On-demand telehealth is in growth mode in B.C.

Kendall-HoA newly arrived business called MedviewMD from Chatham, Ont. has set up shop in four pharmacies in Kamloops, Langley and Chilliwack. Customers can quickly renew prescriptions by meeting via video link with a doctor in Ontario, and it’s all covered under B.C.’s medical services plan (MSP). While telehealth – also called eHealth, telemedicine or virtual medicine – has been growing for years, it has been mostly limited to video links between clinics from rural areas or First Nations asking big-city doctors for an opinion. Now a host of direct-to-consumer businesses are offering fast access to doctors from patients’ homes or the corner drugstore.

It’s either a boon to a health system that can’t provide a family doctor for every British Columbian or a path to publicly funded doctor shopping that’s just a few clicks away.

“It’s very promising in terms of the different types of technology, but I think we need to be cautious,” says Dr. Kendall Ho (pictured), a professor in the University of British Columbia’s faculty of medicine who now leads its Digital Emergency Medicine project.

“Cautious not to say, ‘stay away,’ ” says Ho, “but to be aware. And No. 1 is the fragmentation of care and services. Just because it’s convenient, does that mean it will be helpful to you or harmful to you?”

Risks include seeing different doctors each time so that there’s no long-term knowledge of the patient other than an electronic medical record that each online service stores for itself, says Ho. Worse, if the patient uses several different eHealth systems, doctors could inadvertently prescribe medications without knowing what the patient is already taking.

“From the health system’s point of view, would there be excess utilization? If the patient goes to the doctor and isn’t happy with that opinion, will they go seek a second opinion and a third opinion and a fourth until they find the opinion they need?” asks Ho.

For the taxpayer, telehealth’s ease of access is something that prompted a review by the Ministry of Health two years ago. That review has never been released, but has instead been wrapped into a provincial virtual care strategic plan that’s still in the works, says ministry spokesman Stephen May.

Health Minister Terry Lake was not available for comment.

In general, the government supports digital communication including texts, emails and videos for healthcare – particularly for people who have trouble getting to a doctor – as long as it’s private and secure.

Most recent statistics from the ministry show telehealth visits billed to MSP plateaued at 26,252 in the most recent fiscal year, down slightly from 28,003 in 2014-15, following two years of explosive growth.

There are no limits on telehealth in B.C. and it’s largely left up to doctors to decide whether it’s being used properly.

May said a key component of an optimal virtual care system is a single electronic patient record accessible to a regular team of healthcare professionals. But that remains a distant goal. The Vancouver Island Health Authority is testing a single electronic health record system in Nanaimo as a prototype for the rest of the province. Doctors there have complained that it’s not working adequately to protect patient health so it’s also under review by the ministry.

Telehealth providers say disjointed care from a rotating cast of distant doctors need not happen if it’s used appropriately.

Dan Nead, CEO of MedviewMD, says patients can request the same doctor after an initial visit and schedule follow-up appointments in advance. MedviewMD differs from typical video consultations because it takes place in a set location, adjacent to a pharmacy, and employs nurses who use blood pressure monitors, stethoscopes or devices to measure oxygen in the blood and then feed that information into records shared with the doctor.

“We can commit one of our doctors to you,” says Nead, a self-described ‘Bay Street Guy’ with a background in stock market trading. “We’re working toward dedicating doctors to the same regions, to the same locations, so that idea of having a physician who knows your history and has quite likely seen you in the past is available.

“It all circles around the continuity of care. If you cannot provide follow-up scheduled appointments, then you’re a walk-in clinic,” adds Nead, whose company has 11 locations in Ontario in addition to the four in B.C., with 19 more planned across this province, Alberta and Ontario.

For more information, visit http://www.medviewmd.com/