Virtual care today creates more work

For virtual care to truly reach it's potential clinicians need more powerful tools and evolved processes for care

In many ways the pandemic has accelerated the progress of virtual care in a way that nothing else could possibly have achieved. Today it is perhaps safe to say that there is not a single clinician that has not had to experience delivering virtual care. And very few patients, actively seeking care who haven’t had to experience receiving it. 

From my experiences building Suvera and training as a doctor, it is clear that virtual care has reached a moment of reckoning. Patient satisfaction is higher than it has been accessing care but clinician satisfaction with work is lower than it has been pre-pandemic. 

Essentially as I see it virtual care in its current format is improving accessibility of care for patients but is increasing work for the team caring for them.

In the early days of telemedicine this wasn’t clear. There were early signs that patients would prefer this experience because they could be at home have access to a clinician, cutting out hassle of doing to see the doctor. But it was also thought that patient care would be sub optimal because they would be without a physical exam and would be reduced to a lower fidelity interaction with their clinician along with internet issues, video lags, and technical issues. Not to mention the vast vast majority of clinicians have never been trained our to deliver quality care virtually.

In reality some of these concerns remain. But what has become clear is that virtual care has reduced the effort to accessing care, and for many maintained quality of care, and in some regards improved it. Patients only came in when they needed to and over most interactions in primary care, most were resolved or could be actioned upon over the phone or video. Even when the patient had to come in it was focused and intentional. In and out. 

For most clinicians, over the last year, the apprehension over whether virtual care would be enough to maintain quality, soon became less of a worry. Over time, clinicians have released they could adequately manage patients without seeing them F2F. Yet worries over how this more widely accepted model of care is changing workload for clinicians remains a concern and seems, from my perspective to be one the biggest issue today with delivering care virtually.

The increased access of GPs especially in NHS (which is free at the point of use) has meant for many GPs - virtual care has increased work. 

Having looked at the issue for some time now. I realised this increase in work typically is associated with needing more time for three things - Triaging, Troubleshooting and Coordination of care. 

With triaging - GPs, are receiving more demands for care via virtual care than without it. Hence the need to be better and faster at triaging without compromising quality of care is draining. This means knowing when to escalate the medium of care from an e-consult to video to in person or to A&E. The dynamics of managing multi-channel communication, multi-complex patients with less upfront signals creates greater clinical challenge that fundamentally requires more work. Not to mention the EHRs in place are woefully ill-equipped to support this dynamic and fast moving model of care.

With troubleshooting - virtual care creates more room for error. Virtual care requires more tools which increases the number of potential technical issues, time spent dealing with duplicated information due to lack of interoperability, poor user experience and troubleshooting for patients tech savy and non-tech savy alike. All of this creates additional cognitive burden that makes working as a clinican delivering virtual care again feel like more work. The technology for virtual care just isn’t good enough yet to rely on

With Coordination - unlike when patients used to go to the care team, the care team now go to see the patient via virtual care and so spend more team scheduling around the patient than the other way around. This is the multiple missed phone calls, or the bounced text message or voicemails that go unread. We also mustn't forget that virtual care increases the volume of care because care is more accessible. This overall back and forth, with greater volume of activities will undoubtedly create a time sink that previously wasn’t there.

With this more enhanced understanding of the opportunities and constrains of virtual care (also with much more still to learn). From where I stand, for virtual care to reach it’s full potential better tools, processes and services need to be built  with virtual in mind from the very beginning - to address the increased work that it creates for Clinicans today. The vast majority of patients wouldn’t have it any other way. Virtual care is here to stay.

At Suvera we building to do just that. We are building a proactive virtual care service built with these challenges in mind. By being more proactive with care, we believe we can reduce the work of virtual care by preempting rather than reacting to it. By building purpose built technology to reduce troubleshooting and coordination, we anticipate our clinicians to become some of the most productive at their work in the country. 

Virtual care creates more work today, yes. But that for me signals an opportunity to rethink what we do in the pursuit of a healthcare that is virtual first, that is easy for clinicians, but most importantly improves outcomes for all patients.