Ontario's Virtual Care Streamlined Action Plan

On this Page

1. Overview of areas of focus
2. Initiatives under the bilateral agreement
3. Collaboration with pan-Canadian health organizations
4. Funding allocation table
5. Performance measurement and expected results
   • Summary of jurisdiction-specific indicators and expected results

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I. Overview of areas of focus

In 2019, Ontario announced its Digital First for Health Strategy to support a more modern, patient-centered health system, which prominently features virtual care. Under the Digital First approach, key aspects of the province's strategy for enhancing virtual care include:

• Setting clear targets at a population level for demonstrated use of virtual care;
• Moving towards a provincially set standards-based technology environment that emphasizes patient and provider choice of which tools they use for virtual care, provided privacy, security, usability and interoperability requirements can be met;
• Removing compensation-related barriers to virtual care, while encouraging appropriate use, across provider types (e.g. physicians, home and community care providers);
• Integrating virtual care into health system planning and the development of clinical pathways at multiple levels:
  • Provincial – Ontario Telemedicine Network (OTN) amalgamated into Ontario Health
  • Local – Ontario Health Teams (OHTs) given specific targets for adoption and use of virtual care; and
• Modernizing and connecting provincial supports for navigation and access (e.g. Health Care Navigation Service procurement).

In response to the COVID-19 pandemic, Ontario rapidly enabled and deployed a range of digital tools to address different areas of need, including:

• Enabling widespread, rapid uptake of virtual care (audio and video services) through implementation of temporary OHIP billing codes;
• Supporting mass sign-up of physicians for virtual tools through the Ontario Virtual Care Program (OVCP);
• Investing in regional virtual care solutions through Ontario Health's leadership;
• Giving patients online, real-time access to COVID-19 lab test results; and
• Leveraging Ontario.ca as a platform to provide information, and support Ontarians in making self-assessments and seeking additional care where required.

A substantial amount of patient care is currently delivered by over 13,000 physicians through the publicly funded Ontario Virtual Care Program, with 1.4M patient visits in 2019/20 and 2.2M visits completed in 2020/21.Through the temporary OHIP virtual care billing codes established in March 2020, more than 34 million additional virtual visits have been provided since the onset of the COVID-19 pandemic.

Given the maturing virtual care marketplace and increasing demand for virtual care services by Ontarians, the province is working to modernize its virtual care service offerings and models. Modernization efforts include:

• Expanding physician eligibility for the use of direct-to-patient video visits (for example at the patient's location of choice, such as at home, instead of only at a host site);
• Exploring a wider range of virtual visit modalities (for example audio and secure electronic messaging) to best meet the needs of patients;
• Updating virtual visit solutions standards and virtual care billing guidelines;
• Enhancing the integration and interoperability of virtual solutions and networks; and
• Testing and developing new compensation models to support a sustained shift towards virtual care as a core part of the care patients experience through Ontario Health Teams (OHTs).

II. Initiatives under the bilateral agreement

1. Virtual care initiatives implemented in response to the COVID-19 pandemic

   • A total investment of $1,000,000 will go towards the following 2020-21 priority virtual care initiatives related to COVID-19:
     • Ontario Health virtual care projects, including: virtual self-assessment triage; physician virtual case management; virtual care in the long-term care sector; and virtual critical care services.
   • These virtual care initiatives support the following objectives:
     • Ensuring continued access to safe and effective care during the pandemic by facilitating new and expanded virtual services that limit unnecessary in-person visits to reduce COVID-19 transmission; and
     • Supporting population health management and the ability to identify COVID-19 trends by geography and demographics in order to support public health efforts;
     • Triaging patients virtually, allowing for effective direction to primary care, emergency departments, or COVID-19 assessment centres and reducing unnecessary emergency visits;
     • Directing patients to reliable health information and self-assessment tools available digitally to increase patient knowledge and minimize information seeking requests and visits, freeing up health system capacity for direct patient care; and
     • Allowing programs that existed prior to COVID-19 to continue with minimal impact by ensuring required funds are not entirely reprioritized for pandemic response initiatives.

2. Seamless Care Optimizing the Patient Experience (SCOPE) program^{Footnote 1}

   • A total investment of $15,088,000 will go towards the SCOPE program in fiscal years 2020-21 and 2021-22:
     • In support of the Ministry's response to the COVID-19 pandemic, the Seamless Care Optimizing the Patient Experience (SCOPE) program aims to divert patient emergency department (ED) visits by providing unaffiliated primary care providers (PCPs) with timely advice from other providers on specialty care and medical imaging. The program offers PCPs a single number to access locally-adapted services, including:
       • A navigation hub for assistance in system navigation from a resource Nurse Navigator and home and community care coordinator;
       • A General Internal Medicine (GIM) specialist on-call for expedited phone consultations; and
       • A diagnostic imaging consultant on-call for advice on appropriateness of imaging, interpretation of results, and expedition of urgent imaging.
   • These virtual care initiatives support the following objectives:
   • Strengthening relationships, communication, and integration between hospitals and community and primary care providers;
   • Diverting patient visits to the emergency department to help limit the spread of COVID-19 and ensure emergency services remain accessible during the pandemic; and

     Improving patient navigation through the health system and access to care, including diagnostics and specialist care.

3. Supporting Ontario Health Teams (OHTs) investments in innovative virtual care models^{Footnote 1}

   • A total investment of $22,250,000 will be distributed amongst the expected 46 OHTs in 2021-22 to support the province in its efforts to create more effective, modern, integrated local health care services for all Ontarians. Federal funding will support OHTs with activities such as:
     • Implementation of virtual care (e.g. licenses, training, change management);
     • Testing of virtual care modalities within different team structures (for example integrated in-person and virtual care models) to inform best practices; and
     • Developing local virtual care pathways and preparing for integration with the forthcoming Health Care Navigation Service (HCNS).
   • This initiative will support the following objectives:
     • Achieving a modern, sustainable, and integrated health system by further investing in the provincial OHT model, with a focus on virtual care and digital health as key enablers for achieving more connected and patient-centered services for new and existing OHTs;
     • Improving patient experience and access to care for Ontarians by enabling OHTs to invest in technology, infrastructure, and training that support the implementation and enhancement of virtual care offerings; and
     • Promoting innovation and integration of health services by providing funding for OHTs to develop and test novel integrated models of care that combine traditional in-person and virtual services for their target populations.

4. Advancing provincial virtual visit solutions standards and verification of vendor technologies^{Footnote 1}

   • A total investment of $750,000 will be used in 2021-22 to continue advancing Ontario's efforts to modernize the provincial health system and further integrate the province's digital and virtual systems and tools in order to improve access to convenient, high-quality patient care. Federal funding will support the following work:
     • Moving forward the development of Ontario's virtual visit solution standards, transforming them into a robust verification process for vendor solutions (for example creation of a list of verified vendors for providers to choose from); and
     • Developing a virtual visit interoperability specification to support digital health information exchange aligned with the Digital Health Information Exchange (DHIEX) policy; and
     • Developing accessibility standards for virtual visit solutions in alignment with the Integrated Accessibility Standards Regulation under the Accessibility for Ontarians with Disabilities Act (AODA), including web content accessibility and supported languages, for consideration in an updated version of the standards.
   • This initiative will support the following objectives:
     • Continuing to ensure patient privacy and reducing risks by enhancing virtual technology guidance for vendors and providers that aids in the selection and adoption of appropriate virtual visit solutions;
     • Modernizing virtual care, fostering technology innovation, and increasing provider choice by allowing clinicians to use a wider range of virtual visit technology beyond the Ontario Telemedicine Network (OTN) through the implementation of a standards-based verification process for vendor virtual visit solutions;
     • Improving patient access to and choice of virtual services by allowing providers to use verified vendor solutions beyond OTN technology;
     • Maintaining and expanding the interoperability of existing telemedicine patient host sites that promote secure, equitable access to virtual care across the province by offering French language services, removing the barrier of device ownership and personal broadband access, and increasing availability of virtual care in rural and remote areas, including Indigenous communities; and
     • Facilitating the exchange of patient health information in a seamless, reliable, and consistent manner by increasing the interoperability of virtual visit technology and patient host sites.

5. Virtual urgent care and surgical care^{Footnote 1}

   • A total investment of $6,926,591 will go towards the following work in fiscal year 2021-22:
     • Virtual urgent care, which allows patients to access urgent care virtually for appropriate lower acuity health issues; and
     • Virtual surgical care, which supports pre- and post-surgical care virtually, in order to reduce in-person appointments, minimize patients' potential exposure to COVID-19, and support reducing the back log of surgeries.
   • These virtual care initiatives support the following objectives:
     • Addressing low acuity urgent issues virtually and reducing unnecessary emergency department visits to help limit the spread of COVID-19 and ensure emergency services remain accessible during the pandemic;
     • Supporting underrepresented and underserved populations, including Indigenous communities through targeted virtual urgent care and surgical care programs and community partnerships;
     • Targeting areas with higher than normal COVID-19 case rates in order to help maintain health system capacity and ensure local/regional health services are able meet increasing demands;
     • Reducing hospital wait times and increasing patient convenience by addressing less serious health issues virtually, in many cases avoiding an in-person visit altogether; and
     • Reducing surgery related service backlogs resulting from COVID-19 response measures;
     • Improving patient experience and post-surgery recovery through the use of technology to monitor patients' daily recovery, allowing clinicians to receive live notifications and alerts.

III. Collaboration with pan-Canadian health organizations

• Ontario will benefit from $2M investment from Canada Health Infoway (Infoway) to support a range of virtual care product and service enhancements at Ontario Health.

• As Infoway works to develop pan-Canadian virtual care standards, Ontario will continue to review and provide advice, ensure the standards' alignment with the province's existing virtual care standards, and advocate for the respecting of jurisdictional approaches to standards. As Ontario continues to advance its own standards, learnings will be shared to help inform Infoway's work and so that other jurisdictions may benefit from Ontario's experiences.

• As Infoway's efforts to develop a virtual care clinician change program and digital health literacy program for patients, families, and caregivers progress, Ontario will contribute to this work, throughout the duration of the bilateral agreement, and hopes to leverage its outputs to support the virtual care initiatives funded through the bilateral agreement.

• Pan-Canadian organizations, such as CIHI, can play a supportive role in helping Ontario to advance its virtual care policies and programs by conducting research and sharing findings on the impacts to patient outcomes, if any, resulting from the modality used to deliver care virtually (e.g. audio, video, secure messaging as compared to in-person care). This has been identified as a knowledge gap that is highly relevant to virtual care strategy and policy making. CIHI also plans to develop pan-Canadian virtual care indicators and performance measures, and to facilitate the development of virtual care billing codes. Ontario would benefit from any research outcomes that CIHI or other organizations may provide during the course of the bilateral agreement, to better understand the effectiveness of virtual care and to help inform virtual models of care to be tested and integrated by OHTs, as outlined above.

IV. Funding allocation table

V. Performance measurement and expected results

• Ontario will work collaboratively with CIHI to help define a set of common pan-Canadian indicators, using existing data, that CIHI will use to measure progress on virtual care implementation.
• Ontario will share with CIHI baseline data, within 90 days of mutual agreement between Canada and Ontario on the present Action Plan, and follow-up data, by October 1, 2022, on the following indicators already collected and reported by Ontario Health as part of the province's virtual care program, as per section 5.1.1(h) of the Canada-Ontario bilateral agreement:
  1. Number of virtual care visits conducted in Ontario annually;
  2. Number of patients who participated in a virtual care visit annually; and
  3. Number of patients who used a digital self-care solution annually.

Summary of jurisdiction-specific indicators and expected results