Five must do’s to successfully implement virtual care

June 1, 2020

By

Dr. Husein Moloo

Many clinics across Canada are facing a problem: declining volumes. Volumes are down 60-70% in many clinics. COVID-19 has exacerbated funding cuts and the combination is forcing physicians to make tough decisions such as whether to lay off staff or close their doors completely. The pandemic has been devastating, and the effects are expected to be long-lasting. Nearly 50% of patients plan to reduce in-person visits to their family doctor even as life returns to normal, and 95%+ are planning to or are considering using new virtual walk-in clinics1.

While in-person visits may decrease, virtual care has provided some physicians with hope. 70%+ of patients want virtual care to be provided by their family doctor2. Those who connected with their doctor virtually during COVID-19 report a 91% satisfaction rate – 17 points higher than in-person emergency room visits3. Moving forward, almost half (46%) of Canadians who had the opportunity to use virtual care since the pandemic outbreak would prefer a virtual method as a first point of contact with their doctor4. With new technology solutions that enable family doctors to provide virtual care to their patients, it is easier than ever to add virtual care to your clinic’s toolbelt.

After seeing some clinics stumble on their implementation of virtual care, we have written this guide to help you successfully implement virtual care in your clinic. These are the five must do’s if you’re considering offering virtual care:

  1. Is virtual care right for your clinic?
  2. Choose a solution
  3. Integrate into your clinic workflow
  4. Communicate with your patients
  5. Push the right patients to virtual care

1. Is virtual care right for your clinic?

Virtual care works better for some clinics over others. Ask yourself:

  • Are your patient volumes drastically down due to COVID-19?
  • Are some of your patients not required to have consistent in-person consultations?
  • Do you have scheduling issues with patients who have to navigate taking time off work or driving long distances to visit your clinic?
  • Would your current work-life balance benefit from some greater flexibility?

If the answer to any of the above questions is yes, you might benefit from offering virtual care. That being said, certain specialities (and medical conditions) do not lend themselves to virtual care, especially for the initial consultation, such as orthopaedics, OB/GYN or neurology. 

Before we go further, a common concern we hear is around the quality of care with telemedicine. Is the quality similar? A randomized trial in the United States had patients and physicians complete an in-person and virtual visit and provide their perception of how the two compared. While virtual visits scored slightly lower, it was not statistically significant as is shown in the chart below.


Meanwhile, a 2018 US study of 35,000 patients found clinics that implemented virtual care reduced face-to-face visits by 33% but increased total consultations by 80% over 1.5 years. Additionally, by using tools such as video consultations and secure messaging, patients were more engaged in their healthcare. 

While virtual care can be a valuable tool for many practices, it’s of course important to recognize not every consultation can be conducted virtually.  Virtual care will never replace in-person physician care, but that does not exclude it from being a valuable and convenient way for physicians to treat their patients. 

Given the ‘new normal’ we are entering where a second wave of COVID-19 may strike and where nearly 50% of patients plan to reduce in-person visits, virtual care can be a great tool to reduce the potential decline in volumes.

Note: For more details on billing codes specific to your jurisdiction, the Royal College of Physicians and Surgeons of Canada has compiled billing code resources here


2. Choose a solution

Start by creating a list of “need-to-haves” and “nice-to-haves.” While each clinic has different priorities, below are some of the most common considerations. 

Technological Integration

Consider which technologies are already in use in your clinic. Your EMR provider may offer an integrated virtual care solution. If your EMR does not have a virtual care extension, or you are exploring other options that may offer additional functionality or are lower priced, look for solutions that work in parallel with your existing technology and processes. This will help avoid reconfiguration costs and ensure efficient workflows.

Compliance

As a physician, caring about your patients’ privacy is crucial. This shouldn’t change in an online environment. HIPAA and PIPEDA compliance are essential, and a PIA is required for Alberta and BC. 

While some jurisdictions have temporarily relaxed regulations to allow consultations via non-compliant platforms such as Skype or FaceTime, these are expected to end with COVID-19. It’s best to invest your time and energy into solutions that will last.

Price

Software is a major overhead cost for clinics. EMR-integrated solutions often cost $50 to $100 per physician, which adds up quickly for group practices. If cost is a concern, there are free solutions that offer comparable features. PurposeMed is free and fully compliant in Canada, while Doxy.me is also free and easy to use. Doxy.me’s free version is not fully compliant in Canada however, and while this is okay to use during the pandemic, you will need to upgrade to a paid version thereafter.

Service

Virtual care is rapidly evolving. it is important to have a solution provider who will help work with you to navigate your clinic’s digital transformation. Leverage your physician network and Facebook groups to gather feedback from your peers so you can make an informed decision about service quality.

An important consideration is how big a provider is and where they are located. Larger companies can sometimes have slow response times or charge $150+/hr for training and support. Choose a provider that will be attentive and helpful during your implementation and thereafter. 

It is worthwhile to do your research, get a demo and speak to the software provider so you can gain a better understanding of the technology and ask any questions you may have.


3. Integrate into your clinic workflow

Now that you have selected your virtual care solution, it’s time to integrate it into your clinic. The following three-step process may be helpful as you start your implementation:

1. Review onboarding documents and share them with your team

These contain important  virtual care call procedures and support for getting your clinic’s Privacy Impact Assessment submitted, which is a must for compliance when offering virtual care. These documents should be shared with your team so everyone is familiar with how to use the virtual care solution. At PurposeMed, we offer a Digital Concierge service where we work with your team to get PurposeMed up and running and also optimise other elements of your clinic’s digital presence. 

2. Discuss with your team how your procedures will translate into virtual care

Discussing workflows as a team will help make the virtual care integration process much easier. Your typical clinic workflow shouldn’t have to change much. Many virtual care solutions allow each member of your team to be part of your online clinic, with seamless handoffs between check-in, information gathering, and consult. But this must be worked out.

3. Conduct a test session to gain familiarity 

Prior to seeing patients virtually, spend a few minutes testing the software with your team or family to gain familiarity.  

Depending on personal circumstances, you will want to consider how to optimize your set-up. Some physicians prefer to use tools such as using two monitors or headphones, while many like to see the video of their patient and chart all on one screen, side by side.


4. Communicate with your patients

An important consideration in implementing virtual care is how you will communicate this new offering to your patients. Over 55%+ of patients surveyed do not know if their family doctor offers virtual care5.

If patients do not know you offer virtual care, your patient volumes may be impacted. Further, some patients may not understand how virtual care can benefit them. The success of your virtual care implementation is dependent on patients knowing about it and embracing it. 

While virtual care is new to most patients, the learning curve is generally short. You should communicate the value of virtual visits—easy access, low cost, high-quality care—and set expectations for your patients before their first virtual consult. 

Let your patients know how and when it will be used, and what the possibilities and limitations are. Patients should clearly understand that the clinical service isn’t changing, only the convenience factor is. They should feel comfortable when using your preferred solution, from scheduling an appointment to receiving their prescriptions. 

Below are three great ways you can communicate this information to your patients:

  • Text messaging. Texts allow you to directly share information with your patients on their phones. This is good for important notices and urgent conversations. In fact, according to Twilio, 9 out of 10 text messages are opened within the first three minutes of being received.
  • Email.  Emails are a great alternative for sending long-form information with images and attachments to your patients. Information shared in an email is easily accessible through different devices (i.e. smartphone, tablet, computer) and likely to be saved for future reference. 
  • In-person or over the phone. While this method requires further coordination from you or your administrative team, it is an effective method to engage with your patients and answer any immediate questions and/or concerns they may have. 

You should be as thorough as possible when communicating the value of virtual care and how you will use it to treat patients. We recommend emails as the ideal communication channel.  A recent survey by Canada Health Infoway showed that 63% of patients would like to be able to email their healthcare provider.



If you don’t have your patients’ email addresses, it is possible to attain them. The benefits are well worth it. A patient email list allows you to send appointment reminders, administrative follow-ups, and prescription updates. Here are some quick ways to gather emails:

  • Request email information in patient intake forms. When adding a new patient to your practice, ask for their email address. For privacy reasons, clearly communicate what their email will and will not be used for.
  • Ask for (or confirm) a patient’s email at check-in. Double-check current email information when interacting with a patient before their appointment. If they have not yet provided their email, ask for it!
  • Include your clinic’s email address in all forms of communication. Make your contact information available whenever you send e-receipts or appointment reminders, and encourage patients to communicate with you via email when appropriate.
  • Maintain an up-to-date log of all patient emails. If a patient’s email does not work, note of this in their file and contact them to request a new one. If this is not possible, when checking in, you should confirm the new email address after seeing the note on the patient file. 

Following these best practices will ensure patient engagement with your virtual care service. If you do not have a patient email list and want help to quickly build one, our Digital Concierge can provide you with tailored recommendations as part of our free digital consultation.

5. Push the right patients to virtual care

Virtual care is not meant to replace in-person appointments or the human component of the patient-provider relationship. As such, you should identify which patient populations would benefit the most from using virtual care. 

Patient demographics that lend themselves to virtual care

  • Rural areas: Virtual care is especially beneficial for patients who live far away from their family physician and cannot take time off work. When virtual visits were used in Ontario for outpatient follow-up stroke care, patients reported a total time savings of 80 minutes per visit and median out-of-pocket cost savings of $52.83.
  • Seniors: Given the ageing population and shortage of healthcare professionals, virtual care solves many of the access problems Canadians face when seeking care. A family member of an 88-year old patient in the above study said: “The e-visit saved time and a lot of stress that is involved in taking an elderly patient out especially in bad weather.”
  • Chronic disease: These patients require more follow-ups with their physicians that can be inconvenient for the patient, which can impact the patient-provider relationship, medication adherence, and patient engagement. 
  • Younger and tech-savvier patients: These patients prefer to use virtual care because they are used to tech-enabled services. 



Use cases

With virtual care, physicians can provide multiple health services remotely, such as:

  • Patient follow-ups
  • Diagnosing some acute illnesses
  • Ordering labs, diagnostic imaging and prescriptions (when appropriate)
  • Chronic disease management and monitoring
  • Treatment of mental health conditions
Where virtual care should be avoided

While virtual care can be used for various services, it isn’t the most effective option in certain cases:

  • Emergency care (chest pain, pain crisis, dyspnea etc.)
  • Musculoskeletal concerns or other conditions that would require a physical exam

Additionally, virtual care can be useful for more than just family medicine. Many specialties now use it to provide accessible high-quality care, including radiology, dermatology, nephrology, pathology, oncology, endocrinology, and for mental health. We recommend a physician-led approach—based on patient information—when deciding which patients would benefit from virtual care.

Conclusion

We understand how complicated this all might seem, but we want to show you that with a little planning, you can easily make the transition to virtual care. At PurposeMed, we know that virtual care can be a seamless part of your practice. 

That’s why we offer our Digital Concierge service and provide you with a free digital consultation to assess your needs and help you make the right decisions for your practice and your patients. If you’d like to take advantage of this, or just to generally have a conversation about how your clinic can improve its digital presence, sign up for an account now and our team will be in touch.

1Survey on Canadian Attitudes Towards Virtual Care. Written and paid for by PurposeMed. Completed by the SurveyMonkey Audience Panel, a representative panel of Canadians (N=50)

2Ibid

3Canadian Medical Association, What Canadians Think About Virtual Care https://www.cma.ca/sites/default/files/pdf/virtual-care/cma-virtual-care-public-poll-june-2020-e.pdf

4Ibid

5Ibid

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