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By Ms. Catherine Wang
On March 12, 2020, the day after the World Health Organization declared COVID-19 a pandemic, I sent the following email to UHN President & CEO, Dr. Kevin Smith:
Hi – With things escalating on COVID-19, I was wondering if there's work underway to be able to accelerate the use of virtual care tools?
If not, I can help lead this effort. I don't have a good sense of the tools that are out there and what we could leverage relatively quickly to help support our patients/clinicians, but I can certainly prioritize and put effort into helping provide coordination for UHN.
I remember the morning I sent it. I woke up with an intense feeling of dread and paralysis. Wave one was gaining voracity. I wanted to help, but didn't know how. I watched my colleagues in full crisis management mode, feverishly working to establish Infection Prevention and Control protocols and secure precious personal protective equipment.
It dawned on me that morning, as we were cancelling patient appointments to manage the density of people at our sites, that we needed to find a solution – and fast – to continue care virtually. Without virtual care, delaying patients' diagnoses and treatments would mean plunging our system into further crisis, creating unintended harm to patient care now "on hold" as the pandemic raged on.
'This is not a novel concept. We have tried as a system to make it a mainstream method of delivering care for more than a decade. But, until COVID-19, it's never taken off.'
So, I raised my hand.
I raised my hand without knowing it would be so complicated, or become such a breakthrough, one of the silver linings for our healthcare system in this pandemic. There are dozens of pioneers of virtual care from the past decade better suited to lead UHN's efforts, which shows how naïve I was. But my naiveté was both a blessing and a curse. A year on, I'm still not sure I would have sent that email if I knew the journey ahead.
Virtual care allows healthcare providers to interact remotely with patients. In addition to treating people via telemedicine, providers may use live video, telephone, and instant messaging to communicate with them. This is not a novel concept. We have tried as a system to make it a mainstream method of delivering care for more than a decade. But, until COVID-19, it's never taken off. There are a number of reasons for that, which now look like excuses. Technology barriers; the perception patient care is higher quality when clinicians can touch, feel and interact with patients; preference of patients themselves; the inability of providers to bill for virtual care, are just a few of the reasons cited for the lack of progress.
With the onset of COVID-19, those excuses vanished. In the span of four weeks last spring, we went from 260 virtual care visits per week, to 6000, proving where there's a will, there's a way. Over the last few months, the average number of virtual visits has grown to 8000 per week.
Of course, the reality is it takes more than just sheer will. In the first month of the pandemic, it became apparent UHN – thanks to innovators who introduced a few specialized solutions to enable virtual care – was able to transition quickly and seamlessly for
some groups including heart failure patients, those at Princess Margaret Cancer Centre and ones using the Connected COVID Care Virtual Clinic. What also became clear was we were without an organizational-wide solution to deliver the same virtual options for
all our programs and more than over 270,000 outpatients per year. The first order of business in achieving that goal was rapidly registering UHN's clinicians and on-boarding them to the Ontario Telehealth Network (OTN), the publically-funded, provincial platform for virtual care. Within seven weeks, the number of clinicians registered to the OTN platform doubled from 650 to 1300.
UHN News is presenting a series of essays on the effects of a year of COVID-19 and its legacy for UHN's vision of A Healthier World.
That felt like a job well done. But we soon realized it was only the first step in what will be a much longer journey to making virtual care a permanent, mainstream aspect of Ontario's healthcare network long after the crisis of COVID-19 has passed. That's something patients, who have told us they enjoy the convenience, responsiveness and personal savings in time and money associated with virtual care, will demand. Ongoing engagement from UHN Patient Partners will ensure patient voices continue to be heard as we move forward. Clinicians are pleased with the high quality of care they have been able to deliver virtually and see it as a standard option to offer appropriate patients post-COVID. The success of the Emergency Department (ED) Virtual Care, a six-month pilot project launched in December across UHN, Sunnybrook Health Sciences Centre and St. Michael's Hospital – Unity Health Toronto, underscores that even in what is seen as one of the most in-person forms of patient care, a virtual future will unfold.
'This is not a novel concept. Our collective will is required to sustain the gains we have made in virtual care and further transform the system into one that delivers even better care to patients.'
This first step was more than 10 years in the making. COVID-19 is accelerating our pace on virtual care in a quantum way, where the advancements over the next 10 years will look unrecognizable to us when we look back. At least, that's my hope. But it will not just happen. We'll need to work at it, just as we have over the past year. Since that first sprint to enable UHN clinicians and patients to have basic tools to connect in a secure and private way, virtual care has shown it needs so much more to truly thrive.
Among the needs: a change in culture of "web-side manner" to create a community for patients to feel more connected to clinicians, rather than pushed away by technology. There's also a requirement for that technology to be more integrated to account for complex clinical workflows and allow the full interdisciplinary team to efficiently deliver care to patients. Technical support and clinical guidelines are needed to better support staff and patients through this brave new world, and device access and digital literacy is required for all to remove barriers and allow for equitable access to care.
UHN has moved mountains since the day I sent that email to Kevin on March 12, 2020. Read more about virtual care at UHN. It has been inspiring to watch dedicated leaders stand up solutions in weeks, not years. Our EDs, the UHN Centre for Mental Health, the Brain Rehabilitation Program & Mobility Innovations Centre, the Schroeder Arthritis and physiotherapy across multiple programs are but a few examples. We still have a long way to go. The pandemic has forced us to change the way we deliver care. But our collective will is required to sustain the gains we have made in virtual care and further transform the system into one that delivers even better care to patients. That's a mission worth raising my hand for – and one I will be privileged to pursue with all virtual care leaders across UHN well beyond the pandemic.
Ms. Catherine Wang is Clinical Vice President, UHN, and Assistant Professor, University of Toronto
Previous essays in the Pandemic Perspectives series: