Deploying virtual care in the battle against COVID-19

Toronto’s Michael Garron Hospital (MGH) has swiftly deployed virtual care in its fight against COVID-19. There, a team overseen by Dr. Christopher Smith joined forces with Ontario Health (OTN) to launch a program that leverages a provincial remote monitoring solution to follow patients with COVID-19 at a distance.

“The goal is to ensure symptoms are stable or improving for those who do not require hospitalization or who have been discharged,” says Smith. “We want these patients to know that someone is keeping a close eye on them—something that can be immensely reassuring given how quickly this disease can potentially progress.”

The team developed protocols for intake, assessment, secondary assessment, and escalation—and trained staff across both MGH and South East Toronto Family Health Team (SETFHT). COVID-19-positive patients discharged from hospital or deemed to be at risk because of underlying conditions are enrolled in the program and monitored remotely, at home. They answer questions about their symptoms and condition twice a day through an app or over the phone. At the first sign of concern, a nurse follows up by phone with the patient for further assessment and advice by phone, and can escalate to a family physician or internist consultation. “We recognize that recovering from COVID-19 is a very stressful experience,” says Smith, “and we want to help our patients be as comfortable and confident in their recovery as possible.”


The Central East Local Health Integration Network (LHIN) and Lakeridge Health have launched a similar “virtual ward” for patients with probable or confirmed COVID-19 infection living in the Durham region, with support from RNs and Central East LHIN Home and Community Care Support Services. They can escalate to a virtual video or phone visit and then, if needed, connect patients with a Lakeridge doctor for further assessment. “This approach, while driven by the conditions around COVID-19, represents the type of patient-focused approach that will serve us well as we continue to transform our health care system with digital tools beyond our current crisis, ” says Renato Discenza, Transitional Regional Lead and CEO of Ontario Health East.

Virtual care growth

Virtual care has seen incredible growth during the pandemic. Ontario Health (OTN), which operates the provincial telemedicine network and is just one of several solution providers, has seen about a 25 per cent increase in total active accounts in the last month, from just over 41,000 to about 50,000. And direct-to-patient video visits have risen from about 1,000 per day in late February to about 10,000 a day since March.

“We’ve known for some time that virtual care can be a win-win for patients and care providers alike,” says Dr. Ed Brown, CEO, Ontario Health (OTN). “But with COVID-19, everything has shifted into high gear. People are working harder and faster than ever before to leverage existing technologies to continue to provide needed care while helping to slow the rate of infection and keep Ontario safer.”

Direct-to-patient video and audio visits enable primary and specialty care providers and patients to connect safely, at a distance, and relieve pressure on hospitals, walk-in clinics, and other care facilities. Virtual care solutions support providers to screen patients, assess symptoms and treatment options, and monitor progress, as well as communicate and information share with family members, caregivers, and colleagues.

 

Ontario Virtual Care Clinic

Virtual care is also supporting non-COVID-19 related care delivery. The new Ontario Virtual Care Clinic (OVCC) – seethedoctor.ca — was launched swiftly as a temporary resource for those who don’t have a family doctor or who are unable to access their doctor during the COVID-19 outbreak.

The OVCC is a partnership between the Ontario Medical Association, OntarioMD, and Ontario Health (OTN), with funding support from Canada Health Infoway, and technology provided by Novari Health. It is just one of many examples of how virtual care, with its ability to remove the face-to-face component of care delivery, has become an increasingly critical part of the strategy to “flatten the curve” and support safer care delivery across sectors during the pandemic.

The service is designed to take the primary care load off the health care system, particularly when it comes to ERs but also as a means of reducing face-to-face contact whenever possible. The OVCC connects patients 24/7, and at no charge, to an on-call doctor by video or audio for non-emergency care. All that’s needed is an OHIP number, and the access code provided on the landing page (“health”) and contact information. Once registered patients are placed in the virtual queue to meet with the next available doctor.

Brown expects even more virtual care innovations in the days ahead. Special funding has been allocated to virtual care expansion in the province—and several regional projects have already been approved. “The current level of interest in virtual care is unprecedented,” says Brown, who encourages interested physicians, Ontario Health Teams and hospitals to reach out to Ontario Health (OTN) for advice and support.

“If there is one silver lining in this terrible pandemic, it’s that it’s pushing health care delivery everywhere into the 21st century. With the commitment of government and the passion of health system partners across Ontario, I think the cycle of innovation is just beginning, with many opportunities for new ideas ahead.”