Our vision is that virtual care is used wherever appropriate and preferred by the patient, to provide care closer to home.
Virtual care is embedded in mainstream care provision. It enhances access and equity of care across the care continuum and improves Victorians’ experience and health outcomes.
We will achieve this vision through:
- open and active collaboration between the department and health services
- responding to diverse needs, levels of access to technology and consumers’ backgrounds
- consistent, coordinated and integrated care
- care that supports diverse communities and is culturally safe, including creating an environment that enables self-determination for Aboriginal people
- ensuring health providers are confident in using virtual health technology, and receive ongoing skill development and support
- effective local-level innovation that is scaled to enable equitable access
- improving demand management and system sustainability
Defining virtual care
- Virtual care is a broad term. It includes telehealth (telephone and video-enabled) and remote monitoring. It supports self- management, and it can be provided in different settings and geographical It is used to connect and provide care and connects consumers, families and carers with clinicians and other people caring for them. It supports multidisciplinary care and specialist consultations between clinicians, professional development and peer support (see Figure 1).
- Virtual care can be provided in a number of ways. It can be in real time such as a telehealth consultation, or as asynchronous care where a patient records health parameters to be reviewed as part of care. Virtual care means practitioners can check physiological parameters and experience of different patients remotely, and escalate to virtual assessment of face to face review where indicated.
- Virtual care can be delivered across a variety of settings and care journeys across the care continuum. Patients may have part of their care journey provided virtually alongside more traditional face to face services.
Figure 1: Virtual healthcare technologies
|Telemedicine||Provision of clinical care from a distance using telecommunication and information technology, including text, audio and video consultation|
|Smartphone apps||Vary from simple to more complex apps, that can be linked to biometric devices, to enable self-monitoring of health and wellbeing to remote monitoring by health services|
|Biometric devices for diagnosis and monitoring||Biometric devices, such as ‘wearables’, can track vital signs e.g. heart rate, respiratory rate and blood pressure, and data can be remotely monitored by health practitioners.|
Source: Health Education England 2019, The Topol review: preparing the healthcare workforce to deliver the digital future.
Case Study: Geri-Connect
In 2016, high, unmet demand for specialist geriatric medicine services in the Loddon Mallee region led to increased presentations to regional emergency departments. Bendigo Health established the Geri-Connect Service in 2017 in partnership with Kyabram District Health, Loddon Mallee Rural Health Alliance and Murray Primary Health Network to improve equity, timeliness and quality of care for older people living in residential aged care facilities (RACFs). The service expanded to include the Hume region in 2019–20 and Goulburn Valley Health in 2020.
Geri-Connect uses virtual care technology to provide a timely specialist geriatrician assessment service to older people living in RACFs and within the community.
Local GPs refer residents to Geri-Connect for a comprehensive geriatric assessment undertaken by a geriatrician or an advanced trainee registrar using video consultation. RACF staff support video consultations. The consultations can include family members, carers and GPs. A care management plan is then provided to the older person’s GP to support ongoing care.
Geri-Connect now operates in 69 public and private RACFs and has assessed more than 800 patients a year living in the community. Geri-Connect assessments are almost exclusively MBS-funded.
Benefits of the program:
- 83 per cent reduction in response times for Aged Care Assessment Service assessments for eligible inpatients waiting for permanent placement in a residential aged care facility
- recommendations to reduce polypharmacy for 89 per cent of patients
- completion of comprehensive geriatric assessments for 30 per cent of residents at participating residential aged care facilities, compared with 5 per cent before the project.
More recently, there has been further development of:
- remote monitoring of COVID, diabetes, chronic obstructive pulmonary disease, hypertension heart disease and pressure injury risk for older people living at home
- provision of suitable devices for home consumers with no mobile devices or stable internet connection.
- local and area adult and older adult mental health and wellbeing services deliver multidisciplinary, holistic and integrated treatment, care and support through a range of delivery modes, including telehealth (Recommendation 5.2b)
- each adult and older adult area mental health and wellbeing service delivers a centrally coordinated 24-hour telephone/telehealth crisis response service accessible to service providers and members of the community (Recommendation 8.1)
- mental health clinical assistance is available to ambulance and police through a range of mechanisms including 24-hour telehealth consultation systems for officers responding to mental health crises (Recommendation 10.3).
- by the end of 2022, trial two new digital service delivery initiatives in rural and regional areas that meet the needs of local communities (39.1b)
The strategy complements:
- , which sets out five programs of work to improve the safety and quality of healthcare.
- the , which articulates consistent and defined standards to meet the operational and safety requirements of virtual care models.
Virtual care offers many benefits to consumers, their families and carers, the health workforce, healthcare providers and the broader health system, including:
- Extends care to previously unreachable areas.
- Enables multidisciplinary care across primary, community and acute care.
- Provides faster and more equitable access.
- Flexibility for consumers in how and where they receive care.
- Reduces consumer travel and related costs.
- Facilitates culturally safe environments that include family/carers.
- Reduces risk of exposure to infectious disease.
- Reduces patient transport needs.
- Facilitates increased workforce mobility and more opportunities for professional development.
Models such as virtual emergency departments and virtual post-surgical rehabilitation at home can also alleviate hospital demand (see Figure 2).
Figure 2: Virtual care across the care continuum
Health Care Setting
Care context and benefits
Provided in an emergency context & included self-referral, residential in-reach and secondary triage
✓ Safe alternative to attending an ED
✓ Provides support to paramedics
Provided to patients who would otherwise be admitted to a hospital ward
✓ Reduces (or replaces) inpatients admissions, freeing up beds for higher acuity patients
Provided to patients following surgery to facilitate recovery at home
✓ Reduces length of stay, releasing additional beds and improving flow
Provided through telehealth (video) or telephone
✓ Avoids hospital visits, minimising cost to patients
Provided through multi-disciplinary care teams
✓ Comprehensive care delivery
✓ Reduced avoidable admissions/ transfers
Challenges to strengthening and expanding virtual care include:
- system stewardship of virtual care across Victoria to help overcome fragmentation and ensure quality, safety, equity and value
- risk of poor consumer experience if the system becomes harder to navigate due to many virtual care entry points, with inconsistent approaches
- the impact of the digital divide due to lack of access to internet and technology such as smart devices, poor digital literacy, confidence in using technology, disability and age
- need to strengthen health workforce capabilities and confidence in providing virtual care, while balancing the potential impact on workloads and workforce wellbeing
- the requirement for access to reliable, simple platforms and technical support
- availability of integrated, secure statewide connected and accessible patient record systems
- systems that support cross-service collaboration, including the capacity for GPs and other primary care and community services to access virtual care programs
- funding that enables development and implementation of virtual care models, and funding of novel service offerings.
Reviewed 25 September 2023