The document discusses shifting perspectives on the virtualization of healthcare. It summarizes research from a PwC report on Canadians' attitudes toward improvements in healthcare delivery. Canadians expressed openness to virtual care options like monitoring chronic conditions remotely, virtual visits for post-surgical follow-up, and apps for initial health assessments. The report also examines issues like how virtual care can improve access, quality and sustainability in healthcare systems. It outlines a potential framework for regulating medical apps and digital tools, separating them into categories like over-the-counter and prescription-based apps.

1. Making Care Mobile:
Shifting Perspectives on the
Virtualization of Health Care
ATA Fall Forum
Luncheon Keynote
Sept 10, 2013
@willfalk
slides available on Twitter

2. PwC
Who I am
Will Falk
Managing Partner – Healthcare, PwC Canada
Executive Fellow, Mowat Centre for Policy Innovation
Adjunct Professor, Rotman School of Management
william.f.falk@ca.pwc.com
Twitter: @willfalk
2

3. PwC
Making Care Mobile: Shifting Perspectives on the Virtualization
of Health Care
• Report explores Canadians’ attitudes towards pertinent
issues in the health care industry
• Provides analysis of what citizens expect decision makers to
keep in mind when thinking of the future of health care in
Canada
Goal of the report
• What improvements are citizens looking for in health care?
• What channels are citizens using to access health care and
information now, and in the future?
• What innovations are citizens ready to use that can make
health care delivery more efficient?
• What are the future possibilities in health care delivery?
Key Questions
www.pwc.com/ca/virtualcare
3

4. PwC
Making Care Mobile
Shifting perspectives on the virtualization of health care
More than 2,400 Canadians participated in our research to address the
central question, “What does the future of health care delivery look like?”
4

5. PwC
Virtual assessments via apps are good options in
the right situation…
52%
of patients
indicate that
faster access to
care is the
primary
appeal of
virtual
assessment
1%
8%
15%
20%
21%
36%
No answer
Not sure
None of the above
You use an app for an initial assessment
You send it to your doctor using an app
Doctor takes the photo and communicates with
dermatologist
77% of Canadians were comfortable with virtual mole assessment app
scenario – although, at this time, most prefer doctor-controlled option.
5

6. PwC
Canadians told us they are ready for virtual
monitoring for chronic conditions…
79%
of Canadians
indicate that
they are
comfortable
with virtual
monitoring for
chronic
conditions
Most Canadians indicated they would be comfortable
having a chronic condition monitored virtually...
36%
43%
10%
5%
4%
2%
Yes, definitely
Probably
Not likely
Definitely not
Not sure
No answer
... and 62% of caregivers indicated that virtual health
care would help them to provide care for someone
else (e.g. parent/ child)
6

7. PwC
… and virtual visits for post-surgical follow-up.
54%
of Canadians
indicate that
virtual visits,
home
monitoring,
and virtual
wards are good
care delivery
options
24%
43%
17%
11%
5%
0
Yes, definitely
Probably
Not likely
Definitely not
Not sure
No answer
The majority of Canadians indicated they would be
comfortable having post-surgical follow-up visit
done by video conference.
7

8. PwC
Q: Are mHealth and vHealth different?
Consumer mHealth is exploding in part as a result
8

9. PwC
Telemedicine and mobility are coming together
facilitating delivery of virtual care anywhere
Telemedicine mHealth Virtual Care
9

10. PwC 10
many small pilots 25%
By 2020, more than 25% of care will be delivered
virtually (with provider and patient in separate places).
- Dr. Ed Brown, 2012

11. PwC
Virtual Health Care: We have been through
similar shifts before…
Inpatient
Care
Outpatient
Care
Virtual
Care
1992…
More people leave
hospital after procedure
than remain overnight
202X?…
More virtual visits than
physical visits
Each transition involved people, process, and technology changes.
Major shifts in how we organize our care delivery services and assets
11

12. PwC
Virtualization improves health system access,
quality, productivity, and sustainability…
Access Quality Productivity Sustainability
• Deliver care over
long distances
• Reduced travel
and wait times
• Re-distribution
of HHR – access
to scarce
specialties
• Better waiting
rooms
• Auditability of
decisions
• Use of
manufacturing,
QI, and QA
techniques
• Lower infection
rates/ Infection
control
• Automated
scheduling
• Elimination of
“politeness time”
• Asynchronous
consultations
• Ability to
aggregate
volumes
• Avoidance of
greenhouse gases
• Ability to
substitute lower
cost care providers
• Auction pricing
mechanisms
• Artificial
Intelligence
12

13. Specialists’ Offices
Regional Hospitals
On-Call Emergency Physicians
Public Health Units
Mental Health and Addiction Treatment Centres
Primary Care
Family Health Teams
Community Hospitals
Cancer Centres
First Nations Communities
Psychiatric Hospitals
CCACs
Mental Health Facilities
Federal and Provincial Prisons
Rural Nurse Practitioners
Long-Term Care Homes
Referring Clinician Consulting Clinician
eReferral
4. eConsult (ask a question)
3. eConsult (full assessment)
2. Clinical Videoconference
1.Face-to-Face
Provider to Provider: The Future

14. PwC
Virtual Care solutions will be segmented by cost of
delivery, and offer benefits to specific segments
14
High cost solutions
supported by high
clinical value
Cost-value tradeoff
Cost level can only
be supported using
consumer
electronics
10,000
01,000
001oo
010
Solutioncost/benefit($)
Population (%)
5% 100%50%

15. PwC
Focusing on “frequent flyers” both helps and
hinders developing an at scale virtual care system
1%
34%
5%
66%
10%
79%
50%
99%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ontario Population Health Expenditure
Figure 1. Health Care Cost Concentration:
Distribution of health expenditure for the Ontario population,
by magnitude of expenditure, 2007
$33,335
$6,216
$3,041
$181
Expenditure
Threshold
(2007 Dollars)
Source: ICES
15

16. PwC
The drug delivery system may provide a model for
the organization of apps and devices
Take 2 Apps and
Call Me in the
Morning
Tech Rx
Apps Pharmacy not Apps Store
Apps Formulary
AliveCor Cardiac
Withings Blood Pressure
bant Diabetes
Pain Squad Pain Mgmt
MyIBD Crohn’s Disease
16

17. PwC
We need a process and standards for selection,
and a taxonomy for regulation of apps
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
Criteria for evaluation include:
• Operability
• Privacy & Security
• User Data Safeguards
• Functional Validation
• Clinical Efficacy
17

18. PwC
Front of store apps are mHealth ‘vitamins’ that
supplement a healthy lifestyle
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
18

19. PwC
Over the counter apps may be dispensed after an
assessment of the patient's needs
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
19

20. PwC
Prescription apps: plan of care written by
physician or other health professional
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
20

21. PwC
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
Controlled apps: require close supervision of
management and use
21

22. PwC
Virtual care and Apps fulfillment is now a new
class of service offerings
Front of
Store
Over the
Counter
Prescription
Controlled
Substance
In this stage of their
development, the
‘prescription’ and
‘fulfillment’ of
mHealth Apps need
not be separated
22

23. Thank you.
@willfalk
* slides available on Twitter
This content is for general information purposes only, and should not be used as a substitute
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