British Columbia Virtual Care Action Plan

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Overview of areas of focus

Virtual care enables the direct delivery of care between a patient and a provider—or communication between providers regarding the care of a patient—at distance, using information and communication technologies. The COVID-19 pandemic resulted in a rapid and unprecedented system-wide adoption of virtual care in B.C.

The Province of British Columbia (the Province) has been establishing a foundation of information technology systems and tools to support virtual care adoption. Since COVID-19, adoption of virtual care has dramatically increased with approximately 86% of B.C. patients connecting with a physician virtually (phone, video, email, etc.) between April and September 2020 alone. In-person visits are a necessary and important way for patients to access care; however, this uptake is a significant digital transformation, and work will continue to advance virtual care in B.C. as appropriate.

The Province's COVID-19 response has accelerated implementation of many initiatives to augment and enable virtual care delivery. These include virtual clinics, real time supports for rural patients, access to emergency doctors, First Nations Doctor of the Day program and mental health services, patient portals to view COVID-19 test results and immunization history, remote patient monitoring, and other initiatives, which have demonstrated strong potential for continuation and further expansion.

There is now an opportunity to learn from the progress made thus far to better integrate virtual care pathways and solutions into local, regional, and provincial care delivery, including an appropriate balance of in-person and virtual care based on patients' needs. Capitalizing on these opportunities will continue to require digital and information management and information technology investments to support virtual care.

Concurrently, the Province is also developing and implementing provincial digital health and virtual care policies to ensure the appropriate use of virtual care and make improvements to longitudinal care for patients in a team-based environment. In addition, work is underway to enhance access to specialized services in the primary and community setting, better align virtual care investments to develop a sustainable health system, shift care to communities and patients' homes to relieve demands on the acute care system, and address provider requirements to sustain and scale virtual care adoption and digitally enable in-person care.

In the short run, investments in virtual care will continue to support an effective response to the COVID- 19 pandemic and empower B.C. residents to access care safely and conveniently from the comfort of their homes. Over the long run, the Province's virtual care strategic framework will continue to inform investment decisions on virtual tools, workforce, and other resources to enhance integrated, longitudinal care delivery in the B.C. health-care system.

Initiatives under the bilateral agreement

On May 19, 2020, federal, provincial, and territorial Deputy Ministers of Health agreed to five virtual care priority areas for immediate action in response to the COVID-19 pandemic. A high-level summary of the Province's work to advance initiatives under each of these priority areas is provided below.

1. Secure messaging and file transfer platforms or supports to enable end-to-end messaging

Primary, specialist and community care providers need access to comprehensive, shared clinical information to enable informed decisions based on a patient's care journey. The COVID-19 pandemic has accelerated the need to efficiently share clinical information with these providers, who are seeing patients both in person and virtually. The Province is working to ensure that providers have access to the patient information they need through secure messaging and file transfer platforms to increase patient equity and access to timely, coordinated care in all areas of B.C.

The Province will continue to build upon and leverage existing assets, including expanded access to CareConnect, which provides secure, 24/7 access to a secure and integrated provincial view of patient clinical information. Building on this and other infrastructure, the Province will continue to explore opportunities to collaborate and reduce cross-jurisdictional fragmentation and promote an improved patient experience by setting up providers for success with information required for their encounter (e.g., laboratory results, electronic prescriptions, special authority requests, encounter notes, diagnostic images, etc.). Key work includes implementing and improving privacy and security to ensure the appropriate use of patient information while expanding information-sharing.

Enabling end-to-end messaging will benefit all B.C. residents by consolidating patient clinical information to better inform care providers. This will particularly impact those seeking culturally safe and appropriate care, or those who may not be attached to a physician or nurse practitioner, and whose care is often distributed between care providers.

Federal funding will be used to advance multiple initiatives, including enabling secure sending and receiving of provider notes, referrals, and other digital health information with an open and standards- based approach; extending CareConnect access and content to include community-based primary care; enabling electronic prescribing in B.C.; and digitization of the special authority request process.

2. Secure video-conferencing technology to deliver care to patients remotely

Secure videoconferencing enables patients and providers to confidentially engage in a virtual setting, and has been shown to increase patient satisfaction and safety outcomes. The COVID-19 pandemic has intensified the need for the Province to expand upon secure videoconferencing, appointment notification, secure chat, secure online forms, and user technical support options with local and provincial virtual care providers, programs, and services. The Province is continuing to build upon current infrastructure and to implement solutions that provide virtually enabled care.

With videoconferencing remote care options, patients are conveniently able to access integrated care from home, thereby reducing the need to travel outside their community. Secure video-conferencing technologies also remove barriers to accessing care, and enable patients to access services regardless of location, accommodating better patient flow. Work will focus on ensuring services are built upon a foundation of an open, standards-based approach, including a focus on data privacy and security.

The Province is actively working to remove access barriers for patients who desire to connect with virtual care providers, programs, and services. The Ministry of Health has developed policy on culturally safe virtual care, and there is work being done in B.C. to improve connectivity. Increasingly, Indigenous patients will be able to virtually access culturally safe care, and this initiative will also remove barriers for those who may have difficulty attending an in-person appointment, including people with disabilities. Some initiatives under the scope of this area accommodate multiple language and/or translation options in line with B.C. demographics, and work is underway to explore a further expansion of language supports.

Federal funding will be used to advance multiple initiatives, including a proof of concept for regional access points for indigenous, First Nations and rural patients. This will facilitate access to in-person and virtual care for patients who are not familiar with options within their local primary care network and who need access to 24/7 emergency supports and/or non-urgent supports.

3. Remote patient monitoring technologies

Remote patient monitoring is a method of health-care delivery that uses technologies to remotely gather patient data, such as vital signs and assessment data. The ease and convenience of remote patient monitoring has been shown to increase patients' engagement levels, and provide clinicians a clearer picture of their patients' health over time, better equipping clinicians to understand and manage their patients' health situations. Use of remote patient monitoring technologies has increased during the COVID-19 pandemic as it provides an effective alternative to in-person monitoring for a variety of conditions, including COVID-19 monitoring.

Over the past decade, the Province has been advancing a remote patient monitoring foundation with the Home Health Monitoring project and other initiatives, aimed at supporting the deployment of innovative solutions to B.C. residents across a range of areas, including a variety of chronic conditions. Building on this work, the Province will explore opportunities to expand remote patient monitoring technology into a range of care settings, including primary and community care, specialized care, waitlist monitoring, and acute care, ensuring services are built upon a foundation of an open, standards-based approach, including a focus on data privacy and security. Work has begun to expand the use of remote patient monitoring and to increase interoperability across care settings throughout B.C.

Remote patient monitoring empowers patients to manage their health from the comfort of their homes and with support of their communities. By identifying and acting on opportunities to streamline and coordinate remote patient monitoring throughout B.C., the Province anticipates increasing quality and efficiency of patient care.

Federal funding will be used to advance multiple initiatives, including developing a provincial policy for remote patient monitoring that identifies priority focal areas from a population and public health-based perspective across a range of settings. The Province will optimize and scale up existing offerings and/or identify new areas and increase interoperability across care settings throughout B.C.

4. Patient access to COVID-19 and other lab results

Patient access to COVID-19 and other lab results empowers B.C. residents to proactively manage their health and wellness, improve access to their health information and services, increase care quality, and reduce health-care costs. In response to the COVID-19 pandemic, the Province has accelerated work on B.C.'s Health Gateway, which now includes the provision of self-serve information to patients on immunizations and vaccinations, COVID-19 test results, and dispensed medication history. The Health Gateway provides B.C. residents with easy and secure access to personal health information, regardless of location. In addition, services are being explored to help people navigate services that support their needs, including translation services and other culturally safe supports.

Work will continue to build upon this foundation to enhance B.C.'s Health Gateway and support the patient journey. Federal funding will be used to develop additional functionality in B.C.'s Health Gateway to potentially include lab results, diagnostic imaging reports, hospital and community health visits, personalized care plans, and other additional functionalities. The Province is leveraging the BC Services Card to ensure that B.C. residents' information remains secure, and will explore integration opportunities with other provincial government services.

5. Back-end supports for integration of new platforms and supports, including hardware

Information technology infrastructure and support services are essential to enabling virtual care and the COVID-19 digital response. The Province will continue to invest in a modern infrastructure to sustain virtual care improvements and ensure a seamless patient and provider experience.

Through back-end supports for integration of new platforms and solutions, systems will work more consistently for users. Work will focus on ensuring connected services are built upon a foundation of an open, standards-based approach, including a focus on data privacy and security and data interoperability and integration. This initiative improves equitable access to virtual care in the province and enables all B.C. residents and providers to access technical support, regardless of location.

Subject to the Province's standards for our digital ecosystem, federal funding will be used to support digitally enabled, team-based care, including consolidated support services for B.C. residents and providers to continue to improve user experience.

Collaborative relationships

Where applicable, the Province will continue to work in a collaborative way with:

Funding allocation table
Area 2020/21Footnote * 2021/22Footnote * TotalFootnote *
1. Secure messaging and file-transfer platforms or supports to enable end-to-end messaging $8.0M $8.0M
2. Secure video-conferencing technology to deliver care to patients remotely $3.2M $3.2M
3. Remote patient monitoring technologies $0.6M $0.6M
4. Patient access to COVID-19 and other lab results $2.2M $2.2M
5. Back-end supports for integration of new platforms and supports, including hardware $4.0M $4.0M
Footnote *

These are notional allocations and $s will be adjusted between areas as specific projects that support the Action Plan are implemented

Return to footnote * referrer

Performance measurement and expected results

The Province will be developing a provincial approach to evaluating digital health and virtual care pilots and initiatives, monitoring virtual care, and exploring options for cohort studies to measure the impact virtual care and digital health initiatives have on population health over time. In collaboration with Health Canada, the Canadian Institute for Health Information, and other partners, the Province will work to further define indicators and measures to support pan-Canadian efforts to measure virtual care implementation progress.

Area/initiative Outputs Projected outcomes
1. Secure messaging and file- transfer platforms or supports to enable end-to-end messaging
  • Increase in the number of interactions between providers; increase in provider productivity
  • Increase provider satisfaction with the ability for digital tools to increase care coordination among interdisciplinary teams
  • Improve use of asynchronous virtual care and optimize clinical workflows where possible.
  • Increase patient satisfaction with easy-to-use, easy-to- learn tools, and experiences of culturally safe and appropriate care by the right provider at the right time.
2. Secure video-conferencing technology to deliver care to patients remotely
  • Increase in use of technology in improving access to integrated health services
  • Increase patient satisfaction with virtual care consults
  • Increase patient satisfaction with easy-to-use, easy-to- learn tools, and experiences of culturally safe and appropriate care by the right provider at the right time.
3. Remote patient monitoring technologies
  • Avoided inpatient stays per patient
  • Reduced cost per inpatient stay
  • Reduced emergency department visits
  • Increase in provider productivity
  • Care is provided as close to home as possible
  • Increase patient satisfaction with technology use, and experiences of culturally safe and appropriate care by the right provider at the right time.
4. Patient access to COVID-19 and other lab results
  • All B.C. residents can access COVID-19 test results and immunization records through Health Gateway
  • Increase patient satisfaction with access to their own information, and access to information where appropriate for their children and others they care for, who cannot access their own information
5. Back-end supports for integration of new platforms and supports, including hardware
  • Improved information exchange between platforms leads to better information at point of care, at patient's fingertips, increased provider productivity
  • Improved information from virtual care visits contributes to longitudinal Electronic Health Records and Personal Health Records
  • Better population health, improved patient experience, improved cost per capita
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