Accessible, responsive and equitable healthcare for the digital age
Walking around the waiting rooms at Women’s College Hospital (WCH) these past few months, you would be hard pressed not to wonder where the patients were. The number of people checking in or waiting for their appointment was a far cry from the typically busy clinic areas. It wasn’t a scheduling mistake and the hospital hadn’t drastically reduced its patient volume – the vast majority of appointments had been converted to virtual visits.
“COVID-19 forced all healthcare institutions to rethink how they provide care practically overnight. In a matter of weeks, we were able to shift our model of care to one that was virtual first. Leveraging our virtual infrastructure, developed as a part of our Women’s Virtual program, allowed us to act decisively and quickly,” said Dr. Danielle Martin, executive vice president and chief medical executive, WCH.
Launched at the end of 2019, Women’s Virtual – Canada’s first virtual hospital – is utilizing digital health tools and virtual models of care to re-envision the healthcare experience, making it more accessible, responsive and equitable.
“Healthcare will always be a human enterprise and we will always offer in-person care. But under Women’s Virtual, if we are asking a patient to come into the hospital, it is because face-to-face care is the best way of dealing with their specific health issue. It’s not because we have no other model of care to offer them,” Dr. Martin added.
Virtual Visits
Video visits integrated into WCH’s electronic medical record were first piloted in the mental health program, with practitioners completing roughly 20 visits a month. By May alone, providers across all hospital departments completed more than 1,200 video visits.
Group video visits were launched shortly after. In fact, WCH is the first hospital globally to implement group virtual visits into its electronic patient record, Epic.
“Our team in mental health prioritized those patients most at risk with the highest need for group therapy,” said Dr. Lori Wasserman, WCH psychiatrist. “While we have had to modify some of our groups to better suit virtual, patients have appreciated the opportunity to connect with people who relate to what they are going through.”
Dhara Desai, manager of clinical applications for IM/IT at WCH.
“Each digital tool selected as part of the Women’s Virtual initiative was done with an eye to sustainability and broad usability, ensuring that it would be beneficial across multiple areas,” added Dhara Desai, manager of clinical applications for Information Management and Technology (IM/IT). “As a result, IM/IT has been able to partner with Women’s Virtual and roll-out both video visits and group visits in record time.”
While this rapid acceleration of virtual visits provided care for existing patients, COVID-19 precipitated the need for new virtual care programs directly addressing the needs of those patients most impacted by the pandemic.
COVIDCare@Home
“With most symptomatic yet stable COVID-19 patients self-isolating at home, we knew we needed to develop a program that would offer them real-time virtual care,” explained Dr. Payal Agarwal, a WCH family physician and the medical director of COVIDCare@Home. “Working with our existing partners, we created COVIDCare@Home, a program providing support to both primary care providers treating such patients, as well as direct support to those with COVID-19 through virtual visits and remote monitoring.”
L-R: Dhara Desai and Dr. Payal Agarwal
COVIDCare@Home applies a team-based approach rooted in family medicine, which includes mental health and social work supports, as well as access to WCH’s Acute Ambulatory Care Unit (AACU) should a patient have more complex needs requiring in-person care.
“We serve a diverse patient population, with many patients from communities who traditionally face barriers accessing care. Many are dealing with financial pressure, language barriers or are living in cramped housing. We know that when we treat the full patient, including their medical needs, social needs and mental health needs, they do better. We are also better positioned to escalate their care should their health deteriorate,” Dr. Agarwal highlighted.
Patient outcomes and response to COVIDCare@Home has been overwhelmingly positive, with one patient saying it “made me feel more reassured and I knew that I was never alone. Even though I was self-isolating, I wasn’t alone in this.”
LTC+
As many of us now know, older adults living in long-term care (LTC) have been disproportionately impacted by the pandemic. In fact, LTC residents account for roughly 81 per cent of all COVID-19 deaths in Canada. Given the glaring need to provide enhanced supports to LTC, WCH fast-tracked its LTC+ program.
Developed in partnership with LTC homes, acute care hospitals and community service organizations, LTC+ provides physicians and nursing staff in LTC with one number to call. They can either connect virtually with a specialist 24/7 who will help them troubleshoot a patient problem or an advanced practice nurse who will assist them in assessing the patient’s needs, provide advice and refer them to outside services.
“The care requirements for older adults living in LTC residences are often very complex. It only makes sense to provide additional care supports to enhance quality of care. By enhancing the care that LTC providers are able to deliver onsite and avoiding a transfer to the emergency department, we are helping to reduce their risk of exposure to COVID-19 and simultaneously reducing the volume of patients in our acute care hospitals,” explained Laura Pus, administrative director for Women’s Virtual.
L-R: Dr. Danielle Martin and Laura Pus meet to discuss the LTC+ program
“LTC+ is the first step in our Aging in Place program. Over time, we plan to expand our offering so that more older adults can receive the care they need either in the community or at home, where they want to be,” Pus noted.
The digital revolution is underway in healthcare and there is already a significant uptake of digital solutions. “At WCH, we developed a program like Women’s Virtual because we are committed to ensuring that the digital revolution happens in a way that is consistent with our vision of creating a healthier and more equitable world. The virtual care that we are offering aims to improve health and close the gaps in care many patients experience,” Dr. Martin said.
A Virtual Option
Providing safe, timely and compassionate ‘no touch’ virtual abortion care
With COVID-19 cases rapidly rising in Ontario, hospitals began ramping down services to preserve capacity for acutely ill patients; but for many, their procedures couldn’t wait. The team at Women’s College Hospital’s Bay Centre knew that delaying appointments was not an option for many of their patients.
The Bay Centre specializes in contraceptive services, reproductive and sexual healthcare, and is home to one of the most comprehensive abortion programs in Ontario. Under normal circumstances, patients from across Ontario travel to the clinic to access these services – but when the pandemic began, suddenly many found themselves unable to come into the hospital.Patients who were immunocompromised, in self-isolation or who lived in rural areas had limited access to in-person abortion care at the clinic. “We had to quickly rethink how we deliver this essential healthcare service,” explained Dr. Sarah Warden, medical lead of the Bay Centre’s medical abortion program.
Mifegymiso, which can be taken up to ten weeks into pregnancy, is a safe, non-surgical abortion option that consists of two medications that can be self-administered in the privacy of one’s home. Before the COVID-19 pandemic, the Bay Centre team had been collaborating with Women’s Virtual, the hospital’s virtual care team, to develop a ‘no touch’ abortion program to deliver safe and timely access to Mifegymiso.
“We realized that there was an opportunity to expedite the launch of our virtual medical abortion program that was already being developed,” explained Dr. Warden. By June, Ontario’s first ‘no touch’ abortion program was launched at WCH.
As a first step, patients interested in this virtual option consult with Sarah McCarthy, a registered nurse and team lead at the Bay Centre, to discuss their options, determine their eligibility for the program and review the process.
Following the initial evaluation, a video visit is set up with a physician to review patient records, consent forms, medication instructions and expected symptoms. Afterward, a Mifegymiso prescription is faxed to the patient’s nearest pharmacy, where the patient picks it up and takes it home to terminate their pregnancy. Throughout the entire process, patients are always connected to their care team either by phone or video visit.
Both Warden and McCarthy agree that the ‘no touch’ virtual abortion will continue to provide increased access to safe and effective abortion care that will benefit patients even after the pandemic.
For McCarthy, the feedback from this initiative has been extremely gratifying. “People are grateful that they have access to this option. Being able to have the flexibility to do this from home or in an environment outside the hospital setting has been a big relief for many patients.”
With an endless array of new apps and devices promising to revolutionize patient care and advance the way our health system operates, Ontario isn’t lacking in digital health innovation. However, there remains an opportunity for healthcare organizations to leverage the latest digital tools and ensure they meet the needs of their users.
Often the latest digital tools aren’t leveraged by healthcare organizations and, when they are, they haven’t been evaluated to ensure that they will deliver as needed. But that’s changing.
In 2018, Women’s College Hospital’s Institute for Health System Solutions and Virtual Care (WIHV) was selected by the Ministry of Health to run the Centre for Digital Health Evaluation (CDHE), a single access point for all digital health evaluation needs in Ontario. Made up of a consortium of partners, the CDHE is a one-stop-shop for digital health solutions seeking evaluation.
“The CDHE looks at any digital health tool that has the potential to influence the way care is delivered or how information is exchanged. Our team works to provide timely, rigorous and clinically relevant assessments,” explained Laura Desveaux, the CDHE’s scientific lead. “The CDHE provides a trusted mechanism to systematically navigate the market of digital solutions and generate insights the system needs to make informed decisions.”
The Centre also consults with health system stakeholders, agencies and the Ministry on procurement, adoption and implementation of new digital health solutions along with policy and investment decisions.
Since the COVID-19 pandemic, there has been a surge in virtual care implementation. This has raised questions around the current state of digital healthcare and its impacts. “The pandemic has provided an opportunity to reimagine what healthcare can look like through the accelerated adoption of digital solutions,” said Ena Ujic, manager at the CDHE. “We’ve continued to work with our CDHE partners and with health system stakeholders to help answer questions, such as what have we learned from this accelerated adoption, and where do we go from here?”
As the demand for virtual care grows, so too will the need for evaluation and consultation. The CDHE will be crucial in advancing the care experience, addressing long-standing system issues, and bringing our healthcare into the 21st century.
