Collaboration in action: RTVS rapidly deployed during Covid-19 pandemic

“The best laid schemes o’ mice an’ men / Gang aft a-gley.”  – Robert Burns 

The month of April was extraordinarily busy for many BC rural health organizations. After securing and distributing Zoom healthcare grade videoconference licenses for rural physicians and nurse practitioners in rural BC communities for the next year, RCCbc and our collaborative partners – the Joint Standing Committee on Rural Issues (JSC), First Nations Health Authority (FNHA), the Provincial Health Services Authority (PHSA), Providence Health Care, UBC Department of Emergency Medicine, and the BC Emergency Medicine Network – ran flat out to create and deploy several Real Time Virtual Supports in anticipation of both Covid-19 cases and a surge in urgent and/or emergent cases in rural emergency departments. These pathways are currently live and support rural patients, all BC First Nations citizens, rural primary healthcare providers, rural specialists, and rural BC locums. (See listing at the end of the article)  

The different Real Time Virtual Supports (RTVS) available for patients and rural primary care providers. Created with Lucidchart

These supports were not created overnight. When news of the novel coronavirus was quickly followed by the arrival of the first imported travel-related case to BC in January, members of BC’s Collaborative Centre of Excellence for Virtual Health moved quickly to identify useful resources, and to coordinate and deploy virtual supports to enable rural healthcare providers at the front line. Existing supports – like the ROSe group – pivoted quickly to offering Covid-19 management, while new tools – like RUDi, HEiDi, and the FNHA-led First Nations Virtual Doctor of the Day projects – were organized and deployed in mere weeks. “The rapid launch of these resources wouldn’t have been possible without the strong relationships that were already established between each of the partners,” acknowledges Dr. John Pawlovich, lead for RCCbc’s Real Time Virtual Supports strategy. In the years preceding the Covid-19 pandemic, for example, RCCbc and the First Nations Health Authority committed time and energy in discussing what telehealth and virtual care could look like in rural and remote Indigenous communities. During that same time, PHSA’s Office of Virtual Health generously offered its expertise with various technology platforms and provincial deployment of that tech infrastructure. UBC’s Department of Emergency Medicine and the BC Emergency Medicine Network reached out to RCCbc to build a strong provincial emergency medicine network and database that is inclusive of the rural emergency context. “We are all familiar with each other’s strengths, and have experience collaborating and integrating our work,” observes Dr. Pawlovich. “Because we share that knowledge, trust, and commitment, all partners were able to mobilise both their individual and collective pieces quickly under exigent conditions.”  

The many BC organizations who came together to mount a rurally-focused rapid response to the Covid-19 pandemic

More rural RTVS pathways are in development and will be rolled out at a future date. Keep an eye on developments through RCCbc’s eNewsletter or on the RTVS web page. “Ideally, if we could prevent Covid-19 from entering BC’s rural communities, that would be the best outcome,” said Dr. Pawlovich. “Realistically, we need to resource rural front line healthcare workers so that they have the capacity to address both cases of Covid-19 and any associated surges in ED cases. If they need a second opinion, or an available specialist for a consult, or a fresh set of eyes for a patient concern, that help is can be had nearly instantaneously. These RTVS supports will ensure that rural providers feel supported and less isolated during the pandemic, and likely into the future beyond that as well.” 


RTVS support pathways for BC First Nations citizens and rural BC citizens

  • HEiDi – The HealthLink BC Emergency iDoctor-in-assistance (HEiDi) service introduces a Virtual Physician to the provincial 8-1-1 nurses call flow. HEIDI’s immediate goal is to increase capacity and assist nurses with decision support to meet the needs of the COVID-19 crisis, which has substantially increased the number of calls and time spent on calls due to inherent complexities. 8-1-1 nurses can transfer calls that meet specified clinical criteria to a Medical Office Assistant (MOA) who in turn will arrange for a virtual visit or call with a HEiDi physician. 
  • First Nations Virtual Doctor of the Day – FNHA, in partnership with RCCbc, are ensuring that primary health care is accessible to all First Nations citizens across the province. This service is available 7 days a week from 8:30 am – 4:30 pm. To book an appointment, clients call: 1-855-344-3800. Each visit is triaged and scheduled by a response group of Medical Office Assistants (MOAs) and is hosted by Zoom.  
    This service is currently active province-wide. For more information, contact RCCbc at virtual@rccbc.ca.   

Support pathways for BC rural healthcare providers 

  • Virtual care platform access – provision of Zoom licenses to rural physicians and nurse practitioners, through JSC funding. 
  • RUDi – real time virtual rural generalist and ER support, 24/7Visit the RTVS web page for access info 
  • ROSe – real time virtual intensivist/critical care support, 24/7. Visit the RTVS web page for access info Rural Virtual Dermatology Service – dermatology support is available Monday to Friday from 9 am to 5 pm. Visit the RTVS web page for access info. Calls outside of these times should be directed to the on-call physician/dermatologist and/or your local ER. For details about this service, contact Dr. Nathan Teegee at virtual@rccbc.ca
  • Virtual Locum Service – Working with Locums for Rural BC to offer a more flexible approach to locum support including linking locums with community. Temporary policy and administrative changes are now in place, addressing: 
    • “essential” locum assignments 
    • number of locum days 
    •  support for ALL RSA communities from the Rural GP Locum Program (RGPLP), Rural GPA Locum Program (RGPALP), and Rural Specialist Locum Program (RSLP)
    •  locum assistance via telehealth 

Details about these temporary changes are outlined in the latest Locums for Rural BC newsletter. 
 
If you have any questions, email info@locumsruralbc.ca or leave a message at 1-877-357-4757 and a locum officer will get back to you.