About 60 per cent of healthcare visits in Canada are now conducted virtually, a jump from the 10 to 20 per cent pre-pandemic. My own clinic group is currently “seeing” more than 90 per cent of our patients through phone appointments alongside some additional “visits” conducted through video chat.
Virtual care has allowed Canadians to continue to access health care while maintaining physical distancing and safety. The uptake has been rapid — but we need to make sure that it lasts. One province has taken a step towards maintaining virtual services: Alberta has made the province’s virtual care billing codes permanent. In other regions, the debate and discussion continues, including in Ontario where negotiations are underway between doctors and the province.
In either case, we are laying the foundation of our future. Looking beyond the pandemic, four key levers can help ensure that virtual care remains part of Canada’s “new normal.”
Clinical and Political Leadership
Already, clinical groups and the jurisdictions (provinces, territories) have shown remarkable leadership and collaboration in implementing virtual care swiftly and broadly. However, for the virtual wave to continue, this leadership must too.
As it’s often said, Canada doesn’t have “a” healthcare system; it has 13 co-existing ones. Individuals and organizations such as hospitals, clinical and industry groups and associations will need to work with jurisdictional leaders to influence policy. In the short term, this work might be done foremost at the provincial and territorial levels but looking further ahead, this collaboration must happen nationally as well.
Above all, a rational, evidence-based approach to policy is needed. University-based health policy researchers working with provincial datasets may provide evidence and data relating to the use of virtual care and its role in flattening the curve — data not only applicable to future health emergencies beyond COVID-19 but also to ensuring sustainability within our healthcare system.
Patients’ voices are indispensable. The healthcare system serves patients; it would not exist without them. Individual patients and patient organizations can provide significant support for furthering virtual care services.
Canada Health Infoway’s 2018 and 2019 surveys of Canadians found that patients with access to their personal health information report feeling more confident and involved in managing their health care. The benefits of modernized access will last far beyond COVID-19 and it is critical that patients bring their stories and lived experiences to the table.
Support for Clinicians Using Modern Tools to Benefit Patients
In the midst of this crisis, clinicians are making do with the resources they have on hand — primarily the telephone along with a host of video applications and digital workarounds that mostly do not fit into our existing workflow. While this kind of stopgap is sufficient to weather an acute crisis, our tools and processes must be refined if virtual care is to last beyond the current pandemic.
The effort involved in managing this ongoing change process is enormous and we need to support clinicians, both community- and hospital-based, with the tools they will need in the coming weeks and months
From a technology perspective, this might mean ensuring clinician access to modern, private, integrated, easy-to-use virtual tools. It could mean making interoperable remote monitoring tools as commonplace and inexpensive as a thermometer to prepare for the next pandemic.
However, it’s not all about the technology. To move forward, we need education, training and clinician peer networks to refine, teach and reinforce best practices. Underlying all these initiatives is the need for adequate investment in resources.
When considering long-term implications of virtual care, clinicians’ remuneration structures (commonly equated with billing codes in fee-for-service arrangements) are perhaps the trumpeting elephant in the room.
Jurisdictions that only recently introduced fee codes for virtual care services need to rationally review and refine them. The provinces and territories need to assess the critical role of these updated fee codes in enabling the provision of care during the pandemic to best determine how they can support quality virtual care and continuity of care afterward. It is worth noting that a number of prominent clinical and academic voices have made compelling recommendations on remuneration for virtual healthcare services – the CD Howe Institute’s Modernizing Canada’s Healthcare System through the Virtualization of Services in 2018 and the CMA’s Virtual Care Task Force Report in February 2020.
Throughout the COVID-19 pandemic, Canadian clinicians have demonstrated their ability to adapt quickly and deliver virtual care during a time of crisis. Similarly, Canadian citizens have demonstrated that they have no interest in returning to an outdated status quo. Looking forward, we can build on this success. While the aforementioned four policy themes are not new, they will take on greater relevance as we transition to the next phase of virtual care, post-COVID-19. Through strong leadership, advocacy and collaboration, we can ensure that Canada’s healthcare system takes its place on the 21st century stage.
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Thanks Rashaad, a nice piece. I agree with you.
It is interesting over time how the “firsts” change, and appropriately so. Canadian healthcare has had a number of firsts over the last 20 years. I recall seeing strategies and vision statements state:
Now it is (or should be)
Virtual care first
and appropriately so.
Maybe when we get to the tipping point of Virtual CARE first we can all rally around
Good insight into virtual healthcare in Canada. There need to be good synergy between the available infrastructure and the healthcare to make this successful. A good deal of awareness among the patients is required for them to take up this virtual healthcare system.
Great article Dr. Bhyat.
Our palliative medicine program used to do exclusively home visits. We gave patients a window for our arrival, similar to the cable company.
As a result of virtual care, we have increased our patient roster by 30%, doubled our daily visits, cut our wait time from 5 to 3 days. We are having more frequent contact with patients and same day/next day appointments are always available when necessary. While we still provide home visits, we redoing about 80% virtual (telephone/VC) and 20% visits. We have criteria for flagging visits best done in person (ESL, cognitive impairment, no internet access, etc).
Overall, access to our program has never been higher and both provider and patient/family satisfaction is high.
Yes, this should be the new normal.