Quebec auditor general worried about booming telemedicine, quality of care

Quebec's auditor general is concerned that a boom in telemedicine since the beginning of the COVID-19 pandemic will have a negative impact on the quality of care offered to the population.

In her 2021-22 annual report made public Wednesday, Guylaine Leclerc said the Health Department has not provided a framework for when consultations can be carried out remotely and when a physical examination is required.

Her report states health-care providers and the Health Department weren't ready for the surge in telemedicine that came with the beginning of the pandemic in March 2020.

"They were in no way equipped to be able to deal with the telemedicine needs that there were at that time," Leclerc said.

Since then, the department has still not assessed the extent to which virtual care has contributed to improving the quality of care provided to patients.

The province's emergency health decree, adopted in March 2020, allowed doctors to be paid for remote care, which wasn't the case before. From the outset, the Health Department recommended for technical reasons that physicians use the telephone instead of video conferencing when communicating with their patients, and between March 2020 and September 2021 just one per cent of telemedicine consultations were by video.

"Certain medical acts require visual contact with the patient, if not a physical exam," Leclerc said.

In April 2021, there were 293 doctors in the province who said 90 per cent of all their appointments were done remotely, a proportion judged unacceptable by the Health Department. Another 2,367 doctors favoured telemedicine 40 per cent of the time. It was that month that the department introduced its first guidelines on telemedicine since the beginning of the pandemic.

Leclerc notes that remote medicine was not a new concept and had been used on an experimental basis with the aim of promoting better access to health care. Over the past 20 years, several initiatives were introduced to expand it, but none yielded the expected results. Given that amount of time, Leclerc said she would have expected the department to be far more advanced in its work when the pandemic hit.

In 2018, the government set a target of increasing the number of telemedicine consultations in remote regions by 40 per cent within two years, an objective that was not met due to technological issues and a lack of high-speed internet.

Leclerc noted while most departments devote five per cent of their budgets to technology expenses, the Health Department only sets aside two per cent.

The auditor general concludes that the department will have to better regulate telemedicine in the future as it is here to stay, in particular by having proper guidelines about when it can be used and when a face-to-face appointment is required — such as when meeting a new patient.

The auditor's report said the government will also have to amend the law and adapt the remuneration of doctors to meet this new reality.

The Health Department responded to the findings by saying telemedicine had evolved in the exceptional context of the COVID-19 health emergency, acknowledging that the changes had not occurred as desired.

This report by The Canadian Press was first published March 16, 2022.