New Brunswick

eVisitNB cuts hours in half, but virtual health-care service has improved, says CEO

eVisitNB has cut its hours in half, but the CEO says the number of patients who receive virtual medical care hasn't been reduced and the change has actually improved the service.

Number of patients receiving care has not been reduced, but fewer cancelled appointments

eVisitNB has reduced its registration hours to minimize the number of patients who successfully register being cancelled at the end of the day and told to re-register, says CEO Dr. Serge Melanson. (Colin McPhail/CBC)

eVisitNB has cut its hours in half, but the CEO says the number of patients who receive virtual medical care hasn't been reduced and the change has actually improved the service.

Dr. Serge Melanson confirmed online registration for a video, phone or messaging consultation with a nurse practitioner or doctor is only available between 10 a.m. and 4 p.m., Monday through Sunday now.

Up until last week, registration for the service, offered to all New Brunswickers with a Medicare card free of charge since late January as a way to divert patients from overwhelmed emergency departments during the Omicron spike, was open from 8 a.m. until 8 p.m., seven days a week.

"The problem we had recognized some weeks ago was that the volume of people that were coming to our site and registering was greater than we could meet from a provider perspective," said Melanson.

So some people who registered later in the day and had waited sometimes more than two hours in the virtual waiting room for the next available provider were having their appointments cancelled as the virtual clinic closed.

"Our providers just couldn't keep working. They had to get up the next morning and show up to [their other jobs]. So they stopped seeing people late in the evening."

The technology eVisitNB uses does not permit registrations to be carried over to the following day, said Melanson. Once the clinic closes, the technology shuts down, and anyone waiting to be seen is asked to rebook the following day.

"So of course that was leading to frustration and rightfully so. People were not expecting to kind of have that."

Dr. Serge Melanson, CEO of eVisitNB, said the virtual service is still offering care to roughly 300 patients a day, even with its reduced hours, which he says is more than the province's busiest ERs see in 24 hours. (Submitted by Dr. Serge Melanson)

By "compressing" the registration hours, eVisitNB has "essentially eliminated" the number of patients being "timed out" of the waiting room, said Melanson.

Meanwhile, the service hours have not changed, he said, with some providers still seeing patients as late as 11 p.m.

"So we're still actually seeing the same volume of patients. In fact, this past week we've been seeing more of them."

On Wednesday, for example, nearly 300 patients received consultations for common illnesses, injuries or mental health concerns, said Melanson, and no appointments were cancelled at the end of the day.

The average wait was about 200 minutes — or just over three hours, he said, noting patients don't spend the entire time "ear-to-phone," they receive an email or text message advising them shortly before their consultation is set to begin.

Prior to the registration changes, the average number of patients who received consults daily was about 250, and up to 30 per cent of appointments were cancelled, he said.

Wait times ranged, on average, between two hours and four hours.

By comparison, one of the busiest emergency departments in the province could see about 200 patients in 24 hours, said Melanson, an emergentologist at the Moncton Hospital.

'Lightning speed' solution

"It just goes to show the power of technology, of analytics," said Melanson. "I certainly don't want to be too self-aggrandizing. But, you know, the eVisit team is a very innovative bunch of people who believe in an agility to recognize a problem, analyze the issue in-depth, using good, hard data and then executing a solution to it in a very rapid way.

"So, you know, going from a situation where, these people being timed out at the end of the day was causing a lot of angst and frustration to essentially virtually solving that problem in a matter of weeks. Again, if you compared it to other challenges in health-care system … is almost at lightning speed in terms of how quickly we were able to manage that."

The eVisit team is proud of what it has accomplished so far, he said.

"We like to describe ourselves as a solution in evolution. Meaning we haven't gotten to our final destination yet. We're still working very hard on finding ways to make our service better for patients and better for providers. And we're pretty confident we're going to get there."

Actively recruiting

One way eVisitNB hopes to improve its service is to recruit more health-care providers to provide care for more patients, said Melanson.

It currently has nearly about 75 nurse practitioners and 25 family doctors who log into the system whenever they have a spare hour, or a free afternoon, or a day off from their regular job.

Roughly 95 per cent of them practise in New Brunswick, but two recent recruits are from Nova Scotia and "a few" are from out West.

"One of the benefits of virtual care is as long as providers are licensed and have met all the credentialing requirements to practise in our province, the technology inherently permits them to practise in another province if they want to," said Melanson.

Registration for eVisitNB is now open 10 a.m. until 4 p.m., instead of 8 a.m. until 8 p.m. (eVisitNB)

Although recruiting in health care is "always a challenge," eVisitNB hears from health-care providers from across the country who are interested in joining the team on a weekly basis, he said.

"What we're offering here in New Brunswick and the way that we're doing it is a fairly novel solution, even on a national stage.

"Not to suggest that virtual care isn't being offered elsewhere. Just the way we have it configured and our partnership with government is a fairly unique situation and I think people are just interested in being part of that story."

Scheduled appointments starting next week

Another improvement is eVisitNB will begin offering scheduled appointments, said Melanson.

Right now, the service is on-demand only, meaning people are put in a queue to see the next available provider.

Starting next week, people will be able to choose which option they prefer.

eVisitNB, which started in January 2020, used to offer scheduled appointments prior to its contract with the government, Melanson noted.

"We paused that in January because we really weren't quite sure what to expect when we opened our doors to 780,000 people from one day to the next," he said.

"Now that we're getting a greater understanding, the raw data and analytics on what the trends are with people coming to our site and the reasons for that, we're confident that restarting our scheduled visits next week will just simply offer an additional option to patients."

New and "exciting" technologies are also in the works for eVisitNB, said Melanson.

He declined to divulge any details, but said they will make the services more efficient and the patient experience "more pleasurable."

Up to 9,000 ER visits avoided

On Tuesday, Health Minister Dorothy Shephard told reporters virtual visits are "here to stay."

"I have made it very clear, though, that I fully believe that in-person physician/nurse practitioner appointments are necessary and I want to ensure that they are maintained."

Since the start of its partnership with the province less than six months ago, eVisitNB has handled more than 30,000 appointments, said Melanson.

About 20 to 30 per cent of eVisitNB patients indicated in an exiting testimonial that they would have visited an emergency department if the service hadn't been available.

That's an estimated 8,000 to 9,000 ER visits avoided, he said.

"When you look at the history of how ER departments have been struggling in the last number of years, it's hard to find those big wins that really push the needle in the right direction.

"I think eVisit is a real, tangible and measurable example of what can be done when you deploy innovative technology and deploy services in a different way."

More than 50,000 New Brunswickers have registered with eVisitNB since it started in 2020, said Melanson.

By the end of this year, it's "not inconceivable to think" that one person in 10 New Brunswickers might be an eVisitNB user, which would be a "pretty staggering accomplishment," he said.

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