In the 17 years since Charlene Brophy answered her own first call as a tele-nurse at that shared terminal in AT&T offices in St. John’s, the world of telemedicine—not to mention the world itself—has changed dramatically.

Everything is now digital and interactive, not to mention far less flaky. The phones are still important, but so too are texting and online chats, as well as wearable devices and there’s-an-app-for-that cell phone programs. “It all spurs my imagination,” Brophy says. “I know my 80-year-old mother isn’t going to be texting tomorrow, but who knows where we’ll be in 10 years from now.”

Technology is expanding exponentially, and so too are the numbers of senior citizens. “The world is facing a situation without precedent,” Brophy says. “We will soon have more older people than children… As both the proportion of older people and the length of life increase throughout the world, so will the associated costs of dealing with more illness, disability, and dependency… As we prepare for a new demographic, I look for ways to close the gaps with a remote monitoring solution, at the same time building relationships with partners I need when hands-on care is required.”

In many ways, Fonemed is still about serving under-served areas. “If you have a small town hospital where the emergency room shuts down on nights and weekends,” Brophy explains, “we can install a phone by the emergency room door. The patient comes to the ER, picks up the phone and is connected to a Fonemed nurse.” Often, the nurse can solve the problem directly. If it’s serious enough, the nurse can then contact the doctor on call.

That carefully calibrated “physician-escalation” process not only saves the hard-pressed health care system money, of course, but it can also result in more appropriate care and improved outcomes for patients.

That’s as true for big city hospitals as it is for small town health centres, she adds. Fonemed, for example, can now use monitors to keep track of patients waiting for, or recovering from, complex heart surgery. The patient may be in their own home instead of an expensive hospital bed, but the monitor can still detect any problems and send an immediate alert to Fonemed. A nurse will then check in with the patient, triage the situation, adjust medications and, if necessary, reach out to the doctor. Fonemed can even be used to remind patients it’s time to take their meds, or let them know they need to make a follow-up appointment with their doctor.

More recently, biometric monitoring is being employed to check up on mental health patients. Each day, the patient answers a series of questions on an app on their phone. Depending on the answers, a nurse may call them back. “I got your message. Do you want to talk?” If the problems are more serious, of course, the nurse can direct them instantly to doctors, even emergency rooms. Fonemed also provides telephone and online nurse advice and triage for sexual assault hotlines and occupational exposure hotlines.

Brophy describes herself as a “forward thinker. My job is managing population health. I look toward the path ahead, evaluating how advancements in disruptive technology will change the face of health care and how I do business.” And how all of that will impact two very different health care models in her two key markets: the United States and Canada.

She admits she’s had to learn “to spin on a dime, maneuvering my way through presenting a pitch one day to a single-payer, publicly-funded Canadian health care system and the next day to a multi-payer, heavily private system in the United States, culturally similar, both constantly scrutinized to determine which is producing better health outcomes and access to care.”

“In the U.S., it’s all about dollars and cents. In Canada, it’s about access to care, about reducing demand on overburdened emergency rooms.” There have been studies, she says, that show that by using telehealth approaches, “up to 65 per cent of calls intended for emergency rooms can be redirected to lower levels of care.”

But, she adds, the telehealth world has now become a very competitive business and Fonemed “must be seen as a major player in the international market” in order to remain in the global game.

Which is why Charlene Brophy never stops asking herself, “what else can we do?” These days, that involves expanding Fonemed’s client base in Europe and Africa, as well as creating new win-win services to meet needs that health care providers may not have even realized they needed. “I have my team developing an appointment scheduling app that will allow patients to self-schedule their appointments versus waiting for their physician’s office to open,” Brophy explains. “This will save human resource costs on the physician end, as well as bring patient satisfaction with ease of use. If my pricing is similar or even a little higher than competitors, such an added value offering may seal the deal.”

Forget for the moment that Fonemed (phone medicine, after all) is very much a telephone-centred business. Brophy herself spends a lot of time on the road, selling and managing. In fact, she squeezed in our interview between trips from St. John’s to Fonemed’s corporate office in Ventura and back, all the while navigating around a late winter Newfoundland blizzard packing hurricane force winds. By the time she responded to our follow-up questions, she was already back out on the sky road again.

“When you’re a leader,” she explains, “you can’t afford to have an off day or be less than yourself. You’re always on stage. If you can’t be on, you need to get off. Too many people are depending on you for stability and direction. You can’t walk in and think everything is going to be predictable. I had to learn to expect the unexpected.”

Intriguingly, she adds, “I believe I learned many of the skills I needed at the bedside. The accountability and responsibility of caring for a patient prepared me to accept accountability and responsibility for my organization and my team.”

Her journey to president and CEO has been an unusual one, but she insists, “if I could go back and do it all over again, I would not do anything different.”

Not a bad place to be at all.