Question: Last week, I phoned my doctor’s office to book an appointment. I was told I could do an online video chat with her. Apparently, my “virtual” appointment was meant to help slow down the spread of COVID-19. It was very convenient – and, best of all, I didn’t have to pay for parking. Will I be able to keep seeing my doctor this way after the coronavirus pandemic is over?
Answer: That is certainly the hope of many advocates of virtual care, also known as telemedicine, which can include video conferencing, emails, text messages and old-fashioned phone calls. In the past, many barriers stood in the way of the wider adoption of virtual care. There were concerns about patient privacy and debates over how much to compensate doctors for their time.
But the sudden need for people to keep physically apart has led many provinces to adopt measures that make it easier for doctors to provide certain forms of care without seeing patients face-to-face. Ontario, for instance, has introduced new billing codes, including one that pays doctors for talking to patients on the phone or by video.
Almost overnight, virtual care has become the norm. And that is certainly true when it comes to non-hospitalized patients with COVID-19.
“Anyone who tests positive for COVID-19 at our institution, and has been discharged home to self isolation, is followed-up through a secure online platform or by telephone,” says Dr. Nisha Andany, an infectious-diseases specialist at Sunnybrook Health Sciences Centre in Toronto.
Dr. Andany is part of a team of health care providers who run a clinic for patients with various infectious diseases, ranging from tuberculosis to HIV. Most of the patients have traditionally come to Sunnybrook for their appointments.
But a few of them – such as those who live a long way from the hospital – had the option of doing virtual visits through a program developed by the Ontario Telemedicine Network (OTN), which recently became part of the new provincial agency Ontario Health.
Founded in 2006, OTN is best known for creating a two-way video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their own communities. The patient simply goes to a telemedicine studio – usually in a nearby hospital or medical clinic – and connects with a doctor who may be hundreds of kilometres away.
However, in recent years, OTN has been expanding its virtual care operations in ways that now permit patients to connect to health care providers using their own mobile devices or personal computers. That means a patient doesn’t have to leave home to see a doctor. What’s more, it’s not just meant for patients in remote areas.
So, when the pandemic struck, Dr. Andany and her colleagues were able to shift most of their infectious disease patients – including those with COVID-19 – to OTN’s online video-conferencing platform. Their other patients are being phoned for follow-up care.
In the case of the COVID-19 patients, “we check in on them a few time a week to see how they are doing,” says Dr. Andany. “We know that some of these people will develop severe infection and we want to catch that as early as possible so we can get them into hospital for treatment.”
Of course, virtual care has its limitations. A doctor can‘t physically examine the patient.
As a result, Dr. Andany and her colleagues had to “get a bit creative” to come up with a way to obtain objective measurements of certain patients who seemed to be running into problems, including experiencing shortness of breath.
In the end, they decided to send the patients compact portable devices that measure the level of oxygen in the blood. “One of our team members drove to the patients’ homes and dropped off the monitors in the mailbox or outside,” she says, thereby maintaining appropriate physical distancing.
The monitors are easy to use. “They are very small and basically slide on the end of a finger,” says Dr. Andany. The additional data from the oxygen saturation monitors helps to identify the patients who need immediate treatment and provides reassurance to others.
After the pandemic, Dr. Andany expects that virtual care will become far more common in many areas of medicine. “Once you become comfortable with something, it’s easy to keep doing it,” she says.
Even so, health care providers and patients need to figure out where it works best.
“Because of COVID-19, we had to switch to virtual care very, very quickly,” says Dr. Simron Singh, a medical oncologist at Sunnybrook. “We don’t yet understand its impact on specialized areas of care such as cancer where care had to continue on in the pandemic.”
Dr. Singh has received funding from the Canadian Institutes of Health Research to study the experiences of cancer patients. The study will include focus groups – conducted at a safe physical distance online – and telephone interviews with individual patients. As well, the study will take a deep dive into Ontario Ministry of Health databases – a wealth of information that will enable researchers to link the type of care a patient has received to actual health outcomes. “Does virtual care lead to more emergency department visits or unplanned hospitalizations? We will find out by looking at the data.”
Dr. Singh, who is also head of the patient-centred care portfolio at Cancer Care Ontario, thinks the study will show that virtual care is best suited to certain situations and not others. “There are probably some people who are just not comfortable with it – their emotional needs won’t be met through a virtual visit.” Overall, the greater use of virtual visits should make cancer care much more patient centred, he says.
Indeed, virtual visits are time saving and convenient for many people. They don’t have to take time off work or arrange for childcare to see a doctor. No time is spent travelling to a medical clinic or sitting in a waiting room. And there are no parking fees. But how exactly will the new world of virtual medicine unfold after the pandemic?
Some of the measures introduced by the provinces to make virtual care immediately possible are actually temporary. Will the Ontario Ministry of Health and Long-term Care roll back the new fee codes – including one for telephone calls and video with patients?
“The ministry will continue to monitor the situation and, at a later date, decide on the appropriate course of action regarding these fee codes,” a media-relations spokesperson said in an email.
Privacy concerns must also be addressed. Across Canada, doctors are currently using a wide range of different online platforms to communicate with patients. Some of the platforms might not be secure and fail to provide adequate protection of personal-health information.
Furthermore, some experts worry that the growth of for-profit virtual care companies – some offering virtual walk-in clinics – could undermine the public health system and lead to inconsistent medical care for patients.
Dr. Ed Brown, Chief Executive Officer of OTN at Ontario Health, says the creation of a set of standards could help doctors select the appropriate technology for connecting with their patients in a secure fashion.
Despite these uncertainties and challenges, Dr. Brown is convinced the pandemic represents a major turning point for the health care system. “With all these folks using virtual care, it will be hard to go backwards.”
He notes that certain types of visits will remain in person – especially when a doctor needs to physically examine a patient or perform a medical procedure. But there are many follow-up appointments and exchanges of information that don’t require the patient to come into an office.
“In the future, there is going to be more virtual care than in-person care,” Dr. Brown predicts. “Virtual care has now become mainstream and we always knew this would happen. But, sadly, it was the pandemic that really made it so.”