The pandemic exploded the number of virtual health visits in Canada by 5,600 percent, according to a recent ICES study. And in another study, 91 percent of Canadians said they were satisfied with their virtual health care experience and would seek virtual care again. However, there are challenges behind the scenes, both in how virtual care is delivered and managing virtual care in a wider context of stakeholders and patient needs.
In a recent BetaKit Live, Chris Engst, Director, TELUS Health MyCare, Dr. Khush Amaria, Senior Clinical Director, MindBeacon, and Jeffrey Kadanoff, Managing Director, Esplanade Ventures discussed the challenges facing virtual care and how it can potentially extend care access to the five million Canadians who currently don’t have a family physician.
The four stakeholders of virtual care
While the pandemic brought virtual care into the spotlight, Engst was very clear that virtual care is not new.
“In many jurisdictions, virtual care has been around for many years,” he added.
That said, the healthcare system was primarily based on in-person care until the pandemic, but things changed “out of necessity” to a majority virtual care system.
The sudden shift to virtual care also highlighted how the four different types of stakeholders needed that Engst said need to be considered:
The patient: Engst noted that it’s “one of the more exciting times” for patients, as virtual care technologies in 2021 are much more smooth and functional than the “clunky” technology of previous generations.
The provider: Healthcare providers want to deliver great outcomes for patients, but they are also very busy, said Engst (and perhaps a little particular). With that in mind, virtual care tools need to “enable them, not inhibit them.”
The payer: In Canada, the government is the primary payer of healthcare services. But in many provinces, virtual care was not counted as a billable service pre-pandemic. While all provinces made emergency changes if virtual visits weren’t already approved as billable services, the pandemic highlighted how existing pay structures need to shift for virtual care to thrive.
The regulators and advisors: Like other forms of care, organizations like the Colleges of Nurses and Physicians assess virtual care not just for how effective it is, but also how the technologies used can be securely integrated into existing systems to ensure patient safety and confidentiality.
In order to become a key pillar in the future of healthcare, virtual care innovators need to appease all four stakeholders. For example, Dr. Amaria said that “clinicians are in the business of providing good clinical care,” but are not tech-savvy. That means any virtual care solutions must be simple and easy to use for clinicians, or face serious adoption problems. Similarly, Engst highlighted that because the “EMR is the single source of truth” for doctors, the need for data interoperability and tight integrations are crucial for both patient care and regulatory compliance.
A call for continued innovation
While there are four stakeholders in the healthcare world, innovators and solution builders likely need to contend with one additional stakeholder: investors. Building a healthtech business often requires significant investment upfront to navigate not just the technical complexity of building a solution but also the regulatory hurdles that take time and resources to manage.
For Kadanoff, the bar to innovate in the healthcare space is getting higher. He said he wants to see startups clearly thinking about attacking multiple markets, particularly the United States, and he expects to see innovations that help tackle inherent challenges with virtual care, not just facilitate a video chat with doctors. For example, Kadanoff mentioned Nonagon Care, a startup building a multi-functional piece of hardware that helps doctors remotely assess heart rate, blood oxygen levels, and lung function during virtual care visits, something that’s previously been impossible without a clinic’s medical equipment.
Innovators also need to consider how the virtual care model can be different than simply digitizing in-person care. For example, sharing the founding story of MindBeacon, Dr. Amaria noted that the company’s founder had access to a regular therapist, but didn’t feel the structure – sitting in an office once a week for an hour – truly offered the resources and care he needed. MindBeacon was born of his need for a different kind of mental health care that was readily accessible, contained self-service elements, and ongoing communication with a practitioner instead of the stop-and-start nature of clinic-based care. This isn’t to say that clinic-based care is inferior or unnecessary, just that virtual care presents an opportunity to innovate on care delivery versus only providing a digital version.
On the same note of empowering self-service, Engst explained TELUS Health’s MyCare symptom checker application. Instead of falling down a Google rabbit hole, people can check physician-verified suggestions using the MyCare symptom checker. This information can be relayed to a doctor in a virtual or in-person visit, bringing patients more into the fold of their healthcare.
Expanding healthcare access across Canada
Despite being one of the most developed nations on earth, more than five million Canadians (about 13 percent of the population) do not have access to a family doctor. Without that access, patients are reliant on walk-in clinics or emergency rooms, causing clogs and delays across our healthcare system.
Virtual care presents a massive opportunity to expand healthcare access, but there’s more to the solution than simply putting family doctors on video chat. Dr. Amaria said that virtual care innovators need to consider increasing access both in more remote communities but also in what she calls “underserved” communities. For instance, 70 percent of MindBeacon’s new users were from COVID-19 hotspots in Ontario, which represent some of the most densely populated postal codes in the country.
Dr. Amaria also cautioned against thinking that having virtual care solves all access problems, for instance, those unable to take time off work to attend appointments or who won’t access care at all due to concerns of medical discrimination.
Engst said that while the pendulum shifted toward virtual care due to the pandemic, things will balance out more as society reopens. The focal point in Canada will likely remain primary care and family doctors, but grow to include a multi-disciplinary team that acts seamlessly between the virtual and physical worlds. One day, virtual care might simply be called ‘care’.
For Kadanoff, these changes and challenges are exciting. As a venture capitalist in healthtech, he sees his role as facilitating the new innovations coming down the pipeline. And as far as he’s concerned, no hurdle is going to stop them.
“In our world, it’s full steam ahead,” said Kadanoff.