Saskatchewan Virtual Care Action Plan: Targeted Health Canada funding

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I. Overview of areas of focus

Virtual care in Saskatchewan has primarily been delivered by Saskatchewan's Telehealth Network which began in 1999. It is the province's largest and longest running virtual care service with close to 400 Telehealth sites that delivered approximately 12,000 patient appointments and education sessions in 2020.

Saskatchewan's health system had been exploring options to modernize its aging Telehealth Network assessing whether a software based video conferencing system could serve as a replacement. The pandemic pressed Saskatchewan to quickly deploy one of those solutions so citizens could continue to access health services safely. Privacy and security assessments were completed for the selected video conferencing system however the urgency of the situation did not allow time to complete clinical trials. Additional licenses were purchased and made available to physicians and other patient facing health services for free. The Ministry also enacted temporary telephone and video virtual visit fee codes to support uptake by physicians.

Saskatchewan citizens were quick to adopt the new virtual care options which made it quicker and easier for them to access health care, particularly for those living in rural and remote communities. Between March 2020 and December 2020 Saskatchewan's physician billing system recorded more than 1.7 million virtual appointments, about 170,000 appointments per month (most by telephone). This is a dramatic increase from the pre-pandemic count of 1,000 virtual visits per month. Utilization rates are even higher if one includes the health care programs and services operated by the Saskatchewan Health Authority that are now using video conferencing to deliver services such as physiotherapy, speech therapy, counselling services, etc.

MySaskHealthRecord (MSHR) is a secure website that enables Saskatchewan citizens to quickly and easily access their personal health information including laboratory test results, medical imaging reports, immunization history, prescription history and clinical visit history. All personal information in MySaskHealthRecord is stored securely and can only be accessed through a highly secure, personalized login. The pre-pandemic goal was to grow MSHR to 150,000 accounts by March 2021. That target was achieved by the fall of 2020 as the demand for access to COVID-19 test results grew rapidly.

Shortly before the pandemic began, Saskatchewan's health system had been piloting Remote Patient Monitoring (RPM) to monitor about 10 lung transplant patients. The increasing number of COVID-19 tests results in a system that was working near capacity required an innovative response to support and monitor these patients. RPM was identified as an opportunity to monitor and support the growing number of patients in their homes with only a few health care workers. Existing workflows were adapted to monitor and support patients with COVID-19 in their homes. The new practice illustrated the intrinsic value of this technology and began drawing attention from other areas of the health system.

II. Initiatives under the bilateral agreement

1. Secure clinical video conferencing

In March 2020 Saskatchewan quickly deployed a provincial video conferencing system so that physicians and other health care workers could continue to provide care to patients and not spread the COVID-19 virus. The system had undergone privacy and security reviews but was pressed into service before clinical trials with physicians and other health care professionals could be completed due to the urgent need at the onset of the pandemic.

Health care providers have reported that the interim video conferencing system lacks several important features required for clinical use (virtual waiting room, single use links, integrated scheduling). Similarly, some patients complained that they could not connect with their health care provider using the new system, often because they lacked sufficient bandwidth for a video conference call.

The goal of this initiative is to deliver a secure provincial video conferencing system that is easy to use, works on multiple devices, is reliable, and meets the various needs of patients and the province's health care providers. Achieving these objectives could significantly improve patient access to health care across the province, particularly for people living in rural and remote parts of the province. Over the past several months, Saskatchewan's health system partners have collaborated to create a comprehensive list of requirements to procure a provincial video conference system that addresses the needs of patients and health care providers across the province.

By deploying a provincial video conferencing system our partners will share in a number of benefits, such as:

Support from Health Canada and Infoway will help sustain the programs using the interim system while work gets underway to procure a provincial video conferencing system designed for clinical use in a variety of health care settings. The Infoway lead multi-jurisdictional pre-qualification of vendors will help accelerate the procurement cycle and free up valuable Saskatchewan resources to focus on other health service priorities.

2. MySaskHealthRecord

Patient portals empower people to better manage their health through access to personal information and digital health tools and services. Research has shown that empowering patients to better manage their own health results in fewer Emergency Room visits and reduces hospital admissions.

In Saskatchewan, citizens can register for MSHR to gain access to their personal health information through a secure, password protected website that contains health information such as:

Demand for MSHR accounts has increased dramatically, driven largely by citizens wanting online access to COVID-19 test results. There is an urgent need to increase the number of licenses available to meet demand. The target to enroll 150,000 citizens by March 2021 was achieved in the fall, driven largely by citizens wanting online access to their COVID-19 test results. Federal funds will be used to increase the number of MSHR accounts by 50 percent, for up to 225,000 citizens.

3. Remote patient monitoring

Saskatchewan recently began using Remote Patient Monitoring (RPM) to monitor lung transplant patients following discharge from the hospital. As the number of patients who tested positive for COVID-19 began to rise, efforts quickly pivoted to use RPM to monitor and support these patients from their home. RPM technology allows one health care worker to monitor approximate 100 patients freeing up staff and hospital beds. As of March 9, 2021 just over 1,200 patients had been enrolled in the COVID-19 RPM program.

Federal funding will be used to expand the use of RPM for patients with COVID-19 across the province, including rural and remote communities. Funding will also help develop similar programs for patients with other serious health conditions. For example, there are approximately 64,000 people in Saskatchewan living with COPD, many of them seniors. RPM could be used to help these and other patients with a chronic illnesses to stay healthy and improve the quality of their lives. Federal funding will help expand the use of RPM to monitor patients with COVID-19 and in future patients with other health conditions.

4. COVID auto dialer system and Novari eReferral system

Federal funding will be used to purchase an auto dialer system and supporting Novari eReferral system that will be used to match patients with their test and results and notify them within 24 hours of lab confirmation of a negative COVID-19 test result. The province will continue to contact patients that test positive so they can answer questions and provide additional direction. Patients can choose to be notified by phone or text message.

The auto dialer reduces the number of people needed to contact patients. Front-line staff currently make these calls and the auto-dialer would free them to be redeployed to other pressing work such as providing patient care or supporting vaccination clinics.

Post-pandemic, the auto dialer could be used to notify patients that do not have a smartphone or computer about their lab results or other important health information.

III. Funding allocation table

Funding allocation table
Total funding to Saskatchewan - $6,468,152
Secure video conferencing $239 $917 $315 $1,471
Remote patient monitoring $630 $1,060 n/a $1,690
MySaskHealthRecord $9 $2,011 n/a $2,020
Auto dialer and Novari eReferral $725 $562 n/a $1,287
Totals $1,603 $4,550 $315 $6,468

IV. Performance measurement and expected results

Saskatchewan will use the specific performance measures and targets described below to track and report progress annually for each initiative funded through the bilateral agreement.
Initiatives Outputs Target outcome
Secure video conferencing
  • Number of accounts created for health care providers
  • Number of minutes used/month
  • Number of users in rural or remote communities
  • Numbers of support calls to service desk
  • Increase number of accounts
  • Increase minutes used
  • Increase % of rural /northern patients
  • Decrease number of support calls
Remote patient monitoring
  • Number of patients enrolled
  • Number of clinical areas
  • Increase number of patients enrolled
  • Increase number of clinical areas using RPM
  • Number of citizens with a MSHR account
  • Number of COVID-19 test results posted to MSHR
  • Increase number of citizens with a MSHR account
  • Increased % of COVID-19 test results posted on MSHR
Auto-dialer and Novari eReferral
  • Number of patients notified of their COVID test results by auto dialer
  • Increase number of test results delivered in under 24 hours

In addition, for the duration of the Bilateral Agreement for Virtual Care Priorities, Saskatchewan will work with CIHI and other Canadian jurisdictions to develop a set of mutually acceptable pan-Canadian indicators to measure progress on the implementation of virtual care technology and its impact on citizens. Saskatchewan will further commit its subject matter experts to assist CIHI in the development of appropriate indicators and to share relevant aggregate and potentially disaggregated data, if available.

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