INNOVATION FUND The Future of Academic Medicine New Technology, Therapies, eHealth & mHealth SHOWCASE 2023

Evaluating Virtual Specialist Care Provided During a Pandemic to Inform Best Practice Guidance

New Technology, Therapies, eHealth & mHealth

Jeffrey Mosko,

(416) 864-5684


St. Michael’s Hospital and University of Toronto

Charles Kassardjian



St. Michael’s Hospital and University of Toronto


The transition to virtual care during the pandemic was abrupt and thus there was inadequate time to prepare patients, providers and administrative personnel for this massive shift. It is likely that virtual ambulatory care (VAC) is not being optimally, efficiently, or equitably used. VAC will become a crucial and lasting part of our healthcare system beyond the pandemic. Therefore, finding the optimal manner in which to deliver virtual care, which balances high quality care, patient-centered approaches, and equity, while optimizing costs is critical at this early junction in the implementation of VAC. By studying the impact on patients and providers of a rapid mass transition to virtual care, our group will be able to identify which aspects of virtual care should be incorporated into standard practice models after the conclusion of the pandemic. Incorporating more virtual care into standard subspecialty practice in future may have several positive implications for the healthcare system, including increased capacity, greater efficiency, reduced costs, and improved patient and provider satisfaction with care. These results will have broad applicability.


Background: Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice.

Objective: We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient and physician experience of care.

Methods: This study was designed as a multimethod physician and patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). Participants (patients, physicians and administrative assistants) all attended or worked at St. Michael’s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021.

Results: During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Physicians were overall satisfied with virtual care as well, but not to the same degree as patients. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of “virtual” visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person.

Conclusions: Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care.


Dainty KN, Seaton MB, Estacio A, Hicks LK, Jamieson T, Ward S, Yu CH, Mosko JD, Kassardjian CD. Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study. JMIR Med Inform. 2022 Jun 28;10(6):e37196. doi: 10.2196/37196. PMID: 35482950; PMCID: PMC9239568.

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