Need a blood test?  An appointment at a mobile clinic because you don’t have a doctor? How about trying to book an online visit with a nurse practitioner through VirtualCare NS?  

Going online to access to these medical services can be an efficient way to take care of your health needs. But it can also test the patience of people who have never used computers at work or at home. 

Two weeks ago, it nearly brought Susan Doucette to tears.  

“I could have cried when I started to read the information about how to register for a virtual appointment with a doctor,” Doucette said. “I was tempted to go to Dr. Google first! But I know actual doctors don’t like that.”

Fortunately, Doucette walked through the online registration process with the help of an instructor at the Dartmouth Learning Network, where she’s currently in a class working on their digital literacy skills. The instructor guided her through the prompts and instructions to register with VirtualCare NS. 

The Dartmouth Learning Network is a non-profit agency which helps about 120 adults a year upgrade math, reading, and computer skills. It also helps adults who work full-time but need to upgrade their computer knowledge in order to be considered for a promotion. 

Doucette gave examples of the digital roadblocks she had faced. “The computer said, ‘upload your MSI card.’ I said, ‘What’s an upload?’ How do I take a photo with the computer? It seems there are always gaps in the step-by-step instructions. And I feel this reliance on the internet is developing a hierarchy of who can access medical care. That disturbs me a great deal.” 

Before Doucette retired, she worked 45 years as a receptionist in a dental office without touching a computer. Now, she’s worried that if she loses her family doctor, she’ll have to depend on mastering online communication to get medical care. A single prompt to “upload” or “scan the QR code” can bring the process to a frustrating halt. 

Accessing the growing number of health care services migrating online requires a higher degree of digital skills than answering an email or playing a computer game of solitaire. Nova Scotians who do know how to comfortably navigate online may choose from a variety of portals and links to book appointments for:

• bloodwork at hospitals

• vaccines and Covid PCR tests

• prescription refills, strep throat tests, treatment for tick bites at select pharmacies

• non-emergency medical issues at mobile primary clinics in HRM and a few other locations around the province (depending on staff)

• an online consultation with a doctor or nurse practitioner through VirtualCare NS

But what about people who can’t navigate a website to book a medical appointment? 

Veronica McNeil, executive director of the Dartmouth Learning Network, says:

“It’s creating a multi-tiered system,” said Veronica McNeil, executive director of the Dartmouth Learning Network. “Those who don’t have the computer skills will not be able to access the same quality of care as someone who does. We are all being pushed to become our own advocate, and this is not going to work for everyone.”

“It’s all come too fast,” said Doucette. “People aren’t prepared for this. I talked with the ladies in my coffee group. Only two out of 10 said they could confidently book a medical appointment online.”

How many Doucettes are there?

Last week, the Department of Health & Wellness reported that 63,000 people have registered to obtain medical appointments through VirtualCare NS. However, that represents less than half the 145,000 Nova Scotians who don’t have a family doctor or nurse practitioner and who are eligible to get an online appointment with a doctor through VirtualCare NS. 

That’s provided the person has first registered with the need-a-family-practice website.

It’s difficult to estimate the number or the percentage of Nova Scotians who need help navigating online to access health services. 

“We currently lack up-to-date data on these topics due to the delay in the release of the Program for the International Assessment of Adult Competencies (PIAAC) report, which is considered the gold standard in literacy data collection,” said Ethan de Winter, spokesperson for Literacy Nova Scotia. “The report is now expected to be published in November 2024. In the meantime, we rely on the last publication from 2013 [which you can find a summary of here]. According to the 2013 report, approximately 50% of Nova Scotians would benefit from improving their literacy skills, while 58% would benefit from enhancing their numeracy abilities.”

That’s right — it’s been more than a decade since the last full-fledged assessment of those with or without these critical technological skills. 

Perhaps significantly, 19% of Canadians chose not to participate in the computer portion of the PIAAC survey. 

Although digital literacy skills in Canada were above average compared to other OECD countries, de Winter said governments generally aren’t interested in spending money to find out if there’s a problem, and the studies themselves are difficult to execute because they require coordinating several government departments.

In 2020, Statistics Canada conducted a Canadian Internet Use survey, and the results of a follow-up survey in 2022 will be published this July. These surveys look at how much time and money Canadians are spending online, at work, and at play. Since the pandemic, those numbers have skyrocketed.

Published results from the Canadian Internet Survey from 2020 suggest 91% of Canadians now use computers. 

A deeper dive into the same survey reveals 40% of adults over the age of 75 do not use the internet. 

A research paper published by Statistics Canada in 2021 called, “Internet-use Typology of Canadians: Online Activities and Digital Skills”analyzed how proficient Canadians were at using the internet to access information

Although its usefulness is limited because the survey data are now almost four years old, the analysis does offer insight into groups the authors refer to as digital “haves” and “have nots.” The research paper found:

 About 9% of Canadians are ‘Internet Non-users’ and another 16% are ‘Basic users’. Together, almost one-in-four Canadians (24%) had either no engagement or only very limited engagement with the internet and digital technologies in late 2018 or early 2019.

About 63% of seniors are either ‘Non-users’ or ‘Basic users’ of the internet, as are 40% of Canadians with a high school diploma.

In contrast, 77% of Canadians aged 15 to 34 are either Proficient or Advanced users, as are 76% of Canadians with a bachelor’s degree or higher. Individuals in these latter internet-user groups are most well-positioned to access online programs and services and adapt in an increasingly online society.

The “digital divide” described in the research paper won’t be easy to fix, given that libraries and non-profit groups that work one-on-one to assist people often lack sufficient resources and are primarily dependent on government funding, which ebbs and flows.

Those who struggle to use the Internet to access health care services online “may just give up,” predicted Veronica McNeil. 

Susan Doucette has a friend with multiple sclerosis whom she claims fits that description. The friend has limited access to a computer and no longer has a family doctor, after two retired and the third left the province. 

“My friend says, ‘Now I’m getting some kind of email. What am I going to do with that?’ She has a complex medical history and needs to be followed,” said Doucette. 

Addressing the problem

The Halifax Examiner asked the Department of Health & Wellness and the deputy minister for the new Department of Cybersecurity and Digital Solutions (created last month) to comment on what assistance is being offered to citizens at risk of being left behind because their Internet skills are inadequate. 

An answer was provided by Brendan Elliott, senior communications advisor for Nova Scotia Health which operates the hospitals:

A fundamental goal for Nova Scotia Health in all the programs it offers is accessibility. It’s extremely important that all our services are available to all Nova Scotians.

For instance, we are currently piloting a program in Yarmouth – in partnership with the local hospital foundation – in which someone is on site at the hospital to help residents who either don’t have the technology at home, or, are not comfortable accessing the services online.

Known as Virtual Care @ Yarmouth Hub, this six-month pilot project is part of each organization’s commitment to reducing barriers to services and resources. It is an opportunity to provide personal help to people who may have trouble or questions about accessing virtual care options. 

We recognize that for some, online access saves valuable time and is more convenient. But there are others who would prefer to book their appointments or access care in more traditional ways. For instance, while many find it easier to book blood collection appointments through the online portal, there is also a telephone number people may call to perform the same task.

The same can be said for our primary care mobile clinics, that are making access to care better than ever in this province. In fact, through our Public Service Announcements, we are encouraging people to call to make an appointment…and we’re always evaluating our services to see if there are ways to improve access.

The pilot project underway at the Yarmouth Hospital is an acknowledgement the government knows that citizens’ familiarity with computer technology is an issue. It will be interesting to see if similar initiatives get underway in other communities. 

Susan Doucette is a big fan of adding (and advertising) more phone numbers, so people have an alternative to spending hours online searching for links to various government services. 

“I totally relied on the COVID phone line to book appointments for vaccines,” said Doucette. “It’s reassuring. I’m a person that benefits more from hearing information than reading it.” 

The province’s 811 phone number operates 24/7 and is staffed with Registered Nurses who can answer many medical questions and direct people to the appropriate service. It works well.

MLA offices are another place where people struggling with access to government services can get help. Doucette said she avoided going online this winter to fill out an application for the $1,000 heating assistance rebate offered to homeowners. Instead, she went to her local MLA’s office and got a paper copy of the form. Applications for the rebate closed at the end of March. Doucette said it’s still her intention to complete the form and submit it soon. But she may have missed that deadline.

A glimmer of hope is a fledgling organization called GEO Nova Scotia. GEO stands for “Getting Everyone Online” and the goal of this non-profit is to provide computers and internet access to people who can’t afford to pay. GEO estimates about 20,000 Nova Scotian households are eligible.

GEO got started in north Dartmouth during COVID with $1.6 million in funding from the Department of Community Services. People can’t apply to GEO directly because the computers and Internet are provided through community groups that sign up as partners. 

GEO only got its non-profit status last year, but executive director Matt Spurway said it’s poised to grow quickly:

Since GEO began as a community program in 2020, we have distributed approximately 1500 devices to Nova Scotians (mostly new Chromebooks) in partnership with our network. Examples of “partners” include the Dartmouth Learning Network and the SchoolsPlus program which can offer students and their families assistance with everything from homework to mental health supports and dealing with the justice system.

The GEO Digital Champions program, as we currently offer it, can be called a “train-the-trainer” program. In most cases, Digital Champions are people working to help someone with a different type of problem, and this program helps that person support a client when digital skills are needed. This summer, we have received funding from the federal government to launch a Canada-wide version of digital champions to assist newcomers to this country.

Immigrants are another group who also face barriers when trying to access online government services.  There’s even less information about their struggles because they are often not included in government surveys. 

Meanwhile, Susan Doucette describes how she feels when she can’t navigate a site to reach the finish line to connect with medical help. “It feels as if you have turned the wrong way and now you are facing the corner”. 

Stuck. Frustrated. On your own.  

Jennifer Henderson is a freelance journalist and retired CBC News reporter.

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  1. I just wanted to say thank you for covering this important issue! Many of us in the adult literacy and learning sector are eagerly awaiting the updated PIAAC results later this year. I hope the Examiner will consider covering the story. Especially since (to the best of my memory) Nova Scotia opted in to additional sampling so the results for the province should be quite robust.

  2. Online services appeal to governments for the same reason they appeal to many businesses – they are cheaper than in-person services. People without internet, computers, or digital literacy will suffer, but the well-off will manage just fine and save taxes too!

    1. Governments are not businesses and should be held to a higher standard. Governments are there to serve the whole population under their jurisdiction. Service should take priority over economic efficiency.

  3. I am reasonably proficient with computers, cell phones and have access to the internet like the supposed 91% of Canadians. However, there was a point when my eyesight had deteriorated enough that I was not able to read screens to be able to use the computers, cell phone and the internet for a period of several months while waiting for surgery, which luckily restored my sight. There are a number of other health conditions which can temporarily (or permanently) make it difficult for folks to be able to use their computers or mobile phones, regardless of their computer proficiency. It seems shortsighted for government and health services to favor online services or mobile phone services over traditional booking methods which rely upon upon phones and friendly people. It is deeply frustrating not to be able to see well enough to use one’s computer or mobile phone, especially when one needs to interact with the government or health care services to address the problem. With Nova Scotia’s aging demographics, the policy makers may find that they too are lucky enough to reach an age where they may also suffer a setback in their ability to rely on computers and mobile phones to deal with the government and health care …and perhaps should not throw out traditional methods altogether.

  4. This is a good description of my dad’s experience with trying to use Maple. He has access to the internet and used to be fairly proficient, but now he’s almost 80 and struggles. I’m 3+ hours away and trying to provide tech support was difficult. He ended up in the emergency department last spring in such dire straits that he was assigned a PCP almost immediately afterward.