Jane Philpott is a medical doctor and former member of parliament. From 2015 to 2019, she served as federal minister of health, minister of indigenous services and president of the treasury board. Onil Bhattacharyya is the Frigon Blau chair in family medicine research at Women’s College Hospital, University of Toronto.
It’s easy to book a dinner reservation online. Or if we don’t feel like going out, we can order from a range of menus and have food delivered to our homes. If only health care could do this. Only one in five Canadian family doctors offer the option to book a clinic appointment online. We seem far from a world where we can make Uber-like requests for a house call or virtual visit with a health care provider.
In Canada, most of us can’t even communicate with our family doctor’s office by email or a secure website. But more than 90 per cent of doctors in Sweden offer this option, according to the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, released this week. Only one in five family doctors in Canada offers their patients the option to interact via email or a secure website. Canada ranked worst of all in this measure in the survey of 11 high-income countries.
When we have sophisticated communication technology at our fingertips, it’s remarkable that these tools are not widely used by family doctors and primary care teams. We can shop, study and bank online. Using electronic communication to support high-quality health care delivery is one of the last frontiers. It’s not that we haven’t invested in health information technology. Canada Health Infoway, an organization that supports adoption of digital tools like electronic medical records, received about $2.5 billion in federal funding. This ensured that electronic health records were used for documentation and billing, but they were not required to be patient-centred and seamlessly integrated with every part of the health system.
Smart use of health information technology is important because it’s part of the broader challenge of coordinating care. Family doctors and primary care teams are best suited to coordinating care from specialists and community services, which is the key to health systems that are efficient, effective and affordable. It was the theme of the 2019 Commonwealth Fund Survey.
While the results may not come as a surprise to Canadians, as there are well-known gaps here, it is striking to see that some countries are doing much better. One of the results showed that only half of Canada’s family doctors are notified when a patient is seen in the emergency department or admitted to hospital, compared to more than 80 per cent in the Netherlands.
On top of the fact that only 22 per cent of primary care doctors offer email communication, we generally ranked poorly in using health information technology to support clinical care. Canada was in the bottom of the pack in offering online options to patients for appointment scheduling, prescription refills and viewing test results or visit summaries. There are many barriers to expanded use of health information technology. Some are technical, financial or regulatory. Others identify the lack of support for clinicians who want redesign their practices to incorporate electronic communication in care delivery. But many countries are finding ways to surpass these barriers faster than we are.
Canada ranked second-last in the provision of after-hours care outside the hospital—the U.S. is the only country that’s worse. Well-organized and well-staffed after-hours care is routine in countries like the Netherlands, Norway and New Zealand, where more than 90 per cent of practices offer such arrangements.
We think one of the opportunities that should be pursued is expanded access to virtual visits. In a country as big as ours, when we’re trying to cut down on the economic and environmental costs of travel, Canada should lead the world in offering remote health care delivery options.
In Ontario, the first phase of an eVisit program led by the Ontario Telemedicine Network created billing codes for virtual care using text or video between patients and their providers. The evaluation was led by the Women’s College Hospital Institute for Health Systems Solutions and Virtual Care and included almost 200 doctors and over 14,000 patients. The program found that an increase in access to care did not increase costs or physician workload. This service is being expanded and current reforms to integrate care in Ontario will encourage a digital front door to the health system at a regional level to support the types of care that are currently offered by very few primary care practices.
In Alberta, the same electronic medical record is being implemented across the entire health system, which will allow providers to view each other’s records for the same patient, communicate more easily across institutions and give patients better access to their own information. Since most people want these functions, we should seize this window of opportunity to channel public interest and make sure Canada doesn’t stay at the bottom of the charts on communication and coordination. We can do this by making primary care more like other modern services and use digital tools in ways that many other countries have already done.