Danyaal Raza is a family physician in Toronto and an assistant professor at the University of Toronto. Jillian Ratti is a family physician in Calgary and clinical lecturer at the University of Calgary. Both serve on the Board of Canadian Doctors for Medicare.
Coronavirus is challenging our modern health care system in ways it has never before. With talk of field hospitals, rationing of resources and redeployment of retired health care personnel, the language of disaster relief and war has become common. This disease has our system under immense pressure.
While many of the adaptations being made are ones we wish we did not need, others are welcome, driving health care forward at a pace that in the past would have been measured in years rather than just days. Chief among these leaps is virtual care.
But this pace of change also creates opportunities for pandemic profiteering that some are all too happy to exploit. How so?
We know that robust, high-quality primary care is built on long-term relationships between patients and teams comprising of family doctors, nurse practitioners and other healthcare providers. For those in Canada without a regular primary care provider, walk-in clinics have a role to play as a stop-gap. But for those already attached to a primary care team, their role is highly contentious, and often disrupts continuity of care . With the rapid rise of virtual care, virtual walk-in clinics are no different. Perhaps the best example of this threat is in Alberta.
In the midst of a global emergency, the United Conservative Party (UCP) government announced its adoption of a controversial virtual care mobile app Babylon by Telus Health, owned by the U.S.-based Babylon Holdings Limited. It virtually connects patients to doctors who have no access to patients’ medical records and who compete with patients’ regular family physicians for care.
We’ve just introduced a new innovative way to connect more Albertans with healthcare: the new @TELUSHealth Babylon app.
— Jason Kenney (@jkenney) March 19, 2020
Worse still, Babylon uses unstandardized artificial intelligence algorithms to provide medical recommendations to users, further depersonalizing care. In order to use this service, patients have to consent to allow Telus to “share personal data with members of [their] corporate group and partners” and to allow users’ personal data for “marketing and communications” as well as “foreign government agencies.” It is deeply troubling that Alberta’s Premier, Jason Kenney, took to Twitter to market and promote a poor-quality health service with major privacy concerns.
Babylon’s rollout is not limited to Alberta. It first showed up in British Columbia and has now launched in Ontario. Prior its Canadian debut, it was used in the United Kingdom. Amongst those in the U.K. raising serous concerns were the British Medical Association, the Royal College of General Practitioners and the Royal College of Physicians. The Alberta Medical Association has followed suit, flagging that Premier Kenney introduced Babylon without any consultation with doctors.
Babylon is not alone in this enterprise. There are similar profit-driven virtual care services in other jurisdictions entering into agreements with large Canadian companies. These deserve scrutiny too.
Virtual care’s largest gains are in providing effective support and outreach to rural and remote communities to increase access to care, and in making it easier for those in urban and suburban settings to see their regular primary care provider for routine care. There is so much potential for positive change from appropriate virtual care. As others have pointed out, effective virtual care needs to be married with our fundamental goals for overall health care reform.
Even before COVID-19, many stand-alone virtual clinics were not focused on improving access to care for those who need it most. Instead, for-profit systems tend to “cherry-pick” the healthiest and wealthiest patients, most often in large cities, while “lemon-dropping” (dumping) more complex and vulnerable patients onto the public system. Companies like Babylon, not only poach patients, but also physicians, incentivizing high-volume, low-complexity, and financially-lucrative care.
Virtual care has transformed primary care, both in good ways and bad. A great deal of primary care that would have otherwise been done in person can and should be done through a combination of secure messaging, video and telephone visits. Importantly, virtual medicine is at its best when integrated into a model of care that is centred on provider-patient relationships and continuity.
Patients, not profit, need to be our organizing principle.
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