Textes d'opinion

Take down the barriers to telemedicine

The day started badly, like yesterday. Still the same symptoms, but you don’t feel much like spending the morning at a clinic, and an emergency room even less. You open an application on your phone. In a matter of clicks, a doctor’s face appears. After a brief consultation, you are given a prescription, which is delivered to you a little later that day.

This scenario seems like science fiction, but it is feasible today. We communicate with people on the other side of the planet, we carry out secure banking transactions online with a few clicks. There is no reason why a patient cannot virtually consult a doctor or a nurse for a common ailment.

And yet, for the very large majority of us, a medical visit often represents research, long hours of waiting, and a lost workday (or vacation day). Only 1 per cent of Canadians use virtual care.

Given that the technologies behind telemedicine exist and are proven, why do Canada’s health-care systems remain stuck in the past?

Because our governments, consciously or not, allow all sorts of obstacles to complicate the lives of patients.

For example, a doctor who provides care to people located in a certain province must hold a licence to practise in that province, even if he or she already holds a licence from another province. This outdated requirement prevents a better allocation of medical resources. If doctors are available to lend a hand in our part of the country, even just temporarily, why not welcome them with open arms?

In the case of telemedicine, the maintenance of this same requirement by the majority of provinces is completely ridiculous. More and more Canadian companies are offering their employees access to virtual consultations through their group insurance plans. A doctor who provides such a consultation could renew a prescription for an Alberta patient, then follow up with another from Manitoba suffering from a chronic illness, direct a Quebec patient to a consultation with a specialist, and give advice to a New Brunswick patient, all without leaving his or her office.

Why force this doctor to hold and renew a licence to practise in each of these places? The anatomy of Canadians does not vary a lot from province to province!

The provincial governments have also set out all sorts of conditions that restrict access to telemedicine within the public systems. It is often reserved for patients who live in remote regions or who suffer from particular conditions. Sometimes, the government even requires the patient or the doctor to go to an authorized health facility to receive or provide virtual care. This defeats at least some of the purpose of telemedicine!

The way we pay doctors doesn’t help, either. Fee-for-service payments, which represent around three-quarters of Canadian doctors’ incomes, do not encourage them to carry out actions for which there will be no payment. Unsurprisingly, the very large majority of our doctors are hesitant to write an email or pick up a phone to contact us, let alone have a smartphone consultation.

Finally, our health-care systems are still often far too centred on doctors. While their expertise is sometimes indispensable, there are many situations in which nurses and pharmacists can lend a hand. Allowing them to do more would liberate doctors, a scarce resource, to do other things.

Numerous studies have shown that telemedicine is reliable, practical and effective, and that it could be useful for a large share of our daily health concerns. After all, telemedicine is not so much a new professional field, but rather a new way of making proven treatments available, provided by experienced professionals. Governments should put all of their energy into eliminating the barriers that still remain and that prevent Canadians from enjoying the benefits of telemedicine.

Patrick Déry est analyste associé senior à l’Institut économique de Montréal. Il est l’auteur de « Entrepreneuriat et santé – Comment favoriser le déploiement de la télémédecine au Canada » et signe ce texte à titre personnel.

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