BRITISH COLUMBIA – The COVID-19 pandemic has spurred a healthcare revolution in Canada, forcing a massive shift away from in-person interactions towards virtual care, according to a new report from the C.D. Howe Institute.
In “Canada’s Virtual Care Revolution: A Framework for Success” R. Sacha Bhatia, Trevor Jamieson, James Shaw, Carole Piovesan, Leah T. Kelley and William Falk argue that the pandemic presents the opportunity to embrace a more patient-centric and cost-effective healthcare system. The authors set out a viable roadmap for the delivery of virtual care that is both equitable and geared towards enhancing the health of populations.
“We already know virtual care can succeed because it has been critical throughout the pandemic. During June 2020 virtual care represented over 70 percent of ambulatory care across the country. That is a massive increase from just five months before,” said Dr. Bhatia, Chief Medical Innovation Officer at Women’s College Hospital.
For patients, face-to-face appointments with healthcare providers have traditionally come with certain costs, such as lost income from time off work, childcare and transportation costs. COVID-19 has magnified the costs of physical visits for healthcare providers as well, because of the risk of viral transmission to health workers and fellow patients, the scarcity of personal protective equipment, and increased cleaning costs. Globally, health systems must redesign care to minimize these costs, while conserving face-to-face capacity for patients who need to be seen in person.
The authors propose that care redesign starts with asking three simple questions:
- Is this medical service necessary? Medically unnecessary care not only increases health costs, but raises infection risk to providers, and patients, particularly those from vulnerable groups. In a high-risk COVID environment, some care should necessarily be deferred, perhaps indefinitely, because the risks outweigh any possible benefits.
- Can this medical service be delivered well without physical contact? There are many health services that do not require face-to-face examinations. For example, stable cardiac patients can be safely monitored virtually with vital signs being measured by the patient or existing care providers, opening up space for sicker patients to receive in-person care.
- What site of service is best for physical contact? Virtualizing care where possible can provide needed care while minimizing the costs of physical contact. This can be done in many ways, including phone, video or email.
Applied broadly across the health system, this care redesign would lead to a massive shift away from physical interactions, towards an almost equal ratio of physical to virtual interactions. This would greatly reduce infection risk, but also has the potential to reduce healthcare costs, increase patient convenience and create health system capacity.
“Our team works at several hospitals in Toronto where every specialty group is seeking to reduce unneeded visits, move care to virtual and preserve the scarce face-to-face visit capacity for those patients whose clinical situation demands it. Keeping physical visits to a minimum or relocating them away from the hospital allows the health system to increase overall volumes,” explained Bhatia. “It is not simply a question of replacing physical visits with virtual visits. Multifaceted care plans are being developed that combine various delivery mechanisms to maintain care while minimizing risk.”