Delivering Healthcare to Remote Communities

Spotlight on Canadian Medical Association's Keynote Session with Dr. Katherine Smart: Enabling and Expanding the Implementation of Virtual Care in Canada

A New Way of Caring for Patients

All over the world, the pandemic accelerated the implementation of many services, particularly those related to digitization. This was particularly the case in the healthcare sector in some of the remotest parts of Canada. Dr Katharine Smart , the President of the Canadian Medical Association (CMA), says that “virtual care has been a priority at CMA for many years, long before the pandemic, particularly for people living in rural in remote communities.” Prophetically or maybe ironically, for the year leading up to February 2020, the CMA collaborated with other medical organizations across the country to “create a virtual care taskforce to look at these issues.” The taskforce “published a series of recommendations, including legislation and policy changes that needed to be implemented to pave the way for virtual care in Canada.” The timing in many ways was impeccable because almost immediately after the report came out, COVID-19 hit and it became a “watershed moment for virtual care.” All over the country, particularly in remote areas, “almost overnight we fully transitioned to virtual care out of sheer necessity.”

The intention was for the care of patients to be as “uninterrupted as possible,” and this even included the publication of a “playbook and other resources to help physicians.” The first few months of the pandemic in remote locations led to a lot of lessons being learned, many of which “were not anticipated.” In Yukon for instance, in the northwest of the country, “we were very rapidly able to move to providing consultations either over a platform or over the phone, so that was excellent,” and the transition to virtual care was all but seamless. One of the positive but unintended consequences was that they were “able to bring specialists from the children’s hospital into the appointments with us in our clinic, virtually.” In the case of one family, they were able to have all their appointments with the specialist and with their local doctor online, “and the family never had to travel to Vancouver, which is something that would not have happened in the past.” It would have been more costly and complicated previously, though they would have seen the specialist in person, which also has its advantages.

The Benefits of Virtual Care

Once virtual care became the norm as a result of the pandemic, the CMA conducted a nationwide survey about COVID-19 and virtual healthcare in May 2020. The results showed that “nearly of Canadians surveyed had seen a physician using virtual care options, and that 91% were satisfied with their experience.” In fact, the results were a little unexpected because they also showed that a large majority “would prefer the virtual method as a first point of contact in the future.” It is very likely that “people in rural and remote communities would want their first point of contact to be virtual. It allows them to have access to care and does not require the patient to travel.” If this were to become the norm, “it would really improve efficiencies in our system and limit unnecessary medical travel.”

From a physician’s perspective, a further survey was conducted in April 2021 which showed that doctors are also “keen to embrace virtual care. 94% said they are currently providing virtual care.” However, when drilled down further, it was interesting to note that 93% of this virtual care was by “telephone consults. 51% offered video, 36% provided services via secure email and only 5% used remote patient home monitoring.” The phone is so popular because it is familiar, but also because many people don’t have access to the other platforms, or don’t know how to use them. “There’s still some work to be done in terms of people getting more comfortable with video formats.” The doctors however “expect to continue using virtual care, and were generally satisfied with the virtual care options.” In most cases, they reported that virtual care “improved patient access, enabled higher quality care, ensured more efficient care, and could be better integrated into their workflow.”

“To me, virtual care showcases how we can provide a much more family-centered, team-based, collaborative care approach using virtual platforms as a way of bringing people together. Though ultimately we need to find a good balance between virtual and in-person care, depending on the situation and the scenario.” Dr Katharine Smart, President, Canadian Medical Association

No doubt for a long time, “in-person visits will remain the most common type of consult for physicians and patients,” and nationwide surveys suggest that once the height of the pandemic was over, over half of consults went back to being in-person, with “40% by telephone and 10% by video.” No matter how good virtual care platforms get, there will always be limitations when it comes to “physical exams.” There continue to be reports “that patients are being sent into emergency departments to obtain a physical exam, which is not ideal.” Apart from that, there are always challenges with internet connections and accessibility especially in remote locations, video quality, language, literacy and instructional understanding, and cost. “Some people don’t have minutes on their phone or the financial access to the internet. We need to think about that.”

CMA Recommendations to Improve Virtual Care

In many ways, it has been an exciting 18 months with “amazing progress in this space, but there’s still a lot of work to do to make sure that all health care providers and Canadians can fully benefit from virtual care.” To that end, the CMA “is calling for change” and has seven improvement recommendations:

  1. Virtual care services must be fully integrated across the health and social care system​ – “The goal is a seamless experience for patients between appointments, so this means full integration, including of electronic medical records.”
  2. Virtual care must be permanently established within Canada’s publicly funded health care system​ – Whilst there were a lot of measures during the pandemic that there “swiftly and temporarily enacted, we need to be careful that we don’t return to the pre-pandemic model in which virtual services were largely available only for people who could afford them.”
  3. Physicians and other care providers must be prepared, through education and training, to be leaders of digital health transformation​ – Doctors need to work comfortably in “digital health teams,” and be “nimble and flexible in a way that really does provide much better care, using AI driven technology and other tools.”
  4. Promoting digital literacy and guaranteeing affordable and reliable internet access must be priorities​ – Particularly in “remote locations, internet access must be high quality but also affordable.” Even in cities, the cost is sometimes prohibitive, and “you can only imagine what it’s like in some other communities where beyond the infrastructure issues, it’s important to recognize that many individuals in Canada can’t afford a phone, let alone internet or other devices.”
  5. A set of pan-Canadian standards for patient health information access must be put in place – “This is to ensure that privacy and confidentiality of information is respected and enforced, but it must also not inhibit our movement. This is a challenge for the federal government.”
  6. A pan-Canadian framework to regulate the safety and quality of virtual care services must be put in place​ – “We don’t want to compromise the quality and appropriateness of care by replacing a portion of our inpatient visits with virtual care. Striking the right balance is one of our most challenging issues.”
  7. A national licensure system for physicians should be explored and supported​ – “It’s often very costly so having a national licensure would be a big way to remove that barrier.”
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