Telehealth for a new reality

By Dr. Sandy Buchman

A few weeks ago, the Centre hospitalier de l’Université de Montréal (CHUM) held interesting discussions on health innovation. The objective: to reinvent health with artificial intelligence, therapeutic innovation, 3D printing and telehealth. A whirlwind of innovation surrounds us and a revolution is knocking at the door of our health system. However, an important question arises: What added value do these technological innovations bring to patients?

An Ipsos survey conducted on behalf of the Canadian Medical Association (CMA) last summer provides some very interesting answers. According to the survey, more and more Canadians are welcoming the advent of technology to facilitate access to a health care system that is struggling to fulfill its mandate. Nearly seven in 10 respondents would like to have virtual consultations with doctors and two in three believe that virtual health consultations would lead to faster care.

However, as physicians, we still have a long way to go to meet the expectations of users of the health care system. According to a national survey of physicians in 2019, less than one in five physicians use an interface to transmit prescriptions to pharmacies, one of the most fundamental tasks in medicine.

And although the public is increasingly interested in the opportunities that artificial intelligence may offer within the next 10 years, only 1.3% of physicians say they have incorporated artificial intelligence into their practice at this time. If we add to this the omnipresence of fax machines — the venerable fax — in doctors’ offices and health care facilities, the technological gap seems immense.

Breaking point in sight

The health system is unique. In a world where the GAFA (Google, Amazon, Facebook, Apple) offers services that the user can evaluate and even improve, the health system does not provide such an attractive online experience. And because they are so connected, the members of the Google generation are major consumers of health care. They visit a doctor on average 11 times a year, which represents more visits than the average for seniors. We will soon reach a breaking point, with the health care system offering no more than its traditional level of access to care to connected patients who want to see their doctor more often, in the midst of an aging population with an increasing life expectancy.

For too long, transformation of health systems has been largely achieved through technological and organizational transformation. We must not forget to strike a balance in the management of these transformations so that the patient is at the heart of the value proposition.

Technology is a solution, but it is imperative to incorporate the human element and make it a core consideration in any plans for change. Since the time of Hippocrates, the patient–physician relationship has been the cornerstone of the medical profession, and as physicians we must do everything in our power to ensure that compassion and listening remain in that relationship. In-person consultation will always have its place and nothing can completely replace it, not even a conversation on FaceTime.

When it comes to virtual care Canada is lagging behind many other countries in its adoption. To look at what’s standing in the way, the CMA joined forces with the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada in March 2019 as part of a new task force.

The group’s mandate will be to 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.

The task force will also include members of the eHealth industry and other major Canadian medical and health care associations. The task force is expected to complete its work by the end of 2019, and to have a set of recommendations ready to present to stakeholders in early 2020.

We understand that everyone needs to be included in this endeavour for changes to be lasting and impactful. The Virtual Care Task Force also created four working groups to examine how payment models, licensure and quality standards, interoperability and governance, and medical education will need to be adapted to support virtual care in Canada. As well, the task force is integrating the patient perspective, with a patient advocate member, and at least one patient representative on each working group.

In the coming months and years, many changes will occur in the health system. It will be essential to define the new value proposition not for the patient, but with the patient.

Dr. Sandy Buchman is President of the Canadian Medical Association and an associate professor in the Department of Family and Community Medicine at the University of Toronto and provides home-based palliative and end-of-life care through the Temmy Latner Centre for Palliative Care, Sinai Health System, in Toronto. He also practises palliative care with the Palliative Education and Care for the Homeless (PEACH) program under the auspices of Inner City Health Associates and St. Michael’s Hospital in Toronto.