Senior Provincial Director - Provincial Clinical Programs & Virtual Health at Alberta Health Services

Patricia Chambers

On March 7, 1877, Alexander Graham Bell received a Canadian patent (#7789) for a bell telephone. Later, his father started the Canadian telephone business by leasing wooden hand telephones to customers to use on private lines. It is documented that Graham Bell’s first recorded call was for medical help after he spilt sulphuric acid on himself. Yet, little did Alexander Graham Bell or any of the early pioneers of the telephone business know the dramatic impact this technology would one day have on healthcare.

Through the years, advancements in healthcare have been profoundly shaped by technology. The pace of innovation shows no signs of slowing down with the recent advancements in artificial intelligence (AI), wearables, virtual reality, and video-telehealth. As these cutting-edge technologies drive the future of healthcare forward, the humble telephone remains a significant healthcare tool. The importance of human connection in clinical work, patient-clinician partnerships, and soft skills like listening and being empathic remain paramount to quality healthcare.

In the wake of the COVID-19 pandemic, telephone consultations surged and became a mainstay of healthcare, providing patients access and convenience. A rise in public satisfaction with telephone consultations was noted, and several studies indicated many clinicians also value telephone care. Telephone consultation and triage; the process where calls from people with a healthcare problem or question are received, assessed, and managed by giving advice or referral to the appropriate service in an appropriate timeframe spiked dramatically during the pandemic. In Canada, the N11 telephone system was a literal lifeline to many people with healthcare needs.

N11 is a three-digit shortcut dialing code to reach specialty community services. These telephone numbers are set aside by the Federal Communications Commission (FCC) and operated by the service provider. In Canada, three N11 numbers are dedicated to healthcare and social service support. 911 is the emergency number for police, fire, or emergency medical response; 211 is the telephone number that provides access to local community services, information, and referrals to physical (housing, utilities, food, employment assistance) and mental health (crisis intervention); and 811 is the 24/7 health number for a number of clinical services including tele-triage, health advice, service navigation and treatment options such as telephone/tele-video physician care. In the province of Alberta, Canada, telephone calls to Health Link 811 increased from 881,722 per year in 2018-19 (pre-pandemic) to 4,290,621 per year in 2021-22 during the pandemic peak. In 2022-23 the 811-volume levelled out to 1,743,091 calls per year, volume that is almost double pre-pandemic volumes. Alberta Health Service’s Health Link 811 provides a broad spectrum of healthcare over the telephone, ranging from delivery of routine and emergency care, to conveying laboratory results, facilitating health prevention/ promotion interventions, providing health teaching, and even after-hour care and case management. Multiple specialty lines feed into the Health Link 811 system and are responded to by a variety of clinicians. This N11 telephone service improves access to care and assists in relieving some of the burden felt by both primary care and emergency departments.

" The importance of human connection in clinical work, patient-clinician partnerships, and soft skills like listening and being empathic remain paramount to quality healthcare "

Acute care support is available from the 811 nurse triage telephone services which aim to improve speed of access to reliable care by utilization of provincially standardized guidelines and protocolized tools to deliver care. 911 low acuity calls feed seamlessly into 811 for nurse assessment and care recommendations via a Share Response Line. Triage nurses can pass care to a physician-led telephone-video 811 service line when appropriate. Psychologists, social workers, and mental health clinicians respond to the Addiction and Mental Health Helpline arm of 811 offering triage, referral, supportive listening and crisis intervention.

Alberta’s Health Link 811 service helps to increase the uptake of various preventative programs by being an easy and accessible way to book routine childhood or adult immunizations as well as influenza and COVID-19 vaccinations. Certified tobacco counsellors respond to the AlbertaQuits tobacco cessation line. Intake for various health-related classes ranging from pre-natal education to several cancer screening programs can be accessed over the telephone by calling 811 in Alberta. When the COVID-19 pandemic caused a worldwide shutdown of many ambulatory care services in Alberta, physiotherapists (PT), and occupational therapists (OT) rehabilitation services were offered by 811. Today PT, OT, and therapy assistants offer virtual telephone, video phone, and telerobot care to support those who have musculoskeletal, neurological, chronic pain, or long COVID sequela. Pre-op prehabilitation care is available, and the pediatric arm of the rehabilitation advice program supports parents with concerns they have related to their child’s development and well-being. Other specialty services include a dietitian line, dementia advice line, and an Indigenous health culturally specific / culturally safe service. 811 responds to public health emergencies, offers outbound follow-up calls and is always available. These are examples of some of the healthcare supported by telephone interactions in Alberta.

Digital technology is beginning to play an ever-expanding and vital role in healthcare as the use of remote patient monitoring, wearables, and AI becomes more applicable in diagnosis, treatment, and patient interactions. However, the humble telephone remains a critically important tool, putting the patient at the center of the care interaction. Caution is needed to ensure that the use of digital tools does not push the human connection out of clinical work. The patient-clinician partnership must always be at the center of healthcare and technologies, a tool for clinicians to utilize as an enhancement to care. The pandemic drove changes in healthcare delivery. Some of those changes have remained permanent, noticeably the rise of telephone-based patient-clinician interventions. Alberta’s Health Link 811 demonstrates that simple technology like the telephone can be efficiently utilized to offer accessible, effective, diverse, quality healthcare.