Pan-Canadian virtual care priorities in response to COVID-19

Federal, provincial, territorial collaboration

The COVID-19 pandemic has pushed Canadian health systems to innovate quickly, given the significant disruption the pandemic has caused to the delivery of in-person health services. During COVID, virtual care has been key to enabling Canadians to continue to safely access the services they need.

Throughout this time, the Government of Canada has been committed to working in partnership with provincial and territorial governments to put in a range of digital supports to help Canadians get the information, resources and care they need throughout this unprecedented time. On May 3, 2020, the Prime Minister confirmed this commitment by announcing an investment of $240.5 million to accelerate the use of virtual tools and digital approaches to support Canadians. Of this, $200M is helping provinces and territories accelerate their efforts to meet health care needs through virtual tools and approaches.

Following the Prime Minister's announcement, federal, provincial and territorial officials agreed to focus work on three streams.

Five shared priority areas for investments in technology and infrastructure
- Secure messaging and information-sharing platforms or supports for end-to-end messaging
- Secure video-conferencing technology
- Remote patient monitoring tools
- Patient access to COVID-19 and other lab results
- back-end supports for integration of new platforms and supports, including needed hardware
Evaluation of the impact of virtual care
Policy supports for virtual care

In addition to the federal support to provinces and territories of $150 million, Canada Health Infoway will receive up to $50 million to support provinces and territories in the implementation of new initiatives pursuant to these agreements.

This agenda has been driven by historic Federal, Provincial and Territorial (FPT) collaboration, through a dedicated FPT Virtual Care/Digital Table 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. To inform the work of the FPT Virtual Care/Digital Table, the Virtual Care Expert Working Group ("Expert Working Group"), which includes both stakeholder and government official experts, was struck to provide advice and guidance on issues related to the deployment of virtual care in Canadian health systems.

Policy supports for virtual care

In fall 2020, the FPT Virtual Care/Digital Table endorsed an preliminary policy framework, which identifies barriers and opportunities for the long-term adoption of virtual services within Canada's publicly funded health systems. These policy enablers were categorized into the following "pillars":

patient and community-centred approaches
equity in access to care
provider remuneration/incentive structures
appropriateness, safety and quality of care
provider change management
licensure

The full Policy Framework can be found here: Virtual Care - Policy Framework.

Building off this preliminary policy framework, in January 2021, an external expert, Will Falk was contracted to validate the preliminary FPT policy framework and engage with FPT officials and stakeholders to develop recommendations for actions on virtual care. The resulting diagnostique with recommendations can be found here: The State of Virtual Care in Canada as of Wave Three of the COVID-19 Pandemic.

Equity in access to virtual care was a major theme in discussions at both the FPT Virtual Care/Digital Table and Expert Working Group. Members were seized with the critical importance of ensuring that governments are well-positioned to address/avoid unintended consequences related to equity arising from the widespread uptake and use of virtual care. Led by Dr. Ewan Affleck, an external expert on the Expert Working Group, a Task Team on Equitable Access to Virtual Care was mandated to develop high-level design principles for the consideration of equity in virtual care. The Task Team's comprehensive efforts over the last 18 months culminated in an excellent final report, entitled Enhancing Equitable Access to Virtual Care in Canada.

FPT collaborative efforts on virtual care culminated in a FPT/ Stakeholder Virtual Care Summit on June 22 and 23, 2021. The Summit brought together nearly 80 relevant officials and stakeholders from across the country to discuss the policy enablers underpinning virtual care and to identify considerations for a national action plan to maintain the unprecedented momentum spurred by the pandemic in the delivery of virtual care services. A final summary report, based on the fruitful discussions and key takeaways from the Summit, is available here: Summary Report of the FPT + Stakeholder Virtual Care Summit.

Results

The Centre for Digital Health Evaluation (CDHE) is leading three streams of work with provinces and territories, along with the Canadian Institute for Health Information and Canada Health Infoway, to evaluate the impact of virtual care:

establishing a new digital health evaluation network that includes academics, patient groups, decision-makers, and other stakeholders from all provinces and territories
creating a digital health evaluation framework with standardized methods
conducting two high-impact multi-jurisdictional evaluations of new digital health investments

More information about the CDHE, and its virtual care evaluation work, can be found here: Canadian Network for Digital Health Evaluation.

To enable Canadians to assess progress, the Canadian Institute for Health Information will report the results of this work, based on jurisdiction-specific performance measures.

Bilateral agreements

Following the agreement by federal, provincial and territorial officials on the five priority areas for the federal investments in virtual care, the Government of Canada began multilaterally and bilaterally negotiating virtual care agreements with provinces and territories.

As set out in the agreements, provinces and territories will also provide an action plan within 90 days of signing the agreement, which will set out details of the jurisdiction's specific initiatives for virtual care supported by the federal investments. The agreements and action plans (when available) can be viewed at the following links.

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Pan-Canadian virtual care priorities in response to COVID-19

Federal, provincial, territorial collaboration

Policy supports for virtual care

Results

Bilateral agreements

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Prince Edward Island

Nova Scotia

Newfoundland and Labrador

Nunavut

Northwest Territories

Yukon

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