Keys to Maintaining Virtual Care’s Momentum

The largest Health IT event in Canada – the eHealth Conference – had to move online this year due to COVID-19. It would have been held in lovely Vancouver, but instead the eHealth Virtual Pop-Up event is happening next week, July 20-21st. The conference is hosted by Canada Health Infoway, the Canadian Institute for Health Information and Digital Health Canada.

As an added element of the conference, Canada Health Infoway and @DrRBhyat will be hosting next week’s HCLDR chat. They will be leading us in a topic that is very relevant right now – virtual care (aka #telehealth).

Please join them Tuesday, July 21 at 8:30 p.m. ET (for your local time click here)

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By Dr. Rashaad Bhyat (@DrRBhyat)

Prior to the COVID-19 pandemic, 10 to 20 per cent of health care visits in Canada were conducted virtually. That number is now about 60 per cent, according to statistics tracked by Canada Health Infoway (Infoway).[1] My clinic group is currently “seeing” most of our patients through phone appointments, alongside some additional “visits” conducted through video chat.

Virtual care has allowed Canadians to continue to access health care while maintaining physical distancing. The uptake has been rapid, but we need to make sure that it’s sustained beyond the pandemic. Four key policy themes can help ensure that virtual care remains part of Canada’s “new normal.”

Clinical and Political Leadership

Already, clinical groups and the jurisdictions (provinces and territories) have shown remarkable leadership and collaboration in implementing virtual care. This work must continue. Individuals and organizations such as hospitals, clinical and industry groups and associations can work with jurisdictional leaders to influence policy at provincial, territorial and national levels.

Patient Advocacy

Individual patients and patient organizations can provide significant support for furthering virtual care services. According to a recent analysis by Infoway, the majority of patients report feeling satisfied after experiencing a virtual care visit.[2] From a clinical perspective, I appreciate that virtual care helps me maintain a connection with my patients, whether hearing a voice on the phone or seeing a face on video.

Infoway’s 2018 and 2019 surveys of Canadians found that patients with access to their personal health information report feeling more confident and involved in managing their health care. The benefits of modernized access to health care will last far beyond COVID-19, and it is critical that patients bring their experiences to the table.

Support for Clinicians Using Modern Tools to Benefit Patients

Clinicians are making do with pre-existing resources: primarily the telephone, along with a host of video visit apps and digital work-arounds.  While these stopgaps are sufficient to weather an acute crisis, our tools and processes must be refined if virtual care is to last long-term.

This process will take enormous change management. Supporting clinicians might mean ensuring access to integrated, easy-to-use tools to privately and securely deliver optimal virtual care. It could mean re-examining how we manage patients’ movement through the health system — from triaging to waiting rooms to specialist referrals.

But technology is only one part of the story. Education, training and clinician peer networks are needed to refine, teach and reinforce best practices regarding the use of virtual care.

Modernizing Remuneration

Clinicians’ remuneration structures (commonly equated with billing codes in fee-for-service arrangements) are a major consideration in the long-term implementation of virtual care.

Prior to the pandemic, most regions had some codes for remuneration for care provided virtually, in limited and restricted clinical settings. That has changed rapidly across the country, as virtual care billing codes were opened-up temporarily. With some jurisdictions implementing their permanent use, fee codes for virtual care services will need refining to best determine how they can support quality virtual care and continuity of care afterward.

Looking Forward

Throughout the COVID-19 pandemic, Canadian clinicians have demonstrated their ability to adapt quickly and deliver virtual care during a time of crisis. Similarly, Canadian citizens have demonstrated that they have no interest in returning to an outdated status quo. Please join me (@DrRBhyat) at the next HCLDR tweet chat on Tuesday, July 21 at 8:30 p.m. ET (for your local time click here), when we will discuss the following topics:

  • T1 As the pandemic slows down, how do we ensure the sustainability of virtual care and avoid returning the health system to an outdated status quo?
  • T2 What has your experience with virtual care solutions been during the pandemic? Would you like to continue using these solutions post-COVID-19?
  • T3 With virtual care, what additional support and training might be required for frontline clinicians and office staff? For example, what scenarios are best suited for assessment via virtual visits?
  • T4 What are some ways we can address any uneasiness about virtual visits and ensure patients are comfortable receiving care this way? Can guide books for patients and clinicians be helpful?

[1] “Experience of Health Care During COVID-19 Reported by Canadians,” Canada Health Infoway and Leger, June 2020.

[2] Ibid.

About the Author

Dr. Rashaad Bhyat is Clinician Leader, ACCESS Health at Canada Health Infoway. He is a family physician with a special interest in digital health. He currently practices in an EMR-enabled family practice in the Greater Toronto Area.

Resources

Canada Health Infoway, “Experiences of Health Care During COVID-19 Reported by Canadians,” 25 June 2020, https://www.infoway-inforoute.ca/en/component/edocman/3828-experiences-of-health-care-during-covid-19-reported-by-canadians/view-document?Itemid=101, accessed 8 July 2020.

Canada Health Infoway, “Access to Digital Health Services: 2019 Survey of Canadians Summary Report,” 13 December 2019, https://infoway-inforoute.ca/en/component/edocman/3786-access-to-digital-health-services-2019-survey-of-canadians-summary-report/view-document?Itemid=101, accessed 9 July 2020.

Canada Health Infoway, “Connecting Patients for Better Health: 2018,” 2 August 2018, https://infoway-inforoute.ca/en/component/edocman/3564-connecting-patients-for-better-health-2018/view-document?Itemid=101, accessed 9 July 2020.

Ontario Medical Association, “Virtual Care Telephone and Video Codes: Frequently Asked Questions,” 13 April 2020, https://www.oha.com/Bulletins/OMA%20FAQ%20re%20virtual%20care%20April%202020%20see%20q%2034-38%20%281%29.pdf, accessed 9 July 2020.

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