Opinion: Technology can connect rural patients with urban specialists

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A farmer from northern Alberta had been suffering from an arthritic knee. His family doctor referred him to a specialist clinic in Edmonton to determine if he was a candidate for surgery. His appointment arrived in the mail and coincided with the peak of harvest time. The farmer had no choice but to reschedule the appointment, creating a further delay. The day before the rescheduled appointment, the farmer drove 500 kilometres to Edmonton and stayed overnight at a motel so that he could make his 9 a.m., 20-minute appointment.

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He was advised that his knee arthritis was not advanced enough to recommend surgery, however, the clinical team suggested a program of physical therapy and regular exercise to help with his pain and function. He then headed five hours back home.

Twenty-four per cent of Albertans live in rural communities. Yet many of the specialist clinical services they need are only available in urban health centres. For rural Albertans, seasonal responsibilities can make scheduling difficult; weather events also make travel to appointments difficult and dangerous. We have estimated that the average out-of-pocket, roundtrip cost for a rural Albertan travelling to an urban clinic appointment is more than $500 (based on CRA-approved rates). The consequences of delayed treatment due to affordability of travel or seasonal factors show up in Alberta health databases as increased use of scarce primary-care appointments, more visits to local emergency departments and poorer clinical outcomes for the patient.

Care pathways and practices tend to be created with the urban perspective in mind. Having specialist clinicians in urban centres makes sense as the chronic shortage of expert clinical specialists requires them to provide care where they can have access to the highest number of people. But care processes and practices do not need to be urban-centric, and thanks to new technologies should be able to accommodate the differences between urban and rural lifestyles and priorities.

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So, how do we more effectively link our clinical specialists to our rural, remote and isolated populations? Several technology-supported advances offer a partial solution.

One improvement would be to more effectively use the advanced electronic medical record systems that have already been implemented across our province. The system could be modified to incorporate smart appointment scheduling guided by carefully designed AI algorithms. This would enable appointments to be made more flexibly while avoiding any perceptions of queue-jumping. Smart scheduling systems are already being used in the travel industry — so why not health care?

Another solution is to build on the advances in virtual-care technologies that were quickly adopted during COVID. For the past six years, our Rehabilitation Robotics Laboratory at the University of Alberta has been demonstrating practical ways to improve rural access for complex specialist clinical assessments. We have collaborated with AHS, primary care and supportive living centres to enable practical virtual technologies and clinical protocols to be implemented in rural communities across Alberta.

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In practice, this means patients in rural or remote communities have the potential to access virtual assessments, interactively, in real time with expert clinicians who are based in urban centres. A senior living in a long-term care centre can have her balance issues assessed without having to leave her community. As a local clinician gently moves her head, a special headset fitted with small cameras transmits her eye movements to an urban vestibular specialist who can advise or guide treatment.

Our travelling farmer from northern Alberta can have his knee expertly assessed using a virtual measurement system at his local health centre. These are solutions that are available to us now.

Rather than placing the cost burden of accessing specialist care on the backs of Albertans who live in rural or remote areas, let’s recognize the opportunities that new technologies can offer rural Albertans so that they can access the high-quality health care they are entitled to.

Modest investments will pay back with health-care savings that will benefit all of us. More flexible clinical practices will increase our system’s productivity and reduce reliance on overburdened local services that are further challenged by delayed treatment.

And let’s face it, this access inequity is fundamentally unfair and not aligned with the principles of the Canada Health Act. Let our attitude in moving forward be to support our rural communities by replacing outdated, urban health system-centric clinical processes with more flexible, progressive, patient-centred solutions.

Martin Ferguson-Pell, PhD, is co-director, Rehabilitation Robotics Laboratory, Faculty of Rehabilitation Medicine, University of Alberta.

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