COVID-19 has transformed many lives and communities, causing massive changes over the past ten months. Among many of the systems that adapted to the changing times is patient care. If you’ve needed to contact a doctor in recent months, you will likely have experienced some form of virtual care: including calls, emails, video visits or other remote options.

Virtual care first started to emerge in the early 2000s, but actual utilization remained low compared to today’s standard. In 2018 only 3% of Canadians used online video consultations. In contrast, a recent survey by the Canadian Medical Association found that 47% of people have used a form of virtual care during the pandemic. The question is, how does this alter the carbon footprint of hospitals, and will this behaviour change stick?

I was able to speak with Dr. Lucas Chartier, an emergency medicine physician, UHN emergency department Deputy Medical Director and Medical Director of Quality and Safety. Dr. Chartier was featured in an earlier blog post about unnecessary medical care, which you should check out, if you haven’t already! Our (also virtual) discussion was able to provide a look into how the transition away from in-person visits has impacted environmental costs as well as the quality of patient care.

An example of what a typical virtual ED care call might look like, provided by Dr. Chartier.

When looking at the trajectory of a patient, Dr. Chartier pointed out just how many resources can go into a single visit. Especially due to UHN offering many specialty providers, it’s not uncommon for patients to drive from across Ontario. For follow-ups and other appointments that are easily made virtual, the reduced transport cuts emissions and also saves times for patients – a win-win.

Stats for virtual care wait times demonstrating a convenience over in-person visits

Dr. Chartier shared that patients facing inconvenient travel distances are more likely to miss appointments or bargain for a six month follow-up versus three months. In these instances, telemedicine can offer a more timely and convenient solution.

Another huge factor is the use of PPE, not only for the patients coming in, but the physicians having to change their gloves, masks, face shields etc. Dr. Chartier also brought up an interesting issue; large hospitals have teams of people dedicated to procuring PPE. This is an area where small doctors’ offices can struggle. Therefore virtual care’s reduction in supply use, benefits not only the environment but also allows these smaller practices to focus on patient care rather than logistics.

The environmental savings don’t end there, due to increased sanitation requirements, virtual care saves both time and additional resources for cleaning in between patients. Especially if the patient shows any symptoms of COVID-19, meaning the room would require an even more costly ‘terminal clean’.

Although these points all provide great pros of the transition to virtual care, it doesn’t come without costs and criticism. Dr. Chartier described that when using virtual communication, there is a loss in granularity. For example, seeing how a more frail patient interacts with their environment (e.g., getting out of a chair or onto an examination table etc.) allows for the observation of changes in function over time. These differences are more easily caught in person.

Understandably, it’s currently more common for patients to avoid in-person care. Meaning less interactions with their health care providers, leading to to less granularity. This increases the risk of minimizing symptoms, lowering the chances of early screening of disease. Dr. Chartier stressed that this isn’t just scary for patients, but also health care providers, as they want to be able to provide effective care. We also got a chance to delve into some of his personal pandemic experiences, as even when treating ED patients in person, PPE impacts the ability to form a therapeutic alliance and the trust required between a patient and doctor.

However, improvements are being made in telemedicine, and doctors are adapting more robust methods of virtual care alongside its increasing prevalence. The majority of people who have experienced virtual care have had positive experiences. According to a digital health survey by Accenture, 33% of millennials and 41% of Gen Z have a preference for the new virtual platform.

An area of telemedicine currently being targeted for improvement is Emergency Department visits. Due to patients being more prone to avoid in-person care, there has been a noticeable decrease in visits. This has resulted in patients coming in later than they should have, in worse condition. To mitigate this, UHN has just launched “ED Virtual Visits from Home” as of December 14th, where patients can book online ED appointments. Hopefully, this new strategy will help patients get the emergency care they need promptly, despite any COVID-19 related fears.

To reflect on the question of will virtual care remain this prevalent post-pandemic, that depends on the specialty and circumstance. The real question is what is the safest in between to get the best of both worlds, which as of now is still unknown.