Advancing virtual care in PEI: A plan to improve access and safeguard public health

On this page

1. Overview of areas of focus
2. Initiatives under the bilateral agreement
   1. Growth and consolidation of video visit platforms
   2. Secure patient-provider messaging
   3. Equity of access measures
   4. Expansion of remote patient monitoring and home care
   5. Infrastructure and support improvements
3. Funding allocation table
4. Performance measurements and expected results

I. Overview of areas of focus

Over the past year, there has been enormous growth in the use of virtual care in Prince Edward Island ("PEI"). The Government of PEI has rapidly and successfully deployed a host of new services to ensure Islanders can continue to access the healthcare services they need while minimizing travel and face-to-face contact to limit the spread of COVID-19. Many Islanders have benefited from telephone or video visits with their healthcare providers, and those without a family doctor have gained access to family medicine and primary care services through a virtual platform. A successful pilot of remote patient monitoring – technology that allows healthcare providers to track important health information remotely and in real-time – has been launched in home care, helping seniors to remain safe and healthy at home.

While PEI has been fortunate to experience low rates of COVID-19, it is essential to keep measures such as video visits in place to reduce in-person contacts and protect the health of Islanders. The population of PEI has a higher median age than Canada as a whole^{Footnote 1}, and therefore faces an increased risk from COVID-19. For this reason, PEI plans to build on the demonstrated successes of virtual care and continue to invest in its use as the province recovers from the COVID-19 pandemic. Moving forward, PEI will further integrate virtual care into priority areas within the health care system and that integration will in turn build greater capacity within the system to deliver safe and quality health services to Islanders. By investing in virtual are, Islanders will continue to experience improvements in access to care, convenience, and safety.

II. Initiatives under the bilateral agreement

1. Growth and consolidation of video visit platforms

Outline

Since April of 2020, PEI has implemented video visit solutions including Maple and Zoom for Healthcare. Maple is used to enable Islanders without a family doctor to safely access essential primary care services, while Zoom for Healthcare has been made available to healthcare providers across the island to enable virtual consultations with their patients, aiming to minimize in-person visits to help limit the spread of COVID-19. While Maple is usually a private service paid for by patients, PEI has arranged for this service to be covered by provincial health insurance. Both initiatives have been successful and well-received, and PEI intends to use funding under the Canada-Prince Edward Island Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19 to continue funding both of them. With this work underway, the solutions are implemented and efforts to improve and expand video visit services are ongoing. Video visit solutions like these are in line with priorities agreed to by Deputy Ministers of Health across Canada, including "secure video-conferencing technology to deliver care to patients remotely."

Rationale and objectives

The ongoing use of video visit platforms supports reduced in-person contacts between patients and providers and helps to limit the spread of COVID-19. In addition to the near-term public health benefits, video visits also help reduce systemic barriers to accessing health care for individuals with disabilities, in particular those with mobility challenges. Discussions with patients who have used virtual care highlighted the benefits of these solutions to individuals for whom travelling to an in-person appointment is a significant burden.

Specific objectives include:

• Streamline patient experience
• Obtain more accurate reporting on service usage and quality
• Provide platform for specialty video visits from out-of-province providers
• Consolidate multiple platforms into one to streamline processes, centralize support, consolidate costs and ensure sustainability
• Ensure that there are guidelines for what tool to use in which care setting, for which clinical use case
• Improve support services and harmonize with other virtual care solutions

Working with pan-Canadian health organizations

PEI aims to collaborate with partners across the country, and has been working with Canada Health Infoway on virtual care initiatives so that Islanders can access needed services from the safety of their homes during COVID including video visits, and will continue to collaborate and align with Infoway on virtual care priorities in the future. In particular, PEI sees opportunities to leverage further Infoway funding to build out additional patient-facing digital health solutions that will complement video visits. Collaboration between the provinces and federal partners will lead to more rapid advancement in virtual care, which will benefit all Canadians.

2. Secure patient-provider messaging

Outline

Many healthcare organizations around the world provide a platform for secure, asynchronous communication (that is, not real-time, but more like email or text messages) between providers and patients. Services like this often act as a secure alternative to email and are often one of the most-used aspects of virtual care: in one evaluation, messaging was used in over 90% of virtual primary care visits^{Footnote 2}, far more than video visits. Conversations with healthcare professionals and patients has confirmed the need for a secure messaging service in PEI, and, like video visits, secure messaging is one of the key priorities identified by the Deputy Ministers of Health. With a secure messaging solution in place, Islanders could quickly, easily and securely communicate with their healthcare providers in a way that resembles email or the direct messaging features of many social media services, providing a convenient way to ask non-urgent questions or perhaps arrange prescription renewals without having to meet in real-time.

PEI is in the planning stages of rolling out an electronic medical record (EMR) to community-based healthcare providers that may include this type of service. If it turns out that the EMR meets needs in this area, funding under this agreement will be directed to support services to help healthcare providers incorporate the use of secure messaging into their practices, as it can be a significant change. Services may be provided by the incoming EMR for community-based practitioners. If this is the case, implementation timelines will align to the EMR.

Rationale and objectives

This initiative would meet a demonstrated need in PEI. Specific objectives and intended benefits include:

• Increase convenience for Islanders and improve access to care
• Reduction in unnecessary appointments & in-person visits
• Minimize adverse productivity impacts to Islanders by reducing the need to take time away from work or other commitments for in-person visits

Workflow management tools for providers would be a key aspect of a secure messaging solution. This might mean enabling different clinic staff members or providers to respond based on the type of the request (to be efficient and avoid overburdening family doctors), or providing templates to streamline common requests (such as routine prescription renewals). A secure messaging service is in keeping with the principles of "prioritizing user experience" and "emphasizing data security/privacy" agreed to by the Deputy Ministers of Health, and would be a valuable addition to virtual care in PEI, improving convenience and access to care for many Islanders.

Working with pan-Canadian health organizations

PEI will be working with Canada Health Infoway to explore options for further work that would complement this initiative; such further work might include additional integrations to improve workflows, equipment modernization, or additional patient-facing digital health solutions that would further support dialogue between Islanders and their health care providers. Of particular note, the implementation of a Clinical Data Repository, which may draw on funding from Infoway, would enable many patient-facing solutions and complement the secure messaging solution very effectively.

3. Equity of access measures

Outline

Concerns around equity of access are widely identified in the literature on virtual care. There are many factors that could limit a person's ability to use virtual care, from lack of access to the required technology to literacy challenges to visual or hearing impairments. It is important to ensure that as PEI continues to expand its virtual care service offerings, ensuring that barriers to Islanders accessing and benefiting from these services are minimized or removed is a high priority. PEI will use funding under this agreement to support research, analysis, assessment and recommendations regarding potential equity of access measures and implementation of selected initiatives. Focused research and analysis will help Health PEI and the Department of Health & Wellness to understand the impact of the virtual care programs and ensure that they reach and benefit all Islanders in an equitable way, including implementing measures that support those who are at a disadvantage from using these tools. Following the results of the assessment, implementation of new services to improve access will occur.

Rationale and objectives

Making virtual care services accessible to as many groups as possible makes those services a better use of healthcare funding and, ultimately, is simply the right thing to do. This initiative will initially focus on barriers to accessing virtual care stemming from a lack of access to the required technologies. Approaches are expected to include "device libraries", where Islanders can borrow the devices they need to access virtual care, and community access points where individuals can access virtual care services if they do not have the required technologies at home. These would require training or education for prospective users, as well as support staff, and potential infrastructure enhancements to provide connectivity.

This initiative is intended specifically to improve equitable access to virtual care and break down systemic barriers to accessing quality care. Benefits will be most significant for newcomers and individuals or families with lower incomes.

Specific objectives include:

• Identification of socio-demographic groups currently underserved by virtual care
• Identification of key barriers to access for those groups
• Completion of a benefits evaluation to assess success and guide future measures

4. Expansion of remote patient monitoring and home care

Outline

Remote patient monitoring (RPM) solutions, which allow healthcare providers to remotely keep tabs on patients' vital signs and other key measurements in real-time, are currently used in a limited capacity in PEI. Health PEI uses an RPM system to support a number of patients living with chronic obstructive pulmonary disease (COPD) and congestive heart failure, and a pilot initiative has recently started to use RPM to support home care. The more-established primary care RPM program for chronic disease patients has shown impressive benefits, including large reductions in hospital admissions among program participants and major improvements in participants' ability to manage their conditions after completing the program. Given these very positive results and the success of RPM solutions elsewhere, PEI aims to use funding under this agreement to support these programs, expand the use of RPM in home care and support continued use in primary care. This is in clear alignment with a priority identified by the Deputy Ministers of Health around "remote patient monitoring technologies."

Rationale and objectives

Reducing hospital admissions and enabling people to age in place at home if they choose will both contribute very significantly to the quality of life for many Islanders, as will helping those living with chronic illnesses to better manage their conditions. This also reduces demand on the healthcare system and drives down costs – truly a "win-win" situation. As initial deployments of RPM solutions in the province have already demonstrated very positive outcomes, this is an obvious target area for growth in virtual care services on the island. Funding for updated equipment and relevant support services for RPM would also be aligned to the principle of "prioritizing user experience" identified by the Deputy Ministers of Health; up-to-date and reliable equipment combined with readily available support is key to good user experience.

Specific objectives include:

• Replace aging hardware used by the Primary Care program serving chronic disease patients
• Expand the use of RPM in Home Care, including acquisition of new hardware, integration with the electronic case management system and support for the hiring of additional staff to support the program
• Support expanded use of virtual care tools in home care, including procurement of mobile devices for use by healthcare providers and licensing costs for virtual care applications

Working with pan-Canadian health organizations

Existing remote patient monitoring solutions in both primary care and home care were funded by Canada Health Infoway. PEI will continue to collaborate and align with Infoway on virtual care priorities, including remote patient monitoring, in the future as opportunities present themselves.

5. Infrastructure and support improvements

Outline

Increased use of virtual care solutions such as video visits places greater demand on the network infrastructure in healthcare facilities across the island. Combined with an expected future growth in remote patient monitoring and Internet of Things (IoT) solutions, improvements are required to ensure high-quality, reliable service. This aligns with the priority of "back-end supports for the integration of new platforms and supports, including needed hardware" identified by the Deputy Ministers of Health. PEI will use federal funding to conduct a detailed assessment of needs and technical evaluation of existing infrastructure to support planning of infrastructure improvements.

In addition to infrastructure, there is an obvious need to build expertise, coordination and support capacity for virtual care in the province. A centralized location to manage the infrastructure, vendor contractors, vendor services, device libraries, procurements, develop and provide training, and provide technical user support to end users, providers and to patients. The overarching goal is to streamline the planning and delivery of care through video visits and access to secure communication between providers and patients. Federal funding will also be used to support efforts in this area.

Rationale and objectives

Improved coordination, alignment and harmonization of support services will improve efficiency and create economies of scale while also providing greater consistency of user experience across services, helping to control costs and encourage both patients and healthcare providers to use virtual care services. Unified governance and planning capabilities will also help to ensure future virtual care capabilities are planned to complement existing services and meet needs across the health system (for example, many program areas collaborating to acquire a single solution rather than each program area buying its own).

Existing network infrastructure was not designed to accommodate the loads imposed by widespread use of video visit tools and remote patient monitoring. Enhancements are required to support a wide range of current and future virtual care initiatives. This is in keeping with the principle of "prioritizing user experience" identified by the Deputy Ministers, as inadequate network infrastructure will adversely impact the user experience of many virtual care systems. Ensuring the availability of acceptably high speed (e.g. 4G or LTE) cellular data network access for devices deployed as part of equity of access initiatives must also be confirmed.

Specific objectives include:

• Organizational changes to create centralized virtual care support capabilities and enable better planning, coordination and sharing of resources
• Definition of infrastructure requirements at identified sites, including bandwidth, Wi-Fi coverage, separate networks for administrative vs. clinical use, redundancy, etc.
• Prioritization of infrastructure upgrades to align with planned virtual care/digital health initiatives

Working with pan-Canadian health organizations

PEI has been working with Canada Health Infoway on virtual care initiatives and will continue to collaborate with Infoway on virtual care priorities in the future. Furthermore, PEI will seek to align reporting indicators and capabilities with national organizations such as CIHI.

III. Funding allocation table

IV. Performance measurement and expected results

PEI will to work with CIHI to define a set of pan-Canadian indicators that will be used by CIHI to measure progress on virtual care implementation; where possible and appropriate this will also include disaggregated data (e.g. broken down by age group, gender, etc.).

On a jurisdictional level, more granular indicators and performance targets (i.e. greater specificity than the number of sessions or users per tool) will be required to continue shaping and optimizing PEI's virtual care service offerings to match the needs of Islanders and PEI-based healthcare providers. Improved ability to determine the specific type of service provided virtually (e.g. what sort of consultation was performed during that Zoom call) will be a primary focus.