Due to the aging population in Canada, there is an increasing demand on the health care system. As a result, health care providers are looking at new ways to deliver services in a more timely, efficient, and cost-effective manner. Consequently, the benefits and features of virtual health care are gaining more attention as a possible solution that addresses the need for more accessible and convenient care. Moreover, the applied approaches to social distancing during the ongoing COVID19 pandemic has highlighted the importance of having a durable, virtual health infrastructure. This article discusses the opportunities, challenges, and possibilities of the virtualization of health care services.
Opportunities and Demand
The harms attributed to the long waiting time for health care in Canada, are well-known and significant. According to a 2019 report from the Fraser Institute, surveyed specialist physicians across 12 specialties and 10 provinces indicated that there has been a median waiting time of 20.9 weeks between the referral from a general practitioner and the actual treatment. Moreover, as stated by the Canadian Institute for Health Information, 61% of family doctors are not able to accommodate the urgent appointments within the same or next day. In addition, around 40000 Canadians visit an ER (Emergency Room) every year for very simple inquiries such as renewing prescriptions. These numbers and statistics confirm the necessity of virtual health care which can be beneficial in reducing wait times and improving the continuity of care by making the process of seeking medical attention more convenient. The ability to remotely deliver healthcare services 24-7 from any location, could be a great help in increasing the accessibility of primary health care services when needed. For example, when a person cannot leave the house due to timing concerns or any other reasons, virtual care can be provided instantly.
The other concern that requires a systematic response, is the ongoing health inequity across rural communities. It is also worth emphasizing that rural communities are generally older, less healthy, and less wealthy compared to urban ones. The main reason for the unequal experience of healthcare can be attributed to geographical barriers such as being located too far from any service providers, harsh weather conditions in some of the northern regions that could sometimes make travel impossible. In addition, although 18% of the Canadians are living in rural areas, only 8% of health practitioners are serving these regions. The lack of enough service providers and limited number of physicians in northern and rural areas stems from tough working conditions, such as very long working hours, lack of the required extra education, and not having the opportunities to have the family beside them. In this regard, virtual health care can be a key solution to this matter due to the ability to provide remote services for major primary healthcare demands.
Challenges
Despite all the opportunities and demand, there are some legislative and policy barriers to the implementation of effective virtual care in Canada.
Overall, Canada lacks a national standard framework to support the ability of patients to electronically access their health information from any location at any time. Currently at the local level, patients can access their electronic health information on an application basis. The lack of a patient-centric structure has resulted in the deployment of several portals in various jurisdictions. The development of a patient-centric structure could potentially provide patients with access to required documents or information at the right time and the right location each time. Not having such structure would be a time consuming approach that requires the commitment of a large amount of resources in order to deliver the documents or information to patients effectively and efficiently each time that they are requested. Also, despite all the potential benefits such as improved accessibility and portability, this sort of system does contain a privacy risk. The mitigation of this risk requires the implementation of secure software and communication infrastructure during the interaction between patient and caregiver that prevents unauthorized, third-party access to personal health information. To be effective this would also require the ability to provide proper system maintenance as well as making virtual care records available for patients and caregivers for auditing purposes.
The other barrier that has been holding physicians back from expanding virtual care are licensing concerns. Currently, due to the lack of a national framework for virtual care in Canada, the licensing requirements vary across different provinces and jurisdictions. This makes the process of virtual care extremely difficult and complicated since some physicians may need two different licenses to be able to practice, one in their own jurisdiction and one in their patient’s.
Another challenge in implementing virtual health care is the governance of compensation. Physician remuneration for virtual health services is a significant issue in terms of not having a proper billing system across different provinces. While in some jurisdictions physicians are getting paid for 40 percent of in-person visits, some provinces are charging $2.25 for email and text services,yet, on the other hand, some provinces are not allowed to charge patients for such services at all.
Virtual Health in the Era of Coronavirus
As a result of how widespread Coronavirus has been in Canada since early months of 2020, the implementation of virtual health care has been encouraged by both the government, and public health regulatory organizations and authorities. They have been supporting the urgent shift to virtual health care as this could help to keep patients, caregivers, clinical staff, and all their family members safe by reducing the exposure rate to the virus. Moreover, it seems that Canadians are embracing this option and would like to benefit from the expanded and improved version of it even after the COVID19 crisis. This is evidenced by the results of a national poll conducted between May 14 and 17 of 2020 that was released by the Canadian Medical Association. The poll indicated a 91 percent satisfaction rate among people who visited their doctors virtually during COVID19. Also, 46 percent of participants who had the opportunity to use virtual care during COVID9 would prefer to move forward with this option as the primary point of contact with their doctors even after the pandemic.
Although virtual care cannot replace the entire health care system, it can certainly assist in decreasing the pressure on the Canadian healthcare system by allowing patients and caregivers to save time and money when it comes to in-person visits. Moreover, adopting virtual care can reduce the carbon footprint. As stated by Infoway’s 2019 Access Digital Health Survey, while on average Canadians in rural areas traveled 23.6 kilometres to their primary healthcare place, people in urban areas only traveled 13.1 kilometres. According to Canada Health Infoway, if virtual care could be implemented for half of primary care visits, there will be huge annual financial and environmental savings for the country including, 103 million hours for the Canadian public, $770 million in commuting costs, and 325000 metric tons of CO2 emissions.
In response to the strict need for isolation and social distancing, the Government of Canada has implemented an urgent policy shift from traditional health care delivery to a virtual system. This has been done by temporarily implementing billing codes for all provinces in order to address the challenge of compensation. Also, making that possible for physicians and health providers to use non-clinical virtual communication tools such as Skype and Zoom has been another accelerator of the healthcare virtualization during COVID19.
Future Considerations
This topic is not a new subject in the healthcare field and has been on the agenda for decades. However, due to financial and political challenges, policies to move implement plans for the virtualization of healthcare have not been able to move forwards. So, this can be the silver lining of the current pandemic, as the mandated social distancing policies have forced a rapid growth in adopting virtual care in Canada.
Clearly, the policy changes regarding the governance of compensation for virtual care needs to become permanent after COVID19 in order to maintain the progress that has been made so far toward the virtualization of healthcare. Additionally, since the non-clinical software and platforms can’t be used long-term, when the COVID19 crisis is resolved, there is a strong need for proper software and platforms to guarantee the quality of delivered virtual service as well as the privacy and confidentiality of the patients’ information.
It should also be noted that providing adequate training and education plays a great role in obtaining the best outcomes of virtual healthcare. So, establishing and incorporating virtual care education should be considered as a priority by medical schools and health education planners.
The views, thoughts, and opinions expressed in this article belong solely to the author, and do not reflect the views of Conversationally Speaking Magazine.
Mina Mahdavi
Mina holds a Master’s degree in Engineering and Public Policy from McMaster University. She is mainly interested in working on Canada's public policy issues, specifically health policy. She is currently a policy researcher in STAND Canada and is also translating a health policy book from English to Farsi.
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