Nunavut's Virtual Care Action Plan

On this page

• Background
• Bilateral projects
• Nunavut Patient Portal
• Clinician virtual care service
• Clinical collaboration using Enterprise Microsoft Teams and Microsoft Office 365
• Nunavut virtual shared services
• Funding allocation table
• Evaluation indicators

Background

In April 2020, the Nunavut Department of Health quickly worked to put in place needed virtual care supports so that Nunavut residents could continue to access care during the pandemic. The Department initiated discussions with Canada Health Infoway to utilize $1M in funding that had been allocated for Nunavut under the Rapid Adoptions Virtual Care Fund. A funding agreement was finalized with Canada Health Infoway that led to an investment of $970,000 and the initiation of a series of projects, comprised of:

• Expansion of the license capacity for Microsoft Office 365 to facilitate the expanded utilization of Microsoft teams as a clinical consultation and collaboration platform.
• Upgrading of the video bridge used by Health to deliver virtual care services to increase the number of video sessions that could be supported at the same time. A new bridge was implemented with capacity in the range of 50-80 concurrent video sessions (vs. the previous 10). This extra capacity is being utilized not only for the traditional telehealth applications, but to also support secure remote consultations between physicians and residents.
• Expansion of the number of software licences for the software applications used to connect to the new bridge.
• Acquisition of web-cams and headsets to facilitate the wide-scale use of remote conferencing and remote consultations for clinicians and staff.
• Assessment of the feasibility of integrating Microsoft Teams with the new video bridge.
• Acquisition and implementation of the Telus Health iSheduler Telehealth Manager scheduling system, with interfaces with the territorial Meditech Clinical Information System (CIS), Microsoft Active Directory services, and the new video bridge.

Subsequently, on May 2020, the Federal/Provincial/Territorial (FPT) Conference of Deputy Ministers agreed to five priorities on virtual care to be supported by federal investments. This included additional funding to support virtual care in partnership with the PTs, with $3.11M being allocated for Nunavut to flow through a bilateral agreement. The plan for the new funding covered the following areas:

• Technology and infrastructure:
  • Secure messaging and information-sharing platform or supports for end-to-end messaging
  • Secure video-conferencing technology
  • Remote patient monitoring
  • Patient access to COVID-19 and other lab results
  • Back-end supports for integration of new platforms and supports, including needed hardware

In addition, FPT Deputy Ministers agreed to shared work in two other streams:

• Policy supports for virtual care:
  • Change management, remuneration, workflow and clinical practice linked with implementation of any new tool
  • Need for policy framework to support longer-term uptake and use of virtual care as another channel for delivering insured health services
• Cost-benefit analysis:
  • Benefits analysis and evaluation to assess the impact of virtual services to improve the efficiency and sustainability of care

To support the planning for this process, a Virtual Care Working Group was established within the Department of Health, and proposals were solicited for potential projects. After several months of work by the group a number of projects had been identified (with several formal project submissions) and these were brought forward for consideration by the Health Information Steering Committee within the Department of Health. The projects selected for inclusion to be funded under the bilateral agreement were:

• Nunavut Patient Portal;
• Clinician Virtual Care Service;
• Clinical collaboration using Microsoft Teams.

Bilateral projects

The following projects are being funded through the bilateral agreement with Health Canada:

Nunavut Patient Portal

This project will plan for the implementation of the Meditech Patient and Consumer Health Portal and the Virtual Visit Solution modules within Nunavut's territorial Meditech clinical information system (CIS) environment. The Meditech Patient and Consumer Health Portal engages patients in their care by giving them access to valuable health information online. Patients and their authorized healthcare representatives can manage a wide range of health data from a single portal from wherever they are and at their convenience. Patients can securely send messages to and receive messages from providers, access a Health Summary, request or directly book appointments, and review their health information from within Meditech. The portal also supports Meditech MHealth to allow patients to utilize full portal functionality on smartphones and tablets.

The Virtual Visits enhancement to the Portal will allow patients the ability to video conference with their health care providers directly through the Patient and Consumer Health Portal. Patients will have the ability to request or directly book these appointments from their tablet or smartphone using the MHealth app. Booked appointments provide the patient with immediate notification as well as check-in capability. Within the Meditech Web Ambulatory module (which is planned for initial implementation in Iqaluit, Nunavut in early 2022) the care provider is able to confirm they have a patient in the Video waiting room and can launch the video session as well.

Federal funds will support:

• Finalization of Project Scope and Project Plan;
• Environmental Scan of Portal Deployments in other jurisdictions;
• Development and approval of Portal Conceptual Model for Nunavut;
• Development and approval of Detailed User Requirements for the Nunavut Portal;
• Development of a detailed Project Plan for the acquisition and implementation of the NU Portal, including the proposed technology model for the portal and the potential software components and network services to be utilized

Clinician virtual care service

Virtual health care services will reduce the need for clinicians to travel to Nunavut to support new chronic disease care program, while improving the care Nunavut residents receive in their home communities.

In this project, nurse practitioners and physicians will participate as members of multi-disciplinary chronic disease teams, supporting the health care team in the community health centres in their dealing with their chronic disease patient populations via Telehealth and virtual care technologies. The clinicians will liaise with nurses working in the communities to manage clients remotely. The clinicians will support the provision of care to clients through virtual means during the appointments.

A pilot project was conducted to trial this new care model for chronic disease management. The objective of this program is to expand the virtual care service to provide episodic illness management to health centres. The virtual NP is paired with Licensed Practical Nurses (and other clinicians at the health centre) to provide the virtual services.

Activities under the project will include:

• Finalize scope and budget;
• Adaptation of the service delivery model and clinical workflows from the pilot project to a territorial service;
• Training of the health care staff at the project sites to utilize the service;
• Provision of hardware (such as scopes, patient exam cameras) to the community sites as required;
• Learning by current Health Information Unit eHealth telehealth team to allow enhanced support as part of a virtual health coordination team.
• Deploy and deliver the service;
• Embed data collection to analyze and monitor benefits accomplished by Clinical Virtual Care Service;
• Develop an operational funding model to support transition to a long-term sustainable program service.

Clinical collaboration using Enterprise Microsoft Teams and Microsoft Office 365

The response of the Government of Nunavut to the ransomware incident in the Fall of 2019 saw the adoption of the cloud-based Office 365 (O365) platform from Microsoft as the primary desktop environment for staff, including staff and health care providers within the Department of Health. As part of the O365 environment all GN staff were provided with access to the Microsoft Teams collaboration tool. With the advent of the COVID-19 outbreak restrictions on travel coupled with periods of office shutdowns saw significant growth in the use of Microsoft Teams as a communications tool for traditional conferencing/meeting applications, as well as health care providers utilizing the tool for the support and delivery of clinical services, both for remote consultations as well as file sharing between members of clinical teams. With the pressures arising from COVID-19 this utilization of Microsoft Teams grew organically, without significant planning or the development of policies and guidelines to guide the effective use of the tools or to ensure that standards of patient data privacy and confidentiality were being maintained.

Clinical Collaboration services must exist within the overall health technology environment within the Nunavut Health Care System, which is comprised primary of Meditech's Clinical Information System as well as other software platforms including Medigent and Med/2020. The Team-based clinical collaboration process must integrate with these platforms and not lead to the creation of separate collections of patient information distinct from the single electronic health record existing for each resident in Nunavut.

The work proposed in this area under the Action Plan would see the development of a structured framework within the Department of Health under which the utilization of Microsoft Teams as a tool for clinical collaboration would be strengthened and enhanced.

Federal funding through the bilateral agreement will support a number of specific activities, including:

• Finalize project scope and budget;
• Finalize the operational definition for clinical collaboration within Nunavut and define a number of Use Cases representing the initial models to be supported;
• Conduct a Request for Information Process for software tools (that is integration engine) to integrate MS Teams with the core NU health software platforms;
• Finalize the conceptual model for clinical collaboration;
• Conduct Privacy Impact Assessment (PIA) on the proposed solution for clinical collaboration;
• Acquire/Implement the integration engine solution with a specific focus on Microsoft Teams/Meditech integration;
• Developing training/support materials to support the defined use cases;
• Implement the initial collaboration models based on the use cases;
• Evaluate the initial implementations of clinical collaboration and refine models and use cases.

Nunavut virtual shared services

In addition to the activities under three defined projects, federal funds provided through the bilateral agreement will support additional activities to strengthen the Nunavut Virtual Care Program. These include:

• Agreement and project management: Overall management of the bilateral agreement and the activities under it.
• Virtual care program planning: Development of an overall plan for Virtual Care in NU encompassing the projects under this agreement as well as future expansions into areas such as 811 services and remote patient monitoring.
• Privacy framework development: Development of an overall health data privacy framework to support the implementation and expansion of virtual care services in NU.
• Data management and analytics: Support services to manage the collection and analysis of data from within the projects to support evaluation and program planning activities.
• Benefits evaluation framework: Creation of an overall framework to guide the evaluation of specific projects under the agreement and address the defined indicators under the agreement.
• Technology planning and management; Support services related to technology acquisition and implementation in support of project activities.

In addition to the initiatives supported by federal investments under this bilateral agreement, Canada Health Infoway has also been allocated an additional $2 million of 'in-kind' resources to support the Department in the roll-out of these projects and to strengthen virtual care in Nunavut.

Funding allocation table

Evaluation indicators

Nunavut will collaborate with the Canadian Institute for Health Information (CIHI) in its work to identify a set of pan-Canadian indicators and where possible, provide jurisdiction specific baseline data that will be used by CIHI to measure progress on virtual care implementation, including disaggregated if available.