The Small Business Mastermind

Steve Chamberlain: The biggest reason we've seen the rise of Telemedicine in the last few years is the real crisis that's going on in our Primary Care System here in Canada. There are many amazing things that our Canadian public healthcare system can do but we rank dead last in the developed world when it comes to timely access to primary care.

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Voice Over: You're listening to the Small Business Mastermind, a podcast created by Olympia Benefits to help small businesses juggle business, finance, health, and wellness. I'm your host, Morgan Berna. 

Have you heard the term Telemedicine? Also known as virtual healthcare. It's the delivery of health and health-related services by digital technology.

Meaning, it's a way to talk to doctors and nurses directly from your computer or cellphone. Explained by some as being the answer to the current strains on the medical system, telemedicine opens on-demand medical care up to anyone with internet access.

On this episode, I chat with Steve Chamberlain from Dialogue all about Telemedicine. We go over what exactly it is and what it can be used for, how it works for people with primary care physicians, privacy, and data security as well as how it fits into the business model of a small business. I asked him about common concerns people have with Telemedicine and tips for successful implementation. So, without further ado, let's jump right into this conversation. 

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Morgan Berna: So, hi. We’ve got Steve today. Thank you so much for being here, Steve.

Steve: Yes. Thanks for inviting me. 

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Voice Over: Steve Chamberlain leads Western Canadian Business Development for Dialogue, the leading Canadian platform for virtual healthcare for employers. His career began in the tech world, leading a digital media startup to 25 times revenue growth, and he joined Dialogue after four years with Monster Canada as Director of Enterprise Solutions. Steve is intimately involved in the Calgary community as a member of young professionals in energy and president of the AAISP Calgary Chapter and he was a guest speaker at both the 2016 and 2017 Global Petroleum shows. 

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Morgan: So today, we're talking about Telemedicine and before we kind of jump into all the questions I've got, can you just let us know what Telemedicine is?

Steve: Yes. It's a broad term. To simply put, it's the ability to connect with healthcare virtually via the physician or a psychologist. Telemedicine has kind of been in the public idea for a hundred years. It first came to the province about 1925. There was a guy by the name of Hugo Gernsback, who wrote in the Science and Innovation Magazine about this device called the pterodactyl that he envisioned in the future of medicine where it was essentially a way for doctors to see their patients through a view screen but they would also be able to touch them with like this device with spindly robot arms.

Morgan: I think I've seen something about this. 

Steve: Yes. I'll check with our R&D Department, but I think Telemedicine has kind of moved away from that, but Telemedicine has really grown in prominence here in Canada in the last three or five years. 

Morgan: And it's different than Telehealth, right?

Steve: There's a lot of terms whether it be virtual healthcare, Telemedicine , Telehealth, they all broadly relate to the same topic.

Morgan: Okay. How does it work?

Steve: Each platform works differently but with our platform, the patient can log on to either an app or via desktop, and they are able to go through a brief triage process and then, they're connected to a practitioner via a physician, a nurse practitioner, or a care coordinator. They're able to consult for a medical issue and they're able to be navigated through the physical healthcare system as well. 

Morgan: Yes. I've been trying it out just to make sure that I understood how it all works. So, for listeners out there, I just downloaded an app on my phone, logged in and then you start to chat. Yes, there's kind of initially, you talk to an AI system where it kind of just asks you, "Is this a new problem?" etc.

Steve: Yes, just some background questions about, "What are you here for? How bad is the pain? How long has it been affecting you?" And then, it'll get into some more specific questions based on your answers. So, if it's an eye issue, it'll ask, "Is it watery? Is it runny? Is it itchy?" And really, the idea behind the triage process is it's a way to a kind of more standard, more effectively triage patients in a standard and safe way. But not to cut a human practitioner out of the loop. It's really to enable them to have all the information they need when they do get on that call for a more effective consultation. 

Morgan: Yes. I think I connected to a real person within maybe like five little messages, quick questions. It wasn't too much at all. Then you get connected with someone, and you start chatting, and you can either chat through like texting on the app or on your desktop, or you can do a call or a video?

Steve: That's right, yes. Via chat, via phone or via video. So, for some consultations, I mean, the scope of practice for the physician is obviously the biggest when they can physically see the patient. They can make that medical assessment and they are able to make an assessment. They can prescribe if necessary. They can give specialist referrals, the full scope of practice of Telemedicine is about up to 70% of all front-line care that can be managed virtually.

Morgan: Oh, yes. I think we all know those times we've gone to a doctor and we know we just need an x-ray form or something, and this is a pretty quick way to do it. So, I know, for me, I went through and chatted with someone. We did a video call. That was nice. I found out I talked longer with the person I was chatting with than I would with my primary care doctor. 

Steve: Yes. It's funny you mentioned that because 80% of Canadians said the last time they went to see a family doctor, that visit was less than 20 minutes.

Morgan: Oh yes.

Steve: For 40% it was less than 10. If you're going to an urgent care facility, typically your consultation is limited to 15 minutes. It's limited to one issue. We don't really have those limitations on our platform.

Morgan: Yes. So, I chatted with someone and then afterward, I was given like a follow-up plan which was nice. And then it's kind of nice too to have it in writing there on the apps if you forget. I know some people get like anxiety going to the doctors or you might just kind of blank on what they told you. 

Steve: Yes, even just having a record of your chat. Every patient gets care plan afterwards which details the summary of the call and what to expect in terms of follow-ups and how to apply any medication and just being able to go back and review that can be quite helpful considering we've all had that experience of walking out of the doctor's office and trying to remember exactly what they said.

Morgan: Yes. Like I didn't pay attention at all. I was just focused on trying to remember what to tell the doctor. I usually go in with a big list or something.

Steve: Yes. And further to that, I think part of the advantage of the triage process that we've set up is that when you go to a walk-in clinic, typically in that 15-minute consult, probably the first eight to 10 minutes is the doctor or nurse triaging you.

Morgan: That's true, yes.

Steve: Then, typically you get two to five-minutes for a consult. You got two-minutes for questions and then you're out the door. So, by having that triage process spending two to three-minutes upfront, answering a couple of background questions, it really enables more effective consultations with the practitioner.

Morgan: If you need to go back or if you need to chat further, you can also go back to that original chat and just add in more messages. Correct?

Steve: Exactly. Yes.

Morgan: So, if you kind of need to follow up and then it's nice if you're at work because you can send a chat and then just wait for a reply like would have text for something.

Steve: Yes, exactly. You're not in a waiting room. You can put your phone down. You'll get a notification when a practitioner responds to you. So, it's a convenient way to access healthcare on your own time.

Morgan: One thing that I wasn't sure of is when you do the triage process, you're not always immediately connected with a nurse or a doctor, right? There can sometimes be like you set up an appointment for another day.

Steve: Yes. Typically, most patients like to consult on a time that is convenient for them. So, if you want to be seen right away, typically our patients are being seen within minutes but a ton of patients would rather set up and appointment whether it's on their lunch break or after work, or when at home after the kids have already gone to bed. So, it really does vary.

Morgan: Yes. We're talking about how you go on a video call and stuff and chat with someone who are we chatting with when we're on that call? 

Steve: You're talking to Canadian physicians, nurse practitioners, nurse clinicians, and care coordinators. Dialogue is licensed in all ten provinces and three territories. Each province has it's own licensing requirements. So, if you're in Alberta, you're speaking to a physician who is licensed to practice in Alberta.

Morgan: Okay. And then is who you end up talking to sort of based on that triage process? The severity of what you're talking about as well.

Steve: Exactly. The triage process, because we have a multidisciplinary team of all those different kinds of practitioners, the triage process also is also going to be able to determine what's the best resource for you. Maybe it is a physician or maybe it is a nurse practitioner because nurse practitioners have more experience in particular illnesses, and if it's something that falls outside of the scope of practice for virtual care then you would be directed to a care coordinator who would help you navigate the physical healthcare system. So, just because you're not being able to be treated on the platform, it doesn't mean we can't help you find a local health resource.

Morgan: So, sending you information about like a clinic you could go to or--?

Steve: Yes, exactly. It might be a walk-in clinic for my own personal experience. When I logged on, it was for an elbow infection and needed a physical consultation. The care coordinator provided me with five walk-in clinics closest to my house with the estimated wait time of each. She actually went above and beyond and called ahead to the one that was closest to my house to verify that their information was correct and that I could get in to be seen within a few minutes.

Morgan: Nice. And can you be prescribed, or I guess maybe prescribe is not the right word but can you be referred to things like an x-ray or like labs?

Steve: Yup. Lab work, blood tests, absolutely. 

Morgan: Okay. Awesome. This to me is very exciting because I grew up in British Columbia and in British Columbia, it is so hard to get a doctor. I had such a difficult time. I don't think I had a family doctor since I was a little kid. So, to me, this is quite an interesting thing to hear about, to have that option because I would often spend my lunch break going to a walk-in clinic if I ever needed to or having to go to the hospital for something. I think you had mentioned a stat once to me about how many Canadians don't have or the lack of physicians in Canada…

Steve: Yes. That really relates to why Telemedicine has become so prominent in the last three to five years. The first reason really relates to mobile technology. 86% of Canadians have smartphones now. Most others have a desktop with a camera function. So, people have access to the technology to be able to access healthcare. The second is kind of the expectations around mobile technology. Healthcare is kind of an outlier when it comes to the things we get from our mobile experiences.  Whether they'd be shopping or transportation or banking or communication. Healthcare really has not entered that space for many Canadians. The biggest reason we've seen the rise of Telemedicine in the last few years is the real crisis that's going on in our Primary Care System here in Canada. There are many amazing things that our Canadian public healthcare system can do but we ranked dead last in the developed world when it comes to timely access to primary care. The stat you're referring to 57% of Canadians can’t get a next day appointment with their family physician and if you can't get in to see your family doctor and you're sick or one of your kids are sick, you've got a couple of options, right? Your first option is to ignore the problem and hope it goes away, which you're probably less likely to do if it's for a sick child. The second is to Google your symptoms, which is typically a sure-fire way of freaking yourself out because Dr. Google always seems to come up with the worst-case scenario for anything. But the third option is going to a walk-in clinic or the emergency room and a full 40% of Canadians said the last time they went to an emergency room was to treat something that their family doctor could have treated if they were available.

Morgan: Oh, yes.

Steve: So we've put this enormous burden on the urgent care system in Canada that is just frankly not equipped to handle. So, I'm sure, you and a lot of the folks that are listening have their own personal horror stories about sitting in that waiting room for hours. It's kind of that uniquely Canadian experience. But another fact to that it's just we almost limit our healthcare by the amount of healthcare the system can provide which is backward, right? We would be providing towards a system that caters to the needs of patients first. And ultimately, encourages us all to be proactive about our health and that really is where Telemedicine can make the biggest difference.

Morgan: I know so many people who were, and myself included, I would go to a walk-in, get some sort of test done for whatever my issue at that time was, and if I came back negative, you just never hear back again, and then your choice is either go wait again or to just be like, "All right. I guess I'm just going to deal with this now and then on the other spectrum, if you do, if you are lucky to have a family physician, I know very few people who go for a follow-up. Again, the same thing if you get a test back that's negative, it doesn't necessarily mean the issue is gone. So, I found with this, trying out Dialogue, I got a message a couple of days later just being like, "How are you doing?" And I was like, "Oh, actually this is still bothering me." I just decided that was my life now. 

Steve: Yes. That's a great point. I think we may all have the experience as well of being called back to a doctor's appointment just to be told that everything is fine. I had a circumstance where I had my yearly physical and my family doctor is half an hour away from my house. I had to set up an appointment two days later. He called me. They couldn't discuss results on the phone. I had to go back in. It's been two days just waiting. There was something on my physical that was a red flag. I went back in and my cholesterol was like one point higher than it should have been. 

Morgan: I had that exact same experience because I live here in Calgary too, I got a doctor when I moved here but it is like a half-hour away.  

Steve: Right.

Morgan: And I had an x-ray once and I got called back. So, there I am all worried that I have a broken bone and yes, it was just to say that it was fine.

Steve: Yes. It's just an inefficient way of delivering healthcare and the reality is there is a better way of delivering it today. 

Morgan: So, let's talk about the types of things Telemedicine can be used for. I know it can be used for physical health. Maybe you can give us tips, there are ideas there, but then it can also be used for mental health as well?

Steve: That's right. So, the scope of practice with virtual care is very broad whether it's ear, nose, and throat, flu, sexual health, dermatology, healthcare navigation. Mental health is really an interesting one because we didn't design Dialogue as a mental health platform but what we found is that up to 40%, depending on the day, up to 40% of our practitioners' time is dedicated to mental health issues.

Morgan: Oh, really?

Steve: Yes and there's a couple of reasons for that. The first is just that mental health issues just naturally take more time than physical healthcare issues. That's why that continuity of care when you're speaking to someone, you're getting those proactive follow-ups are so important. The broader point is that Telemedicine Dialogue really enables people to have such a safe, convenient, and anonymous way of accessing mental health support especially for employees who have not sought out mental treatment in the past. It can be a daunting experience, especially if you're booking time off work to go see a psychologist or book a psychologist appointment and wait four to six months to see one. Whereas with Dialogue, you could just log on. You can chat with a practitioner, even if it is something as simple as, "Hey I haven't been feeling like myself for the last few days" or "I've been having trouble getting out of bed." It's just it has been such an invaluable resource for so many of our patients.

Morgan: What type of care is available for mental health? A psychologist? Or is therapy done through the app or anything like that? 

Steve: Yes. Some of our practitioners do have training in CBT Psychotherapy on the platform. We also do have available what we call Allied Health Professionals which include psychologists. So, there is the ability to connect with psychologists on the platform. But really, it is just about reducing the barriers of access to care and lowering the stigma to be able to reach out to someone and chat with someone about a mental health issue instead of feeling like you have to deal with the problem by yourself. 

Morgan: It sounds like just in general, it can help you just be more proactive about different areas of your health.

Steve: Yes. Exactly.

Morgan: And they know it's commonly used by companies to implement Telemedicine for their employees. So, helping all the employees be more proactive about their health, would that be one of the main benefits?

Steve: Yes. For an employer, there's a ton of different benefits. It broadly fits into a wellness strategy. So, encouraging employees to be fit and well in their lives which for an employer has another fact of having an employee be more productive at work. We got a ton of feedback from our clients because we are solely a business-to-business company. So, we only work with employers and the kind of feedback includes a reduction in absenteeism, so folks don't have to leave work or miss half day of work to go to a medical appointment. Presenteeism, so the ability to get treatment when you need it and not be preoccupied at work if you got an illness. 

Morgan: Presenteeism is when you still show up even though you're sick, right?

Steve: Exactly. Maybe you're not as productive because you're struggling with an illness at work that's being untreated, or you're just preoccupied whether it may be a mental health condition that's undiagnosed and is affecting your day to day at work. You mentioned, your own experiences moving to a new place and finding a family doctor. If they have an employee they've brought in from somewhere else. It's likely that employee is struggling to find a family doctor of their own, for employers that go through high stress or have a lot of high-stress situations in their workforce, or especially employers who have a remote workforce.

Morgan: Oh yes. That's a good point.

Steve: So, either remote employees or their company is physically located in a more remote area outside of a major city center where healthcare resources are already stretched. 

Morgan: And you also can't really check in on your employee too.

Steve: Exactly. 

Morgan: Is this intended to be a supplement or a replacement for family doctors?

Steve: It's a supplement. It's not intended to be a replacement for a family doctor, and it's not intended to keep employees chained to their desks either. If you're sick and you need a physical examination, you should visit your family doctor or urgent care. But the focus is being able to respond more effectively to primary care and be more proactive about your health. When we're sick now, we as Canadians, we kind of make this like this time-health judgment. 

Morgan: Absolutely.

Steve: We're sick but we recognize it, "If I go in and get physical treatment now, it's probably going to be two or three hours out of my day. So maybe I'll just wait until tomorrow and hope things improve and then I'll make that judgment again. So, this allows us to take that judgment out of it where we have 24/7 access to practitioners. We don't have to leave our homes. We can do it right from the comfort of our homes using our smartphone or desktops. Really, there are no stupid questions when it comes to accessing Telemedicine. If you got a concern on your mind about your health, you have to ability to consult with our practitioners. No judgment involved.

Morgan: I think that's an interesting point about the time barrier there because for our neighbors down in America, they must think about the money. Can they afford to go to this?

Steve: Exactly.

Morgan: But here we must think, "Yeah, do I have the time to go do this?" And for people that is money too like having to take the afternoon off work or having to leave-- [cross talk]

Steve: Exactly. It's a more explicit cost health calculation that folks in the United States must make but up in Canada because primary healthcare access is free. It's a time-health judgment.

Morgan: Yes. Absolutely.  Are there areas of Canada where it's more heavily used? Do you see?

Steve: It really depends because each province has its own unique challenges. Victoria and Vancouver for example, it's very tough to find new family doctors. Victoria used to have this find a new family doctor service that was available on a website and they actually took that down because, a, there were no family doctors available and b, the ones who were on the website just weren't being updated. So, it is really tough. In Quebec as well where it's incredibly tough to find a family doctor. So, there are a lot of people who rely on urgent care and walk-in clinics. In the prairie provinces like Alberta, Saskatchewan, Manitoba, the access issue is still there especially in a place like Saskatchewan. It's much more pronounced in rural areas where there's a big rural doctor shortage. They've made a lot of improvement in that area for the last couple of years but it's still a challenge. In Manitoba, mental health funding relative to the Canadian national average on mental health spending is quite significantly lower, so Manitoba is experiencing this unique mental health crisis.

Morgan: Okay, yes.

Steve: Not to say that the Canadian system as a whole is adequately funded from a mental health perspective so it really does depend on your different provinces, where you live, each province has its own unique challenges.

Morgan: Who can use Telemedicine? Who is it best for?

Steve: So, we see from our demographic info of folks who are using our service; we see a really wide range when it comes to demographics both male and female, geographically, age. One area where we do see a higher uptake is folks with young families.

Morgan: Yes, I was going to ask: parents?

Steve: Yes, parents with young families with sick children, you're not going to take risks with your child's health. So, that, again, that time health judgement when it's your time versus your child's health, you're going to prioritize your child's health--

Morgan: Oh, yes, completely different.

Steve: And folks with young families are three times as likely to visit the emergency room in general here in Canada, so that's where we see a big uptake.

Morgan: How does Telemedicine benefit small businesses?

Steve: Yes, so, it's really interesting. So, as a company we do only work with employers, so we have experience with working with a wide range of both industries and company sizes. And myself personally, I work with companies small as two to three, all the way up to 20 to 25,000 and I think there's three primary reasons it works really well for small businesses. First is kind of the broader wellness strategy. So, one of your previous podcasts Dr. Terry, he'd mention that to really get the benefits and apologies to Dr. Terry if I'm oversimplifying but really to get the benefits you really need more of a comprehensive wellness program. No picking out one or two individual models and hoping it makes a bigger difference on the broader subset. I mean the reality for a lot of small businesses is ideally, we could offer everything to everyone but there are limited resources. So, companies do have to make tough choices about what's most effective for my business and the appeal that we've heard about Telemedicine is it really does apply to everyone. There's an interesting stat that 71% of Canadians employees said they would actually trade off current benefits for improved access to practitioners.

Morgan: Oh, wow.

Steve: And the reason behind that is simply we all need access to primary care, whether it's for us or our children that's something all Canadians need and all understand the challenges that exist within the current system, so I think there's a really broad appeal to a large subset of your employees. Second reason is that we talked a little bit of absenteeism and presenteeism and loss of productivity and I think that's really multiplied when it comes to a small business, especially if a leader is affected. So, in a large organization, if you've got a team of eight financial analysts and one has to miss half day of work. The impact on a 20,000 person organization is going to affect that manager's life day-to-day, especially if they're working on a critical project, but a large organization is not going to go under because of the missed work of one financial analyst on a team but if that eight-person team represents your whole company and you're working on a critical project and a critical part of that team is missing or is there but spent all night up in the emergency room with a sick child only to be told, "Hey, it's actually just a flu, she just needs to sleep." That can have a really dramatic effect on a business' short- and long-term future. 

Morgan: Oh, yes.

Steve: And the final piece to this is really when it comes to implementation the network affects so the mark of a successful virtual care project, when we're implementing it within employers high utilization, if you're investing in a program you want people to use it as much as possible, that's how you're going to derive the benefit out of it. So, we enable organizations when they come on-board with Dialogue, with a full implementation playbook whether it's webinars, e-mails, e-mail templates, really just this whole package of best practices.

Morgan: Oh, like e-mails they can send out to their team to let them know how it works?

Steve: Yes, exactly.

Morgan: That's great.

Steve: The broader challenge when implementing a project like Telemedicine is not the actual tech implementation that's really easy. The broader challenge is communication, it's a new benefit, virtual care has a broad appeal, for example the Alberta Medical Association last year ran a study, found that 83% of Albertans would be likely to use virtual care if it were available but only a third knew anything about virtual care. So, if you're introducing a virtual care benefit it might sound good on paper but if people don't know what it is, what its limitations are, what are the expectations around it, that can have negative consequences when people try to use it and maybe can't get the access they expect. 

So, beyond this playbook really what we found when implementing these projects is the project that have most success have those internal champions. So, word-of-mouth is really important when it comes to spread. Even in our own personal lives, we're much more likely to try a product if it gets a personal recommendation from someone we know and trust. So, those network effects and that word-of-mouth is really multiplied when you're in a small organization. So in a large organization maybe you'll get these different sells. So, for that team of eight financial analysts if one person uses it it's more likely that other members on their team are going to use it? For a small business that's more likely that everyone in your company is going to use it and take advantage of it.

Morgan: That's a good point because I think a lot of times companies offer employees things, and I know personally, I'll get that e-mail that's really long or something but if there's just a one-time e-mail and no chat about it ever again, or no follow-up or it's mentioned in my orientation and we never talk about it again it's really easy to completely forget about the things that are offered to you, so being able to have a communication plan is great.

Steve: And there's ongoing communications, I mean, that's part of our communication strategy but again he most effective method of communication was if you were going through that situation and you were planning on going to a walking clinic and leaving at lunch and you had a co-worker say, "Hey."

Morgan: Yes, "Do you remember?"

Steve: "You can actually access, you can have a consultation virtually on your lunch break."

Morgan: Yes.

Steve: Instead.

Morgan: Then you can still eat lunch. 

Steve: Exactly, yes. Our physicians won't judge you if you're eating while you're consulting.

Morgan: I want to go back for a second to the second point that you just mentioned there which was a little bit about leadership well-being? So, you wouldn't have heard this yet because we don't have it live yet but we've recorded an episode all about leadership well-being and how it's actually a risk mitigation strategy for companies so that's going to come out just before this episode does. And that's a good point, we've been talking a lot about employees so far, but for the actual business owner themselves being able to take a little more control of their own health and being able to check-in because, yes, the employees are busy, and yes they need to leave at lunch but the business owner is often even busier and health issues go just unresolved and then if that person gets an injury or an illness it's a huge detriment on the business.

Steve: Yes, exactly, I mean you feel a lot of personal responsibility to be present and to be working and just even putting aside the short-term consequences of maybe missing a half day of work. One of the really exciting things about kind of the future of Telemedicine is, where are we in 10 years when more people have access to Telemedicine? What are the long term effects on things like chronic conditions or long-term mental health conditions? When more people do have access to being proactive about their health, what kind of impact is that going to have long-term on people's health?

Morgan: When there's a lot of conditions on the rise like diabetes is getting huge and it's supposed to just keep growing over the next couple of years, I imagine being able to be a little more proactive and maybe people can catch symptoms of these chronic conditions a little earlier?

Steve: Exactly.

Morgan: Yes. Have you heard of any other uses of this? Outside of just the business owner and the employees?

Steve: Yes, one of the interesting things about Dialogue is it's focused on family health, so it not only covers employees but their spouses and dependent children as well. So that's critical for a situation like we talked about before with a young child that's sick but because they're dependent children they may be also be covered when they go off to university. Especially if they're moving away from home, they're in a new city, they are in university, so healthcare access and finding a primary care doctor might not be their first priority.

Morgan: No.

Steve: It can be really helpful to be able to log-in and obviously, as a dependent child over the age of 14 they're going to have access to their own account where they can manage their own healthcare independently.

Morgan: Yes, and then they'll also have access to the mental health component as well which I think it's quite big when you--

Steve: Absolutely.

Morgan: --go off to university and everything's a big change.

Steve: It is.

Morgan: I wanted to address some of the common concerns I've seen online, and you just can let me know your thoughts on these.

Steve: Sure.

Morgan: Telemedicine took off quite quickly in the US from kind of what I'm seeing, I mean that makes a lot of sense, people there don't have the same type of healthcare system we do, but it's been a little bit slower in Canada. Do you have any ideas why that might be?

Steve: Yes, in the US about 85 to 90% of companies offer some sort of Telemedicine solution in the US and the US is an employer driven health care system. So, the Telemedicine solutions that exist in the US are still a fee for service but because you can find efficiencies, they are cheaper so that's really the benefit for an employee instead of going to a physical walking clinic and paying $130 dollars for a consult. You can get a virtual consult and pay $45 or $75 dollars. So, it's been kind of an easier model to integrate with in the US? And Canada because there's still are costs associated with building a virtual care network. There's costs associated with that and the expectation in Canada is that primary care access should be free. So, whether it's a lack of response from government to integrate virtual healthcare into the public healthcare system and what we've seen is this really has been an employer driven movement when it comes to Telemedicine.

Morgan: Yes, that's true.

Steve: Where employers are sponsoring this like they would an employer benefit, like they would for a massage or a chiropractor appointment, virtual healthcare has existed in that space, where employees and their families are still accessing it for no cost. But the employer is able to derive enough benefit out of it that they're able to subsidize that cost.

Morgan: And you're seeing the numbers going up of people that are implementing this?

Steve: Absolutely.

Morgan: Yes.

Steve: In Canada we're closer to about 10% of companies that have implemented this, but we've seen a dramatic rise, even just with our platform in the last few years.

Morgan: What about people who have concerns using this platform because of privacy, I imagine that's one of the biggest concerns.

Steve: Yes, absolutely. Privacy is a critical priority for us because we are dealing with personal health information and ultimately, we are a healthcare company first. So, this isn't like a Mark Zuckerberg like move fast and break things type of industry. It's really critical that when we roll out a solution like this, we get it right the first time.

Morgan: Yes.

Steve: So, to that end, I can only speak for Dialogue but we take it this very seriously and we have our SOC 2 compliance certificate, which is kind of a standard that ensures that data is managed safely, secured and confidentially. And it's then audited by a third party, so in our case it was PWC who made sure that were in-compliance of all those rigorous standards. So, our Chief Privacy Officer is a medical doctor which helps as well because he not only understands data security but he understands medical security as well. And the impacts of, for example, not e-mailing patient information not sharing patient information or identifiable patient information between different teams, so there's a lot a rigorous protocols that we've been able to put in place to ensure that patients are safe and confidentially treated on the platform.

Morgan: Yes. So, for an employee their employer can't see anything they're submitting or--

Steve: Absolutely not.

Morgan: Yes, okay. With Telemedicine, is it more difficult to develop an ongoing relationship with your practitioner because you often get to see someone new each time? Or can you see the same doctor multiple times?

Steve: Yes, so when we were designing our care delivery model, so how we deliver care to patients one of the really key things for us was to adhere to what the Canadian Medical Association recommended.

Morgan: Okay.

Steve: Because we are a healthcare company first, so what the CMA recommends is a multidisciplinary continuity of care model when it comes to delivering care, especially virtually. And what that means is not only do we have that multidisciplinary team of physicians and nurses and nurse practitioners and care coordinators but they all work together as a team because a majority of them are actually employed directly by Dialogue and that's really critical because it means that a patient has that continuity of care right through their first episode. So this isn't like an Uber for doctors where you're getting a different doctor every time. You can request the same physician and you always know that you're working with the same medical team. The simplest way to think about it it's like a virtual community clinic.

Morgan: Okay, yes, that makes sense. And what about anybody that has concerns about getting inadequate assessment, people who really feel like they need that hands-on treatment, I know you mention that a lot of conditions can be treated virtually about 70% you were saying, but for that person who is maybe just a little anxious that they're not going to get adequate treatment what would you say?

Steve: Yes, any patient who comes on our platform can be sure that if our practitioners be that a physician or a nurse practitioner it doesn't feel like they can make a safe assessment virtually they won't they're going to recommend that the patient go in for a physical examination. So, our medical team is cognizant of their limitations virtually. And there's something called gestalt, I'm probably mispronouncing that, it's a medical of kind of the feel a doctor gets when they're speaking with a patient. 

Morgan: Oh, okay.

Steve: So, consulting virtually you can replicate a lot of that because you're seeing how the patient is reacting, what their physical motions are, but it's not a complete replacement for physical touch in some circumstances. So, again, if a practitioner doesn't feel like they can make a safe assessment or safe treatment then they will not.

Morgan: So, let's talk about implementation in a business. So if a business is interested how quick is this to implement? Is it difficult to implement? Is that process look like?

Steve: The actual implementation is very simple, it's typically either it depends if your client's working, if this client is working through Olympia Benefits or not, but if they're working through Olympia Benefits it's as simple speaking to Olympia Benefits and having it added to your plan. If it's a business that's not aligned with Olympia Benefits yet, you'd work directly with us, you'll have an agreement directly with us and it's just a simple CSV upload into a portal. It's a really simple process.

Morgan: Of your team?

Steve: Of your team, if your employee's first name, last name, date of birth.

Morgan: Yes, okay.

Steve: And e-mail address.

Morgan: That's great.

Steve: That's really all the information we need and each employee has the ability to add their own family members, that's something that you as an employer have to manage. So, once that's done, again, the challenge really comes down to communication and that's where you'll be connected with a Customer Success Manager who works on our team who's going to be able to provide you that full implementation and on-boarding playbook to ensure that you have the resources necessary to roll it out for your team.

Morgan: That's nice, you don't have to worry about figuring all that out. I know you mentioned you have the communication plan, do you have any other tips you would suggest to make sure that a business owner is getting the most out of their Telemedicine account?

Steve: Yes, I think the important thing is just organizational buy-in of wellness in general. Understanding that an employee that feels well and is proactive about their health is going to be a more productive employee. So, just you getting that general buy-in and building the culture around those kind of ideas that that's going to go a long way to be able to encourage this kind of use. And really being able to connect it as a broader strategy.

Morgan: Yes, that's a good point.

Steve: Instead of adding this is as a benefit that's over here, this connects to the wellness strategy in this way, this connects to our benefit strategy in this way, enabling where it's not a side load benefit, it's really part of a broader cultural piece of a company.

Morgan: Yes. So, right now this is my last question for you, so right now you can talk about your physical, mental health. Where do you see this going, are there going to be more elements of health, more features added, what's the future for Telemedicine?

Steve: That's a big question.

Morgan: Ha-ha, what's your business strategy? 

Steve: Yes, so, I mean, the big piece of the future of Telemedicine is the scope of practice is only going to get bigger as technology improves. So, for example, can we get to a place where an apple watch can take a heart rate measure that would be medically acceptable. For us, as a company, it means diving into different areas of health where Telemedicine can be applied, especially mental health, we've rolled out a new mental health platform. Where can we see improvements in technology? I mean, we mentioned our triage process; when we started out, we had kind of a nurse only triage where you connected with a nurse, she would go through this triage process and what they found was, it took about 20 minutes to safely in a standardize way triage a patient?

Morgan: Yes.

Steve: We've reduced that time by 85%

Morgan: Oh, yes, when I did that it was like a couple of minutes maybe, yes.

Steve: Yes, and we're working with one of the Montreal super hospitals right now on a pilot of program to actually integrate our technology with their triage process. It's not just how do we take an emergency room and have it existed virtually? It's about how can we leverage technology and digital health to improve the processes. So, triage and follow-ups are two of them, incorporating electronic medical records is another, can we get into the business of predictive health. So, if we know on a patient's medical history, they have a history of respiratory diseases, we know that tomorrow is going to be a muggy day outside, can we send notifications to that patient letting them know that they're at higher risk and they should prepare in this way.

What are the effects on long-term chronic conditions be at mental health or physical health and the final, here's the big unknown is what part is government going to play in this because right now this is an employer driven movement but the government will be involved in some capacity at some point. Right now, one of the most impactful changes they could make today would be through licensing. So, the CMA just released a survey that said that 91% of physicians would support the implementation of National Licensure. So, that would mean a patient or a practitioner who's licensed to practice in Alberta could be licensed to practice right across the country.

Morgan: Oh, that's good.

Steve: Which not only would have benefits for Telemedicine but it would have benefits for the whole medical community. So, whether their licensing changes this, whether it's a government investment in Telemedicine that's the great unknown here in Canada, but right now we found tremendous success within the employer market, employers have really stepped up taking advantage of being able to provide better support for their employee's health.

Morgan: Yes, yes. So ultimately just improving Canadian health.

Steve: That's it, lowering the barriers of access to care, that's our mission at Dialogue and so far, we've seen tremendous results from being able to enable employees to get better access to healthcare.

Morgan: Awesome.

***

Voice Over: Thank you so much for tuning into this episode of the "Small Business Mastermind" and a special thank you to our guest, Steve Chamberlain. If you enjoyed this episode, please be sure to subscribe to this podcast. This will make sure you're notified when new episodes are posted. For our Apple podcast listeners I'd really appreciate if you took a moment to rate and review this podcast, it will not only help me see which topics and episodes you're loving but it will also help other people find this podcast as well. We have new episodes on the way, so please stay tuned and I will talk to you again very soon.

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