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PRAXES Medical Group Blog

We hope to bring you a diverse selection of posts sharing exciting profiles and stories on the fast-paced world of global emergency telemedicine and PRAXES services. We invite you to get to know our talented team of medical professionals and learn more about the innovative industries and clients we support. Please feel free to touch base with us with your comments or questions.

November 2015 – Getting to know PRAXES Project Manager / Business Analyst, Neil McWilliam

September 2015 – Top 5 medical supplies every sailor should have on-board

July 2015 – The challenges of delivering high-quality telemedicine

May 2015 – Getting to know PRAXES Technical Support Specialist Jeff Scribner

March 2015 – One Clipper Race Partner’s Story

February 2015 – Getting to know PRAXES procurement coordinator Dave Sumarah

January 2015 – Seven recommended sources of Medical Information on the Internet

December 2014 – Life as an Emergency Physician

 

Getting to know PRAXES Project Manager / Business Analyst, Neil McWilliam

Originally from Riverview, New Brunswick, Neil McWilliam joined the PRAXES team as Project Manager / Business Analyst in August 2015. He comes from an IT background and began his career working for Clinidata, providing tele-care services to the population of New Brunswick, then Clindata’s parent company, Sykes Assistance Services, providing tele-care services to Ontario, New Brunswick and Newfoundland. More recently, he worked at McKesson Canada leading the applications team for the Nova Scotia 811 service, and helped collaborate on developing a chronic disease management program for diabetes, two drug adherence programs, the Nova Scotia provincial gambling support program, and the Nova Scotia Tobacco Free line, among many other projects. He’s looking forward to managing and guiding the growing list of PRAXES’ technical projects. McWilliam took some time to answer a few questions for us on his unique position at PRAXES.

Can you explain what your role as PRAXES Project Manager / Business Analyst entails?

My position is focused on managing PRAXES’ active projects, scoping out new projects, getting buy-in from the stakeholders and managing projects and workloads effectively. I’m also doing an assessment of the technologies being used at PRAXES and making sure that we’re using the most appropriate technologies. In August, I had the opportunity to meet with our RSA and Global Excel Management contacts, so that was very interesting and exciting. The first major project I will be leading is the University of New Brunswick project offering telemedicine services to international students with RSA insurance.

 

PRAXES Project Manager / Business Analyst, Neil McWilliam

PRAXES Project Manager / Business Analyst, Neil McWilliam

What makes working with the team at PRAXES unique for you?

I like that it’s a small team and we can move quickly. I came from a large, corporate environment and it often took a long time to move things forward. It appeals to me to now be part of a close-knit team and really get the work done.

 

In your opinion, what makes PRAXES different than other telemedicine suppliers?

I’ve been in the tele-health industry for ten years and to me what’s different about PRAXES is that they have highly qualified and experienced physicians who are able to take calls and respond within just a few minutes. The technology behind the scenes effectively allows interactions with our customers. There are some innovative concepts we are working on to improve accessibility from remote locations and vessels. The EMwerx software is integrated with technologies, such as: SMS, email, and video conferencing. It also has automatic prescription features, and a secure built in EMR. Putting all of these elements together really opens up a variety possibilities for the future of telemedicine. It’s really quite exciting.

 

What do you think are the most important skills you need for your position at PRAXES?

My project management experience and technical background are definitely key. I also have 10 years of experience in the tele-health industry working with clinical experts, including: physicians, nurses, and therapists. I think this experience will really help me.

 

When you’re not working, what are some of your favourite pastimes?

Well, I have a 23 month-old daughter, Emily, so spending time with her is a big part of my life. She keeps me very busy! I play acoustic and electric guitar whenever I have the chance and I also really enjoy doing a little bit of web development on the side.

Top 5 medical supplies every sailor should have on-board

ClipperTelemed+ and PRAXES Medical Director, Doctor John Ross, shares his top five essential medical supplies he recommends every sailor carry on-board their vessels for long voyages.

A question frequently comes in to me from sailors. They want to know what are the ‘must haves’ in terms of medical supplies that should be stocked for a long voyage at sea. Of course, that is a tough question. So, I canvassed a number of my colleagues who are also sailors, including Clipper Race 2013 – 14 winning skipper, Eric Holden, to get their input. As a result, I had to make two lists, both of which address the fragility of humans in remote, sometimes hostile conditions.

List 1:

  1. Coffee
  2. Cheesies
  3. Rum
  4. Chocolate
  5. Nicotine patches. If there are smokers on board, that is a ridiculous addiction – a long voyage is an ideal time to quit.

List 2:

  1. This is cheating by slipping an extra item in, but one of the MOST important medical supply to have on board a marine vessel for long journeys is ENOUGH WATER. Occasionally, skippers miscalculate the volume of water required for an active crew in hot and/or dry climates. Water making machinery can break down. Rationing water can put the whole crew at risk of a variety problems such as acute kidney injury, fainting with blunt trauma, kidney stones and others with short and long term consequences.
  1. Anti-nausea meds – This is a ‘no brainer’ but also confusing because there are so many available or not available, in various regions and countries. It seems individuals must find the medication that works best for them. Most have side effects. Drowsiness is an important factor to consider, especially for someone on watch or requiring alertness. Dry mouth, difficulty passing urine or mental fuzziness are other effects. There are more than 25 different compounds as well as herbal remedies available. A medication with a variety of delivery methods is best, that is orally swallowed, dissolved under the tongue, per rectum, injectable into muscle or intravenous. Some can be obtained ‘off the shelf’ while others require a prescription. Commonly used medications include dimenhydrinate (Gravol but also marketed as Sleep Eze and other sleeping meds); meclizine (non-sedating); scopolamine patches; odansetron (expensive) and a few others that can be obtained in Europe or Asia.
  1. Pain meds – This should be another no-brainer. For long voyages, a variety of substances should be considered. Acetaminophen/paracetamol (Tylenol) is useful for mild to moderate pain. Anti-inflammatories (also called non-steroidal anti-inflammatories) can be used as an alternate to acetaminophen in many cases, but because they are ‘anti-inflammatory’ they are particularly useful in musculoskeletal pain due to sprains, strains and minor trauma. However, they do have more potential side effects than acetaminophen. Irritation and occasional ulceration of the stomach or small intestine is possible. They can affect kidney function. They can affect blood clotting. They are generally very safe, and are widely used, but recognizing when to use them, how much, how long and when not to use them is important. Examples are ibuprofen, naproxen, diclofenac, ASA, indomethacin, tenoxicam, ketorolac and celecoxib.

Narcotics such as codeine, morphine, oxycodone, hydromorphone and other synthetic opioids also have a place when painful injuries or medical problems arise and there is a delay to accessing definitive medical care. The use of these controlled substances require a doctor’s order, special prescriptions, a locked and controlled area on the boat, someone accountable for their use and documentation of how they were used. Unused narcotics must also be accounted for. Some people do not understand these requirements and mismanage these medications. Government narcotic control acts have clearly defined expectations and serious consequences for misuse.

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  1. Antibiotics – There is no question antibiotics are grossly overused around the world. People believe that a stuffed nose is bacterial sinusitis, a sore throat is strep throat, a cough is pneumonia, diarrhea requires treatment and so on. All these are rare to uncommon. Humans have excellent immune systems that can, if given a chance, respond to all sorts of challenges. Sometimes doctors do not take time to counsel people and explain illnesses that get better on their own, or patients demand a pill as a ‘quick fix.’ Patients end up taking an unnecessary antibiotic while they are getting better anyway and they attribute the cure to the pill – a false association. But it leads to thinking a visit to the doctor and a pill are required when similar symptoms occur again. Diarrhea, vaginal infections, rashes, antibiotic resistance are all side-effects.

Nevertheless, there are times when they do have a role:

  • Sore throat + fever + tender, swollen lymph nodes in the neck only (if there are swollen nodes in many body locations it is probably something else) plus white material on the tonsils is probably ‘strept throat.’ However, even then, there is controversy about use of antibiotics.
  • Green mucus, fever, frontal headache is probably bacterial sinusitis.
  • An increasingly painful tooth that is starting to cause facial swelling is probably a bacterial dental infection.
  • Fever, cough, productive yellow/green sputum, maybe one sided chest pain is probably pneumonia.
  • Burning, frequency, urgency, passing small amounts of urine is probably a urinary tract infection.
  • A cut three days ago that is getting redder and leaking some fluid is probably infected.
  • A generalized abdominal pain that has localized to the right lower area that hurts with every wave bump, associated with a mild fever, nausea and loss of appetite may be appendicitis.

Each area of the body is prone to different types of bacterial infections. Specific antibiotics treat certain areas better than others – some may not work at all in one area and be first choice in another. So a well-stocked ship should ideally carry a few different choices that can be used if indicated. Randomly using antibiotics or relying on ‘cure all’ broad-spectrum drugs is not ideal. Discussion with someone with experience prior to antibiotic use is recommended. They can suggest what to take with you, when to use them, and what to watch for.

  1. Wound Management Supplies – Band-Aids, steri-strips, wound glue (sounds good and can work well but can be tough to use and only selective areas are appropriate), larger dressings, wraps, disinfectant solution – essentially a good first aid kit. Some cuts can be large. Although most will heal, eventually, having a way of closing larger wounds makes considerable sense in remote, constantly moving, marine settings. A suture kit with multiple sutures and/or a skin stapler with staple removal tool are ideal. One can get some basic teaching in person from someone who knows how to suture wounds. There are also on-line videos available to view prior to departure. Another part of wound management is preventing wounds in the first place. Zinc oxide cream, in large amounts, is a critical material to have on board sailing vessels. It is a skin barrier cream. It is good on the face for sunburn prevention. It is really useful in the groin and buttock areas to reduce the negative effects of dampness from sitting on gunwales, hard deck work, lack of showers, etc.
  1. On-line Medical Advice – Crew on large container ships and freighters, fishing vessels in international waters, large yachts and a wide range of vessels have a variety of medical kits that range from extremely basic to very extensive WHO kits. Captains, skippers, and crew have a broad range of medical or first aid training. International laws mandate that countries that border oceans should have sea rescue centers and be able to provide timely medical advice. Like the wide range of medical kits and trained personnel on vessels, there is a very wide range of on-shore emergency medical advice available. Some understand the rigors of the maritime environment; some do not. Some may be comfortable providing advice for patients they cannot see or interview themselves; many are not comfortable with that. Some have high quality medical training; some do not.

With current medical knowledge and using modern telecommunication systems, it is possible for an experienced physician to provide very good diagnosis and treatment of a lot of illnesses and injuries, working with non-medical personnel in remote settings. But it requires having a system in place that can quickly access skilled, well-trained doctors who understand the remote setting and can accept the limitations of providing remote medical care.

Ship and boat owners spend large sums of money on high tech equipment and yet medical care of the crew is an afterthought. In 2015, it is possible to provide rapid access high quality advice using standardized well-stocked medical kits designed by the on-line doctors and this is a service that Praxes Medical Group provides.

The challenges of delivering high-quality telemedicine

Doctor Samuel Campbell talks about the complexities of providing the best telemedicine support possible to clients in remote locations.

Dr. Samuel Campbell has been with PRAXES since 1997 and has seen the growth of the telemedicine industry firsthand. He trained in South Africa and worked there for three years before moving to Canada to practice in the far north around the British Columbia and Alaska border for five years. After specializing in emergency medicine in Vancouver, Campbell moved to Halifax where he still resides. In addition to working with PRAXES, he is Professor of Emergency Medicine at Dalhousie University and Chief of the Department of Emergency Medicine at the Charles V Keating Emergency and Trauma Centre at the Queen Elizabeth II Health Services Centre. Campbell also works as a provincial trauma team leader and on-line medical control physician for Nova Scotia Ground Ambulance, LifeFlight, the Community Emergency Care Centre program and the extended paramedic program and the Nova Scotia Regional Poison Centre. He answered a few questions for us on the complex challenges of providing the best telemedicine support possible.

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You have such a diverse background and extensive experience in medicine. How do you apply your specialties and knowledge to your work providing telemedicine care with PRAXES?

I am extremely fortunate in working with some of the best minds in emergency medicine and critical thinking in the world, including my colleagues at PRAXES. Our association with the Academic Centre allows us, in addition to being the generalists required of us by emergency medicine, to have special areas of interest, and each of us is able to learn from the special knowledge of our colleagues. If time permits, modern communication systems allow us to consult with each other in really complicated or unusual cases to make the best and most patient-centred decision. My own research interests include medical support of remote healthcare providers, the emergency management of infectious and respiratory disease, continuous quality improvement and emergency airway management.

 

Telemedicine has evolved to become a viable option for healthcare. What are some of the challenges you face when providing telemedicine support?

The concept of remote support of people with emergencies extends many of the complexities that exist in contemporary emergency medical care. In John Ross’ earlier blog about being an emergency physician, he mentions the ‘undifferentiated’ nature of the emergency medicine patient. While TV shows might suggest that patients who present for emergency care are actively seizing, have blood squirting out of a wound or are profoundly unconscious after a drug overdose, these cases represent a very small proportion of what we do. Far more cases present a puzzle both from a diagnostic and a treatment perspective, and the ability to avoid being seduced by what seems an easy diagnosis, but is actually an atypical presentation of something worse – is very important. Perhaps only in primary care, is the cause of the patient’s concern, or any potential solution to their problem, as ill-defined. In emergency medicine, the need to decide what to do in a short frame of time is added to this complexity. In many cases, decisions will need to be made without all of the information that would be ideal to inform what is actually going on. Depending on how sick the patient is, a diagnosis might be less important than a specific action, referred to as ‘empiric therapy’ (therapy based on experience and on the basis of a clinical educated guess), which estimates what is most likely to kill the patient and treating it as if it is that, while you wait for the situation to become more clear.

 

There are many factors involved when making a medical decision from a distance such as the environment and the other individuals working with your patient. How do these elements affect your work?

After 20 years of delivering remote emergency advice in many different settings, to providers from lay patients alone at sea to emergency specialists in modern hospitals, I continue to receive calls that are very different from any I have had before, with new and unusual circumstances and challenges. I continue to make decisions I have never made before, adapting knowledge from a hundred other scenarios, usually in partnership with the caller, who, as the person on scene, really knows the most about what can and can’t be done. It is a thrilling, exciting and very rewarding job, and as our ability to communicate remotely continues to expand, the possible options for managing each case expand with it. Whenever I have been away for a holiday, I am excited to get back to work and receive my first call.

Part Two

In the second of a two-part post, PRAXES Dr. Samuel Campbell further examines the challenging variables of delivering high-quality telemedicine and the complex differences between treating a patient in person versus remotely.

What are some of the overall challenges the medical industry faces when treating a patient in an emergency situation?

In this era of resource limitations and long waits for emergency care, any decision regarding how you manage one patient has to take into account the impact that the action will have on other patients or on the system trying to carry the load. Furthermore, medical intervention and testing is not always benign and unnecessary tests can lead to false results that further muddy the situation, delaying diagnosis and correct treatment while leading to unnecessary treatment and/or more invasive testing. It has been estimated that over a third of the money spent on healthcare in North America adds no value to patient care, and the emergency department is as guilty as the rest of the system in this regard.

 

Are there specific variables you must give special consideration when treating a patient remotely?

When it comes to supporting the emergency care of someone remotely, via telephone, videoconference or even by text, so many more variables complicate decision making. When the patient is away from organized care, there are the usual emergency medicine questions regarding diagnoses but contextual elements specific to the case also need to be considered, such as:

  •    Where is the patient and how far are they from a better health care location?
  •    How much more likely are the most dangerous possible diagnoses than the more benign ones?
  •    Who is there to take care of the patient and what is their training?
  •    What facilities and medications do they have available?
  •    Are there other people nearby with medications that we can borrow while waiting for transport to arrive?
  •    What are the medical risks of moving them/or of leaving them where they are?
  •    Would others be endangered if we had to get them out of there? If so, by how much?
  •    What is the risk of misdiagnosis in this particular patient? For example, is a ‘wait and see’ strategy made more risky by sacrificing transport time just waiting?
  •    What are the risks of empiric therapy and is it available?
  •    Am I about to spend a huge amount of money transporting a patient for the wrong reason?

 

What are some of the key differences between treating a patient in a hospital setting versus treating a patient remotely via telemedicine?

A decision made while working with a patient remotely may appropriately differ significantly from one which would be made if the patient was in front of you in a hospital setting. You might over-treat with antibiotics in a patient with only a small probability of a bacterial infection, or you may leave a patient with chest pain out at sea, even if you are worried he might be having a heart attack, if the risk to him and his rescuers are clearly higher than the risk of poor outcome from his heart.

To complicate things further is the need to address cognitive biases that all of us are prone to, and which can be amplified in the uncertainty illustrated above. For example, we tend to believe what we want to believe which might be the most convenient diagnosis. We persist with our first impressions, noticing things that support them as a conclusion less than things that refute them. We might inherit the impressions of others, and make different decisions if scenarios are presented to us in different ways. We make different decisions if we are tired, angry, impatient or depressed, and may attribute clinical findings to certain personal characteristics that have nothing to do with the question at hand. An example of how we might address a bias is asking ourselves if we are ordering a medevac only because we don’t have the cognitive energy to really evaluate the risks of leaving the patient where he is. Or are we considering a recent case experience that was totally unlike the current one but which went badly because you decided to delay a medevac. There is also possibility of making a decision because we feel more comfortable with just doing something (potential errors of commission) than with doing nothing (potential error of omission). Providing remote medical direction is both challenging and stimulating. The sense that we are providing some comfort and help to those to whom the ‘usual’ medical system cannot reach is a significant factor that keeps us engaged.

Getting to know PRAXES Technical Support Specialist Jeff Scribner

Getting to know PRAXES Technical Support Specialist Jeff Scribner

Originally from Fredericton, New Brunswick, PRAXES Technical Support Specialist, Jeff Scribner, describes his technical skills as self-taught and the result of being part of a tech-savvy generation. Scribner studied marine biology at Dalhousie University but after graduating in 2009 found that the opportunities in his field were limited due to the recession at the time. A mutual connection led Scribner to meet the team at PRAXES over five years ago and after a sharing of ideas and discussions, he was offered a position as Technical Support Specialist. Scribner took some time to answer a few questions on his unique career path and why working with PRAXES is a challenging yet complementary fit for his own love of adventure and travel.

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Volcán de Fuego from Acatenango summit, Guatemala, February 2015.

How did you first learn about PRAXES Medical Group and how did the opportunity to work with them transpire?

I love playing squash and through a squash contact I initially met PRAXES CEO Susan Helliwell, who also plays.  I ended up having an interview with Susan Helliwell and John Hockin and they both saw something in me and decided to offer me the job. Early on, we had a big project with Nova Scotia Ground Search and Rescue. I was hired on to test software, write help tools and training material and to work with the NSGSAR to teach them how to use the software. I would also listen to their feedback and work with our developer to improve upon the service and software. From there, my position really grew and spilled over into many different responsibilities including website coordinator, communications, social media coordinator, and covering technical issues for PRAXES on the medical side of the business.

 

Can you describe what your position currently entails?

If anyone has a technical problem they come to me. Primarily, I work very closely with our software provider to oversee development of the EMwerx software we use for our telemedicine service and Search and Rescue clients. We now have four provincial Search and Rescue organizations using our software and my role has grown to client manager for these projects. To name a few other tasks, I co-ordinate publishing our newsletter, blog and website content and layout. I create training material for our various projects (Camtasia videos, GIF animations image editing and documents). Additionally, I contribute to SOP and technical documentation, train new employees and clients and work to optimize our website using SEO, Google Analytics, Google Adwords and implementing advice from industry leaders.

 

Previously, you lived in Halifax and when you decided to move to Montreal, you considered resigning. However, you’ve managed to move and travel while continuing to work for PRAXES. How do you feel about this option to work remotely?

At the time I was ready for a change from Halifax. I’d been with PRAXES for three great years and so I gave six months notice and sat down with Susan to let her know. She understood I wanted change but made a counter-offer and suggested I continue to work with PRAXES from home. We did this for a few months and kept meeting to make sure that things were getting done. Working remotely you have to be more disciplined and it’s a learning curve to separate home and work spaces. The word ‘remote’ comes up a lot with PRAXES actually. We deliver remote healthcare to clients in remote locations. We have more remote workers than we have in the office. It’s really only possible when you have an open-minded leader like Susan. She’s someone who trusts her staff and this builds a cooperative type of work environment.

 

You’ve been with PRAXES for over five years now and have really seen the company grow. Telemedicine is also growing as a viable option in healthcare. In your opinion, what does the future look like for telemedicine in the healthcare industry?

It makes a lot of sense with technology now offering more ways and easier ways to communicate. For people who are disabled or simply can’t get to a hospital, telemedicine is a great option. It could be a big player for those in rural communities and on the private side, which we are really focusing on. There’s certainly an un-tapped market for telemedicine for those in isolated, remote locations for workers and for those who are travelling and are far from familiar healthcare services.

 

What are your favourite aspects of your position with PRAXES?

I have to say working remotely is one of my favourite aspects at the moment. I haven’t lived in one spot since June 2014. This past year, I was in Central America for three months, Western Canada and California for over a month and in Peru for a month – all the while working full time. It’s been great but it also really requires me to focus and not get distracted. I still need to get up every day and get my work done like everyone else so it’s up to me to be disciplined.

The people at PRAXES also make it an amazing company to work for. Since my position isn’t one that I was specifically trained for and since PRAXES is a small company, I’ve really had the opportunity to learn a lot of different things. Susan and John give you the opportunity to try new things and they challenge you. They place trust in you and it’s not a top-down approach and I find that a very progressive way of running a business.

 

What are some of your interests and pursuits when you’re not working?

Travel is definitely a big interest but I would say that music is my biggest passion. I’m always exploring new sounds and I spend a lot of time listening to and searching for new music. Most of my spending money goes towards concerts and vinyl and I play guitar as well. Currently, I’m interested in learning to play a new instrument. Playing squash has also been a big part of my life which coincidentally is what led me to meet Susan and John.

One Clipper Race Partner's Story

The dynamic partnership between Halifax-based PRAXES Medical Group and UK-based Clipper Ventures Plc has been steadily growing for several years now. PRAXES VP of Marketing, John Hockin, discusses how an ambitious vision has evolved into an exciting and powerful international partnership.

Over the years, PRAXES has had a diverse group of clients in industrial markets such as the marine sector and offshore oil and gas, among others. What inspired the company to reach out to the Clipper Round the World Yacht Race?

PRAXES is Canada’s premier supplier of telemedicine to industries active in remote and dangerous environments. We help clients deal immediately with medical emergencies, while simultaneously reducing their medical costs. We try to help clients avoid medevacs and diversions – situations which can cost them over $100,000 an incident.

We are now leveraging 18 years of industrial experience and moving into consumer markets as well. Most people don’t really understand the potential power of telemedicine.  They live in urban locations where 911 services are available. Few realize that perhaps 95% of the earth’s surface has no such service. We wanted to increase awareness of PRAXES services to a broad global audience and we needed an example that an average person would connect with – they could see themselves as potential users.

I knew that working with an around the world yacht race would illustrate the reach of our services. How much further can you get from medical support than the middle of an ocean?

 

How was the relationship with the Clipper Round the World Yacht Race first established?

Clipper Round the World Yacht Race Founder, Sir Robin Knox-Johnston, was a boyhood hero of mine. I was fascinated with his adventures and his ability to do things that no one else had ever done. In 2011, I was looking for a way to showcase the PRAXES service to a global audience but we are a small business with limited marketing resources.

The intent at the outset was to offer our service to the race and prove its value in front of a huge global audience. We did not know what would happen from a business perspective, but hoped that increased awareness would lead to business opportunities that were not yet in view. Our Clipper Race partners also told us that most of the biggest successes had come from opportunities that were not visible at the outset of the relationship. Remarkably, this had been our exact experience!

I began communicating with Clipper Race Manager Gillian Russell back in 2011. We exchanged messages over many months as we got acquainted with each other. The race didn’t have telemedicine support at the time. Coincidentally, the Clipper Race finished the 2011/2012 race and experienced a very high level of insurance claims, so future insurance costs were an issue for them. All of this was happening at the same time that I was reaching out to Gillian.

Luckily for us, the race was in Halifax in June 2012, so our CEO Susan Helliwell and I were able to meet the race team personally. We explained how our service had assisted the marine industry in the past. We explained that we believed many medical situations could be handled on-board. Our physicians felt that 35% of past incidents could have been successfully resolved on board. This face-to-face meeting made a huge difference. Our teams liked each other and over the course of many meetings we built confidence in each other, and realized we had common goals. Neither of us wanted to start a partnership for promotional reasons only – we both wanted to make a difference and prove medically and financially, that we could improve medical support for crews.

 

PRAXES then became the Global Emergency Medical Support Partner for the Clipper Race 2013 – 14 and has become a Fleet Sponsor for the 2015/16 race. What were the results of PRAXES support in the last race?

Our goals were to handle more medical incidents on board and thus reduce the number of on-shore hospital visits, claims and cost for the race. We also wanted to achieve a high level of satisfaction with our service among skippers, crew, staff and even families. The results were gratifying and support our claim that telemedicine has a role to play in improving remote health care delivery:

  • Insurance claims were down by 50%
  • Financial pay-outs were down by 57%
  • Satisfaction of the service has come to us via the ringing endorsements of the skippers and crew
  • Clipper Ventures was so satisfied they set up a joint venture company with us to market the PRAXES service globally

 

Today, PRAXES and Clipper Ventures Plc are launching a global joint venture business called ClipperTelemed+™. Can you describe how this business venture came to fruition?

From the outset we at PRAXES had two big dreams – that we might someday be able to partner with Clipper Ventures to jointly launch a business and that a future yacht would have our name on it – both have already been achieved!

We wanted to prove from the beginning that an international company like Clipper Ventures could experience extraordinary results using the PRAXES telemedicine service. After the 2013-14 Clipper Race, crews and staff gave us a strong endorsement. Canadian winner Eric Holden has subsequently asked PRAXES to support his personal ocean racing activities. Surprisingly Sir Robin identified a benefit that we missed. He said that the service reduced worry for the family of crew members who remained at home.

Based on these race results we decided to approach Clipper Ventures about a joint venture. At a race-end reception in July 2014, I had an opportunity to speak to CEO William Ward. William was perhaps the busiest man in the world on that day!  But I introduced myself and pitched the idea of turning the PRAXES service into a global Clipper product. I asked him what he thought. In less than a minute he looked at me and said “Yes, email me next week.” This was the beginning of ClipperTelemed+™!

Since July we’ve been working with Clipper Ventures COO Jeremy Knight and have developed the business plan, scoped the service, fleshed out administrative responsibilities, hired a Business Development Manager and jointly entered a yacht in the upcoming race!

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ClipperTelemed+™ is a telemedicine service that will be available to commercial shipping, private yacht and super-yacht owners. With the launch scheduled for this spring, it sounds like 2015 will be a busy year for PRAXES. Can you share some of the news regarding your plans?

So much has happened in the last six months! The Clipper Ventures team moves quickly and our ClipperTelemed+™ branded yacht is already in the water. We will be at the UK vessel launch event on April 17. The crew and skipper will be assigned on April 25 and the service will officially begin taking customers on May 1. Our ClipperTelemed+™ crew will be offering corporate sailing days in the UK during June and July, in the run up to the race start on Aug 30.

For the 2015-16 Clipper Race, PRAXES has become a fleet sponsor, which means we supply all medical support services including medical kits. Our joint venture will have a yacht named ClipperTelemed+™ in the race and for 11 months it will provide lots of marketing horsepower. Our Business Development Manager, Tom Bettle will be working to promote it. We are expecting to get a lot of international interest in both PRAXES and ClipperTelemed+™. We also hope to significantly raise the profile of PRAXES here at home in Canada, using the race as a promotion vehicle.

We’re thrilled about working with one of the world’s premiere sports events. The Clipper Race is followed by over one billion people, many of whom are potential customers for our telemedicine service.

I’ve been working with various marketing partnerships for many decades but I’ve never had a better marketing partner than Clipper Ventures. Whenever I’ve had a request or an idea, their answer is always “yes”. Their “yes” attitude shows they will go to any possible lengths to support a partner.

Seven recommended sources of Medical Information on the Internet

Seven recommended sources of Medical Information on the Internet

by Dr. Donald Haigh, PRAXES Occupational Health physician

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Finding accurate medical and scientific data on the Internet can be a daunting task. In addition, the results of incorrect information can be serious (missed consultations, missed diagnoses, missed treatment, etc.). These are the Internet sites that I recommend as better than most in terms of scientific validity:

  • The National Library of Medicine sub-site MEDLINEPlus.http://www.nlm.nih.gov/medlineplus/ This is an American list in plain English and plain Spanish of over 18 million peer-reviewed medical citations plus the advice from many of the Specialist Groups in the USA (called Academies)
  • For Occupational Medicine/Industrial Hygiene/Safety information. I recommend 2 sites; one American and 1 Canadian
    • The National Institute of Occupational Safety and Health (NIOSH) in the USAhttp://www.cdc.gov/niosh/ This organisation is a section of Centers for Disease Control and Prevention {CDC} of the American Government. Many freebies are offered including the unsurpassed NIOSH Pocket Guide to Chemical Hazards. The language can be somewhat technical
    • The Canadian Center for Occupational Safety and Health in Canadahttp://www.ccohs.ca/ This group is a combined Management, Labour, Academic administered website developed to inform Canadian workers of health and safety risks in the workplace as well as prevention. It provides the different regulatory rules in each province of Canada. The language is simple and straight forward.
  • Environmental Health
    • Canada www.ec.gc.ca A gateway to all pertinent information concerning Canada’s Environment
    • USA  www.epa.gov Web site for the US Environmental Protection Agency (EPA) with lots of research results etc.
  • Preventive Medicine. There are 2 major sites which give the best information on the most useful medical screening examinations

Ignorance is the curse of God; knowledge is the wing wherewith we fly to heaven.

-William Shakespeare

Donald Haigh M.Sc, MDCM, FCBOM, CIME

Meet PRAXES procurement co-coordinator Dave Sumarah

Getting to know PRAXES Procurement Co-ordinator Dave Sumarah

In 2013, Emergency Medical Technician Dave Sumarah, decided to apply for a paramedic position with PRAXES Medical Group after receiving a suggestion from a friend who was working with the company. After having worked for many years with Emergency Medical Care in various locations around Nova Scotia, Sumarah was ready for something a little different. A few months after successfully securing the paramedic position at PRAXES, the procurement co-ordinator position became available and once again, he didn’t hesitate to embrace the opportunity. Today, the Fairview, Nova Scotia raised Sumarah balances several roles at PRAXES and says he enjoys the engagement of building on his skills and tackling new challenges. He took some time to answer a few questions on his dynamic, fast-paced career.

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Could you explain what your role as procurement co-ordinator entails?

I get to wear several different hats with PRAXES but the procurement co-ordinator role is one that I’m especially proud of because I’m learning so much.  Procurement involves working with clients who require medications and equipment for their off-site clinics or off-site ambulances and travel bags. It’s making sure that whatever our clients’ personnel may need will be in place and we work in tandem with the EMwerx software. So, if a client calls in we will often know what medications and equipment they have in place.  Many companies have different requests and legislations – every client is specific and it’s interesting to navigate that. Additionally, I work as a healthcare technician with Doctor Haigh to facilitate screenings for those workers who need to meet physical requirements for their jobs. I also work as a paramedic at the Burnside Correctional Facility so I’m still always very hands-on involved. I find that balancing these three roles keeps me engaged and constantly learning.

 

What makes working with the team at PRAXES unique for you?

We’re a small, concentrated office and the roles and responsibilities for everyone here can overlap. For example, if one or two of our key players have to travel or attend a site visit, the other players will step up and make sure that all our clients’ needs are being met. I find that PRAXES is a great environment for encouraging adaptability and we’re all multi-taskers. We pride ourselves on tackling issues that may be unexpected and we’re always willing to accommodate. A request may mean going off-site or on the off-hours but we make it happen, no matter what.

 

In your opinion, what makes PRAXES different than other telemedicine suppliers?

It’s hard to say exactly but I think that one aspect is that we have a software system that our clients really like. It’s efficient and adaptive and the information is available with the touch of a button but more than anything I really find that PRAXES puts the client first. We really push for client satisfaction and that’s something that you don’t always find elsewhere. It’s refreshing. We go above and beyond to make sure our clients are looked after.

 

What do you think are the most important skills you need for your position at PRAXES?

One of the skills I’m most experienced in is treating injuries and illnesses and getting it done and that’s something I’ve done for a long time. This is what I do at the Burnside Correctional Facility and this is old hat to me. But in the clinic, sometimes we are screening people who may be relatively healthy but have minor issues. For example, the captains and crews of fishing vessels who need to be screened may feel that we are slowing them down and that this will effect their livelihood. In fact, we are here to help and want to address any health issues they may have – be it high blood pressure or simply the need to have a healthier diet. One skill that I think is crucial is the ability to communicate and be empathetic with our clients – to let them know we are on their side.

 

What do enjoy most about working with PRAXES?

Honestly, I feel valuable and I always get the sense that I am contributing to the welfare of the company and the team. PRAXES makes me feel like I am an important player and to me that is just so huge. It keeps me very motivated and ready to take on the next challenge.

 

When you’re not working, what are some of your favourite pastimes?

I used to play basketball and I do like to stay fit so when I have some spare time I go to the gym and try to keep up on cardio and running. I smoked for 18 years and I quit in 2009 so I’ve really been trying to get back to a healthy lifestyle and this is becoming more and more important to me. I used to be very sociable but I really appreciate family life nowadays. I love spending time with my wife and three-year-old little boy. These days, I’d much rather be playing on the floor with my son than pretty much anything else!

Life as an Emergency Physician

Life as an Emergency Physician

PRAXES Medical Director, Doctor John Ross, shares insights on his fast-paced, dynamic career:

The role of a PRAXES emergency telemedicine physician can be unpredictable, challenging and often exciting. PRAXES Medical Director, Doctor John Ross, is dedicated to global health and wellness and takes pride in providing the most efficient and accurate telemedicine support possible. In addition to his career with PRAXES, Ross is a trauma team leader at Capital Health, a professor at the Royal College emergency training program at Dalhousie University, a published author and much more. Ross took some time out of his busy schedule to discuss what it takes to be a PRAXES emergency telemedicine physician and what makes him so passionate about what he does.

JRoss

When you’re on-call with PRAXES, what would be an example of the type of call you might respond to?  What steps do you follow?

Currently all calls come through on cell phone. We are on call from 0800-0800. When the phone rings, call identifier shows it is coming from the Praxes Communications Centre. The call taker tells me who is calling and where they are, generally something about the problem such as age, complaint, and often basic vital signs. We have asked callers to obtain some basic information to make the call most efficient. Calls from offshore fishing, container ships, cruise ships go through the Joint Rescue Coordination Centre (JRCC). In those cases, the next person I talk to will be their radio controller, who then connects the ship at sea. As you might imagine, the quality of the call depends on radio/phone quality, satellite transmission, caller accent and many other factors. For land based calls, they can come directly from a land phone or via satellite in the far north.

Call types are a broad spectrum. They can come from really experienced medically trained people who have a good sense of what the problem is and what to do next such as calls from the Burnside Jail from paramedics, most of whom we already know. They often call because in order to do certain things they require a physician’s approval and oversight. Other callers are skippers of boats who have very limited first aid training and little equipment – so the conversations can be dramatically different.

Once the chat is over, a plan of some sort is agreed to. It might be anywhere from ‘give two ibuprofen and see how it goes’ to ‘this person needs to be helicopter medevac-ed immediately – we’ll help get that arranged.’ Callers have different levels of medical knowledge and supplies on hand. Some can treat quite a lot – captains on Clearwater vessels and the skippers on Clipper yachts have a number of antibiotics and pain meds, other have less. Some cases will be ‘start this and that, but divert to the nearest port or other vessel or medevac.’ The decision to get someone off is made by the skipper who can guesstimate their time to port or to get within a safe helicopter to and from range. For example, if they are 300 nautical miles off the coast and the helicopter can only go 200 nautical miles including hover time for extrication, we need to consider these factors. We need to consider who is there coordinating the medevac. It might be the Coast Guard or military search and rescue technicians (SARTechs.) Sometimes that involves getting their authorizing doctor on the line to further discuss the risks and benefits. Flying out to get someone comes with lots of risks and costs.

What is your top priority when assisting a client through a medical situation from a distance?

Patient safety while considering everyone else who is at the site is a top priority. One has to remember that although I might be fairly comfortable treating a problem on board a vessel or mining site, the people there may not be. Also, weather and many factors may influence whether to medevac or transport someone. For example, they don’t sound too bad right now, but in eight hours, the weather is going to make transport impossible, so they should go just in case it becomes necessary later. It is all done as collaboratively as possible. I have the medical knowledge, but logistics and caller comfort are all part of the mix. One needs to keep an open mind and be as flexible as possible.

In your opinion, what are some of the most valuable characteristics an emergency physician with PRAXES must possess?

They need experience in caring for potentially sick, undifferentiated patients. Our emergency physicians are excellent at seeing a high volume of sick and relatively well people and being able to differentiate them. They are up-to-date in terms of managing a broad range of problems. They are good communicators. They are good team players as the ED requires seamless working with patients, families, RNs, paramedics, RTs, social workers, administrative staff, housekeeping, security and others. ‘Undiff’ means that they do not have a known diagnosis, and under the circumstances, are not going to get a definitive one with limited resources. Our PRAXES emergency physicians really like what they do.

Is there a particular PRAXES incident that you can share that stands out as being quite dramatic and memorable?

Honestly, there are so many. Just recently I had a call at 0300 from a cruise ship. The captain of the ship was the first person I spoke with after being connected by JRCC who explained their current location. The ship’s doctor was with the patient and the captain gave me some basic information. Then the doctor came on and he sounded very worried. He had done what he could and I thought he was considering the right possibilities for the elderly passenger with increasingly severe shortness of breath (SOB). SOB, chest pain, abdominal pain each have a long list of possible causes. It is impossible to know in such a setting what is the cause. It might be a combination of things. Sometimes, even at specialist hospitals the cause is not definitively found. So, he was starting several treatments at the same time for some of the possible causes and we agreed the passenger had to come off immediately. The ship could divert to the nearest appropriate port in approximately seven hours or he could be lifted off in two to three hours. It was dark and the weather was good. Time was of the essence. So, I authorized a medevac. JRCC contacted the SARTechs. I got a call 30 minutes later from someone asking about the best destination. He could go to a regional hospital in Nova Scotia and be there in 15-20 minutes after extrication, or fly longer to a tertiary care hospital. I felt he would do fine in a regional hospital. I called that hospital hours later and he was safely in the ICU and they were still trying to figure out the complexity of his problem.

You wear many hats such as trauma team leader, emergency physician, professor and author. Clearly, you are very passionate about health and wellness on a global scale. When you find some time away from work, what do you like to do?

I am still very interested in global health and building capacity in developing countries for emergency care – Tanzania for several years and now trying to establish a program in Nicaragua. I’m also interested in Canada’s far north for the same reasons. So travel and learning about the world, its networks and interdependencies and complexities are passions of mine. I try to exercise regularly to preserve my mental health. I enjoy biking, kayaking, racquet sports, and even just jumping up and down being flogged by a relentless person on a DVD when traveling! I’m always reading eclectic stuff, and trying to think outside the box while working on a bunch of weird projects. But best of all, I love hanging out with my wife and two boys whenever we have the opportunity.

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