This is a brief response to the nine commentaries on my paper regarding virtual care as of the sixth wave of the COVID-19 pandemic (Falk 2022). Virtual care and its digital support infrastructure have had an iterative de...This is a brief response to the nine commentaries on my paper regarding virtual care as of the sixth wave of the COVID-19 pandemic (Falk 2022). Virtual care and its digital support infrastructure have had an iterative developmental path since the arrival of the pandemic in early 2020. Real-time policy making has been the norm in the field, and iteration by thoughtful opinion leaders seems a sensible way of continuing to move the discussion forward.
The constraints of the COVID-19 pandemic accelerated the adoption of virtual care. The role of virtual care in the mix of healthcare services is being re-examined as the pandemic evolves. For many diverse Indigenous comm...The constraints of the COVID-19 pandemic accelerated the adoption of virtual care. The role of virtual care in the mix of healthcare services is being re-examined as the pandemic evolves. For many diverse Indigenous communities (rural, remote, urban), virtual care has the potential to increase access to healthcare and improv health outcomes, or to worsen existing inequities. Thoughtful co-design of virtual care programs, attention to user experience and enabling policy decisions can unlock the potential of virtual care for Indigenous individuals and communities.
As Canadian leaders of the world's largest virtual care organization, we bring a national and a global perspective to our response to Falk's (2022) paper on virtual care in Canada in this issue. With more than 20 years o...As Canadian leaders of the world's largest virtual care organization, we bring a national and a global perspective to our response to Falk's (2022) paper on virtual care in Canada in this issue. With more than 20 years of experience enabling virtual care and more than 90 million people accessing our virtual care services and tools in more than 170 countries, across more than 600 health systems and more than 70 clinical use cases, we have already done or witnessed first-hand many of the changes that Falk anticipates Canadians will contend with as we expand channels to and modalities of care beyond the incumbent monochannel of in-person, physician-mediated service delivery. In this essay, we respond to Falk's (2022) paper in three ways: (1) we disagree with the definition of virtual care; (2) we agree with - and expand on - the analysis and ideas; and (3) we reveal two gaps in Falk's analysis that will or should be at the forefront of the Canadian discourse. That is, we disagree with the narrow framing of virtual care, we agree with the locks and keys (and suggest, from experience, other ways to think about the keys) and we table important gaps that are notably missing from the debate.
As the Canadian healthcare system struggles to keep pace with the demand, it is becoming increasingly urgent to find more solutions to ensure that Canadians receive the care they deserve and expect. The author shares per...As the Canadian healthcare system struggles to keep pace with the demand, it is becoming increasingly urgent to find more solutions to ensure that Canadians receive the care they deserve and expect. The author shares perspectives on the value of privately delivered solutions in our publicly funded healthcare system. He draws on the notion of bringing together a mix of knowledge, expertise and talent to help reduce barriers and improve access to care. In addition to virtual care, he examines examples of mobile integrated health programs and partnerships that are working to deliver care to communities.
Principles for determining physician compensation in the provision of virtual care are discussed along with analysis of the virtual care components included in the 2022 Ontario Physician Services Agreement (SEAMO 2022)....Principles for determining physician compensation in the provision of virtual care are discussed along with analysis of the virtual care components included in the 2022 Ontario Physician Services Agreement (SEAMO 2022). Ministries and medical associations should continue to discuss appropriate payment for virtual advice for patients who do not have a primary care provider. They should also determine methods for payment for physician engagement in apps designed to optimize treatment of chronic diseases.
Virtual care (VC) was rapidly introduced into mainstream health service delivery due to COVID-19. To maintain and integrate VC with in-person care, one important change management approach requires a holistic educational...Virtual care (VC) was rapidly introduced into mainstream health service delivery due to COVID-19. To maintain and integrate VC with in-person care, one important change management approach requires a holistic educational strategy for the health professions. Pratt's (1998) "five perspectives of teaching" is an effective framework to guide the development of VC education to holistically increase the knowledge and skills of health professionals and stimulate health system change through the Transmission, Apprenticeship, Developmental, Nurturing and Social Reform perspectives. This article then makes five recommendations to implement this strategy through purposeful involvement and collaborations between stakeholder organizations.
Canadian physicians' perceptions on their use of and experience with virtual care offer important insights into finding the right balance in virtual care. Using data from the 2021 National Survey of Canadian Physicians c...Canadian physicians' perceptions on their use of and experience with virtual care offer important insights into finding the right balance in virtual care. Using data from the 2021 National Survey of Canadian Physicians conducted by Canada Health Infoway and the Canadian Medical Association (Canada Health Infoway and CMA 2021), we explored the mix of virtual care use by physicians, satisfaction with and challenges of virtual care and other perspectives around its continued use. We discuss how these data inform and enrich some of the key recommendations put forward by Falk (2022) in this issue.
We respond to Falk's (2022) recent recommendations around interoperability. Although we applaud the notion that the health data of Canadians be usable - that is, machine interpretable - and widely clinically available, F...We respond to Falk's (2022) recent recommendations around interoperability. Although we applaud the notion that the health data of Canadians be usable - that is, machine interpretable - and widely clinically available, Falk's (2022) recommendations must be extended. Specifically, interoperability must centre on the person and people's rights to hold and control a usable copy of their health information for their own purposes. Also, we must acknowledge that Canada is a small global market and avoid internal fragmentation with competing jurisdictional standards. Our national strategy must align with major trading partners. To do otherwise will disenfranchise Canadians and our digital health innovators.
An evaluation of the paper by Falk (2022) in this issue using a word count method found that it omits consideration of substantial efforts, inherent data rights and experiences with virtual care from certain jurisdiction...An evaluation of the paper by Falk (2022) in this issue using a word count method found that it omits consideration of substantial efforts, inherent data rights and experiences with virtual care from certain jurisdictions, professions and Indigenous groups. Although equity is positioned as a core policy pillar of virtual care, it is not defined, nor are factors underlying digital health inequity described. Deficits in health informatics training, regulation, pedagogy and research in Canada likely contribute to an inequitable approach to health informatics planning. A commitment to definitional rigour, taxonomic clarity and evidence-informed informatics will help promote digital health equity.
Excitement over the rapid implementation of virtual care has been a common theme of the pandemic. Virtual care was an essential option that eliminated the risk of physical contact early on, but does it fit into what we e...Excitement over the rapid implementation of virtual care has been a common theme of the pandemic. Virtual care was an essential option that eliminated the risk of physical contact early on, but does it fit into what we envision as an optimal future health system? Pulling from the knowledge gained through more than 500 conversations about a better healthcare system(s), the author outlines some of the fundamental elements that will be critical for the future and where virtual care fits in the big picture. In fact, the author believes that the vision of a patient having a highfunctioning care team that meets their unique needs cannot exist without virtual care.
Virtual care has stabilized at about one-third of visits as the sixth wave of the pandemic in Canada ebbs from about twice that at the peak of the first wave but is up more than tenfold from pre-pandemic levels. This has...Virtual care has stabilized at about one-third of visits as the sixth wave of the pandemic in Canada ebbs from about twice that at the peak of the first wave but is up more than tenfold from pre-pandemic levels. This has created huge changes and challenges, which the author reviews in an attempt to make workable policy recommendations and find a balance among competing priorities. Falk revisits recommendations from his Health Canada report (Falk 2021), updating and expanding on recommendations concerning remuneration, licensure, equity and access. He introduces newly available data on specialty and primary care use and discusses the practical implications for change management and system development. He expands his recommendations for aggressive regulatory changes and standards for digital health and virtual care.
The adage "Never let a good crisis go to waste," widely attributed to Winston Churchill (Gruère 2019), has echoed throughout the COVID-19 pandemic. It aptly describes the rapid uptake of virtual care since March 2020 and...The adage "Never let a good crisis go to waste," widely attributed to Winston Churchill (Gruère 2019), has echoed throughout the COVID-19 pandemic. It aptly describes the rapid uptake of virtual care since March 2020 and other developments that it has inspired, including renewed attention to health information and data governance, interoperability, health equity, appropriateness and cross-border licensure.
The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR) Strategic Plan 2021-2026 (CIHR IHSPR 2021) aims to accelerate healthcare system transformation to achieve the Quadru...The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR) Strategic Plan 2021-2026 (CIHR IHSPR 2021) aims to accelerate healthcare system transformation to achieve the Quadruple Aim and health equity through research. This special issue features a collection of commentaries from academic and health system leaders who were invited to respond to IHSPR's strategic plan and share insights regarding the opportunities the plan presents and areas where more attention may be needed. The present paper features a response from the IHSPR team and outlines the next steps regarding implementation. IHSPR is deeply grateful to the commentary authors for their insight, advice and recommendations, which will help to inform the implementation of the plan.
In its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) convincingly expresses its desire to expand capacity for applied health services and...In its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) convincingly expresses its desire to expand capacity for applied health services and policy research (HSPR) and better mobilize research results for health system transformation geared toward the Quadruple Aim and health equity for all (CIHR IHSPR 2021). These strategic priorities echo views widely shared within the HSPR community, and we commend IHSPR for its leadership and vision. Recognizing the systemic challenges ahead of us, this commentary considers the HSPR community's capacity to achieve the promise of learning health systems, given the obstacles likely to hinder their rapid scale-up over the next five years. Next, we consider the spread of virtual care during the pandemic to illustrate the embedded and negotiated nature of innovation in health systems and the need for vigilance as to the social distribution of their benefits and costs. Finally, a critical review of the strategic plan provides insights into how research is governed in the HSPR field. Based on this analysis, it appears essential to reconsider health system transformation as social system transformation and strengthen interdisciplinary and comparative research. Looking forward, developing a science of science to better understand the conditions associated with high-impact research should be a cross-cutting priority for Canada's HSPR community.
The Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) has published its Strategic Plan 2021-2026 (CIHR IHSPR 2021) and, as members of the Expert Advisory Group for a Pan-Ca...The Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) has published its Strategic Plan 2021-2026 (CIHR IHSPR 2021) and, as members of the Expert Advisory Group for a Pan-Canadian Health Data Strategy, we are providing commentary on the second strategic priority of IHSPR's Strategy related to health data and digital health. Systemic barriers have prevented the timely and effective collection, sharing and use of health data in Canada. Many of these systemic barriers relate to the fragmented health data foundation, lack of coordinated data governance and a risk-averse culture. As IHSPR mobilizes its strategic plan, it will be important to consider and address these factors head-on to contribute to a stronger health data foundation that would help achieve both IHSPR's strategic objectives and meaningfully contribute to elevating Canada's health data ecosystem.
The new Canadian Institutes of Health Research - Institute of Health Services and Policy Research's Strategic Plan 2021-2026 (CIHR IHSPR 2021) holds potential. Barriers are anticipated, including that commitments to equi...The new Canadian Institutes of Health Research - Institute of Health Services and Policy Research's Strategic Plan 2021-2026 (CIHR IHSPR 2021) holds potential. Barriers are anticipated, including that commitments to equity, diversity and inclusion (EDI) are tokenistic. This commentary provides four recommendations to support EDI as transformative. First, EDI must start with an honest history of the role of institutions in upholding injustice. Second, performative EDI must be replaced by changes in money, power and resources. Third, data collection alone must never be the end goal of EDI. And fourth, for EDI to be transformative, it must be grounded in praxis, taking direction from communities and movements seeking justice.
Our healthcare systems depend on human capital for effectiveness. The Canadian Institutes of Health Research - Institute of Health Services and Policy Research has prioritized building capacity for "solution-oriented res...Our healthcare systems depend on human capital for effectiveness. The Canadian Institutes of Health Research - Institute of Health Services and Policy Research has prioritized building capacity for "solution-oriented research and evidence-informed health care system transformation" (CIHR IHSPR 2021a: 20) as a core strategic direction. In this commentary, we articulate strategies for positioning PhD-trained scientists at the forefront of this transformation, including refreshing a competency framework that outlines the skill set required for maximum impact, exploring opportunities to expand embedded research career pathways and considering new ways to support the evolution of learning health systems. We conclude highlighting the need to modernize how real-world research impact is recognized.
Murphy GT, Sampalli T, Embrett M
… +10 more, Sim M, Murdoch J, McIsaac K, Lawrence L, Guk J, Carson A, Chamberland-Rowe C, MacLellan M, MacInnis M, Urban R
The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic pr...The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic priorities being outlined by many health systems in Canada and internationally (CIHR IHSPR 2021). The IHSPR Health System Impact Fellow program has been a strong influence on the embedded research and scientist program in Nova Scotia, namely, the Network of Scholars Program, which was implemented just before the pandemic. The network includes scientists and scholars from diverse academic backgrounds and skill levels including alumni of the Health System Impact Fellow program. The Network of Scholars has over 30 scholars and approximately 100 academic partners and scientists supporting embedded activities such as rapid reviews, implementation science and rapid evaluation initiatives. These embedded activities are front facing to the needs and priorities of the health system. This commentary highlights the importance of IHSPR's outlined strategic plan and direction, which are consistent with the experience and the needs for embedded supports within the Nova Scotia health system.
Much of health services and policy research is applied. We offer four provocations to stimulate thinking about the relationship between research and the "systems" it aims to influence. We conclude that a focus on partner...Much of health services and policy research is applied. We offer four provocations to stimulate thinking about the relationship between research and the "systems" it aims to influence. We conclude that a focus on partnership implies that researchers need to be empathetic to the timelines and needs of policy makers, while true relationships are bidirectional. Focusing on the priorities of "systems" will emphasize short-term issues. This leads to researchers often conducting post-implementation evaluation, where they have had little involvement in policy or intervention design. Finally, a focus on single-project return of investment will tend to undervalue riskier - but also potentially more rewarding - research.
The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026: Accelerate Health Care System Transformation through Research to Achieve the Quadruple A...The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026: Accelerate Health Care System Transformation through Research to Achieve the Quadruple Aim and Health Equity for All (CIHR IHSPR 2021) outlines the Institute's key priority areas for investment and activity over the next five years. IHSPR used an evidence-informed strategic planning process that was pan-Canadian in scope and designed to elicit the health services and policy research priorities of decision makers, providers, researchers, patients, communities and the public. This paper outlines IHSPR's four key strategic priorities for supporting and optimizing research in transforming Canada's healthcare delivery systems over the next five years.