Virtual care use ignited by #COVID19 pandemic

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The COVID-19 pandemic has provided the opportunity for Canada to go from “worst to first” in using virtual care and assessing its impact.

That’s according to Dr. Sacha Bhatia (@sacha_bhatia), FM Hill Chair in Health Systems Solutions and the Chief Medical Innovation Officer at Women’s College Hospital in Toronto and currently one of the country’s more eloquent advocates for virtual care.

Dr. Bhatia made the comment during his participation in a virtual discussion hosted by Massey College. The Massey Dialogues session was hosted by Principal Nathalie Des Rosiers and also featured former University of Toronto medical school dean Dr. Catherine Whiteside and Massey fellow and medical student Krish Bilimoria (@KHBilimoria).

In addition to virtual care, the wide-ranging discussion also touched on changing attitudes towards sharing patient data and the need to adjust medical education to prepare new physicians to practise in a virtual environment.

Dr. Bhatia noted the approach and attitude of physicians towards virtual care has changed significantly in the last couple of months because COVID-19 introduced new risks to physical contact for both physicians and patients. “In some ways the COVID pandemic was the match that lit the fire around this revolution in virtual care,” he said.

When it was announced that half of all patients visits in China would be conducted virtually when the pandemic was at its peak in that country, many viewed this as being unattainable. But now, he said, 70% of patient consults in some areas of Canada are occurring virtually and in some instances the use of virtual visits has grown by 780%.

The paradox that Canada has been a pioneer and is admired globally for developing telemedicine to service remote and isolated communities but lags other countries in integrating virtual care into routine practice was touched on.

Dr. Bhatia said “tremendous inertia” against using virtual care in most physician practices in Canada was coupled with concerns about patient privacy, quality of care issues and “the elephant in the room” – adequate remuneration for virtual consults.

With the significant growth in virtual care, Dr. Bhatia said an important issue now is determining the impact of this on the quality of care and outcomes. “This has happened very fast and we don’t know what the impact of that is going to be,” he said.

“There was a rush for us to do this to protect our patients and providers … but now if we’re going to make it sustainable we need to do the research to begin to understand what the impact of that has been. Canada has an opportunity here to be a real leader internationally in understanding the impact of virtual care and changing the care model.”

Many standards of practice for virtual care have not yet been fully developed, Dr. Bhatia acknowledged.

“There are a lot of conditions for which we are making up as we go to be perfectly honest”

As a medical student, Bilimoria said questions now have to be asked about how clinical skills and evaluation will have to change to adapt to virtual care models. “How do you evaluate and assess patients virtually?”

(The importance of adapting medical education to deal with virtual care is a key but underappreciated part of the Virtual Care Task Force report released earlier this year by the Canadian Medical Association, Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada)

“I think medical student involvement at all levels from education to research is going to be absolutely critical,” said Dr. Bhatia.

Dr. Whiteside said another component of the current reshaping of care delivery is digital care and the challenge of allowing patients to have access their own medical records while at the same time allowing those involved in their circle of care to also share the information. She noted that privacy legislation in various jurisdictions across the country is being opened up so access to data can be more patient-centric.

With the COVID-19 pandemic, Dr. Bhatia noted “research and practise are effectively occurring in real time” and this makes it even more important that new models for collecting and sharing data are put in place.  “Using research will actively help develop new treatments and new approaches that will potentially help save lives not in six or seven years from now but literally next month.”

He said there needs to be a much more pragmatic approach to how we think of data and privacy and that the public must be engaged in that conversation.

All participants in the discussion raised the issue of equity and concerns that virtual care is not necessarily being provided in an equitable fashion. Dr. Bhatia said this is of special concern given data that marginalized groups are already being impacted to a greater degree by COVID-19.

However, Dr. Whiteside said “COVID is enabling us to actually get closer to that kind of productive and positive relationship that we need to really move the agenda forward for access to data (and) engagement of patients and their caregivers in decision making”

The full Massey Dialogues session can be accessed here.