Dr. Sacha Bhatia is a cardiologist and director of the WCH Institute for Health System Solutions and Virtual Care (WIHV) at Women’s College Hospital. Will Falk is Senior Fellow at the C.D. Howe Institute.
At the heart of health care are face-to-face interactions between health professionals and their patients and families. That is what makes it the ultimate “bricks and mortar” industry.
Health care continues to be defined by visits to hospitals and doctors’ offices and now, increasingly, by time spent waiting in hallways. Answering health care’s challenges in the 21st century will not be achieved by having more 20th century doctor’s offices and hospitals. It will come from modernizing our system through the use of new digital tools and integrating them into the day-to-day work of caring for patients.
In our C.D. Howe Institute paper, “Modernizing Canada’s Healthcare System Through the Virtualization of Services,” we discuss how to practically modernize our system to meet the needs of today’s patients and their families. Virtual care is not a distant future: The technology is already here, or soon-to-be. What we need is a sensible policy framework for virtual care, to provide opportunities for a thriving community of Canadian digital companies to expand, while helping support doctors and nurses better care for patients. The infrastructure needed to make this happen is not bricks and mortar, but software and connectivity.
Our public system has had difficulty embracing modernization. Many valiant efforts have been made to drag health care delivery into the 21st century, but progress has been slow. The problem is not with the technology – other industries such as the banking industry have made the digital leap. The barriers to health system modernization are outdated regulations and policies, and the needs of special interest groups, which affect everything from privacy to labour negotiations that impede our ability to move forward.
For example, we often insist on physical contact for care delivery and we make it difficult for physicians to be paid for e-mailing or phoning their patients for advice. As a result, patients end up waiting long hours in doctor’s offices for test results or prescription renewals that are easily communicated over the phone or made available electronically. Imagine if lawyers or bankers were not paid for their time making calls or e-mailing clients, and what impact that would have on their interactions with their clients.
Virtual care presents opportunities for a more efficient, more effective Canadian health-care system. For example, data systems in hospitals and doctors offices can be merged, to better enable machine learning and artificial intelligence to discover new ways of caring for patients. Remote home care, electronic referral systems and a suite of digital tools connecting patients and families with their care teams can improve the efficiency of our public system, and increase its capacity to manage bed shortages and wait times. These services are already a reality in many places, but are not yet ubiquitous in the current Canadian system.
Our report outlines these and other examples of virtual services, and the practical mechanisms necessary to their implementation. All patients should have access to their own health information by 2020 for them to share directly with health providers. Comprehensive reviews of all health-care services are also vital, to determine which services to virtualize and their prices. Finally, we must evaluate the rollout of virtual care to see whether it improves the patient experience and relieves health outcomes, without increasing the administrative burden on front-line health providers.
The private sector has already recognized the demand for virtual health-care services. SunLife is now offering its “my Sun Life Mobile” app to millions of Canadians with not one but three virtual primary care services, plus a directory of allied health practitioners to its customers. Other insurers and an innovative Toronto startup named LeagueLife are also moving quickly to offer virtual services. Loblaw, Walmart, Rexall, Telus and many other companies in adjacent spaces such as retail, pharmacy and telecoms have recognized that they enter the health-care space, and are now increasingly providing direct health services to patients in their homes or at retail locations.
These are positive development for consumers, but appear to be happening outside of the current publicly funded system. Without clear government direction on how to introduce virtual services into our public-health system, we are in danger of creating a two-tiered system only available to those who can pay to get out of the hallway and back into their homes.
The good news for governments is that most of this virtualization can be accomplished through straightforward policy changes without spending new dollars. We give ten practical policy recommendations in our report, such as requiring physicians to use secure e-mail, and making online bookings and e-prescriptions a standard practice of care. Making fee code changes to cover virtual services will also allow patients to receive care in ways that are most convenient for them.
These sensible policy changes should appeal to any political party who wants to help modernize and improve our overstretched health system. Because it’s 2018.