Transcript: Is Virtual Health Care Here to Stay? | May 04, 2021

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of George Drew and one of Walter Kronkite. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a blue shirt and a black tie.

A caption on screen reads "Is virtual care here to stay? @spaikin, @theagenda."

Steve says NECESSITY HAS BEEN THE MOTHER OF INVENTION THROUGHOUT THIS PANDEMIC. AND IN THE FIELD OF HEALTH CARE, THAT'S MEANT A SHIFT TO VIRTUAL MEDICINE THE LIKES OF WHICH HAD APPARENTLY BEEN IMPOSSIBLE UNTIL IT WASN'T. NOW THAT WE'VE GOT IT, WILL IT CHANGE HEALTH CARE FOREVER? LET'S ASK: IN YELLOWKNIFE, NORTHWEST TERRITORIES: DR. EWAN AFFLECK, INFORMATICIAN WITH THE COLLEGE OF PHYSICIANS AND SURGEONS OF ALBERTA AND CO-CHAIR OF THE CANADIAN MEDICAL ASSOCIATION VIRTUAL CARE TASK FORCE...

Ewan is in his fifties, clean-shaven and balding. He's wearing a gray sweater.

Steve continues IN FREDERICTON, NEW BRUNSWICK: DR. ANN COLLINS, PRESIDENT OF THE CANADIAN MEDICAL ASSOCIATION AND A FAMILY MEDICINE PRACTITIONER...

Ann is in her fifties, with chin-length blond hair and bangs. She's wearing a black blazer and a white blouse.

Steve continues AND IN LONDON, ONTARIO: DR. KEITH THOMPSON, A FAMILY PHYSICIAN, WHO ALSO TEACHES IN THE DEPARTMENT OF FAMILY MEDICINE AT WESTERN UNIVERSITY...

Keith is in his late forties, clean-shaven and bald. He's wearing a blue sweater and a white shirt.

Steve continues WE ARE GLAD TO HAVE YOU THREE WITH US ON TVO TONIGHT FROM RELATIVELY NEAR TO VERY, VERY FAR AWAY. YOU MIGHT BE OUR FIRST N.W.T. GUEST, DR. AFFLECK, SO WE'RE GOING TO PUT YOU TO WORK RIGHT AWAY. MY FIRST QUESTION IS A BIT OF A QUIRKY ONE, BUT I'VE NEVER HEARD THIS TITLE BEFORE. WHAT'S AN INFORMATICIAN?

The caption changes to "Ewan Affleck. College of Physicians and Surgeons of Alberta."

Ewan says IT'S A GOOD QUESTION. I THINK YOU'RE NOT UNUSUAL IN NOT UNDERSTANDING THE TERM. SO A HEALTH INFORMATICIAN IS ONE WHO DESIGNS HEALTH SYSTEMS FOR HEALTH CARE PURPOSES TO PROMOTE QUALITY OF CARE. SO VERY SIMPLY, STEVE, HEALTH INFORMATION IS ESSENTIAL BASICALLY TO EVERY DECISION WE MAKE IN HEALTH CARE, AND SO IF THE INTEGRITY OF THAT INFORMATION IS POORLY DESIGNED, THEN THE LIKELIHOOD OF QUALITY CARE DECREASES. SO GUYS LIKE ME HELP DO THAT.

Steve says WITH THAT IN PLACE, WHEN YOU TALK ABOUT VIRTUAL CARE, WHAT SPECIFICALLY ARE YOU REFERRING TO?

The caption changes to "Ewan Affleck, @ewan_affleck."

Ewan says AND THAT'S AGAIN AN IMPORTANT QUESTION BECAUSE WE'VE SUFFERED IN THE HEALTH INDUSTRY WITH A LACK OF CONSISTENCY OF DEFINITIONS. SO VIRTUAL CARE IS BASICALLY CARE THAT IS PROVIDED THROUGH ANY VARIETY OF TECHNOLOGIES THAT IS OVER DISTANCE. THERE'S A DISTANCE BETWEEN THE PROVIDER AND THE RECIPIENT OF CARE, THE PATIENT OR THE BENEFICIARY OF CARE. BUT IT DOESN'T HAVE TO BE TRADITIONALLY LIKE A PHYSICIAN AND A PATIENT. IT CAN BE ANY MEMBER OF A CIRCLE OF CARE, A SPEECH LANGUAGE PATHOLOGIST OR EVEN CARE-GIVERS, FAMILY MEMBERS OR OTHER PEOPLE WHO ARE IN THE PATIENT'S CIRCLE OF CARE. SO THAT'S WHAT VIRTUAL CARE IS.

Steve says APOLOGIES. WHAT HAD TO HAPPEN FOR PHYSICIANS IN THIS PROVINCE TO GET UP AND RUNNING ONLINE?

The caption changes to "Ann Collins. Canadian Medical Association. @DrAnnCollins."

Ann says UNFORTUNATELY, STEVE, IT WAS THE PANDEMIC. ONCE THE VIRUS CAME INTO OUR LIVES AND AS YOU KNOW LAST MARCH WE WERE ESSENTIALLY PUT INTO A LOCKDOWN ACROSS THE COUNTRY, PHYSICIANS AND PATIENTS COULD NO LONGER COME TOGETHER IN MANY INSTANCES IN A FACE-TO-FACE MEETING OR IN-PERSON MEETING, IN PART DUE TO PUBLIC HEALTH GUIDELINES ABOUT REDUCING THE POTENTIAL FOR TRANSMISSION OF THE VIRUS, BUT ALSO A KEY PLAYER AT THAT TIME WAS THE LACK OF ABILITY OR RESOURCING FOR CLINICIANS LIKE MYSELF IN A SOLO FAMILY PRACTICE TO BE ABLE TO ACCESS PPE.

Steve says SO ALL IT TOOK WAS A ONCE-IN-A-CENTURY GLOBAL PANDEMIC TO SORT OF URGE THE PEOPLE WHO RUN THE GOVERNMENT OF ONTARIO TO RECONSIDER THIS; IS THAT ALL?

Ann says WELL, WE KNOW THAT VIRTUAL CARE WAS AROUND LONG BEFORE THE PANDEMIC. IN FACT, SOME WOULD SAY THAT IN CANADA WE WERE LAGGING BEHIND IN HOW WE UTILIZED VIRTUAL CARE IN THE PROVISION OF CARE. BUT ABSOLUTELY THE CRITICAL TURNING POINT WAS THE ARRIVAL OF THE PANDEMIC.

Steve says DR. THOMPSON, FOR A FAMILY DOC LIKE YOU, WHAT DOES USING VIRTUAL CARE ALLOW YOU TO DO BETTER NOW THAT YOU COULDN'T DO BEFORE?

The caption changes to "Keith Thompson. Western University."

Keith says WELL, CERTAINLY THERE'S A COUPLE OF THINGS, STEVE. THE CONVENIENCE FACTOR FOR PATIENTS I THINK IS IMPORTANT AND THAT WAS A KEY THING I'VE NOTICED IN THE ENGAGEMENT. ALSO THE METHOD BY WHICH WE ENGAGE, THOSE OF US LEVERAGING OUR ELECTRONIC MEDICAL RECORDS AND HAVE SPENT TIME COLLECTING EMAILS OR MEANS OF COMMUNICATING WITH OUR PATIENTS OTHER THAN TELEPHONE OR VIDEO. I, FOR EXAMPLE, SOME OF MY COLLEAGUES HAVE BEEN ABLE TO SEND VIA AN e-mail OR TEXT A LINK TO MATERIALS, YOU KNOW, TO EDUCATE PATIENTS OR INFORM THEM, LINK IN LAB RESULTS, ET CETERA, THAT WE CAN SEND TO THE PATIENTS AND SORT OF MAKE THEM PART OF THAT PROCESS LEARNING ABOUT THEIR DISEASE, RIGHT? SO THEY'RE INCLUDED, THEY'RE COLLABORATIVE IN THEIR CARE. AND I THINK THAT'S IMPROVED WITH THE LEVERAGING OF ALL THESE TECHNOLOGIES.

Steve says SO DO I INFER FROM THAT THAT YOU'RE A BIG FAN OF THIS?

Keith says YOU KNOW, I REALLY AM. I'LL SAY, LISTEN, FOR ME AS A PRIMARY CARE AND FEE FOR SERVICE GUY, I HAVE TO SAY THE ANNOUNCEMENT OF THESE FEE CODES BY THE MINISTRY OF HEALTH WAS A LIFELINE. I COULD NOT HAVE SURVIVED. I'M ONLY PAID WHEN I SEE PATIENTS AND THAT WAS FACE TO FACE. WE WERE DOING A LITTLE OF VIDEO ENCOUNTER, BUT IT WAS CLUNKY AND WASN'T A SEAMLESS WORK FLOW. I THINK WE'RE STRUGGLING WITH THAT AND WHAT THIS IS GOING TO LOOK LIKE GOING FORWARD. I LOVE IT. THE MAJORITY OF MY PATIENTS LOVE IT. THEY'RE GRATEFUL NOT TO COME TO THE OFFICE FOR A 10-OR 15-MINUTE CHAT BY TELEPHONE. WHY CAN'T THAT BE DONE BY TEXT MESSAGE, ET CETERA.

Steve says I THINK WE HAVE EMPIRICAL INFORMATION THAT BUTTRESSES THE ARGUMENT YOU JUST MADE. THERE WAS A NATION-WIDE SURVEY OF 1800 CANADIANS LAST MAY, GOING BACK TO 2020 NOW, TWO MONTHS INTO THE PANDEMIC SHUTDOWN, AND THE QUESTION IS WHAT DO CANADIANS THINK ABOUT VIRTUAL HEALTH CARE, AND HERE'S WHAT... TONY, WHY DON'T WE PUT THESE NUMBERS UP? THANKS.

A slate appears on screen, with the title "What Canadians think about virtual health care."

Steve reads data from the slate and says
THOSE THAT CONNECTED WITH THEIR DOCTOR VIRTUALLY DURING CoVID-19 RECORDED A 91 percent SATISFACTION RATE. 46 percent WOULD PREFER A VIRTUAL METHOD AS A FIRST POINT OF CONTACT WITH THEIR DOCTOR. 45 percent BELIEVE VIRTUAL CARE COULD IMPROVE ACCESS TO SPECIALISTS. AND 41 percent BELIEVE VIRTUAL CARE COULD IMPROVE THE TIMELINESS OF TEST RESULTS. OKAY. DR. COLLINS, CLEARLY SOME ENTHUSIASM THERE ON BEHALF OF THE PEOPLE OF CANADA FOR THOSE SURVEYED. YOUR MEMBERSHIP, HAVE THEY BEEN EQUALLY AS ENTHUSIASTIC?

Ann says I WOULD SAY YES. WE KNOW THAT FROM OUR RESPONSE... FROM OUR SURVEY OF OUR MEMBERS THAT THEY HAVE SEEN PATIENT SATISFACTION AND THEY TOO ARE SATISFIED KNOWING, THOUGH, THAT THEY STILL HAVE TO BE IN MANY PARTS OF THE COUNTRY SOME IMPROVEMENTS MADE IN HOW WE USE VIRTUAL CARE AND HOW WE CAN DELIVER VIRTUAL CARE. BUT AS DR. THOMPSON ALLUDED TO, TO BE ABLE TO HAVE THAT CONTACT WITH YOUR PATIENTS IN A TIME WHEN OTHER CONTACT WAS RISKY OR JUST NOT POSSIBLE, IT'S BEEN... WE'VE SEEN HUGE UPTAKE PRIMARILY WITH PRIMARY CARE PHYSICIANS BUT IT'S ALSO BEEN INTERESTING TO SEE HOW SPECIALISTS HAVE ALSO TAPPED INTO THIS AND USED IT TO PROVIDE ACCESS FOR CONSULTATION SERVICES.

Steve says NOW, DR. AFFLECK, I PRESUME VIRTUAL CARE IS AN OPTION THAT MEANS ONE THING WHEN YOU'RE TALKING ABOUT PEOPLE WHO LIVE IN A CITY AS DENSELY POPULATED AS TORONTO, FOR EXAMPLE. BUT IN REMOTE COMMUNITIES AND THE PLACES THAT YOU SERVE IN THE NORTHWEST TERRITORIES, IS IT A WHOLE OTHER BALL OF WAX?

Ewan says YES AND NO. I MEAN, THE VALUE OF VIRTUAL CARE CERTAINLY FOR REMOTE AND PEOPLE... CANADIANS IN REMOTE AND RURAL LOCATIONS IS SELF-EVIDENT. I MEAN, THERE'S HUGE INEQUITY IN CARE FOR CERTAIN PEOPLE. THEY DO NOT HAVE ACCESS TO ALL KINDS OF SERVICES READILY IN THEIR COMMUNITIES. AND SOME OF THOSE SERVICES CAN BE VIRTUALIZED. SO THAT THE ARGUMENT IS MANIFEST THAT THERE IS VALUE IN VIRTUALIZATION OF SERVICES DESPITE THAT WE'VE... YOU KNOW, AS ANN SAID, VIRTUALIZATION HAS BEEN AROUND FOR A LONG TIME, THE TECHNOLOGIES ARE THERE, AND YET AS A NATION WE'VE BEEN QUITE SLOW TO ADOPT THIS. BUT THERE ARE ARGUMENTS VIRTUALIZATION BOTH IN URBAN AND RURAL AND REMOTE PLACES THAT ARE VERY JUST. YOU HAVE TO USE CLINICAL DISCRETION TO ESTABLISH WHEN IT IS APPROPRIATE TO USE. IT'S NOT A PANACEA. BUT THIS DIFFERS DEPENDING ON LOCATION.

Steve says WELL, LET ME FOLLOW UP WITH DR. THOMPSON ON THAT ISSUE OF HESITANCY AND WHY, FOR EXAMPLE, PROVINCIAL GOVERNMENTS HAVE BEEN RESISTANT TO BRING THIS IN. WHAT'S BEEN THE HESITATION, DO YOU THINK?

Keith says I THINK THERE COULD BE A COUPLE OF LAYERS TO THAT, STEVE. CERTAINLY ONE OF THE CONCERNS WOULD BE UTILIZATION. AND ONE OF THE DANGERS ALWAYS IN OPENING UP THESE TECHNOLOGIES AND THE EASE OF ACCESS FOR PATIENTS THERE'S THAT PUSH FOR THE CONVENIENCE FACTOR, AND FOR US AS PRIMARY CARE, WE WANT THAT CONTINUITY OF CARE, WE WANT THAT CONTINUOUS STORY. BUT THERE IS A DANGER, RIGHT? WE CAN GAMIFY, IF I CAN USE THAT EXPRESSION, THIS TECHNOLOGY. WE SAW WHERE A PHYSICIAN SERVICE PROVIDING METHADONE BECAME A CASH COW AND NOT SERVING ANY OTHER NEED. I THINK WE ALWAYS HAVE TO BE CAREFUL AS WE STUDY THIS GOING FORWARD IS WE DON'T WANT TO BE USING THIS EXCESSIVELY JUST BECAUSE IT'S EASY. FOR EXAMPLE, I START RENEWING EVERY PATIENT'S DRUG REFILL AND ENGAGING THEM BY TELEPHONE AND TEXT AND BILLING FOR THAT ENCOUNTER, WHICH I MAY NOT HAVE DONE WHEN THAT FEE SERVICE WASN'T AVAILABLE. I THINK THAT MAY BE PART OF THE HESITANCY. THE OTHER CERTAIN ASPECT WOULD BE THAT QUALITY OF CARE. SO, YOU KNOW, WE'RE STUDYING... I'M NOT TEACHING FACULTY, I'M ADJUNCT AT WESTERN. GOING FORWARD WE HOPE TO LOOK AT THAT HYBRID MODEL. WHAT KIND OF THINGS CAN WE ENCOUNTER SAFELY? WHAT ARE THOSE ISSUES, RIGHT, THAT CAN BE SEEN VIRTUALLY OR MAYBE A SIMPLE TEXT MESSAGE AND WHAT'S THAT GOING TO LOOK LIKE? SO THAT COULD BE AGAIN WHERE THE MINISTRY IS HOLDING BACK AND SAYING, YOU KNOW, QUALITY BE MAINTAINED OR SAFETY BE MAINTAINED USING THESE TECHNOLOGIES FOR SURE.

Steve says WELL, TO THAT END, DR. COLLINS, DO YOU THINK THERE IS A SENSE THAT VIRTUAL CARE IS BEING SEEN AS THE DEFAULT KIND OF CARE THAT IS PROVIDED AND DOCTORS IN THE FUTURE MIGHT ONLY ACTUALLY SEE THEIR PATIENTS IN PERSON ON RARER OCCASIONS?

Ann says WELL, CERTAINLY, STEVE, CMA'S VIEW ON THAT IS THAT IT WAS NEVER... VIRTUAL CARE IS NEVER MEANT TO REPLACE IN-PERSON CARE. IT'S MEANT TO BE COMPLEMENTARY. AND IDEALLY, IT SHOULD BE USED WHERE THERE IS AN ESTABLISHED DOCTOR-PATIENT RELATIONSHIP. CERTAINLY I THINK THAT YOU MAKE A GOOD POINT, AND WE ARE ONLY GOING TO SEE AN EXPLOSION OF FURTHER DEVICES, ARTIFICIAL INTELLIGENCE, OTHER ADJUNCTS TO VIRTUAL CARE THAT WILL BE ABLE TO EXPAND ITS USE. BUT, NO. AT THE END OF THE DAY, WHEN A PERSON PRESENTS WITH A PROBLEM AND YOU CAN MANAGE IT SO FAR PERHAPS WITH VIRTUAL CARE, THERE SHOULD BE SOMEONE AT THE END OF THAT CARE RELATIONSHIP THAT CAN ACTUALLY SEE THE PATIENT. THERE ARE TIMES WHEN YOU KNOW THAT YOU'RE NOT MAKING... YOU'RE NOT HITTING THE MARK. YOU'RE NOT KNOWING WHAT'S WRONG WITH THIS PATIENT. YOU HAVE TO SEE THEM. YOU HAVE TO BRING THEM IN. YOU HAVE TO TOUCH THEM. YOU HAVE TO LAY YOUR HANDS ON. AND OF COURSE THERE ARE MANY OTHER THINGS THAT WE CURRENTLY PROVIDE AS SERVICES IN PRIMARY CARE LIKE IMMUNIZATIONS AND OTHER SCREENING PROCEDURES THAT NEED TO BE DONE IN PERSON, WITH CONTACT.

Steve says DR. AFFLECK, LET ME TRY THIS WITH YOU. ARE THERE SAFETY CONCERNS AROUND THE USE OF VIRTUAL CARE?

Ewan says IN SHORT, YES, STEVE, THERE ARE SAFETY CONCERNS. AND THERE ARE SAFETY CONCERNS WITH ANY USE OF TECHNOLOGY IN HEALTH CARE. SO WE HAVE TO BE VERY PRUDENT WITH THAT. A VERY SIMPLE WAY TO LOOK AT IT IS THAT A LOT OF ISSUES HAPPEN BETWEEN THE INTERFACE IN CARE. SO IF YOU SEE YOUR FAMILY DOCTOR AND THEY REFER YOU TO A SPECIALIST OR IF YOU'RE SEEING A REHAB PERSON OR YOU'RE GOING FOR SURGERY, THE INTERFACE BETWEEN THOSE SERVICES, IF INFORMATION IS LOST, IF LAB RESULTS ARE LOST, X-RAYS, WHATEVER, COMMUNICATION OF ANY SORT IS LOST, THEN THE INDIVIDUAL CARING FOR YOU WILL HAVE LESS INFORMATION ON WHICH TO ADJUDICATE YOUR CARE AND POTENTIALLY ERRORS CAN BE MADE OR YOUR CARE MAY JUST BE... YOU WILL NOT GET THE FOLLOW-UP YOU REQUIRE, RIGHT, FOR SOMETHING THAT IS TIME SENSITIVE. SO VIRTUAL CARE BY DEFINITION INVOLVES THE USE OF INFORMATION OR THE TRANSMISSION, EXCHANGE OF INFORMATION BETWEEN SERVICES AND INDIVIDUALS, AND SO WE HAVE TO ENSURE THAT THAT OCCURS IN A WAY THAT ENSURES THE INTEGRITY OF THE INFORMATION. OTHERWISE, IT CAN BE UNSAFE. AND I WILL JUST FINISH THE STATEMENT BY SAYING THERE'S NOT A LONG TRADITION OF EVALUATING THE SAFETY OF THESE TECHNOLOGIES. WE EVALUATE THEM WITH RESPECT TO PRIVACY AND SECURITY, BUT NOT SAFETY. SO THIS IS SOMETHING AS A COLLECTIVE IN CANADA WE NEED TO BEGIN ADDRESSING.

Steve says LET ME FOLLOW UP WITH DR. THOMPSON ON THAT. ARE YOU CONCERNED THAT VIRTUAL CARE OPENS THE DOOR FOR MORE EXAMPLES OF MISDIAGNOSIS?

Keith says I THINK THERE IS THAT POTENTIAL. I THINK PART OF WHAT'S BEING DISCUSSED HERE AND CERTAINLY IN REFERENCES AND EWAN AS WELL IS THAT THESE TECHNOLOGIES WORK BEST IN EXISTING RELATIONSHIPS. SO, YOU KNOW, WE HAVE THE ADVANTAGE OF KNOWING OUR PATIENTS WELL, BUT CERTAINLY WE NEED THE WHOLE STORY, AND SO ONE OF THE DANGERS IS, IF THERE'S EPISODIC CARE, WHETHER IT'S VIRTUAL OR FACE-TO-FACE FOR THAT MATTER IN A WALK-IN CLINIC, NOT HAVING THE FULL BACKGROUND ON THE PATIENT CAN REALLY POSE SOME SERIOUS ISSUES. SO THIS WILL BE THE CHALLENGE GOING FORWARD, IS THE TYPES OF CLINICAL ENCOUNTERS WE HAVE OR THE TYPES OF PROBLEMS, FOR EXAMPLE, ACUTE CHEST PAIN. NOT APPROPRIATE, RIGHT? IT MIGHT BE A TRIAGE ENCOUNTER THAT YOU HAVE, BUT REALLY THAT PERSON NEEDS TO BE SEEN URGENTLY AT HOSPITAL. I DO KNOW OF ONE CASE APPARENTLY THAT WENT OFF THE RAILS. IT WAS APPARENTLY A NECROTIZING. IT WAS A VIRTUAL ENCOUNTER AND THE PHYSICIAN WAS FOUND UNFORTUNATELY TO BE RESPONSIBLE FOR NOT MANAGING THAT APPROPRIATELY. THERE WAS DISCIPLINE. IT SHOULD HAVE BEEN TRIAGED TO THE HOSPITAL. THAT BEING SAID, THAT IS A DIAGNOSIS YOU COULD MISS IN YOUR OFFICE PUTTING HANDS ON THE ABDOMEN AND FEELING. PART OF THIS INVOLVES WHAT SORT OF RELATIONSHIP WE HAVE WITH A PATIENT. THEY HAVE TO TRUST US THAT WE'RE DOING THE BEST FOR THEM. BUT WE ALSO HAVE TO MAKE SURE THAT IF WE'RE THINKING OF A MORE SERIOUS DIAGNOSIS, WHAT'S THE BEST WAY TO TRIAGE AND DEAL WITH THIS, RIGHT? IT MAY BE GOING TO A DEEPER ENCOUNTER THAT'S GOING TO BE FACE TO FACE IN HOSPITAL OR IN CLINIC.

Steve says DR. COLLINS, IF YOU DON'T MIND I'M GOING TO ASK YOU A FEW PERSONAL QUESTIONS. I KNOW YOU'RE HERE REPRESENTING CANADA'S DOCTORS BUT THIS IS NOT MERELY AN ACADEMIC EXERCISE FOR YOU. HOW IS YOUR MOM?

Ann says MY MOM IS GREAT, THANKS, STEVE.

Steve says HOW OLD IS YOUR MOM?

Ann says MY MOM IS 89 AND SHE HAS GIVEN ME PERMISSION TO RELEASE THAT INFORMATION. AND SHE LIVES IN RURAL NEW BRUNSWICK.

Steve says SHE HAS USED VIRTUAL MEDICINE?

Ann says SHE HAS. IN FACT PROBABLY HER LAST THREE ENCOUNTERS WITH HER FAMILY PHYSICIAN WHO IS LOCATED ABOUT 70 KILOMETRES FROM WHERE MY MOM LIVES, HAVE GONE VERY WELL. THEY'VE BEEN BOTH SATISFYING TO MY MOM AND HER PHYSICIAN WHO IS A COLLEAGUE FEELS THAT SHE HAS BEEN ABLE TO PROVIDE THE CARE THAT MOM NEEDS. AND THAT'S BEEN REALLY CRITICAL.

Steve says DON'T TAKE THIS THE WRONG WAY, BUT 89 YEARS OLD IS AN INTERESTING TIME AT LIFE TO START TRYING SOMETHING RADICALLY NEW AS IT RELATE TO YOUR HEALTH CARE. SO HOW... HOW TOUGH WAS THE TRANSITION FOR HER TO ACCEPT THIS NEW WAY OF DEALING WITH HER DOCTOR?

Ann says NOT AT ALL, REALLY, BECAUSE OF THE DISTANCE FROM WHICH SHE LIVES FROM HER FAMILY PHYSICIAN. SHE OF COURSE... I SHOULDN'T SAY "OF COURSE," BUT SHE NO LONGER DRIVES SO SHE RELIES ON A FAMILY MEMBER, MY BROTHER, HER CARETAKER, TO TAKE TIME AWAY FROM WORK TO BRING HER IN TO FREDERICTON TO SEE HER FAMILY PHYSICIAN WHEN THAT IS NEEDED. SO IN THOSE THREE INSTANCES, THAT WAS ALL AVOIDED. THEY AVOIDED SOME TRAVEL OVER NOT-SO-GREAT ROADS IN THE WINTERTIME. WINTERTIME IN NEW BRUNSWICK CAN BE HARD. SHE IS REASSURED THAT SHE HAS AN UPCOMING FACE-TO-FACE VISIT BECAUSE SHE STILL LIKES THAT. THAT'S STILL IMPORTANT TO HER. BUT OTHERWISE, SHE HAS BEEN QUITE SATISFIED WITH THIS TYPE OF ENCOUNTER.

Steve says AGAIN, I DON'T WANT TO MAKE ANY GENERALIZATIONS HERE. SOME PEOPLE, REGARDLESS OF AGE, ARE WHIZZES AT COMPUTERS, AND SOME PEOPLE REGARDLESS OF AGE... MYSELF INCLUDED... ARE NOT. SO HAS SHE HAD ANY DIFFICULTY AS AN 89-YEAR-OLD DOING WHATEVER IT IS YOU HAVE TO DO TO LOG ON, TO LINK IN, TO MAKE THAT VIRTUAL APPOINTMENT WORK FOR HER IF SHE DOES DO IT ON A COMPUTER?

Ann says SO I THINK YOU'VE BROUGHT TO THE DISCUSSION A REALLY IMPORTANT POINT. WHAT WE DO KNOW IS THAT MOST... OR MANY, I SHOULD SAY, AND I THINK IT'S PROBABLY JURISDICTIONAL, MANY PHYSICIANS AND THEIR PATIENTS CONTINUE TO USE PHONE ONLY AS A MEANS OF CONNECTING, AND IN MY MOTHER'S CASE, THAT WAS THE SITUATION. SHE WOULD NOT LIKELY BE ABLE TO MANAGE THAT ON HER OWN. SHE WOULD NEED SOME INTERVENTION FROM, AGAIN, MY BROTHER, HER CARETAKER, TO DO THAT. BUT I THINK THAT HIGHLIGHTS ON BOTH SIDES OF THE STORY THAT NOT ALL PHYSICIANS ARE YET COMFORTABLE USING A VISUAL ASPECT TO VIRTUAL CARE. CLEARLY AT THIS PANEL THAT'S NOT THE CASE. BUT WE KNOW THAT PHONE IS STILL THE PRIMARY WAY OF CONNECTING IN MANY PARTS OF THE COUNTRY. AND ALSO WHEN WE SPEAK ABOUT NOT JUST SENIORS, THERE ARE OTHERS WHO MAYBE DON'T HAVE ACCESS. WE ALL THINK WE HAVE A COMPUTER OR A PHONE. THAT'S NOT THE CASE. OR TO HAVE THAT DIGI KNOWLEDGE TO CONNECT BOTH AUDIO AND VISUALLY. THAT POINTS OUT ANOTHER AREA THAT WE STILL HAVE WORK TO DO TO DELIVER GOOD VIRTUAL CARE.

Steve says ALL RIGHT. THAT TAKES ME TO DR. THOMPSON NEXT BECAUSE YOU'VE HIT ON A REALLY IMPORTANT SUBJECT HERE, AND THAT IS OF COURSE IN CANADA, A LOT OF PEOPLE GET VERY SQUEAMISH WHEN THEY THINK THERE IS ANYTHING INEQUITABLE IN THE HEALTH CARE SYSTEM. CERTAINLY IN POLITICS IT'S ONE OF THE THIRD RAILS OF POLITICS IN THIS COUNTRY. SO DR. THOMPSON, I'D LIKE TO KNOW WHAT DISCUSSIONS ARE GOING ON RIGHT NOW ABOUT CREATING A SYSTEM THAT WILL ENSURE THAT VIRTUAL CARE IS EQUITABLE REGARDLESS OF WHERE YOU LIVE, REGARDLESS OF HOW MUCH BANDWIDTH YOU HAVE, ET CETERA, ET CETERA.

Keith says EXCELLENT QUESTION. I'M SPEAKING TO YOU FROM FIRST NATIONS LANDS SO ACKNOWLEDGING THAT. THAT IS ONE AREA HERE AT WESTERN WE'RE INTERESTED IN RESEARCHING FURTHER AND HOW DO WE KEEP ACCESS EQUITABLE. THERE'S ALREADY INEQUITY WITHIN THE SYSTEM CERTAINLY REGIONAL BECAUSE HEALTH CARE RESOURCE, IT'S THE MANPOWER, IT'S THE STAFFING. SO IF WE THINK OF GOOD INNOVATION AS BEING CUSTOMER DISCOVERY, I THINK ONE OF THE THINGS WE NEED TO BE CAREFUL ABOUT IS THE CUSTOMER IS THE PATIENT. THERE'S ALSO THE PHYSICIAN WHO IS A USER. BUT WE NEED TO I THINK GO OUTSIDE OF OUR COMFORT ZONE A BIT, AND THOSE PEOPLE THAT ARE MARGINALIZED, RIGHT? WE NEED TO ASK THEM: WHAT ARE YOUR NEEDS? AND SO I THINK THE APPROACH THAT IS BEING DISCUSSED NOW IS GETTING DEEPER INTO THAT TERRITORY AND SAYING: HOW CAN WE SERVE YOU? HOW CAN WE WORK WITH YOU? WHAT ARE YOUR NEEDS? RATHER THAN OPENING A LAPTOP AND LAYING IT ON THE TABLE IN FRONT OF THEM AND SAYING, "HERE, WE'LL SHOW YOU HOW TO USE THIS." NO, NO. WE WANT TO MAKE THEM PARTNERS IN THIS PROCESS. EQUITABLE ACCESS IN TERMS OF, YOU KNOW, THE USE OF THE TECHNOLOGY. SO PEOPLE WITH DISABILITIES OF SOME SORT OR ARE CHALLENGED IN MANY WAYS, HOW IS THIS TECHNOLOGY USER FRIENDLY TO THEM? AND IF WE HAVE PEOPLE, PATIENTS, THAT ARE HOUSING-DEPRIVED, THAT ARE ON THE STREET LITERALLY, WHAT IS OF VALUE TO THEM? THERE'S A REALLY NEAT PROGRAM BY VETERANS HOSPITAL WHICH HAS USED SOCIAL SHERPAS, PEOPLE WHO HAVE BEEN THROUGH TRAUMA THEMSELVES AND TRAINED IN THESE SOCIAL SYSTEMS. AND THEY COME ALONGSIDE WITH THEIR TABLET IN HAND GOING STREET-SIDE BESIDE THE PEOPLE THEY'RE BEFRIENDING AND BUILDING TRUST. DO YOU WANT TO TALK TO MY NURSE SALLY? SHE IS ON THE LINE. AND TRYING TO PULL THEM INTO THE RESOURCES THAT MAYBE WOULD HELP THEM. SO I THINK WHEN WE TALK ABOUT EQUITY, YES, IT'S CERTAINLY HEALTH CARE. BUT YOU KNOW, STEVE, IT'S NOT JUST ACCESS TO CARE THAT DETERMINES GOOD OUTCOME. THERE'S SOCIAL DETERMINANTS. AND EVEN WORLD HEALTH ORGANIZATION IS LOOKING AT THIS. THEY TALK ABOUT DIGITAL LITERACY BUT CERTAINLY DIGITAL DETERMINANTS OF HEALTH AND THAT'S GOING TO BE A BIG PART OF HOW THIS MOVES FORWARD. WHAT'S THE LINE TO CONNECT TO THESE PEOPLE. BUT MORE IMPORTANTLY HOW DO WE BUILD THAT SOCIAL INFRASTRUCTURE TO HELP THEM BEYOND HEALTH CARE ALONE.

Steve says SURE. I DO WANT TO CIRCLE BACK TO SOMETHING DR. AFFLECK MENTIONED AND THAT'S THE ISSUE OF SECURITY. WHAT CONCERNS DO YOU HAVE ABOUT SECURITY WITH SOCIAL MEDICINE?

Ewan says THE SECURITY CONCERNS ARE NOT UNIQUE... IT'S ALL HEALTH SERVICE. WE HAVE TO ASSURE THE PRIVACY AND SECURITY OF PATIENTS' INFORMATION IRRESPECTIVE OF THE TECHNOLOGY, WHETHER IT'S PAPER-BASED OR A DIGITAL TECHNOLOGY THAT IS IN USE. AND THIS IS A WAY IN WHICH CANADA HAS NOT LAGGED AS MUCH, AND, YOU KNOW, THERE ARE INFORMATION AND PRIVACY COMMISSIONERS IN EACH JURISDICTION. SO IF ANYONE IS DEPLOYING TECHNOLOGIES, THEY NEED TO COMPLETE WHAT IS CALLED A PRIVACY IMPACT ASSESSMENT AND THEY NEED TO ENSURE THAT THEIR TECHNOLOGY ADHERES TO CERTAIN STANDARDS OF PRIVACY AND SECURITY. BUT THEN WITH VIRTUALIZATION, THERE ARE OTHER CONSIDERATIONS. YOU'RE, YOU KNOW, CHATTING WITH PEOPLE IN NON-TRADITIONAL ENVIRONMENTS, LIKE NOT EXAMINING ROOMS, AND YOU HAVE TO BE... THE SAME THING IN YOUR INDUSTRY, STEVE. YOU KNOW, YOU'VE HAD... DOUBTLESS THAT WE'VE ALL SEEN EXAMPLES OF PEOPLE ON THE AIR AND LIVE AND THEIR KID RUNS BEHIND OR SOMEONE COMING OUT OF THE SHOWER OR SOMETHING DURING THE TIME OF COVID. SO ALL OF THESE CONSIDERATIONS NEED TO COME IN WITH VIRTUALIZATION, PARTICULARLY WHEN YOU'RE USING VIDEO. BUT AS ANN SAID, THE MOVEMENT TO VIRTUALIZATION IN CANADA HAS LARGELY BEEN PHONE CARE AND WE'RE NOT... WE HAVE NOT ADAPTED SIGNIFICANTLY TO MANY OTHER VIRTUAL TECHNOLOGIES. SO THERE'S A LOT OF UPSTREAM WORK TO BE DONE TO ACTUALLY COHERENTLY DESIGN AN INTEGRATED VIRTUAL CARE SERVICE FOR CANADIANS. WE'VE REALLY JUST TOUCHED THE SURFACE HERE.

Steve says IN WHICH CASE, DR. COLLINS, YOU HEARD A GOOD LIST THERE OF CONCERNS ABOUT SECURITY. DO YOU THINK THERE'S ANYTHING ON THAT LIST THAT IS SO PROBLEMATIC THAT IT CAN'T BE RESOLVED?

Ann says NO, I DON'T. PEOPLE WILL BECOME... FROM THE OTHER SIDE OF THE CHAIR, THE PATIENT CHAIR, IF YOU WILL, YOU KNOW, WE'VE HAD CONVERSATIONS... I'VE HAD CONVERSATIONS WHEN I WAS USING VIRTUAL CARE WHERE PATIENTS WERE IN A LINEUP AT A COFFEE SHOP. SOME OF THAT IS ON THE PATIENT. THEY MAY... YOU KNOW, THEY ACCEPT THAT THEY ARE IN A NON-SECURE, NON-CONFIDENTIAL ENVIRONMENT. BUT VIRTUAL CARE IS STILL IN MANY WAYS IN ITS INFANCY, MAYBE MOVING INTO TODDLERSHIP. AND SO PATIENTS WILL ADAPT TO THAT. THEY'LL ACCEPT WHAT THEY'RE WILLING TO ACCEPT. AND I DO BELIEVE THAT WITH THE ADVANCEMENT OF TECHNOLOGIES, WITH THE ADVANCEMENT OF EDUCATION, THE CMA HAS JUST COME OUT WITH A TASK FORCE REPORT JUST BEFORE THIS EXPLOSION OF VIRTUAL CARE, DR. AFFLECK WAS VERY MUCH A PART OF THAT. THAT WORK WAS JUST BEGINNING. THAT WORK IS GOING TO CONTINUE. AND THESE ISSUES WILL BE ADDRESSED. I THINK THAT THEY CAN BE OVERCOME.

Steve says OKAY. DR. THOMPSON, I DON'T KNOW THIS FOR SURE BUT I'M GOING TO GUESS THAT WHEN YOU FIRST BROKE INTO MEDICINE, MAYBE 90 percent OF YOUR WORK WAS PERSON TO PERSON, YOU KNOW, MAYBE THE ODD BIT OF STUFF ON THE PHONE. BUT NOW WITH THE PANDEMIC, I DON'T KNOW, ARE YOU CLOSER TO 50-50 NOW OR WHAT?

Keith says I WOULD SAY RIGHT NOW WE'RE IN A BIT OF A HOT ZONE HERE IN LONDON. SO WE WERE STARTING TO OPEN UP BUT RIGHT NOW, STEVE, WE'RE CERTAINLY PROBABLY 80 percent VIRTUAL, TELEPHONE, VIDEO, PATIENTS SENDING ME A PICTURE ON THE PLATFORM OF THEIR RASH, ET CETERA. SO JUST A SMALL PERCENTAGE THAT WOULD BE REQUIRED FACE TO FACE. BABY EXAMS, IMMUNIZATIONS, ET CETERA.

Steve says IS THERE A TARGET HERE?

Keith says I WOULD SAY THERE'S... YOU KNOW, THE PATIENT PROBABLY HELPS DETERMINE THAT. I HAVE OBVIOUSLY MY AGENDA AND WHAT I FEEL NEEDS TO BE SEEN BASED ON GOOD CLINICAL CARE. BUT THE PATIENTS I THINK DETERMINE THAT AS WELL. WHAT I'M INTERESTED IN AND CERTAINLY FASCINATED... IAN McWHINNEY, ONE OF OUR FOUNDING FATHERS OF MEDICINE HERE IN LONDON TALKS ABOUT THE REASONS PATIENTS ENGAGE WITH US. IT'S THE TOLERANCE. IT'S THEIR LIMIT OF ANXIETY. THEY'RE SO WORRIED. IT'S THE TICKET IN. THEY COME IN WANTING TO TALK ABOUT THEIR SMOKING BUT REALLY THERE'S ANOTHER ISSUE BEHIND IT THEY'RE CONCERNED ABOUT. OR ADMINISTRATIVE DUTIES. SO THOSE DRIVING FORCES ARE STILL THERE WHETHER IT'S VIRTUAL OR FACE TO FACE. I'VE HAD PATIENTS SAY TO ME, OH, DOC, I REALLY WANT TO SEE YOU. I MIGHT NOT THINK IT'S A SIGNIFICANT ISSUE BUT THEY NEED THAT CONTACT, THERE'S A HEALING ASPECT THAT... AGAIN, WE HAVE TO BE COGNIZANT OF THAT MIGHT NOT BE ADDRESSED VIRTUALLY. I THINK THAT'S KIND OF WHAT DETERMINES HOW WE ENGAGE.

Steve says JUST TO BE ABSOLUTELY CLEAR HERE. IF A PATIENT SAYS TO YOU, DOC, I KNOW YOU THINK YOU CAN HANDLE THIS VIRTUALLY BUT I REALLY NEED TO SEE YOU, YOU WILL SEE THAT PATIENT?

Keith says ABSOLUTELY. I'M GOING TO DO MY BEST WITHIN THE SAFETY GUIDELINES AND INFECTION CONTROL, WHICH IS DEFINITELY SLOWING DOWN OUR DAY-TO-DAY WORKFLOW IN THE OFFICE BUT, YEAH, ABSOLUTELY.

Steve says OKAY. JUST A FEW MINUTES TO GO HERE. DR. COLLINS, LET ME GET YOU ON THIS. WE'VE DONE THIS PROGRAM I GUESS THIS FOCUS ON VIRTUAL MEDICINE A FEW TIMES SINCE THIS PANDEMIC HIT. I ALWAYS LIKE TO ASK THIS QUESTION AT THE END BECAUSE OF COURSE THE PANDEMIC, AS YOU'VE ALL INDICATED, HAS ALLOWED THE POSSIBILITY OF VIRTUAL MEDICINE COULD BECOME A BIGGER PART OF THE HEALTH CARE SYSTEM. BUT THEN THE QUESTION BECOMES: ONCE THE PANDEMIC IS OVER, AND GOD WILLING SOME DAY IT WILL BE, DOES EVERYTHING GO BACK TO THE WAY IT WAS? WHAT DO YOU THINK?

Ann says NO. I DO BELIEVE THAT THERE WILL ALWAYS BE AN ELEMENT OF VIRTUAL CARE. THERE NEEDS TO BE FIRMING UP OF THE POLICIES AROUND PAYMENT AND THAT TYPE OF THING, WHICH I KNOW MANY DIFFERENT JURISDICTIONS ARE WORKING ON IN TERMS OF FEE CODES AND EXPECTATIONS AND SO ON. BUT THERE'S BEEN SUCH A HIGH DEGREE OF SATISFACTION EXPRESSED BY BOTH PHYSICIANS AND PATIENTS, PLUS IT HAS ALLOWED EASIER ACCESS TO CARE IN MANY INSTANCES, AND ACCESS TO CARE IS A CRITICAL COMPONENT OF THE DOCTOR-PATIENT RELATIONSHIP. SO, NO, I DON'T FORESEE GOING BACK TO SOLELY IN-PERSON VISITS WITH FULL WAITING ROOMS AT ALL.

Steve says DR. AFFLECK, VIRTUAL CARE HERE TO STAY?

Ewan says ABSOLUTELY. I HOPE SO. I'VE BEEN WORKING IN THIS DOMAIN FOR 25 YEARS. I WAS LIKE THE MAYTAG REPAIRMAN UNTIL ONE DAY A VIRUS CAME ALONG AND EVERYONE WAS PHONING. I'M HOPING IT'S HERE TO SAY. REALLY, THE FUNDAMENTAL QUESTION IS: DOES THIS IMPROVE THE QUALITY OF CARE FOR CANADIANS? AND I DON'T THINK THERE'S ANY DOUBT. THERE ARE MULTIPLE USE CASES WHEN VIRTUALIZATION OF SERVICES IMPROVES PEOPLE'S CARE.

Steve says THAT'S ONE OF THE KEY QUESTIONS. THE OTHER KEY QUESTION IS WHETHER OR NOT IT CAN HELP BEND THE COST CURVE. IS THIS A POTENTIAL WAY TO MORE EFFECTIVELY SPEND MONEY IN THE HEALTH CARE SYSTEM?

Ewan says YEAH. AND THE INTERESTING THING ABOUT BENDING THE COST CURVE IN HEALTH CARE, THERE'S A SAYING THAT QUALITY CURES COST. IF YOU JUST TRY TO SAVE MONEY IN HEALTH CARE BY CUTTING SERVICES OR CUTTING RESOURCES OR WHATEVER, YOU USUALLY PROMOTE POORER OUTCOMES AND THEN LONG-TERM YOU'LL PROMOTE GREATER COST. SO THE WAY TO DECREASE THE COST CURVE IS TO ENSURE IMPROVED QUALITY OF CARE. AND SO THAT IS THE FUNDAMENTAL QUESTION HERE: DOES THIS IMPROVE QUALITY OF CARE? I MEAN, IF YOU JUST LOOK AT CANADA'S NORTH, YOU KNOW, KEITH WAS MENTIONING, YOU KNOW, SOMEONE WITH A HEART ATTACK A LITTLE WHILE AGO OR SOMEONE WITH, YOU KNOW, THAT IN DOWNTOWN TORONTO YOU WOULD PROBABLY WANT TO GET THEM TO BE SEEN IMMEDIATELY IN THE EMERGENCY ROOM. WELL, IN SOME REMOTE PLACES IN NORTHERN CANADA WHERE THEY HAVE TO FLY OUT AND IT MAY TAKE 20 HOURS TO GET THEM THERE, YOU CAN USE VIRTUAL CARE TO MITIGATE THAT CARE. AND IF YOU LOOK AT THE COST OF TRANSPORTATION IN THE NORTH OR REMOTE AND RURAL CANADA, YOU CAN OFFSET COSTS SUBSTANTIALLY BY PROVIDING SERVICES VIRTUALLY THAT YOU OTHERWISE COULDN'T.

The caption changes to "Producer: Sandra Gionas, @sandragionas."

Steve says GOTCHA. I'M JUMPING IN THERE, FORGIVE ME, DR. AFFLECK. THAT'S OUR TIME. I DO WANT TO THANK ALL THREE DOCTORS, EWAN AFFLECK, ANN COLLINS, AND KEITH THOMPSON FOR COMING ONTO TVO TONIGHT. WE'LL LET YOU GET BACK TO WHAT YOU THREE DO SO WELL, WHICH IS HELP PEOPLE. STAY HEALTHY. THANKS EVERYBODY.

Ann says THANK YOU.

Keith says THANK YOU SO MUCH.

Watch: Is Virtual Health Care Here to Stay?