Recently the Alberta government announced its partnership with Telus to make the Babylon app available to Albertans.
Babylon provides a means to connect virtually with contracted physicians in order to get medical advice. It comes at a time when the system is challenged by the Covid 19 pandemic and increasingly stretched resources.
I would like to follow-up my last post with some analysis of this decision and what it means to Albertans.
I will begin by restating what we believe the system should be providing Albertans. Safe, continuous, collaborative, patient-partnered care.
Babylon is a piece of communication technology. It is a communication tool that enables patients to reach a doctor, and doctors who are contracted with Babylon to respond to patients.
From a safety aspect, it should be recognized that technology itself is not capable of providing care.
It takes a team of people, including the patient, working together to achieve safe and quality care. Technology tools that connect patients and their doctors have been available for some time, including systems that meet all privacy, security and confidentiality regulations. What has been needed in Alberta has been the willingness of the government as well as the agreement of the doctors on the funding framework needed to incentivize the transition to greater utilization of virtual care and other digital health tools. While some doctors and clinics already have embraced this advancement to enhance their work with their patients, many others have been waiting for the traditional payment methods to be resolved before moving forward. This situation shows the basic problem with the fee-for-service model.
The Babylon approach is not an enhancement to an existing relationship between patients and their doctors, but one that simply connects the two without any prior relationship.
The risk with this comes in a number of areas. The virtually connected doctor does not automatically have all of the information about the patient. While access to Netcare, the acute (hospital and labs) system may be available, any of the patient’s information that is only at the primary care level will not.
Babylon also doesn’t appear to be structured in a way that would expect to connect the same patient with the same doctor in the future. This certainly keeps any continuity disconnected and makes any ongoing partnership with the patient problematic. As for collaboration, it is unlikely any ongoing relationships would exist with others who could be members of the care team when Babylon is based on the individual one-time interaction between a patient and a doctor contracted to be available.
Primary care doctors who have developed relationships with their patients, and have been able to utilize new technology to connect and organize care with their patients, have the ability to maintain “continuity”, to “collaborate” with other care team members, and “partner” with patients in their care.
If we consider whether the decision by the Alberta government to provide Babylon is one that elevates safety, maintains safety or degrades safety, our conclusion is that it degrades patient safety.
While there may be an argument that where patients don’t have a family doctor and need answers now with respect to their health care, a Babylon doctor may provide one-time answers based on limited information, but the critical components of care are missing.
It would have been much better to first take quick action to increase the capacity of the system’s family doctors to utilize virtual care technology. Thiss approach covers continuity of the relationship and information, collaboration, and patient partnerships. This approach would be keeping safety as a priority. If it was determined that additional short-term capacity was needed, adding a fallback or second choice component in something like Babylon could have been added then.
The announcement by Minister Shandro yesterday, to temporarily put in place billing codes to support all primary care doctors to utilize virtual care tools is an appropriate decision now, given the circumstances. I believe that this can make some additional capacity available that has been held back. It may help take some of the potential future load off emergency departments. I believe it will be safer by making it easier for the information to be available to everyone engaged on the team providing advice for, and making decisions with patients on their care.
I give great credit to those doctors and clinics that have previously embraced the available technology and gone ahead to set up the processes to provide the best virtual care they can. They are in the best place to deal with these challenging times now. Credit also goes to those who have seen the need and the promise, and invested their own talents, sweat and money to develop these tools and to make them available to doctors and patients. Together these two groups have improved the safety of both patients and providers.
Adding a temporary fee code won’t make the changes necessary to turn the system toward the right destination in the long run. Paying fee-for-service, or what it really is, for piece work, is just that. It is not about safety or care. It is simply money paid for a single act. This model incentivizes volume over safety or quality. There are many examples in all parts of the economy where people over time, shift and respond to this narrow focus. It isn’t the individual’s fault. It is simply the result of reacting to or working with the signals being made through the payment. In some instances, it works ok but these examples almost always have a safety/quality criteria as well as volume. Other people also take care of making sure that the rest of the conditions are managed in a way that keeps the system safe, efficient and competitive. For the health system to provide safe care, it cannot be done reinforcing individualism and individual tasks when we must have the best efforts of all team members contributing to safe care. Compensation must find the balance between accountability for the whole effort and rewarding how well this is accomplished.
Minister Shandro and the government of Alberta, have the opportunity, and I believe the obligation, to work with the people in the system and with Alberta’s citizens, to choose a better health care destination and ensure the voyage is launched on course for it.
The Covid-19 pandemic is a huge challenge that we have to deal with right now. It is also important for us to retain what we learn about safety and care through this battle and to apply all of this going forward.
As Albertans, we need to pay attention, to expect transparency throughout, and to learn what really is happening with our health system. We all need to support, even demand, a safer and better system for patients and providers alike.