Doing virtual care right: Organized medicine in Canada speaks up


A major new report on virtual care in Canada is significant not only for its (extensive) content and recommendations but perhaps more importantly for who compiled and released the report.

The report comes from a task force representing Canada’s three main national medical organizations – the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada, and the College of Family Physicians of Canada – working in an almost unprecedented collaboration. Given that the report also had the involvement of patients, families and caregivers, it merits receiving serious attention.

Rather than attempt to tackle digital health as a whole – which would arguably include AI, genomics, 3D printing and any number of other technological advances – the task force focused just on virtual care which it defines as “any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care.”

The mandate of the task force was to “to develop strategies and recommendations for promoting the delivery of publicly insured medical services — by the Canadian medical community — through virtual means.”

The report contains a very comprehensive overview of the history and current status of virtual both in Canada and elsewhere but what is most striking is the outlook taken by task force members and the recommendations that arose from that outlook.

The task force makes it clear a national framework is required to advance what the report sees as a clear requirement to incorporate virtual care into the publicly funded health care system.

Without such a framework, the task force cautions “there is a risk that a series of fragmented virtual care services will be established that detract from continuity  and potentially lead to quality of care issues.” However, the report does acknowledge work already being done at the federal as well as the provincial/territorial levels to advance virtual care and urges that the task force recommendations should build on these initiatives.

“While the majority of Canadian physicians’ offices and health care facilities now use some form of digital record keeping, and a majority of households have Internet access, there is a long way to go in terms of the use of digital technology to provide publicly insured, virtual care,” the report states. It also state that “consumer demand and the ability to improve access mean virtual care will become more and more prevalent in the Canadian health care system” but notes this “will remain fragmented and be delivered inequitably unless appropriate steps are taken.”

Task force members are also firmly committed to the concept that virtual care should be incorporated into the continuity of care provided by existing health care teams – rather than being offered as separate services. However, the task force acknowledges the nuances of what virtual care can do, stating “although virtual care has the potential to increase access to medical and health care, it also has the potential to exacerbate inequalities in access to care, both in terms of geography and socioeconomic status.”

The patient focus on the report should not be understated. “Notions of patient ownership of health information and actual access to information are often at odds,” the report notes, adding “Canada lacks national standards to support patients having electronic access to their health information wherever they are in the country.” This led the task force to adopt the principle that “in a virtual care ecosystem, patients and family should have digital access to their entire suite of health information (health and social services) according to managed protocols that uphold ownership, custodianship, autonomy, security, privacy, data integrity and quality care.”

The report also acknowledges the additional pressures that working in an electronic environment and can place on the medical profession. “These concerns are real, but can be mitigated by a considered approach to health information technology design and deployment that supports user-friendly workflow and by ensuring requirements to deliver virtual care do not place additional burdens on the medical profession. The report also contains has a major recommendation for addressing remuneration to encourage physicians to use virtual care platforms.

Overall, the report contains far more than the summary above and the summaries of the deliberations of each of the task force working groups; interoperability and governance, licensure and quality of care, payment models, and medical education, each merit a closer read.


Better, but not there yet: Use of IT in primary care in Canada


When it comes to the use of information technology in primary care in Canada the best that can be said is that all the numbers have trended in the right direction since 2015.

Released by the Canadian Institutes of Health Information (CIHI) last week, the 2019 version of the Commonwealth Fund International Health Policy survey of 11 developed countries focused on primary care physicians and contains a wealth of data on the use of technology as well as on access and coordination of care.

At a time when Canadians and especially primary care physicians are engaged intense discussions about how to better use digital technology to improve care and better involve patients, what is most striking about some of the Commonwealth Fund findings is just how far many Canadian jurisdictions are from even having the basic tools to do this.

While the survey confirms the fact that overall Canadian primary care physicians have made huge gains in incorporating electronic medical records into their practices in the last decade (kudos to @Infoway and all the money put into enabling this in the 2000s), these gains are not evenly distributed. And when it comes to the use of health IT, Canada continues to lag behind other countries polled, in many instances badly.

While 86% of Canadian primary care physicians overall report using electronic medical records (EMRs), the 2019 survey shows only 1 in 4 (26%) are using EMRs in PEI while that percentage is 61% for primary care doctors in New Brunswick and Newfoundland.

Of course, the absence of an EMR makes any electronic engagement with patients or use of information technology to improve quality care a moot point.

As for providing patients with electronic access to their records or enabling electronic communication, Canada continues to also lag most other nations surveyed. Only 23% of Canadian primary care docs offered the option to ask medical questions via email or a secure website, and only 5% have the capacity to let patients see summaries of their medical record online.

These numbers fell far below the average among the other 11 Commonwealth Fund countries surveyed , which includes Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S.

We are also falling short when it comes to connectivity between physicians: The survey showed only 25% of Canadian family doctors used EMRs to exchange clinical summaries and 36% to exchange laboratory results with other physicians (Commonwealth Fund averages: 63% and 65%, respectively).

So, some good stats when looks at 2015 numbers provided for comparison, but many miles to go.

(Illustration: Cover of Future Practice magazine published by the Canadian Medical Association, May 2011)