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The last four months have seen the rapid rise of the use of virtual care tools in practice.  This has been a remarkable change. Doctors went from about 7% use of virtual care to 89% of primary care physicians using a virtual care tool, and 80% of all visits happening virtually. Due to the rapid spread of the coronavirus pandemic, doctors and nurses went straight into problem-solving mode (which I am very proud of, I must say!) and changed the way we provide care almost overnight. Having said that, there are major gaps in care that we must get to very soon or the downstream effect will be a challenge.  Virtual care is here to stay. The horse is out of the barn and cannot really be corralled again, but some order needs to be applied to the current disarray.  Where do we need to direct our attention next? 

1) Provision of virtual care in some of our most challenging care environments:  long-term care and congregate housing like group homes for disabled adults, shelters, hospices, jails, etc., are perfect examples.  Some of these places have started to apply virtual care.  Many have not.  There needs to be a consistent approach to making sure location and living conditions are taken into account and prioritized. 

2) Many medical problems require examination and the laying of hands to diagnose or treat.  Paramount at this point in time is cancer screening, preventative health visits, palliative care, lung disease, neurological disorders.  How will we do better with virtual to get these programs up and running again?  We will have ago to rethink our processes.  Physical exams are still possible virtually, but they take on an entirely different form.  This will require retraining and knowledge transfer. 

3) We must focus on areas where inequity of care prevailed before COVID-19; remote communities with poor internet access, indigenous communities, homeless communities, refugees and recent immigrants are all at a disadvantage when it comes to high tech solutions like video visits.  The reasons are obvious.  They must be faced head on and planned for.  The approaches needed here will be different. 

4) Some high-risk areas are left behind: seniors care, the mental health system, and home care come to mind.  We must pay attention to these as they are ripe for care redesign and virtual care may actually be very impactful. 

5) Integration of products into the point of care is important. This largely does not happen now.  For this, we require APIs from EMRs and hospital information systems, rules allowing open data flow and a reduction of the competitive nature of the virtual care and data business.  We need a more unified approach focused on creative co-design and outcomes. 

6) Standards for virtual care tools are important now, and certification to these standards must follow to ensure safety. “Caveat emptor” thinking applied at the start of the pandemic crisis, but we are past that now. Security and privacy can and must be guaranteed.   

7) Attention to the blending of virtual and in-person care is needed.  We can never be permanently ”all virtual” or even “80% virtual”.  In a recent CMA survey, 60% of patients stated that they still want an in-person visit as the first option for their new problem  This is because we are human, and trust between humans evolves by looking into each other’s eyes, interpreting body language, and even holding a hand in tough times. This is important as the physician-patient relationship is special, and trust matters. 

OntarioMD is helping to lead the pace of change for clinicians in adopting virtual care.  We want to be there for you.  You are living the change and crafting your practice for excellence in real time.  We need your ideas about where your energy in making your technology life better is best spent.  I encourage you to bring them to us.  We are developing a plan for the future that responds to your practice needs.  Help us design it.  Reach out to me with ideas at darren.larsen@OntarioMD.com.