Launch of doctor app a wake-up call for Saskatchewan's health system, says expert

When her three-year-old daughter Serenity developed a rash on her face during the Thanksgiving weekend, Regina mother Megan Reves got a prescription to treat it from a family physician in about 15 minutes — all without leaving her kitchen.

"There are not many things that are more of a nightmare than bundling up sick kids to go to a walk-in clinic," Reves said.

Instead, Reves used an app called Lumeca, run by one of several Canadian companies now offering paying subscribers 24/7 access to licensed doctors via text, audio or video consultations. Reves's family pays $50 a month for a Lumeca subscription to cover common health problems ranging from acne to yeast infections.

While customers may appreciate the convenience, some experts say the new services highlight shortcomings in the public system.

Health apps challenge existing system 

Steven Lewis, a Saskatchewan health policy analyst now based in Australia, said companies like Lumeca are exploiting a weakness in the public health care system. Their presence, he said, is challenging an outdated model of primary care to start delivering on the public's expectations for patient-centred care in the digital age. 

"We perform worse than most [Organization for Economic Co-operation and Development] countries in terms of same-day access and the availability of non-in-person consultations," says Lewis. "Our system is fragmented and organized primarily around the convenience and preference of providers."

Digital doctoring appears to be gaining traction.

Lumeca — which launched in Saskatchewan in June 2019 — declined to share its subscription numbers. But a spokesperson for Ontario-based Maple, which went live in the fall of 2016, reports about three per cent of its 500,000 Canadian subscribers — so about 15,000 — are Saskatchewan residents.

 At Kaiser Permanente, a large health care provider in the U.S., more than half of its 100-million-plus annual physician encounters are now done through virtual visits. 

Dr. Jackie Bucko, a Saskatoon family physician who practises at the Cornerstone Medical Clinic, was one of the first doctors to join Lumeca. She says she does her virtual moonlighting "from my kid's soccer game, at the hospital, at the lake, at the office ... all over the place." 

Saskatchewan's health system does offer patients some virtual care options, including the toll-free HealthLine, a phone-only service staffed by registered nurses who instruct callers on self-care or direct them to a clinic, their family doctor or an emergency department.

And Telehealth provides patients with virtual access to specialist physicians, but patients need to travel to one of 400 specially equipped sites to use the service. 

Neither of those services put patients in touch with doctors on demand.

 Two big hurdles ahead: tech and doctor pay

The province faces two main hurdles when it comes to virtual care, or telemedicine: technology and doctor pay. Saskatchewan hasn't yet developed or adopted secure technologies that would allow family physicians to offer patients this kind of service. And family doctors can't bill the health system for visits that aren't face-to-face.

While the Ministry of Health won't say whether virtual visits are likely to become publicly funded services, it's on the government's radar. In a written statement, the ministry says it "recognizes the benefits of non-face-to-face visits and is interested in adding choice for residents where there is an opportunity to improve patient access and satisfaction with health services. 

Apps could increase health disparity, says critic

Canadian Doctors for Medicare sees huge potential for virtual care to help Canadians, but would prefer to see it applied in a more equitable way. 

Spokesperson Dr. Melanie Bechard says that, because companies like Lumeca are selling subscriptions for a service not currently covered as an insured service by most provinces, they are following the letter — but not necessarily the spirit — of the Canada Health Act. 

She says it could increase health disparities. 

"If we're only having the services available to those who can pay, we might be seeing that those who are wealthier, who already tend to be healthier on average, are getting even more time with doctors."

Lumeca CEO Shawn Hazen sees things differently. 

"The person who uses Lumeca for their care means that they don't take up a visit in the public system," he said. "This allows a non-user to access this open spot." 

The public system also benefits when his company diverts patients with minor health issues away from already-crowded ERs, Hazen said.

Prince Albert family physician Dr. Stan Oleksinski doesn't see the rise of telehealth apps as inherently good or bad. They are simply another channel for communicating with patients, one that can complement — but not replace — the existing physician-patient relationship. 

"I would hope that patients are receiving care in face-to-face meetings periodically as well, not all online, because that's not best for continuity of care." 

He says research shows that people who see the same family doctor on a regular basis have lower mortality rates than people who don't.

Oleksinski isn't worried about apps poaching his patients because Saskatchewan doesn't have enough family doctors to meet the demands of our growing population. "So the more exposure there is to family physicians, the better."

As for the future, health analyst Lewis says the public system needs to provide the same level of service, making private-pay apps obsolete.

 "It's a shame that there is a market niche, if there is one, for this new company. That has nothing to do with this company, and everything to do with how slow primary health care has been to move into the late 20th, let alone the early 21st century."

Lumeca's Hazen says the company believes it can keep ahead in technological advances to give it continued appeal to clients.