Widespread access to high-speed Internet has enabled many Canadians to connect with the most important aspects of their lives online - whether it’s through social media, online banking, ecommerce, or global news. However, the Canadian healthcare system remains disconnected as virtual approaches to healthcare are underutilized or unavailable. In fact, the Canadian Medical Association reported that only 1% of Canadians were using virtual healthcare in 2019. Overall, the uptake of virtual healthcare has been slow due to issues with privacy, regulation, and reimbursement. However, the COVID-19 pandemic is rapidly accelerating the rise of virtual approaches to care as providers seek alternative ways to provide quality care while adhering to physical distancing measures and mitigating clinical and hospital overwhelm. This unprecedented crisis has highlighted the incredible capabilities of our healthcare system and the unwavering commitment and competency of our healthcare workers. However, it is also underscoring the need to address issues of access to care, hospital/clinical capacity, and patient-centred care. Virtual healthcare approaches present an exciting and timely opportunity to address these issues and strengthen our health systems.
Prioritizing the adoption of virtualized approaches to care has the potential to drive value through increased access to care, enhanced patient experience, and reduced burden on healthcare systems in Canada. For example, video visits or asynchronous messaging expands clinician access for remote areas. Many rural and remote communities in Canada experience poorer access to healthcare services and shortages of healthcare providers. The lack of access to primary care providers in rural areas can be associated with health disparities, including higher rates of smoking and obesity. Furthermore, the inability to take time off from work can delay care. A survey of American employees shows 9 in 10 people would cancel or reschedule a preventative appointment due to job pressure. By eliminating the need to travel to in-person appointments, we can increase access to healthcare, increase access to specialists, and improve patient experience. Moreover, implementing virtual healthcare in chronic disease management can increase cost savings due to improved clinical outcomes and reduced unnecessary emergency department visits.
Demonstrating the value of embracing technology in healthcare is the Ontario Telemedicine Network (OTN), which delivers virtual care to maximize and modernize consumer access to care while reducing pressure on hospitals. From 2018 to 2019, OTN reported over 1 million clinical video visits. Part of OTN is Telehomecare - a remote care management program offered to patients with chronic obstructive pulmonary disease and congestive heart failure. Through Telehomecare, patients can monitor their vitals at home and answer daily questions about their conditions from a tablet while trained nurses monitor results and provide weekly telephone coaching. By receiving care at home, patients are empowered and supported to be an active participant in the management of their condition. In 2018, Telehomecare successfully reduced unnecessary hospital admissions and emergency department visits; with 9 Local Health Integration networks and 3372 patients enrolled, 3 001 emergency department visits and 2 792 hospital admissions were avoided. The program successfully enhanced patient experience as 91% of patients reported an improved quality of life and 93% of patients felt participation enabled better management of their conditions. One patient reported, this is an absolutely amazing program! I highly recommend it. My mom is a CHF patient and I am her primary caregiver. We have completed this program. It has helped us to achieve 3 years of no hospitalizations for her! An absolute miracle considering her history.” Other virtual care solutions delivered by OTN include retinal screening for diabetes, indigenous services, specialist services, and palliative care.
The outcomes observed in other countries further demonstrate the potential impact of integrating virtual healthcare in health systems. Internationally, Australia provides a good example of the financial value and opportunity of virtual approaches to healthcare. A 12-month telehealth chronic disease self-management trial provided patients with devices for remotely communicating with clinicians and monitoring vital signs. Compared to the predicted costs associated with traditional care, the use of telemedicine resulted in $648 or 24% savings in healthcare expenses for each patient involved in the trial over one year. The savings can be attributed to reduced frequency and cost of general practitioner visits, specialist visits, and medical procedures. Specifically, a 53% decline in hospital admissions and 76% reduction in length of hospital stay for those enrolled in the trial were measured.
Aside from this potential to save on costs and alleviate financial burden on a healthcare system, patients enrolled in the trial program were also 40% less likely to die compared to patients receiving conventional care and reported improvements in anxiety, depression, quality of life, and understanding of their chronic conditions. With an aging population and rise of chronic disease in Ontario, these outcomes highlight the unique and valuable benefits of embracing virtual healthcare approaches. The need to expand capacity and access for seniors and those with underlying health conditions has also never been more urgent given the ongoing COVID-19 pandemic. Last month, new billing codes were created to compensate virtual visits, however the current government computer system will be unable to accommodate these codes until June or July. A recent survey by the Ontario Medical Association reports that nearly half of all primary-care clinics in Ontario are currently at risk of closing if the provincial government is unable to immediately pay physicians for their virtual appointments with patients. At the best of times this presents an unacceptable and preventable problem. But during a pandemic, a delay in expanding our health system’s capacity or hindering the ability of doctors to treat and “see” patients could be fatal for some.
Led by Doug Ford, the Progressive Conservative Party ran (and won) on an ambitious platform that included reducing hospital wait time and ending hallway healthcare. And speaking to the launch of Ontario Health, Minister of Health Christine Elliot said that with a “new health agency with one strategy and one set of priorities, the province is able to leverage the best practices and combine expertise from all the health agencies and now Ontario Telemedicine Network”. However, in May 2019 they revealed a $70 million cut to eHealth Ontario which funds digital health programs and a $52 million cut in funding for health policy and research. We are now seeing more clearly than ever the need to increase access to care, improve efficiency, reduce costs, and enhance patient experience in Ontario’s healthcare system. So we must ask ourselves and our politicians: why are funding decisions being made that directly undermine the ability of healthcare professionals, health system planners, and patients to embrace technology and approaches that would address, at least in part, all of these issues?
Vivian is a fourth-year student at Western University working towards an Honours Specialization in Interdisciplinary Medical Sciences. She has a keen interest in public health and promoting health equity.
Andrea is a Research Assistant with the International Centre for Health Innovation. She is passionate about knowledge translation and bridging the gap between academia and industry.