Virtual care: That weird thing in the corner, and the lawyers

At last week’s #ChildHealthCan2020 virtual conference, Dr. Reshma Amin, a pediatric respirologist from the Hospital for Sick Children in Toronto gave an overview of an innovative program she directs that provides a virtual care platform for those requiring mechanical ventilation at home.

When Dr. Amin concluded her presentation by giving five tips for clinicians to consider when thinking of setting up a virtual program at their institution it was telling that while considering how patients are going to use the program was on the list, the other four items all dealt with the need to consider privacy and security issues.

The fact that Dr. Amin talked about SOC-2 (a framework to assess secure management of data by 3rd party vendors) seemed to send a virtual shudder through the spines those hoping to encourage clinicians to provide more programs that are not in-person. While nobody rates the importance of maintaining patient privacy and confidentiality higher than physicians a palatable sense of frustration emerged later in the conference when panelists discussed how to make it easier for clinicians to provide good virtual care.

On that panel was Dr. Sacha Bhatia, chief medical innovation officer at Women’s College Hospital in Toronto. While not exactly a rant, Dr. Bhatia did deliver a lengthy set of remarks on why he feels a lack of coordination in privacy requirements is hampering the development of the delivery of virtual care.

Just as Dr. Amin was able to accelerate implementation of her mechanical ventilation program as a result of the COVID-19 pandemic, Dr. Bhatia said he feels COVID-19 has helped changed the environment for virtual care. “I think we’ve kicked the can down the road a little bit, because of COVID,” he said. “Everyone sort of like put their fingers in their ears and said, it’s a pandemic, so we should be able to do that stuff (deliver virtual care). And, honestly, that’s been great.”

But he added he felt it was “unfair” to put the requirement on doctors, nurses and other providers “who just want to take care of patients” to negotiate through the regulatory landscape required for implementing new virtual care programs.

“Virtual care now is care. I think we can’t just treat it like a research project or some weird thing that we do anymore, because these are things that really help people. For a long time we’ve treated virtual care as this weird thing in the corner? No, this has real implications for people today. So we need to treat it like that.

“The challenge is the law. Every hospital in the country has a set of lawyers that interpret our policies around privacy and legal risk completely differently. And if you get them all in a room, they won’t agree.”

Dr. Bhatia said there was a need to come to a common consensus on regulations and laws governing the sharing of patient information. “We want to be safe. But let’s all agree on what that means and let’s just get on with it. ”

Whitehorse pediatrician and Canadian Medical Association (CMA) president-elect Dr. Katharine Smart was on the same panel and said she essentially agreed with Dr. Bhatian and called for a common sense approach to privacy and the sharing of patient information.

“I also think it’s going to be challenging, because every province has different legislation, and the way that privacy is considered is quite different across different provinces.”

“I don’t think that it’s going to be simple, by any means,” Dr. Smart added, “but I think we have to keep pushing for that common sense approach so we can communicate with our patients and they should understand the risks and benefits of whatever we do and be able to consent to that without there being 10 steps and barriers in between.”