Digital healthcare meets pandemic tipping point

By Jennifer Marron
Published June 7, 2021 | 3 min read

The pandemic has accelerated digital adoption across the economy and society. Healthcare is no exception.

How many times did you visit a doctor’s office in the past year? If the answer is zero, you’re not alone. According to a recent study done by the Canadian Medical Association Journal, Ontario saw an almost 80% decrease in primary in-person health-care office visits during the early months of the pandemic. Meanwhile, virtual consultations with doctors skyrocketed across Canada.

Telemedicine holds the promise of enabling more Canadians to get the medical help they need, at a time when that need has arguably never been greater. As many as 40% of working Canadians experienced a decline to their physical health throughout the pandemic, according to a recent RBC Insurance poll.

To better understand the challenges, we spoke to three executives from telemedicine firms Maple, Well Health Technologies and Dialogue on our latest Disruptors podcast. All three firms experienced exponential growth during the past year and are cautiously optimistic for a more digital, patient-centric future for all Canadians.

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Here’s some of what we heard:

Technology democratizes access to care, and helps make the system more efficient

Maple CEO Dr. Brett Belchetz is an emergency-room physician whose own experience of giving quick medical advice to friends and family over FaceTime inspired the vision for his company. Maple’s platform enables patients to connect directly with doctors in minutes via a smartphone or computer. Belchetz says telehealth provides a more convenient option for less-urgent medical needs and care, and frees up capacity for those who require in-person care.

“Every time I went to work in the hospital, I would see patients waiting eight hours to see me for three minutes of my time for really simple needs, like a prescription renewal, treatment of a urinary tract infection, or to have a rash looked at,” he said.

Changing the system is very complex and difficult, but telehealth has proven its worth

As CEO of the fourth-largest operator of health clinics in Canada, Well Health Technologies’ Hamed Shahbazi understands the challenges in driving change or pushing for the adoption of new technologies in an already overwhelmed health care system.

“I think a big reason for the lag in digitization and modernization is just how busy and burdened this group is and how little time they have for change management — and that’s where COVID was both treacherous and valuable,” he said.

According to Statistics Canada, most Canadians (91%) use the Internet and 75% also use social networking websites and apps, making telehealth a great option for care with fewer logistical efforts. A 2015 Harvard Medical School study estimated that, on average, a typical visit to a doctor takes over two hours — of which only 20 minutes are spent face-to-face with the physician. Virtual care offers a convenient and accessible solution for both patients and physicians in the comforts of home.

Digital health enables better communication and proactive insights

A 2018 study showed that around 40% of Canadians track one or more aspect of their health using connected care technologies, with 68% saying smart digital devices have allowed them to maintain or improve their health condition. Proponents of digital health believe that if they can measure an aspect of their life on a regular basis, they can improve it.

Digital tools may also be particularly valuable when it comes to treating mental health care. Montreal-based Dialogue launched a “high touch” mental health program before the pandemic, where every patient is assigned a doctor and therapist, along with a dedicated case manager for maintaining regular contact.

“This multidisciplinary team works with that patient to bring them to remission as quickly as possible, and then we maintain ongoing follow-up to make sure that these people don’t dip or don’t go back to some of those mental health issues that we know can be recurring,” said Anna Chif, the company’s co-founder and chief strategy and product officer.

“I think medicine overall is moving from, ‘I’m sick, I’m getting care’, to, ‘here are some behaviours you can change and here are some tools to do that’ in order to ensure that you don’t go down a path that leads you to sickness,” she said.


Speaker 1 – Theresa Do [00:00:01] If you’re anything like me, you’ve probably found yourself becoming hyper aware of your health over the past 14 months. Is this just a cough or is it the cough? The pandemic has made us experts and what symptoms to look out for — covid or otherwise. It’s also forced us to reconsider how we seek help. In the “before times”, the answer was simple: book an appointment to visit your doctor could take a couple of weeks, but eventually you’d have a time to show up at their office. Since covid, we’ve been turning to the digital alternative to in-person. Telehealth, basically, any way to get advice from qualified professionals or access your health records from anywhere has taken off. Consider this. In February 2020, fewer than a quarter of family physicians in Canada made themselves available by email, and just four percent provided video visits. Three months into the pandemic, virtual care represented more than 70 percent of the ambulatory care provided. What was once a slow moving part of the Canadian economy is now one of its most competitive and innovative.

 

This is Disruptors an RBC podcast, I’m Trinh Theresa Do, sitting in for John Stackhouse. In the first half of this episode, we’ll welcome an expert panel to discuss the state of digital health in Canada and get them to crystal ball what the future might hold for this fast changing sector. And in the second half, we’ll talk to the co-founder of a Montreal based telemedicine company that promises to put a human face on digital health care. While the digitization of health was well underway prior to 2020, the pandemic changed the rules of engagement almost immediately. Experts were projecting that 30 percent of all the ambulatory encounters in North America would be virtual by next year 2022. Compare that to just two percent at the start of 2020. Of course, those numbers are actually even higher in the middle of last year because so many of us were afraid of going to the doctor’s office or you know, even leaving the house. So where will those numbers land once a new normal or new comfortable reality is established? To explore this question and many others. I’d like to introduce two of the leading players in the Canadian digital health industry, Dr. Brett Belchetz is co-founder and CEO of Maple, a national virtual care provider connecting patients and health care practitioners for online medical visits. He’s also a practicing physician in Toronto and former management consultant with McKinsey and Co. Welcome to Disruptors, Brett.

Speaker 2 – Dr. Brett Belchetz [00:02:50] My pleasure. Thanks for having me.

Speaker 1 [00:02:52] And also here with us today is Hamed Shahbazi, the founder and CEO of Well Health Technologies. A serial entrepreneur, Hamad also founded payment solutions provider Tío Networks, which was sold to PayPal in 2017. Hamed, welcome to Disruptors.

Speaker 3 – Hamed Shahbazi [00:03:06] It’s great to be here. Thanks for having me, Theresa.

Speaker 1 [00:03:08] Before we get into the state of this fast moving and complex industry, I’d like to understand how you both got into it in the first place. Brett, you’re an E.R. doctor. That’s probably a very busy and demanding job. So why did you decide to launch Maple back in 2015? And how do you balance that while still doing some shifts at the hospital?

Speaker 2 [00:03:28] I would say my experiences in the hospital are actually one of the primary drivers for what led me to start this company. Every time I went to work in the hospital, I would see patients waiting eight hours to see me for three minutes of my time for really simple needs, like a prescription renewal, treatment of a urinary tract infection, to have a rash looked at. And at the same time, what I was noting is that my friends and family members, they didn’t have to have that unpleasant eight hour wait in the emergency room. So my friends and family members, they got to text me and they got to FaceTime me and I was able to solve most of their issues in a matter of a few minutes while I was at home and while they were at home by text message or by FaceTime. And that made me realize there was an opportunity to bring that kind of convenience of health care to everybody in the country. And that was really the moment that led us to say, let’s build that platform. We didn’t see anybody else that was doing that. We didn’t see anything like that in Canada. Let’s build that ourselves and let’s bring that kind of convenience to all Canadians. When we started Maple, I was working a full time set of emergency room shifts at the same time as running Maple. And typically I would run Maple from 8:00 a.m. until six p.m. and then go to the hospital in the evenings. And that was not an enjoyable life and not very good for friends and family relationships either. That’s definitely been dialed back over the years. And so typically I’ll do a couple shifts a month, typically on weekends, just to keep my skills up. But by and large, my Monday to Friday schedule is all about the business.

Speaker 1 [00:04:46] Hamed, when you founded well, in 2010, it was a network of yoga studios, I believe, licensing, the Deepak Chopra brand. And you’re a long time tech entrepreneur. So what was the appeal of health and wellness and why did you ultimately pivot away from yoga?

Speaker 3 [00:05:00] I had a relationship with Dr. Deepak Chopra and thought that it was really a phenomenal opportunity to bring his practices and teachings, especially the consciousness-based meditation and yoga practices that he was teaching in his Lucosta centre down in California. And Tio was sold in 2017, and I was pretty busy operating that business. I’ve always been interested in, I’ll just call them wellness technologies. I think yoga is a wellness technology. So is meditation. So exercise. And I’ve always been kind of a bio hacker and an entrepreneur at heart. And I think the journey as an entrepreneur often leads you to a place of wanting to aspire to greater and greater impact. And there’s no more juicy opportunity for impact, if I could use that word, than health care, because I think it’s sort of the original impact investment sector and the opportunity to tech enable businesses with something that really gave me confidence to understand that I didn’t need to necessarily be a doctor like Brett to make a difference, I could make a difference by bringing whatever gifts and talents that I had, but also bringing together talented people like Brett. My experiences in medical clinics in British Columbia definitely were instructive and helpful to understanding that there was a lag in health care digitization and modernization — and a tremendous opportunity to get involved with that and really push that along. And a recognition that no sector evades digitization, so this is going to happen at some point in time. And what a great opportunity to be a part of. And so while, Well, does have telehealth services like Maple, we also do a bunch of other things. We own health care clinics and allied health and primary care. We have secondary care practitioners. We have electronic medical records, services. We have billing and back office, just a whole suite of, I’ll just say, practitioner empowerment and enablement technologies and tools.

Speaker 1 [00:07:01] And that’s a good lead in actually, I’m curious if you can give our listeners a quick description about where Well and your respective offerings, where do they fit into the broader health care landscape in Canada?

Speaker 3 [00:07:11] So much of health care is driven by those workers, those frontline workers, the physicians. And I think a big reason for the lag in digitization and modernization is just how busy and burdened this group is and how little time they have for change management. And I think that’s where covid was both treacherous and valuable. Stepping back, that’s what, Well, really set out to empower the two most important subjects in the health care equation, the patient and the doctor. And we started our focus on the doctor and other health care practitioners. So, again, the vast majority of all the different products and services that we have, even though they’re organized in different business unit, that’s really sort of the unifying principle that they’re assisting physicians in and supporting their business.

Speaker 1 [00:07:58] Brett, I’d like to turn to you with the same question. Can you give us a quick overview of Maple and how it fits into the landscape in Canada as well?

Speaker 2 [00:08:06] If you go back to the premise as to why we started the business, the number one thing we were solving for was that it was very, very difficult to get access to primary care, specialty care, etc. And so our entire system looked at this problem set, which was contrary to what is the common misconception in Canada, that we have a lack of access to care because we don’t have enough doctors. In fact, the problem is that we don’t use our existing physician workforce well. If you actually look at the statistics of physician workforce utilization in Canada, what you’ll find is that 50 percent of primary care doctors and 50 percent of specialists actually do not work full year full time. So there’s tons of hours up for grab. And there’s many, many reasons why we’re not using all of those physician hours that are available. I would say that probably the number one driver of that is the way the physical health care system is designed, is that it makes it very hard for a physician to want to work or to be able to work full time. If we go back to what we do, we built a platform that really allows us to tap into all that excess capacity to make it available in the virtual world to patients that are across the country. So we’re able to blow away wait times that you would see and shift based systems that you see in the physical health care system. So our average wait time in that system is about two minutes, so from the time a patient clicks to say, I need to see a doctor, they’re typically speaking to a doctor in about two minutes time.

Speaker 1 [00:09:22] Hamed, your company has bet big on bricks and mortar. Well is the single largest operator of primary health care clinics in B.C. and the fourth largest operator in Canada, I’m sure your background in payments was very helpful in handling medical claims processes for physicians and other practice management needs. My question is, why was it important for, Well to be in the practice management clinic operations business?

Speaker 3 [00:09:45] Well, again, had a bit of a different mission and objective than Maple. And for us, we were really wanted to invest and grow in areas that we felt would also be benefited greatly by digitization and modernization. So in our view, there was a really valuable opportunity to help progress the plain vanilla medical clinic and to make it the clinic of tomorrow. And what does that really mean? That means elevating the software and workflow and tools and capabilities of clinicians and practitioners. It also means elevating the cybersecurity. It means improving the payment technology – it means so many of these clinics were operating in the Stone Age. And and so it just seemed like a really valuable endeavour, both from a value creation perspective, but also from a purpose perspective. Given how many of these clinics are out there and the need for them to continue to be there.

Speaker 1 [00:10:42] I want to quickly turn to the use of technology in your work, in providing access to services and improving health care outcomes, but also lean into the physical question, the bricks and mortar question, which will always be a mainstay in health care. And Brett, I understand you’re driving towards an omnichannel health experience. Can you tell us more about that?

Speaker 2 [00:11:01] I think from clinical experience, I can tell you that about 50 percent of problems are pretty transactional and don’t require me to touch a patient, but 50 percent of problems require me to do something that is physical. And so speaking about omni channel, then the question is how do we then enact an omni channel strategy for a company such as ourselves that exists only in the virtual world? And I think for us it’s not about building out our own chain of clinics. I think there are many people that have excellent powerful chains of clinics and we don’t need to replicate that. There are companies like Hamed’s company that they have a fantastic presence in the physical world, our partnership with Loblaw and Shoppers Drug Mart, who made a very large investment in our company in the fall of 2020, they have one of the largest physical presences in the country in terms of a physical footprint of health care clinics. And many of those clinics are able to be increased in terms of the level of care they’re providing. So I think in terms of omni channel, where we go is we’re awesome I think in the virtual world, I think we’ve created a great experience there. But those who have really done a great job perfecting the in-person experience, what we want to have is a system of very well orchestrated handoffs between the physical and virtual world. I don’t want to go and build a chain of physical clinics. I want to work with those who’ve done it and I want to coordinate that very well.

Speaker 1 [00:12:11] Concerns over data and privacy have been very big topics recently, especially so. I’m curious, how do you allay the concerns and objections from some patients, doctors and others in the sector about how privacy is handled? Brett, I’ll turn to you.

Speaker 2 [00:12:26] End to end, it starts with, we have a very basic set of requirements in Canada around what our privacy law requires. There’s some very well accepted standards around what you have to do in terms of data security. And we have to make sure that we very transparently communicate how we adhere to all of those requirements under Canadian privacy legislation. And certainly, I think in the early days of digital health care in Canada, there were a number of players that were not properly adhering to that. And even during the early days of the pandemic, we saw the use of platforms for virtual care that did not adhere to Canadian privacy legislation requirements. We saw many health care providers thinking that they could use FaceTime for a health care visit, which you cannot for a number of reasons. I think the other side of it is, when you look in the digital health space and especially in the United States, what you’ll see is there are many, many businesses whose entire economic model is based on the monetization of patient data. And that is quite problematic. I think while there is a certain segment of the population that is probably OK with that, I think many patients would feel very, very concerned about the fact that they are viewed as an asset to be monetized and especially with their health care information. We as a company, for instance, have taken a philosophy from the beginning that we will never monetize your patient data, we will never sell your data to others. We will never let others profit off of your data.

Speaker 3 [00:13:42] Yeah, so I would echo what Brett said. I think he laid it out really nicely. And we have precisely the same philosophy. We do not monetize patient data under any circumstances. We also have, you know, a ton of data. I think that’s a really important statement for a player like us to make. We have the third largest EMR in the country on a portfolio of telehealth assets, which is something I haven’t really talked much about, which is a sizable portfolio, depending on what metric you use. I’m sure we’re somewhere in the top three, but we probably have well over 20 million consumers in our combined EMR databases, and that’s not even considering some of the other assets that we have. So we have a tremendous amount of data. And to us, it’s incredibly important to draw a hard line, a very clear line about that.

Speaker 1 [00:14:32] Where do you see things going post pandemic? What opportunities are there for entrepreneurs and leaders like yourselves who want to improve the way health care is delivered in Canada? Brett, we’ll start with you.

Speaker 2 [00:14:44] So I think we’re really at a crossroads as we come out of the pandemic. I think we’re in a place where we’re either going to achieve remarkable gains in terms of where we go or we’re going to see things back track. Unfortunately, a lot of where we go will depend on what our governments decide to do next. We’ve had an attitude for a little while with government is that we want to sort of have our cake and eat it too, which is we’re going to be able to reduce our capital spending on hospitals because we’re going to move a lot of care to be virtual, but we’re not going to fund the virtual infrastructure. So now we can just take a lot of money and save it. And I think that’s where the attitude was. And I think you’re starting to see a growing realization on the part of government here in Canada. And you’ve seen a lot of announcements of investments in virtual care where they’ve started to say, in fact, we should fund virtual infrastructure the same way we fund physical. We want patients and doctors and allied health care providers to have very strong and good experiences in virtual. We want it all interconnected. So we are actually going to realize that we need to dedicate similar to what Kaiser did, very large amounts of funding that we’re going to save in the hospital system to virtual care. At some point in time, every entrepreneurial company, no matter where you’re born, has to say what’s the most receptive market for us? And I want it to be Canada because I’m very proud Canadian. I want our government to create awesome digital infrastructure. But in the end, we as a company are going to go where there’s opportunity and I hope it’s here, but if it’s not here, we’ll go to where the opportunity is.

Speaker 1 [00:15:59] It sounds like some cautious optimism, but still big questions ahead. How about how about you, from your perch, what does the future look like?

Speaker 3 [00:16:05] When I ask people, what do you think is the most important factor in maintaining good health? You’d be surprised. The answer, access to quality health care rarely comes up. It turns out your behaviours, your lifestyle is what really drives the greatest influence in terms of where you go from a health and wellness perspective. The problem is a lot of people just don’t know how to act. They don’t know how to eat. They don’t know that there are gently eroding their good health over time. Patient empowerment platforms that bring your data together demonstrate how you’re doing against those benchmarks and nudge you gently and maybe sometimes not so gently are incredibly important.

Speaker 1 [00:16:49] As we’ve said, this sector is very complex and there are a lot of challenges facing us. But from our conversations today, both of you have expressed a lot of optimism and enthusiasm for the challenge. So thank you both for being here today on our show. Hamed and Brett, I really appreciate your time.

Speaker 3 [00:17:07] Thanks, Theresa. I really appreciate it. And thanks to Brett as well.

Speaker 2 [00:17:10] And thank you so much for having me. It was a real pleasure and also a pleasure chatting with you again Hamed.

Speaker 1 [00:17:15] My guests today have been Brett Belchetz, CEO of Maple, and Hamed Shahbazi the CEO of Well Health Technologies. Coming up, we’ll talk to another leader in the telemedicine space about how they aim to humanize the delivery of telehealth services.

Midpoint – Speaker 1: You’re listening to Disruptors, an RBC podcast. I’m Teresa Do, filling in for John Stackhouse. Key to success of any entrepreneur is a keen sense of creativity. And in case you missed it, Disruptors recently dropped a special two-part series on the subject with guests from iconic Canadian brands like Lululemon and Shopify, plus Richard Florida, the urban studies guru behind the book, The Rise of the Creative Class. Find it wherever you get your podcasts.

PART 2

Welcome back. As our previous panel laid out, digital health is a vibrant sector full of opportunities, but some Canadians are still hesitant to log on, preferring the in-person intimate experience that they get with their primary care provider. The question is, can digital health care providers offer the same sort of intimate care that your local doctor or clinic can? Can virtual care show love? To answer that question, I’d like to introduce Anna Chif, the co-founder and chief strategy and product officer for Dialogue, a Montreal based telemedicine company. Dialogue promises to, quote, humanize health care and offer a more personalized approach to digital health care delivery. Anna, welcome to Disruptors.

Speaker 4 – Anna Chif [00:18:56] Thank you. Thank you so much, Theresa.

Speaker 1 [00:18:58] So the story of health care is ultimately the story of human beings. And everyone’s journey through the health care system is a very personal one. Anna, can you tell our listeners the story about your grandmother and how it is you came to found Dialogue back in 2016.

Speaker 4 [00:19:15] So, you know, I always speak about the founding of Dialogue as an alignment of stars. We came, we’re three co-founders. We were part of Diagram and we all came to working on Dialogue from a very personal experience and mine that still inspires me today and gets me out of bed is, in early 2016 I was taking care of my grandmother who was in palliative care. She was struggling from from a cancer that took over her body and was exchanging with my mother quite a bit, kind of the shifts in staying with her. And every time we had a question, we, it was a struggle to get answers. And I vividly remember this one night where she was very sick and I tried to get a hold of her doctor. And the nurse of our oncologist basically said, look, like he can see her, but you need to bring her to the emergency room. And I was like, it doesn’t make sense, it’s 2016, and there’s got to be a different way. And that to me was like this deep motivation for building a service and a product that has empathy and care at the core of what we do. And today we serve thousands of individuals every day. And what I think about the fact that some of them come with these sorts of issues that couldn’t be answered five years ago, I think it’s just it’s something that today is still really, really motivating, at least, you know, to me personally.

Speaker 1 [00:20:40] My my grandmother, she passed away last year. And I remember before she passed, she was in and out of the hospital because of her diabetes, which gotten very severe. But I remember there was one acute point where she was so afraid of going back to the hospital because it felt very inhuman — you wait there for hours and then you see a doctor for a few minutes and they kind of look at you, they look away and they leave the room. And I remember that being so heartbreaking because you want to care for them. You want them to have the best possible health they can where they are. And and yet sometimes our system doesn’t allow for that.

Speaker 4 [00:21:16] And you know, what’s really kind of special, I would say, in Canada is that the providers that we have, the doctors, the nurses that work in our health care system, the reason they do it is because they care for people. So what to me is so special about technology and virtual care is just this ability to redirect a portion of the population being treated differently so that the people who really need this in-person care get it and get that attention, and that it’s not just a few minutes coming from a physician who probably has the best intentions, but it’s just not set up in a way yet to tackle every person.

Speaker 1 [00:21:51] You’re based in Montreal, which was ground zero for, unfortunately, casualties in the first wave of the pandemic, especially among seniors and long term care homes. How did those first few months affect you personally, especially as someone working in the health care sector?

Speaker 4 [00:22:06] One of the investments that we’ve done earlier on at Dialogue is investing in smart triage, so we have, we call her Chloë. It’s it’s an automated medical assistant. So what we did is within a few days, hackathon style, we made that Chloe available to all Canadians. And that was before every government had their own guidelines and regulations. And so everybody, especially when it hit and all of Canada went into confinement, people were looking for information. So what we did is we made Chloe accessible to everybody and we were redirecting based on symptoms and questions and province or location, we’re redirecting patients to the right next step in the right information. At some point, we’ve welcome a million users in a week. So we had to scale up our platform and make sure that all these people could gain access if they needed to the platform. And the other part of the story, and that’s something we hear in the news quite a bit related to the pandemic, but we see it in the numbers. It’s mental health issues doubled on our platform between 2020 and 2021. It’s massive, right? It is, thankfully, getting more and more destigmatized because I think more and more people are living it. But the number of people who come on the platform at the brink of burnout because either their employer is cutting employees and shutting down or putting everybody on temporary leave or some other sectors like the virtual care sector that are booming and that are expanding so fast that how can you keep up with that scale up and the remote work and kids at home and young kids at home. I had a covid baby. And so just personally learning to manage having a baby that didn’t see anybody, not being able to see my family, my family, not knowing him, you know, working throughout that. And I think it’s just it just brought these virtual medical services to be much more human and to use that approach in every single interaction.

Speaker 1 [00:24:08] You hear of people who are more comfortable speaking about their struggles in the comfort of their own homes. And yet there are also others who have trouble connecting with practitioners over the screen. So how are you approaching that?

Speaker 4 [00:24:21] So that’s a really great question. And we actually pre pandemic launched a mental health program that we called a very high touch mental health program. So what we did in that program specifically was, every member who would come in, who would have access to that specific mental health program with any health or wellness concern, we would surround that patient with, first, a case manager who acts as an accountability partner or somebody who follows up, but also a doctor and a therapist. And different people react to different things. So it’s not just therapists in person or in video or not. Some people are much better reacting to medication because of the way they are. And they trust more the kind of, the external solution or medication then working through painful realities that they’re going through, and so it depends. So we would have this multidisciplinary team that works with that patient to bring them to remission as quickly as possible. And then we maintain ongoing follow-up to make sure that these people don’t dip or don’t go back to some of those mental health issues that we know can be recurring. But you’re absolutely right. That approach is not for everybody. And one of the new programs that will be launching in 2021 is actually Internet based cognitive behavioral therapy. So something that is much more patient led and that also can address a wider scope of mental health issues. Often a lot of individuals don’t perceive themselves as suffering from mental health issues. They might say, you know what, I’m just having a really stressful time and so getting into that direction of having cognitive behavioral therapy that you kind of do on your own pace becomes really interesting and important.

Speaker 1 [00:26:06] I’d like to pivot towards the broader approach of the company. There was a strategic decision to target employers for your services rather than going directly to patients. Why was that decision made?

Speaker 4 [00:26:17] Our platform has always been this B2B. So what is B2B mean? It just means that when we make the platform available, we make it available to employers for their employees or through channels. It could be insurers such as Canada Life, Sunlife and others. It could be student associations. The reason we took that approach is that we always believed and that I think resonates quite well with just the Canadian health care system, is that a patient should be empowered to use a service whenever they need when it comes to their health and wellness. And so we don’t have this notion of the individual paying for consultation. And it also doesn’t create this obligation on the medical side to deliver something. So we have a team that we recruit, that we train, that we train the Dialogue kind of empathy way, but we always make sure that what the team does for any given member or patient is the best thing for that patient, despite somebody coming in and saying, well, I want antibiotics. So there isn’t that that expectation. So for us, having the employer pay made it more accessible and also remove that odd dynamic where because I paid you as an individual, I’m now expecting that you do what I paid you for. It also allowed us to train our staff in a certain way, very much around empathy and follow ups and follow ups are obviously free because it’s all included as part of what your employer offers to you. And it’s also a way to focus for us. I think every company picks an angle of focus and for us, making sure that we work with our clients to ensure that as many employees as possible in those organizations use the service is our focus.

Speaker 1 [00:28:07] You mentioned the Dialogue way a couple of times. And I’d love to ask you more about, that, how does that approach stand out and what goes into developing that empathy?

Speaker 4 [00:28:18] You asked me for stories, so I’ll start with a story. So we, when we were getting started, we had this nurse, Chloe, and by the way, our medical automated assistant is called Chloe after this wonderful human being. But she was she was a nurse that was working on Dialogue. She was our first nurse. She joined us before Dialogue even had a name. And for her, the reason she went into nursing is because she deeply cared about every individual. And at the very beginning, when we had two patients a day and then 20 patients a day, she was handling every single one of them. And she knew those patients and she was following up. And I remember we were sitting in a cafe with her and I said to her because we hired a second and a third nurse, and I said, Chloe, we need to we need to codify what you do. We need to like, write it down. And that list and that cafe became this initial training that we started giving every single member that was coming in. And so back then, there wasn’t a Dialogue way. It was just that’s how we wanted to treat every single person who came on the platform. And as we hired more people, we started screening for people who deeply care, who see medicine as a way to improve and make people’s lives better and happier. And over time, this bullet list on a piece of paper drawn in a cafe turned into a real training that every single professional who works on our platform today, whether it’s a care coordinator, a doctor or a nurse practitioner.

Speaker 1 [00:29:48] What challenges do you see over the next 14 months in scaling this platform and now that you’ve gone public, bringing more and more Canadians onto it?

Speaker 4 [00:29:58] So certainly one of the challenges and opportunities is to make sure we prioritize the right products and services for our members and make sure that people continue using it and continue coming back to Dialogue. From the early days, when, we said don’t Google it, Dialogue it, because when you Google something, it’s quite terrifying. And when you come to Dialogue, it’s quite reassuring. So I think it’s continuing to build that, to build that habit. I would say those will be the right challenges. How do we continue scaling that, offering the right products? And quite frankly, I certainly don’t want to take it as a given that our Dialogue way or that our culture is something that is nailed forever. I think as we continue scaling, as we’re bringing more and more individuals as part of the team, that is certainly top of mind.

Speaker 1 [00:30:44] So then my final question following on that, is where do you see virtual care going in Canada next year and beyond?

Speaker 4 [00:30:52] From a Dialogue standpoint I think it’s going more and more into this proactive and predictive type of medicine where patients come in, maybe share some information and over time, we’re able to give them something more relevant and capture issues at the very, very kind of nascent point of them, as opposed to treating issues that have been lingering for years. So that’s definitely somewhere I see both Dialogue going. But I think medicine overall is moving from I’m sick, I’m getting care, to: here are some behaviours you can change and here are some tools to do that in order to ensure that you don’t go down a path that leads you to sickness.

Speaker 1 [00:31:34] A much more proactive balanced, holistic way of living and approaching one’s health care. That is so fascinating, Anna, thank you so much for your time and for this conversation.

Speaker 4 Thank you. Thanks, Theresa.

Speaker 1 My guest today has been Anna Chif, the co-founder of Dialogue. I’d also like to thank Brett Belchetz, the CEO of Maple and Hamed Shahbazi, the CEO of Well Health Technologies. I’m Teresa Do and this is Disruptors, an RBC Podcast. Join us next time when we’ll talk to some of Canada’s leading indigenous entrepreneurs about the skill sets required to create the leaders of tomorrow. Talk to you soon.

Speaker 4 [00:32:16] Royal Bank of Canada is an investor of Maple (RBC holds Class A Common).

Disruptors, an RBC podcast is created by the RBC Thought Leadership Group and does not constitute a recommendation for any organization, product or service. It’s produced and recorded by Jar Audio. For more Disruptors content, like or subscribe wherever you get your podcasts and visit RBC Dotcom slash disruptors.


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Jennifer Marron


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