Canada was one of the first nations to offer virtual care in the 1970s. The late Dr. Maxwell House conducted appointments via telephone to expand his reach to patients in remote areas across Newfoundland. Despite Dr. House’s innovative efforts just under four decades ago, many patients are still required to travel to see their doctors in Canada. The infrastructure to care for Canadians through modalities other than face-to-face appointments in a physician’s office, such as tele-medicine, is not new; the technology required to facilitate virtual health care has existed for decades. Despite the presence of available technology, widespread adoption of virtual health care systems has not occurred in Canada. While most Canadians view virtual health care as a viable option, the three main obstacles to widespread virtual health care adoption in Canada are:
- Lack of Country-wide Coverage and Payment Options for Physicians – The Canada Medical Act, passed in 1912, created the Medical Council of Canada for the purpose of establishing a pan-Canadian standard for portable eligibility of licensure. It exclusively covers emergency care for individuals temporarily outside their home jurisdiction, and any other care requires prior approval to be covered by insurance. This legislation makes it challenging for physicians to provide patient care, and to receive payment. There is a limited number of physician payment models in Canada; as a result, virtual care is growing faster in the private non-insured sector (outside of provincial medical care plans).
- Physician Licensing Inconsistencies – Depending on the province or territory, physicians may have different requirements to provide virtual care to patients. For example, Saskatchewan offers a specific telemedicine licence and New Brunswick permits physicians from other jurisdictions to provide telemedicine services through a telemedicine regulation. However, British Columbia, Ontario, Nova Scotia and Newfoundland do not require physicians to be licensed in their province or territory to provide virtual care. In a recent survey on virtual care in Canada, 91% of Canadian physicians supported creating a pan-Canadian to practice in any Canadian province or territory.
- Lack of Interoperability – There are currently data-related challenges to virtual care, including sending and receiving referrals, exchanging information with clinicians and sharing information with pharmacies. In a report from the Canadian Medical Agency (CMA) on virtual care, there are several recommendations to create a pan-Canadian information architecture to uphold consistent interoperability standards for virtual care, including a framework to exchange information, a technical architecture, a patient/provider registry network and a portable method for health informatics legislation and policy.
While these obstacles to adoption of virtual care in Canada might seem too big to solve in a short period of time, other countries have built models which can become a guiding light for providers in Canada. In a discussion paper published by the CMA in August 2019, several countries have created and launched country-wide digital strategies:
- England unveiled their long-term health care plan, National Health Service, in 2018 with the goal that every patient will have a digital option for primary care within five years along with a comprehensive digital transformation strategy.
- The Kaiser Permanente system, with over 12 million health plan members in the United States, reported that half of all interactions between patients and health care teams were virtual in 2017; interactions included telephone calls (50%), secure messages (40%), scheduled telephone visits (10%) and video visits (0.2%).
- France launched Ma Santé 2022 in 2018; Ma Santé 2022 is a comprehensive strategy to clearly define digital governance, the interoperability of health information systems and advocate for a broader range of digital health services, such as telemedicine, across the country.
- Australia’s digital health strategy was released in 2018 with a focus on the importance of using digital information and technology to improve the quality of care, prevent adverse drug events, increase vaccination rates and provide care accessibility for people living in rural and remote areas.
Learning from other digital health economies, Canada is slowly paving the path forward for connected healthcare solution. New virtual care technical solutions, such as Microsoft Teams, have helped hospitals, physicians, health care administrators and many more share information, collaborate and facilitate virtual patient appointments.
Many Canadian physicians have made a concerted effort to care for patients in a “virtual first” manner due to COVID-19. While the current global pandemic has accelerated virtual care delivery, it occurred at a slower pace than the United States, the United Kingdom and several other European countries. “We’re basically witnessing 10 years of change in one week,” said Dr. Sam Wessely, a general practitioner in London during a recent interview with the New York Times. “It used to be that 95 percent of patient contact was face-to-face: You go to see your doctor, as it has been for decades, centuries. But that has changed completely.”
In May 2020, Canada’s Prime Minister, Justin Trudeau, invested $240.5 million to create, enhance and deploy virtual care and mental health tools. In collaboration with Canadian provinces, territories and stakeholders, these funds have been allocated to create digital platforms and applications, improve access to virtual mental health supports and make it possible for Canadians to meet with their regular health providers and specialist health services through telephone, text or videoconferencing. Virtual care funding at the provincial level, including an investment of $14.5 million by Ontario in December 2020, is an encouraging sign that Canada is committed to making virtual care the health care of the present and the future.