Virtual Care: Bandwidth or Band-aid?
Estimated read time: 5 minutes.
Masking, elbow bumping, hand sanitizing—the pandemic led to new expectations and fundamental changes to the way we do things. Among these changes is the widespread normalcy of physicians and other practitioners providing virtual care for their patients. Just as employees had differing reactions to returning to in-person work after years of working remotely, health care providers and patients alike have varying perspectives when it comes to virtual care versus in-person appointments. While assessing the role of virtual care in the Alberta healthcare setting, one must take two questions into consideration: when does virtual care improve quality care and how can it be designed to minimize the potential for patient harm?
What is virtual care?
As defined by the Alberta Virtual Care Working Group, “virtual care encompasses any interaction between patients and/or members of their circle of care occurring remotely, using any form of communication or information technology with the aim of facilitating or maximizing quality of patient care.”
In a way, it is comparable to businesses moving weekly meetings out of the conference room and into an online space. Virtual care allows physicians and other healthcare providers to move appointments out of traditional medical settings and into the patient’s home or preferred location.
Do patients want virtual care?
Focus groups and online discussions
In 2021, CPSA conducted a series of focus groups during which Albertans could share their thoughts and opinions on virtual care. Through these valuable discussions, Albertans revealed that virtual care enabled accessibility and efficiency while also reducing potential health risks that can come from in-person interactions. Many Albertans feel the virtual medium better supports integrated care since family members and other healthcare team members can also log on and take part in an appointment.
In contrast, Albertans expressed concern that virtual care could be challenging for those without access to or knowledge of how to use the required technology. With sensitive information being discussed, many were concerned that data privacy and safety could be impacted. Without in-person contact, many participants also felt there could be negative impacts to quality of care, communication and the overall physician-patient relationship.
2022 Survey results
In 2022, CPSA took part in a third-party survey to learn more about Albertans’ perspectives on virtual care. The survey included 900 Albertans, ages 18 and over.
When it comes to virtual care, Albertans are split between those who believe virtual care is just as good or better than an in-person appointment (50%) and those who prefer in-person appointments (44%). The 2022 survey responses echo the findings from the focus group. The most common concern is a physician’s ability to adequately assess patient needs virtually, with just over one-third of Albertans believing that in-person encounters are better suited to achieve quality patient assessments.
How do physicians feel about virtual care?
Due to the noticeable post-2020 shift toward virtual care, CPSA’s updated Virtual Care standard of practice went into effect on Jan. 1, 2022 after consultation with regulated members, partner organizations and Albertans. Through the consultation process, regulated members shared their thoughts, concerns and suggestions on the topic.
Similar to the sentiments expressed by Albertans, many physicians felt virtual care improved accessibility for patients who live in rural or remote areas, strengthening continuity of care since it allows patients to connect more frequently with their regular provider.
Despite these benefits, most physicians still felt that virtual care would be best used for check-ins and occasional appointments with long-term patients. Agreeing with Albertans, many physicians felt that virtual care has limitations and virtual assessments could lead to inappropriate referrals to emergency services and specialists. Many expressed concern that if virtual care replaced in-person care completely, overall quality of care could suffer.
Physician standards
With this feedback from physicians and the public in mind, CPSA’s Virtual Care standard of practice was updated and officially replaced the prior Telemedicine standard.
The amendments included the requirement that physicians providing virtual care must make access to in-person care available to their patients. The standard indicates that physicians providing virtual care must have a physical clinic or agreement with a clinic within reasonable travel proximity to the patient to fulfill the need for in-person care when needed or requested. It also sets clear expectations on keeping other care providers informed throughout the virtual care process to support the patient’s medical home.
Do virtual care services work?
Dr. Ewan Affleck, CPSA Senior Medical Advisor, Health Informatics and chair of the Alberta Virtual Care Coordinating Body states that there are gaps in the provision of virtual care that bear consideration.
Digital literacy and design
Health informatics is the study of information design and use in health care and medical informatics is the application of health informatics knowledge in the medical setting to promote quality care. According to Dr. Affleck, physician training has not kept up with technological and knowledge requirements needed to assure competent virtual care service. This gap should be filled with a move toward incorporating digital-age medical informatics curriculum in undergraduate, post-graduate and continuing medical education. This change would better prepare physicians for a world with significantly more virtual care demands, prompting higher-quality health services.
In addition to shortcomings regarding digital literacy, Dr. Affleck has identified that digital health information services are often not properly evaluated, and consequently, their impact on the quality of health service is not known. Virtual care services must be dependable, evidence-based and well-integrated to ensure vital patient information is accessible across systems throughout a patient’s care journey. Systems that support the harmonization of health data design will, in turn, support continuity and quality of care.
Conclusion
With a significant shift in culture and expectations, it’s safe to say that virtual care is here to stay. As indicated by patients and physicians alike, virtual care should supplement in-person care rather than replace it. When managing patients, physicians will need to follow practice standards and become adept at determining when a virtual appointment is appropriate and permissible, and when an in-person appointment is preferable. Proper training for physicians in virtual care service delivery will help address knowledge gaps and improve quality of care. The systems used for virtual care should also be examined to ensure they are evidence-based and support seamless health data exchange.
As health care continues to evolve within the virtual landscape, CPSA will continue listening to Albertans and regulated members to ensure their comments and concerns are heard, gaps are addressed and patients are provided with the highest-quality care.
