A physician connects with specialist support using RTVS.
How Real-Time Virtual Support is transforming healthcare for remote, rural and Indigenous communities across B.C.
Dr. Dean Johnston was in his neurology clinic in downtown Vancouver when he received a worrying call from a colleague about a patient more than a thousand kilometres away in Fort Nelson, B.C.
“There were a number of bright spots appearing on the MRI scan of the patient’s brain, indicating white matter inflammation,” recalls Dr. Johnston, a neurologist and clinical associate professor with UBC’s Faculty of Medicine. “The patient was also suffering from kidney failure, anemia, had a distinct rash, and rapidly progressive cognitive impairment to the point where they couldn’t speak.”
Recognizing the urgency of the case, Dr. Johnston — together with a team of other specialists who are part of Real-Time Virtual Support (RTVS) — acted without hesitation.
They connected by video link with the patient’s family doctor in Fort Nelson to assess the patient, and within a few hours had offered a remote diagnosis: lupus cerebritis — a rare, but potentially fatal complication that occurs when lupus affects a patient’s brain and spinal cord.
“If the family doctor hadn’t reached out through RTVS, and if we hadn’t acted quickly, this patient would have died,” says Dr. Johnston, recalling a series of rapid medical interventions they initiated, ultimately saving the patient’s life.
Closing the health inequity gaps
A partnership between UBC’s Faculty of Medicine, the Rural Coordination Centre of British Columbia (RCCbc), the First Nations Health Authority and other health authorities across the province, RTVS connects physicians, nurses and other healthcare providers working in B.C.’s rural, remote and Indigenous communities with emergency and specialist support — when and where they need it.
“Essentially, what we’ve done with RTVS is braid together cutting-edge technology with on-the-ground care to improve support for communities that have historically had many barriers to accessing care,” says RTVS co-founder Dr. John Pawlovich, the Rural Doctors’ UBC Chair in Rural Health.
RTVS offers multiple different helplines, or pathways, three of which are available 24 hours per day, seven days a week — the emergency line (known as RUDi), maternity and newborn line (MaBAL), and pediatric line (CHARLiE). An additional six specialist pathways, ranging from neurology to dermatology, are available weekdays during office hours.
“Now, with a click of a button, healthcare providers working in rural, remote and Indigenous communities can connect online with a colleague and receive help and advice about patients they’re supporting,” says Dr. Pawlovich.
RTVS also offers several patient-facing pathways, including the First Nations Virtual Doctor of the Day, First Nations Virtual Substance Use and Psychiatry Service, as well as the emergency medicine HEiDi (HealthLink Emergency iDoctor in-assistance) line.
“It’s about closing the health and healthcare inequity gaps that exist between remote, rural and Indigenous communities and better-resourced urban centres by making high-quality care accessible to everyone, everywhere in the province,” says Dr. Ray Markham, a clinical professor in the Faculty of Medicine’s Department of Family Practice and executive director, medicine, at RCCbc.
A catalyst for change
RTVS was born at the start of the pandemic, when UBC Faculty of Medicine’s Dr. Pawlovich, Dr. Markham, and Dr. Kendall Ho — along with partners across the health sector — recognized the critical need for a province-wide virtual care service.
“When COVID-19 hit, we knew right away that on-demand, virtual care would have an increasingly essential role to play in addressing inequitable access to care, particularly for people living in B.C.’s rural, remote and Indigenous communities,” says Dr. Ho, a professor in the Faculty of Medicine’s Department of Emergency Medicine and lead of UBC Digital Emergency Medicine.
Building on existing partnerships and more than a decade of prior work, they immediately turned their attention to accelerating the development of a virtual care support service.
Dr. Ho and the UBC Digital Emergency Medicine team were specifically involved with helping to set up the patient-facing emergency support line HEiDi, which is available to both rural and urban patients and connected to the provincial 8-1-1 health information line.
The HEiDi service now employs more than 140 part-time physicians throughout the province who assist 8-1-1 nurses with urgent health inquiries and ensure appropriate triage to health services. Since its inception, HEiDi has provided services to more than 200,000 patients and helped reduce unnecessary visits to emergency rooms by more than 70 per cent.
Today, Dr. Ho and the UBC Digital Emergency Medicine team remain actively involved with RTVS, leading the continuous provincial research evaluation of the service, with a focus on understanding everything from its overall effectiveness to the experience of patients and physicians on the receiving end.
“Ultimately, what we’re seeing is that RTVS eases the burden on health professionals in these communities, which enhances the quality of care. The network is also helping to improve continuity of care and access to culturally appropriate care within the health system,” explains Dr. Ho.
‘We are here for you’
Emergency physician and UBC clinical faculty member Dr. Brydon Blacklaws was at his home in Powell River, a coastline community of around 14,000 on B.C.’s Sunshine Coast, when the call came in.
“An emergency department in northeastern B.C. needed our support,” recalls Dr. Blacklaws, who serves as the co-lead and department head of RTVS’s emergency pathway RUDi (Rural Urgent Doctor in-aid).
Dr. Blacklaws and a team of RUDi doctors stepped in to help.
“Using RTVS video technology, we took turns over the course of the next several months being first call at night for nurses in the emergency department who were caring for patients with everything from chest pain to leg injuries,” says Dr. Blacklaws.
Supporting smaller emergency departments at night is just one of the many ways RTVS’s emergency pathway is making a difference.
“In the bigger urban hospitals, physicians have colleagues around all the time to ask questions and receive support. But when you work in rural and remote areas, you don’t necessarily have someone to ask. You might be completely alone,” says Dr. Blacklaws.
In its first 18 months of existence, RUDi virtual emergency physicians provided more than 16,000 hours of coverage and 2,800 hours of clinical time supporting healthcare providers in 75 rural communities. RUDi now provides support to over 150 rural and remote communities, ranging from Williams Lake to Chetwynd on the eastern foothills of the Rocky Mountains. In May of this year, it received 2,250 calls alone.
“Just knowing there’s a trusted team to help can make all the difference.”
— Dr. Brydon Blacklaws
For Dr. Blacklaws, who spent the better half of a decade working in smaller emergency departments in B.C.’s rural communities, seeing the impact of RUDi has been deeply rewarding.
“So many times over the course of my own career as a rural emergency physician, I wanted to call for help, but I was often not sure who to call,” says Dr. Blacklaws.
“With RUDi, we are here for you 24/7. It can be as simple as offering a second set of eyes on a fracture or reviewing a chest X-ray all the way through to being ‘right by your side’ when dealing with a major trauma when things are critical and truly time sensitive.”
