Virtual Care Feasible in High-Volume Cancer Center

Alejandro Berlin, M.D., M.Sc.

Implementation of virtual care at scale at a high-volume cancer center may be feasible, according to new study findings.

Such an approach preserved outpatient caseloads and maintained care quality all while rendering high patient and practitioner satisfaction. The findings could help guide the transformation of telemedicine after the COVID-19 pandemic is over.

Alejandro Berlin, M.D., M.Sc., and colleagues examined the outcomes of a cancer center-wide virtual care program in response to the pandemic. The team of investigators collected data from the Princess Margaret Cancer Center in Canada from March 23 to May 22, 2020. They aimed to streamline the mass redistribution of virtual care and supporting healthcare practitioner remote workflows.

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The investigators developed the Virtual Care Management System (VCMS), a browser-based application that integrated with the enterprise scheduling system and electronic health record system. The VCMS could list the physician’s upcoming in-person visits, federation of the last clinical note for rapid contextualization, and documentation of the virtual care triage decision. The decisions were transferred to the administrative assistants in a task list for rebooking. Further, the virtual care clinic list had the functionality to capture and communicate visit-specific medical orders to administrative staff to ensure timely, traceable, and coordinated completion.

Berlin and the team identified the impact in three domains: care delivery, patient and practitioner experiences with virtual care, and potential cost savings. They also assessed six domains of quality outlined by the Institute of Medicine, including effectiveness, safety, timeliness, patient-centeredness, equitability, and efficiency.

Overall, there were a total of 22,085 virtual care visits conducted (mean, 514 visits per day), making up 68.4% (range, 18.8%-100%) of daily visits compared with .8% before launch (P <.001). A month after deployment, ambulatory clinic volumes recovered (3,714-4,091 patients per week). Chemotherapy and radiotherapy caseloads (1,943-2,461 patients per week) remained stable throughout. The team did not identify changes in institutional or provincial quality-of-care indexes.

There was a total of 3,791 surveys administered and completed by 3,507 patients and 284 practitioners. Of those who took the survey, 82% of patients and 72% of practitioners indicated overall satisfaction with virtual care.

The cost of the initiative was $159,246 (CAD$ 202,537) and displacement-related cost savings to patients totaled approximately $2,481,381 (CAD$ 3,155,946).

Additional research is needed to outline the optimal integration and modalities of virtual care visits.

Still, the data supported the use of such technology while minimizing disruption to patient care during a pandemic.

The study, “Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19,” was published online in JAMA Oncology.