Whether it’s the World Health Organization (WHO) announcing it will use TikTok for communication; calls for doctors to join virtual medicine networks to share knowledge; or real-time digital maps to display up-to-date global spread – it’s clear that digital technology is influencing how we are responding to the COVID-19 pandemic at a system level.
Technology, specifically virtual care, has come to the forefront to help improve access to patient care during the pandemic.
Virtual health care is not new. Wearables, remote patient monitoring devices, and telemedicine are being used in many places to limit in-person visits to health care institutions and improve efficiency. But it has yet to take off widely in Canada.
“The truth is that we’re a bit behind the eight ball. Most of our care has been delivered in person for a really long time,” says Dr. Sacha Bhatia, the Chief Medical Innovation Officer at Women’s College Hospital (WCH) Research Institute in Toronto.
Many are seeing the current pandemic as a chance for Canada to finally get out from behind the eight ball when it comes to virtual care. Officials are concerned that hospitals won’t have the beds or equipment to care for thousands of patients if the COVID-19 virus sweeps across Canada the way it has across Italy or China. Many Canadian hospitals already operate at or above capacity. There is hope that virtual care can keep people out of an already stressed hospital system.
Health care workers themselves are also a limited resource, who are vulnerable in outbreaks. In the 2003 SARS outbreak in Toronto, health care workers made up 43 per cent of the 438 cases. In China, more than 3,300 healthcare workers have been infected with COVID-19. Virtual care could help protect critical front line workers from being infected.
Canada has a long way to go if we hope to leverage technology in the vast and coordinated fashion that China did to reduce COVID-19 transmission.
In addition to building 16 hospitals, they moved 50 percent of all medical care online within a few weeks. Not just coronavirus care, all care. Patients could see a specialist virtually, have medications prescribed, and then have it delivered to their home.
Virtual providers could direct patients to satellite ‘fever clinics’ that would measure vital signs and assess symptoms, travel history, sick contacts, and triage further testing. (They also got the turnaround time for the coronavirus swab testing down to four hours – something we’ve yet to achieve out west.)
According to Bhatia, models of care with technological integration are not standard practice in Canada and there are significant barriers to widespread use.
“Up until recently with this government, there has been little to no movement on actually putting virtual care into OHIP for a variety of reasons,” Bhatia says of Ontario specifically.
But there are signs that this is quickly changing.
Just last week, the Ontario government announced an agreement with the Ontario Medical Association to introduce funding to support physicians who deliver virtual care and open the market to more virtual care companies.
Governments have also been rushing to set up assessment centres where people can be quickly examined and potentially tested for the virus, in some cases by drive-thru. There is discussion about creating virtual components to these centres – like using a phone to interact with front line workers, receiving negative test results via text, and deploying digital home monitoring to those ordered to self-isolate.
North York General Hospital in Toronto has also created a website for people to look up their COVID-19 test results so they do not need to come back for a face-to-face appointment.
Alberta has already launched a digital tool for patients to avoid an assessment centre all together. It has already been widely used. Similar online tools are expected imminently in Ontario.
Virtual care can also help creatively distribute the increased workload by leveraging all possible support. The virus will likely impact different communities to different degrees. Virtual care can help bring health professional expertise into areas that may have been heavily impacted by the disease. Healthcare workers who find themselves quarantined due to mild illness, travel or exposure can opt to work virtually from their home.
In parts of Canada, paramedics or public-health nurses are already providing in-home and virtual care so they don’t have to visit hospitals or clinics. This is happening in Renfrew County, near Ottawa, according to Mathieu Grenier, the Deputy Chief of Clinical and Professional Development for the County of Renfrew’s Paramedic Services.
In partnership with public health, Renfrew County’s paramedic services arrange to do in-home test swabs and follow-up appropriate treatment plans for potentially infected patients.
They leave cellular enabled medical equipment to remotely monitor their blood pressure and oxygen levels, and leave thermometers so patients can take their own temperature. Devices provided to patients link directly to the community paramedic program for monitoring and can be shared with the hospital or physicians.
“They can also video conference with public health staff or primary care physicians if anything changes with their condition. It’s already proven to be effective and we are quickly trying to accomplish more of it in the context of COVID-19,” Grenier says.
Renfrew has been implementing similar services prior to COVID-19 for patients with conditions like COPD or diabetes, which Grenier says has been highly successful in remotely managing complex chronic disease and reducing the need for conventional face-to-face health system use.
If access to this type of program was more broadly available in Canada, it would allow older patients or those with comorbidities to opt for a virtual visit rather than coming in for a routine check-up.
Grenier says these programs that leverage technology should be quickly scaled to address the current and impending barriers to care that COVID-19 has unmasked. If they can help people effectively self-care at home, it can save our most precious 911 and hospital resources for those who need them most.
The technology needed to combat the spread of coronavirus exists and is actively being used in many places. As Bhatia says, “none of this is Star Trek or science-fiction.”
People have chaffed at Canada’s slow adoption of virtual healthcare for many years. Now, in the midst of this pandemic, there is virtually no other choice but to quickly and broadly modernize patient care delivery.
Fortunately there are signs that is already starting to happen.