Special report: Rural echocardiography in northern BC: What’s next?

“Most of our assumptions have outlived their uselessness.” 
—Marshall McLuhan

The medical hinterland of Bri­tish Columbia is on the cusp of great change. Rural health care has met the information technology age and things are about to get interesting. 

Gone will be the days of patients traveling long distances over an incredibly beautiful but deadly landscape to access something so ordinary as an ultrasound. The medical community has long embraced the belief that patients need to travel to regional centres to access sophisticated medical services. Today rural phy­sicians and their patients are experiencing advanced medical services in a manner that obviates much of this long-distance travel. Echocardiography is one of these services.

Fraser Lake is located near the geo­graphic centre of BC. It is a dot along Highway 16 that meanders from Prince Rupert in the west to well beyond the Rockies in the east. There is no hospital and there are no specialists. The nearest regional referral centre is approximately 160 km away at the newly named University Hospital of Northern BC in Prince George. 

In 2002 Fraser Lake developed a rural cardiac clinic to help manage the plethora of cardiac patients along the interior of Highway 16. Originally car­diac exercise testing was the main reason for referral to this clinic. A joint GP-specialist model of care was es­tablished, which has become a model of collaborative care. 

Drs John Boone and Brett Heilbron offered their services as the main cardiologists supporting this program. In 2002, any patient requiring an echocardiogram either had to go to Prince George or beyond, or simply do without. In fact when heart failure data started to be collected in the early portion of the last decade, it was unconscionable to see how few of these patients were accessing guideline-based care that included an echocardiogram.  

In 2004 a “rural echo proposal” was put forth to the multiple players in diagnostic imaging in BC. This was a co­operative venture between the au­thor and a strongly supportive Northern Health Authority. It was a proposal that articulated the need to bring echocardiograms into a rural health care facility away from the regional centres. 

The idea was to provide patient-centred care and bring technology to the patient rather than the contrary. But as the saying goes, life is all about timing, and the time was not right. The medical establishment was still clinging to what it knew. A proposal such as this seemed ludicrous. 

However in 2007, the rural echo proposal developed a pulse. Not a strong one, but a pulse nonetheless. As primary care reform and chronic disease management became common­place terminology, administrative  and medical minds loosened their grip on the past and started to be more receptive to innovation. 

In 2008 a pilot project commenced. Michael Mckiernan, a technician specializing in cardiac echo, arrived in Fraser Lake on a cold December morning with his portable echo unit the size of a laptop computer. Echo studies were conducted in our adapted stress-testing room and transported back to Prince George on a DVD. Results were reported by the radiologists in Prince George (Drs Larry Breckon and Al Leighton) and faxed back to the ordering physician. 

One year later the Pilot Echo Project was presented at the Health Innovations Forum meeting in Richmond, BC. In the summer of 2010 the Diagnostic and Accreditation Program of BC granted the Fraser Lake Echo Program a 3-year term. The accreditation report was a glowing reflection of  the kind of service possible in a far-out-of-the-way, dot-on-the-map kind of place like Fraser Lake.

The fall of 2010 marked 2 years of echo service in Fraser Lake. As of September 2010, 555 patients have made their way through Fraser Lake’s inconspicuous cardiac clinic doors. Wait times are down across the region, and most importantly patients requiring cardiac care are getting the quality echo study they need. 

The Northern Health Authority has done their dissection of the numbers and this service makes financial sense. It is a service I was once told was impossible to deliver. This service is now being replicated—illustrating the truth of Samuel Johnson’s sentiment that “aspirations are… possibilities.”

Acknowledgments
Special thanks to Dr Larry Breckon (radiology lead for the Rural Echo Project) for his ongoing support of this program.  

This article has been peer reviewed.

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Dr Pawlovich is a clinical assistant professor at the University of British Columbia and head of the Department of Rural Family Practice, Northern Interior, in Fraser Lake, BC.