Abstract
Introduction: The advent of the COVID-19 pandemic necessitated the need for several hospital-based ambulatory clinics to rapidly adopt digital health tools and virtual models of care to minimize community spread of the virus. The expansion and adoption of virtual care has the potential to become one of the biggest transformations in healthcare delivery of our time, which under normal circumstances would take years to accomplish. The accelerated need to better understand patient and provider digital health and virtual care needs in response to the pandemic led to the creation of a digital health and virtual care (DHVC) task force at a major urban hospital.
Objectives: The objective of this case study example describes the development, implementation and outcomes of a task force aimed at developing a vision for the delivery of excellent, equitable and efficient digitally integrated healthcare at a major urban hospital. The structure for the task force included two dedicated chairs supervising three working projects focused on: a) strategies and partnerships b) evaluation and data; and c) equity and quality. The task force set up a monthly meeting to refine parameters of how to define and categorize DHVC, update key findings from each working group, and to strategize on what activities were needed to achieve intended outcomes.
Key Findings: At the onset of the DHVC task force, virtual visits were defined as any that enabled direct patient care provided by phone or video while digital tools included any tool used before, during, or after a healthcare encounter to facilitate care including appointment booking, transmissions of test requisitions or education materials, remote monitoring and responding to patient inquiries. The ‘strategies and partnerships’ group explored existing policies and initiatives within and outside the hospital setting to enable DHVC adoption. The ‘evaluation and data’ group explored the capacity of the hospital to collect and extract metrics of DHVC through existing hospital databases and the ‘equity and quality’ groups worked to identify policies and best practices around delivery of safe and equitable DHVC. As well, the groups coordinated to create a provider and patient survey of DHVC experience, which included collecting data on facilitators and barriers to equitable DHVC (e.g., access to the Internet, digital literacy, language barriers, etc.).
Conclusions: The DHVC task force identified a number of barriers and facilitators to the widespread adoption of DHVC across the hospital organization. A number of recommendations were generated to optimize the adoption and monitoring of DHVC, which included strategies related to promoting the uptake of DHVC by equity-deserving patient groups.
Implications for applicability: The DHVC task force initiative provides a road map to help other healthcare organizations develop their own processes required to enable a critical reflection on the use of DHVC within their own settings.