Models of Health Service Delivery

Dr. Virginia Robinson is the RCCbc representative leading the deployment of the Intelligent Network for Point of Care Ultrasound project, which is one of several projects within Canada’s Digital Technology Supercluster. RCCbc – along with partners Providence Health, UBC Faculty of Medicine, Change Healthcare, and Clarius – devised and executed a plan to place 50 hand held ultrasound probes into the offices and emergency departments of rural BC doctors. This exciting project will enable the development of a PACS system and Artificial Intelligence (AI) cloud technology so that rurally-relevant images can be shared with any provider in the province. This project will improve timesensitive diagnoses and potentially reduce and/or facilitate patient transfers, all of which will improve local delivery of patient care 

The IN PoCUS project launched in November 2019, initially focusing on the complexity of the cloud network and baseline image acquisition for the development of the AI support, as well as the development of echo and first trimester ultrasound modules. However, with the arrival of Covid-19 in British Columbia in January 2020 and the subsequent strong recommendation from Italian physicians to use hand held ultrasound to aid in the diagnosis of Covid-19, RCCbc rapidly expedited and expanded the projectissuing the call for participants in April 2020 instead of Fall 2020. The project currently does not include the AI component, as there wasn’t sufficient time to build those supports ahead of the pandemic. It will, however, be developed as the project progresses.  

There was excellent uptake from the initial call for applications, with several dozen rural physicians and some residents expressing interest in participating in the project. An additional benefit of rapid deployment of IN PoCUS into rural BC is that partner relationships significantly deepened during the process to launch the program earlier, and there is a new sense of being able to transition to a nimble and rapid approach when necessary despite the complexity of the project with multiple stakeholders. 

View a Global BC News video about the IN PoCUS project

 

Over the past few years, RCCbc has participated at the General Practice Service Committee’s (GPSC) Primary Care Networks (PCN) table, providing a ‘rural enhancement’ lens for this transformational initiative as it deploys across the province. The conversations about deployment of PCNs in a rural context have taken place at RCCbc’s Network of Rural Divisions table, supporting the 23 Divisions of Family Practice with a rural footprint to both cross-pollinate and disseminate information, innovations and learnings to their rural healthcare colleagues. 

RCCbc has provided in-community supports for rural PCNs. Each division may utilize the funding to build relationships and find ways to work together with partners to build a PCN Service Plan. The funding provides flexibility for divisions to support providers by providing travel and time support, covering overhead or otherwise ensuring that they may participate in the planning without incurring hardship. Funding for meaningful engagement and partnership development with First Nations communities has been well utilized. There is a hope that through evaluation tools and support the communities will be able to share their stories and add to the developmental evaluation nature of learning as we go. The opportunity to share between divisions is facilitated through the Network of Rural Divisions and through the help of external consultants. 

With the arrival of Covid-19 in British Columbia, there has been a massive shift by the province’s primary care providers and PCNs to providing Virtual Healthcare so that patients and healthcare workers can maintain safe physical distancing. The pandemic will likely alter many PCN plans – in fact, it has already resulted in the First Nations Health Authority iterating First Nations Primary Care Initiatives, and has already raised new questions about what team-based care will look like in this environment, how an virtual care be used to address patient attachment, or how do we create longitudinal primary care relationships virtually? 

Dr. Ray Markham and Networks Director Kim Williams note that some of the challenges posed by Covid-19 in rural communities has – in most cases – resulted in a collaborative working relationship between health authorities and rural communities. These shared experiences will likely and strengthen the partnerships already in place and positively impact PCN implementation moving forward.  

In 2019-20, the work of Dr. Alan Rabinowitz focused on several different areas, including exploring models and frameworks of care that incorporate: translational medicine and digital health transformation, exploring urban-rural and quaternary-primary models of care and collaboration, virtual care strategies, and global health and collaboration. Broadly, Dr. Rabinowitz views these ‘tools’ as essential interrelated pieces that have a high probability to contribute positively to the transformation of the medical care ecosystem in BC. Other activities Dr. Rabinowitz sees as essential in this transformation work are: the building of the new St. Paul’s Hospital, which will have supercluster computing capacity available to serve the provincial population on site; and, the continuing engagement of RCCbc with other healthcare organizations using the Pentagram Partnership Plus framework for building collaboration and addressing health equity issues.   

Translational medicine and digital health transformation focuses on bringing expert knowledge and technologies from the “benchside” (e.g. a research labto the bedside and/or community as a means of maximizing safe delivery of clinical medical benefits at the individual patient level. This work – in combination with other tools, such as virtual care, or urban/rural models of collaboration – allow clinical providers to leverage a different approach to delivering healthcare, one in which access to care in rural and remote communities is supported by a broader provincial or global network of care, and where the rural provider is not left on his or her own to deal with an urgent or emergent situation without supports. An example of this work has involved Drs. Rabinowitz, John Pawlovich and Ray Markham in researching acute cardiac events (and subsequent transport if required) in rural and remote settings (see “RTVS” summary for details). Dr. Rabinowitz – who has provided cardiology support to rural healthcare providers previously through the Patient Transfer Network – is advising on the study, along with Vancouver General Hospital. This project is still in the early phases and is currently collecting specific use cases and purposes to populate the strictly rural-focus model.  

Similarly, Dr. Rabinowitz has consulted with leaders at FNHA to explore how translational medicine could be delivered through virtual care, with potential supports through quaternary care/primary care collaborations. Although these conversations were disrupted by the Covid-19 pandemic, the pivoting of the entire province towards virtually-enabled healthcare delivery suggests that when the pandemic ends, the medical community within BC will be well positioned to see what ‘legacies’ — of knowledge, technology, and collaboration – will remain in the aftermath.  

As part of his ongoing work for RCCbc, Dr. Rabinowitz continues to explore with Dr. Ray Markham and others, opportunities for global health collaboration, which would cross-pollinate best global health practices currently ongoing with First Nations and other communities in BC.