Manitoba Virtual Care Action Plan

In 2019, Shared Health released Manitoba's Clinical and Preventive Services Plan (CPSP), a five-year plan that outlines new approaches to health care for our province that will guide improvements to access, quality and patient outcomes for all Manitobans. The plan was developed over 18 months, and included consultation with clinical providers and health care professionals working on the front-lines of care as well as community leaders, health organizations and individuals. Manitoba is committed to improving access to care and quality of patient outcomes within the modern system proposed by clinical experts. Increasing the use of virtual care was a consistent theme throughout the plan's development, with health care providers emphasizing the need to plan and deliver health services differently and better, in response to Manitoba's unique population and geography.

In response to the COVID-19 Pandemic, Manitoba rapidly established new and expanded virtual solutions to support continued access to care and critical health information. While use of traditional virtual solutions such as hospital to hospital telehealth decreased, in large part due to necessary restrictions on facility access, use of other virtual solutions, many of them new, reflected both a new demand and increased acceptance of virtual approaches, virtual visits, including telephone visits, experienced broad adoption across Manitoba with 2.8M tariff claims processed for virtual visits since March 2020.

Among Manitoba's COVID-19 Response, the following new virtual tools were implemented:

Work on the detailed implementation of the CPSP is actively underway. Several key virtual care initiatives are included in the planning and are targeted to be delivered by the end of fiscal year 2022/23.

These initiatives will allow Manitoba to rapidly deploy virtual care solutions for Manitobans, ensuring ongoing access to high-quality care not only in response to COVID-19 but as part of the longer-term implementation of the clinical plan.

1. Initiative - Remote Home Monitoring

Provincial Remote Home Monitoring Project

Manitoba is establishing a remote home monitoring service and is currently selecting a Provincial Remote Home Monitoring solution through public tender. In late 2020, remote monitoring of patients with low to mid acuity COVID-19 was established as part of the Virtual Outpatient COVID Monitoring (VCOP) initiative based at Health Sciences Centre Winnipeg (HSC). VCOP provides service to patients with COVID-19 who have been discharged from HSC or referred to the program by an Alternative Isolation Accommodation (AIA) site. The initiative allows patients to connect regularly with a care team during their period of self-isolation or following discharge from hospital. The program is able to support those who may require home oxygen during their recovery and includes partnerships with emergency response services to ensure timely response should patients require in-person follow up or experience more severe symptoms.

Building upon the success of the VCOP initiative, Remote Home Monitoring will include implementation to support monitoring of patients at home with the following Chronic Diseases: Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF) and Type 2 Diabetes with potential expansion to other conditions in the future. Other conditions will be established during further refinement of Manitoba's Provincial Clinical and Preventive Services Plan and may include Mental Health and Addictions, contact follow-up for COVID, and post-surgical care monitoring, among others.

Home or community-based programs can offer more intensive virtual health counselling, provincial coordination, remote monitoring of biometrics and client reported health to support self-management at home (e.g., for patients living with chronic and complex medical needs. This could result in decreased Emergency Department visits, decreased hospitalizations, readmissions and hospital days within the patient cohort. In addition, this can result in increased patient and provider satisfaction, increased self-monitoring, increased medication adherence, increased physical activation and patient quality of life.

Key target milestones (estimated)

Overall budget - $5.1M (to be supported by funding from Manitoba Health and Canada Health Infoway).

Performance measures

Number of new clients supported in the new program - Target is 800 patients annually receiving chronic care monitoring with associated emergency visits and inpatient days being avoided

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

Enhanced virtual care - (Virtual Visits and Collaboration Project)

The virtual visit and collaboration group of projects are foundational initiatives within the digital health support of the Provincial Clinical and Preventive Services Plan. These will add virtual capabilities to home/patient location options to existing virtual solutions connecting patients in facility-based locations to health care services. Investments in additional virtual tools and services for patients and care providers will support the practice changes and ensure coordinated access to care through a wider range of virtual means. The initial focus will be on mental health and primary care settings to address COVID-19 pressures and resolve process and workflow barriers.

Digital solutions are expected to include videoconferencing with point of care integration, secure messaging, and other tools to support workflow such as securely ordering labs.

Virtual visits have long been available in Manitoba via video conferencing tools such as MBTelehealth equipment in 189 telehealth sites. Although an extremely beneficial tool prior to COVID-19, there were limitations to accessing these virtual tools as a result of COVID-19 restrictions on access to health care facilities where this technology is most often located. With the introduction of virtual care, individuals are able to receive care without leaving their homes and without travelling to a health care facility.

There is a gap in Manitoba as none of the current applications meet the full requirements for virtual collaboration.

Due to the COVID-19 pandemic, some virtual tools have been fast tracked to provide virtual meetings and virtual visits safely. With use and adoption there are now additional needs and capabilities to be investigated and implemented for patients and caregivers to provide a consistent, safe, modern and standardized virtual care experience.

This initiative will enable increased access to care through virtual care, particularly for residents living in rural or northern locations. This will result in decreased requirement for patients to travel and will improve access to care closer to home. Through implementation of formal supports, practice standards and guidelines, there is an expectation that there will be an improvement of uptake for this service by both patients and providers.

Federal funding will be used over 2020-21 and 2021-22 to support the implementation of service including procurement of any new solutions identified, establishing clinical workflows, and organizational change management, and implementation and other expenses in alignment with the Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19. Manitoba will also explore opportunities to engage Canada Health Infoway for use of additional available funding and support.

Key milestones (estimated)

Provincial Virtual Care Service Delivery Framework - May 2021

Overall budget - $7.0M (including federal support $2,189.0 K)

Performance measures

Increased access to Rapid Access to Addictions Medicine Clinics for individuals - (metrics under development)

3. Initiative - Patient access to COVID-19 and other lab results

Patient Engagement Platform Project

Improving and simplifying patient navigation of the health system is a priority of the CPSP and an area that virtual health can support by easing access to an individual's own health information.

Currently, the public must search in multiple places for information about care options and generally do not have easy access to their own health information. While this project will not address all gaps, it will create a foundation for significant improvements. Initially this project will establish mechanisms for the public to access health information in both official languages, beginning most likely, with lab results. Access to selected patient engagement surveys building on work already underway to standardize on PROMS (Patient reported outcome measures) and PREMS (Patient reported experience measures) will also be established. Additional scope to be considered depending on project delivery timelines is to include patient engagement tools (for example, provide health system feedback, volunteer for opportunities to participate in patient committees).

This initiative will enable better access for the public to their health care information to assist them in self-management and care decisions. This will also result in reduced calls to primary care for routine lab test results and provide better feedback on health system performance.

Federal funding will be used over 2020-21 and 2021-22 to support the implementation of the solutions including procurement, establishing workflows, developing information and materials for the public, organizational change management, and implementation activities and other expenses in alignment with the Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19. Manitoba will also explore opportunities to engage Canada Health Infoway for use of additional available funding and support.

Key milestones (estimated)

Overall budget - $5.7M (including federal support of $1,211.4 K)

Performance measures (in development)

All Manitobans receiving lab tests are able to access these online

4. Initiative - Back-end supports; hardware for integration of new platforms

Provincial Surgery Waitlist and Information Management Project

COVID-19 has had a significant and lasting impact on elective and non-urgent surgical procedures, requiring postponement and cancellation of thousands of surgical slates in order to ensure staffing, beds and resources could be redeployed to support critical care capacity for Manitoba's sickest patients. As a result, Manitoba must now both re-start and catch up on surgical scheduling, however, processes to support surgical prioritization and demand management are at present manual and disjointed.

Manitoba is intending to implement a provincial system to provide insights to surgical demand and to support priority-based scheduling. These tools will position Manitoba to produce accurate, transparent, real-time data to inform provincial decision makers and support ongoing CPSP system change. The surgical tracking system currently in use is nearing end of life and does not have interoperability with surgical systems or future central intake. Access to robust real time data would allow immediate flagging of cases that do not meet provincial guidelines.

This project will implement a provincial surgical prioritization and scheduling system for surgical slating. This will both improve patient flow and monitor surgical slate utilization. The solution will be integrated with the provincial Client Registry. This aligns with the CPSP Integrated Access planning which is considering broader intake, consultation and referral solutions.

This initiative will enable more effective management of procedure scheduling which may assist in reducing the backlog of delayed procedures due to COVID-19 restrictions. Reducing delays with key procedures will improve patient access to care.

Federal funding will be used over 2020-21 and 2021-22 to support the implementation of the solution including: establishing workflows, interfaces to other related systems, organizational change management, and implementation activities and other expenses in alignment with the Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19.

Key milestones (project to be completed within 17 months of start up, pending funding approval)

Overall budget - $2.3M (including federal support of $389.4K)

Performance measures (in development)

Reduce workload associated with manual tracking of measures - (metrics under development)
Reduce backlog of surgical procedures that were delayed due to COVID - (metrics under development)

Rural Connectivity Project

Ensuring consistent and reliable connectivity to support the Digital Health projects outlined above across rural Manitoba will allow patients and providers to make appropriate use of these key initiatives with potential to improve quality of care. Addressing current connectivity limitations to enhance network capacity in rural SDOs is a priority.

This project provides a mechanism to address anticipated bandwidth and network limitations for the projects above to meet targets, which will enable system performance and service levels to a standard necessary for digital services. It will address capability gaps and inequities that may put digital enabler projects at risk in some settings.
A key CPSP transformation principle is that patients will have equitable and accessible access to services and are not disadvantaged by geography. This initiative will improve existing infrastructure to all rural RHAs which can reduce technical limitations that impact their ability to fully participate in future provincial digital systems initiatives.

Federal funding will be used over 2020-21 and 2021-22 to support the implementation of the solutions including assessment of existing capabilities, procurement, of hardware or services and rollout to the impacted service delivery organizations and other expenses in alignment with the Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19. Manitoba will also explore opportunities to engage Canada Health Infoway for use of additional available funding and support.

Key milestones (estimated)

Overall budget - $6.8M (including federal support of $3,254.2K)

Performance measures (in development)

Consistent network and infrastructure standards - Target To be determined

Federal funding allocation tableTable 1 footnote *
($1,000's) 2020-21 2021-22 2022-23 Total
Patient Engagement Platform $62.0 $1,023.3 $126.1 $1,211.4
Enhanced Virtual Care $110.0 $1,698.5 $380.5 $2,189.0
Provincial Surgery Waitlist and Information Management n/a $311.5 $77.9 $389.4
Rural Connectivity n/a $2,788.3 $465.9 $3,254.2
Total Funding $172.0 $5,821.6 $1,050.4 $7,044.0

Summary of jurisdiction-specific indicators and expected results

Manitoba will work collaboratively with CIHI to identify a set of pan-Canadian indicators and provide jurisdiction specific baseline data that will be used by CIHI to measure progress on virtual care implementation supported by federal funding under this agreement; where possible and appropriate this will also include disaggregated data (e.g. broken down by age group, gender, etc.).

Initiatives/Projects Outputs Target Outcomes
Patient engagement platform All Manitobans undergoing lab tests are able to access results online
  • 90% of publicly funded lab tests available
Enhanced Virtual Care Increased access to health services, including access to Rapid Access to Addictions Medicine Clinics
  • Increase in virtual visit volumes particularly in mental health
Surgical Prioritization and Scheduling Reduce workload associated with manual tracking of measures
  • Reduce backlog of surgical procedures
Rural Connectivity Consistent network and infrastructure standards
  • Undertake connectivity modernization in at least 50% of facilities targeted for capital construction through the clinical and preventive services plan to meet the requirements of new virtual solutions.
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