Robert Bertelink
Robert Bertelink, Clinical Coordinator for the Cardiovascular Prevention and Rehabilitation Program at UHN, and his colleagues have been conducting virtual care visits with cardiac rehab patients. (Photo: UHN)

The number of UHN patients seeing their care team via virtual visits has increased dramatically over the past two weeks – a fact born of the reality of the COVID-19 pandemic and the efforts of the newly-minted Virtual Care Team working with their provincial counterparts to make it happen.

For nearly 20 years at UHN, virtual care – telephone, video conferencing and digital platforms – has played an important part in ensuring patients who are unable to travel can still get the care they need. But since geographic distancing has become the norm in the pandemic, it's playing a critical role in providing continuity of care and keeping patients out of the hospital.

"Through virtual care, our patients have access to specialist appointments that would have otherwise been put on hold during the pandemic," says Jeff Baine, Manager of UHN's Telehealth Program, part of UHN Digital. "If they were still coming in for non-urgent appointments, they would be putting themselves at an additional risk of exposure to COVID-19."

Prior to COVID-19, UHN's Telehealth program was used by about 775 healthcare providers, including physicians, allied health, nurse practitioners and administrative professionals. This past week, Jeff and his team have onboarded more than 550 new clinical users with a wide range of specialties and patient types – and more requests are coming in every day.

UHN Telehealth now has users across all 10 programs at each hospital site. On Thursday, UHN conducted 1350 virtual visits, up from 50 two weeks ago. More than 800 additional patients are scheduled for virtual care appointments on Friday.

To handle the increased demand, UHN Digital has established a Virtual Care Team, which is comprised of UHN Telehealth and redeployed staff from Diagnostic Partnerships and UHN Digital. The team has worked with the Ontario Telemedicine Network and Ontario Health to establish a process of bulk-uploading users, as well as rolling out key educational contacts for each program to answer questions about Telehealth.

"Quite understandably, clinicians have felt heightened anxiety about tracking and monitoring patients," says Jeff, who is co-leading the implementation with Jennifer Catton, Senior Manager of Strategy and Quality with Diagnostic Partnerships.

"Telehealth gives them a solution to continue seeing their patients safely." Read more about UHN Virtual Care.

In addition to bulk-uploads and educational contacts, the team has also released patient education materials, scripts for administrative professionals to schedule Telehealth appointments and designed a unified patient consent process alongside UHN Privacy.

Jeff Baine
Jeff Baine, Manager of UHN’s Telehealth Program, has been implementing the virtual care scale-up with the new Virtual Care Team, which he co-leads along with Jennifer Catton, Senior Manager of Strategy and Quality with Diagnostic Partnerships. (Photo: Courtesy Jeff Baine)

"It's not just about the numbers; we very much are keeping focus on quality of care, access, appropriateness, care-provider communication and privacy and security," says Dr. Peter Rossos, Chief Medical Information Officer and co-sponsor of the Virtual Care Team with Catherine Wang, Vice President of Clinical Ops & Diagnostic Partnerships.

UHN's Telehealth Program began in 2002 and has always focused on providing care to patients facing barriers such as geography and mobility. Since its inception, the program has evolved from just physician and patient appointments to virtual team-based care. And, now, responding to COVID-19.

"There have been countless people across the organization who have helped us get to the point where we are now," Dr. Rossos says. "And, more importantly helping us get to the point where we want to be over the next days and weeks to address this situation.

"This is most definitely a TeamUHN success story."

One of the multiple programs to transition patients to virtual care is UHN's Cardiovascular Prevention and Rehabilitation Program*. In a matter of weeks, the program has gone from in-person rehab to 1,000 participants being managed remotely, using phone, email, and web resources.

"Feedback from our clinical team is that most people understand we have closed for in-person rehab, but when they find out that we will still call them once a week, they are very appreciative," says Crystal Aultman, Project Manager for Cardiac Rehab. "It feels good that we can still be supporting them."

As patient education is considered a core component of cardiac rehab, earlier this week, the program launched a daily online education program through Cardiac College. It covers stress and mental health during COVID-19; hot topics related to heart health; nutrition and exercise at home; and will include a calendar of events.

"Amidst the current health crisis, we're striving to keep people socially connected while physically distanced," says Crystal. "Checking in with patients each week – through both the virtual clinical care and education – helps us achieve that feeling of connectedness."

And many patients, including City-TV reporter Cristina Howorun, have expressed appreciation for the increased access to virtual care across all UHN programs.

At the Peter Munk Cardiac Centre (PMCC), work is underway to increase the capacity of Medly, the digital heart failure management program and another form of virtual care. Co-created by Dr. Heather Ross, Division Head of Cardiology at the PMCC and site lead for the Ted Rogers Centre for Heart Research, and Joe Cafazzo, Executive Director of UHN's eHealth Innovation, Medly allows clinicians to rapidly assess and triage patients based on symptoms inputted through a mobile app.

On March 1, there were just over 400 patients being cared for through Medly. As information about the potential impact of COVID-19 developed, the Heart Failure team led by Dr. Michael McDonald began to accelerate on-boarding of patients. With the support of two reassigned nurses, the team is targeting anywhere from a 50 per cent to 100 per cent increase in patients followed through the platform.

"Even in a pandemic, Medly allows our patients to still receive the care they need," says Dr. McDonald.

"Our goal has always been to introduce more patients to the program, but we've sped up the on-boarding process to keep a vulnerable patient population out of the hospital to decrease their risk of exposure to COVID-19."

Although virtual care is not a new concept, and many clinicians connected with patients virtually prior to COVID-19, the opportunity to be able to see and monitor patients during the pandemic has provided comfort for both clinician and patient.

"Many patients are in self-imposed isolation, they have chronic illnesses, they aren't connected with their usual support and they are worried," says Dr. Rossos, who is also a gastroenterologist at UHN.

"The fact their clinician is still checking in and made themselves available is reassuring. During my virtual visits, I've also had patients say to me, 'you know what doctor, you take care of yourself.'

"I really think it's a question of us taking care of each other. We're all in this together."

*We are proud of the cardiovascular care we provide at UHN. From prevention, to acute, to rehabilitation, we offer an integrated continuum of care through the Peter Munk Cardiac Centre and Toronto Rehab. The Cardiovascular Prevention and Rehabilitation Program at UHN is located at Toronto Western Hospital’s GoodLife Fitness Cardiovascular Rehabilitation Unit and Toronto Rehab’s Rumsey Centre.

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