The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services

Abstract

Background News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. Objective The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. Methods A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. Results The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. Conclusions These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.

Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada

“…Yet this flexibility creates multiple challenges to directly compare programs, pool data, determine overall impact, and identify recommendations for future funding. While the VUC pilot programs described in the current work were rapidly introduced, many incorporated standard elements of program design such as a leadership structure, budget, patient engagement, and evaluation plan, and thus were not victim to many of the shortcomings recently described by a similar program implementation in Australia where rapid cycling and implementation were at the expense of evaluation and sustainability efforts ( 14 ).…”

“…Prior to the COVID-19 pandemic, there was a paucity of data related to virtual urgent and emergent care services in the published literature (7,8). As a result of innovations stemming from the pandemic, additional VUC services have been described for multiple American, Canadian, and Australian programs (9)(10)(11)(12)(13)(14). Despite the recent surge in publications related to virtual urgent and emergent care, implementation lessons learned remain underreported (14).…”

“…As a result of innovations stemming from the pandemic, additional VUC services have been described for multiple American, Canadian, and Australian programs ( 9 – 14 ). Despite the recent surge in publications related to virtual urgent and emergent care, implementation lessons learned remain underreported ( 14 ).…”

Improving the quality and sustainability of home-based acute care models using virtual care technology

“…Despite evidence suggesting that HITH is an optimal use case for RPM, the technology has not been routinely deployed in HITH programs throughout Australia. However, the onset of the global pandemic appears to have ignited clinical interest in remote patient monitoring technology [20]. It has also facilitated the rise of a new service model that combines HITH service provision with RPM and secure videoconferencing technology to create a new care delivery paradigm known as the 'virtual hospital'.…”

ChatGPT: Is This Patient Education Tool for Urological Malignancies Readable for the General Population?

“…The advent of the worldwide web and increasing adoption of virtual technology has “closed the gap” dramatically in the last decade, as can be witnessed during the COVID-19 pandemic. 5 Utilizing Telehealth conferencing, online resources, multi-way conversations over platforms such as Microsoft Teams and Zoom to name but a few equips the modern day health professional with a multitude of methods to communicate with patients effectively. 6 Similarly, patients can now have access to a large volume of information about their health conditions at the click of a mouse, without needing to seek medical advice or explanations from a medical professional.…”