Elizabeth, a 40-year-old from Moncton, NB, was diagnosed with a unique tumour that couldn’t be treated locally. Dr. Calvin Law, an oncology surgeon at Sunnybrook Health Sciences Centre in Toronto, was able to see her pre-op and post-op by videoconference. Elizabeth had to travel to Toronto only once – for her surgery.
Franklin, a senior with congestive heart failure, uses a tablet with wireless blood pressure cuff, weigh scale and pulse oximeter at home. Andrea Portelance, RN, at the Toronto Central LHIN, monitors his vital signs at a distance and provides personalized health coaching by phone. He has regained confidence in his self-management capability and has avoided having to go to the ER since he started the program.
Dr. Nihal El Khouly, a family physician in Bolton, ON, responds to a secure message one of her patients sent from their smartphone. The patient gets a timely response and avoids the need to arrange an office visit.
These three real examples of virtual care in action demonstrate what patient-centred care can look like. And increasingly, providers and policy makers are paying attention.
That’s because our healthcare systems across Canada are aiming to turn themselves upside down, moving from a predominantly provider-centric world to a patient-centric one. Providers and governments from coast to coast are talking to patients and looking to design new models of care delivery that improve the patient experience.
The solutions generally involve strategies to integrate care delivery across the continuum while treating patients as partners in their own care, rather than just as…well… patients. These new care models come in many different flavours and names. In Ontario, we are calling these Integrated Care Delivery Systems “Ontario Health Teams”. But whatever one calls them, the goal is the same. It’s about value-based care that optimizes the outcomes that matter most to patients within the available budget.
It’s long been recognized that digital health is central to integrating care in this way. Electronic health records need to be shared across the circle of care, including patients and caregivers. Data needs to be aggregated and analyzed to proactively apply preventive care and to examine progress against quality metrics.
The electronic health record journey has been long — and expensive — and we have made enormous strides over the last decade.
However, there is a second type of digital care that has not received as much attention. While the electronic health record world focuses on sharing and collecting data, virtual care focuses on the use of technology to support patients in the community and to deliver care directly to them. Used well, it improves access to care and can greatly enhance the patient experience.
The use of virtual care is growing rapidly. In 2018, there were over 960,000 clinical videoconferencing events in Ontario, similar to Dr. Law’s use above. More than 19,000 patients have participated in remote monitoring and coaching to empower patients with chronic disease in Ontario, as described above, since the program began. And in primary care, more than 30,000 patients and 275 primary care providers in Ontario are signed up for the project alongside Dr. El Khouly, enabling patients to securely message their own family doctor.
As we embark on the integrated care journey, virtual care will emerge as a mainstream cornerstone of the restructuring efforts.
To start with, virtual care will become the “front door” to care. It helps patients know who their provider teams are and to understand the resources available. It makes it easy to know where to go and how to connect for care. It adds convenience and will reduce hospital use. The ‘front door’ engages patients by easily linking them to “my care providers” and “my health services.”
Moreover, virtual care also provides a whole new array of tools for providers that can be offered to patients in an integrated care model. There are many areas that can be addressed but here are a few examples:
▪Palliative Care: The Champlain region engaged in a pilot program to support palliative care at home using remote monitoring for pain and symptom management, enabling people to spend more time at home with family during that very challenging period.
▪Specialist Access: Providers across Ontario did 56,000 video visits directly to people’s homes in 2018, providing a new level of convenience for patients and reducing pressure on hospitals.
▪Mental Health: Big White Wall, a free online peer community for people with mild to moderate depression or anxiety, was introduced in Ontario, starting this past fall, and some 16,000 people have signed up to use it.
Virtual care solutions not only improve the patient experience but also tend to be relatively inexpensive to acquire and can be used in ways that tend to reduce cost or improve efficiency. This is a “win win.” Better experience at lower cost. That’s why other industries like banking, travel and retail are already using online services.
How to get there
At present, there is a prevalence of excellent virtual care solutions, apps and technologies available out there. That’s the easy part. The challenge on this front is deciding which are fit for purpose and how to deliver them as simply and coherently as possible to providers and patients.
The harder part is creating the integrated care networks needed to deliver the care. That is a longer road that will need great leadership from our provider communities and our policy makers.
What about the patients, you say? I think they are more than ready. All they have to do is pick up their smartphones!
Better care, lower cost
▪Dr. Arsh Jain, a nephrologist at London Heath Sciences Centre, uses virtual technology to help patients succeed at home dialysis. The alternative is hospital dialysis, which costs about $30,000 more annually per patient.
▪Patients who live in Northern Ontario are provided with travel subsidies if they need to travel to receive health care. If all of the patients who used clinical videoconferencing for their specialist care in 2018 had travelled instead, it could have cost as much as $40 million in travel grants.
▪Some regions in Ontario that deliver the aforementioned remote monitoring and coaching program for chronic disease report reductions in hospitalization of more than 50% for heart failure patients. It is estimated that more than $11 million in hospital admissions were avoided last year.