On March 7, 2023, the Sandra Rotman Centre for Health Sector Strategy at U of T hosted a panel titled “Digital Health and Primary Care.” The panel focused on how primary care delivery is evolving in Canada and around the world due to the implementation of virtual health.
A lack of human resources
Dr. Payal Agarwal, a family physician at Women’s College Hospital (WCH) and Innovation Fellow at the WCH Institute for Health System Solutions and Virtual Care was the first panellist. She explained that a significant challenge in primary care is the lack of human resources, which can be mainly attributed to burnout as a result of poor systems in place. Digital systems are becoming essential, as two million people in Ontario do not have primary care providers, and digital solutions could address that deficit.
Primary care consists of three key elements: access, teams, and relationships — all of which technology is capable of facilitating and enhancing. To solve a number of issues faced by the health-care system, Agarwal suggested implementing ongoing multi-modal communication between care providers and patients. She stressed the importance of making the patient an active member involved in their care and comfortable with their health record. She also stressed the importance of moving toward teams and removing workload of primary care providers to improve efficiency. Finally, she stated that while it is important to invest in new technology, it is as important to invest in the infrastructure for success.
Enabling access to health care
The second panellist was Dr. Jonathan Fitzsimon, a family physician and the medical lead for the Renfrew County Virtual Triage and Assessment Centre and the Renfrew County Integrated Virtual Care. Renfrew County, explained Dr. Fitzsimon, is the largest county in Ontario and consists of a population that is older, at a socioeconomic disadvantage, and has a higher rate on average of chronic disease. There is also double the average number of individuals without a family doctor, and the county lacks walk-in clinics and urgent care centers, evidently resulting in a heavy reliance on emergency departments. It was the COVID-19 pandemic that forced change, as they could no longer use one single center to diagnose and care for patients.
To solve this issue without massive infrastructure upheaval, Fitzsimon presented a new model for primary care departments that takes advantage of digital solutions. The model showed how, first, patients would call the Renfrew County Virtual Triage and Medical Center, where they would speak to a receptionist and undergo triage, followed by registration and an appointment booking. Patients would then have a clinician assessment that might lead to treatment, escalation, or transfer to emergency departments.
The county decided to take this further in order to reduce isolation within their population by offering virtual care, including appointments by video chat. It was this hybrid project that has combined virtual with in person care, the collaboration between family doctors and paramedics and in the clinic versus at home, reducing the issues surrounding access. This hybrid project benefitted nearly 2,500 patients, providing preventative care to patients who never had the opportunity before.
Zayna Khayat, the third panellist, is the vice president at Teladoc Health and a health futurist at Deloitte Canada. While the main element of primary care in Canada is diagnostics and treatment, she argued that there should also be a focus on prevention, referrals and coordinating follow ups, and monitoring once you have been diagnosed and treated. A virtual model implemented by some practices in the United States focuses on all four elements of primary care to decrease the need for diagnostics and treatment.
She subsequently spoke on how the referrals system in the UK’s National Health Service (NHS) has improved. Through connecting general practitioners directly with specialists, they are able to communicate quickly before referring a patient that might not even need to see that specialist. This has improved the workload of specialists, as they are only getting patients referred that they are actually qualified to treat or that they can actually help.
By focusing on individuals who have low access to health care, Khayat believes we can learn more about the inefficiencies in our current systems. The advantage to trying to solve the issue of individuals who have no access to health care is that it is a fresh start where program implementation is concerned, and there aren’t any old behaviours that need to be unlearned or problems that need to be rectified.
Finally, Micheline Wiebe, the Chief Virtual Health Officer for the British Columbia Health Services Authority, spoke about the situation in British Columbia (BC) in terms of virtual health care. One of the biggest challenges to healthcare access in BC is the landscape, with mountains and oceans isolating communities from primary care centers. During the pandemic, the number of virtual health-care appointments rose from 62,000 in 2019 to 13.2 million.
Real-time virtual support pathways
Wiebe also discussed a major digital health initiative being carried out in BC: Emergency Health Services, which offers virtual services such as check-ins, visits with care providers, and help for patients to take care of themselves. Another example is Real-Time Virtual Support Pathways, which was facilitated by the rural coordination center of BC. This initiative focuses on reaching out to communities and continuously offering support to rural healthcare providers, instead of relying on more traditional models where rural communities reach out to urbanized health care facilities when needed. It provides support to rural health care providers, creates good collaboration between the virtual providers in urban or regional areas with the rural care providers, and is offered in all the specialty services. This has reduced isolation and enhanced retention in the rural community in BC.
It was incredibly insightful to learn about what solutions are being implemented to change the structural issues of virtual health care. It is motivating to see how these programs have not only improved access to virtual health care, but health care in general in terms of prevention, access to healthcare, and empowering physicians in isolated areas.