By Dr. Brendan Carr

As healthcare leaders, we’re challenged every year to find tangible, sustainable approaches to healthcare that are patient-focused, cost effective and in keeping with evidence-based best practice. Despite its many proven benefits, I believe one of the most overlooked opportunities in healthcare today is virtual patient-clinician care.

It’s hard to pinpoint exactly why we have been so slow in Canada to embrace virtual care as a viable way to build capacity within an overwhelmed system. While the technology and expertise exist, particularly here in Ontario, there are few examples across the country where virtual patient-clinician services have moved beyond the pilot stage to successful implementation. Yet in a recent Ipsos survey commissioned by the Canadian Medical Association, seven in 10 respondents said they would take advantage of virtual physician visits, with many believing it would lead to more timely, more convenient and ultimately, better overall healthcare.

Digital technology has already transformed the way people bank, shop, and communicate. So why not the way people receive care?

At Osler, our own experience has convinced us that virtual care has a significant role to play in reducing the demand on emergency departments, building capacity in the system, and empowering patients to actively manage their own healthcare journey. It’s among the many reasons why virtual approaches to care are among the priorities outlined in our new 2019-24 Strategic Plan, Going Beyond for Healthier Communities.

Osler is no stranger to virtual care having partnered with the Ontario Telemedicine Network (OTN) on its highly successful Telehomecare program in 2012. More recently, our work has focused on introducing virtual patient-clinician care in our palliative care program at Brampton Civic Hospital. While our multi-faceted program includes an inpatient care unit, inpatient consultation services, an outpatient clinic and physician home visiting, like many others we face growing wait times for outpatient consults and follow-up outpatient visits, with demand often exceeding capacity.

Our palliative care team was eager to increase access to the program while also empowering patients to self-report symptoms as a way to prevent unnecessary visits to the hospital in between appointments. This led them to pilot two virtual care initiatives: conducting virtual home visits using a secure online app on the patient’s computer, tablet or mobile phone, and introducing a mobile health app that enables patients to remotely self-report symptoms to their palliative care physician and clinical team to allow for more timely interventions.

Partnering with OTN, the team initiated virtual home visits with a select group of patients who were impacted by current wait times, lived more than a 30-minute drive away from Osler’s Brampton Civic Hospital site, and were experiencing urgent pain or symptoms issues. By conducting home visits virtually, palliative care physicians were able to double their outreach from four to up to eight home visits in a single day.

Among our key learnings, we discovered that virtual patient-clinician care:

• Offers a platform for patient equity as it effectively removes barriers to accessing care like geographic location and financial issues (transportation, parking expenses);
• Helps lessen the burden on informal caregivers by minimizing the need for transportation to and from clinic appointments, and by reducing unnecessary visits to the emergency department;
• Provides for greater efficiencies through the timely digital submission of home care orders, consults and medication changes; and
• Facilitates out-of-town family involvement in family meetings about goals of care and care updates.

Patients and informal caregivers alike were surprised at how much care could be managed virtually without the need for an in-person physical exam. Patients also appeared to be more open and at ease discussing their pain and symptom issues from the comfort of their homes, leading to more informed decision-making about their care.

Osler also partnered with uCarenet and the Centre for Aging and Brain Health Innovation to design, develop and study a mobile browser-based e-health app (RELIEF) that empowers palliative care patients to self-report their pain, symptoms and distress to their clinical team on a daily basis from the comfort of their own homes.

The app provides nurses and physicians with real-time data of patient self-reported symptoms and alerts them when there is a change to a patient’s status, thus allowing for timely intervention and treatment when required. This helps reduce patient and family distress, prevent unnecessary hospitalizations and visits to the ED, and ensures that palliative care patients remain in their homes as independently and as safely as possible, for as long as possible.

While we’re only beginning to scratch the surface when it comes to leveraging virtual technologies, this two-pronged approach to virtual care has yielded promising results that hold exciting possibilities for hospitals, Health Links, and other sectors including long-term and hospice care. Let us not lose sight of these opportunities to empower patients and build the much-needed capacity we need to sustain our health system.

Dr. Brendan Carr is President and CEO, William Osler Health System.