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Telemedicine: Connecting communities

Pathology is one of the rare medical specialties that never brings practitioners into direct contact with the patient and does not require their physical presence to make a diagnosis. By creating connections between pathologists who work in isolation from one another, and between the rural and urban communities they serve, telepathology – the creation, exchange and analysis of virtual slides - is helping to address long-standing gaps in health care and ensuring all patients receive the best-possible diagnosis and treatment.

 The telepathology project at Réseau universitaire intégré en santé de l'Université Laval (RUIS-UL) (Laval University’s Integrated Health Network) has plans to create a network for approximately 40 pathologists in eastern Quebec over 21 disparate sites, making it the largest telepathology project in Canada.

Dr. Bernard Têtu, the project director, says the project’s objective is to “reproduce what we were doing in our university hospital hundreds of kilometres away” at remote communities. For instance, even in a facility with no pathologist on site, “we can use this equipment to do a remote consult so that a pathologist at Laval can show a technician where to cut a frozen specimen.” In this case, the pathologist could use telepathology to check whether an operation had removed the cancer completely.

In university hospitals and certain regional hospitals, medical resources are sometimes barely adequate to cover their own overall pathology needs, and some can only offer intermittent presence in hospitals lacking pathologists. This shortfall means patients in outlying areas who require surgery must often travel to an urban hospital, something many older patients in distant communities are unable to do.

When a pathologist is only available in a hospital for a few days a week or month, the system must book certain surgeries according to the pathologist’s availability. And if the pathologist must leave before the operation takes place, the surgery might have to be postponed. As well, other surgeries could be postponed, because they are replaced by the cases requiring a pathologist.

More complicated procedures can be delayed because the slides have to be sent out to a specialized hospital and then returned to the originating hospital for analysis. This means patients must wait several days to learn about a possible cancer diagnosis. The other impact for the patient is that two procedures are needed, which is more expensive and which could involve more scheduling delays.

In addition to addressing the above concerns, RUIS-UL’s telepathology project will reduce the professional isolation of the region’s pathologists who are currently unable to obtain an emergency consultation with a colleague for complex cases.

“In 20 per cent of cases, a pathologist requires a second opinion,” Dr. Têtu says. “In a university hospital, we can consult our peers next door. Now we can bring that same consultation ability to remote regions.”

The greater collaboration with colleagues afforded by telepathology may aid in recruiting pathologists to positions in outlying regions where such sharing of duties is not otherwise possible. Dr. Têtu points out, “If a pathologist goes on vacation, now nobody has to cover at the hospital—it can be done by others in the region. We can share the workload across a greater geographic area. ”

RUIS-UL is finalizing its agreement with Olympus and has started preparing sites for the delivery and installation of equipment. The goal is to have five sites up and running by the end of December 2009, and four new sites added by March 2010.

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