By BERNIE BELLAN It was in May of this year when I read an article in the Winnipeg Free Press by business reporter Martin Cash which told of a new venture that was going to provide an entirely new way for people who needed to see a doctor for urgent care. The venture was known as QDoc and it was the brainchild of two members of our local Jewish community: Dave Berkowits and Dr. Norm Silver.
As Cash wrote at the time, “it is being designed as the Uber for medical clinics to help link local patients, especially the elderly, parents with young children and people in remote locations far from a hospital or medical centre easily and quickly — and at no cost — with local physicians using an innovative patent-pending technology.”
Fascinated as I was by Cash’s story – and subsequent stories in other news media, including on Global TV and CTV News, I thought it was early days and, rather than contact Silver and Berkowits immediately to write a story of my own, I would wait a few months to see how QDoc had evolved in that time.
Recently I sat down with Berkowits and Silver at their downtown Winnipeg office to find our more about how QDoc has progressed – and to try to obtain a better understanding of just who it is that QDoc is most likely to help.
As it was explained to me during the course of the lengthy conversation I had with Silver and Berkowits, QDoc is “designed for episodic care” – similar to what is available at the groundbreaking Minor Illness and Injury Clinic on Corydon, the concept for which both Silver and Berkowits helped develop.
I asked Berkowits and Silver to tell me about their respective backgrounds prior to becoming involved with QDoc.
Berkowits said that he’s long been involved “on the technical side. I’ve spent my whole career mostly in diagnostic imaging. Recently I spent 15 years commuting from Winnipeg to Calgary. This is very exciting because now it’s a chance to be at home – and a chance to work with Norm. Norm is very passionate about medical technology.”
Silver jumped in at that point to say that he had recently retired from his position as an emergency room paediatric physician – “as of July 1st,” he explained. “I really did only five or five shifts the past year,” he noted, as he’s been devoting his full time to developing QDoc.
Silver added that “Dave has loads of experience in technology, but a huge amount of his experience is medical related as well, and my area is medical, but I’m familiar with programming as well.”
I asked how long they’ve known each other?
“Many years,” Silver answered.
I asked how old they were?
Berkowits said he’s 60, while Silver said he’s 50, adding that “Dave looks younger while I look older.”
I asked whether Norm is the oldest of the three very well known Silver brothers (the other two being dermatologist Shane and financial planner Michael).
Silver said that he is – older than Shane by a year and a half, and six years older than Michael.
Dave Berkowits’s younger brother, by the way, is Rady JCC Executive Director Rob Berkowits. Dave Berkowits’s sister, Heather, is actually married to Norm Silver. There is also another sister in the Berkowits family: Heather. Dave is the oldest of the four Berkowits siblings, he said, with 10 years between him and Heather, who is the youngest of the four.
Silver noted that he and Berkowits have become especially close the past 10 years – often working out together at the Rady JCC, “where we try to solve the world’s medical technology problems.”
I wondered where the idea for QDoc came from?
Silver said that “one of us would come up with an idea – and we basically had no ego about these things – and one of us would say, ‘Here’s a great idea,’ and the other would say, ‘Yah, but maybe we should do it this way instead,’ and in the end we would come up with a way better idea than either one of us would have come up with on his own.”
It was just about a year ago that QDoc did what is known as a “soft launch”. Silver and Berkowits had received help from a variety of sources, of which key assistance came from something known as North Forge Technology Exchange. North Forge is an organization supported by a number of private businesses that provides support and advice for start-ups in the technology sector. QDoc began with $1 million in capital, all of which was raised in Manitoba. Both Silver and Berkowits poured a lot of their own money into the venture.
At that point I wanted to explore just how it is that QDoc works. Silver and Berkowits suggested that I actually go online and register on QDoc to see how easy it is to access their system.
Subsequently, I did that following my conversation with them. I went to the QDoc home page and filled out the information needed to register and complete a patient profile. It was simply a matter of giving some very basic data, including name, address, phone number, and medical numbers (both the 6 digit number and the 9 digit number that all Manitobans have).
Once that was completed there is an optional area in which you can give information about allergies, your family doctor’s name, and the name and address of a pharmacy to which you might want a prescription sent – if that is a result of your online visit with a doctor.
At that point you are asked to fill out information explaining why you would like to see a doctor. If you have pictures that might be useful to a doctor in understanding your situation, you are asked to upload them.
Then, you would click on a button that says “I am ready for the doctor.”
That’s where QDoc works like Uber, as Martin Cash noted in his May article. At any given time there are doctors available to speak with you. Given the information you’ve just provided, QDoc will determine which available doctor is best suited to respond to your query and, within minutes you should be contacted by a doctor.
Berkowits explained: “We look at things like geographic location. Then the doctors who are available will get text messages on their phone – and, just like Uber, the first one to answer the text will connect with you.”
Silver also noted that “95% of the patients who contact QDoc have been ‘self-triaging’” and have had experience explaining their symptoms when they’ve presented in person either to a doctor’s office, an urgent care centre, or an emergency room.
During the course of our conversation though, several times Silver and Berkowits remarked upon the fact that, as QDoc has grown rapidly in terms of the number of patient visits, it’s become apparent that the vast majority of users are rural based – upwards of 75% at the present time, Silver said.
“In the rural areas, it’s hard to see a doctor,” he noted. And, although there has been quite a bit of publicity about QDoc in media, as I noted at the outset, it’s been primarily through word of mouth that people have become aware of QDoc.
Others “have said their pharmacists told them about QDoc,” Silver added. “Or someone else might have called a quick care clinic, but were told they couldn’t be seen and were suggested to try QDoc instead. Health Links has recommended us. So have emergency rooms.”
Looking back to his own education in medical school, which was over 25 years ago, Silver said that, long before “virtual care” became a reality (and which really came into its own as a result of Covid), “70-90% of diagnoses were shown to be able to be made by history alone; that’s without seeing the patient. When you look at adding video and talking to the patient, we know from our own metrics that 95% of diagnoses can be done without having to touch the patient.”
He added that studies in BC and Ontario have shown that when people were asked what they thought of virtual care, “98% thought it was as good as, if not better than in-person care.”
I was curious though, as to what the doctors who were standing by to receive texts from QDoc would be doing when they’re not actually working with QDoc.
“They all have other jobs,” Silver explained. “I’d say 80% of them are emergency physicians – because they do shift work.”
I wondered how many QDoc visits require referrals to other doctors? (In the Free Press article, Martin Cash told the story of a woman who contacted QDoc when her seven-year-old son was hit with a baseball bat. The doctor who responded to her query arranged for her son to see an ear, nose, and throat specialist the next day.)
But, as Silver explained, that would have been the exception rather than the rule when it comes to consultations with a doctor on QDoc, saying that “95% of our patients are taken care of without any other help” needed from any other doctors.
Also, since those first reports of QDoc in various media appeared in May, QDoc has been able to assemble quite a bit more information about how the program is being utilized. For one, there’s been a monthly volume increase of 70% month over month each of the past four months. (There were 144 visits to QDoc in May, but well over 1,000 in August.) As a result of all the new data that’s been gathered based on who’s been using QDoc It’s been a constantly evolving learning curve, Silver explained, but they’ve now arrived at some interesting observations, including: “15% of our patients would have gone to the emergency department if we didn’t exist and, (as has already been noted) 76% of our patients are from outside of Winnipeg – that’s where the need is.”
As far as how patients interact with the doctors, I wondered about the software that’s used?
“We have our own software that we’ve built from scratch,” Berkowits explained. “It’s an end to end encrypted video conversation. The audio side of it is recorded and kept as part of a medical record.”
“So it protects the doctor – and the patient,” Silver added.
In terms of what the patient would actually see on their computer screen, here is how it was explained to me: The screen would show: “We are searching for a doctor for you.” Then, “when the doctor accepts the call, they would hit the link on their computer or mobile device and doctor and patient would be connected together, with both audio and video. The doctor would be writing notes and ordering prescriptions, if necessary, while the patient might be asked to upload pictures or, with video, show the doctor if they have, for instance, skin lesions or, say, it’s your son who’s having trouble breathing, the doctor could examine him on camera.
Then, the doctor could fax a prescription to a pharmacy of your choosing. (It may seem archaic but prescriptions are still faxed into pharmacies in Manitoba, rather than sent digitally.) If lab tests are needed, the patient can receive an order for tests that can be printed out and taken to a lab.
The results of those tests will be sent to the doctor who ordered the tests, but if, for instance, the patient didn’t actually go for the tests that the doctor might have ordered, QDoc will send a follow-up communication to the patient saying “You forgot.”
What QDoc also does, at the end of every interaction between a doctor and patient, is ask the patient whether QDoc can send a copy of the report prepared by whichever doctor has treated that particular patient to that patient’s family doctor.
I asked whether QDoc is available 24/7?
The answer was “Yes. We don’t always have coverage 24/7,” but the system will respond 24/7 and, if there is no doctor available at a particular moment you’ll be told that.
Currently, according to Silver, there are “34” doctors in the QDoc system. “We want it be as attractive as possible for doctors working with us, so we want to give them a lot of work. Most of them are pretty motivated. Eighty percent of our paediatric patients right now are seen within five minutes of logging on.”
Another benefit of QDoc is that the 34 doctors who presently make up the total number of physicians on call at present are all connected through WhatsApp, where they share information and can discuss particular cases.
Silver gave this example: “A doctor who’s seeing a patient who happens to be in Brandon and who should really be seen by a doctor in person can ask on WhatsApp: “Is there anyone in Brandon who can see such and such patient tomorrow?” and a physician in Brandon can respond, “Yes, I can see your patient.” (Since the likelihood is that Brandon doctor is an emergency room physician, he or she will also likely say: “Tell your patient to come to emergency and tell the nurse that I’ve agreed to see your patient.”
As Berkowits observed, “virtual health care – since the pandemic, has become widely accepted, but the platform that we’ve built is widely collaborative.”
Something that Silver added – about emergency room physicians, is that quite often they’ll deal with a case such as a car accident or a drug overdose where a patient may present in an unconscious or semi-conscious state, the doctor treats them, the patient wakes up – and can be quite belligerent. But treating a patient virtually, where the doctor is able to give immediate and effective treatment – and the patient is very much appreciative – well, that’s very rewarding for emergency doctors – and is one of the reasons so many of them are flocking to join QDoc.
I suggested to Silver and Berkowits though, that someone would have to have either a computer or a mobile device in order to contact Doc.
While they didn’t totally disagree, Silver gave an example of a new initiative that’s been taken in cooperation with the public sector as an example how QDoc can be used to help patients who have no access to a computer:
“We have a partnership with something called the Downtown Community Safety Partnership,” he explained. “They’re relatively new and they’re funded by government. They’re working with homeless people. If they can get the money, they’re going to be carrying tablets and then they can help homeless people contact us. A lot of these people don’t go to a doctor, they don’t go to a hospital, they don’t trust authority.” But, as Silver noted, a doctor from QDoc might be in the best position to provide help – through a worker from this downtown organization.
Similarly, QDoc will also be working with one personal care home by installing a large screen TV through which residents, with the help of an aide, will be able to communicate with a doctor.
I wondered though, whether an initiative of that sort wouldn’t be perceived as taking the place of a visit to a family doctor?
Silver said that wouldn’t be the purpose, but where it would make sense would be, for example, if a resident suddenly developed a rash – and it might take weeks to see a family doctor.
Again, it occurred to me that there could often be a language barrier between patients and doctors on QDoc. I wondered whether QDoc had any contingencies in place that might help to resolve difficulties of that sort.
Berkowits said that “there are translation services that are free from the government and we’re going to try and partner in real time so that we’ll have three people involved in a virtual call: the patient, the doctor, and the interpreter,” but, he admitted that’s not on the immediate horizon.
I asked how much QDoc could conceivably grow, especially if it continues at its current rate of 70% expansion every month?
Silver answered that “we’d like to get to one per cent market share.”
I asked what he meant by that?
He said it “translates into $15 million of revenue.”
I asked how many patients would have to use QDoc’s service to reach that goal?
He said it “would be 150,000 patient contacts a year.”
In the long term the goal is to open up in every province in Canada, Silver added.
As far as how much money QDoc makes on every call, they take 15% of whatever amount the physician would bill Manitoba Health Services.
Considering that Berkowits and Silver have some pretty serious ambitions to grow their company, starting first in Manitoba, then in all of Canada, with the possibility of licensing their software to other countries as well, I asked whether they’re looking for additional investors?
“We’ve talked about that a little bit,” Silver said. “But, we don’t think we need investors. We’ve been able to get a lot of grants so far ($200,000 worth, he specified). “We should be cash flow neutral by early next year – if we don’t keep hiring more programmers.” (He explained that currently QDoc has 10 programmers.)
I asked Berkowits, who’s the software guru behind QDoc, what more needs to be done with the existing software powering QDoc?
“We have a list of features that we want to keep introducing,” he explained. “When we started out initially we were pretty happy for just a patient and doctor to connect. But, as we built this out we started taking a look at other electronic medical record systems and how they do things, we also want to make it easier and better for the physician. We want to work on our platform.”
Berkowits then went on to describe some of the enhancements that DocQ would like to make, including incorporating: “Artificial intelligence, natural language processing, ambient listening, conscription services.” (There’s not enough room to expand upon each of those subjects here. Suffice to say that this is an entirely new world of virtual medicine that Berkowits and Silver are planning on entering.)
At the end of our conversation Silver suggested that, in addition to trying the QDoc portal to see how easy it is to register as a patient, I take a look at the reviews QDoc has received from patients. Now, while I’m always a little bit sceptical of online reviews, the number of Google reviews that I was able to see (69 as of the date I looked at them – Sept. 4) showed unanimous praise for QDoc. While this article was not intended as an endorsement of QDoc – although it might certainly be perceived that way, the high praise QDoc has received thus far from patients is certainly an indication that Berkowits and Silver have hit upon something that promises to fill a desperate need within our health care system.
Norm Silver had also suggested that I might want to talk with at least one of the doctors who is working with QDoc to get a sense of what a doctor’s perspective is on the QDoc platform.
I spoke with Dr. Taft Micks, who is an emergency room physician based out of Brandon. As I expected – given that Dr. Micks had volunteered to speak with me after having been contacted by Dr. Silver, he was quite enthusiastic about his experience with QDoc thus far. He told me that he’s been with QDoc from the very beginning – which goes back to last October.
As an emergency physician, Dr. Micks said that he’s constrained by several of the limitations that apply to the delivery of emergency medicine in this province. He noted that “I don’t fee like I can take the time to address people’s needs in emergency,” but when he’s on QDoc, “I’m able to connect with a patient almost instantaneously” and “from a physician’s perspective, I’m able to arrange treatment.”
Micks added that he’s like to see emergency services expanded, but he’s quite aware that’s not realistic at this point. And, even though he’d be prepared to put in more hours in the emergency ward in Brandon, where he’s currently working 32 hours a week, Micks is quite aware that expanding emergency services will require hiring more nurses – a problem that won’t be resolved in the short term.
As a result, he’s been spending increasing amounts of time working with QDoc and, he added, he’s hoping to scale back the amount of time he’ll be spending in the emergency department as a result.
Micks observed that what QDoc is doing “is the future of medicine.”
“The software is designed to be as physician friendly as possible – as opposed to other software” that he and other physicians have struggled to learn, he said.
His only concern, he noted, is that as QDoc becomes increasingly popular, wait times to interact with a physician might take longer, but in the meantime he said he’s been quite impressed with how the system has been working thus far.