Nunavut's Virtual Care Action Plan

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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:

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:

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

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:

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:

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:

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:

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:

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

Funding allocation tableFootnote *
Total Funding to Nunavut - $3,114,518.00

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.

Summary of jurisdiction-specific indicators and expected results
Initiatives Outputs Target outcome
Nunavut Patient Portal
  • Level of public input secured on proposed portal
  • Level of clinician/heath care provider input secured on proposed portal
  • Supported service and technology model to move forward with a range of services:
    • Secure messaging
    • Access to information
    • Scheduling
Clinician virtual care service
  • Patient and provider satisfaction, patient outcomes
  • Changes in patient consultation profiles (ratios of virtual consultations to in person consultation)
  • Improved quality of life for Nunavut population that live with chronic diseases
Clinical collaboration using Microsoft Teams and Office 365
  • Utilization of Microsoft Teams for clinical collaboration
    • % of clinicians using Microsoft Teams
    • Satisfaction of clinicians with the Microsoft Teams platform
  • Number of privacy breaches arising from clinical collaboration
  • Significant increase in the daily rate of utilization of Microsoft Teams by clinicians
  • Zero tolerance policy for privacy breaches arising from Microsoft Teams collaboration
Nunavut virtual shared services
  • Develop an overall plan for Virtual Care in Nunavut, and frameworks for privacy evaluation and data collection
  • Identify policies and directives that will enable expanded access for Nunavut citizens, while respecting security / privacy.
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