London hospitals offer virtual-visits designed for inclusiveness

As part of the vision to enable equitable access to virtual care, London Health Sciences Centre and St. Joseph’s Health Care London have been enhancing their technology so that a wider-range of patients are able to benefit from virtual visits – including the disabled and those who find it difficult to use computer technology.

While virtual care for ambulatory patients at London Health Sciences and St. Joseph’s Health Care, London made up only about 3% of all visits prior to the COVID-19 pandemic, at the height of the crisis, nearly 90% of outpatients were being seen in this way.

Right now, some 30% to 40% of outpatients are using virtual visits, commented Stephanie Johnston, manager of Virtual Care Operations at LHSC and St. Joseph’s.

“It’s likely to continue in this way,” said Johnston. “It’s a profound shift.”

Johnston noted that virtual care consists of both telephone calls and video visits. For video, the hospitals have been making use of Webex Instant Connect by Cisco.

While telephone communication makes up the majority of the virtual calls, Johnston observed that use of video is growing and that patients who use it actually like it better.

A study conducted by the hospitals found that patients who used video are two times more likely to find the experience satisfactory than those who communicated by telephone with clinicians.

The effectiveness of video visits has led Johnston and her colleagues to put time and resources into improving the experience by integrating with the hospitals’ electronic medical records. What once took over 40 clicks and about three-and-a-half minutes for administrative staff to connect to one virtual visit, is down to just 30 seconds.

Patients don’t have to download any software either, but instead, they simply enter a web-based session in which no personal information is stored.

They also receive electronic reminders about their appointments, something that benefits patients and caregivers and reduces the number of missed encounters.

While virtual care has enabled patients during the coronavirus pandemic to continue seeing their caregivers, many observers have noted that segments of the public haven’t benefited. They include individuals with cognitive challenges or hearing impairments, others who may struggle with English as a second language, as well as those without computer literacy.

On this score, Cisco’s Webex team has made dramatic improvements to virtual care in the past two years.

“We’ve brought equal access to the forefront,” said Sarah Reuter, general manager of Webex Canada.

“We implemented screen-reader support for those with visual impairments, and we’ve created closed-captioning for the hearing impaired,” said Reuter. “It’s now baked into the product.”

The single-click access to the Webex is also important, said Reiter, as it makes it easier for those without much computer experience to easily get into an online appointment with a doctor.

“If they had to do 10 clicks, it wouldn’t be accepted,” she asserted. “We wanted to shorten the whole process, so with one click, they’re in.”

Reiter emphasized that Webex sessions are held over secure networks, and that patient information never leaves the system.

Johnston said the team is also creating “store and forward” solutions for those working hours during which clinicians may be unavailable. This will give patients the ability, 24-hours a day, to leave messages and information for their caregivers using the virtual care solutions.

When they are free, the clinicians can pick up the messages and set up virtual care meetings, if needed.

“Patients are looking for flexibility,” commented Johnston, noting the rise of virtual care has provided several major benefits.

“Patients can call during a break at work or from home,” she said. Importantly, the technology is saving many patients long commutes to the hospitals.

Families with children have been among the prime users of virtual care, adds Johnston. Patients with mental health needs have also made substantial use of the technology, as have people with chronic conditions and those with physical disabilities who find it difficult to make the trip to a hospital.

Johnston said that LHSC and St. Joseph’s will continue to expand their use of virtual care. Key to the work, she said, will be including patients in the design of new features and programs. “Patients will help us to drive change,” she said. “They will show us how care needs to be delivered.”