'The sky's kind of the limit': COVID-19 ushers in new era of e-health, says Higgs

Saint John family doctor Mike Simon's waiting room is only half as full as it was prior to the COVID-19 outbreak, but he's no less busy.

He now has virtual appointments with the other patients.

"We're sort of separating patients into those who I have to see [in person] and examine, versus those that I can talk to on the phone about test results, or reordering medications, or counselling," said Simon.

"It's allowing us to keep the social distancing rules in place and it's allowing us to keep medical care ongoing without compromising patients' health.

"It's great."

84% of all GP appointments virtual

Last month the provincial government authorized physicians to see patients virtually for routine services, such as prescription renewals and followup health advice, to minimize in-person contact and help curb the spread of COVID-19.

The appointments can take place over the phone or through a secure video-chat software.

According to the Department of Health, 84 per cent of all family doctor appointments across the province have been handled virtually since then.

I think that … the future is e-health and it is extremely important for us to be able to meet the demands that are facing our province.- Blaine Higgs, premier

Premier Blaine Higgs believes COVID-19 has ushered in a new era of e-health that is here to stay.

"Not only that, I hope that we'll be able to continue what we've learned here and expand upon it," he said. "It would be a shame for us to move back from what we have experienced during this, the innovation we've seen."

"I think that, you know, the future is e-health and it is extremely important for us to be able to meet the demands that are facing our province."

Could help with doctor shortage

Higgs believes virtual appointments, for example, will continue after the pandemic is over and could help ease the province's doctor shortage.

Virtual appointments tend to take less time, he said, and would enable doctors to see more patients.

"We should be able to utilize technology to absolutely manage our number of doctors required," said Higgs.

Virtual visits could also work for non-critical patients in busy or understaffed emergency departments, or for those who live in remote areas and need to see a specialist, he said.

As of the end of February, 39,677 New Brunswickers were registered with Patient Connect NB as needing a family doctor, according to the Department of Health.

Fredericton has the most registrants at 7,199, followed by Moncton at 5,967 and Saint John at 5,690.

But not everyone on the list is an orphaned patient, said department spokesperson Bruce Macfarlane. Up to 20 per cent have a primary health-care provider but want to change, he said.

eConsult avoids unnecessary referrals

The eConsult program, which enables family doctors to consult electronically with specialists, is also proving promising, said Health Minister Hugh Flemming.

The program, introduced in 2018 and expanded in the past month, shows about 40 per cent of cases can be dealt with without the patient being sent to the specialist, he said.

"Unnecessary referrals were avoided by using eConsult, and this has been seen to improve population health, it reduces the per capita spending, it provides better and quicker service, it's higher level of patient and provider satisfaction. So it's a very good program."

Four new specialties — cardiology, hematology, medical oncology and internal medicine — have been added to the program, bringing the total to 15.

Patient access to medical file

The premier also envisions expanding the e-health records system to give patients access to their own medical file so they can "be more in tune with their particular situation" and get any test results as soon as they're available instead of waiting days or weeks to hear them from their doctor.

"The sky's kind of the limit," Higgs said.

Last week the province launched a new web portal — myhealth.gnb.ca — where people tested for COVID-19 on or after April 20 can securely access their results online as soon as they are available instead of waiting for a phone call from Public Health.

They will still receive a call from Public Health, but the site will enable them to get their results faster, as soon as the tests have been processed, usually within 24 to 48 hours.

New Brunswick marked its 11th straight day with no new cases of COVID-19 on Wednesday.

Of the province's 118 total cases to date, only four remain active, one of whom is in hospital, chief medical officer of health Dr. Jennifer Russell announced. That's a 97 per cent recovery rate.

But Russell expects a second wave of the virus related to travel or even community transmission.

'Walls have really come down'

Higgs said a lot has been accomplished in the past month, with the Department of Health, the two regional health authorities, doctors and other stakeholders all working together to combat COVID-19.

"The walls have really come down … between our different health organizations."

He cites as an example being able to quickly find nursing home placements for 180 seniors who had been awaiting placement in hospital — so-called alternate level of care, or ALC, patients, resolving a long-standing problem to make way for an anticipated influx of COVID-19 patients.

That spirit of co-operation continues as they discuss augmenting services at the province's hospitals, currently running at about 60 to 70 per cent capacity, Higgs said.

"So we're looking at how do we ramp that up, but not in a way that was done in the past.

"How do we change our ability to have a better experience for patients coming to receive health care, both for their knowledge level and for their actual ability to get in and out, you know, in a reasonable period of time?"

Doctors 'very ready' to use technology

Based on his discussions with doctors, Higgs said they're "very ready" to use technology.

"They want to be part of a changing environment because they recognize how critical it is to the success of future health care in our province."

Dr. Chris Goodyear, president of the New Brunswick Medical Society, said the feedback from physicians about virtual appointments has been positive so far.

"It seems like most are happy with being able to provide some of the care for their patients virtually," he said.

"It's certainly not going to supplant an office visit" because some patients will still require a physical exam, such as a patient with a breast lump.

"But as most physicians become more comfortable with it, it's certainly going to be part of their toolkit going forward in terms of patient care."

Virtual care offers several advantages for patients as well, said Goodyear.

It can spare those with mobility problems from having to travel to their doctor's office, he said.

When a winter storm forces an office to shut down, patients could still be seen virtually.

It also enables doctors to work outside normal office hours and schedule appointments at times that are most convenient for both them and their patient, said Goodyear.

So if, for example, a patient needed to have their blood pressure medication reviewed, instead of having to take a half day off of work to go to their doctor's office, they might be able to schedule an evening virtual visit, he said.

"I don't think we've touched on all the opportunities that virtual care can present going forward. And as we get more comfortable with this and as more technology comes into play, it's only going to improve what we can do for patients."

Not much video yet

Goodyear, who is a general surgeon at the Dr. Everett Chalmers Regional Hospital in Fredericton, has used virtual appointments to follow up on some of his patients after surgery.

He has also used virtual appointments to see some new referrals, such as patients with gallbladder disease, going over their medical history, any lab work and diagnostic imaging.

"So I have that in front of me and I'm able to discuss everything with the patient."

He has used both the telephone and video platforms, but believes the majority of virtual care being offered by doctors right now is only over the phone.

"A lot of patients don't necessarily have access to the internet, and they may just be more comfortable with a phone call," he said.

Not all physicians are comfortable with the video option yet either, Goodyear said.

"As it continues on, certainly we may see a shift from mostly phone models to more video models."

Nervous about hacking

Simon has only used the telephone for his virtual appointments with his Saint John-area patients.

"I'm a little nervous personally about online security and any kind of hacking that could happen," he said, noting he still uses a lot of hard copy documents.

He also finds it easier for both him and his patients to just pick up the phone than to launch a video platform on a computer.

"It seems to be quite successful for me," said Simon. "I'm delivering what I consider good care through the phone. So I haven't felt a need to change."

The security of the video platforms being used by doctors and "privacy stuff certainly have to be looked at," said the health minister.

"That's an evolving situation. And again, a legitimate question, but we're early in the process," said Flemming. "It was done to deal with COVID."

"Limited discussions" had been underway between the province and the medical society about virtual appointments, but "the wheels of government move slowly at times."

There were details to work out, such as remuneration and documentation, he said.

"But once you get something like COVID you just say, 'Look, let's do it because we need to preserve the social distancing, we need to tackle a pandemic, and we'll maybe work out some of the normal details after the fact instead of before.'"

Although the virtual appointments were brought in "hastily because of the pandemic," Flemming said the province will work with other stakeholders to see what other e-health opportunities exist, given the "power of technology."

"I mean, everybody has a cellphone, which is much more than a phone now, it's a pocket computer," he said.

And "health care is constantly innovating, it's constantly improving, it's constantly looking at best practices.

"So, my goodness, why wouldn't we?"