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The question: Last week, I phoned my doctor’s office to book an appointment. I was told I could do an online video chat with her. Apparently, my “virtual” appointment was meant to help slow down the spread of COVID-19. It was very convenient – and, best of all, I didn’t have to pay for parking. Will I be able to keep seeing my doctor this way after the pandemic is over?

The answer: That is certainly the hope of many advocates of virtual care, also known as telemedicine, which can include video conferencing, e-mails, and old-fashioned phone calls.

In the past, many barriers stood in the way of the wider adoption of virtual care. There were concerns about patient privacy and debates over how much to compensate doctors for their time.

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But the sudden need for people to keep physically apart has led many provinces to adopt measures that make it easier for doctors to provide certain forms of care without seeing patients face-to-face. Ontario, for instance, has introduced new billing codes, including one that pays doctors for talking to patients on the phone or by video.

Almost overnight, virtual care has become the norm. And that is certainly true when it comes to nonhospitalized patients with COVID-19.

“Anyone who tests positive for COVID-19 at our institution, and has been discharged home to self isolation, is followed-up through a secure online platform or by telephone,” says Dr. Nisha Andany, an infectious-diseases specialist at Sunnybrook Health Sciences Centre in Toronto.

Andany is part of a team of health care providers who run a clinic for patients with various infectious diseases, ranging from tuberculosis to HIV. Most of the patients have traditionally come to Sunnybrook for their appointments. But a few of them – such as those who live a long way from the hospital – had the option of doing virtual visits through a program developed by the Ontario Telemedicine Network (OTN), which recently became part of the new provincial agency Ontario Health.

Founded in 2006, OTN is best known for creating a two-way video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their own communities. The patient simply goes to a telemedicine studio – usually in a nearby hospital or medical clinic – and connects with a doctor who may be hundreds of kilometres away.

However, in recent years, OTN has been expanding its virtual-care operations in ways that now permit patients to connect to health care providers using their own mobile devices or personal computers. That means a patient doesn’t have to leave home to see a doctor. What’s more, it’s not just meant for patients in remote areas.

So, when the pandemic struck, Dr. Andany and her colleagues were able to shift most of their infectious disease patients – including those with COVID-19 – to OTN’s online video-conferencing platform. Their other patients are being phoned for follow-up care.

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In the case of the COVID-19 patients, “we check in on them a few time a week to see how they are doing,” says Andany. “We know that some of these people will develop severe infection and we want to catch that as early as possible so we can get them into hospital for treatment.”

After the pandemic, Andany expects that virtual care will become far more common in many areas of medicine. Even so, health care providers and patients need to figure out where it works best.

“Because of COVID-19, we had to switch to virtual care very, very quickly,” says Dr. Simron Singh, a medical oncologist at Sunnybrook. “We don’t yet understand its impact on specialized areas of care such as cancer where care had to continue on in the pandemic.”

Singh has received funding from the Canadian Institutes of Health Research to study the experiences of cancer patients. The study will include focus groups and telephone interviews with patients.

As well, the study will take a deep dive into Ontario Ministry of Health databases – a wealth of information that will enable researchers to link the type of care a patient has received to actual health outcomes.

Over all, the greater use of virtual visits should make cancer care much more patient-centred, Singh says.

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Indeed, virtual visits are time saving and convenient for many people. They don’t have to take time off work or arrange for child care to see a doctor. No time is spent travelling to a medical clinic or sitting in a waiting room.

Dr. Ed Brown, chief executive officer of OTN, is also convinced the pandemic represents a major turning point for the health care system.

He notes that certain types of visits will remain in-person, such as when a doctor needs to physically examine a patient or perform a medical procedure. But there are many follow-up appointments and exchanges of information that don’t require the patient to come into an office.

“In the future, there is going to be more virtual care than in-person care,” Brown predicts.

Paul Taylor is a Patient Navigation Adviser at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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