Scaling up virtual care in Canada: Addressing the barriers to capitalize on the opportunities

By Dr. Gigi Osler

In the world of medicine, we are living in an incredibly exciting time. Remarkable innovations in everything from minimally invasive surgery to biologic treatments continue to improve health outcomes. Yet in Canada, we struggle to evolve our models of health care delivery- models that have essentially remained unchanged since the 1960s. Although the world we live in has changed a great deal, with technology at the centre of many daily transactions, health care delivery has changed very little.

The time has come for new technologies which enable virtual care to be integrated into our health care system. A survey conducted last summer by the CMA confirmed that Canadians are ready: seven out of 10 would take advantage of virtual physicians’ visits, if it were available. In fact, 75 per cent of Canadians believe new technologies could help address issues related to access and wait times.

At the same time, when we look at the early development of virtual care, it’s noteworthy that Canada was once a pioneer in this area. In the 1970’s, the late Dr. Maxwell House of Memorial University of Newfoundland was using telephone technology to provide virtual consultations to remote communities throughout the province. In a province as vast as Newfoundland, the benefits of this innovation were obvious. Yet despite these early innovations in virtual care, today Canada still lags behind in its adoption. So what is holding us back?

In a discussion paper published by the CMA last August, four barriers were identified:

  • Governance of compensation mechanism: Most provincial payment systems are based on face-to-face encounters between the patient and the physician and compensation for e-consultation remains very limited. In contrast, private sector companies have been very active in this space, offering a pay-per-visit fee or membership model for anyone willing to pay out of pocket.
  • Regulatory barriers: This is perhaps one of the most complex challenges. Regulations and policies have not evolved to support the introduction of virtual care and new technologies. Simple tasks, such as electronic prescribing, still require an original signature, forcing many medical professionals to rely on the fax machine – and so on. The other key issue is the delivery of care across provincial boundaries. In most jurisdictions, a physician cannot provide care to a patient in another province without a license from the patient’s provincial regulatory body.
  • Security of personal information: When we speak of electronic forms of communications, issues of privacy arise – and with good reason. More and more, we learn of privacy breaches with far reaching impacts.
  • Digital divide and access to technology: Consistent access to proper broadband technology is not guaranteed across the country. A 2014 survey found that only 85% of Canadians living in rural communities have access to high speed internet. And this divide is even greater in many remote, northern, and Indigenous communities. For this reason, we were encouraged by the federal government’s commitment to high speed internet in rural and remote communities as part of its 2019 budget.

The barriers to virtual care are not insurmountable, but they need to be reviewed and – most of all – addressed. This is why the CMA has joined forces with the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada to create a taskforce on virtual care. The physician-led group, composed of representatives from regulatory bodies, medical and healthcare organizations, eHealth industry, as well as patients, will identify the regulatory and administrative changes needed to support virtual care in Canada, and to allow physicians to deliver care to patients within and across provincial/territorial boundaries. I look forward to sharing the group’s report later this year.

Virtual care offers unparalleled potential for efficiencies and improved access in our health care system. But the barriers are real and complex. For this reason, we need thoughtful, innovative thinking to ensure we are able to fulfill the vision of a better health care system for all Canadians.

Dr. Gigi Osler is President of the Canadian Medical Association.