Healthcare has long been accused of being slow to adopt new technology. The adoption of telemedicine in Canada has been no different. The most recent available data in 2014 shows that only 0.15% of all billable services in Canada were conducted virtually using telemedicine solutions. As with many other things in modern life, COVID-19 has necessitated the acceleration of “virtual visits” as public health concerns have mandated doctors and patients be physically separated as much as is medically appropriate, in order to prevent unwanted spread of the virus. This physical separation of doctor and patient will help to accomplish the short-term goal of “flattening the curve”, but it also presents an opportunity to rethink how we deliver health care in Canada and how patients, providers and the health care system could benefit from virtual technologies.
COVID-19 has exposed a vast number of patients to virtual medicine in a very short period of time. The reality, however, is that telemedicine has been around since the 1970’s. Telemedicine has long been used to provide better access of care to patients in remote parts of the country by connecting them to doctors at designated telehealth sites. With new technologies and improvements in connectivity, telemedicine no longer requires special sites and patients can receive care directly from their own home, through a secure video conference with a doctor. This has obvious benefits to the patient in terms of time and money saved. When virtual visits were used In Ontario for outpatient follow-up stroke care, patients reported a total time savings of 80 minutes per visit and median out-of-pocket costs savings of $52.83. This is what one family member of an 88-year old patient in the study had to say:
“The e-visit saved time and a lot of stress that is involved in taking an elderly patient out especially in bad weather.”
Some might argue that virtual visits lead to worse care being provided and lower patient satisfaction than an in-person visit. A randomized trial in the United States had patients and physicians complete both an in-person and virtual visit and provide their perceptions on both to be able to make a comparison. While virtual visits did score lower on all dimensions, they did not differ significantly as is shown in the chart below. It is true that not all medical complaints are appropriate for virtual care and that proper triaging of visits is essential. Virtual care will never replace in-person physician care, but that does not exclude it from being a valuable and convenient tool for doctors to reach their patients.
Patient Perceptions of Face-to-Face and Virtual Visits
Clearly, there are benefits to patients in using virtual visits to access some of their health care, but they are not the only ones who benefit. Historically, the job of a doctor has not allowed for an abundance of flexibility in their work schedule. In order to earn a living and provide care to their patients, doctors were required to be in the clinic or at the hospital. Many younger doctors are looking to add more flexibility to their practice, in order to have some semblance of work-life balance in their career. Virtual medicine has enormous potential in helping physicians achieve this goal. To highlight this potential, consider the two following modifications to a practicing family doctor’s schedule:
With virtual medicine incorporated into this physician’s practice, he or she is able to live a more flexible life, while still fulfilling their care obligation to their patients. By working from home, they are able to spend more time with their family, a big plus for many young parents. By having the ability to work in the evening without the need for a staff member to be available, they are able to adjust their schedule to best fit into their desired lifestyle. COVID-19 has shown doctors the benefits of having flexibility in their life, and this does not need to disappear in the post-COVID-19 world.
The Canada Health Act (1984) lists accessibility as one of its five conditions that are essential to Canada’s health care system. With the advancement of technology, no Canadian should struggle to access the care they require and providing this care need not be expensive to the health care system. Previously, a study involving follow-up stroke care in Ontario was highlighted to demonstrate benefits to patients. This 75-patient pilot project also had an estimated savings of ~$23,000 - $28,000 to the health care system, highlighting that it is possible to satisfy all stakeholders through creative uses of virtual medicine. COVID-19 has put health care at the forefront of many discussions and telemedicine has quickly jumped into the spotlight. COVID-19 will pass and life will eventually return to normal. For everyone’s benefit, this new normal should include virtual medicine as a key component in how health care is delivered to Canadians. Crises and shocks tend to disrupt and reshape industries. In terms of telemedicine in the Canadian health care system, this would be a welcome disruption.
Riley Love is a community pharmacist and Ivey MBA 2020 graduate. He is interested in how technology can help drive efficiency in the Canadian health care system.
Dr.Husein Moloo is a practising physician in Alberta and CEO and Co-Founder of PurposeMed.com. He is passionate about improving access to health care for all Canadians.