Telemedicine

Telehealth is “the use of advanced telecommunications technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers” (Reid, 1996). In recent years, the coronavirus 2019 (COVID-19) pandemic has seen a resurgence of this trend. As the government issued stay-at-home orders and hospitals put on hold any non-emergent surgeries and procedures, in-person appointments became less feasible. This led to the adoption of Telehealth solutions, which assisted Canadians to continue to access quality health care while reducing the risk of exposure to the virus.

A national poll found that almost half of Canadians have used a Telehealth service since the beginning of the pandemic (Abacus Data, 2020). The survey also found that 91% of those patients were satisfied with their experience (Abacus Data, 2020).

Virtual care offers many potential benefits. It is ideal for people who need non-emergent medical assistance without going to a walk-in clinic, hospital or doctor's office. These benefits include reduced wait times, improved clinical outcomes, cost-effectiveness, and increased service access (Kronfli, 2020). As a busy Registered Nurse, I have had to take time off of work in the past for medical appointments. However, with virtual care options, I can now attend medical appointments virtually on my lunch break.

Access to health care is also a challenge for patients in rural and remote areas who must travel to urban centres for appointments (Kronfli, 2020). In Canada, out of 13 provinces and territories, 50% of the population lives in rural areas in three of them (Jennet & Andruchuck, 2001). Canada’s size, population distribution, and varied climate challenge equitable access to healthcare services (Jennet & Andruchuck, 2001). Access to health care can also be a challenge for patients who have mobility issues, elderly, and disabilities. Virtual care can help elevate these challenges regarding access to health care. Telehealth also saves individuals and the health system money by cutting down travel costs, time off work to attend appointments, and decreasing hospitalizations (Canadian Medical Association, 2019). For practitioners, virtual care reduces clinicians’ travel time and transition time between patients (Canadian Medical Association, 2019). I have seen the benefit of Telemedicine firsthand in my workplace. The University of Ottawa Heart Institute offers a virtual care program for patients far from Ottawa. Patients can go to a designated local hospital or community centre with video-conferencing equipment, an examination camera, a digital stethoscope and a nurse in the room, allowing a full assessment to be completed remotely (UOHI, 2023). Other specialists are also available for telemedicine appointments, including physiotherapists, smoking cessation experts, prevention specialists, and rehabilitation specialists. This program allows patients to be followed for cardiac care while helping them save time and money travelling to the Heart Institute (UOHI, 2023).

Although the benefits of Telehealth in Canada are numerous, it is not without challenges. Barriers to virtual care include but are not limited to social determinants of health (age, race/ethnicities, socioeconomic status, geography, and disabilities), structural factors (interoperability, connectivity and access to technology) and systemic factors (policies, regulations and legislation of Telehealth) (Health Canada, 2021).

The main challenge found with implementing virtual care is equitable access to care. There is concern about gaps in digital literacy and access to digital devices and the internet. Patients who stand to benefit the most from Telehealth (elderly, persons with disabilities, and patients living in rural areas) are also the least able to access it (Canadian Medical Association, 2019). To help low-income households, the Government of Canada announced a 1.75$ billion investment through the Universal Broadband Fund to enhance access to high-speed internet for all Canadians by 2030 (Prime Minister of Canada, 2021). Programs such as Connected for Success by Rogers and Internet for Good by Telus also help provide affordable internet to low-income households (Health Canada, 2021). New Brunswick, Saskatchewan and Nova Scotia also plan to offer devices to older adults in nursing homes to access virtual care (Health Canada, 2021).

Digital literacy education is also imperative for healthcare providers to provide quality patient care. The Canadian Medical Association (2019) highlights the importance of virtual care education beginning in medical school and being present in ongoing professional development for health care providers. These initiatives can help alleviate some barriers to accessing Telehealth in Canada.

To summarize, the COVID-19 pandemic has pushed virtual care into Canada's forefront of primary health care. Virtual care complements our healthcare system by allowing providers to treat patients beyond the hospital. With the ongoing repercussions of the COVID-19 pandemic, such as a backlog in non-essential surgeries, a rise in chronic conditions, increasing mental health issues and Canada’s aging population, the virtual care solution can help ensure patients have access to the care that they need (Kronfli, 2020).

Abacus Data (commissioned by CMA). 2020. What Canadians Think about Virtual Health Care? https://abacusdata.ca/wpcontent/uploads/2020/06/CMA-Abacus-May-2020-Jun-4-ENv2.pdf

Canadian Medical Association. (2019). Virtual Care in Canada: Discussion paper. Retrieved from https://www.cma.ca/sites/default/files/pdf/News/Virtual_Care_discussionpaper_v2EN.pdf

Gervais, B. (2021, June 24). Cross-Canada virtual care licensure requirements and best practices. Lexology. Retrieved from https://www.lexology.com/library/detail.aspx?g=e3fd41d7-1dcd-40f1-9e2f-991e30a174f9

Government of Canada. (2020). Canada Health Act. Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html

Health Quality Ontario. (20210) Primary Care Performance in Ontario. https://www.hqontario.ca/System-Performance/Primary-Care-Performance

Health Canada. (2021, June 29). Enhancing Equitable Access to Virtual Care in Canada.

Retrieved from https://www.canada.ca/content/dam/hc-sc/documents/corporate/transparency_229055456/health-agreements/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19/template-ett-report-docx-eng.pdf

House, A., Roberts, J. (1977). Telemedicine in Canada. CMAJ 117(4) 386-8

Jennet, P.A., Andruchuck, K. (2001). Telehealth: ‘real life’ implementation issues. Computer Methods and Programs in Biomedicine. 64(3) 169-174 https://doi.org/10.1016/S0169-2607(00)00136-X

Kronfli, C. (2020). Realizing the Full Potential of Virtual Care in Ontario. Ontario Chamber of Commerce. Retrieved from https://occ.ca/wp-content/uploads/COVID19-Policy-Brief-Virtual-Care-final.pdf

Prime Minister of Canada. 2020. Connecting all Canadians to high-speed Internet. https://pm.gc.ca/en/news/newsreleases/2020/11/09/connecting-all-canadians-high-speed-internet

Reid, J. (1996). A telemedicine primer: Understanding the issues. Artcraft, Billings MT

University of Ottawa Heart Institute (UOHI). 2023. Cardiac Virtual Care Program. Retrieved from https://www.ottawaheart.ca/patients-visitors/clinics-and-programs/cardiac-virtual-care-program

Virtual Task Force Report. (2020). Virtual Care Recommendations for scaling up virtual medical services. Retrieved from https://www.cma.ca/sites/default/files/pdf/virtual-care/ReportoftheVirtualCareTaskForce.pdf