Virtual care has been defined as any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies with the aim of facilitating or maximizing the quality and effectiveness of patient care.
Canada was an early pioneer in the development of virtual care through the work of the late Dr. Maxwell House of Memorial University of Newfoundland in the 1970s; he used telephone technology to provide virtual consultations to remote sites throughout the province. Canada has since been surpassed by other countries in the uptake of virtual care. For example, in April 2019 it was reported that 14% of the almost 23 million general practice appointments in England were conducted on the telephone and 0.5% were conducted by video conference. In the United States (US) the Kaiser Permanente system, which covers 12 million health plan members, is perhaps the world leader. It has reported that in 2017 approximately one-half of all “touches” between patients and health care teams were virtual. Of the 85.5 million virtual contacts, the most frequent were phone calls (50%), followed by secure messages (40%), scheduled phone visits (10%) and video visits (0.2%). Elsewhere in the US, health care systems such as Intermountain and Mercy are creating virtual hospitals through extensive use of telehealth technology.
Understanding the barriers to virtual care
There are three main barriers to the widespread uptake of virtual care in Canada:
- governance of compensation mechanisms with respect to insured services within provincial/territorial (PT) boundaries and portability of coverage across PT boundaries;
- licensure restrictions on the provision of care cross-PT boundaries that are a legacy of the 1867 British North America Act; and
- lack of interoperability/connectivity between and among patients, physicians and health facilities.
In addition to the above listed barriers, education and training for virtual care − incorporating virtual care in the medical curriculum and in continuing professional development − is another key area that needs further review.
The Virtual Care Task Force
The Canadian Medical Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have struck a Virtual Care Task Force with the participation of other national medical associations and patients. Their mandate is to develop recommendations to address the issues described above with a view to increasing the adoption of virtual care across Canada.
Your contributions to these discussions will help inform the task force’s recommendations. Thank you for your participation.