The year is 2025. On the heels of yet another global pandemic, the world again has been tossed into an unknown reality with a renewed round of virtual attendance for social gatherings. The social arena once more has forever changed but this time the healthcare industry is prepared with an incredible innovation.
Picture a world where access to healthcare is one click away, by both computer and phone … a world where physical exams, patient diagnosis, prescription and medication delivery are all completed over a virtual medium. In this world, the physical interaction between patients and their primary care professionals has diminished while medical care is more accessible. So much so, patients need only to reach into their pocket …
As futuristic as this sounds, the question is how do we get there from today? How can we kick-start the Virtual Care (VC) we have today and what can we expect along the way?
In these uncertain times, physicians and healthcare providers have continued to find novel ways to provide care while protecting the health of those involved. Having to meet increasing demands with limited capacity, while maintaining social distancing policies, has led to a focus on VC where “remotely” refers to care that is not delivered in person.
Although Canada launched Telemedicine (TM) more than 40 years ago for rural and isolated communities, adoption of VC for all communities since then has been in fits and starts. COVID-19 has forced a rapid acceleration in its development as virtual visits went from being a small fraction of healthcare delivery to a primary means of connecting patients to practitioners in 2020.
The VC taskforce led by the Canadian Medical Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons has called on all governments to make VC a priority.
“We need to demonstrate to clinicians, patients and to payers that this is a good solution. That means changing some minds,” Simon Hagens, who leads performance analytics at Canada Health Infoway (CHI), an independent digital health organization funded by the federal government, told CTV News recently.
Although there are clear advantages to VC – quicker access to specialists; care for older patients with comorbidities while allowing them to stay home; better access to primary care for those who live in remote area; dispensing and delivering drugs directly to patients free of charge – there is an impression that it may negatively impact the “therapeutic alliance,” the relationship, between patient and physician.
Patients who receive patient-centred care from physicians are found to be less likely to report depression symptoms and more likely to report better health outcomes due to direct daily contact with the physician. However, at the same time, virtual communication decreases levels of stress and increases patient satisfaction scores.
Establishing a bond is embedded in human nature. It leads directly to our great strength or deep sorrow. While the visits are done remotely, with VC physicians don’t need to wear a face mask and shield. Verbal communication plays a critical role in establishing a physician-patient relationship. Since TM and VC allow for the use of a translator, better communication may be established by switching to an online method.
But let’s take a moment to address the unavoidable concern. You accept the fact that VC is the new reality for all of us and ask yourself: “How good could this possibly be? This is all new…”
The concern of diagnostic accuracy in virtual visits is a valid one. Based on limited evidence, diagnostic accuracy in virtual visits is 71-91 per cent, similar to in-person visits. However, this study does not address continuity of care or patient outcomes. LiveHealth Online, a health plan telehealth provider, found that patients were less likely to have a regular source of primary care and nearly half reported easier and quicker access to a physician.
Sight, touch, hearing, taste and smell … In an ideal world we would have all of our senses to assess the world around us. Although VC limits the use of all of our senses, it offers a unique proposition for audio care. In the geriatric population, clinical liaisons are used to help patients, especially in long-term care institutions, to communicate with their healthcare providers and families as hearing loss, visual and cognitive impairments or decreased mobility may impact an older person’s ability to set up and communicate in a call.
Visual imaging may be required for physical examinations and establishing diagnosis and VC cannot deliver chemotherapy, stitch wounds, perform surgery or take X-rays. Thus, the onus will still be on the physician to ensure adequate access to the patient through appropriate means.
Now let’s travel again to 2025 and a fully developed VC health system. You receive a notification to discuss the results of your investigations at 12 p.m. Your virtual pharmacist has received an updated prescription from your doctor. Another notification has been sent to your phone that all updates to your prescriptions have been made and the medications were sent to your home address. Knowing that you may have some questions regarding your management, your virtual doctor has been notified to discuss all health-related changes in a question/answer session to ensure your comprehension.
This is the world to come, a world of abundance to the access of healthcare, virtually.