Good virtual care – some principles

Is it appropriate to ask patients to be available during a 3-4 hour window for a virtual visit by a physician?  That was the question debated by some Canadian physicians on Twitter last week and it highlights the fact that many issues underpinning the optimal, ethical delivery of virtual care are still being worked out.

With the rapid expansion of virtual care due to the COVID-19 pandemic the delivery of ethical and appropriate care in a virtual format becomes even more important. This whole area been addressed in the most recent issue of the Canadian Journal of Physician Leadership by digital care pioneer Dr. Kendall Ho (@Kho8888) from the University of British Columbia, Dr. Ken Harris, deputy CEO of the Royal College of Physicians and Surgeons of Canada and Toni Leamon, a patient advocate and member of the Canadian Medical Association’s (@CMA_Docs) Patient Voice Group.

The authors note that with the growth of virtual care “it is vital that the health professional community carefully examine the quality of care being delivered digitally and determine when it is appropriate to use VC as an alternative to face-to-face care.”

“Although it is acceptable to challenge traditional thought, the use of virtual care should always be anchored on the principles that underpin the practice of medicine itself,” they add. “Modern information and communication technologies should only be considered as tools to facilitate and optimize care. Their use should benefit our patients and do no harm — a fundamental tenet of medical practice.”

The article look at principles of virtual care in 4 domains; clinical, medicolegal, adragogic, and social. What is outlined contains few surprising or contenious views.

For example, in the realm of clinical care, the article states: “judging whether to choose virtual care for health service delivery should be based on whether it is a reasonable or better option than in-person encounters in providing safe, accessible, timely, and high-quality health care to patients.”

Among the principles, the authors do include continuity of care – a factor stressed by practising physicians and one that can be lacking when virtual care is delivered outside of the usual physician-patient relationship. They write that virtual care should be considered “as time points in a continuous string of interventions in longitudinal patient journeys” and as such virtual visits should include a clear process for patient follow-up.

The article includes a lengthy section on the necessity of appropriately educating medical students about virtual care, noting that planning a curriculum would benefit from “co-creation with and participation of patients, caregivers, and communities.”

The issue of equity is also raised and the article notes that providers should be aware “not all patients have the same access to technology, because of variability and availability of resources or infrastructure in different communities and contexts.”

On the issue of how and when patients should be available for virtual interactions, the section on the principle of transparency states this should include “clear expectations about response times and ‘when the virtual office is open’.”

The authors conclude: “Tomorrow’s best practices in virtual care will certainly be different from those of today through technological innovation and evolution, and new understanding and lessons will be generated from expanding clinical applications. All stakeholders must be adaptive and flexible, as new technologies and VC approaches emerge.” 

(Image courtesy of Northern Weldarc Ltd)

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