Question: One of my friends says she can do a video chat with her doctor using a cell phone. I wish my doctor offered this convenient alternative to an office appointment. Why isn’t this option more widely available?
Answer: A recent opinion poll found that the majority of Canadians are just like you. They want greater access to digital health services, such as “virtual” visits in which patients can see their doctors online through mobile devices or personal computers.
Until now, numerous technical and bureaucratic barriers have stood in the way of these innovations.
But increasingly the medical profession is recognizing that patients want change – and a pilot project involving your friend may point the way to the future.
The pilot project is run by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the provincial government.
OTN is best known for creating a two-way video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their own communities. The patient simply goes to a telemedicine studio – usually in a nearby hospital or medical clinic – and connects with a doctor who may be hundreds of kilometres away.
However, in the pilot project – called OTN Invite – the studio has been replaced with the patient’s own mobile device or personal computer. That means a patient doesn’t have to leave home to see a doctor. What’s more, it’s not just meant for patients in remote areas.
So far, about 600 doctors across Ontario have joined the project and are now offering virtual visits to selected patients.
“It’s not for everything,” says Dr. Ed Brown, the chief executive officer of OTN. Some patients, he notes, still need to be physically examined by a clinician. But for certain types of appointments – in which a hands-on approach isn’t necessary – it can be a welcome alternative to an office visit.
Virtual visits save doctors and patients valuable time, says Dr. Ilana Halperin, an endocrinologist at Sunnybrook Health Sciences Centre in Toronto.
“In the past, I felt guilty bringing patients to my office when I knew it was for quick follow-up appointments,” she explains. “Some of them had taken time off work and paid for parking. I would often spend more time with them than was really needed because I felt I owed it to them.”
But with virtual appointments, Dr. Halperin spends just the amount of time that’s necessary.
“It improves efficiency which is another way of saying it improves access to care because I am able to see more patients,” she says.
“I actually did a virtual visit with a patient who was on vacation in Florida. It really is bringing care to where people are at.”
Patients certainly seem to like the convenience. “It saves me about two hours in travel and waiting time – and I don’t have to arrange child-care for my two young kids,” says Taryn O’Donohue, one of Dr. Halperin’s patients who has type 1 diabetes.
At a recent virtual appointment, Dr. Halperin reviewed data that had been downloaded from Mrs. O’Donohue’s insulin pump. “I didn’t need to be within three feet of my doctor to have a conversation with her and to know that I am on track health-wise,” says Mrs. O’Donohue.
The process for arranging a virtual appointment is fairly straightforward. Doctors, who are participating in the pilot project, go to a secure OTN network hub to book a time. The patient is then sent a confirmation notice and instructions on what to do. (A special app is required for using the service with a smart phone.) And, at the pre-arranged time, the patient clicks on a privacy-protected link to the doctor’s office and the video chat can begin.
Even so, obstacles remain. Some patients, for instance, lack the basic prerequisite for an online chat – a high-speed Internet connection, says Dr. Brown.
Other provinces are also exploring various forms of online health care and telemedicine. A key consideration is how much physicians should be paid for providing these services. For OTN Invite, doctors use the same billing codes that they do for in-person appointments.
Meanwhile, the Canadian Medical Association has formed a virtual-care task force that will be releasing recommendations later this year.
“We support virtual care, but we want it to be expanded in an appropriate manner,” says Dr. Sohail Gandhi, president of the Ontario Medical Association. He is particularly concerned that a patient might see a different health-care provider with every virtual visit. If that happens,” continuity of care” could suffer, he says.
Dr. Brown says OTN Invite is primarily aimed at medical specialists who tend to treat a group of patients with regularly scheduled follow-up appointments.
“The physicians we surveyed said about 30 per cent of all visits could potentially be done virtually,” says Dr. Brown.
Change, though, has its challenges. “People think it’s a theoretically great innovation, but providers still have to figure out how to fit it into their busy work flow,” says Dr. Halperin. In her medical practice, she books all her virtual appointments at the beginning and end of the day. That gives her some flexibility if she is running behind schedule – without inconveniencing the patients in her waiting room. Her assistant will send a message to the online patients, notifying them that their appointments may be a bit later than planned.
That approach seems to work just fine for patients like Mrs. O’Donohue. “I can do work around the house until my appointment,” she says. “At least there’s no waiting in the doctor’s office.”
And, for physicians, there’s been one unexpected benefit. Virtual visits have reduced the number of patients who don’t show up for their appointments, says Dr. Brown. That adds to the overall efficiency of the health-care system.
