A Framework for Digital Health Policy: Insights from Virtual Primary Care Systems Across Five Nations

Digital health technologies used in primary care, referred to as, virtual primary care, allow patients to interact with primary healthcare professionals remotely though the current iteration of virtual primary care may also come with several unintended consequences, such as accessibility barriers and cream skimming. The World Health Organization (WHO) has a well-established framework to understand the functional components of health systems. However, the existing building blocks framework does not sufficiently account for the disruptive and multi-modal impact of digital transformations. In this review, we aimed to develop the first iteration of this updated framework by reviewing the deployment of virtual primary care systems in five leading countries: Canada, Finland, Germany and Sweden and the United Kingdom (England). We found that all five countries have taken different approaches with the deployment of virtual primary care, yet seven common themes were highlighted across countries: (1) stated policy objectives, (2) regulation and governance, (3) financing and reimbursement, (4) delivery and integration, (5) workforce training and support, (6) IT systems and data sharing, and (7) the extent of patient involvement in the virtual primary care system. The conceptual framework that was derived from these findings offers a set of guiding principles that can facilitate the assessment of virtual primary care in health system settings.Author summary: Remote consultations in primary care feature in some health systems for several years. With the arrival of Covid-19, there was a concerted widespread effort to move towards remote consultations. But there may be negative impacts on patient care when consultations are not in person. To better understand the impact of remote consultations in primary care we conducted a narrative review and map the findings against the World Health Organization framework of the functional features of health systems. We develop the first iteration of this updated framework that accounts for the heterogenous nature of digital transformations and review the deployment of virtual primary care systems in five leading nations: Canada, Finland, Germany and Sweden and the United Kingdom (England). Seven common themes emerge: the stated policy objectives, regulation and governance, financing and reimbursement, delivery and integration, workforce training and support, IT systems and data sharing, and the extent of patient involvement in the virtual primary care system.