13:05:18 ...With the brains are thinking about how we can use data to actually solve problems. So, welcome everyone and thanks for doing this and thank you, Jason.
13:05:28 Alright. Thanks so much, Soo Min. Thank you. And Dr. Jason Field, CEO of Life Sciences Ontario. Jason.
13:05:34 Thanks, Jayson I don't want to take much time because I know you guys have the, the heart of the discussion coming here and looking forward to, to hearing a bit of it.
13:05:45 You know when Jayson reached out to me about this, I thought it was a great idea and it was something that we wanted to support.
13:05:52 Certainly COVID-19 has been a challenging time for all of us.
13:05:58 But one of the things that it has also done is it's accelerated adoption of technologies like virtual communications and, you know, I don't think we're ever going to go back fully to how things were before the pandemic.
13:06:13 So this is a really important discussion to have about how we can make the most of this opportunity to advance new technologies in terms of digital health communication.
13:06:24 The other thing that COVID-19 did was it really exposed inequities in health care, and I think digital health communications has a tremendous opportunity to help address some of those inequities and access to health care for all Canadians so I think
13:06:41 that's an important element that shouldn't be forgotten as part of this discussion. So I'm going to stop there and just thank all of you for participating.
13:06:49 Looking forward to some of the discussion. Unfortunately I'm going to have to drop off at some point, but I'm going to hang in as long as I can because this is exciting and I want to hear what you have to say, so. Jayson.
13:06:59 Thank you. Alright, thanks so much Jason. Cheers.
13:07:03 So why don't we just do a quick round robin, say hello and introduce yourself, if you don't mind, Mr. James Cran. Good afternoon, everyone. Thank you, Jayson once again for allowing us to be or me to be a part of it.
13:07:18 I guess I'm more from the industry side, my background; I've been about 30 years in the drug industry both on the industry side itself and then on the supplier side.
13:07:28 I think I can bring some insights today, I had an agency called antibody healthcare communications that I launched, I guess back in 2003, with two of us and we drove it to the largest healthcare communications agency in Canada, and then I actually walked
13:07:41 away from it a couple of years, just before Covid and mainly to focus on digital technologies to really impact healthcare providers and Canadians. So I'm looking for the discussion Jayson is nice to see you, because I know we've done some podcasts together in the
13:07:57 past as here to know, one of our database companies has been supportive of the LSO as we talked about things like pricing changes here in Canada but Jayson thank you for allowing me to be part of the discussion.
13:08:10 Okay, thank you so much. Dr Kendall Ho? All right, thank you.
13:08:14 Jason thank you so much for inviting me. My name is Kendall Ho, emergency doctor in Vancouver also professor at UBC faculty of medicine, like to just take a minute for land acknowledgments that I'm calling in from the traditional and unceded territories
13:08:31 of the Squamish Musqueam and Tsleil-Waututh First Nations. Really a pleasure for me to participate in this conversation. I carry out area in my practice in terms of virtual care, we support our governments, over the last year and a half, and establishing some
13:08:48 virtual care lines to support patients and peers in delivery of care. I also do research in the area of digital health using sensors, wearable data analytics, machine learning, in terms of supporting care, and really looking forward to this conversation
13:09:05 to discuss how can we bring technology forward, the best way we can. And also to understand that health care, it's really about longitudinal care. And so where this virtual care fit into this longitudinal journey of the patients.
13:09:19 What does quality of virtual care mean. And when would we need to hand over, virtual care to in-person care for appropriateness and quality and safety so looking forward to diving into this conversation.
13:09:32 Thank you so much, Dr. Sharon Domb. Afternoon and morning to some of you anyways thank you for having me. So I'm also a frontline clinician. I'm a family physician at Sunnybrook here in Toronto, associate professor at University of Toronto.
13:09:47 I've been involved in IT endeavors for the better part of probably 15 years, and really excited about this initiative. When the pandemic hit we had to pivot our whole team to virtual care as everybody else did.
13:09:59 And really, you know, learned on the fly and I'm excited that we actually got pushed into the 21st century because we weren't there, and we needed to be so happy to see where we can move with this, going forward.
13:10:12 I think we were talking about digital electronic medical records for 50 years, so yeah. So, point well taken.
13:10:18 Dr Darren Larson.
13:10:20 Hi everybody, good to see all of you who I know so well. A lot of you have been with a long time there. Darren Larson and family doctor at Women's College Hospital and Family Health Team their senior fellow at the Women's Institute for Health System solutions
13:10:33 virtual care also teach at U of T and the Institute for Health Policy Management and Evaluation and the Masters of health information, information program and of course going on right now and strategy and spent half my time now with Accenture as the senior advisor
13:10:48 advisor and Canadian health care for the new Accenture health practice so really excited to be here in this conversation, living it every day in my practice, plus also from the policy side and also from the implementation side so great to be with you.
13:11:01 Thanks, Darren.
13:11:02 Mr. Todd Staples.
13:11:06 Hey everyone, again, Jayson lots of rounds of thank yous for you. Here's another one I was really excited to be part of this group.
13:11:13 I am the head of healthcare innovation for Acto technologies. Acto is an omni channel education platform the first omnichannel education platform specifically for Life Sciences.
13:11:24 So what we do is we help global, pharmaceutical medical device companies, educate and engage learners across the entire care continuum, and create a unified educational experience across the whole continuum and I'm really happy to
13:11:39 be here.
13:11:41 Specifically what I'm focused on at Acto is taking this amazing tech stack that we have of AI and machine learning and micro learning and finding out how we can best reshape that specifically for HCPs for their educational journey so excited to learn
13:11:57 and listen in and contribute wherever I can. Thank you Todd. And last but not least, Dr. Brendan Byrne.
13:12:14 Hey Jayson. Yeah, thanks and kudos for you to setting this up.
13:12:09 I am speaking to you guys from the traditional unceded territory of the Semiahmoo first nation, otherwise known as White Rock BC.
13:12:18 I'm a family physician by training lifestyle medicine physician now by choice but I spent a lot of years in technology at a real diversion. Founded one of the early MR companies that did pretty well, sold it to Telus, built their kind of EMR group, do a
13:12:37 bunch of acquisitions and then landed as Chief Innovation officer at Telus Health, which brought me back to practice because kind of seeing all the exciting innovations I thought, gee, why can't we start to do this on the front line so
13:12:49 my practice has been a little bit of an incubator, trying to pull kind of some of these new technologies into place. But as a bunch of you kind of noticed that, you know, Covid, was an accelerant.
13:13:02 Right.
13:13:02 You know, things that that had seemed...
13:13:04 That would be nice to do were suddenly essential to do, and I'm really looking forward to the conversation around, what, where do we go with virtual care.
13:13:14 You know we're not going to go backwards but.
13:13:16 But we also have to acknowledge that for 90% of physicians in the country virtual care is a telephone not not interactive video like a lot of us would would be excited to see except I'm looking forward to the conversation.
13:13:29 I well great thank you so much, Brendan.
13:13:33 And I think just, just before we move on, I just want to pause for a moment.
13:13:38 Zoila has done all the heavy lifting and make this possible. So, Could you introduce yourself.
13:13:45 Thank you so Hi everybody. It's nice to see everybody face to face finally instead of through email profile pictures. So as Dr. Parker mentioned my name is Zoila, I am a first year student in the master of biotechnology program at UTM.
13:14:03 I have a focus on digital health technologies.
13:14:06 So this is a very new field for for me, as I graduated previously with a bachelor's degree in medical and biological physics.
13:14:15 But I am looking to transition into more digital applications of health so this talk will be very useful for for me to learn from as well as all of my peers.
13:14:26 And again, I just wanted to thank everybody so much for volunteering your time. It will be very useful again for myself, my peers and other people in this field to learn from people such as yourself with so much background and experience so thank
13:14:43 you for your time and your insights and I look forward to, to hearing from everybody.
13:14:52 Okay. Great. Thanks, thanks so much Zoila. Okay so what so we're finished with the introductions. Now folks, so why don't we kind of transition now into why we're here.
13:15:00 So, I just shared a screen and you know this is a, we have something like this has not really been to my knowledge tried before so we'll see how this goes okay but we're, we only have three questions to discuss.
13:15:15 So we certainly have time to discuss these issues. And so they're our first task is sort of the possibly the biggest question is what is the best way best way for best way for physicians to make it to me communicate to patients by a digital medium.
13:15:34 So why don't we maybe I don't think I want to be calling on people, let's just have a discussion so let's let I know visually things can be a little awkward but I.
13:15:43 This is not a panel guys we're just working in chatting here So, any thoughts on this?
13:15:50 Sure, maybe I'll, I'll jump in. To start, I thought about three things that would be helpful in terms of structuring a good communication with our patients number one is, if at all possible.
13:16:04 Meet the patients where they are in their comfort of technology.
13:16:09 There are many times we can say, you know, please go to this platform, please go to that platform. But if there's a way for us to say to ask the patient what platform.
13:16:18 Are you comfortable with.
13:16:20 I think that's a better way to connect. Now, of course there are issues about security etc for all those, but I think meaning a patient where they are, would be important.
13:16:29 Secondly, I think, as, as Darren pointed out, currently, many virtual care is by telephone only.
13:16:37 And so I think by expanding to multi channel virtual communication is great. So for example, expand the video expansion to text messaging expansion to, you know, discussion groups.
13:16:52 The more medium, the more likely we can collect more information.
13:16:58 So I think that's a second. So this would include sensors wearables are using natural language processing or your mobile phone to detect certain types of behavior.
13:17:08 But then the third is very important is that every virtual care, should we think about long term care, and how this virtual care fit in that long to no care.
13:17:18 I'm sure that there are an insurance speak about the importance of long term care. And so virtual care is not just episodic intervention on an acute illness, but really should rest on the foundational longitudinal care to truly give patients, a strong
13:17:33 protection and quality of care.
13:17:37 I that's it that's a great point.
13:17:40 Sorry, Darren, go ahead.
13:17:44 Oh you're muted there sorry, Darren. Let's just make sure you're... I said Kendall thank you we think alike, exactly as I was gonna say where the patients are is where you start.
13:17:53 And the other thing to remember is that the patients don't need the same kind of digital communication for each problem, every single time. So you know we I always think in terms of what do we have to do right now in order to address a visit, let's say,
13:18:06 which is going to be a synchronous form of digital versus what can we do offline or after the fact, or in conversation back and forth it's more asynchronous and nice point to this study that was done by Ontario telemedicine network when I was in Ontario
13:18:18 MD around the virtual care platform and the rollout there and the surveys, with with patients they found that 93% of the patients chose not to use video and they chose not to use video and prefer in fact things like email and text messaging, in a non synchronous
13:18:33 way because of very simple things like when I'm sick. I look terrible I look even worse on my, you know, fisheye zoom lens on my iPad. I don't want my doctor seeing or my nurse seeing my really horribly kept apartment right now, I might have five people behind
13:18:47 me and in a very close quarters environment. So very real reasons about humans about why they don't want to use video, and why we're still using in my own clinic which is supposed to be a very advanced virtual kind of community are still using the telephone
13:19:01 for about 90% of our virtual care business because that's what patients want. So, it isn't always the most bright shiny thing is the best thing for patients I think what we really need is some way of triaging the right type of visit the right type of
13:19:13 of communications technology for the right problem at the right time with the right person so that triaging piece in my mind is a big unmet need all the stuff about.
13:19:22 Okay, great, thank you for sharing. Sharon?
13:19:26 I just want to come out and spoke about what you said so Kendall I agree that, you know, we need to meet patients where we're at. I think we also need to meet clinicians where they're at.
13:19:33 And there's a big heterogeneity in terms of how comfortable clinicians are with various, you know piece of technology. Right, so we were talking about what the, you know, patients are comfortable with. Absolutely true.
13:19:45 But you know what some physicians don't want to use video because they're not comfortable with it, they go to the phone because they're comfortable with it.
13:19:53 But you know there's complexities with sending out a link to a video thing you need to you know make sure you've got the right setup.
13:19:59 You need to make sure that you've got a microphone attached to your computer, you're going to make sure you've got a camera.
13:20:05 So there's some technical aspects to it but there's also some, you know, just IT, things that people need to be comfortable with.
13:20:12 So that was comment number one.
13:20:15 I'm going to comment - Darren, and I'm curious about your, your statistic, with respect to people not wanting video because that is not our experience and so I'd be curious to see that study that you looked at and I wonder whether or not that has something
13:20:28 to do with the patient comfort level whether or not there's any, you know, social determinants of health that are coming into play with people's comfort or accessibility to, you know, technology, and whether or not that's an issue.
13:20:42 But we have actually had very very positive feedback for our video encounters and patients feel like they're much more like an in person encounter than they do on the phone.
13:20:53 So I think there's some you know mixed feedback with that.
13:20:56 But there's certainly you know interesting things here and I think the other thing going back to your question, Jason.
13:21:03 What's the best way for physicians to communicate, I think, you know, all of the things mentioned above, but I think some of the real important things for clinicians are we need to have something that's integrated with our EMRs, and our systems that were
13:21:15 already using so not to I think we need to not be pushing towards separate standalone systems because most physicians are not looking for yet another system to use.
13:21:27 Yeah, for sure. Brendan?
13:21:30 Yeah, I think this is, this is great because I put my hand up and I think a bunch of the things I was thinking have already been said. So I think one of the things that is so important is that concept of different appointments have different best practices,
13:21:45 right and so there are times where you really do want to see the person and watch the body language as much as you can virtually.
13:21:53 There are also times where you actually do need to see a person can put in person.
13:21:58 I think the, you know, so it's I think that triage piece is really important.
13:22:03 The technology piece as Sharon just said, you know, integration with the tools that physicians are using, and integrations such that it, you know, it doesn't disrupt every, every visit, you know, because overwhelmingly what I've heard from my colleagues
13:22:19 is they defaulted to phone because they lost five minutes on it almost every single visit because of technical issues with the platform they are choosing so that's still a big hurdle out there and,
13:22:31 And I think that it's it's a challenge.
13:22:35 And I think that, you know, going back on the triage piece looking at, you know, there are some visits where you know synchronous versus asynchronous is another aspect to this.
13:22:46 And, you know, there are fee structures get in the way, right. So, there may or may not be a fee structure to to account for that. And the, the one thing that I learned during this was in my practice I do a lot of explanation of things and asynchronous
13:23:04 video. Walking people through things that I didn't necessarily need to, you know, try to explain insulin resistance to people in a 10 minute visit.
13:23:14 I actually have a pretty good video that can do that, and I can actually follow up and, you know, the concept I'm going with this kind of flip the exam room a little bit like flipping the classroom where you know the lectures are done at home and the
13:23:25 homework is done it in the classroom.
13:23:27 I think that's a concept here for patients that's really useful as the explanations can actually be packaged in a multimedia format that they can run asynchronously.
13:23:36 And then you're there as a human being to answer questions and to see where they able to understand it, did it make sense to them, did apply to them.
13:23:44 So I think that there's a lot of potential in that aspect.
13:23:49 But I do think the triage piece and best practices around the triage is, is what's needed.
13:23:57 If either for yourself Brendan or for anyone else. Maybe we can expand a little bit on because you guys make reference to triage and maybe you spend a little bit on what are the what are the kind of the best kind of appointments, you know clinically
13:24:13 to have and and what are unnecessary? So maybe so certainly comes to mind is, you know, maybe in the context of neurology, you know, if you want to do assessment or meet with multiple sclerosis patients, you might want to do that in person, as opposed
13:24:29 to a video consult. So can we expand a little bit on the, on this, the triage inside of in person, versus video. Like, what are the kind of the clinical characteristics that might demand one over the other.
13:24:42 I sorry Sure, yeah. Okay.
13:24:46 Okay, go ahead. Brendan. Okay. Well, I just going to kick, kick it off and I don't think I have a definitive answer by any measure here so I think we'll tag team on this, but but I think, you know, there are times where you physically need to examine
13:25:00 a person, and that's very clear and a lot of what I find with my practice I'll do a consultation.
13:25:09 And the other aspect I didn't really mention that, you know, digital technologies and virtual care can also include the use of structured detailed questionnaires so that the time with the practitioner, isn't spent transcribing a whole bunch of history
13:25:26 that the time is actually spent, you know, getting to know the person.
13:25:31 And so I think that you know the use of some of these technologies to to prepare for the meeting, kind of, ahead of time so in my practice. By the time I meet with somebody.
13:25:41 They've spent probably about 30 minutes, putting down kind of their information in a structured format that allows me to to really talk to them about a lot more of the social factors and social determinants of health and then necessarily going, going
13:26:02 into reviewing kind of what you know what their past medical history was.
13:26:01 So, but, but that type of visit where our first meeting a person, you know, seeing somebody, you know, seeing seeing them I think is very important. The video is very very important at that time.
13:26:11 Also when you're explaining things it's very important to be able to see people. Often we have other things where it's a follow up on you know on a medication or a follow up on a particular intervention.
13:26:23 That's very, very simple, and I, that, you know, I don't necessarily need to see the person and a telephone call could work. Asynchronous could work just as well because it's just an exchange of simple information.
13:26:37 Did you know, were you able to do this Yes Did you have any issues now, right, let's say, so I think that those are some aspects as well. Maybe I'll turn it over.
13:26:46 to Sharon.
13:26:46 Okay, thanks so I mean I agree with Brendan we use a lot of these pre visit questionnaires as well to sort of fill in a lot of the basics and it's a huge help.
13:26:54 I think we're we're at overall is a you know in a transition zone where we're trying to figure out what needs to be virtual, what needs to be in person and virtual could be, you know, zoom, or another video platform or phone.
13:27:07 There are certain things to us that are clear that have to be in person, so you can't weigh a baby through any mode of virtual care.
13:27:14 You can't listen to a fetal heart through any mode of virtual care. So there are certain things that really are impossible to do.
13:27:22 Virtually. There are a lot of things that are kind of in the middle where you know what if somebody, you can check someone's blood pressure cuff if they have a home cuff and have a way to send in their readings, and you can look at them.
13:27:35 So I think we're we're finding that we're sort of in a transition. Now, there are certain ones that we can tell or page that our admin assistants who are booking the appointments, this has to be in person this category of visit.
13:27:47 This can definitely be by phone like a follow up for anxiety or depression or whatnot.
13:27:52 But there's a whole category in the middle and to be quite frank patients don't always say exactly what they're coming in for, or they say one thing and they have a list of four things.
13:28:01 So those are the ones that we're finding challenging to, to be able to triage properly and we're still ending up with some duplicate visits where we do a virtual and then, you know what, I've got to bring in to do that because I got to look at something.
13:28:12 So I don't think we're there yet but I concur with what was said before we really need to sort of figure out some algorithms to be able to help our frontline staff be able to triage properly so that we have less that end up being those double visits and
13:28:25 more that I end up being triage appropriately right off the bat.
13:28:29 For our clinic I don't think we're there yet in terms of figuring this out well.
13:28:35 Thank you. Todd I realize you had your hand up for a while there.
13:28:38 No, that's fine. I think one of the things that stands out to me here is the idea of silos and I'm not sure who said about the EMRs being integrated Sharon I think it was you integrating whatever video digital medium communication system into the EMR
13:28:55 so critical well we've seen it at ACTO, one of the things that that helped us a lot was looking at all these great like well intentions behind all these new tools to create all this efficiency, and it actually created all these silos of information there's
13:29:11 locked down in the box it's hard to bring together. So I really resonate with that.
13:29:16 And then in terms of, you know, our understandings of the, the biggest pain point for HCPs is time, right so anywhere that we can save time for the HCPS they can put that back into catching up on paperwork see more patients and doing all the things that
13:29:30 they're struggling to get caught up on because of the, the stressful overbearing schedule. And I think one opportunity would be when questions that are asked that are repeat questions that a lot of patients asked, finding a way to capture those answers
13:29:46 and use those asynchronously and even suggest the right video clip and the right piece of content at the right time. They can be shared with 20 patients instead of just one you've just created a huge time efficiency there.
13:29:59 Yeah, it's a, and I don't you know I could see prob- perhaps some emerging services or opportunities they're kind of external to the healthcare system.
13:30:10 Kendall. Yeah, really appreciate Todd's point I'll come back to that a little bit.
13:30:15 But I'll speak to the triage point first. Maybe I'll bring a slightly different perspective that I work with a provincial agency 811, where patient calls information so I don't have a starting relationship with these patients.
13:30:30 So I do appreciate Sharon and and Brandon's point about, you know, patients that they know about. So far, since we started, we've seen over 60,000 cases.
13:30:42 And we found that about 75% of cases telephones, is adequate in making recommendation. Do you need to go to emerge. Do you need to see a family doctor you can stay home, but about 25% of cases is, it's indispensable to video.
13:31:00 And in those cases, for example, you know someone calls and said, I just banged my face and I have a cut on my face that's jagged, but it's not bleeding.
13:31:10 Do I need to go to emergency and get it sutured, I really don't want to be exposed to Covid.
13:31:15 There's no phone that can replace the camera to actually for me to be able to look at the wound itself.
13:31:22 There was a funny case, a mother with a toddler who fell off the bed, five feet. Half an hour later call and then set the foot is very swollen, that the toddler is crying.
13:31:33 Do I need to take the toddler in for x rays.
13:31:37 The mother is very good within about, you know, 10 seconds we got zoom connection. And when she turned her camera to where her child was, he was gone.
13:31:52 And for the next 30 seconds were chasing down the toddler down the hallway up the stairs. And he was just running around so I said, you know, at this point, why don't we just wait, you know if by this afternoon. The toddler is not complaining.
13:31:59 That's okay.
13:32:01 I think the third case is important and then that comes back to Todd's point.
13:32:06 This is a case of a 30 year old female, who was diagnosed Covid three days prior to the call.
13:32:13 And when they call in when the husband called in, it was because she was getting more and more short breath into wondering whether they need to go to emergency.
13:32:21 At that point, turning on a camera. It's clear that she was struggling for breath, they bought an oxygen saturation. In fact, there's a drop of five points of oxygen saturation within the last 12 hours.
13:32:34 It was clear that she needs to go to emerge. But the reason they call it's not really about, you know, do I need to go to emerge or not because they knew it.
13:32:44 But what the husband was calling is.
13:32:47 If she goes to the emerge.
13:32:49 Will I ever see her leave the hospital again.
13:32:53 And their question was, you know, is this an ICU case.
13:32:57 And I was privileged to be able to brought into their home at that particular moment to support that decision, but to also reassure them that there are medications available in a hospital so you got to get it treated, it is severe.
13:33:12 I can't guarantee they won't survive but obviously it's a moment that we take advantage to be able, it really a privilege to be able to help them. And so coming back to touch point yeah efficiency is very important.
13:33:25 You know, how do we maximize that but I hope that technology will only be an enabler. And I hope that technology brings us closer - health professionals and patients - as opposed to farther away, no separate information, not quite know where things are because
13:33:41 of efficiency I'll cut down compensation so I can do more electronic charting.
13:33:46 Okay, I think you Kendall, and I'm sorry guys I'm losing track of the order a bit but Brendan and then Darren, Brendan.
13:34:04 Um, yeah, it really like to kind of reiterate just just what Kendall said, and I think it actually should be a governing principle here. But, technology has the potential of really kind of fostering better connection.
13:34:10 Right. And so, you know it's it's a better connection when you can, you know, interact with somebody in a way that's actually more convenient for them and doesn't take them out of their, their lives for three hours as they sit in your waiting room and
13:34:21 so on and so forth.
13:34:24 And I feel like the other piece with that is, you know, we, we often kind of, you know, in our processes have a lot of things that we need to accomplish and if we can kind of flip those so that they're not taking place during the exam time, and that that's
13:34:40 done so that the physician-patient interaction can truly be human. So we actually can do the things that humans need to do which is sometimes like you know, see, see the person for where they're at.
13:34:53 Sometimes explain things sometimes just, you know, express, you know, compassion, or empathy, whereas Kendall just said, your reassurance right there.
13:35:02 These are human factors that you know know questionnaire can do or no asynchronous video can do.
13:35:06 But, but we can do that. And we sometimes miss that because we're fussing with the technology or we're trying to do this or that. So I think that was a huge piece.
13:35:17 The other thing that I think is really interesting, you know, I think Todd was talking about it is, in terms of things that we need to communicate to people.
13:35:28 You know, we can do a better job with that, especially if we have tools that are - so we can use video, we can use interactive reports that allow people to pace themselves.
13:35:39 We can actually use patients' own data in some of these reports and that's something that I really started to try to do is to use kind of the data that we're actually gathering to show people what's happening with them and explain it in context in a in
13:35:53 a format that they can take the time with, and then be present to be able to answer their specific questions, rather than, you know, going, going there.
13:36:03 So those are a couple of points I just wanted to bring up. Sorry Brendan and before, before we move on, maybe we talked about reassurance and you mean done best in person or by video?
13:36:14 I think you can do it either, right, and I think that.
13:36:27 And again, I think, going back to it I think the very first point that Kendall made was the best place for the person, so it's kind of that balance between what Sharon said and Kendall said yeah, there's some things you just can't do by video so clearly
13:36:32 you want to triage that so that you know you're not trying to weigh the baby over the phone.
13:36:35 But there are other things where persons going to be way more comfortable actually speaking to you from home.
13:36:43 And, you know, a video connection with somebody at home where they're comfortable they haven't had to commute, they haven't had to wait in your waiting room, and they're able to in the quiet of their own home have a heart to heart conversation can be,
13:36:55 you know, just just as good.

13:36:58 Okay, thank you. Darren? I'm not really worried about the the the well, though, you know, those who are young and well and capable and able to get around and visited doc in the box or do a maple virtual clinic visit or whatever they want to do.
13:37:12 I'm really worried about those who are truly, I think disadvantaged either by illness or in capacity or having three jobs and no ability to get into the clinic period and where do we meet them, the, you know, for this summer, like for all of wave three
13:37:26 I had the honor of running the women's college Covid care at home program so we ran an entire program for people with Covid at home, including pregnant women being discharged from hospital sometimes in very desperate circumstances on oxygen fully supported
13:37:39 with drugs and IVs and rescued and we did that virtually 100%. And we did that with, we did put equipment in the home, we'd send by Uber, a baby scale, if it was a newborn coming out of hospital the baby scale went by Uber to the house.
13:37:52 It was essentially you know loaned for a while and they would come back as remonde from the baby we sent pulse oximeter to everybody and we sent medication kits out it was a very organized approach and I think as we getting into these are integrated healthcare
13:38:04 systems now that we're seeing across the country with managed care moving from one environment to another. We're going to see the use of virtual far more often.
13:38:13 And one of the things that we're not using really at all in my experience in health yet, are some of these digital front doors so on the line of triaging, you know the tools now that are being built for interpreting language and asking the appropriate questions
13:38:26 based on feedback and things are getting better and better and better and I don't want to call them bots necessarily but they are like virtual nurses or virtual secretaries for an office, and a way to get into an office to triage appointment is now becoming
13:38:40 becoming much more streamlined, if we started to address these tools now they're not perfect and we worry about them making mistakes medicolegally and things like that but but it won't be long until a virtual assistant I think can help us with a lot
13:38:53 of this front end work, and in fact triage highest risk lowest risk and the needs for people to come in, when they need to be some of this work is being pioneered in Sweden so some really great work there.
13:39:03 So there's some really great work there. Kaiser Permanente as well has done a lot of work on digital front door and virtual and I posted a paper in the chat around what Kaiser has done since the pandemic and their movement of virtual in the types of offerings.
13:39:14 So, so I think what we fail to do is we fail to look at the whole problem holistically, we look at it from a lens of a virtual care company or a bright shiny thing and to lend a hand or a program, and it would be, I can't wait for these integrated care
13:39:27 systems to evolve and to a degree some degree of Accountable Care follow up, where we're going to be able to say what the system needs to look after this group of patients that population or individuals, is there, and we're going to offer it.
13:39:38 And I don't think it's far away, frankly. Oh, interesting. You know, I, I realize we can't get off topic here but it's a perfect intersection with a long shot I just had with biomedical engineering over the last 24 hours with their graduate students,
13:39:52 they're working with, you know, they have a project they're working with artificial intelligence and mental health care application. The FDA regulatory landscape here is unclear.
13:40:01 And one of the things that we've kind of come up with within the regulatory landscape is probably the lowest risk application of AI is in triage. So it's just a very nice connection with your with your point there. Brendan?
13:40:14 Yes, I think just going back over with. Daren just said, you know, I think that that holistic view is so important. Right.
13:40:25 You know there when I did a lot of my innovation work there's so many solutions looking for problems and see that the tech doesn't fit.
13:40:34 Because it's not you know it's not fit for purpose in that front line.
13:40:41 What I do think is hampering us is, is, is the current kind of organizational structures in healthcare, right. So, you know, the, the, the, you know, kind of the typical family practice, you know is not necessarily, kind of, you know, the right, you know,
13:41:01 the right entity take to get this right, divisions of family practice or family health teams there are other structures that are better, but but still the the the alignment around their remuneration the alignment around kind of the the the you know what's
13:41:15 permissible or not permissible.
13:41:17 These things are not that holistic. And so, you know, we're actually I think sometimes struggling with, with that, but, but I think that, you know, looking at the big picture of what we're trying to do in care, and then across that can give across
13:41:34 the you know the whole, whole person is extremely important.
13:41:40 Well thank you. Sharon.
13:41:42 So, Brendan I agree with what what you're saying. And you raise an interesting point which is that you know how do we do this is it just you know in a typical family doctor's office or even in a family health team or whatnot.
13:41:55 This begs the question of how do we deal with healthcare providers who are by, you know, by and large, not IT experts, and there's no support in the system to provide IT.
13:42:09 Technology outside of a few little bits, you know here and there, there's not that kind of support right so if somebody wants to integrate, you know, using questionnaires or upfront you know online booking that has upfront triage and whatnot.
13:42:24 Somebody needs to spend the time to integrate those systems into their office processes, and that's a gap in the system right. Most docs A don't have the technical know how and B don't want to spend the time which is unpaid time, integrating all of
13:42:40 this for many it's, it would be time well spent because it would save them time in the long run, but it's a big hurdle to jump and I think we've got to figure out how we how we address that gap too.
13:42:51 So I think this relates back earlier to the commentary that you guys had about, you know, meaning the place of the of the patient but also meeting the clinician where they're comfortable as well I think Sharon that something you talked about and.
13:43:06 And I sort of, I think these, these comments kind of echo that. And we don't. There's obviously all kinds of turning wheels here we can't get sucked into, but uh but I think you know I'm putting a question, question mark.
13:43:21 Beside holistic here because I just want to be careful we don't have these kind of umbrella term that we have trouble operationalizing, but as your as you're speaking I can see how holistic can kind of be operationalized and.
13:43:33 And that is, you know, one of them is, is a physician comfortable with it.
13:43:38 You know, do they have the technical expertise, is it a preference. And that has to intersect with, with the patient as well, James.
13:43:59 Yeah, really enjoyed the conversation as far as a non physician, so not treating patients but dealing with a lot of physicians and with a couple different platforms, it's interesting care to know what you can see on my screen we actually have two databases.
13:44:02 One is about 100,000 Canadians have consented into our database, the other is about 50,000 HCPs, which majority are family physicians and specialists, and for one of the up and coming I guess virtual platforms, a platform called Banty if you've heard
13:44:16 of it which is a medical platform we actually did some research and went back out to both patients and HCPs and to Sharon's point, I believe the biggest feedback that came back outside of a lot of things maybe that you've mentioned was simplicity.
13:44:31 How simple is it to get on and off, not only for myself but for my patients, which was interesting obviously the integration EMR was a big one, but that simple simple simple was one of the biggest pieces of feedback that we heard loud and clear from,
13:44:46 we're talking about thousands of Canadians and thousands of HCPs.
13:44:52 I don't think Apple is entering the healthcare arena yet James but in terms of the demand for simplicity, but I understand what you're saying for sure.
13:45:01 Brendan.
13:45:03 Yeah, one thing I forgot to mention. So one of my experiences was I run group medical visits and do an educational program through medical visits.
13:45:13 This, the, the switch to to virtual and doing it through zoom was was actually one of the best things that that happened for that so again kind of back to, you know, we're thinking kind of so much of this one on one, you know, part of the holistic triage
13:45:29 thing is what things could also be done better and group context, and how to facilitate that.
13:45:35 But, you know, back to the IT support piece.
13:45:39 Yeah, it's it's you know it's it's challenging and nerve wracking to do some of that stuff on your own kind of, you know, flying feel like flying by the seat of the past.
13:45:49 I can you just expand on that point Brendan, I mean, again I you know guys I'm not a clinician but my concern with the group medical visits is, is there any problem with reimbursement codes or anything like that.
13:46:01 So, so again kind of the the the opening for us was just that there's a code, in BC for group medical visits for these. So that so that's really where it worked and it's really a phenomenal tool to educate a cohort of people through, through
13:46:18 some, you know, fairly significant, you know, in my case, what we're doing is around lifestyle behaviors for type two diabetes.
13:46:26 And you can actually you know it's what's great in the group is one person asked the question and everybody else benefits from that question right.
13:46:33 And as the practitioner you start to realize kind of what pieces you're, you're actually getting through to people with and what pieces you're confusing them with so very helpful, you know, zoom, you know, zoom worked quite well, your ability to share
13:46:47 the screen, you know one of the things I find when I do my regular interactions, it drives me crazy. My EMR has an integrated.
13:46:58 You know, virtual care piece, but you can't share screen, you know, and so, you know you find yourself sending them a documents, kind of through email while you're doing this you're kind of like this is this is crazy, so that the tech piece.
13:47:09 More often than not, you know it as much as it enables, it gets in the way. But, you know, zoom actually worked pretty well for this the, the only challenge is it's it's not back again, integrated back to the, the, the EMR unfortunately kind of in BC the
13:47:26 the provincial health services, did a you know a group license deal with the HIPAA compliance zoom, so that there was, was actually something a little bit more secure.
13:47:37 So, and in many environments zoom is integrated. So in the hospital I launched him directly from the hospital record which is easy, certainly in the practice is not we're using the TELUS product and it's not integrated Well, for, for sharing screens,
13:47:48 as you said, Brendan but I say over and over again, when I'm speaking about why do we go to virtual so fast during pandemic it took two things one was like a burning platform so worldwide pandemic is a great reason.
13:47:59 The second is three billing codes in Ontario, that was it three billing codes we were sitting here waiting waiting waiting we went from 4% to 91% in the space of two weeks, and it will never drift back to 4% again I think we've become fairly used to both patients
13:48:14 and providers have become quite used to the idea that virtual has a really good place in what we do and what we're trying to figure out now is what's that balance like how much do we, how much should we reserve in our day for virtual visits versus in
13:48:26 person visits, how do we make sure that we get the babies in for their weights in person in that we, we don't just cave to, the person who's asking for their fifth renewal of their blood pressure product virtually without them, sending us a blood pressure
13:48:39 reading or check him in office so there is that kind of workflow change management, I mean Sharon I have both been involved with the program at Ontario MD for ever.
13:48:48 Basically, around changing physician behavior change management program funded by the province and, and that kind of thing is a rarity. If we were to take that same bucket of of knowledge and the same skills physician or clinician workforce and move it
13:49:02 into these other areas we started with OMD with virtual now, and we would actually have a process to train up and get people up, then working creatively and design kind of way with the vendors to say can you make something that works for me, as
13:49:14 as works for the patient because here's my workflow, like you got to know what I do every day and you got to know what the patient needs, and let's make sure we can even switch with be able to switch from asynchronous and synchronous if need be, we have
13:49:26 to be able to switch from phone to video if we want and, and I even take patients, sending me photos by texting right into my EMR off my mobile app on my phone because it works.
13:49:35 So you know whatever it takes to do we have to think that through, and there. I think the systems need to figure out how to help doctors and nurses and other parts of the team manage that, in a very proactive way not in a piecemeal way.
13:49:48 Yeah, no, I hear those are those are good points. Before we go on to the kind of the next point guys I just wanted to circle back, and maybe there's not much more to be said about this but the, the, The group medical visits.
13:50:02 What is the strategic benefit of group medical benefit what what, qualitatively what what benefit might that offer over individual meetings.
13:50:14 And if it's none that's fine I'm just asking.
13:50:17 Yeah no, the thing that's that's so effective with group medical visits is you can kind of pool the time that you have with people.
13:50:25 And, and go into more detail in terms of an explanation, and more opportunity for question and answer.
13:50:31 So, you know, try to explain it in a 10 minute visit, you know, a concept, you know, like insulin resistance and pancreatic insufficiency and type two diabetes.
13:50:43 You know you're going to butcher it, and group medical visit allows you to take the time and explain it, and take the time to be sure that that people get it.
13:50:53 And by pooling 20 or 30 people in the group.
13:50:56 You actually as a physician get compensated fairly for your time.
13:51:01 And everybody gets a, you know, can get 60 or 90 minutes with you as you go through it so it really works very well for that.
13:51:09 And I think so so you know that kind of knowledge transfer piece.
13:51:13 But the other piece that's that's really helpful for our people going through something similar can support each other and and and the you know the experience of seeing people, you know, realize that they're, they're not alone with their struggle and
13:51:29 that other people are having the same struggle, and even better sometimes where people have, you know, overcome an obstacle and share that with somebody, it's a lot more credible when it comes from somebody who you know has a condition that says says,
13:51:43 here's what I did and it did work.
13:51:46 So, so that's where the group, the group medical visits I think have a real place. So I'm going to do a clinical First, I'm going to do a clinical first year Brendan on your point, I'm going to quote Julius Caesar's book Conquest of Gall, and Julius Caesar
13:51:59 points out that he can teach his troops as much as he wants. But at the end of the day, there are certain lessons they need to learn from each other that they will just never take seriously if they come from him.
13:52:09 That's been instructed to me as a prof, and I think it resonates with it echoes points you're making now.
13:52:14 So that's a clinical First Ladies and gentlemen, we just cited Julius Caesar in the context of healthcare.
13:52:20 Let's, Let's move on to our next question if we can.
13:52:23 Well we sort of touched on this. Well okay, we have touched. Let's see if there's any more comments on this, what is the best use of virtual care.
13:52:32 Beyond COVID.
13:52:34 So, you know, obviously COVID's promoting lots of changes right now. But when covert passes and eventually will, where do we see virtual care then. Yeah, sorry.
13:52:45 Sharon.
13:52:44 I'll take a stab at this I mean I think there are a number, a number of situations that we can see a utility for virtual care on an ongoing basis and I'll give you a few clinical scenarios that might speak to that.
13:52:56 So a lot of us for example have people that are at work, and taking off two hours to come to an office visit that could be done simply on the phone and paying you know exorbitant parking rates and spending two hours instead of 15 minutes on the phone
13:53:10 for something that could equally be done virtually really doesn't make sense for the patient. So I think there's going to be some that are going to be patient driven that we just need to sort out that triaging process, that should continue in a virtual
13:53:21 way.
13:53:23 I think there are some situations where geographical boundaries are an issue so you know we've got university students that go to university.
13:53:30 They've got an existing relationship with a physician. Do they really need to all of a sudden find a new physician to discuss renewal of their birth control pill or can they do that with somebody that's somewhere else in the same province so we're not
13:53:42 dealing with licensing issues, but you know the continuity there is better so I think that's better for patient care. If we can continue that type of thing on a virtual basis.
13:53:53 We also have extended family. Certainly as patients get older if extended family members need to participate or want to participate in the encounters, being able to do that virtually especially if the family member doesn't live in the same city or can't
13:54:05 take, you know the day off work or come into town for a visit, great to be able to bring them in and bring them into the encounter virtually so I think there are a number of situations that should remain virtual if we can move forward and again, you
13:54:19 know I can't speak to other provinces, but in Ontario. You know, we only know until September of 2022 that virtual care is going to be funded in any capacity.
13:54:28 And that's pretty typical of the Ministry of Health right so we don't know what is going to be funded so we can make these grandiose plans and if they delist that we're going to be back to the drawing board.
13:54:48 So we're all kind of hoping that doesn't happen but we'll see where we land. I love your I love your third point, as you speak that way I kind of see like caregivers of the patient of question is kind of like the mirror image of the nurse on your side.
13:54:51 You know they're they're often overlooked especially in an entrepreneurial side when people think about products, they're often overlooked as part of this.
13:54:58 So I think that's a fantastic point.
13:55:02 Darren. Yeah, so two other areas I'm doing some work right now, very interesting work in a, in a province that has a critical shortage of clinicians and physicians and virtual care has a really big role for actually serving, sometimes small hospitals that don't have
13:55:15 in house staff to look after maybe 10 or 12 beds, but they're just as enough they can't really close. Also primary care to people that have no family physicians or nurse practitioner neighborhood and that's the far north right through to more rural areas
13:55:28 of every one of our provinces and a really big body of work now moving ahead on chronic disease management so the creation of virtual care clinics and manage a chronic disease likely we know in a diabetic education type environment or a chronic lung disease
13:55:40 or kidney disease program, those kinds of things rely a lot on continuity over time with a team and a virtual program can bring in a team, and actually have multiple people working with the patient at the same time at the same visit without the moving
13:55:54 brings efficiency into play, particularly with different care provider types they're looking everything from like an alarm program to a respiratory therapist to a doctor to the pharmacist.
13:56:03 And then we have the ability to track people over time using tools on the outside where they enter their own data they look at their spirometry they look at the numbers of puffs use of medications per day for their lung, and we track that and then intervene
13:56:15 with a system of monitoring that says look we know this person's getting worse. We have to intervene before it's too late. So those are three areas into virtual emergency room for places with now no physicians in house, the areas that have very real staffing
13:56:30 shortages, either permanently or temporarily, and chronic disease management.
13:56:35 Okay, great points and sorry, Kendall.
13:56:42 Oh sorry you're muted there Kendall sorry. Great, thank you. I really love the example that Sharon and Darren brought out I certainly agree with those.
13:56:55 Maybe I introduced three additional areas so one is about interprofessional team based care.
13:56:57 I think the continuity of the conversation is important for patients sometimes they get advice from a health professional physician, and then they get advice from a nurse get advice from physical therapists, occupational therapists.
13:57:12 Obviously if they align that's great, but sometimes there are differences or nuances of those conversations, those type of team based care to be able to bring everybody into a room for effective, efficient conversations.
13:57:25 Great. In this model, historically, you know when we do consultations emergency physician consulting specialists or family doctors, consulting specialists that right now I mean we're sending a letter over a patient see the consultant, and then the patient
13:57:39 come back, you know as an emergency doctor say you know what, what did the specialist tell you before you come to emerge, or the GP, but I think, again, this virtual care it we can bring those parties together at the same time, I think we can really speed
13:57:53 things up. However, it does cause change in workflow. And so I think that's going to be a lot of consideration, how to do that.
13:58:01 Second area is about interface with acute care. For example, people live in rural remote have to fly down, you know take about a day's trip, just to go to a surgeon's office to discuss a CT scan for 10 minutes and fly back those virtual
13:58:19 care will be superior and also post op, after surgery to bring the family from a rural remote location to look at dressing change. And then after they go back to again do a session.
13:58:31 So the family can show the care team how dressing changes are done, are again superior in terms of what we do. And my final point is this, I'm going to come back to emergency, that's where I feel most comfortable, is, is the fact that, you know, if we
13:58:46 go shopping, when I was, you know, growing up, my shopping experience started with let's drive to the mall.
13:58:52 But now, for my kid's shopping means go to Amazon. For emergency. We're still thinking that you know, I need to have emergency care so I will drive to emergency.
13:59:05 If we can start the emergency experience at home, and then have that launch you know care. I think that that you know when you need, you can then go to emerge when you don't need, we can support you at home.
13:59:18 I think we can extend that emergency concept to home. Again, that's a huge use of how virtual care can help us in post-covid times.
13:59:32 Yeah, some excellent points and just before we move on from that I sorry, Kendall if I can push you on this point. The professional team based care, I mean I'm envisioning 100 doodle surveys being sent on a daily basis for that like how the logistics
13:59:42 of implementation for people's schedules and reimbursement. Are you talking about kind of a goal, where do you see that as feasible with your current scheduling and reimbursement codes.
13:59:51 Yeah, NBC, one of the areas not not where I'm working but with my virtual key team by rural coordination center of British Columbia, is looking at the setting up a front from consultations to conversations.
14:00:06 If, in some ways, pay a role physician sees a patient, sees a rash.
14:00:11 And then within a certain time be able to book that conversation with a dermatologist so that there'll be a three way conversation. Not only does it help the patient, so that the dermatologist said, use this cream, but the patient feels the family doctor
14:00:26 as the advocate in that room so the family can say, Well, wait a minute, there's some nuance about this patient, about this particular cream and right away jump in.
14:00:34 And then also for the family doctor. They also then able to ask, Well, if this cream doesn't work dermatologist. What would you go next. And so that helps with the advancement of management and for the dermatologist.
14:00:47 he or she gets to know the clinical situation a lot better. So one example that team-based care.. I, you know, as a non clinician I can certainly appreciate what you're saying, but my concern is scheduling, like is it feasible to schedule something like this,
14:01:03 what's your experience with that.
14:01:05 Yeah, so that's what that from consultation to conversation initiative is doing so that they can set up those types of models within a certain division family practice with specialist.
14:01:16 So hopefully there will be more to report on that. Okay.
14:01:26 Great. Thank you. Brandon.
14:01:26 I had a couple of points for this what would a comment so in my practice, I work with an exercise physiologist, couple of dietitians and health counselor, and we do team based care.
14:01:33 This scheduling in were contained and we're one organization and the scheduling is is a nightmare.
14:01:39 The tools aren't great for it. And so, there's there's probably a lot of things that could be set up better there.
14:01:46 You know just back to kind of the best use of of virtual care, you know one thing I just really want to go back to which is, I mean it's one on one for everybody here but, you know, the notion that we we used to think it was okay to bring in people with
14:01:59 COPD and lung disease and so on, into a crowded waiting room with the sick people and people with, with flu. And this was this was just okay because that's the way the fee code work and there was no fee code to actually support virtual care.
14:02:15 Clearly we can't go backwards on that, right. We've done so much better job in terms of not having our, our practices be be, you know, be vectors of of exchange of infectious disease.
14:02:27 So that was, I mean, obvious and I just want to put it down. The other one that kind of building on Darren's point around, you know, there's this opportunity around creating some structures here around, you know you said it kind of around chronic disease,
14:02:42 you know, innovation work we took some stuff around Clayton Christensen who, a Harvard Business prof who has you know kind of the job to be done framework, and in health care that you know the job to be done is, is from the patient perspective so you
14:02:57 know Clayton Christensen is a great example was, you know, nobody really wants to drill they want a quarter inch hole.
14:03:02 You know, and and what's the job to be done in health care for the patient and and and it varies and so when you look at kind of a person with type two diabetes there's several jobs to be done that are adjacent that actually can be coordinated.
14:03:29 And I think there's a real opportunity to take virtual care, and even package around some of these jobs to be done into, you know, apps that not only do they they have, you know, interactive educational components, but they also have tracking so they
14:03:32 can interact with, you know, Apple Health kit or Google Health and you know the devices can can be reported back. They have the ability to have coaching they have the ability to have team based care and virtual care so there's there's, there's a lot of
14:03:45 technology that can come together fairly quickly and easily around these things.
14:03:50 Part of it is just, you know, organizing our health system to start to realize that, you know, we don't have to do that, as you know as Kendall said that that that old approach of, they have to drive to us and then they have to drive to the next person
14:04:02 and then they have to drive to the next person.
14:04:04 Why can't we integrate around these common jobs to be done in healthcare, and use some of our virtual tools to do that.
14:04:12 Yeah, I think that's a great point.
14:04:16 To me, it's, it's kind of a next step, if you will, you know, I think the, I think the rest. I think the rest of our whole, including our regulatory environment has to catch up to I think your comments, but I think a good positive point it's just the
14:04:30 last 18 months or so, we've seen a number of mental health apps, get approved by the US Food and Drug Administration and these are our intermediate and high risk devices software approval so there has been a clear shift in in the kind of software development
14:04:46 that's that's been taking place so that could be a next step.
14:04:49 Any, any other comments on this guys, we have one more question we're going to tackle and Todd?
14:04:57 Yeah, just want to reply Brendan I love everything you're saying there and a big fan of the jobs to be done framework, I think, tying a few of these ideas together that we're just discussed.
14:05:07 The team based care and the ability to quickly draw in multiple two or even more specialists to have conversations. I think Brendan that's part of where I see kind of what you could call it coaching app where it just brings multiple people together.
14:05:22 And on the commercial pharmaceutical side we're doing that with sales reps right sales reps trainers field managers ride-alongs. And it's the same idea where if you have a system that can tap into people's availability, understand their specialty, and
14:05:37 in particular in Canada, the wait times to see specialists, I'm in the US but what I've heard is six to 22 months to see a specialist in Canada.
14:05:47 That is outrageous and how virtual care, and this team based approach, finding those shorter moments where a specialist is available, that is in sync with one of primary care and the patient is available.
14:06:01 I think it radically change the issue with wait times, especially from that enormous amount of time in Canada. Sharon I'd love your feedback too.
14:06:12 But it's interesting as I think about it, I mean, part of the problem with all these wait times is also our technical stupidity with respect to booking.
14:06:21 We have no integrated booking system. So, I have no way of knowing as a family physician. If I send off a gastroenterology referral, I could send it to my local guy because I usually send them and he's in my EMR address book, but there could be a new
14:06:37 grad six blocks away that has a booking six months sooner and I don't know about it. So, until we get as a system into a you know funneling system and Darren can probably speak to this but where we funnel all of our referrals, it gets done geographically
14:06:54 and by first available for new appointments, based on where the patient lives, we're spinning our wheels, right so there are multiple issues that are impacting on this issue and our system as a whole, and I can only speak to, you know, Ontario system
14:07:09 I can't speak to the US system. But I can tell you the Ontario system is built out of, and I'm sorry, Darren, to say this but it is built out of sticks and stones and held together by band aids, and you know it is completely silos, things do not communicate,
14:07:24 we don't have a well integrated functioning system in the big scheme of things so that that is contributing to what's going on here. So I'm not sure.
14:07:44 I only got duct tape in my hospital so.
14:07:39 It's a mess. I'm just being quite honest with that. But that's the holistic view right like taking a system level approach to wear roadblocks and we have lots of specialist I mean if I have a real sick patient and called my buddy and haven't seen that day or tomorrow
14:07:52 that, the wait times are variable conversation and loaded with all kinds of politic and all kinds of propaganda but but the idea is we don't have assurance, it is a really centralized way of accessing different types of care specialists are only one thing
14:08:06 like I have a hard time, you know, getting a patient in to see a child psychologist, as I do a neurosurgeon. In fact it's probably easier to see a neurosurgeon. So, so it's one of those things where we don't really have a view of it, availability, we don't have
14:08:38 kind of process yet for referrals in or even at even an index of who the providers are like one of the single best things we can do in this province is to build a provider registry that actually means something, not just the type of clinician but what
14:08:34 they do all day long. So, all these are digital tools that help us work better and you know we default to government to build this but I'm not sure government has to build this government can procure it and have it built by others that are better if there
14:08:46 are single payer but we're not really very trusting yet in Canada about the private public private partnership space. And I think that's work that needs to happen as our governments post-Covid are largely broken and broken, so it's going to be a long time
14:09:00 before we let them do anything, you know, full, full some.
14:09:05 And I'm going to jump in there and ask a dramatic question I learned this from you Darren. Darren, what's the best way most reliable way to reach your physician,
14:09:14 The most reliable way to reach a physician? Yeah, I don't know, show up on my doorstep? Fax! The fax machine, you taught me that. That's right, that's right. Oh I don't know guys we're talking about technology but really the most reliable way to
14:09:22 fight you guys is still the fax machine so that that that really.. Well everybody has one every EMR integrates to it and you know it doesn't send data since pictures but, you know, that is we can read those pictures, it works for our flow, but it doesn't mean
14:09:40 it's the way we should do it. You know the idea about moving data around so the patient doesn't even have to move this is another digital concept is data should flow around the patients that are the information around the patient flows with him to other
14:09:51 environments so the care can be either preemptively offered their before they arrive, or two so the patient actually doesn't have to move. And so we haven't really tackled even how data moves in the silos of data, or who owns it yet but that's a whole other
14:10:05 hour and a half you might want to plan for us.
14:10:08 Sorry Brandon.
14:10:09 I love that you brought up the fax.
14:10:11 Yeah. Everyone jumps on the fax, but I always come back to and say, show me something else that has the same network, right, like the reality is the network effect on facts works and it is hard to displace because it's hard to create another network
14:10:24 like that for any of these other kind of messaging apps.
14:10:28 I wanted to be provocative here in in building on the conversation. You know, I, we need a system level view.
14:10:39 And, you know, the government isn't going to build the technology but they're going to procure it. Having been involved in kind of both sides of procurement, that's it's a deeply flawed process.
14:10:48 And when that actually often screws up the end results.
14:10:53 So one of the things I see it happening in any solder in Covid is you start to see the emergence of private companies now stepping in and not just doing technology but doing technology and healthcare.
14:11:06 And, and, you know, finding that they can integrate across the continuum of care more quickly and more effectively than public system. So, you know, I'm really curious kind of what this group thinks about that, because, you know, I can see speed of, of,
14:11:37 you know, delivery happening but but huge issues in from, from my perspective on a whole bunch of fronts.
14:11:38 Any comments or any comments or questions based on Brendan's comments guys?
14:11:56 Go ahead go ahead no Kendall you first please, please. Oh, thanks Darren. I just want to comment on on Brendan's provocative question in fact it does kind of slide into your question three, perhaps, Jayson.
14:12:03 And that is, you know, at the end of the day, I said, is a physician, do not invent mobile phones. We are dependent on technology companies to come up with ways for us to support our patients.
14:12:19 It's always been such for example, you know in my ICU in my emergency room.
14:12:24 The monitoring of heart rates oxygen saturation, I couldn't have invented that you know we need technology.
14:12:30 And so as we go into the world of software, if we go into the world of, you know, from electronic health record to to scheduling system to covert tracking to AI and ML.
14:12:45 How do we build that collaboration and trust and understand that as we move forward, we need each other. I think that's important. Secondly, how do we stay above board in these types of collaborations.
14:12:59 So that so that we can advance things forward and number three is how do we protect the security of the information, as we move forward as we have public private interface and health professionals, professional responsibilities of protection of privacy.
14:13:15 And then finally, how do we how do we really arrive that a new world of practice because once you get into AI. The question is, at this point, you know, up till now, health professionals and very specifically physicians and in the case of the pharmacist, nursing,
14:13:32 nursing, we are responsible for our recommendation to our patients and behavior. Once you go into AI, once you go to machine learning. We then become dependent on some degree of the database, some degree of the veracity and volume of the database and
14:13:47 potential buyers within the database to place our judgments. And so how do we adjust that thinking to the point that it's becoming more of a system piece.
14:13:57 And how do we look for accountability I think those are all questions that we were important for us to think about what we talked about this public private partnership.
14:14:06 Darren? Yeah I'm going to I'm going to use an example of without using any names of a, you know, big Canadian supermarket chain owning a big Canadian pharmacy chain which owns the second largest EMR in Canada, which is invested in the single largest virtual
14:14:21 care company in Canada and the single best patient engagement platform in Canada to create it and hired an American VP from Humana Healthcare to come in and create an ecosystem of health delivery for their customers, which includes, you know, a patient
14:14:38 portal includes loyalty points that every Canadian actually uses already. It includes a knowledge base around what what every Canadian puts into their basket in the grocery store and their pharmacy and, to a degree with consent, the ability
14:14:54 to tap tackle some of the data in the EMR because patients will consent to use of data if they get a few extra points in their loyalty program, or a discount on their laundry detergent.
14:15:06 So it's quite interesting to see how companies are going to come along in the next five years and build healthy ecosystems in a way that we want to pretend isn't happening but yet we kind of welcome because we want to see it done better.
14:15:19 And then, and then you put into play two other major companies, one large Canadian telecommunications firm and another one, a large or medium sized clinical entity, out of the West Coast want to the same thing and I think we're going to see these systems
14:15:32 forming organically in public private partnerships, meaning you know companies will create managed care organizations that will be funded through the regular funding pool through how doctors are paid and nurses are paid and be able to tap into provincial
14:15:45 program funding and take some of the burden off are very overtaxed publicly managed system I think you'll still be publicly funded in the perfect world but the managed system is going to be very different.
14:15:56 And part of me welcomes that because I think in certain cases, having that complete view of what a patient is and meeting them where they're at is probably best done by a company.
14:16:06 I'm not sure necessarily at that company but any company can maybe look at it differently so that's a very radical way of looking at this, but I think that this is coming, and it's going to be full of accountability.
14:16:17 And I think that I welcome accountability personally as a clinician but also as someone who is a taxpayer, and someone who wants to know that all my money being put into healthcare taxes is being spent well, and maybe we need to rely on the innovation
14:16:28 of companies that do it 10 times faster, stronger and better, instead of building it ourselves in within the public space to say let's do it together.
14:16:37 I don't see any other way frankly I don't see a way out. Other than that, you touched on a huge point which you know goes beyond what we can talk about here in terms of commercialization and so forth but there are other other critical elements there we
14:16:50 can't get into right now so I totally agree with what you, what you've said, and I realized in this, it's hard to have a discussion like this without both talking about but you know practical operational steps and you know, having a wish list of what we could
14:17:02 do next, if we could. Kendall?
14:17:05 I'm just gonna jump in.
14:17:09 Darren, I certainly agree, a lot of what he says and what you're saying Darren. I just want to bring in a counterpoint.
14:17:18 My, my worry is this - that in pursuit of those. That's the low hanging fruits of the cases get used, but the inequity worsens. So, the rural remotes, the indigenous communities where care delivery is challenging for the long term, you know, practice family
14:17:45 practice, where would he putting in the daily mileage to follow the patients is vital. It's not just the episodic prescription of a cream.
14:17:56 I'm worried.
14:17:59 If we rely too heavily on private sector to develop these ecosystems, without the true balance of the public health system to support true equity of care that over time.
14:18:13 That can lead to imbalance in our system, but of course Darren, I work with you many for many years I know that that's not what you mean. And I love to see different parts of the system being balanced, but I think it's vitally important for us to understand
14:18:28 the Canadian public health system, the importance of fundamentality of equity of access of care, and the, let's include equity, diversity inclusion, so that every Canadian has ability to access care, or at least get towards that equity of access of
14:18:49 care, equally would be fantastic. 100% Kendall that's what the partnership is about in my mind.
14:18:54 We have to figure out what that partnership looks like. To ensure that you know this system that it isn't everyone's community, you know, there is one of these supermarkets in every small town in Canada, how, you know, becomes a potential point of access
14:19:07 so I agree with you 100%. Governments have to learn how to trust industry better though, for sure.
14:19:15 Yeah. You guys are touching on huge issues here and I don't, I can't I can't go down this rabbit hole. Before we move on, do you have a common question before we move on to.
14:19:35 Now I was just going to dive into the rabbit hole but
14:19:34 you can't follow the rabbit okay don't follow the rabbit. Okay, so let's, let's go to the last question then. What is it, and this really is really about your quality of life, ladies and gentlemen, what is the best way for vendors professional associations
14:19:47 to communicate information to healthcare professionals in a digital medium. We all know that physicians don't get enough email, so let's just let's just put that out there right now.
14:19:57 So we know that you want more email because that's a big hit. Okay so, so what will make your life simpler?
14:20:06 Less noise like for me it's less noise, I have to say I want to see you. I know you're joking but we don't want an email I actually have a filter on my email that moves, emails around based on my behavior, and it has filters newsletters out, and and filters
14:20:21 out advertising and things and I go to them eventually but I mean, there are a lot. There are a lot of my own medical association sends me probably in an email every day.
14:20:33 Right now, or certainly during pandemic it was every day and they heard from their from their members please don't do that like twice a week but now even, you know it's like this and it's a retraction and then as a conversation and it's a government thing
14:20:41 thing and an advocacy piece like it's, we're in negotiations right now in Ontario. So we hear from a medical association, all the time about how well it's not going right so it's it's so much noise now I don't quite know what to do about that.
14:20:53 For me it's been turning off Twitter, it's been turning off Facebook I don't have them anymore. And relying only on LinkedIn because it's the only sane place I can see any conversation happening right now in social media world, and and I don't I get the
14:21:08 email newsletters so they don't have a better way. I don't have another sense of how to beam they stuff I need to know into my head without me being cluttered by politic and propaganda and advertising the rest of it, there's no easy way in my mind.
14:21:28 Yeah. Interesting. Interesting. Other interesting other thoughts, comments on this? Please yeah Darren you're talking about what you're doing proactively on your side.
14:21:31 I guess let's turn around what what can the people sending do to improve the situation Kendall, you're gonna make a comment there. I think, I think Sharon unmuted before me so Sharon okay.
14:21:44 I'm just gonna say guys you know, with respect to what you know Darren said, you know, there are two sides to that coin right I agree with them I mean the amount of noise right now is a nightmare.
14:21:54 I don't, you know, to me, I almost appreciate what I get and come, you know, putting a lot of their emails that would have come every day into one weekly thing, but you know the reality is do we ever get to read those things.
14:22:08 So, you know, sometimes yes if the headline grabs us, but the volume of information coming across my desk right now is impossible to keep up with for me anyways I think you know a lot of people are experiencing the same thing it's just impossible.
14:22:20 So I don't have any concrete good suggestions because I don't think I want to see that on LinkedIn either to be honest, so.
14:22:28 Yeah.
14:22:29 Okay, thank you, James.
14:22:31 Yeah, and this is interesting, hearing some of the feedback, how much stuff you're getting beyond so I'll represent the pharma industry if they're seen as a vendor, which hopefully they're not but if they are, and during the pandemic really what's happening
14:22:45 I know you've talked about I mentioned type two diabetes a couple of you a few times, the newer brands that have come into Canada in the last two years, and some of these are much better than critical standards, the adoption has been terrible.
14:22:57 It wasn't great to begin with, with the pandemic post-pandemic new brands have really not had much adoption so for the drug industry which I'm a part of, you know, we're trying to figure out what is the best way.
14:23:08 Now we probably have a hybrid model as you know armies of drug reps were at home, for the most part, trying to contact physicians either virtually or via email, which is tough.
14:23:18 But for us, we're trying to obviously understand what is the best way to get new information let's say about a medication, whether it be an educational format or promotional, so I'd be really interested to hear what you would suggest email is one thing,
14:23:33 obviously the industry does, amongst other things, but this has been a real issue especially for new medications coming into Canada.
14:23:41 Thank you. Todd.
14:23:45 This is not so much of an answer, maybe a more of a hypothesis that I'd love feedback on. I think this question is not so much about the best way but again is the, the material.
14:23:56 And what we're trying to explore is, if we can really understand what is most important. And what is currently happening for those HCPs to a real granular level.
14:24:10 If we can only deliver them the information that would actually be useful.
14:24:16 Reducing the noise. It's kind of like if you had a filter set where you could use an AI to automatically filter out anything you were not concerned with at all and that point in your career or for any current cases or anything you're trying to learn more
14:24:28 about. And I think that's one of the beauties of healthcare technology because it can it can monitor and look at the things you're looking at the cases you have the articles you're reading on PubMed highlights you're making notes you're taking in Evernote
14:24:43 or wherever your tools are and intuitively know what would be useful, and have that type of material, maybe land in your inbox maybe that's what a sales rep shows up on your door with. So, I'd love to know if a solution like that would somewhat solve the
14:24:58 same problem.
14:25:00 Thank you. Kendall?
14:25:04 Thanks, I really liked that, that thought that Todd raised.
14:25:10 So I have two thoughts. One is, you know, historically, we were all being threatened by junk mails in our mailbox. But somehow, an algorithm or some kind of algorithm figure out so that we are now, reducing it to manageable, not is completely gone.
14:25:27 So if there's a customizable way for us to be able to have some ways of streamlining or selecting. I think you'll be great. I don't think it's company-dependent, because if one company says please select what you need from me, and I select that and our
14:25:43 company come to me and do that etc I think I'd get exhausted just as fill out those surveys, but on the other hand if there's a way that we can intelligently.
14:25:53 Select I think they'll be great. And secondly, perhaps, is, is there a way I think it's a collaboration, I don't think it'd one way, is how do we figure out the communication take place that fits into the workflow of health professionals.
14:26:08 There are different kinds of workflows and. And so the question is, how can we make sure that information is not only is appropriate interested for the health professionals, but also fit into workflow I think that would be ideal.
14:26:24 I'm sorry guys I'm losing track. Brendan.
14:26:26 Yes, so. I mean, this, it's a, it's kind of a universal question in all places signal versus noise right and the problem is the signal is so context specific, and.
14:26:39 And so, you know, often, you, you know, you're not looking for that piece of email or a piece of information that was shared with you on email, but three weeks from now, you may be in the context that that information would actually be useful.
14:26:53 So, I think for people trying to communicate with healthcare professionals. One is, is, you know, the creation of good content that can be found and trust.
14:27:05 And so, and that's a balance right and so if you're, you know, you know, by, by nature, if you're if you're selling a product, the trust level is going to be down a little bit because you've got an agenda there.
14:27:17 But you know funding of good information and having that be be accessible.
14:27:22 I think is part of the equation. So, I think the opportunity for for people to communicate with healthcare professionals is creating really good.
14:27:32 Yeah, good, good content that can be trusted.
14:27:36 Okay, thank you, Brendan, Sharon.
14:27:42 Thanks.
14:27:43 So I think you know it's an interesting question to raise and I'm just thinking specifically with, with respect to the drug information.
14:27:51 I think being quite honest, most of us delete those emails immediately.
14:28:05 Because we don't have the time to go through them and it's not that it's not important information I'm just being candid but we don't have the time like I think many of us are getting 100 to 200 emails a day, like it's it becomes unmanageable especially
14:28:10 with a clinic and when you're running messages, you know in your EMR as well. It's a question of, you know, hitting the top things where I think it might be relevant and used is if there was a way that we could integrate this with decision support within
14:28:24 the MRT because people are looking at their EMR, and they're looking at clinical information. So if there was something that was database not perceived that it was coming from a drug company but if there was a decision tool that came up and said okay
14:28:38 well, you know, hey there's, you know, in looking for somebody who needed a new diabetic med, and it came up and said, oh, by the way, did you know about this new blah blah blah.
14:28:48 Here's the study, you know, click to the link to, you know, the new diabetes guidelines that recommend this as first line or something like that, that might be point of care, it's going to make me remember because I'm using it at the time.
14:29:02 So that's the type of thing that I think would be more applicable to stick with people and be relevant.
14:29:08 Okay. Great. Thanks. Sharon, great points, Todd, I think Todd, you're going to have the last words here because we're going to have to wrap up.
14:29:14 No, great feedback and my follow up on that is trust and credibility Brendan I think you mentioned this I think that is pivotal in getting into getting an audience right if if the if there's no trust between those two sides of the table.
14:29:37 Nothing's no communication there no information is going to help so I'm going just a tiny bit deeper in this idea of what would all of you physicians on the call here think if there was some sort of credibility rating for pieces of content, almost like
14:29:49 a Yelp rating for a clinical paper where physicians in your specialty could give a simple thumbs up or even a detailed rating of the clinical impact that that piece of content had on their practice.
14:30:04 And so, Sharon, I think, Well, I think you're gonna have the last word here Oh, let's see if we can respond to Todd's comment.
14:30:11 Well sorry I don't want to have the last word but it all depends on who's doing those ratings.
14:30:17 Like I think that's going to be what the real key is I mean if it was an organization that I trusted was looking at the data in a, in an appropriate way.
14:30:25 Yes, I would, I would trust that if it was you know my colleague down the street who just clicked yes because that's how they deal with so do with social media know.
14:30:34 So I think it would depend on that. You're going to see this in just one quick thing on that if I could, I subscribe this thing called ground news which takes news feeds from all over the world and reach them on a bias score.
14:30:48 In terms of left and right politics so you can actually then focus down either on the ultimate point of view the you don't know, or the point of view you want to support but I could see that kind of evidence based skill happening to within the stuff
14:30:59 we get in terms of bias, you know evidence versus non conjecture versus reality politic versus promotion, like those kind of skills, could be could be created and then they could be voted upon but it wouldn't just be a thumbs up or thumbs down to it has
14:31:14 have to be some degree of credibility rating, which is more complicated.
14:31:19 Thank you Darren, guys, I'm sure I just, I just, I just can be respectful of everyone's time, we're going to have to do a hard stop now.
14:31:27 Thank you everyone for doing this.
14:31:30 I had no idea how this was going to go, quite frankly, and I gotta say, this is one of the most. One of the best intellectual times I've had in a while this was quite a lot of fun and I learned a lot.
14:31:41 Thank you so much. We will follow up by email to let you know. And you'll give us feedback will decide the next steps here. Obviously we're going to put this out on various platforms as we discussed and will do kind of a little retrospective review and
14:31:53 decide whether or not you know that there's a paper that we might also put out as kind of a consequence, or outcome of this session. But thank you everyone so much for joining.
14:32:04 And we probably won't speak again in virtually anytime soon so have a happy holiday.
14:32:12 If I could put it that way.
14:32:14 Thank you for organizing.
14:32:15 Thanks everybody, Jayson Nice to meet everyone.
14:32:20 Bye bye. Bye guys.