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Written by: Y. Razvi, H. Wong

In March of 2020, the COVID-19 pandemic changed the world. Healthcare policies encouraged work from home orders, physical distancing, prolonged isolation and widespread use of masks and personal protective equipment. Medicine was not immune to that change and in April 2020, the Ontario provincial government introduced billing codes that allowed providers to be equally compensated for in-person and telemedicine-based practice [1]. This allowed widespread adoption of remote, physically distanced, virtual care across the province of Ontario.

Although telemedicine has been available in Ontario since the mid-90s, it wasn’t until the arrival of COVID-19 that it achieved widespread adoption. Before the pandemic, provincially funded telemedicine was operating as a pilot project through the Ontario Telehealth Network (OTN). Province wide virtual care billing codes in June of 2019 were as low as $28,000 for all pediatric providers. One year later during the height of the pandemic in Ontario, the same billing codes reached $2 million dollars for June of 2020 [3]. This represented an astounding rate of adoption in an incredibly short period of time.

Telemedicine has made an impact in a number of areas outside of improving the delivery of care in office based practice.  For example, families in rural communities have long faced multiple barriers to care. Telemedicine has helped overcome these challenges by making it easier to attend visits with specialists at urban centres  [4]. Community hospitals have also utilized telemedicine to improve continuity of care and availability of medical personnel during the pandemic [5]. On a provincial and national level, telemedicine contributes to our efforts to reduce our carbon footprint. Healthcare contributes approximately 4.6% to Canada’s total emissions, translating to 23 000 years of life lost due to disability and early death [6]. The use of virtual care will be necessary in reducing these emissions, with one study showing decreases of around 40-70 times emissions compared to in-person care [7]. Medicine was transformed from an inefficient, inaccessible, office-based practice to an easily accessible, environmentally friendly and widely available telemedicine-based practice.

The role and uptake of telemedicine will continue to evolve with better technology and infrastructure, particularly with the adoption of  high speed 5G networks. Stable, reliable, high bandwidth communication will promote better and more effective remote examinations. Beyond this, the development of augmented reality, remote biometric monitoring through wearable technology, and artificial intelligence will increase efficiency and effectiveness in care.

Virtual care will become increasingly more important to providing good care to young families moving outside of the city. Pediatricians, such as myself, need to find better and more effective solutions to bringing the best care to those families and during this process, we also have an opportunity to make a positive, long-lasting contribution to society.


1.  OHIP – Bulletins – Health Care Professionals – MOHLTC [Internet]. [cited 2021 Aug 8]. Available from:

2. Personal communications with Ontario Medical Association Research & Analytics

3.  SC H, JP M, P D, DJ T, S C. Impact of telemedicine on visit attendance for paediatric patients receiving endocrinology specialty care. J Telemed Telecare [Internet]. 2020 [cited 2021 Jul 13]; Available from:

4.  Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Heal 2020 201 [Internet]. 2020 Aug 1 [cited 2021 Aug 8];20(1):1–9. Available from:

5.  Vogel L. Canada’s health system is among the least green. CMAJ [Internet]. 2019 Dec 2 [cited 2021 Aug 20];191(48):E1342–3. Available from:

6.  Holmner Å, Ebi KL, Lazuardi L, Nilsson M. Carbon Footprint of Telemedicine Solutions – Unexplored Opportunity for Reducing Carbon Emissions in the Health Sector. PLoS One [Internet]. 2014 Sep 4 [cited 2021 Aug 8];9(9). Available from: /pmc/articles/PMC4154849/