Doctor warns of risks to patients’ privacy amid surge in virtual care

OTTAWA — A top doctor in medical informatics says the lack of a pan-Canadian approach to remote patient care during the COVID-19 crisis is putting some patients’ privacy at risk of being compromised.

Dr. Ewan Affleck, senior medical adviser in health informatics at the College of Physicians and Surgeons of Alberta, says the use of “unsecure” applications are being deployed out of necessity as the healthcare system grapples with the spread of the virus.

“What has happened in the last 10 days, is the privacy, regulatory, and legislative environment has been thrown out the window and everyone is saying you can use whatever you want,” says Affleck.

“So, we’re using unsecure technologies like WhatsApp, FaceTime, Zoom, whatever you have to communicate,” he said. “It’s a dog’s breakfast.”

Affleck says these platforms are being used to connect patients with their medical providers while abiding by mandatory social distancing rules.

“There is a massive shift in the entire paradigm of health care in Canada occurring as we speak, through virtualization of every service,” says Affleck. “It’s not optimal, but the risks to life, and personal and population health is felt to be so great that this is being enabled in the short-term.”

The Canadian Medical Protective Association (CMPA) – the not-for-profit body that provides legal defence and risk-management advice to Canadian physicians –offers guidance on implementing e-health and telemedicine, including electronic messaging and video conferencing.

Dr. Dennis Desai, the CMPA’s senior physician adviser for quality improvement and e-health, says all physicians should err on the side of caution when using Zoom, Skype or similar applications with their patients.

“Some software companies make it their business model to not sell their software but to gather information, so they mine it. So even though the data is encrypted, they hold the encryption key,” says Desai.

“That’s not ideal, especially if they hold information outside of Canada. There’s some provinces that have strict regulations against that.”

Desai says in times of crisis, privacy concerns do tend to take a backseat to patient health.

“One can’t be dogmatic in these times,” he said. “Now it’s just ‘Get the job done.'”

In the absence of a more secure telehealth network, however, he advises physicians operating these platforms to sift through their privacy policies, address the potential risks with patients, and obtain consent before use.

“What they need is the information on what the risks are rather than blanket, ‘You can do this, you can’t do that,’” he said. “It’s best to go through the policies of [companies] so you’re relatively confident that privacy is protected.”

Desai says it’s the regional regulatory authorities that are required to provide more specific advice on what platforms to use and which to avoid.

Each provincial regulatory body has for the most part issued memos to providers encouraging remote care during the COVID-19 pandemic – some more detailed than others.

Doctors of B.C. suggests the use of WhatsApp, Zoom or FaceTime for video or messaging requirements.

They also recommend prioritizing care over privacy needs.

“Choose tools that work well for you and your patient regardless of whether they formally meet privacy and security requirements. That is secondary to delivering care,” reads a virtual care toolkit on their website.

Doctors Manitoba stated that while in the long-term, video-integrated software within the electronic medical system is ideal, in the short-term, Skype or Zoom would suffice.

“Note: that solutions without cost usually do not commit to security during the transmission so patients should be aware and clinical information should be limited to the minimum necessary,” the group said.

The College of Physicians and Surgeons of Alberta takes a similar approach, stating it “recognizes that, in the extraordinary circumstances posed by the pandemic where patient safety may be compromised by a delay in deployment of virtual care technologies, short-term use of unregulated virtual care technology can be justified.”

Instead of a patchwork response to the crisis, Affleck says a national virtual care strategy should have been adopted years ago.

“There are few of us who have been promoting this and now suddenly it seems to be the flavour of the week,” he said. “We did not profit from the opportunity that has been available to us since the World Wide Web was invented.”

Affleck says he hopes the sudden necessity for virtual care needs will push Canada to adopt more concrete, uniform standards for the future.

“All the players all need to agree on a model and get along. What’s the likelihood of that? Not high except in the face of something like a pandemic. So here suddenly there is a common foe,” he says.