Rapid development of virtual care tools in response to COVID-19: case studies in three Australian health services.

Abstract

News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people whilst maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefit but the rapid cycle development also created risks. To understand the socio-technical aspects of the rapid cycle development of seven different COVID-19 virtual care tools and identify enablers, barriers and risks at three health services in Victoria, Australia. This research used a qualitative, embedded, multiple case study design. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyse structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical services developers enabled strong solutions which in some cases were highly scalable. Conventional project methodologies - such as steering committees, scope, budget control, tight functional specification, consumer engagement and co-design, universal accessibility and post-implementation evaluation - were ignored almost universally in this environment. These three health services took a variety of approaches to rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.