Telehealth in Canada

Posted: January 4th, 2023

Telehealth in Canada

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Telehealth in Canada

Telehealth is an emerging technology that is gaining acceptance in healthcare across the world. By leveraging information and communication technologies, telehealth promises to improve access to quality healthcare and bridge the challenges caused by geographical and time separation between patients and healthcare professionals. Telehealth is gaining popularity in Canada, although the country lags behind the neighboring United States, and New Zealand and the UK, mainly due to the lack of a national telehealth framework (Owens, 2018). Canadian nurses are restricted from providing telehealth services across provinces and territories unless they are licensed to practice in those jurisdictions (Canadian Nursing Association, 2017). Moreover, the healthcare workforce in Canada is not equitably distributed across the provinces and territories. As such, the provincial and territorial fragmentation of nursing services hinders the universal adoption of telehealth across the country and delivery of the benefits associated with telehealth. Having a national telehealth policy can help improve healthcare access, efficiency and effectiveness across Canada. A national telehealth strategic framework can help achieve the ambitions of a universal healthcare system in the country despite its decentralized nature. This would allow underserved Canadians to access healthcare services promptly and cost-effectively while bridging the healthcare disparities between rural and urban Canada.

Background

Canada has a highly developed healthcare system that is administered by highly qualified healthcare professionals (Gory, 2018). However, the country has insufficient healthcare professionals, as demonstrated by its 28^th rank among the 33 high-income counties in the world in terms of the ratio of physicians to the population (Lumeca, 2019). Therefore, Canada experiences shortages that cause Canadians to wait an average of four weeks before seeing a physician. Moreover, the cost of healthcare is rising in the country, having doubled in the last two decades (Lumeca, 2019). While telehealth has the potential to overcome these challenges, it requires a cohesive framework to be effective across a country (World Health Organization, 2012). However, telehealth is administered differently in the provinces and territories in Canada because of the lack of a national telehealth framework in the country (Canadian Nursing Association, 2017). Altogether, in Canada, telehealth has not grown at the rates witnessed in other countries like the United States, despite its potential in the country.  

Definition and Scope

Telehealth is the application of electronic and telecommunication technologies to provide healthcare services to patients remotely (World Health Organization, 2012). Therefore, telehealth is often associated with terms such as telemedicine, telenursing, telehomecare, teleconsultation and e-health (Canadian Nursing Association, 2017). Moreover, telehealth is diverse because it involves different aspects of healthcare. Therefore, telehealth has advanced to include telephamacy, remote monitoring, mobile health and live videoconferencing and many more (Mechanic & Kimball, 2019).

Shortages in healthcare personnel and the geographical diversity in Canada remain barriers to the equitable provision of healthcare across the country. However, nursing practice is particularly benefiting from the advancements in telehealth, considering the continued shortages in nurses alongside the ever-rising cost of healthcare. The country can be persuaded to adopt a national telehealth policy if the benefits and challenges are well understood by the policymakers and healthcare practitioners. In turn, the barriers limiting the application of telehealth by nurses across Canada would be reduced, enabling the underserved Canadians to benefit from quality healthcare promptly, conveniently and cost-effectively. Therefore, this discussion focuses on the need for a cohesive approach to telehealth at the national level rather than the policy change in the healthcare administration in Canada.     

Benefits and Challenges

Telehealth can deliver numerous benefits to healthcare systems and individuals patients when used currently and prudently. Improved access to healthcare is a commonly cited benefit. Patients that are located far from their healthcare providers often miss appointments. Also, patients are unable to access healthcare on time and do not communicate face-to-face with their providers regularly. Patients may lack the means or the finances to travel to hospitals or clinics to honor their appointments. Besides, they may be unable to access a nurse or a doctor late at night after working hours or over the weekend when their health condition worsens or in case of an emergency. Moreover, healthcare professionals may be physically unavailable when needed by patients considering their heavy workload and busy schedules. To overcome the distance and time challenges, telehealth allows patients to access professional healthcare at any time and from any location through a mobile device provided there is cellular and internet connectivity (Mataxen & Webb 2019). Indeed, telehealth has enabled the provision of nursing services around the clock, which can translate into improved population health outcomes. For instance, in Quebec, the Eastern Quebec Telepathology Network (EQTN), which brings together 22 hospitals, serves 1.7 million people spread across urban and rural areas in the province who are attended by 59 pathologists (Alami et al., 2018). With 35 of these personnel being located in Quebec City, EQTN has helped bridge the inequitable access across the territory (Alami et al., 2018).     

Telehealth can reduce the cost of healthcare and reduce the financial burden on healthcare systems in countries that are ravaged by rising healthcare costs. Specifically, telehealth can reduce the frequency of hospital visits by eliminating the unnecessary ones for issues that can be resolved remotely by a healthcare practitioner. Moreover, it reduces the need to visit different health professionals physically because they can be accessed simultaneously and conveniently using technology, thus reducing travel expenses. Moreover, communication costs are continuously reducing with the continued technology advancements. For instance, in the United States, nursing homes have reported a 10% reduction in inpatient hospitalization due to the off-hours use of telehealth (Mechanic & Kimball, 2019). Also, telehealth delivered an annual saving of approximately $150,000 per nursing home in Medicare costs while the Veterans Health Administration (VHA) saved about $6,500 annually per patient (Mechanic & Kimball, 2019).    

Telehealth can improve the patients’ ability to manage their health-related matters, thus giving them autonomy on their health. Telehealth empowers patients helping access information for the management of their health conditions at the convenience of their homes. Patients are also kept well-informed on their health status at the click of a button, thus enabling them to monitor their health progress continuously. Therefore, patients gain independence as they have increased autonomy over their health. This encourages them to adhere to professional health advice and pursue healthy lifestyles to avoid health complications and hospitalization, which has a positive effect on the high cost of healthcare.  

However, telehealth is challenged some disadvantages, which may hinder the realization of its promised benefits. Privacy of personal information is a major hindrance to the adoption of telehealth. The concern that patient information and records shared digitally may be accessed by unauthorized individuals prevails. For this reason, a significant number of Canadians mistrust telehealth and prefer traditional healthcare approaches instead. Moreover, it raises the risk of litigation for healthcare practitioners who violate informed consent confidentiality requirements unknowingly (Mechanic & Kimball, 2019). Besides, misdiagnosis can occur because of the absence of physical proximity between the healthcare professional and patient. Poor quality of audio and video data alongside the inability to physically test a patient may compromise the quality of diagnosis.

Rutledge et al. (2014) observed that healthcare training programs raise awareness about the benefits and disadvantages, and barriers of implementing telehealth. This is because many of these outcomes are yet to be observed in real life, considering that many telehealth initiatives are in their initial stages.

Impacts and Implications

Telehealth portends to influence nursing practice significantly. In an environment in which nurses have heavy workloads and are unevenly distributed, telenursing promises to enable nurses to provide quality services to many patients without the need for physical meetings. In Canada, several large telehealth providers such as Wello, Dialogue, Maple, GoeVisit and Akira exist, with their business models focusing on reducing in-person visits to healthcare centers (Gory, 2018). Moreover, nurses can expand their reach to the underserved population where nursing professionals are scarce. Already, most of the nurses using telehealth in the country, including 90% of those surveyed at Island Health, recommended telehealth as a way of reaching rural populations and vulnerable communities (Allen, et al., 2015).

However, some nurses and patients were apprehensive that telehealth would dilute the professional-patient relationship, affecting the health outcomes adversely. Koivunen and Saranto (2018) revealed that the attitudes and skill deficiency of nurses were hindering the implementation of telehealth even when the technological tools were available. Consequently, nursing education has to impart skills that would enable nursing practitioners to use telehealth effectively. With telehealth comprising of diverse technologies, skill training should focus on developing assessment, communication and relational practice skills that would facilitate the provision of holistic patient-centered care using different telehealth technologies (Nagel & Penner, 2016).   

Recommendations

While Canada is making significant progress towards the adoption of telehealth, the efforts should be coordinated and cohesive across the country. The federal government needs to invest in a nationwide strategy that would facilitate the establishment of a telehealth network across all the provinces and territories of the country. In this regard, the federal government should collaborate with the private sector to develop a nationwide telehealth infrastructure that can be shared among the different administrative establishments in the country. This included having a comprehensive nurse training program that developed diverse competencies that would allow nurses to use diverse telehealth technologies effectively and efficiently (Van Houwelingen et al., 2016).  

Conclusion

The country wide adoption of telehealth in Canada is constrained by the lack of a national strategy, despite the significant progress made by the private healthcare establishments across the various provinces and territories in the country. With the Canadian healthcare sector experiencing a shortage of healthcare professionals, telehealth promises to bridge the shortfall, while improving access to quality healthcare and reducing the disparities in health outcomes across the country. Rather than develop different telehealth initiatives that are fragmented across the vast country, the nation can benefit significantly by adopting a nationwide framework that would facilitate the establishment of a national telehealth network. This would encourage equitable development of telehealth infrastructure across the country and efficient utilization of the nursing professional in the country.    

References

Alami, H., Fortin, J. P., Gagnon, M. P., Pollender, H., Têtu, B., & Tanguay, F. (2018). The challenges of a complex and innovative telehealth project: A qualitative evaluation of the eastern Quebec Telepathology network. International Journal of Health Policy and Management, 7(5), 421-432.

Allen, M., Aylott, M., Loyola, M., Moric, M., & Saffarek, L. (2015). Nurses: extending care through telehealth. ITCH, 208, 35-39.

Canadian Nursing Association (2017). Fact sheet: Telehealth. Retrieved 19 January 2020 from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/telehealth-fact-sheet.pdf?la=en&hash=AB1B315626AF74B3A3E1A2D7DB46001BE23E2238.

Gory, C. (2018). Is telemedicine the next big thing in Canadian health care? Orchard Benefits. Retrieved 19 January 2020 from https://orchardbenefits.ca/is-telemedicine-the-next-big-thing-in-canadian-health-care/.

Koivunen, M., & Saranto, K. (2018). Nursing professionals’ experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scandinavian journal of caring sciences, 32(1), 24-44.

Lumeca (2019). Is telemedicine actually more affordable? Lumeca Health Inc. Retrieved 19 January 2020 from https://lumeca.com/is-telemedicine-actually-more-affordable/.

Mataxen, P. A., & Webb, L. D. (2019). Telehealth nursing: More than just a phone call. Nursing, 49(4), 11-13.

Mechanic, O. J., & Kimball, A. B. (2019). Telehealth systems. StatPearls Publishing.

Nagel, D. A., & Penner, J. L. (2016). Conceptualizing telehealth in nursing practice: advancing a conceptual model to fill a virtual gap. Journal of Holistic Nursing, 34(1), 91-104.

Owens, B. (2018). Telemedicine on the rise but lagging in Canada. Canadian Medical Association Journal, 190(38), E1149.

Rutledge, C. M., Haney, T., Bordelon, M., Renaud, M., & Fowler, C. (2014). Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations. International Journal of Nursing Education Scholarship, 11(1), 1-9.

Van Houwelingen, C. T., Moerman, A. H., Ettema, R. G., Kort, H. S., & Ten Cate, O. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse Education Today, 39, 50-62.

World Health Organization (2012). National e-health strategy toolkit: Overview. World Health Organization and International Telecommunication Union. Retrieved 19 January 2020 from https://www.who.int/ehealth/publications/overview.pdf.