"It's just exploded": patients turn to telehealth during pandemic

Telehealth services in BC are fielding high call volumes as patients turn to virtual care during the COVID-19 pandemic.

These services allow patients to see a doctor through their smartphone or computer by video chat, and are often free for British Columbians under the Medical Services Plan (MSP).

“It’s just exploded,” said Dr. Amit Mathur, an optometrist and president of CloudMD. “It’s now to the point where we’re busy adding doctors and shifts constantly.”

The company started in BC about six weeks ago in a bid to give British Columbians more convenient access to primary care. Right after they launched, the coronavirus pandemic became a serious local concern.

CloudMD wouldn’t provide its call volume data but said the business has taken off during the pandemic. At a time when people are encouraged to stay home and may be fearful of going in person to a waiting room or hospital, Mathur says services like his provide a vital stopgap.

“Regular patients who have their regular medical concerns, they don’t want to take the risk,” he said.

Telehealth doctors treating suspected COVID-19 patients virtually

Dr. Essam Hamza, a physician and CEO of Cloud MD, told Daily Hive that telehealth has become an important triaging tool so patients with mild suspected coronavirus infections don’t clog emergency rooms.

Doctors can’t test patients for COVID-19 at virtual appointments, but Hamza doesn’t think that would necessarily be different in an in-person visit since tests kits were reserved until recently for healthcare workers, long-term care residents, close contacts of other confirmed cases, and people needing hospitalization.

BC broadened its coronavirus testing guidelines on April 8 by allowing any physician to order a COVID-19 test based on their clinical judgment.

“Besides there being a shortage of testing [kits] … At this point there’s already community spread. It doesn’t change case management to know whether it’s COVID or not,” Hamza said.

In mild cases there’s still not much doctors can do except tell patients to rest at home in isolation with plenty of fluids and Tylenol. Hamza gives all COVID-19-suspected patients advice about what to do if their symptoms worsen, and when they should head to hospital.

When billing the province, Hamza puts down a COVID-19 diagnosis code for all patients he suspects of having coronavirus infection. But as of now, Hamza says there’s no mechanism for primary care providers like him to report suspected cases of COVID-19 that haven’t been confirmed with a test. So those patients aren’t included in the official case statistics BC health officials update six days a week.

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Telus Babylon is another virtual medicine service in BC run by the communication company of the same name. Jill Yetman with Telus’ public relations team told Daily Hive that they’ve tripled their physician count, tripled their clinical operations capacity, and tripled their average daily number of appointments in the month since pandemic control measures were implemented in Canada.

How provincial billing codes enable telehealth services

Services like Cloud MD and Telus Babylon take advantage of a built-in billing code for a telehealth consultation in BC, making the service free for patients because it’s covered under MSP.

In late March, the BC expanded billable telehealth services in response to the pandemic, according to Doctors of BC. Other provinces are doing the same. Ontario invested in expanding their telehealth infrastructure, and Alberta activated emergency billing codes to help patients get care virtually during the crisis.

Daily Hive reached out to the Ministry of Health to ask for more information about telehealth’s history in the province and details about billing codes, but did not receive a response before press time.

Telehealth has existed in BC for most of this decade, and the province was a trailblazer in implementing a non-restrictive billing code, according to a 2014 report in The Medical Post. Medeo and Livecare (now a subsidiary of Cloud MD) were two early providers.

When is a telehealth appointment appropriate?

Hamza refers to telemedicine as a great “equalizer” because patients in rural communities can see specialists easily as long as they have internet. Cloud MD also focuses on helping patients who don’t have a family doctor or those who need help after-hours.

Hamza admits that telehealth isn’t appropriate for all scenarios. If a doctor needs to touch a patient, that can’t be done over the phone. But for routine appointments like adjusting medication or referring someone for mental health help, virtual care works just fine, he says.

Daily Hive spoke with two women who’ve used telehealth services before, and both said they liked the convenience.

Jordan Ladouceur uses Access Virtual (formerly EQ virtual) to refill prescriptions for her birth control and anti-depressants. She began using the service while she was in school in Kamloops and not able to see her family doctor, and still uses it now because it’s “so much easier than taking a half-day” off work.

“Some doctors are better than others,” she said. “Some are very get-it-done, and I’ve had some really probe into it,” by asking questions about how she’s feeling.

Sharon Nadeem used Telus’ Babylon service to get a birth control prescription. She’d had trouble in the past making it to an in-person appointment to refill the prescription before her pills ran out, and liked Babylon’s convenience.

“When you get off work at 5 or 6 pm you can’t always go to a doctor at the end of that,” she said.

Babylon faxed the prescription to her pharmacy, and after getting a blood pressure test there (which patients need to do before going on birth control), she was set.

“I’m surprised more people don’t know about it,” Nadeem said.

Telehealth concerns

At least one primary care expert has some reservations about private, for-profit companies operating telehealth services.

“If you can imagine, a care provider is invested in the relationship that they have with the patient. And at the same time they’re getting paid for that care,” said Rita McCracken, a family physician and assistant professor at the University of British Columbia.

“A for-profit entity is not invested in the particular patient. They don’t have a relationship with the human being; they have a relationship with the billing codes.”

To back up her position, McCracken points to research that suggests for-profit nursing homes provide inferior care to residents. She’s concerned the same could be true of telehealth providers.

Research already suggests that antibiotics are prescribed for patients with viral colds (which they don’t help treat) more often at walk-in clinics, McCracken said. She worries that other examples of less-than-ideal care may happen at these virtual walk-in appointments.

The creators of CloudMD say their years of experience in healthcare mean they’ve created their platform with the needs of patients and providers in mind. But according to McCracken, being a doctor yourself doesn’t make you “immune to mechanisms of capitalism.”

McCracken says on the surface it’s great for patients to have easier access to doctors, but she hopes that care is continuing instead of episodic.

Ideally, she’d like to see technology like this put in the hands of primary care providers who can use it to augment their existing relationships with patients. Both Cloud MD and Telus say they have technology options available to general practitioners who want to incorporate it into their existing practice.

For now, though, it’s clear the global pandemic has more patients curious about how they can get medical care from home.

“We’re just trying to add more doctors,” Hamza said. “We’re hitting new records every day.”