Advancing the Use of Health Technology to Improve Quality of Care

The pandemic caused an acceleration of virtual care

In all industries across most of the world, the pandemic changed the way services are delivered and the way people access those services. In some cases the changes were temporary based on circumstance, whilst in other industries those changes were a catalyst for permanent change. That was certainly the case at the Fraser Health Authority in British Columbia, which had begun services like the provision of virtual healthcare just before the pandemic, and was looking to modernize other services too. Christy Boyce, the Virtual Health Learning Consultant, says that pre-COVID, they had just begun enabling telehealth rooms using video conferencing solutions, but essentially these were still in their infancy. It was however a strong priority and important for them to enact such solutions because Fraser Health is the largest health authority in British Columbia, with a team of just over 43,000 staff, medical staff and volunteers, responsible for the delivery of hospital and community based services and other health services to more than 1.9 million people in 20 diverse communities. Not all of them are always able to visit a hospital, so providing virtual opportunities was important.

The plans were in place for pilot trials and remote patient monitoring, but then the pandemic came along and everything changed. Suddenly our focus was reactive with a massive demand for video-based care. Like almost everyone, within a matter of days they shifted their activities to create and provide clinical guidelines, software and process training, and hardware, all of which was designed to allow clinicians to actually reach their patients despite the mandatory social distancing. It was all being done on the fly, and we were rapidly still building out some of the core structures and features as we flew.

2021 saw a consolidation of all the learnings, with a clinical service redesign and improved virtual access points. By mid-2022, this led to the virtual healthcare team being five times larger than pre-COVID, with specialized resources to incorporate evidence into clinical practice. We’re now moving beyond the use of just video-based care for patient assessment and treatment. We’re supporting innovative ideas and are actively redesigning outpatient education. For the first time since the pandemic began, when it comes to virtual health, we feel more sturdy and reliable.

How Fraser Health measures up

In fact, they are feeling so comfortable in this space that they adopted the Virtual Care Maturity Model. Maria Montenegro, the Evaluation Lead for Virtual Health at the Fraser Health Authority, says that this model was actually developed by Digital Health Canada and is a guide to help organizations identify where they are in their virtual care journey. The framework has three levels of maturity across six domains. Since Fraser Health had to ramp up their operations so quickly, it has helped us understand where our maturity of virtual care is at and how we can move forward. The model is not specifically an assessment tool, but it is a way of measuring performance against certain standards since it compares results with other jurisdiction. More importantly, it allow us to have patient partner involvement and the engagement of other key partners. It reflects their experiences and perspectives. Once the results have been analyzed and plotted, they will be embedded into our strategic planning for 2023 and 2024.

As mentioned, the maturity model has three broad levels. Christy Boyce says that by applying the model, Fraser Health is able to see where they are currently at, and how they can improve. For instance, under the banner of digital health literacy, patient and provider literacy is still underestimated as a virtual health success factor. This means that both clinicians and patients don’t always have the literacy to engage in virtual healthcare seamlessly. This means we will be emboldening clinician education for student nurses, doctors and allied healthcare workers to make sure that everyone enters into the organization with strong computer and digital health literacy. It also means the creation of e-learning platforms and “striving to support public partnerships that improve patient digital literacy.

As a result of not all patients having the requisite literacy, there is inequity and we are still seeing gaps in virtual care service access. Not only is there a literacy gap, but a technology access gap as well. This particularly affects marginalized groups such as the homeless or hearing or visually challenged persons, but also people who don’t have secure WiFi. This is related to the domain of infrastructure, and to combat this, policies will be enacted, but Fraser Health is also working with municipalities to create virtual care access points in sports clubs or public and community based locations. Ensuring better access and infrastructure is a very necessary step.

The third and final level relates to the field of regulation. There are currently many gaps in policy and regulation that are still constraining our evolution and our forward momentum for virtual health adoption and integration. For instance, currently many of the regulations that Fraser Health uses were not specifically designed for virtual care and thus need to be reworked to fit virtual care in. For the future, it is hoped that new policies can be developed and can serve as a centralized repository for general virtual care guidelines and care standards related to all modalities of virtual care.

Future plans

Overall, Maria Montenegro says that for now, Fraser Health is mostly in the basic maturity level, so there’s still lots of work to do. The highest score came from the user experience domain, but we still know that there’s a lot we can do to improve in this respect. For instance, Fraser Health is currently developing a patient engagement strategy to make sure that we are consistently and respectfully engaging patients in our work. In fact, they are even considering setting up patient advisory councils and research programs, as well as standardized indicators to measure quality and patient experience, specifically as it relates to virtual care. 

Virtual care at Fraser Health, even before the pandemic was a priority, but has now become mainstream. However, feeding into this maturity model has allowed them to see where they currently sit and where they need to improve.