Prince Edward Island's groundbreaking telehospice project owes at least a small debt to France's space program. In December, Digital Telehealth Inc. based in Dartmouth, N.S., announced it had been named the project leader of an 18-month start-up of Canada's first network dedicated to palliative home care.

Contracted by the West Prince Health Authority, Digital has worked with the Canadian Palliative Care Association, Island Tel, Island Hospice, and West Prince Hospice in a joint effort to bring both cost-savings and improved care to terminally ill patients. Co-funded by Health Canada, the $126,000 project operates on what Digital CEO Wayne Bell terms low-bandwidth POTS (plain old telephone service) lines.

A U.S. Food and Drug Administration-approved Aviva System bedside patient unit from American Telecare enables 15-frame-a-second video transmission (compared to 30-frames for full-motion video) over those POTS lines. This allows caregivers working from the system's central unit, back at the healthcare facility, to see the patient and vice versa. The interactive "peripherals" of the system can also keep round-the-clock watch on the patient's temperature, blood pressure, pulse, heart and lung sounds, as well as do glucose, blood oxygen, and electrocardiogram testing.

"The nice thing about these units is that all their data are automatically uploaded to the patient's chart at the central station," says West Island's telehospice co-ordinator, Myra Ramsey. "So there is no room left for error either on the healthcare professional's or the patient's side. Nothing has to be copied down or read back. So it is 100 percent accurate."

It's also accurate to say that the project is a reflection of the experience, dedication, and training of the various project partners. Ramsey has been interested in palliative care since the beginning of her nursing career and did exhaustive research on suitable systems for the project.

Dr. Rod Elford of Calgary, a principal business partner of Bell's at Digital, brought a unique combination of medical and technical expertise to the work. "When he graduated from medical school in Alberta he went on to study space medicine in France and that got him involved in telemedicine," explains Bell. "When he came back home he wanted more training, the university put together a unique two-year graduate program that saw him study telehealth in the United States, Norway, and under Max House in Newfoundland. So he became the first in the world, so far as we know, to hold a master's degree in telehealth."

Under Bell's direction Digital will also provide the training needed by the home-based caregivers to run their end of the network. "We're independently developing educational programs for the caregivers in the home," says Bell. "We're looking at the best way to do that but initially we're thinking it will be Internet based because of its convenience for people."

Patients referred by West Prince physicians for palliative care services are eligible for telehospice hook up. Initially the system will handle just 12 remote patients. But even at that size, the world is going to know about it. Digital will be exhibiting its telehealth developments in the Canada Pavilion at the new millennium's first World's Fair in Hannover, Germany beginning in June. Some 200 countries are participating and over 50 million visitors are expected at the five-month long event.

But it's not the big show that motivates most, says Bell. It's the little 15-frame-a-second bedside images that will appear somewhat intermittently, but clearly, to PEI's telehospice nurses on their central station screen. (Privacy is assured. At the patient end, a button must be pushed before any bedside images are transmitted.)

"It seems that home care has been down the list of telehealth projects in Canada, yet the greatest volume of patients are actually in the home," says Bell. "So home care is where you're going to get the greatest bang for the healthcare technology buck. This has to be more than just about major hospitals connecting with each other."

Bell adds that when you "put the microscope on" such major, high-cost IT projects, it's difficult to identify what savings or other tangible benefits are being achieved. But when a dying patient, for example, can be cared for professionally via an inexpensive telehospice network at home rather than at the hospital, the benefits to the patient, to his or her family, and to provincial health care costs are obvious.

"I've had the daughter of one patient already tell me how grateful the family is that we've been able to leave her mother at home and yet still know and see what her condition is," says Ramsay. Ramsay describes the breadbox-sized Aviva unit as having a camera eye on its upper edge, a speaker-phone, a small computer-like screen for video and a read-out interface so that the patient or home caregiver can also see the readings being transmitted back to the central unit. Two simple buttons operate the device.

Both Bell and Ramsay fully expect the telehospice network and its simple, low-cost technology to carry on long after its initial 18-month pilot stage. It can be readily extended, they say, to other types of patients at further cost savings to the healthcare system.