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The power of connections

When they delivered the house call, Dr. Dennis DiValentino and his team noticed the patient they were visiting did not have electricity or heat in their home. “Our nurse was in her winter jacket and we conducted the visit by flashlight…it was unbelievable,” he said. 

This is the gap in care Dr. DiValentino is working to address with his house calls―allowing him to reach patients that otherwise go underserved and improve their access to quality care. What makes them unique, however, is that he’s able to reach his patients without ever leaving his office.

It’s well known that the relationship between patients’ incomes and their health is deeply intertwined. In Ontario specifically, only 49.4% of the poorest people report their health status as excellent or very good, compared with nearly 72.9% of the richest people. Coupled with their inability to access the resources necessary to maintain good health, many Canadians living in poverty face three perceived barriers when accessing care: their difficult living conditions, their poor quality of interactions with providers and the complexity of health care system organization and functioning.

It all began when he noticed a pattern within his practice in the urban core of Hamilton, ON. Knowing that not all his patients are able to access care consistently in the same way, Dr. DiValentino wondered how he could better reach them. “This recurring pattern is something that was going to sink our health care system if we didn’t address it,” he said, “and we thought technology would be a great way of doing that.” For him, the answer was founding Rapid Access Medical Care, or RAMCare, a platform that made him a 2017 Joule Innovation grant recipient.

“When I applied for the grant, I was at the beginning of my evolution in focusing on technology and it was the most exciting thing to happen,” he said, “and it led me to connect to other physicians who are like-minded.”

From approximately 4-5 visits a day with traditional house calls, RAMCare’s Virtual House Call Program makes it possible to increase the number of home visits a physician can conduct while continuing to see patients in their clinic.

Visiting patients face-to-face, wherever they may be, is a nurse with a house call bag. It includes all the tools you would imagine in a traditional house call bag, but with one difference―it’s boosted by technology: a stethoscope, an otoscope, a dermascope, a blood pressure cuff and a wifi-enabled tablet.

What started out primarily focused on patients within the homeless population ended up having impact far beyond—with those below the poverty line, mobility challenges, chronic conditions, post-discharge, seniors, mental health impairments―anyone who has difficulty accessing care through the standard approach.

Working closely with Joule through the grant program, Dr. DiValentino was connected with Dr. Yanick Beaulieu, the founder of IIT Reacts, an integrated and secure collaboration platform they use for enhanced video conferencing in appointments. This helped propel his initiative further: “The collaboration that was sparked by Joule started to move things forward in a material way. That was two years ago now, and we still work together today.”

Through their connection with Reacts, RAMCare is in the process of adding the Philips Lumify device to their toolkit so they can conduct ultrasounds on patients remotely guided by in real-time by a physician.

Without disruptive change and the application of technology to health care, I think the universal health care system we’re so proud of is going to go by the wayside and I don’t want to see that happen—I think there’s a lot of people that share that opinion.

Get Dr. DiValentino's perspective

Listen to Dr. DiValentino on the Boldly podcast


This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at