Virtual care: Signposts along the way


Virtual care has been propelled to near the top of the health care communications agenda by the #COVID19 pandemic. It’s now hard to avoid podcasts, articles and webinars dealing with the way the delivery of care has embraced virtual platforms in the face of the need for physical distancing between physicians and patients.

I have touched on this in earlier posts and will continue to do so, especially with the #ehealth2020 conference coming up in 12 days and @CMPAmembers selecting this as the topic for their annual meeting focus in August.

But in the interim, and at the risk of being accused of missing more seminal markers of where we are going in the virtual space I want to quickly offer up the following snapshots:

  1. Early in the year, Canada’s most prominent medical organizations (@CMA_DOCS, @Royal_College and @FamPhysCan) prophetically produced a virtual care task force report laying down a series of recommendations needed to integrate virtual care into the health mainstream. They have subsequently followed up with polling data backing the use of virtual care and are now heavily promoting a patient guide on how to navigate a patient visit. This is an unprecedented endorsement of the use of virtual platforms in Canada. The guide states that virtual care is a way for patients and physicians to continue to work together “to achieve the best health outcomes possible.”
  2. The Canadian Society of Physician Leaders (@CSPLeaders) has been hosting a series of podcasts dealing with how physician leaders have been approaching the #COVID19 pandemic and lessons learned. It is interesting that many of the 19 people interviewed to date have focused on the adoption of virtual care as one of the more significant changes in the health care system as a result of the pandemic. Many of these physicians have also predicted that the ways in which virtual platforms are being used will permanently change how health care is delivered in Canada. In fact, comments about virtual care were so pervasive that CSPL turned them into a specific podcast.

To quote from a couple of the interviews:

  • I think this pandemic has given us a very tangible use case for virtual care that we are aggressively exploring … across the country. I think we will come out of this years ahead of where we might have been in terms of the clarity around how we can use virtual care for follow up and for primary care …:  Dr. Brendan Carr, president and CEO of the Nova Scotia Health Authority
  • Prior to the pandemic, I would say that less than 1% of our consultations were being done virtually. And now that … it’s become an imperative that we reduce the risk of infection, I imagine that rate has jumped to maybe 40% of consultations being done via telemedicine. In many cases, we aren’t going to be going back, because we’re realising that there are many advantages to virtual care: For example, monitoring patients at home, and perhaps pre screening patients to determine whether or not it’s wise for them to come into the emergency: Dr. Philip Edgcumbe, a young physician innovator.
  1. Earlier this week, @BMJ_Open published the definitive version of a pilot project involving the use of virtual care in five regions in Ontario and involving 326 primary care providers and 14,291 registered patients in rostered practices. Results from the retrospective cohort study have been reported earlier but not in this peer-reviewed context.

Described as the largest evaluation of virtual care within primary care in Canada, the study looked at both video and secure messaging on digital platforms provided through the Ontario Telemedicine Network, and patient and provider preferences for each.

Key findings from the retrospective analysis included:

  • 99% of patients indicating they would use virtual care services again
  • Physicians and patients showed a preference for secure messaging over video visits.
  • Providers indicated that 81% of virtual visits required no follow-up for that issue

The authors concluded that “despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.”

  1. The Centre for Addiction and Mental Health (@CAMHNews) – which has seen virtual visits grow 850% in March and April has just hosted a podcast discussing virtual care with @DavidGratzer and Dr. Jay Shore, chair of the American Psychiatric Association’s Telepsychiatry Committee. While psychiatry is often identified as one of the specialists best suited for the virtual delivery of care, the discussion also referenced challenges such as the digital divide and inequities in access to virtual services.

To quote Dr. Gratzer “everyone right now is getting virtual care for the most part because we don’t have an alternative. This isn’t a true system it’s an accidental happenstance system, so to speak.”

In the podcast, Dr. Shore also talked about the concept of hybrid care where physicians and patients interact in a variety of ways in the post-COVID world. “I have relationships with people in person, over video, over telephone, texting, patient portals, social networking. And so it’s understanding how to use the technologies to form good, strong relationships for clinical care, trying to understand which technology to use with which patient and when.”

As noted the above are just a small selection of the ongoing discussion about virtual care and its role in a post-COVID19 world in Canada.

Stay tuned.

( Photo of Hungarian Pavilion, La Biennale di Venezia, 2017)