Virtual Visits: Hype or Hope?

Contributed by Dr. Anil Maheshwari

In this time of ongoing changes in our healthcare system, technology has emerged as one of the most promising ways to provide better care for our patients. One of the key areas of focus for the new Ontario Health Teams is digital health. The government clearly envisions technology tools such as virtual visits playing an important role in the province’s healthcare system.

You may be asking yourself, “What is a virtual visit?” My definition of a virtual visit is an interaction that occurs between a patient and healthcare provider without having to be in the same place at the same time.

In the Waterloo Wellington area, 67 clinicians have conducted over 10,000 virtual visits so far and the feedback has been overwhelmingly positive. Feedback indicates that 94% of patients thought that their virtual visit was the same or better than an in-person visit, and 94% of patients would recommend the solution to friends and family. In addition, 91% of providers indicated that the solution is easy to use, and 81% would recommend the solution to their colleagues.

We have rolled out three types of virtual visits at our 15-physician Family Health Team – secure messaging, phone calls and video visits.  We currently have over 2,800 patients signed up on our platform.

Our physicians have been predominantly using secure messaging, which provide a variety of benefits:

  • Patients and physicians are able to send and receive messages at their convenience;
  • Patients document their visit, which means less documentation to be done by the physician;
  • Everything that is documented is saved for the patient to come back and look at later, which leads to fewer communication mishaps;
  • Providers can send documents including handouts, prescriptions, laboratory and radiology requisitions;
  • Patients can send pictures of rashes, medicine bottles and other documents to their providers, who are able to save this information in the patients’ charts; and
  • The messaging takes less time than standard, telephone or video visits.

We are now looking to do more phone calls and video visits, which need to be scheduled. The biggest advantages to these are that the provider is able to hear and/or see the patient and is reimbursed at the same rate as an office visit for most standard visits. It can be more convenient for both the patient and the physician.

Virtual visits are clearly an important part of the future for the healthcare system. According to Kaiser Permanente CEO Bernard J. Tyson, out of 100 million patient-provider visits in 2016, 52% were done virtually. While Kaiser Permanente is a fully capitated model in the United States, virtual visits also work in our current system because the government understands the value of these types of visits and is reimbursing phone and video visits at the same rate as office visits. Physicians in a rostered model continue to shadow bill and fee-for-service physicians continue to receive the full fee-for-service rates. Messaging pays a slightly lower rate in both models but, as discussed above, has several advantages.

Overall, the most active virtual visit adopters in our group feel that using technology is a great way to provide care and avoid unnecessary face-to-face visits, saving both patients and clinicians a lot of time. We also understand that virtual visits will only improve with better integration into our electronic medical record.

Virtual visits should also allow us to prevent outside usage by patients. According to our data, high users of our platform were able to retain 8.5% more of their access bonuses while our control group’s access bonuses actually fell by an average of 5% during the same time period. A net difference of 13.5% provides some evidence that this technology does in fact prevent outside usage.

As we are better able to integrate these new types of visits into our office flow, we believe that many more physicians will see the benefits and embrace this technology.

Hear more insights from OntarioMD Peer Leader Dr. Maheshwari at his session, Virtual Care: Hype or Hope?, at OntarioMD’s EMR: Every Step Conference in Toronto. Register to join us on September 26. You can also get more information and support from OntarioMD anytime at support@ontariomd.com.

The Impact of AI Automation in Healthcare

Contributed by Dr. Sunny Vikrum Malhotra

The application of artificial intelligence (AI) in the medical field holds great potential for improving patient health. AI has already made an impact around the world, assisting in the process of diagnosing, treating and preventing many health problems. A major priority in the healthcare industry is finding new ways to improve efficiency and reduce costs, and automating manual tasks is one way to achieve this. Robotic process automation (RPA), for example, can streamline many office procedures by decreasing paperwork and shortening the time it takes to process files. This form of technology can reach even further heights by decreasing costs, increasing efficiency and enhancing patient care. 

As technology continues to expand, the number of ways that information can be exchanged is increasing. However, it’s important to recognize that no one solution can be the answer to all our challenges. A combination of approaches, including operational AI, can connect patient data from the Internet of Things/wearable devices and allow organizations to use it effectively. A multifaceted problem requires a multifaceted solution.

Ontario Health Teams (OHT) represent a new model of integrated care delivery that will allow patients, communities, providers and leaders to each play a role in a value-based health care system. OHTs will give healthcare providers the ability to work together in teams to deliver coordinated and standardized care for patients.

However, as the number of OHTs expands and the population continues to grow,  healthcare providers will see increasingly higher volumes of work and are seeking solutions for this workload. It is already becoming evident that providers are overwhelmed with patient care responsibilities, leading to clinician burnout.

However, in order to see successful and sustainable change in the healthcare sector, large-scale adoption of digital health programs will need to be part of the solution. These programs have the ability to decrease the time it takes to complete administrative tasks, thus reducing staff turnover and decreasing burnout. They can also effectively allocate staff to more meaningful frontline care, leading to a much more fulfilling and rewarding experience for workers, as well as increasing engagement and retention. The Ontario government recently introduced its Ontario Health Teams: Digital Health Playbook to help OHTs build a digital health plan that will help meet their clinical and practice objectives.

As the use of digital health applications continues to expand in the healthcare system and government encourages the use of this technology to improve patient care, we believe that government-led reimbursement policies will aid in increasing the use of digital health tools such as operational AI, telehealth and remote monitoring

Clinicians are at an important juncture in the digital health transformation. Hear more insights from Dr. Malhotra at his session, Using AI Automation to Improve Health Costs, Revenue and Outcomes, at OntarioMD’s EMR: Every Step Conference in Toronto. Register to join us on September 26. You can also get more information and support from OntarioMD anytime at support@ontariomd.com.

Part 2 of OntarioMD’s Virtual Panel on the Digital Health Transition

This is the second part of our OntarioMD virtual panel discussion, in which we ask the patient advocates and clinicians who spoke at our Ottawa EMR: Every Step Conference keynote panel in June for their insights on the question “What will a successful digital health transition look like to you?” If you missed Part 1 of our virtual panel, you can read it here.

Also, don’t miss your chance to join us at our Toronto EMR: Every Step Conference on September 26 for more great education and networking around how to build an effective patient-centred health care system driven by digital health technology.

Claire Dawe-McCord, Former Member, Minister’s Patient and Family Advisory Council

We have reached a tipping point in Ontario where if the digital health transition is not properly executed soon, we will be left stagnant in an ever-developing electronic world. As a Health Sciences student and a patient with many complex, life-threatening disorders, I believe digital health is crucial not only to the functioning of our health system, but also to the safety of patients. At age nine, I began experiencing what seemed to be vague, unconnected symptoms that landed me in the emergency department and specialist offices countless times. Every test came back inconclusive, until I became extremely ill in grade 11 and spent ten days in a medically induced coma and months as a hospital in-patient. During that time, I luckily received the diagnoses I had long awaited, Ehlers-Danlos Syndrome and a sodium channel malformation resulting in a rare neuromuscular disorder which often induces massive potassium abnormalities.

Rare diseases are difficult for patients and caregivers to navigate; In the years following my diagnoses I have had to repeatedly explain my disorders to health care providers, often in critical situations. This is where digital health can play an important role. For many people, digital health is about efficiency and cost cutting, but for patients like me, having quick digital access to my records can mean the difference between life and death.

For me, a successful digital health transition would involve a single sign-in system where all of my records dating back to when they were first digitized from all of my providers – including my primary care team both at home and at university – can be accessed in real time both by me and by any providers who may require the information. Ideally, this system would also incorporate ways for patients to make the “small things” easier: that means, being able to email my care team, book appointments online, and see where I stand on wait lists for specialist referrals.

Dr. Daniel Pepe, Family Physician, London Lambeth Family Medicine Clinic

Navigating a successful digital health transition is not an easy feat. The current digital landscape is a partially developed polaroid at best. I first was exposed to “digital healthcare” during my first night on call as a surgical resident. As a medical student, I had learned to be efficient by opening each chart to the correct page, filling out as much information as I could for my senior so that with a swipe of a pen we could move onto the next room. However, overnight, our hospital went “online” with electronic ordering and our workflow was immediately thrown into chaos.

As a family physician, I have learned that digital health transitions provide us with an opportunity to not just digitize our processes, but to, more importantly, evaluate and improve our underlying culture. Thus, I believe a successful digital health transition must be able to transform the underlying culture. Digital health solutions today provide us with a rudimentary quilt of various partially integrated solutions that allow us to do some, but not all, of the functionality we require to be effective digital healthcare providers. I would contend that the most effective digital solutions are those that enhance, rather that detract, from the patient-doctor relationship.

Most importantly, we must look to digital solutions to allow us to solve problems dynamically. A few days ago, I was reflecting on how the problems I see are sometimes due to medical illnesses, sometimes due to social determinants of health, and other times due to access to, or awareness of, community services. Imagine an e-referral network where we could simultaneously search for an endocrinologist, Meals on Wheels or assisted living. That to me is a holistic solution to upstream care that doesn’t involve huge investment, but just requires making the current solutions more readily available to providers.

One thing is clear to me – this transition will not happen successfully without the intentional inclusion and empowerment of patients, caregivers and families. Google would never design a new product without considering the user experience, and we, as healthcare providers and leaders, need to focus on the patient journey from diagnosis until end of life. We don’t need many tools, but they need to be employed in a thoughtful way. Technology has the ability to help us deliver the best care, at the right time, by the right provider, through the right means.

OntarioMD’s Virtual Panel Discusses the Digital Health Transition

If you attended OntarioMD’s Ottawa EMR: Every Step Conference this past June, you know about the amazing discussion and insights shared by our keynote panel on the challenges and opportunities of patient access to electronic medical information. We’ve invited our Ottawa panelists to continue the conversation over the coming weeks here on OntarioMD’s blog, to discuss the question “What will a successful digital health transition look like to you?”

Join us at our Toronto EMR: Every Step Conference on September 26  for more great education and networking around how to build an effective patient-centred health care system driven by digital health technology.

Julie Drury, Former Chair, Ontario Minister’s Patient and Family Advisory Council

In our current health care landscape, patients are their own care coordinators, information gatherers and information disseminators. That is a reality that is unlikely to change as patients become increasingly supported to be partners in their care, are encouraged toward self-care and self-management, and are engaged in shared decision making.

These are all good things.

However, we are no longer a ‘paper-based’ society, and there are high levels of inefficiency, poor communication and issues of patient safety in the absence of digital solutions. Patients must submit applications for requests to access their health information (and pay for it). They create binders of their own personal health information, and they are forced to use technology such as CD images to access and share information.

We are increasingly a digital society. We bank, pay bills, make appointments (other than medical), update our health cards, licenses and pet registration, all online. Digital health is slowly evolving through the application of EMRs in clinicians’ offices, EHRs in hospitals, and the establishment of patient portals. We are discussing electronic referrals and electronic consultations. Virtual care via secure email and video-medical technology is slowly emerging. However, this transition to electronic information is being hampered by outdated privacy legislation that limits information exchange, clinicians who do not want patients to have unfettered access to their information, and patient portals/EHRs that are not interoperable.

In some instances, solutions to these issues are on the horizon. But from the patient perspective, these solutions seem to be focused around organizational and provider needs, while the needs and expectations of patients is secondary.

For a digital health care system transition to be effective for all system participants, patients must be part of the conversation.

Selina Brudnicki, Program Lead, Digital Patient Experience, University Health Network

As Ontario Health Teams move toward a connected health care system centred on patients and their families and caregivers, a successful digital health transition must enable seamless flow of information for patients, authorized care providers and family/caregivers that make up their circle of care. Flow of information includes electronic access to data and analytics; virtual, real-time or asynchronous communication; and the ability to facilitate other types of interactions. This supports safe transitions and activates patients to gain the skills and confidence they need to participate in their own care. Patient activation leads to better health outcomes and care experiences.

One of the basic digital needs of patients is online access to their complete health record information, including test results, reports and clinic/doctor notes, so they can communicate effectively with their care team to make safe, timely and informed decisions. Transparency helps patients feel more engaged, and engaged patients are “more likely to adhere to treatment plans and medications, follow through on screening and prevention protocols, detect and prevent errors, and adopt more effective management strategies for chronic illnesses.” 

Unfortunately, barriers to patient access exist such as health professionals’ fear of increased workload, telephone calls and duration of appointments. Despite these concerns, that fear has been unfounded. There is a perception that patients and society may expect more of physicians and care teams in the future. EMR vendors could help reduce fears and potential burnout caused by excessive time, effort and frustration associated with electronic documentation. Observing and understanding the needs and challenges of providers, patients and family/caregivers could improve their EMR products and result in efficiencies and better experiences.

Seamless flow of information requires health data to flow privately and securely between information systems or applications when authorized to do so. Interoperability standards already exist and we must advocate that these services be readily available for the purpose of health information exchange, integration and retrieval of data. With recent advances in technology and innovation, it will be important for patients to gain visibility and transparency into all their health data, wherever it lives, and be able to control, authorize and monitor secondary use by third-party companies or organizations.

Ontario Health Teams (OHTs) hold the promise of organizing and delivering care that is more connected to patients in their local communities. Health systems and health data have lived in fragmented silos for far too long, and we must be careful that we do not create new types of silos. We must find better ways to collaborate, share knowledge and expertise across OHTs and disciplines, and think beyond ‘health care’ toward larger goals of ‘health.’ Bringing together patients, family/caregivers, care providers (including solo primary and community care practitioners), privacy/policymakers, government, technical and innovator subject matter experts would help leverage and scale investments and find sustainable solutions toward a connected health system.