Are changes coming to telemedicine after pandemic growing pains?

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The pandemic accelerated the growth of telemedicine in Canada, breaking down barriers to accessibility, but experts question the ongoing level of demand for these services post-COVID-19 and want the industry to be more tightly regulated.

Telemedicine broadly refers to any type of health care delivered virtually, whether it’s through video, phone calls or texts. The industry can be further broken down between public-sector platforms, which connect patients to their family physicians, and private-sector platforms, which connect patients to a practitioner or a private clinic for a one-time or annual membership fee.

The rapid growth of the telemedicine industry has largely been driven by the private sector, with companies such as Toronto-based Maple Corp. seeing a tripling of visit volumes in the span of several days last March, says co-founder and chief executive officer Brett Belchetz.

But the sudden adoption of telemedicine in Canadian health care has also meant the sector is saturated with technology startups that may struggle to stay afloat after the pandemic.

“Is there really a material difference between two telemedicine platforms if they’re just providing that simple [doctor’s] visit? Probably not,” says Sachin Aggarwal, CEO of Toronto-based digital health company Think Research.

“What’s going to differentiate these companies in the future is going to be if they’re able to provide some of the more complex workflows that the health care system is going to demand.”

Many Canadian telemedicine companies are already starting to branch out and provide niche services, such as Think Research’s long-term-care products that help support facility staff by guiding them through common care and health conditions. But the development of telemedicine technology has outpaced government regulations, leaving both the public and private sectors struggling to find equilibrium in the industry.

“This type of platform straddles a very thin line between consumer technology and medical technology,” says Plinio Morita, assistant professor in the School of Public Health Sciences at the University of Waterloo.

Mr. Morita said while this adds to the difficulty in regulating telemedicine companies, it is necessary to develop a “stronger regulation ecosystem,” particularly on the privacy front given that the industry grew so quickly and it’s not always clear if companies are meeting all privacy requirements.

Currently, since health care is a provincial responsibility, each province or territory regulates telemedicine differently. On the privacy side, telemedicine providers need to abide by each province’s personal health information legislation. Some of the major concerns about privacy relate to how secure networks are, and how information is collected and who it is shared with.

Inderveer Mahal, a family physician in Vancouver’s Downtown Eastside and a member of Doctors of B.C.’s Council on Health Economics and Policy, agrees that more government involvement is necessary, particularly to encourage collaboration between the public and private sectors. “Whether it was intentional or unintentional, I think they are developing in silos,” she says.

While virtual care can provide the tools to break down barriers to accessibility, Dr. Mahal says this is only possible if technology is “tailored” to specific populations, which is not what she is seeing.

“When we’re talking about developing virtual care, we need to do it in the context of our existing infrastructure with the existing relationships, and not just hand it off” to private corporations, says Dr. Mahal. “We actually need buy-in from provincial and federal governments.”

For Dr. Belchetz, the view from the private sector is similar. “One of the things that I’m really hoping will happen over the coming years is that the government will start to understand that telemedicine, to do it well, requires expensive infrastructure.”

While he said the provincial governments have “stepped up to the plate” in instituting billing codes that allow physicians to bill and get paid for virtual care services they provide to patients – which means patients won’t have to pay out of pocket for the care – there is still not enough government funding for the platforms themselves.

Because of Canada’s fragmented health care system, telemedicine adoption and funding has looked different across each jurisdiction. The Yukon government, for instance, worked with the Yukon Medical Association to use the online platform doxy.me, while Ontario gave physicians freedom in choosing which companies or platforms they used to provide telemedicine services. On the funding front, last December, Ontario announced it would invest $14.5-million in virtual care.

Governments need to support more flexibility in billing to push the industry forward, says Ali Mohamed, the founder of the Telemedicine Association of Canada and the co-founder and CEO of Lyte Medical, a telemedicine provider. Looking ahead to a post-pandemic future, experts agree that telemedicine is here to stay, though in what form and how popular it will be remains to be seen.

A Canadian Medical Association poll done last May shows the majority of Canadians are satisfied with virtual care and would like to continue to have that option, although 62 per cent of those polled still preferred an in-person visit with their physician.

Aside from convenience, Mr. Morita and Dr. Mahal both say a hybrid model is especially necessary for patients from vulnerable populations.

Mr. Morita pointed out that people in an abusive relationship, for example, may not be comfortable accessing health care from home and therefore a clinic visit would be safer. Similarly, while Dr. Mahal finds that telemedicine is beneficial in meeting precariously housed patients where they are, for people dealing with trauma it’s much easier to build a connection and offer support in person.

As a patient herself, Dr. Mahal says she wishes that these telemedicine technologies were available to her own specialists.

“They know my history, they know my background, I trust them. There’s a relationship there that’s developed that you can’t replicate.”

For Mr. Morita, he is “100 per cent sure that by the time the pandemic is over, we’re not going to have the same level of demand that we have for these technologies right now.”

Mr. Mohamed is more optimistic about the industry’s future. “I think that we’re just scratching the surface when it comes to the technology side. Telemedicine is still in its infancy.”