Virtual Care

The Guelph and Area OHT will build off our existing digital capabilities to address two system needs: the need for providers to consult and refer to provide seamless care and the need for patients to access alternatives to face to face visits.

  1. Clinician to clinician virtual care is available locally using:
  2. OTN eConsults. As of August 2019, 111 primary care physicians have signed up for the OTN Hub and one-third of those providers have completed 3 or more eConsults within the past 6 months.
  3. Ocean eReferral Network – The System Coordinated Access (SCA) program has expanded the Ocean eReferral network in Guelph and Area. More than 75 clinicians are sending electronic referrals using the program. 7,313 patients are currently eligible to receive e-mail confirmations of referrals and 2,021 (28%) have received e-mailed notification of their referral.
  4. Clinician to patient virtual care is provided as follows:

In Year 1, the team will expand primary care’s access to palliative and MH&A populations through the use of the Think Research Virtual Care platform. Current benefits of the use of this solution are documented in the SWLHIN section of the evaluation completed by Women’s College Hospital Institute for Health Systems Solutions and Virtual Care (WIHV)

Currently, 567 (0.34%) Guelph and area residents have had a virtual visit with their own primary care provider (1,071 visits total). Patients are also regularly accessing specialist virtual visits using OTN Hub, including Year 1 population visits with mental health and addiction professionals . OTN eVisit Activity in 2018-2019 includes a total of 2,660 events of which 1635 were Studio (room based) and 1,024 between patient and provider computers (PCVC). These events enabled virtual visits for 2,177 Mental Health, 21 Neuro and 99 Primary care encounters.

Moving forward, we will accelerate adoption of these platforms to ensure the G&A OHT will reach initial goals of expanding virtual care offerings. Virtual visit options will be used to increase palliative patient access to primary care and secondary palliative care providers to optimize palliative care in the home in the last 90 days of life.

A potential Year 2 initiative is being explored that would leverage an existing virtual care application called Relief whereby patients/caregivers can track their symptoms daily. Concerning trends are flagged to a member of the ‘Integrated Primary Care Team’.

There are increased Virtual Care licenses being procured by the eCE through the OTN vendor of record to enable MH&A clients with Tier 5 needs to connect with care without having to make/keep an appointment and/or visit a clinic. Further support from the Ministry to obtain additional licences as per the playbook will be necessary. The app will allow nurses/outreach workers in the field to virtually connect the client with a primary care provider to facilitate check-ins. Additionally, the OTN platform will continue to be leveraged to support visits and psychiatry service.

The G&A OHT has the eHealth Centre of Excellence (eCE) as a core partner. Our ability to leverage the experience of this group, who led the innovation procurement within the Provincial Vendor of Record for Virtual Care, is an important element of our projected success. The eCE has secured licenses through the OTN vendor of record to support salaried clinicians in the immediate term – and will be expanded to more physicians when Ontario physician billing codes are resolved. eCE is committed to support change management needs of the G&A OHT.

The eCE has achieved significant success in virtual care during the past 18 months that apply not only to our Year 1 priority populations but will support us in addressing the needs of our full attributed population. Recent successful adoption of virtual care in Waterloo-Wellington include:

  • 76% of Primary Care Providers (PCP) adopting Virtual Visits have conducted at least one virtual visit with their patients.
  • Over 7,800 patients are registered to use the platform, and over 15,000 visits have been completed.
  • 64% of registered patients have had at least one virtual visit (41% of invited patients have registered).
  • Patients typically request virtual visits with their PCP for: medication and prescriptions, following up on test results, addressing new health issues, and managing chronic conditions.

In Year 1, the G&A Area OHT Digital Health Working Group will, as part of the development of the ‘Guelph and Area Digital Health Plan’, review the virtual offerings of all partners and will streamline offerings such that all partners are using an optimized and consolidated set of virtual care tools. These will include Think Research Virtual Care app, and OTN eVisits to enhance the care not only of the Year 1 priority populations but of the full attributed population over time. As mentioned, the eCE has recently procured additional licenses to support OHT development.

Additional virtual care innovations have been identified for future adoption within the G&A OHT. These include the following applications:

  1. Mobile version of PSS (to support real time documentation in the patient’s EMR)
  2. Adoption of digital self-assessment (Inter-RAI) to assist with triaging referrals to the most appropriate provider
  3. Access to the 24/7 Serious Illness Call Line for palliative symptom support

We are confident that we can achieve our Year 1 target with the two recommended applications (i.e. OTN eConsults and Ocean eReferral Network). We are optimistic that through focused effort and change management support from the eCE, that we can increase the number of practices set up for virtual visits and the number of patients who register for this.

Telemedicine remains an uninsured service.  Remuneration is provided through the provincial telemedicine program.  While the absence of an OHIP billing code for physician virtual visits is an ongoing concern, the clinical pathways to support our priority populations involve many other provider types with alternative compensation models who will use these applications. Expansion of existing OHIP billing codes (i.e. K738 and K739) to include clinician-to-patient eConsults, will greatly improve the pool of physicians and patients who can benefit from this service.

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