One very big silver lining to 2020 was the dramatic uptake in the use of virtual health care in Canada. During the first wave of the pandemic over 70 per cent of outpatient care was delivered virtually. Before COVID-19, speaking to a family doctor about a new health problem, simply getting a prescription renewal or having a visit with a specialist required most Canadians to take time off work, travel to their local clinic or hospital and sit in a waiting room for upwards of an hour or more. But now doctors can bill for virtual visits and Canadians can receive medical care from the comfort of their own home.
As the second wave crests, and hospitals are once again filling up with COVID patients, providing care to other patients while keeping them safe and out of our hospitals and clinics is critical. Our recently published C.D. Howe policy paper, “Canada’s Virtual Care Revolution: A Framework for Success,” outlines a roadmap to making virtual care an integral part of the health system, now and into the future.
There have always been costs to in-person care, but they have traditionally been borne primarily by patients, not by providers or the health system. Patients lost wages and had to pay for travel and parking. These costs were a minor nuisance for some, but a serious impediment for others. For providers, the COVID pandemic created significant costs to physical contact, including the risk of viral transmission, increased use of personal protective equipment (PPE), quarantine and isolation time, serious worry and, in some cases, bouts of COVID itself for themselves and their families.
In the pandemic’s first days, governments wisely liberalized billing codes so physicians could bill video and phone visits using existing infrastructure. Rapid virtualization of care followed, ensuring patients suffering from such chronic diseases as diabetes, mental illness and heart disease could receive regular care with reduced infection risk, to patients and providers alike.
As the first deliveries of COVID vaccines allow us to begin thinking about a return to a more normal life it’s not yet clear whether advances in virtual care will be sustained. We believe virtual care should stay, and should become a central pillar of a new health delivery system that ensures all Canadians get the right care at the right time. The fundamental redesign of health-care delivery that we would like to see starts with three simple questions: Is this service really necessary? Can it be delivered virtually? And where is the right place for in-person contact?https://financialpost.com/opinion/opinion-keep-the-virtual-health-care-revolution-going
“Is this service really necessary?” speaks to the issue of medical appropriateness, which took on greater importance during the pandemic, when both patients and providers weighed the benefit of treatment against the risk of infection. In some cases, both sides may agree that no treatment is really required. Routine pre-operative testing before low-risk surgeries, like cataract operations, is a good example of a service that could just be done away with.
“Can it be delivered virtually?” is about more than simply Zoom. The video and telephone visits with providers that Canadians have grown used to since last spring could be expanded to include asynchronous messaging like email, remote monitoring of patients using such wearable devices as the Apple Watch, or online mental health counselling. Before COVID, many Canadians felt they had no choice but to incur the personal costs of visiting their health-care provider. Now that they know such costs really aren’t necessary, they may well insist — and in our view they should — on virtual service.
As to the “right place for in-person contact,” even if a health service really does need to be delivered in person, a hospital or clinic isn’t necessarily the best place for meeting. Home-based therapies, for example, delivered by homecare nurses and connected to the broader care team digitally, could be promising ways to manage patients with such chronic diseases as heart failure.
A modern health-care system underpinned by virtual care will require a modern policy framework for it to be sustainable. Virtual care is care and needs to be treated as such. Virtual care models should be safe and clinically effective, and the impact on costs and outcomes should be both measurable and in fact measured. Compensation structures will have to include the full suite of virtual care tools, including both real-time virtual visits and email or text communications. Finally, we will need to take a common-sense approach to health information that balances privacy and health care needs.
The COVID pandemic has forced a once-in-a-generation innovation on the health-care sector. Sustaining and advancing our gains in virtual care post-vaccine will be crucial to building the patient-centred health-care system all Canadians want.
R. Sacha Bhatia is the chief medical innovation officer, Women’s College Hospital, Toronto, where William Falk is an innovation fellow. He is also a senior fellow at the C.D. Howe Institute and an adjunct professor at the Rotman School of Management, University of Toronto.