my daughter for 30 seconds, my daughter urinated on the examination table. The doctor appologized for us having to come in and said my daughter was fine.

So it ends. No today child services calls and say that they have to come with a nurse to inspect our home and give our daughter an examination. They said they can only come during working hours. Now I need to miss work. They have to have someone inspect my home. I am sure this is recorded by either health canada or the provincial government. I believe our family doctor needs to be contacted.

Obviously I have contacted an attorney, and have been advised to have someone in the house with us when the inspection takes place.

Could anyone help me in the sense that has anyone else gone through something like this. It is humiliating. If anything we are new parents, likely overly cautious, phoned telehealth for information and an opinion. Because of a 5 minute telephone call, poorly asked questions and not listening to answers, it has turned into a weeklong and now possibly litigious affair.

I will NEVER consider calling again. And by the way most nurses and doctors in emergency centres I have spoken with today, Telehealth is a massive burden on emergency rooms, doing the exact opposite of what it was attended for.

Do I have legal recourse?

Anonymous February 14, 2007 at 8:14 am

I have two young children 11 and 7, and I have used Telehealth for 3 years. Their services have been invaluable to me, in terms of educating me about asthma attacks, handling high fevers, alaceration on tongue, liquid paper on eyelashes, foreskin stuck on penis, and giving optimal doses of tylenol to reduce fever. Without them, I would be at ER because my physician do not work on weekends, and what I may feel as a panic/emergency can be handled with advice from the Telehealth Nurse. But, somethings are urgent when I don’t even know, and Telehealth is the number I call for help. Example. My child’s foreskin retracted all the way for the first time and could not be pull back. He was in extreme pain. Teleheath told me to sit him in a bath of warm water to gently pull the skin back, and if it could not be done n 20 minutes, it was an extreme medical emergency. Who would have known that? If I had drive and wait at the doctor’s office, it would be too late. I am very grateful that Teleheath has taught and walked me through my son’s asthma attacks. I have learn to watch for warning signs of respiratory distress and when he need to be taken to ER. I am now more competent and confident to handle the accidents & illness that occur because Telehealth walked me through every step of the way, advising of all symptoms to watch for… and I take notes every time. If I had to pay for their service, I would.

Brad February 15, 2010 at 12:14 pm

Telehealth is a joke!!! My wife was just bitten by a dog today. We were unsure of what precautions to take and what our next step to take should be. She has had a tetanus shot in the past 8-9 months. However I didnt know if that was recent enough. We called Telehealth and were told it would be a 90 minute wait. Yes that’s right one and one half hour. She’s off to the ER now with her sister. I’m timing it. Because I’m sure she’ll be back in an hour. I’ll update later.

Brad February 15, 2010 at 2:12 pm

As predicted. Back from the ER and pharmacy. With Prescription filled and 2 stitches. All in under 1 hr 10 mins. Telehealth is a waste of tax payer dollars. All nurses, triage and reception personnel agreed with me on this. It’s another federal and provincial embarassment!!!!!!!

Anonymous July 10, 2010 at 10:17 pm

Telehealth is an ADVISORY service, not an EMERGENCY service. Just think for one moment, the difference between triaging a patient in person and doing it over the phone.

You’re calling for THEIR professional advice, so stop complaining about the procedure. It’s funny how it seems everyone knows how to do everyone else’s job. I’m sure there’s a reason as to why they NEED to break down every detail. If they give the wrong information BASED on what YOU gave them, what do you think would happen?

To ‘Dazed’: had you considered that the nurse was concerned about your daughter based on the information that YOU gave the nurse? You called Telehealth and suddenly you’re daughter is ok. Well, does the nurse really know that? She/he’s trying to help you. You even said yourself that you “basically let her answer her own questions”. Are you a nurse? No you’re not. You called for a nurse’s opinion, so answer the questions.

Honestly, we are spoiled rotten with services and people can do nothing but complain. The sense of entitlement is sickning.

T April 17, 2012 at 12:54 pm

I have had a few very positive experiences in the past with telehealth. However, on one occasion I had a question and had to call back 5 times because they transferred me to someone who couldn’t help me, disconnected me or didn’t call back. That is fine because I am able to look after myself and make an appointment with my doctor (which from now on, I will just do) and I do appreciate that they’re there and the service they provide, but it’s useless if they’re not going to call people back or follow up. It would be incredibly frustrating to be an elderly person trying to use this service and not receiving any assistance. This really needs to be looked at and improved upon if they are going to have this service in the first place. If they are not going to call people back, they should use the money for the service and put it into beds etc

Sharon Hall May 26, 2012 at 8:48 pm

As a taxpayer, I find Telehealth to be an insult to the healthcare of the people of Ontario. The so called registered nurse you are speaking with first of all, never answers your innitial question. Instead, she or he asks you a list of questions that have nothing to do with your innnitial call. My tax dollars pay these clowns to do a job and frankly, I am tired of being jerked around by hasbeens answering a telephone and telling you to go to emergency for something they could advise you to do. It was my understanding that these nurses are supposed to give you medical advice, but I’ve not once recieved medical advice to my questions. Instead, they want you to go to Emergency and fill a waiting room for no reason other than to shift their responsibity to someone else that is overworked as it is. It’s an American joke in the wrong country,,,,,,,,,,, Time to get rid of it and stop playing with the healthcare of the people paying them to sit on their asses and answer phones. Put these same people on the floor in a hospital and make them work. i BET they wouldn’t be able to last 3 hours of the day!!!!!!!!!!!! Tired of the crap!!!!!!!!!!!!

Anonymous July 8, 2012 at 7:36 pm

i have 2 boys and my experience with telehealth is just not worth wasting time waiting for the obvious answers,90% of time they will tell you to go to the emergence right away,if we call to a service like that we call for advices, and from what i have seen and heared from these nurses only 10% of time when you call for normal issues like fever and cold you might get advive but always their easy way out is go to the hospital
so my opinions are:
1) if you feel so sick just go to the hospital,dont wait 2 hours for these nurses to tell you just that,cause they dont have any advice that will lead you to stay home.
2) if you or your kids are not so sick and you want some advice,just ask friends and family members for some advice,better than waiting for 2 hours to hear just what anybody around you would tell you

these people are just waste of time

John August 5, 2012 at 2:19 pm

I’m not sure what’s longer. The wait for someone at telehealth to get back to me or the wait in the ER. Our health system is equivalent to a 76′ Pinto.

anonymous October 7, 2012 at 12:26 am

Wow, Quit complaining about a Free Service that is available 24/7! Think of all the places that don’t have this service and then what will you do if your baby gets sick in the middle of the night. And by the way if you call in the middle of the night with symptoms that need to be looked at in the next 3-4 hours then the only choice you have is the Emergency department. It’s not their fault you waited til midnight to call about chest pain you’ve been having for days! It’s not their fault the public isn’t educated on the basics such as how to care for a fever. And for all the “haters” – make formal complaints and for all the supporters give positive feedback to Telehealth.
And since I am a Registered Nurse; please don’t judge my career. I don’t go around saying….those lazy bankers, those no good waitresses. I have dedicated my life to helping others and feel fulfilled…but when some people express such negativity it makes me what to be a stay at home Mom instead

Anonymous January 30, 2013 at 12:33 pm

As an RN in a busy Emergency room I can tell you that TeleHealth is of no use to us, it probably just drums up more business.

Patients arrive telling us that they have spoken to a nurse at TeleHealth and were told to go to the nearest emergency room. They then tell us that they are faxing us a report so we don’t have to assess them. This is never the case, often times that report doesn’t come for hours or even days later and the telephone conversation does not substitute for a physical triage assessment when the patient is sitting in front of you.

I think the money would be better spend providing extras services for our Emergency Departments, this would relieve some of the pressure on the system… NOT TELEHEALTH!!!

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