Patients want greater access to digital health services. Yet, according to a recent Canadian Medical Association survey, only about 1% of Canadians report using virtual care or online patient portals.
Another 2019 survey by the Commonwealth Fund reveals that only 22% of Canadian primary care doctors offer patients the option to communicate via email or secure website to ask a medical question.
Reflecting on Canada’s position compared to other countries surveyed, Dr. Onil Bhattacharyya pointedly observed that we are “a tremendous outlier in this respect” at a recent Quality Rounds.
But there is good news. In 2018, Ontarians made nearly 900,000 virtual visits with health care professionals and interest in virtual health care is growing every day – for eVisits, online consultations, email, and more.
Over the coming months, we will be speaking with providers and patients alike to learn more about what successful adoption and implementation of virtual care looks like in Ontario.
We recently had a chance to speak to Dr. Ilana Halperin about her experience. Dr. Halperin, staff physician at Sunnybrook Health Sciences Centre and Quality Lead for the division of endocrinology at the University of Toronto, is an early adopter of virtual care solutions, like eConsult and video visits. In 2017, she joined the Ontario Telemedicine Network’s Home Video Visits pilot and has been using OTNconnect to have virtual visits with her patients ever since.
How frequently do you use virtual visits?
About 15% of my outpatient visits are virtual, but it could be more! I usually do about 10 virtual visits a week, each with a different patient, and I usually see about 60 patients a week.
What has been the response from your patients?
My patients love it. Connecting with them has been better, especially for those that require high frequency but low touch interactions. The beauty of home video visits means they can be anywhere: at home, at work, in their car, in their backyards! It’s an app they can use from their mobile or personal computer.
How have you integrated virtual visits into your practice?
I find it better to block off time for video visits. I try to reserve the first and last 4-6 appointments of the day for video visits. The reason I choose to do it this way has a lot to do with the physical layout of my clinic at Sunnybrook, which doubles as my office space. I don’t have a waiting room so patients can be just outside the door and might be able to hear what’s going on. Maximizing privacy and confidentiality is one reason I schedule my video visits at the beginning and end of the day. Another reason is to improve the flow of patients I’m seeing in-person. If a patient has to wait, I’d rather they wait online than in-person at my clinic. I’m usually on time in the morning but if I’m running behind later, my admin will let my afternoon video visit patients know.
We know that video visits may not be suitable for all patients. What kinds of considerations do you think about before offering to meet a patient virtually?
First, I think about whether a detailed physical exam is required. If so, a video visit is not the right kind of visit. I think about whether I need to deliver bad news and whether the technology is suitable for a potentially complex conversation. I also consider if asking patients to take time off work and pay for parking is really required. Generally, I reserve video visits for simple follow-ups, like discussing the results of laboratory tests and adjusting medications, and they are usually pretty quick.
This past summer you tweeted about doing a virtual clinic from the cottage and generated a lot of conversation about work-life balance. At a time when physician burnout is on the rise, how has video visits impacted you?
Yes! This past August I tweeted about doing a virtual clinic from the cottage. These were follow-up cases and a detailed physical exam was not required. The only reason I could do it is because I could access a fully functional EMR remotely. I use Accuro and sign in using VPN. I actually had two laptops open, one with the OTN app and the other with my EMR. I could send messages through the EMR to my admin assistant to email patients their next lab req and book follow-up. I can fax scripts directly from the EMR as well. The virtual clinic made it possible for me to have an extra long weekend, I beat the traffic out of the city and maximized my family time. Digital heath tools are allowing for more flexibility for patients and providers.
What advice do you have for other clinicians looking to implement virtual visits?
Consider how you will integrate virtual care into your clinical workflow, how you will find the time, and what you’re hoping to achieve. Maybe you’re in a busy outpatient clinic seeing 25-30 patients a day and you want to turn 10-20% of those into virtual visits. I’ve also found my tech savvy administrative assistant to be a big help, especially for managing a virtual patient waiting room. And now when booking she’ll ask “this patient has a question, should I book a video?”…which is great!
Interested in learning more? Hear more from Dr. Halperin and others at Ontario Health’s recent Quality Rounds, called The Promise of Virtual Care. View the recording here.