VIDEO TECHNOLOGY REDUCES “NO-SHOWS” IN COVID ERA June 25, 2020 When in-person mental health appointments were stopped due to COVID-19, a new virtual technology allowed clients to continue sessions from home Krisan Palmer, Virtual Care Manager When it became clear in March that COVID-19 was at New Brunswick’s doorstep, the healthcare system quickly mobilized to prepare for an influx of new patients. While most of the population began isolating at home, other parts of the health system had to devise ways to ensure existing high-risk patients and clients could still access it. The Addictions and Mental Health team was concerned about the impact on the mental wellbeing of its weekly caseload of 2,500 patients without their ability to be seen by a mental health practitioner. IMPLEMENTATION A live video solution was proposed, and Krisan Palmer, Virtual Care Manager and Clinical Lead was tasked with overseeing the rapid rollout of the Virtual Care Platform to almost 700 mental health clinicians across Horizon. “My role is to act as the liaison between the IT folks and clinicians, advocating for both the patient and the clinician to ensure technologies meet their clinical needs or they will not be adopted,” she said. “As a nurse, I know how frustrating technology can be at times when front line staff is given something to use with little or no input from the end-user.” A secure video Virtual Care Platform had already been in use within Horizon in conjunction with other specialties and Horizon’s mobile app, but it had not yet been fully deployed for real-time interactive video sessions. The pandemic prompted the rapid deployment of this aspect, incorporating Zoom, to Horizon’s 700 mental health practitioners. ADULT CLIENTS BENEFIT Dr. Anthony Njoku is Horizon’s Chief of Psychiatry for the Fredericton area and is no stranger to technology. He has been using video conferencing to see clients throughout Atlantic Canada at Horizon’s Operational Stress Injury Clinic (OSI) in Fredericton. An operational stress injury (OSI) is any constant psychological problem resulting from operational duties performed while serving in the Canadian Forces (CF) or as a member of the RCMP. Traditional appointments require clients to travel to a nearby hospital or clinic to use a video conference room. The new Virtual Care Platform means clients can log in for their video sessions using their phone, tablet, or computer from the comfort of their homes. Dr. Njoku remembers the common thinking for years had been that psychiatric treatment must occur in the hospital. Instead, the wide use of the Virtual Care Platform for personal video sessions is proving to be more convenient for the client and one that reduces the anxiety. “Now with COVID, this technology has taken things to a new level,” said Dr. Njoku. “It’s opening up service delivery and meeting clients at their point of need-wherever they are.” SAINT JOHN CHILDREN AND YOUTH CLIENTS Dr. Anjum Faridi, a child and adolescent psychiatrist for Horizon’s Saint John area and his three colleagues treat hundreds of youth. Dr. Faridi prefers his initial session with his clients to be in-person, as it allows him to better understand the dynamics and to pick up on non-verbal cues. For this reason, Dr. Faridi admits he was somewhat apprehensive about using the new technology initially, but since adopting it, he has seen the many benefits firsthand. “Moving to virtual was a seamless progression to this norm,” he said. “I just click the link and connect.” Dr. Faridi and hundreds of his mental health clinician colleagues have found that the clients and their families have enthusiastically embraced the transition to virtual care. As a result, the number of missed appointments compared to in-person appointments has dropped to almost zero. For example, in January, before virtual care was implemented, almost 14 per cent of clients across Horizon either cancelled or did not attend; in April it was half that, or seven per cent. Clients who called ahead to cancel in January amounted to 3.5 per cent of clients whereas in April, it was less than a tenth of that with .33 per cent cancelling their virtual appointments. Dr. Faridi notes it eliminates transportation issues and provides clients more privacy. PARENTS ENJOY THE CONVENIENCE Roger Vincent’s nine-year-old son Xavier has been in treatment for Oppositional Defiance Disorder (ODD) since 2016. Xavier sees a counsellor weekly. It took a couple of sessions before the technology was able to hold Xavier’s attention, but he is now very comfortable with it. “The counsellor would call him on Zoom and Xavier would go to his room with the iPad and do a session with the counsellor,” said Roger. “Xavier also had a psychiatric consultation with Dr. Faridi last week and we did it from home and it worked well.” In the pre-pandemic world, Xavier would see his counsellor weekly at school. His psychiatric appointments were more involved. They required Roger to leave work, pick up Xavier, attend his appointment, drop him off at school, and return to work-an ordeal that could take two or more hours. As a parent, Roger finds the Virtual Care Platform, an “incredible convenience.” “In certain circumstances, especially in the world we’re living in currently, having the online option of Zoom is phenomenal,” said Roger. “The outcome and the result are exactly the same, minus the inconvenience.” WIDER APPLICATIONS Most practitioners and clients agree. While it has been a necessary tool during COVID-19, the Addictions and Mental Health team expects Virtual Care to be a prominent part of their toolkit even after things begin to return to normal. The applications are endless and Krisan Palmer’s passion for improved access to health care for patients and clients means she won’t rest until this technology is more broadly available across many health disciplines. Cardiac Rehab and Heart Function clinics now have access and Krisan is currently in the process of deploying the technology in Public Health and Horizon’s Community Health Centres, with Oncology needs to be assessed soon after. Clinicians use it for individual sessions as well as for group sessions and clinical team meetings. Patients and clients can also now send information to their clinicians using the Horizon Health Virtual App, available for download from Apple or Google Play. Krisan sees Virtual Care as more than a tool for live interaction but also as a means to move data such as from an electronic stethoscope or pictures or videos of wounds for diagnosis. “Right now, the focus is on the direct virtual encounter,” said Krisan. “As people get more comfortable and as needs are identified, we can incorporate ways to move this medical data in a timely, secure, and confidential manner.” While the pandemic created loads of challenges to the health care system, it has been an unexpected motivation liberating Horizon to experiment with innovative technologies. For Krisan Palmer, technology is only as good as the people it serves. As a former nurse, she still carries the bedside compassion that drew her to her career and experiences a strong sense of reward when it improves the lives of patients and clients. “Clinical needs are what should drive the technology,” she said. “No one has time to fuss with workarounds in technology because it takes time away from patient care.”