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Ahead of meeting with Telus, Health Canada officials were concerned about virtual care ‘inequities’

Telus building

Health Canada was also concerned with whether Telus’s health IT systems, the largest in Canada, would be interoperable with non-Telus systems for patient information sharing.

Digestible version:

  • In preparation for a meeting with Telus early last year, Health Canada expressed concern that some uninsured Canadians may not be able to afford to pay for some virtual health services.
  • The February 2021 meeting, notes of which are laid out in a summary document, was requested by Telus, which wanted to provide context on its telehealth products, including Babylon and Akira.
  • For Health Canada, the meeting was to get a better understanding from a provider of telehealth about the role of virtual care in the publicly-funded system and the importance of health data to improve the system.
  • The meeting was part of a larger endeavor by the federal government to craft a strategy for the future of health data.
  • Telus is the country’s largest health IT company and provides electronic medical record systems in use by roughly 20,000 physicians, making it the largest provider of that service.
  • Health Canada was also concerned about whether Telus’s systems would allow for them to seamlessly share data with other systems or if it would be exclusive to just Telus products.

Key quote:

“You could also probe for Telus’ views on how to address the inequities arising from charging patients for services that they could otherwise get through an in-person visit to their doctor.”

Health Canada pre-meeting notes

What this story contributes:

This story provides some of the concerns conceived by Health Canada officials about the current and future state of virtual health.

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Deeper version:

Ahead of a February 2021 meeting with Telus, officials from Health Canada who sought input about virtual care in Canada’s health care system expressed concern about possible “inequities” with products that allowed patients to remotely meet with a physician.

“While virtual care has the potential to transform health care, particularly in the primary care sector, and improve patient access to care, it could also drive greater inequities in Canada if not carefully designed, implemented, and regulated,” said meeting notes ahead of the meeting with Telus.

“In particular, the rise of virtual care platforms — essentially virtual walk-in clinics — risks increasing the divide between those who can afford services and those who cannot,” the notes added.

At the forefront of the digital health evolution is Canada’s Number 3 telecom, Telus, whose executives have told the company’s investors that its virtual care products will be huge. Initially available in British Columbia, its Babylon virtual walk-in consultation product was expanded to other provinces in the wake of the Covid-19 pandemic, including in Alberta, Saskatchewan and Ontario.

For the uninsured, Babylon costs $70, according to the notes. Otherwise, the service is covered by the provincial, territorial or employer insurance.

The company’s other telehealth service, called Akira — which it acquired in 2019 and then upgraded to Telus Health Virtual Care in April 2021 — is offered on an exclusively employer benefit basis and similarly provides a patients with access to health professionals, including nurses, for diagnoses, specialist referrals, and prescription medicines. The service provides care to over 2.8 million Canadians, according to Telus.

According to the notes, Health Canada was prepared to ask Telus how to “address the inequities arising from charging patients for services that they could otherwise get through an in-person visit to their doctor.”

The rise of virtual health care services has reached its apex with the pandemic, which has kept people at home as hospitals and clinics were stretched past their capacity.

The federal government has plowed millions into virtual care, including $150 million spread out to the provinces to increase virtual care access and an additional $50 million to Canada Health Infoway, which provides support to governments trying to digitize healthcare services and includes e-prescription services.

The federal government has also been working on a pan-Canadian health data strategy, which includes input from various players, including the provincial and territorial governments, as well as vendors like Telus. It has held a number of meetings throughout 2021 and so far released two reports that have concluded that “Canada needs to make it easy for everyone to have access to the right data at the right time to develop the right insight for health outcomes that benefit individuals, communities and society.”

One concern on the part of federal health officials is the lack of interoperability with all health systems, with one of the aforementioned reports recommending implementing such a standard by default.

“[Health Canada] has an interest in accelerating the adoption of digital tools within Canadian health systems and in enabling connectivity of these solutions such that patient information is available across multiple points of care,” it said in the notes.

Telus holds the largest share in the market for electronic medical records (EMR) systems, providing such services to tens of thousands of doctors. It provides health benefits management systems to over 10,000 pharmacies, 11,000 dental clinics and 33,000 extended healthcare providers across the country, according to Health Canada, which noted Telus’s influential position with its trove of primary care data.

Health Canada wanted to know whether those systems would be interoperable with other systems, meaning patient data could be shared seamlessly across the country. The department, according to the notes, anticipated before the meeting that Telus would commit to the systems’ standardization and interoperability. (Telus did not respond to a request for comment.)

That was the other concern for Health Canada: Telus’s protection of its EMR data, which the department said could go toward improving population health insights or system improvement.

“Many Telus products and services are primarily or solely compatible with other Telus solutions,” including plugging into the EMR systems. “While this approach may be convenient for clinicians already using Telus products, it could be restrictive in other situations.

“This lack of technical interoperability constrains providers in the use of new innovative remote patient monitoring or other tools, and results in system capture of all Telus products, whether they are the best suited to meet patient/provider needs or not,” the notes added.

In a statement to the downUP, a Health Canada spokesperson said that, “COVID-19 has highlighted challenges with Canada‚Äôs ability to optimally collect, share, and use data to support the health of Canadians.

“Reliable, timely and relevant health data are crucial to inform decision-making during public health events and to improve health outcomes for Canadians in the longer term.”

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