After COVID-19, screens and phones will remain vital to care, experts predict
Imagine… using a computer and webcam to remotely diagnose a serious medical condition. Or give breastfeeding advice to a new mother. Or help a stressed-out teenager manage his anxiety.
It was a grand dream. But as the calendar flipped from 2019 to 2020, it all still sounded elusively futuristic.
In theory, performing assessments, checkups and counselling on a wide scale, with the expert in one location and the healthcare user in another, seemed to be just a matter of time.
But how much time? How long would it realistically take to clear the technical hurdles, obtain the government’s endorsement and earn the public’s trust?
No one was really sure.
And then, in early March, the future came calling. As the COVID-19 lockdown took hold, the order was issued: Implement telehealth—now!
Suddenly, staff in sites across CIUSSS West-Central Montreal were scrambling to figure out how healthcare users could receive the attention they needed, while isolated in the safety of their homes.
“COVID-19 was definitely a catalyst for the type of change we’ve been talking about and envisioning for quite a while,” says Dr. Justin Cross, the CIUSSS’s Chief Digital Health Officer.
“Of course, the pandemic was not the catalyst anyone wanted. But there’s no denying that it pushed us in the direction we needed to go.”
Within days, new telehealth services sprouted, while existing programs were broadened and strengthened. Among the most notable:
- In the Goldman Herzl Family Practice Centre at the JGH, appointments using telehealth (also known as telemedicine) became the norm. By late May, the proportion of inperson visits had plummeted to an average of 12 or 13 per cent of all visits.
- In the Segal Cancer Centre at the JGH, patients are now participating in virtual visits with their oncologist. They are also monitored remotely via a personalized, virtual clinic.
- In the field of mental health, video-conferencing is being used to conduct psychiatric and mental health assessments, “broadcast” helpful webinar presentations to a large audience, and arrange group discussions in the Youth Drop-In clinic.
- The Côte-des-Neiges Birthing Centre is using Zoom for postpartum checkups and breastfeeding support.
- Under Dr. Nathalie Saad, the Tele-Pulmonary Rehabilitation Program has broadened its approach: It enables patients with pulmonary difficulties to remain at home and use a video link to speak with a healthcare professional about therapeutic exercises.
- In response to the mental health crisis among vulnerable seniors, the Telehealth Intervention Program for Isolated Older Adults has been established to connect clients with volunteers for a weekly morale-raising phone call.
“Even though the healthcare user and practitioner may be far from each other, the bond between them remains strong,” says Dr. Lawrence Rosenberg, President and CEO of CIUSSS West-Central Montreal. “Telehealth provides users with the reassurance that their needs can be taken care of quickly and properly.”
Anna D’Ambra, Clinical Telehealth Pilot for the CIUSSS and a Specialized Clinical Informatics Analyst with the Digital Health team, notes that some telehealth services did exist before COVID-19.
However, she says, patients generally had to travel to a healthcare site to connect by video with the medical professional.
A key reason for the pre-COVID-19 scarcity of telemedicine, explains Dr. Cross, was the lack of widespread reimbursement by the Ministry of Health and Social Services to physicians for most telehealth activities.
The watershed moment came this past February, just before COVID-19 struck the province. The Ministry realized that to prevent the spread of the virus, most patients (and many members of staff, including some clinicians) had to stay away from hospitals and certain other healthcare facilities.
So, moving quickly, the government “approved reimbursement for most physician services that were delivered by video and telephone,” says Dr. Cross.
By this point, the Digital Health team had been up and running for a couple of months, with a mandate to bring to life Dr. Rosenberg’s vision: enabling care to be provided to healthcare users, no matter where they might be located—in essence, a hospital at home.
Of key importance in getting team members up to speed was Sabine Cohen, Associate Director of Digital Health, whose role includes responsibility for the crucial area of information security. As well, Ms. Cohen acted as liaison with the Ministry of Health in implementing a version of Zoom with stronger security.
“We’re not saying—and we’ve never said—that in-person visits will be discontinued,” Dr. Cross insists. “In many cases, the patient does need a physical exam or needs to be present in person when the relationship with the healthcare provider is being established.
“What we are saying, however, is that many visits just don’t need to happen in person. A large number of conditions are simple and straightforward, and they can be treated over a distance.”
“The clinicians have also told us that patients like being able to keep an appointment without having to take time off work, search for an expensive parking spot, or find a babysitter,” says Michael Shulha, Associate to the Director for Digital Health. “They see all of these conveniences as real benefits.”
Among the most vigorous telehealth advocates is Dr. Nathalie Saad, who began using digital technology as far back as 2017 to make her expertise in pulmonary rehabilitation available to patients across Quebec.
Today she is the CIUSSS’s physician-champion of telehealth, in addition to serving as a JGH respirologist and Director of the Outpatient Pulmonary Rehabilitation Program at Mount Sinai Hospital.
Dr. Saad’s ongoing objective has been to provide Quebec-wide support to individuals who need help in managing their COPD, the #1 cause of recurring visits to the Emergency Department.
Since 2017, this tele-pulmonary rehab program has helped more than 300 patients in seven centres, some in the general Montreal region (Verdun, Joliette) and others farther away (Abitibi, Outaouais, Lanaudière).
“The biggest difference since March 11 is that now we can actually reach out to patients in their homes,” says Dr. Saad. “Because of the pandemic, we’ve adapted our program to be able to provide instruction to our patients and get them to exercise at home.
“However, we have to stop seeing telemedicine as being different from a regular clinic. This means we need appointments, we need structure, we need systematic follow-ups, we need to be able to get test results and, where necessary, we need the flexibility to see the patient in person in the clinic.”
The CIUSSS’s Digital Health team will be looking at ways—some of which may previously have been unforeseen—of putting telehealth to entirely new uses, says Danina Kapetanovic, who is spearheading the Innovations and Entrepreneurship Program in the office of the President and CEO.
“Telehealth is is not limited to just a video-type visit,” adds Anna D’Ambra. “What we’re now seeing is really only the beginning, just a taste of the very near future and a preview of what’s to come.”
