The future of virtual care
Necessity made virtual care the norm during the first three waves of the pandemic, and now health care practitioners are finding ways to make it sustainable into the future
By Crystal Mackay, MA’05
Dr. Erin Spicer was working on inpatient service at London Health Sciences Centre when the first patients were admitted with COVID-19 in April 2020. At the time, doctors knew very little about the disease progression and symptoms. They were concerned when they discharged patients from hospital and needed a way to provide followup care while reducing the risk of transmission.
Spicer and her colleagues quickly developed a virtual care model that combined telephone consults with symptom tracking and take-home pulse oximeters to measure blood oxygen levels.
“We developed this care model whereby patients only needed a phone so we could contact them and we provided them with everything else that they needed,” said Spicer, resident alumna and Associate Professor, Medicine.
At the same time, as the first wave of lockdowns were implemented, doctors and dentists across the country were adapting their practices to incorporate virtual care and telehealth to reduce exposure to the virus. Dr. Daniel Pepe,
MD’14, was working with a team to mobilize primary care doctors to provide virtual triage to patients exhibiting COVID-19 symptoms.
It was an unprecedented way of providing acute care in an unprecedented time, and also brought to the fore how virtual care could be rapidly and effectively implemented in a variety of settings.
“A hybrid of in-person and virtual care is going to be a part of my practice forever.” — Dr. Kevin Fung
“The pandemic really normalized virtual care,” said Pepe, Adjunct Professor, Family Medicine, who was involved in leading initiatives in virtual and digital care well before the pandemic hit. “We had been asking ourselves, how do we convert a province from non-virtual care to virtual care? The pandemic gave us the willingness to just say, ‘this is essential, we must do this,’ and it was done.”
And while the pandemic provided the impetus to make virtual care a standard part of practice, it also provided insight for health care providers on how it could be used more broadly when the pandemic ends. Especially for patient visits that don’t require an examination, (for example communicating results from tests or renewing prescriptions), virtual care’s advantages became abundantly clear.
“A hybrid of in-person and virtual care is going to be a part of my practice forever,” said Dr. Kevin Fung, resident alumnus and Chair/Chief, Otolaryngology – Head and Neck Surgery. As a surgeon who specializes in head and neck cancer, he provided hundreds of virtual appointments throughout the past year for patients who didn’t require a hands-on examination. “This is here to stay. From a provider and patient lens, I can’t imagine it going back to the way it was.”
With a catchment area several hundred kilometres wide, providing patients with an option to not have to travel to the hospital has been transformative for his practice. “For patients to not have to book a day off of work, or get a babysitter to travel from Windsor to get their test results, has been an incredible advantage.”
Fung says part of what has made it maintainable is the change in the way doctors can bill for virtual care. Early in the pandemic, the provincial government opened up billing codes for the first time so that doctors could be paid for
their time providing virtual and telehealth care through the Ontario Health Insurance Plan.
Even for dentists, whose practice is centred largely on hands-on treatment, teledentistry filled some of the gaps during the pandemic. Dr. Anand Soni, DDS’98, used teledentistry to triage emergency patients. He pulled up charts remotely, discussed their concerns over secure video conference and then decided if the issue could be treated with medication or if the patient needed to be seen in the office.
“COVID highlighted a big advantage of teledentistry – connection with the office without being physically present,” said Soni. “Many patients simply needed the reassurance without having to come in.”
Dr. Guido Filler has been using virtual care for his paediatric nephrology patients since 1999 as a way to reach those in rural and remote areas and he was one of the early adopters of the Ontario Telehealth Network.
“It was incomprehensible to me coming from a different health system in Germany that a patient would travel from North Bay to Ottawa for a consult,” he said.
As it has become more widely adopted during the pandemic, Filler has been involved in research to investigate the patients’ perceptions of virtual care, and has found that satisfaction depends on the context, type of visit and the individual patient.
While their research showed that many patients liked telemedicine if an in-person visit occurred after no more than two virtual visits, they found that patients with more complex conditions preferred in-person visits. And for patients with anxiety, some preferred over-the-phone care while others preferred in-person care.
Contextual factors, like distance to travel and cost savings, also played a role in overall satisfaction with virtual care, as did whether or not the patient felt they needed to show the doctor physical symptoms.
“The main takeaway from this study is that it is very important to have a mix of both virtual and in-person care depending on the patient and the type of visit,” said Filler.
Spicer and her team have also been collecting data and patient feedback about their virtual care model for COVID-19 patients through the Western Centre for Quality, Innovation and Safety at Schulich Medicine & Dentistry and have been adapting their practice according to those results.
“The format of the clinic is always changing, and that’s being driven by patient experience and patient input,” said Spicer. “This is a great example of what we can do with virtual care, so going into the future, I think this is a great first step.”
Pepe agrees that this is only the beginning, and part of what needs to be done to make virtual care sustainable into the future is further integration across all systems.
In an ideal digital- and virtual-first future, Pepe envisions a practice where all referrals can be done digitally (and finally do-away with the muchbemoaned fax machine), and charts and records are online and integrated so multiple providers and the patient can access their medical history.
“It’s not as simple as just seeing your doctor virtually,” explained Pepe. “That’s one small, but important function of a much bigger picture.”