A vital step forward in providing Ontarians with a sustainable, patient-centred health care system was taken this week by Ontario’s Minister of Health. The Hon. Christine Elliott announced that doctors in Ontario — family doctors and specialists — will be able to initiate patient visits conducted through video on the patient’s own device and be compensated just as though it were an in-person visit. This is a remarkable advance.
Virtual health care itself is nothing new in Ontario. Since the mid 1990s patients living in rural and northern communities have been able to attend at local health facilities equipped with video technology and see a remote specialist many kilometres away. OTN now supports the largest such network in the world. In fact, last year there were more than one million such video visits between Ontario patients and their providers.
With the proliferation of technology — particularly smartphones beginning in 2007 — we asked ourselves why video visits couldn’t take place in much the same way with patients using their own technology rather than attending a health facility. Common sense — and research — told us that, first and foremost, consumers — the patients — were ready.
That readiness was demonstrated here in Ontario by OTN’s home video visit pilot. Working with many partners in the health care system, the pilot was launched in November 2017. In its first year, more than 11,000 home video visits were conducted by 565 providers. Of these, 41 per cent were psychiatric home video visits, 27 per cent were general/family medicine visits and the balance were other specialist visits. One-third of the patients saw their doctor on a smartphone, 46 per cent used a computer and 14 per cent used a tablet. More interesting was the patient response: of those surveyed, 62 per cent said the experience was the same as an in-person visit and 19 per cent said it was better.
As predicted, virtual health care saved these patients time — about four hours on average — and travel. About one in five said they saved more than 100 kms of travel. Patients, both rural and urban, added that they avoided missing work and they felt the experience was more efficient.
Equally important, the health care provider experience was also positive. More than 76 per cent said they would continue using video visits “always” or “very often” (when appropriate) within their clinical practice.
We have also seen that virtual health care, when used appropriately, can help make the system itself more sustainable. One of the important reasons for this is continuity of care. The Canadian Institute for Health Information said in its 2015 report Continuity of Care with Family Medicine Physicians: Why it Matters that continuity of care reduces hospitalizations and emergency department use and is also linked to improved patient health.
The World Health Organization estimated that home-based primary care results in 17 per cent lower cost medical care, 13 per cent fewer hospital admissions and 27 per cent fewer visits to an emergency department. Making it more convenient to see your OWN doctor through virtual care means you are getting better care and are less likely to need to go to an emergency room or use a walk-in clinic.
As a result of the Minister’s announcement, video visits will now become a funded part of our health care system for all patient visits with their own primary care provider – maintaining continuity of care – and for all specialist visits. The potential is broad. Our experience showed that video visits can be used for everything from pediatric diabetes consultations to post-operative medication management to providing a university student far from home the chance to see her own family doctor, to preliminary screening for organ donor recipients who live far away. And for so much more.
We are at the threshold of a major sea-change in our health care system. I believe that soon enough, virtual visits, including video and secure messaging, will be more common than in-person visits. At that point we won’t be talking about virtual care separately; it will just be called “health care”.