Tweets signaled COVID-19 outbreaks

Twitter and other social media platforms can serve as powerful tools to help predict outbreaks of both infectious and non-infectious diseases and should be viewed as more than just a breeding ground for misinformation.

This was recently confirmed in work by Gina Debogovich, senior director at the United Health Group and Dr. Danita Kiser (PhD) at Optum which they discussed at a session during last week’s Health Information and Management Systems Society (HIMSS) meeting in Orlando, FL.

Their assessment of several million US tweets in the early stages of the COVID-19 pandemic, showed that information contained in tweets about COVID-10 was 7-10 days ahead of public case data.

The work of Debogovich and Dr. Kiser was based on the hypothesis that “social media conversations may contain insights into COVID prevalence and may be a leading indicator for cases and hospitalization.” Debogovich said Twitter was chosen as the social media platform to evaluate because meta-data with the tweets often contains the geographic location of the tweet.

In their study, natural language process techniques were used to identify COVID-19 related tweets and classify them into different categories. Statistical analysis and machine learning was then used to determine if the tweets were leading indicators of COVID-19 spread in a community.

In their initial work,  more than 15,000 geo-located tweets that contained either an address or the latitude and longitude of the tweeter were hand classified into 7 primary categories and further divided by proximity or no proximity.

The categories used were:

  • Confirmed (the tweet stated the subject had or believe they had COVID-19)
  • Showing symptoms (the tweet indicated the subject had symptoms of COVID-19)
  • Perished (subject had died as a result of COVID-19)
  • Recovered
  • Quarantine (subject was in quarantine)
  • News (usually about a news article related to COVID-19)
  • Hoax (message contained misinformation)

Tweets were further categorized by whether they contained location data or not.

Having developed the categories, Debogovich and Dr. Kiser then assessed 100 million tweets posted from February 2020 to February 2021. They found that in the first phases of the pandemic public case data lagged tweets by 7-10 days on average. However this was reduced to 2 days in second wave of pandemic.

As a result of these findings, Debogovich and Dr. Kiser concluded that Twitter data could be useful for predicting future COVID-19 cases but the accuracy depended on the dynamics of the pandemic and tweets were most beneficial during times in which cases were rising or trending up.

Waste-water analysis and other tools are helpful in predicting infectious disease outbreaks but digital surveillance could be more effective in predicting spikes in symptoms, said Debogovich.

The study confirms early research done during Twitter’s infancy in which researchers showed how tweets could be used to predict outbreaks of influenza and other diseases. During the presentation, Debogovich said the rapid analysis of the huge amounts of data available on social media platforms remain underutilized for research and public health purposes. Mining data from social media is “hard work” and complex but could be the next big thing in predicting disease outbreaks, she concluded.

Clinicians express views on the digital future at #HIMSS22

The majority (56%) of clinicians participating in a large, global survey believe that “the majority” of their clinical decisions in the future will be made with tools using artificial intelligence (AI)

However, in the poll of about 3000 physicians and nurses conducted in 111 countries (including Canada) by Ipsos for Elsevier Health,  the majority of respondents expressed concern that medical and nursing school training was not keeping up with the need to educate them properly with the knowledge and skills needed to use modern technologies.

Findings from The Clinician of the Future study were released during the Health Information and Management Systems Society (HIMSS) annual meeting here and discussed during a sponsored session by Dr. Ian Chuang, chief medical officer for Elsevier Health.

Meanwhile results from HIMSS own State of Healthcare survey conducted at the end of last year and including 359 physicians from five countries was also releasee and discussed at the meeting. That report confirmed clinicians feel digital transformation is well underway with 90% of respondents identifying ongoing digital initiatives within their own organizations.

Interestingly, while many health system leaders polled in the HIMSS survey had reservations about the pace of digital transformation within healthcare, 16% of US clinicians said they felt their organizations had completed the transformation process and about half felt the process was well underway.

According to U.S.-based clinicians, tools that do not fit into clinical workflows, lack of proper training and lack of clear communication within the health organization are impeding transformation efforts. However, UK clinicians identified lack of clear communication as the top barrier to digital transformation.

While 88% of clinicians in the HIMSS survey reported their digital skills have improved over the past year and 79% reported choosing to use digital health tools on their own initiative, respondents in the Elsevier survey were less confident of their skills in using new digital technologies.

Of those responding to the survey, 69% feel the widspread use of digital health technology will be a challenging burden on clinician responsibilities if clinicians are not appropriately supported. In addition, 83% felt training needs to be overhauled to keep pace with intro of new technologies. Dr. Chuang said there is a sense that it is not just new information that needs to be taught but rather a shift in the whole medical education paradigm. As one US clinician quoted in the report said: “There’s no time spent separately to learn technology. That education needs to be instilled into the system to ensure all doctors are educated.”

The survey also found that 69% of clinicians globally felt overwhelmed with the current volume of data they had to deal with. While 38% of the clinicians felt receiving training and education in order to remain current will be the top educational priority over the next decade, a similar percentage believe training in the effective use of digital health technologies to assist in the delivery of patient care remotely will be the second priority

#HIMSS22 – Battling burnout with technology

Orlando, FL — Can the technological beast that has made many physician lives so miserable by drastically increasing the administrative work required to support electronic medical records be tamed and used to help reduce burnout?

That possibility was raised at several sessions here at the annual meeting of the Health Information and Management Systems Society (#HIMSS22).

The issue was first addressed in an Executive Forum held as one of a series of pre-conference symposia where speakers raised the prospect that both better analytics and the expanded use of virtual care could help with workforce retention and also in reducing burnout.

In a panel discussion, Mikki Clancy, chief digital officer at Premier Health in Ohio noted how the hospitals in her network have started using AI to reduce the administrative burden facing nurses, automating more tasks that previously had been done manually and using predictive analytics to help support more flexible working conditions. In the same discussion, Albert Marinez chief analytics officer at Intermountain Healthcare said that many clinicians have become burned out during the current pandemic and want to stop providing direct patient care in a hospital environment. For some of these physicians, he said, the broader opportunities now offered in virtual care offer an alternative which can allow them to still interact with patients in a more flexible environment.

It’s not just hospital-based physicians who are feeling more burdened today as a result of the pandemic and the requirements of maintaining electronic medical records. To quote the American Association of Family Physicians (AAFP): “The family medicine experience is based on a deeply personal physician-patient interaction that requires support from technology. But many technologies used in practice today have eroded the experience rather than enhancing it.” 

It was in part to address this that AAFP created its Innovation Laboratory  in 2018 to partner with technology companies to rigorously test new technologies such as AI and voice and mobile technologies to eliminate or decrease burnout by reducing the administrative burden on family physicians.

At a HIMSS session, Dr. Steven Waldren, VP and chief medical informatics officer at the AAFP, discussed two successful pilot projects AI Digital Assistants:

  • Suki (suki.a) is an AI-powered digital assistant that allows physicians to minimize documentation/charting time.
  • Navina ( integrates with the practice’s EHR and automates data aggregation and analysis to create a comprehensive patient portrait for physician review. Dr. Waldren said this tool can not only save time, it also helps ensure that no relevant information is missed.

An AAFP document states both tools “use voice recognition, natural language processing, and artificial intelligence to provide physicians with an AI assistant that continually listens, learns, and adapts to a physician’s documentation patterns and needs. The vision is for the AI assistant to be similar to a medical assistant or nurse who understands a physician’s preferences, anticipates their needs, and completes their charting for them.” 

With both of these tools, AAFP first demonstrated proof of concept with a small group of physicians and then tested the tools with groups of more than 100 practising family physicians.

With the documentation reduction tool, physicians who completed the 30 day trial saw a 72% reduction in their median documentation time per note for an estimated time saving of 3.3 hours/week. Participating physicians also expressed satisfaction with the quality of notes prepared as being more meaningful and professional. “We conclude that an AI assistant for Documentation is an

essential innovation for all family physicians who have documentation burden and experience burnout,” the report on the trial stated.

Initial results of the tool used to create patient summaries, found use of the tool reduced by 70% the time taken by a physician to prepare for a patient visit.

Numerous other sessions at HIMSS promoted a variety of technological tools and systems with the promise of helping to reduce burnout  These included:

  • APIs (Application Programming Interfaces)
  • Next-Gen Community Platforms
  • AI-optimized staffing schedulers

Cyberattack: Not “if” but “when”

“An ER doctor is on the 26th hour of her 28 hour shift and she hastily clicks on a link which she thinks will take her to an update from a patient’s family. All of a sudden her monitor is red with a black skull and crossbones flashing and a message demanding payment immediately. She looks up and sees the same message on the other monitors across the ER. Doctors and patients are starting to notice. And the ER, which is always experiencing a low level of chaos, kicks up into high gear as doctors have to work with first responders to divert patients to nearby hospitals. This is the nighmare scenario which has become all too commonplace.”

                                                 Lauren Boas Hayes describing a fictional ransomware attack

Orlando, Fl — Cybersecurity has joined interoperability as a standing theme at the world’s biggest health information technology conference – demonstrating how modern technology has now become a major threat to healthcare in addition to being a transformative asset.

Long gone are the days when ransomware and other security issues were a hypothetical threat discussed in one of the more obscure rooms at the HIMSS (the Health Information and Management Systems Society) annual convention.  At this year’s conference, cybersecurity was the topic of a full-day pre-conference symposium and had its own Command Center in the exhibit hall with several dozen companies presenting a series of talks on a variety of security issues.

Cybersecurity was similarly featured at the new ViVE22 health technology and innovation conference held the week prior to HIMSS in Miami Beach.

The issue is not just preoccupying the healthcare community in the US. In Canada, HealthcareCAN and the CIO Strategy Council announced last week that they were launching a project to develop standards to support cyber resiliency. “It is no secret that Canadian healthcare and health research institutions have proven to be popular targets for cyber attacks and the frequency of these events is only increasing, which brings an increased risk to patient care,” said Paul-Émile Cloutier, President & CEO of HealthCareCAN in announcing the project.

Despite the resources being put into combatting security threats in hospitals and healthcare systems it is clear the problem is growing and experts note physicians and others working in these organizations are still not conscious of the problem and how they can inadvertently contribute to it.

At the HIMSS conference, the organization discussed results of its 2021 cybersecurity survey which showed phishing and ransomware were the most significant security incidents reported by all types of US healthcare organizations among the 167 responding organizations.

In a news conference, Lee Kim, director of privacy and security at HIMSS, said the issue is not “if” a healthcare organization will be subject to a cyberware attack but rather “when”. With phishing being a major cause of security breaches, Kim said it made sense for organizations to have requirements with “teeth” to make sure employees follow proper procedures when dealing with emails.

While hackers are hitting healthcare systems all the time, Kim said only 78% of healthcare organizations are implementing firewalls across the board and there is not nearly enough encryption of data occurring. Security is still not being adequately funded at many hospitals and other healthcare institutions, she added

At ViVE, Lauren Boes Hayes, senior advisor for technology and innovation at the Cybersecurity and Infrastructure Security Agency (CISA) gave a brief but comprehensive presentation on the scope of the cybersecurity threat in the US and basic measures physicians could take to counter it.

“The healthcare industry and first responders have felt the disruptive impact of cyber attacks more so than any other industry over the past couple of years as the scourge of ransomware attacks has plagued healthcare systems around the world,” she said.

Hayes said healthcare organizations are particularly prone to ransomware attacks because “up time is everything” and these institutions are mostly likely to pay a ransom to regain control of their systems.

She detailed three fundamental bad practices which CISA feels can impair security.

  • Using unsupported software
  • Using default passwords or common passwords
  • Using single factor authentication especially remotely

“Investing in the technologies and teams who can implement a secure technology architecture with appropriate network segmentation, device inventories and exhaustive backups are proven to prevent catastrophic loss in the event of a successful attack,” Hayes said.

Virtual care: Not just where but how – #ViVE2022

Establishing virtual care as an accepted part of the healthcare system as a result of the COVID-19 pandemic is fundamentally changing not only where care is delivered but also how.

The implications of this for physicians and patients were discussed during a panel discussion at the ViVE 2022 conference this week in Miami Beach. While all speakers were from the US and the discussion was framed in the context of the US healthcare system much of what was said had direct relevance to Canadians.

“Pre-pandemic was mainly just telehealth,” said Carrie Nixon, managing partner in Nixon Gwilt Law and moderator of the panel discussion. “Right now, we’re in a space where virtual cares is encompassing remote patient monitoring … chronic care management services … asynchronous communication and artificial intelligence algorithms and applications.”

Commenting on the impact of changes in delivery forced on the system as a result of COVID-19, panelist Dr. Kyna Fong (PhD), CEO and co-founder of Elation Health said “not unexpectedly, there’s been a huge upswing in adoption of virtual care in independent (physician) practices. I’d say over two thirds of our clinics have incorporated virtual care into their regular everyday delivery of care for patients.”

Similar to what has happened in Canada, Dr. Fong observed that during the pandemic payment for virtual services has been on parity with delivery of in-person services for fee-for-service physicians. But she also noted that physicians using other payment models were already using virtual care and interacting asynchronously with patients.

As in Canada, where primary care physician advocates stress the value of a longtitudinal, comprehensive relationship, Dr. Fong said virtual interactions required due to the pandemic were seen in many instances to strengthen this relationship. “Some physicians would tell the story of having their first telehealth visit and finally seeing what their (the patient’s) home looks like or show them the way they kept their meds.”

Another panelist, Dr. Tania Elliot, chief medical officer for virtual care, clinical & network services, Ascension Healthcare, confirmed this beneficial aspect of virtual care. As an allergist, she said the ability to use virtual care with thousands of patients and see into the patient’s homes was “transformational”.

“For respiratory disease in particular, one of the most important things we could do for patients is understand their home environment and understand what might be triggering their respiratory symptoms. “ By doing a live walkthrough of patients homes in virtual visits or viewing the information asynchronously, Dr. Elliot said, she was able to assess ventilation, heating and other issues that can impact respiratory care and as a result better manage their condition and reduce the medications they required.

Additionally, she said, patients who were victims of domestic violence and unwilling to have an office visit were able to share their story in a way that otherwise would have been totally missed.

“I felt like telehealth really enabled me to see people living their daily lives,” said Dr. Elliot. “Telehealth is not just about access and convenience, it’s about longitudinal care delivery.”

However, Dr. Elliot acknowledged that not all physicians have had the same “eye-opening” experience with telehealth and its unrealistic to expect them to be at the same maturity level in providing virtual visits. Also – as in Canada – she said there are ongoing concerns about whether virtual visits will continue to be reimbursed adequately going forward.

Overall, Dr. Elliot said “when we’re asking physicians and practices to do more telehealth, we have to recognise that that is going to require change management and workflow related changes and perhaps interacting with different types of technologies. We have to think through the lens of the patient experience, the physician experience and the office staff experience if we’re going to expect that our physicians are now engaging in this hybrid care model (of virtual and in-person care).”

Panelist Dr. Roy Schoenberg, president and co-CEO of American Well, said one needs to appreciate the “visceral” impact telehealth can have on people by allowing them to experience care in their own environment. Another big change, he said, is that virtual care now is not just providing a channel such as the phone or video for the physician and patient to communicate but is also enabling other technologies to enhance the delivery of care.

A very important implication of this, said Dr. Schoenberg is that health care is now expanding beyond the 0.01% of the time when the patient directly interacts with the clinician in the office. With remote monitoring devices and automated technologies, he said, a much larger part of the patient’s life becomes part of the healthcare that surrounds person on an ongoing basis.

“The transition from looking at telehealth as a where healthcare happens to how health care is being rendered is the change,” he said.

On the issue of digital literacy and whether some patient populations are being disadvantaged by the growth of virtual care, Dr. Elliot cautioned against imposing one’s own perceptions and assumptions on these groups. She said data from her organization showed socially vulnerable patients from disadvantaged areas as identified by zip code used virtual care to the same degree as other populations. “We can assure these patients have access to virtual care,” she said, be it through family members, libraries or whatever.

“It’s incumbent upon us to problem solve for patients,” Dr. Elliot said. “We’ve seen 50% fewer no show rates for virtual visits than in person visits. People will figure out a way to access their doctors. We need to give them the tools to do that.”

However, panelist Dr. Geeta Nayyar, a rheumatologist and executive medical director at Salesforce stressed there was still a need to find the right balance about when to deliver care virtually and when to do it in-person. “Bladder surgery cannot be done on Zoom,” she said.

Virtual care panel at #ViVE

#ViVE2022 panel addresses opioid epidemic

The new ViVE 2022 healthcare information technology conference now taking place in Miami Beach is a giddy whirlwind of delegates taking maskless selfies after surviving 2-years of COVID-19 lockdown.

This merger of meetings from the College of Health Information Management Executives (CHIME) and the HLTH digital marketplace offers fluorescent colours and images, breathless pitches from healthcare start-ups and seemingly endless repetitions of health IT’s current favourite buzz words and phrases (‘transformation’, ‘value-based care’ and ‘equity’ ranking high on the list).

But it also offers sessions where respected clinicians discuss how digital health can be brought to bear on some of North America’s most significant healthcare issues – the opioid epidemic being a prime example.

On the first day of ViVE, a panel of five experts provided an update from the front-lines on an epidemic which took 100,000 lives in the US in the last year, an increase of 28.5% over the previous year. One of the panelists, Dr. Scott Weiner, chief of health policy and public health at Brigham and Women’s Hospital, Boston noted the number of overdoses associated with opioids has risen over the last two years even though the number opioids being prescribed has actually dropped significantly – pointing to the impact of the COVID-19 pandemic – and mental health issues associated with being isolated.

While acknowledging the role fentanyl and the illicit supply of synethic opioids is currently playing in the pandemic, much of the presentation at ViVE focused on how digital health is helping encourage and monitor appropriate prescribing in acute-care settings post-surgery.

Patricia Lavely, VP and Chief Information and Digital Officer in the Health District of Palm Beach County, described reported results from a CHIME survey of these opioid-use reduction technologies and strategies.

The results from 2021 showed that:

  • 100% of organizations had electronic prescribing of controlled substances
  • 92% had order set maintenance to offer non-opioid options
  • 90% had an eprescribing modules connected to the State or regional Prescription Drug Monitoring Program (PDMP)

Other data from the survey showed organizations reported that this eprescribing connectivity had the highest impact on opioid-use reduction. It was also noted that CHIME has an Opioid Task Force to offer resources for its members but many hospitals were not yet taking advantage of all the health IT tools available and doing all the “easy things” they could do to help deal with this issue.

Lavely said despite the use of technology and electronic health records, opioid overdose deaths continue to rise at a “horrific pace” and that much more needs to be done to identify at-risk patients and those with an opioid use disorder.

Panelist Dr. Matt Sullivan, chief information officer at Atrium Health, noted that while health informatics specialists have huge amounts of data on patients in association with opioid use more needs to be done to analyze and share what can be learned from this information.

A discussion of existing patient risk scores concluded their usefulness was limited because they depend on patients giving honest answers and also fail to take into account many other variables besides prescription drug use associated with the risk of having a substance use disorder.

Panelists acknowledged the importance of harm reduction and especially the use of naloxone to reduce opioid deaths and also said more must be done in healthcare institutions to reduce the stigma against drug use.

“One thing we can take away from this session (on the opioid epidemic) is that harm reduction and naloxone will save lives,” said Dr. Sean Kelly, chief medical officer of WELL Heath and moderator of the session.

It was acknowledged at the start of the session that many patients need adequate pain relief and may fail to obtain it. But as panelist Dr. Greg Polston, chief informaticist and associate medical director UC San Diego Health noted more than once, misprescribing opioids is something that can lead to a clinician losing their license.

Overall it was noted that while clinicians and those working in health IT are doing a lot to help deal with the opioid epidemic more can be done even though many of the variables involved remain out of their control.

Opioid Panel at ViVE 2022

Continuity of care trumps instant access to virtual care: Poll

Canadians like the convenience of having instant access to virtual care through virtual “walk-in” clinics but the majority place a higher value on having an established relationship with their own primary care physician.

That’s one of the conclusion that can be drawn from findings of a new poll by Ipsos conducted on behalf of the Canadian Medical Association.

The study focused specifically on the perceived value of the continuity of care that is a cornerstone of the traditional doctor-patient relationship between primary care physicians and patients in Canada. This continuity of care was also the focus of a recent report by the College of Family Physicians of Canada which was highly critical of for-profit virtual care.

The online Ipsos poll of 2,000 Canadians was conducted conducted between September 14-23, 2021.

It found that 81% of respondents agreed it is important to have an ongoing relationship with a family doctor who understands their changing needs, while 79% agree it is important to have an ongoing relationship with a family doctor who understands them as a person.

Asked whether they placed a higher priority on an ongoing relationship with a family doctor or team or on having care that was more convenient, 59% of those polled favoured the ongoing relationship while 33% gave equal importance to continuity of care and convenience.

Asked about virtual walk-in clinics where patients can receive care by phone, video or other means when they want it, only 9% of respondents placed the value of this service above having an ongoing relationship with a family doctor. However about a third of those polled said they are less concerned about having an ongoing relationship with one family doctor, if the doctors and health care providers providing their care had electronic access to their health records.

Of the 36% of Canadians who said they had used a virtual walk-in clinic, 48% said the experience was positive – a rating that falls below the 59% of who report an overall positive experience with a family physician. While only 28% of all those surveyed said they would consider using a walk-in clinic, 40% said they would be more likely to use a virtual walk-in clinic than a family physician for minor illnesses or injuries or for prescription refills. The same percentage said they would trust a doctor in a virtual walk-in if they did not have an established relationship with a family doctor.

Despite the problematic findings about virtual walk-in clinics in this poll, other findings confirm how virtual care is becoming a standard feature of medical care in Canada since the COVID-19 pandemic began. Six in 10 of those surveyed said they were aware their family doctor offers virtual services, an increase from before the pandemic when only 12% knew their family physician offered this service. In addition, more than half (54%) said it was very/somewhat important to them that their family doctor offer virtual services.

While the telephone remains both the preferred means and actual way in which patients access virtual services, the survey did find the percentages of patients wanting to communicate by either video, email or text were significantly higher than what their physician currently offered.

Based on the findings in the survey and more in-depth conversations with a smaller group, Ipsos concluded that “continuity of care is important for the majority of Canadians … but virtual episodic care has a role to play in providing more timely access to health care and it is seen as somewhat overdue in today’s digital world.”

Against for-profit virtual care: @FamPhysCan makes the continuity of care case

One of the cornerstones of primary care medicine in Canada is continuity of care and the idea that care offered by the same family practice over the lifetime of the patient is the ideal state.

Continuity of care is also seen by primary care advocates as one of the most compelling arguments against having virtual health care services offered by for-profit private companies.

This case was recently made most explicitly by the College of Family Physicians of Canada (CFPC) in a Feb. 22 report titled: Buying Access Will Cost You: The Unintended Consequences of For-Profit Virtual Care.

The report is a direct attempt to counter the recent significant growth of for-profit virtual care in Canada. An evaluation of virtual care in Canada by CADTH published in June, 2021 listed 12 private companies offering a variety of virtual care services in Canada with most being paid on individual basis although some services are covered by private insurance or public health plans.

The CFPC report is also a followup to a CFPC policy statement “Strengthening Health Care – Access Done Right” published in August, 2021 which stressed the need for “access to high-quality, comprehensive, continuous primary care close to home …” That document implicitly questioned the growth of private companies providing intermittent virtual services detached from the relationship between patients and their family physicians.

In the new report and an accompaying news release, the CFPC detailed how the organization feels paid-access virtual care is inferior to continuous, patient-centred care which has “a host of benefits for patients including greater quality of life, better health outcomes, and lower rates of emergency department use.”

“Episodic for-profit care also jeopardizes patients’ continuity of care,” says the report. “Patients using episodic virtual care are less likely to regularly visit their family doctor. Further, providers working through for-profit solutions often do not have access to a patient’s full health record and they generally do not share information with the patient’s regular care provider to maintain continuity.”

The report cites a report from the Ontario Auditor General’s office which found patients using for-profit virtual care are less likely to be regularly seeing their family physician and that this demonstrates a lack of continuity.

The importance of using virtual care to support continuity of care with an established provider rather than for-profit services was also tacitly endorsed in the second Virtual Care Task Force report prepared by the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada as well as the CFPC.

Interestingly, Maple – one of Canada’s leading for-profit virtual care companies – also recently strongly endorsed the concept of continuity of care and that organization’s commitment to the idea.

“Continuity of care is a crucial component of effective healthcare, and in a virtual setting, the consistency and quality of care that a person receives as they transition between care settings is more seamless than ever,” stated Maple in a blog published Oct. 21.

The blog goes on to talk about informational and management continuity and argues that Maple supports both:

“Informational continuity is delivered through access to a patient’s medical history, by both the patient and provider, in order to give complete informative care via shared or electronic health records. This enables providers to view the patient’s history and build on previous treatment and diagnosis. In a virtual setting such as Maple, access to consistent patient record-keeping ensures comprehensive care during every single visit.

“Coordination of care across multiple providers, which adapts to needs over time, is defined as management continuity. Any healthcare provider interacting with the patient can collaborate with others involved, both in a virtual setting and the physical world. As more patients turn to virtual care to complement in person care, it’s important that they have control over their documentation and that’s why we’ve built in a secure medical records feature,” says Christy Prada, vice president of business development at Maple.

The blog does not address the pivotal concern of the College of Family Physicians of Canada that private companies such as Maple who offer virtual care interrupt or impede the continuity of care offered by family physicians. The CFPC statement also does not deal with the issue of the million plus Canadians who do not have a regular family physician and are thereby denied the benefits of continuity of care by a regular primary care provider – and the niche private virtual care companies could or should fill in helping give these patients the care they need. While CFPC acknowledged in their report that “for-profit virtual care services, such as virtual walk-in clinics, have acted as a stop-gap measure to improve access to care for some” it added that  “in doing so (they) present serious risks to the health care system.”