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Wirelessly enabling the long-distance house call

Dr. John Semple, surgeon in chief at Women's College Hospital goes over and his patient Sandra Rouhi the functionality of the QoC Health software on a Samsung smartphone that allows doctors to monitor their patients' progress as they recover at home from their surgery.

Tim Fraser/tim fraser The Globe and Mail

When Sandra Rouhi found out she carried a gene that put her at a high risk for developing breast cancer, she opted for a bilateral mastectomy, and then reconstructive surgery. Twenty-four hours after that operation, she was recovering in the comfort of her home, armed with a smartphone, which her surgeon asked her to use to take pictures of her breasts. It was so easy to do, her two young children often helped take photos of the incision.

When a lumpy bruise appeared at the surgical site four weeks later, she worried she wasn't healing properly and sent a picture to her surgeon, John Semple, who was halfway across the world on a vacation and research trip in Nepal. "I asked his office: 'Can you please find him on a mountain and have him check this out,' " Ms. Rouhi said.

From a wireless connection at a hotel in Pokhara, Dr. Semple logged on to his tablet and looked at the picture Ms. Rouhi had sent, along with notes about how she was feeling and her pain level. He quickly determined the bruising was normal, and there was no need for a hospital visit. "It made me much more relaxed. It totally took my stress level down," Ms. Rouhi said. "I felt like a doctor was checking in on me daily."

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The app Dr. Semple helped create and used to diagnose Ms. Rouhi is one part of a technological revolution poised to reshape the health-care industry in Canada. With the federal government holding fast to a per-capita funding model for the provinces, it's innovation, not cash, that will save overcrowded hospitals struggling under crushing budgets and charged with improving the experience of patients like Ms. Rouhi.

In the United States, it's already possible to have a $2 app perform an eye exam and deliver a prescription. Sleep studies typically performed in high-tech labs can now be done at home for about $100. Electrocardiograms can be performed on a smartphone. Next week, a conference in Toronto brings together health-care and IT practitioners to pitch mobile technology as one avenue of salvation for an industry in need of a fix.

Canada's premiers are on board. They recognized in talks this week that these types of innovations will chart the future of health care and have agreed to draft standards to ensure ideas are shared among the country's 13 different health-care systems.

Even something as targeted as Dr. Semple's app, aimed at the 30-day post-procedure window, could have a major impact. More than one-third of patients in Ontario discharged from internal medicine wards were readmitted to hospital within 90 days, at an estimated cost of more than $700-million a year, according to a 2011 study. There were 140,000 readmissions within 30 days of hospital discharge in Ontario in 2009.

Peter Adams, senior health-care IT adviser for Toronto's MaRS Discovery District, described Dr. Semple's app as the "tip of the iceberg," saying that technology and others like it are capable of saving the health-care system millions in unnecessary hospital readmissions, needless suffering and potential deaths.

"Physicians and patients need relevant information delivered at the right time in the right form," he said. "Surgeons want to be in touch; it helps them to do what they need to do."

Yet these types of technological innovations in hospitals remain rare. Concerns about the privacy of patients' information are prevalent and can stymie innovation, noted Joseph Cafazzo, leader of the Centre for Global eHealth Innovation at the University Health Network in Toronto. "It can sometimes be daunting, trying to ensure that the information that is being transferred is, in fact, secure and private," Dr. Cafazzo said.

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There are also questions about ensuring equitable access to these new modes of medical care, said Mark Farrow, vice-president and chief information officer at Hamilton Health Sciences. Not everyone can afford a smartphone or knows how to use one.

Still, Mr. Farrow, who is presenting at next week's mobile health-care summit in Toronto, expects the use of smartphones and tablets in hospitals will increase, especially once electronic health records are fully adopted. Patients themselves are driving some of the technological changes. "People are starting to want to take more control" of their health, Mr. Farrow said.

Increasingly in the health system, doctors have the big ideas, and some are the entrepreneurs – they know exactly what areas of their job are ripe for technological intervention. Dr. Semple's app, for example, was born from a particular need. Women's College Hospital in Toronto, where Dr. Semple is surgeon-in-chief, is an ambulatory care centre, so patients are in hospital no longer than 23 hours. He needed a way to keep tabs on a patient's recovery and avoid complications before the next clinic visit.

"The post-operative period is so neglected, it is like a black hole," Dr. Semple said. "All we do is send the patients out and then you cross your fingers and hope things are good when they come back."

He formed QoC Health, a patient health-care-focused technology company, with three others and developed the app. For the pilot test, he sent 20 patients who had undergone orthopedic surgery and breast-reconstruction surgery home with a smartphone and instructions on how to file their daily reports. Another 40 patients will join the pilot before it ends in March. Dr. Semple will then evaluate the results, hoping to market the app to hospitals and other health-care organizations.

Ontario Health Minister Deb Matthews said more innovation of this kind is needed, particularly as provinces grapple with fiscal constraints. While she cautioned that new technologies must be carefully evaluated to ensure patients' privacy is protected, she noted: "Technology is the best friend of health care right now because we know technology can help us do things that are a lot less expensive, but also [provide]far better patient care."

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In Ontario, the pay packets of hospital executives are now linked to their progress in meeting quality-of-care targets, ranging from improving hand hygiene to freeing up beds by discharging patients earlier in the day. A portion of their compensation can be clawed back if the executives fail to meet the targets.

Saskatchewan Health Minister Don McMorris expects technological advancements will reshape health care, but how best to share innovative practices among provinces and territories remains a quandary. Mr. McMorris isn't certain the federal government is best suited for this role, contending it's up to each province to seek out medical innovations.

Cardiologist Eric Topol, chief academic officer at Scripps Health, a non-profit integrated health system based in San Diego, has used this digital revolution in medicine on his patients as well. He's been doing electrocardiograms through a smartphone for six months, eliminating the need for hundreds of larger-scale EKGs.

"The best thing we can do is keep people out of the hospital," Dr. Topol said. "Technology is quickly working to pre-empt a lot of hospitalizations and office visits. This is just the beginning."

With a report from Renata D'Aliesio

Over the next year, The Globe will explore the innovations that are reshaping Canada's health-care system.

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