The amendment to the Medical Service Act that institutionalizes telemedicine recently passed the National Assembly. Telemedicine, which had been allowed temporarily during COVID-19, has been incorporated into the formal system and is set to be fully implemented. North America has already used phone- and video-based remote care as part of routine medicine for decades. We visited the field in Canada to see how it actually operates. [Editor's note]
"Patients with dementia can be treated remotely."
On the 27th of last month (local time), at Toronto General Hospital. In the office of geriatric psychiatrist Lee Joo-eun, there was a black computer with a small camera. Lee treats patients with dementia through this device.
It is not easy for patients with dementia to visit a hospital. In many cases, going out itself is risky because of cognitive decline and loss of a sense of direction. Lee said, "I ask patients to show me around their home so I can check whether things are piled up or if there is a risk of falling." Lee explained that one symptom of dementia, difficulty organizing, can actually be assessed more closely through the screen.
◇ Share an email with the doctor… consult symptoms by camera
Canada's land area is about 9.98 million square kilometers, the second largest in the world after Russia. It is about 100 times the size of Korea and 45 times the size of the Korean Peninsula. Patients living in medically underserved areas sometimes need two to three hours to get to a hospital. When there is a blizzard, they can lose eight hours on the road. The more difficult it is for patients to visit hospitals, the more likely diseases become chronic. That is why Canada began phone-based remote care in the late 1970s.
It snowed in Ontario that day. As the bitter wind swept the streets, the remaining snow turned to ice. The roads were slippery, making it hard for older adults or people with mobility issues to get around. In such cases, patients in Canada can see a doctor from home. Lee said, "For patients with dementia, the first visit is usually in person, and after checking their gait and so on, follow-ups are done remotely," adding, "If driving is difficult or coming to the hospital is hard, we do a video visit."
To meet a patient, a doctor logs onto a telemedicine platform and selects the appointment date and medical specialty. Patients leave their email address with the hospital and receive a web link for remote care. At the appointed time, they click the link and discuss their symptoms with the doctor.
Lee said, "I always see patients for more than 20 minutes, and sometimes it takes about 46 minutes," adding, "It's also possible to have a video conversation with the patient's family."
◇ Emergency situations → linked to police, staff at the patient's side
In Korea, remote care was temporarily allowed in 2020 due to the COVID-19 pandemic, then shifted to a pilot program in 2023. The amendment to the Medical Service Act to legalize remote care recently passed a plenary session of the National Assembly and is expected to be fully introduced. However, particularly among private clinics, some express concern about how to respond remotely when a patient is in an emergency.
In Canada, doctors can coordinate with police to assess a patient's condition in such situations. For example, if a patient makes remarks suggesting self-harm, the doctor fills out a so-called form and contacts the police by fax, among other methods. Police can visit the home to check on the patient or take the patient to a nearby hospital. This safety mechanism is in place to protect the golden time when every second counts.
Lee added, however, "Just having police show up can be traumatic for patients, so we need to approach as carefully as possible," saying, "Rather than that, I try to persuade the patient, and if they can come (to the hospital), I recommend meeting in person."
There are hurdles to clear before remote care becomes part of everyday life for patients in Korea. Some older adults may struggle with technologies like smartphones. In Canada, practices vary by province, but so-called social workers help ensure remote visits go smoothly by staying close to patients. Lee said, "Hospitals have programs, including social workers, to help patients who are seen remotely."
Giuseppe Guaiana, a psychiatrist at St. Thomas Elgin General Hospital in Ontario, explained, "Because technical issues can arise with remote care, we place personnel near patients who can respond to a variety of situations."