Gary Bushby who is part of an internet-based heart monitoring system in Abbortsford May 19, 2011.JOHN LEHMANN/THE GLOBE AND MAIL
Ever since he was diagnosed with heart failure three years ago, Gary Bushby has had a new morning ritual. Not a crumb passes his lips before he weighs himself, takes his blood pressure and logs on to a hospital website to tell a computer program how he's feeling.
Mr. Bushby, 57, is part of an Internet-based health-care program that monitors heart patients at home instead of requiring them to show up in person. Developed at St. Paul's Hospital in Vancouver, the technology has saved him hours of travel for appointments - he lives in Abbotsford, B.C., about 70 kilometres away - and given him peace of mind, he says.
If his vital signs or responses to questions such as "Are you feeling fatigued?" suggest he's at risk, the software will alert a nurse to phone Mr. Bushby right away.
"Even though I'm not sitting in their office, they keep track of me," he says. "It's just a good feeling knowing that people are there all the time."
As the population ages and health care dollars are stretched thin, Canadian institutions are finding new ways to provide health care in patients' own homes.
Telehealth - an umbrella term for telephone and Web-based technologies that deliver health services - has taken off in the past five years, according to Canada Health Infoway, a government-funded organization that invests with provinces in initiatives such as electronic health-care records.
Increasingly, nurses are making "virtual house calls" using remote patient monitoring systems.
Internet-based programs may be as effective as face-to-face follow-ups, says Scott Lear, a researcher at St. Paul's Hospital and Simon Fraser University.
In pilot tests for an online cardiac rehabilitation program, he says, "we saw improvements that would be consistent with what we'd find if patients came to the hospital-based program."
In addition, Dr. Lear is studying a telehealth program to monitor patients with two or more chronic diseases, including Type 2 diabetes, kidney disease and chronic obstructive lung disease.
Although people suffer from the same diseases across Canada, special-care institutions for conditions such as heart disease are concentrated in major urban centres, Dr. Lear points out. Access to health care is not universal in Canada because patients in rural areas either have to travel long distances or forgo treatment, resulting in worse health, he says. But "telehealth solutions can actually break down the inequity."
While hospitals have separate departments for kidney, heart and lung, online monitoring programs can gather information about a patient's medications, symptoms and vital statistics in one place and provide recommendations that account for all of the patient's conditions, Dr. Lear says.
He adds that patients who log in daily become partners in managing their own health.
Mr. Bushby says the heart failure program has helped him maintain lifestyle changes after his health crisis. He takes medication, follows a low-sodium diet and restricts his fluid intake to manage his condition. The online system "just keeps me on track," he says.
Other remote monitoring systems have been time-tested at the University of Ottawa Heart Institute. The centre has used home monitors linked to telephone systems since 2005, and now has about 160 of the devices for its heart patients.
Christine Struthers, an advanced practice nurse for the institute's cardiac telehealth program, says the home monitors help nurses catch problems early, resulting in fewer patients returning to the hospital. The readmission rate after six months has been "significantly better" since the institute adopted the system, she says.
The monitors are equipped with a weighing scale and blood pressure cuff, as well as a small electrocardiography (ECG) device if required. Data are transmitted to nurses' computers in Ottawa by a phone line or a modem that links to a cell tower.
The home monitor prompts patients with a script that says, "Good morning. It's time to take your vital signs. Please step on the scale," and so on. Then the patient is instructed to answer questions such as "Have there been any changes in your medications?" by pushing buttons for yes or no.
Despite their lack of bedside manner, the monitors are a hit with patients, she says. "They love it. The bigger issue we have is weaning them off them."
Patients at the institute suffer from conditions such as heart failure, unstable angina and heart attacks. They appreciate feeling they have a safety net when they're discharged, often to remote areas in northern Ontario, Alberta or British Columbia, Ms. Struthers says. "They know they're still connected to the Heart Institute."
But after about four months of daily monitoring, patients are required to return the device by bus and begin a three-month follow-up program using an interactive voice response system.
Every two weeks, the patient receives an automated phone call and answers medical questions by pressing numbers on a phone pad.
The use of interactive voice response to monitor cardiac patients is a first in Canada, Ms. Struthers says, adding that the combination of home monitors and automated phone calls has improved patients' self-care and reduced their time in hospital. "That saves a huge amount of money."
The home monitors are so well received that boomer children have tried to purchase the equipment for their parents, she says, although the devices are not for sale to patients.
Nevertheless, if adopted for the long term, telehealth systems have potential to extend the period of self-sufficiency for elderly people living alone, who will soon make up the majority of Canadians, Ms. Struthers says.
"They look at all of these technologies as a way for them to stay at home."