Dr. Marie Carole Boucher had had enough. Enough of seeing patients lose their sight because of a disease that was easily curable. To prevent any more of these patients from falling through the cracks, she implemented a telemedicine program to have work previously performed by doctors performed by cameras and nurses. Her goal today is to implement this program throughout the province of Quebec. La Presse met with her to see how the program functions.
PHILIPPE MERCURE LA PRESSE
In her office at Maisonneuve-Rosemont Hospital, Dr. Marie Carole Boucher opens a file with a click of the mouse. A large orange ball with red stripes appears on the screen. The photo does not depict a planet contrary to what one could initially believe but the interior of a patient’s eye.
This photo was taken using a special camera installed in Chisasibi, a Cree community located more than 1,000 kilometres away in the James Bay region. Dr. Boucher zooms in on a specific zone on her screen.
“Look here,” she says, pointing to a reddish spot. “It’s a haemorrhage. The patient does not know it, but if it is not treated within the next month, his sight will be irreversibly affected.” The specialist consults the patient’s information on the screen and then types in a few instructions.
“This will provide him with the treatment he needs. That’s what an efficient service corridor looks like,” she states with obvious satisfaction. All in all, Dr. Boucher’s intervention took less than two minutes. Another click of the mouse, another orange ball displayed on the screen.
That’s how it works: screening, triage and treatment of diabetic retinopathy using modern technology. Dr. Boucher indicates that the field is “booming” and that a few programs and pilot projects are underway in Quebec (see capsule).
An Insidious Scourge
Diabetic retinopathy is the main cause of blindness among people under the age of 60. It results from diabetes attacking the blood vessels that irrigate the eye. The damaged vessels release blood that accumulates on the retina. To compensate for the lack of blood circulation, the eye can also react by increasing the growth of abnormal blood vessels which end up bleeding and further hinder the person’s sight.
The disease can be effectively treated using laser technology or medication. However, diabetes is taking on epidemic proportions and the system is having trouble keeping up with all of the patients who require treatment.
The problem with this disease is that there are no warning signs. People experience absolutely no symptoms because the disease has already reached an advanced stage once they start losing their sight.
Dr. Marie Carole Boucher, MD
The Right Patient At The Right Time
Her solution consists of deploying fundus cameras in clinics, community healthcare centres (CLSCs) and pharmacies. Each camera costs about $35,000, can be operated by a technician or a nurse and is capable of photographing patients’ retinas in less than ten minutes.
“The idea is to install the cameras where they are accessible to patients,” she says.
Eye photos are automatically sent to healthcare specialists. Duly trained nurses have the ability to analyze the photos and they only send those involving problem cases to physicians. “The physician ends up examining only 10 out of every 100 screening images. And when he sees the patients, he sees them at the right time,” she explains. She hammers out her mantra like a slogan: “The right patient at the right place and at the right time.”
She also insists that the system’s purpose is not limited to detecting the disease. It also automatically ensures the follow-up of patients. The gains are particularly notable in the case of patients who live in remote areas, including Aboriginals among whom diabetes is a rampant health issue.
Given the reliability of the diagnoses as well as the effectiveness and cost-effectiveness of the treatments, Dr. Boucher estimates that diabetic retinopathy is the “ideal disease for telemedicine.” A revolutionary way of doing things? Dr. Boucher does not think so. To the contrary, she believes that this ‘revolution’ has been a long way in the making.
“Look around you. Everyone has been exchanging photos and images for years,” she points out. “It’s so easy! How is it that our healthcare system never thought of doing so? It makes absolutely no sense.”
The Maisonneuve-Rosemont Hospital University Centre for Ophthalmology was the first in Quebec to deploy a camera-based retinopathy detection and monitoring program. A camera was installed at the hospital and the program covers the entire east end of the Island of Montreal. The program was funded by philanthropic donations (the president of Perseus Capital, Jean Turmel, and the Fondation J.-Louis Lévesque each donated $120,000 to the program).
A second official program, for which the McGill Integrated University Health Network (known as RIUS McGill) and the Quebec Ministry of Health and Social Services (MSSS) are responsible, covers the James Bay region with nine fundus cameras deployed in nine communities.
Two pilot projects headed by the RUIS McGill and RUIS University of Montreal with the support of the MSSS have led to the installation of a fundus camera at community health centres including de la Montagne, in the Côte-des-Neiges district, and another one in Pointe-de-l’Île, in Montreal’s east end.