Meeting Purpose

The BC-PAN’s first operational phase meeting was a two-day Zoom conference meeting on September
30 and October 1, 2020. The purpose of this day’s meeting was for the college partners seek input from public advisors on upholding regulation standards and practices in keeping with the constantly evolving landscape of virtual healthcare, especially in light of the COVID-19 pandemic.

Key Learnings

• The public believes that virtual care should continue to be provided post the pandemic. It is important that virtual care platforms are safe, secure, confidential, and accessible.
• Expectations and standards that health care providers are qualified and culturally competent are the same for virtual care as in person.

Virtual Care

Susanna spoke to the group about the evolution of virtual care pre and post the COVID-19 pandemic:

• Prior to COVID-19, there was an average of 1,800 virtual care visits across BC per week. In June, the number of visits grew to more than 19,000 a week.
• Virtual health enables a patient to access clinical services such as:
  • Virtual health visits
  • Remote patient monitoring (monitoring patient health and sending information to their care team electronically)
  • Clinical digital messaging
  • Online treatment and resources
• This is an emerging field. The colleges want public advisors’ guidance on how to support a positive public experience with virtual care.

Susanna gave suggestions for engaging in dialogue throughout the meeting:

• Step up and step back: Those who tend to let others speak are encouraged to bring their voice forward. Those who speak frequently are encouraged to create space for others.
• Speak personally: College partners are interested in the advisors’ experiences as a member of the public. It is also important not to generalize individual experiences.
• Differentiate between intent and impact: Be self aware and empathetic of people’s feelings rather than being defensive.
• Respect confidentiality: Some will disclose personal experiences or other’s stories. Please do not share the content of what is discussed outside of the group.

Questions regarding experiences accessing virtual care

Have you ever used phone, email, virtual platform, text or video to access health services?

If yes:

▪ What were the positive aspects of your experience?
▪ What was challenging about the experience?

If no:

▪ What would make you want to use virtual care?
▪ What concerns might you have about the experience?

And:

▪ Should health care providers continue to prominently offer virtual care once the
pandemic is over? Why or why not?

Advisor Feedback

• Most public advisors have utilized virtual health services because of the pandemic. The telephone was the most popular medium used.
• Seniors experience greater challenges in accessing virtual care. Some may have difficulties even handling a phone call due to mobility, hearing, or comprehensive issues.
• Privacy issues and ease of access are the greatest concerns.
  • There needs to be a balance. Platforms cannot be too restrictive so virtual care cannot be provided, but patient safety must be upheld.
• A record of the interaction to review what was said by the patient and the practitioner may be helpful.
• Face to face interaction makes some more comfortable to ask questions. Phone calls have a time constraint so people may feel less willing to ask questions.
• Healthcare providers should continue to offer virtual care.
  • Some healthcare visits still require face to face interaction.
  • Virtual visits can be used for following up appointments, filling prescriptions, etc.
  • Virtual care can be a substitute for a walk-in clinic or emergency care.

Criteria of Excellent Virtual Care

Susanna presented a list for advisors to review and rank individually. The results were:

1. Personal information is safe
2. Effective treatment
3. Technology is easy to use
4. Appropriate consent process
5. Culturally and patient responsive care
6. Continuity of care after the appointment
7. Options for in-person care when needed
8. Consistent across health care providers
9. Practitioner is known to me
10. Practitioner is competent with the technology
11. Avenues for advocacy and family/peer support
12. Clear communication about fees and billing

Excellent Virtual Care at All Stages

Advisors were separated into break out rooms for small group discussions. Each group began with a different stage of virtual care but were asked to evaluate all three stages:

• Pre-appointment: Finding a practitioner, understanding the approach to virtual care, making a booking, testing technology, etc.
• Visit with your practitioner: Ease of technology, what information is recorded and in what ways, practitioner demeanor, etc.
• Follow up: Getting and filling prescriptions, filing a complaint, etc.

Advisors were asked:

• What would enable a virtual care experience for patients that meets our top criteria?
• What potential challenges may need to be addressed?
• What expectations do you have about virtual care, in comparison to in-person care?

Advisor Feedback

Pre-appointment:

• People must trust that the system is safe, secure, and confidential.
• It is difficult to access care if an individual does not already have a practitioner that provides virtual services.
  • It would be helpful if regulators could provide a list of practitioners that offer virtual care.
• Would like to know that the practitioner is accepting patients, qualified, and culturally competent.
• There are stigmas and barriers related to a variety of health conditions. Some individuals need more assurance that their health information is secure.
• Knowing the practitioner or meeting them prior to virtual care would make most more comfortable to have a virtual consultation – having an initial face to face meeting is critical.

Visit with your practitioner:

• A platform that the patient is comfortable with, visual component, security of personal information, ease of use, and competency of practitioner are all important aspects of a successful virtual care experience.
• Patients need to have the correct tools to access virtual care; infrastructure, speed of internet, etc.
• Virtual care provides the opportunity to balance the patient-practitioner power imbalance if done properly. Being on the phone helps to cerate a more neutral environment, but the practitioner’s tonality may still be condescending.
• Colleges can create an environment where the patient understands key information and ensure that practitioners do not abuse the use of virtual care.
• Concerns about where information is being sent to – sensitive photos and examinations must be dealt with securely.
• The standard of virtual care and in person care should be the same within the limitations of technology.
• It is important to advocate for the aging and nonverbal population.

Follow up:

• It would be helpful to schedule the follow up during the initial session as well as be notified of the information patients need to provide the practitioner in advance (blood pressure, temperature, etc.)
• Consistency between health care providers and accurate recordings of previous visits/questions asked.
• The practitioner needs to allocate ample time to the patient because some have several health concerns.
• Individuals may not have access to technology/internet. Remote communities are affected because of insufficient infrastructure.
• There must be confirmation that filing a complaint would be the same if the care is virtual.

Other comments:

• How can nonverbal patients have equitable access to care?
  • Visuals are needed – telephone calls need a trusted facilitator.
  • There should be some capacity to be able to use augmentative communication tools such as the ToBI system.
• Virtual care has strengths but can also potentially enhance the inequities in our health care system if we become to dependent.
• Trust and accessibility: peer support can be beneficial so people can have assistance accessing and navigating the system.
  • The navigator must be a part of the system – not a volunteer.