In the land of universal health care, the idea of telemedicine is as much about cultural change as it is about innovation and cost savings. Are Canadians ready to break new ground?
As a Canadian who grew up under universal health care, I have never had to pay a dime for medical treatment. Anytime I get sick, or want a test, I simply call my family doctor, book an appointment, present my health card (like a winning lottery ticket in my opinion) and voila, as we say here. I get everything I want without paying a cent.
The same goes for emergency medicine. If I start vomiting or have heart palpitations, I head to the nearest hospital emergency room where I am treated … for free.
Never mind I might have to wait 12 hours to be seen in the ER, or spend two weeks waiting to see my family doctor and even longer to see a specialist. Some Canadians wait months to see a specialist and even longer for surgery.
Patience is a virtue in Canada
Seven years ago, I was facing surgery for a female problem and it took two years from the time I first complained to my family doctor to the day I finally had my surgery. Everything went swimmingly well and I returned home victorious and tumor-free. Except if the problem happens again, I have no way of contacting the same surgeon I had before. I am not allowed to see him without a referral. I have to go back to my family doctor, get a referral and on and on and on. And if he is not seeing new patients anymore because his waiting list is too long, I get referred to whoever is available and the cycle repeats itself.
Universal health care is broken
No one will disagree that the universal health care system in Canada has served our country well but it is undoubtedly broken. It costs too much, doctors are overworked and underpaid, waiting lists are ridiculously long and patients are paying the price, sometimes with their lives.
And yes there is abuse. Many folks run to the doctor for a hangnail and the system pays. But there have been horror stories of patients dying on stretchers in hospital hallways because no one noticed them or there was nowhere to put them because the place was overflowing.
Think tanks across this great nation of ours are espousing the virtues of innovation, an immediate overhaul of the Canadian health care system and perhaps even a two-tiered system where the rich pay out of their pockets and the poor continue to receive government-subsidized care.
Telemedicine to the rescue?
Digital health and telemedicine hold tremendous promise for the future of health care in Canada, especially in a country as geographically diverse as ours. As the second largest country in area in the world with a fraction of the population of our neighbours to the south, our health care treatment is sometimes based purely on access or geographical limitations.
You can drive or fly thousands and thousands of kilometres in Canada without seeing a soul and then suddenly, in the middle of absolutely nowhere, you see settlements of a few hundred people.
Where is the nearest doctor or emergency room? In many cases, it is fly-in physicians or nurse practitioners who visit these remote areas once a year (if that), complemented by nurse practitioners on the ground who visit more regularly within a shorter distance as part of their practice.
The Canadian experience so far
Telehealth services are currently available in every province and territory in Canada, linking health care professionals with patients via methods such as videoconferencing to give patients greater access to care
Whether these telehealth services are delivered by hospital centres or smaller health regions with smaller staff, the benefits for patients and health care providers are similar in that they provide patients with greater access to specialized care, reduce travel times and reduce wait times.
In a 2011 study commissioned by Canada Health Infoway, nearly 260,000 telehealth events were recorded in Canada in 2010. Several jurisdictions reported 187,385 clinical events, 44,600 educational events and 27,538 administrative events. In addition, nearly 2,500 patients received telehomecare.
Electronic health records
Imagine if health care professionals never had to set foot on the frozen tundra to check up on their patients. Imagine if they could Skype or Face Time with their patients instead. Imagine if the health records of people living in these remote communities could be transmitted digitally to the nearest clinic, health center or hospital and the patients could be treated as quickly as possible, transported by public dollars, treated and sent on their way.
Are Canadians ready for this?
Although the numbers from Canada Health Infoway are extremely promising, I doubt the average Canadian is aware of this achievement or the growing trend at large. Canadians may be confused to hear these numbers because telemedicine is certainly not part of our everyday interaction with our physicians.
Is our country ready for telemedicine? Are physicians ready? Are patients ready?
From my view, doctors are not entrepreneurs in this country so even if they decided to embrace telemedicine or virtual visits in a grander way (because it is the right thing to do and their patients are demanding it), it is their government masters, not their patients, who would have to reimburse them for doing it. That is if the province or territory where they practice approves of it, if the necessary infrastructure is in place and if it pays to do it. Never mind what the patient wants. Is this patient-centered health care?
Yes and no
It is true that some provinces (health care is a provincial and territorial responsibility in Canada funded centrally by the federal government) have begun to embrace telemedicine as a way of reaching patients faster and in more remote locations. Plus, industry has begun to be recognized for its early adoption of digital health and telemedicine as a possible solution.
The Canada Health Infoway recently announced four national innovation awards for leaders in e-Visits, e-Request for Prescriptions Renewals or Refills, e-Reports of Services and e-Request of Services. The Infoway reports Canadians and individual clinical teams have used digital health solutions some 50 million times over the past year.
Telemedicine and digital health, however, are by no means the status quo. There is much work to do before that ever happens. But these recent awards point to a difference in mind-set, a new breed of health care practitioners who see the value in it all.
Culture change necessary
No one likes change, especially Canadians. We are a conservative lot, far less entrepreneurial and outspoken than our American friends. And certainly where health care is concerned, we tend to default to feeling like we have no power. We are reactive instead of proactive.
I am facing another potential surgery, only this time it is for an existing thyroid problem. I did something the other night that I actually thought was against the rules. I surfed for the name of a specialist who could perform the surgery I need through minimally invasive means and I actually e-mailed him directly. I was surprised to see his e-mail listed on the university website where he teaches.
Low and behold, the next day I actually got a response from him inviting me to contact his office for information about his waiting list. All I would have to do, he said, is get a referral from my family doctor and I could see him—no problem. He practices in Montreal, two hours away from where I live.
I was shocked. I was shocked that he answered my e-mail and that we actually exchanged a few subsequent e-mails. I thought for sure he would tell me some law prevented him from dealing with patients directly. It was like driving solo for the first time. I felt kind of free and grown up.
American take-away messages
Canadians and Americans are both grappling with how to pay for health care in an affordable, more equitable way that keeps everyone happy.
As we struggle to find a balance between universal and private health care, digital health solutions such as telemedicine do offer at least a glimpse into a more promising future—and how breaking down barriers, challenging the status quo and leveraging technology to save money and create new paradigms is really at the center of it all—regardless of which side of the political fence (or border) you are on.
The nuviun industry network is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.