By Fran Yanor, Local Journalism Initiative Reporter

Some rural doctors have been toiling for a decade to achieve what the COVID-19 pandemic delivered in weeks.

Within a month of the pandemic hitting B.C., social distancing and other measures have forced health practitioners to dramatically shift their mindsets and practices from nearly 100 per cent in-person visits, to the majority of care now delivered virtually.

One of the early architects and adopters of telemedicine, Dr. John Pawlovich, lead telehealth expert at the Rural Coordination Centre of B.C. and medical director of Carrier Sekani Family Services based in Prince George, has helped to develop online programs to support to health practitioners and patients in rural, remote and Indigenous communities. /DAVID LUGGI

“I think, we were in low single digit percentage points provincially for telehealth type visits,” said Jeff Hunter, Chief Information Officer for Northern Health, responsible for telehealth programs in the health authority. “I don’t have good numbers yet, but from what I hear anecdotally with physicians is they’re doing upwards of 80% by video, or by phone in primary care.”

Dr. John Pawlovich is the telehealth sector lead for the Rural Coordination Centre of BC and unlike most general practitioners, he had already been delivering two-thirds of his care virtually before COVID-19 hit. He is a medical director at Carrier Sekani Family Services, which he called “pioneers of telemedicine in the north.” It serves remote and Indigenous communities in

Carrier territory in north central B.C. and it was work in these communities a decade ago that first helped them understand how telehealth could assist during emergencies such as heart attacks and stroke as well as work in day-to-day primary care.

A host of telemedicine initiatives already in operation regionally, or well-developed enough to come onstream quickly, have gotten a boost during the COVID-19 epidemic.

A rural virtual locum doctor program will serve communities without a full-time physician and support doctors serving not-easily-reached rural and remote populations with a second virtual presence if needed.

“The capability to have a virtual doctor support a community quickly, makes a lot of sense during this pandemic time,”said Pawlovich.

When the provincial 811 COVID-19 information service was overwhelmed by callers, a virtual assessment program was quickly mobilized. In the north, phone traffic to this service was unprecedented. As of Apr. 17, after little more than a month, agents in Northern Health have fielded 9,636 calls, 4083 nursing visits and 2753 nurse practitioner or physician virtual visits.

The pandemic also fueled the Virtual Doctor of the Day into life. A First Nations Health Authority-led program, it allows Indigenous people without a family physician to access a doctor no matter where they live in the province.

Pawlovich. said these programs didn’t come out of thin air. “They came out of a lot of work over the last decade by many people.”
The painstaking process of experimentation of different telehealth initiatives led the way to an existing pilot program in the Robson Valley that continues to give rural doctors ‘on demand’ access and support of either an rural emergency room generalist or a critical care doctor ‘at the bedside.’

“It’s a click of a button on your phone and you have a video link to an intensivist that can see what’s going on in your emergency room and can chat you through things,” said Dr. Stefan

Du Toit, who works out of the Valemount Health Centre.

Having another medical professional, off-site, and emotionally removed from the situation and dedicated to helping, was monumental. Before telehealth, rural doctors phoned colleagues or cold call the nearest emergency room, hoping the doctors on duty weren’t too exhausted or overwhelmed by their own emergencies to stop and help.

COVID-19 social distancing measures have fueled increased use of telehealth by health care practitioners. Some early adopters like Dr. Stefan Du Toit (pictured) in Valemount, have been using digital apps and video conferencing for years to get emergency room peer support and quicker access to critical care specialists for their patients. /JOHN PAWLOVICH

Now, Du Toit and his colleagues connect “with a friendly face” through apps on iPads, mounted on a trolley, and linked to a big screen hung on the wall.

A scientific evaluation of the Robson Valley pilot project concluded cost and time savings for patients who averted hospital visits, and more confidence in diagnoses for rural doctors who got a second opinion.

Both programs are now offered to all physicians working in rural, remote and Indigenous communities.

The only downside to the earliest telehealth initiatives was the increased workload for consulting doctors.

“These people would make themselves available 24/7 with no funding for their time,” said Pawlovich.

The pandemic changed that. Doctors can now bill for virtual care, which Pawlovich called ‘transformative.’

Funding has enriched the programs Du Toit, Pawlovich and other rural doctors previously relied on, infusing them with much-needed resources and support, and ensuring funding for the technology and the second-opinion doctors who provide the round-the-clock advice.

Where is it all going?

People living in rural and remote communities, and indigenous communities have the greatest inequities in accessing health care, Pavlovich says. “People don’t live as long in these communities and they can’t access healthcare in the same way.”

His dream is a reimagining of the whole health care sector in B.C.. To move from disparate pieces and people working in silos, to a provincial healthcare team, separated by geography, but connected by technology and relationships. To live anywhere in the province and have access to a full range of healthcare services, virtually.

“We could do a lot more care that way,” said Pawlovich. “And more effectively and thoughtfully close healthcare gaps across the province and increase access for everybody.”

What seemed impossible – to get wholesale buy-in from practitioners, funders, communities, and the Ministry of Health at the same time – has just come to pass.

“What that tells me is that it is possible,” said Pawlovich. “Because it just happened.”

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