Au-delà de l’évaluation des bénéfices : réflexion sur les conséquences inattendues de la télésanté

Abstract

La télésanté est considérée comme un levier incontournable dans les choix des politiques en santé. Toutefois, il subsiste de nombreux enjeux face à son intégration réussie dans les pratiques cliniques. À ce jour, un grand nombre d’initiatives en télésanté peine à dépasser le stade de projet pilote. Cette situation s’explique en partie par une culture de l’innovation qui est principalement focalisée sur les bénéfices attendus de la technologie et moins sur les changements et les transformations qu’elle peut entraîner. La télésanté est utilisée dans des établissements de santé dont la dynamique sociale est pour le moins complexe. Son introduction entraîne des conséquences inattendues pouvant affecter aussi bien les patients, les communautés, les professionnels, les établissements que les systèmes de santé et la société dans son ensemble. L’objectif de cet article est de discuter de certaines des conséquences inattendues découlant de l’utilisation de la télésanté dans les établissements et systèmes de santé.

A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada)

“…Some of the technologies deployed were originally designed and developed for the business world. The lack of flexibility, ergonomics, ease of use, compatibility with existing systems and infrastructures and/or functionalities adapted to local contexts could constitute an obstacle to a quality medical consultation (16,64). Some of the technologies recommended by the Quebec MSSS were incompatible with certain Internet browsers, unusable in environments without high-speed Internet access (e.g., rural and remote areas) and/or did not have downloadable versions for Mac or "old" computers still in use in some health organizations.…”

“…Finally, legal and regulatory issues directly or indirectly affect all the aspects mentioned above. The issue of reserved acts and professional skills (e.g., union agreements, recognition of new expertise, enhancement of activity, privileges, and responsibilities) was already recognized as one of the main obstacles to the use of telehealth in Quebec and elsewhere (13,15,64,100). In the context of COVID-19, this has affected other health care providers (e.g., social service staff, occupational therapists, physiotherapists, psychologists) (36).…”

“…"Direct-to-consumer" services proliferated in a "legal gray area" and a "policy vacuum" as individuals could pay for medically necessary services that provincial health insurance plans must cover to comply with the basic principles of Canada Health Act (82). Moreover, the management, exchange and processing, or even secondary uses, of the data resulting from these consultations also constituted a gray area in terms of supervision and governance (e.g., commercial use, outsourcing) (15,64,78,82,84). Recently, Quebec has experienced several high-profile incidents related to the "sale" and/or use for commercial purposes of electronic medical record data without the knowledge of patients (e.g., insurance companies, pharmaceutical industry) (102,103).…”

Telemedicine perceptions and experiences of socially vulnerable households during the early stages of the COVID-19 pandemic: a qualitative study

“…5 The ubiquitous uptake of telemedicine was accompanied by both enthusiasm and caution -enthusiasm about its postpandemic utility in triaging and managing patients with nonurgent conditions, and facilitating access especially among remote populations, 6 and caution regarding clinical, organizational, professional, economic, legal and regulatory complexities, including the potential of medical errors, duplication of visits and issues with patient confidentiality. [7][8][9][10] In Quebec, several family doctors serving high-needs, multicultural and low-income patient populations observed their absence among those receiving telemedicine during the initial waves of the pandemic. Of concomitant concern was evidence indicating growing racialized inequities in COVID-19-related health care and health outcomes.…”