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Better with age shorts
Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health. Health Canada is committed to improving the lives of all of Canada's people and to making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system.
The COVID-19 pandemic has forced us to innovate quickly and change how we work to adapt to new realities. It caused significant disruption to the delivery of in-person health services, and forced us to re-think the way we deliver care. The pandemic has served as a catalyst to accelerate the rapid deployment of virtual services so Canadians can safely access the care they need.
As co-Chairs of the Federal, Provincial and Territorial Virtual Care/Digital Table, we have had the opportunity to provide guidance and direction to the collaborative federal, provincial and territorial effort to adopt quality virtual care in Canada. We have learned that while virtual care holds the promise of more accessible, integrated, and convenient patient care, to do so it must be intentionally designed to enhance equity and ensure that all Canadians can benefit from this modality of care. The Equity Task Team was created to apply an equity lens to the design and implementation of virtual care and develop principle-based recommendations for a collaborative approach to equitable virtual care across stakeholders and jurisdictions.
As we look beyond the pandemic and reimagine health service with integrated virtual care the work of the Equity Task Team can serve as a guide to co-design and deploy deliberate, principle-based virtual care that enhances equity in health care.
As co-Chairs of the FPT Virtual Care and Digital Health Table, we would like to commend Dr. Affleck and the Equity Task Team for the clear and robust quality of this report.
Jo Voisin Associate Assistant Deputy Minister, Strategic Policy Branch, Health Canada Co-Chair FPT Virtual Care/Digital Table
Message from the Chair
As Chair of the Task Team on Equitable Access to Virtual Care, I would like to express my gratitude to the members of the team for their invaluable contribution to this report. Their collective expertise and wisdom have contributed immeasurably to the development of principle-based recommendations that if pursued will promote digital health equity in the publicly funded Canadian health service.
Virtual Care in Canada: The current context
The COVID-19 pandemic resulted in provincial and territorial governments rapidly accelerating the deployment of virtual care across Canada so that Canadians were able to effectively access publicly-funded health care services in a safe, physically distanced manner. However, the rapid deployment of virtual care impaired the capacity to constructively apply the appropriate design features required to promote quality of care, and specifically equitable health services. It is recognized that virtual care, if not designed thoughtfully, has the potential to exacerbate the digital divide, and compromise health equity.
To promote collaboration, the Federal, Provincial, Territorial (FPT) Virtual Care/Digital Table was struck in March 2020 with a mandate to consider and develop a proposed plan for accelerating the deployment of virtual care in Canada both during COVID and for the longer-term. In addition, the Virtual Care Expert Working Group ("Expert Working Group") was struck to provide advice and guidance on FPT work on virtual care. As part of this work, equity emerged as a critical issue, and there was interest from FPT governments to examine how best to ensure equitable access to virtual care within the publicly-funded health care system.
Equity in virtual care, a subset of digital health equity, is defined by the Equity Task Team as:
"The provision of remote health services using any form of communication or information technology to facilitate or maximize the quality of patient care by joining patients and/or members of their circle of care in a manner that ensures an absence of avoidable or remediable differences among groups of people based on digital or social determinants of health."
The Task Team on Equitable Access to Virtual Care (Equity Task Team) was created under the Virtual Care Expert Working Group with a mandate to develop a principle-based framework for equitable access to virtual care and provide guidance and recommendations on the concrete actions that FPT governments can take to ensure that virtual care promotes equity as a critical dimension of quality care. The Equity Task Team took a pan-Canadian approach to examining equity in virtual care, with work focused on four stepwise thematic exercises, including: defining equity in virtual care and identifying barriers to equitable access; identifying domestic and international best practices aimed at enhancing equitable access to virtual care; developing high-level principles for the design of virtual care; and, developing recommendations based on the established design principles.
Among the key findings was that Canada lacks a defined pan-Canadian approach to, or vision for, equity in virtual care services, in the same way that it lacks a pan-Canadian approach to health equity in care delivery. This absence of vision and design principles to guide the equitable deployment of virtual care contributes to and potentially exacerbates underlying inequities in the provision of high-quality digital care.
A lack of health data related to equity makes it difficult to understand the scope of the problem in Canada, as well as to determine the differential impact for underserved populations. In particular, a dearth of disaggregated data is of significant concern in designing virtual care services in an equitable manner.
The Equity Task Team suggests that it is critical to examine both social and digital determinants of health in examining barriers to equity in access to virtual care. In the literature, there is a general tendency to focus on the social determinants in studying inequity in health, which in the context of digital health leads to the exclusion of important, uniquely digital factors that can promote inequity in virtual care.