Virtual Care Operational Framework core elements

Consumer-centredness

• Clinical Governance

  Core Principle 1

  When integrating virtual care into services, it is essential to ensure that there is a systematic approach to maintaining and improving the safety and quality of patient care. Implementation of virtual care must be supported by effective clinical governance and have pathways for clinical escalation to ensure high quality care is delivered and the patient’s wellbeing is safeguarded.

  Clinical governance frameworks work best when supported by a strong safety culture.

  Strong clinical governance should include safety and quality systems to monitor and analyse adverse patient safety events relating to virtual care and improve patient care through appropriate action or recommendations.

  There are several resources available to support Victorian Public Health Services to ensure they have appropriate clinical governance processes in place.

  1. The Delivering high-quality healthcare: Victorian clinical governance framework helps health services to:

  • understand the clinical governance roles and responsibilities within the health service
  • evaluate their clinical governance systems, processes, and reporting mechanisms
  • ensure individual and collective accountability for high quality and safe

  2. The Australian Commission on Safety and Quality in Health Care (the Commission) has developed the National Model Clinical Governance Framework to support the delivery of safe and high-quality care. Service providers should refer to the framework for more details on clinical governance, and the associated roles and responsibilities.

  Recommended actions

  Pillar	Action
  Corporate Governance	Ensure organisation has a fully integrated corporate governance model in place that includes clinical, risk, financial and other (human resources, legal etc.) governance. Medico-legal aspects of telehealth services for Victorian public health services provides an overview of the laws that need to be considered when delivering or receiving medical advice using telehealth technologies.
  Clinical Governance	Ensure strong clinical governance model aligned with National Safety and Quality Health Service (NSQHS) Standards.
  Authorising Environment	Ensure all virtual care service provision has been endorsed by health service through Health Service approval mechanisms

• Digital Technology

  Core Principles 3 and 4

  Integration of virtual care as a tool to complement existing clinical services can be challenging due to inconsistent inter-operability capability. The use of inter-operability standards is encouraged when implementing clinical applications and technologies. Health services must have robust technological governance in place to mitigate risks associated with implementation and on- going use. Risk management and governance frameworks should be localised to the health service context and operating environment.

  Healthdirect Video Call is the preferred platform for virtual/telehealth care consulting for Victorian public health services (hospitals, community health services, maternal health services etc.). It provides a secure, reliable service that uses consumer grade devices (e.g., mobile phone, tablets, or computer) that complement clinical workflows familiar to providers and patients. Information about the platform functionality is available at the Healthdirect Video Call Resource Centre.

  Recommended actions

  Pillar	Action
  Standardisation	Use ICT platforms that conform with standards, guidelines, and frameworks. The Department of Health has developed the Clinical information system and EMR application and interoperability standard which defines the minimum set of functional requirements for any implementation of CIS and EMR by health services in the Victorian Public Health Sector.
  Security and authentication	Non-authorised participants should not have access to the virtual care appointment or participate on the consultation.
  Localised Platform	The Digital Transformation Agency’s (DTA) Hosting Certification Framework governs public sector data and requires all data to be stored onshore.
  Workflow Integration	Optimise patient care through use of digital technology that integrates into and complements clinical workflows.
  Technology Governance4	Incorporate effective implementation methodologies and change/release communication, training for digital health

  ⁴ Further work on the safety and regulatory aspects of remote physiological monitoring will be added into the Framework over time.

• Partnering with consumers

  Core Principle 6

  Co-design of virtual care models with patients and clinicians is crucial to ensuring that a “patient first” approach is adhered to. This outlines that the patient is supported to achieve the best possible health outcomes, in a manner that prioritises them over the technology, platform, or other potential players. Emphasis should be placed on patient experience and patient reported measures to drive the re-design of services that incorporate a virtual care modality and must demonstrate responsiveness to the needs of patients.

  Recommended actions

  Pillar	Action
  Consumer voice	Virtual care service delivery should incorporate the development of an engagement plan to ensure that Aboriginal and Torres Strait Islander and diverse consumer voice is recognised. That consumers are partners in design, and health services are demonstrating responsiveness to the needs of the patients and the communities they serve.
  Complementary tool or value- add	Consider alternatives to providing services exclusively through virtual care if the patient choice is for face-to-face consultations or if provision of services virtually is not the most appropriate method for health care delivery. Consumers should be involved in discussions about the appropriate modality of care and their right to choose must be respected.
  Patient feedback	Ensure patient feedback is sought in an inclusive and culturally appropriate way and considered in future development. Consider systems for collecting and monitoring patient-reported experiences, outcomes and are considered in the design of services that incorporate virtual care.
  Privacy and confidentiality	Virtual care service delivery must adhere to privacy, data sovereignty and confidentiality obligations.

• Digitally capable workforce

  Core Principle 7

  To ensure a consistent and high standard of experience and care for all users, but particularly consumers, it is essential to ensure that the workforce delivering virtual care models understand the expected values, behaviours and skills required of clinicians to support the implementation of virtual care.

  The Australian Digital Health Agency (“The Agency”) has developed a National Digital Health Workforce and Education Roadmap to “help the workforce confidently use digital technologies to deliver better health and care by setting a pathway for building digital health capability and leadership to deliver contemporary care.”

  Health Services should provide resources such education guidelines, frameworks, and training to support building the capacity of the workforce to enable them to adopt and deliver virtual care.

  Health Services should ensure compliance with mandated frameworks and codes (including National Disability Insurance Scheme, Aged Care and Working with Children).

  There is value in developing a system of Virtual Care workforce and system credentialing. Clinicians should ensure that they are:

  • Digitally competent
  • Professionally collaborative
  • Have excellent verbal communication skills (speaking and listening)
  • Cognisant of patient and staff safety and privacy requirements
  • Undertake any required credentialing and maintain their professional

  Recommended actions

  Pillar	Action
  Workforce requirements	Development of virtual care guidelines regarding service providers expected skills, behaviour and guidelines
  Capability building	Provision of resources (including access to education, training and/or mentorship) to enable skill development

• Access and equity

  Core Principle 3 and 8

  Virtual care can offer more access points to healthcare delivery for the Victorian community, however, if operational considerations of service delivery and digital literacy and access to technology are not considered early on, it can lead to disparities in health care access. With continuing advancements in technological capability and interconnectedness, it is likely that new and effective ways of providing virtual care enabled models of care will continue to emerge. When undertaking programs utilising virtual care, it is essential that the end-to-end workflow of patient and clinical data is considered to ensure that service provision can be achieved without clinical impacts and barriers.

  Recommended actions

  Pillar	Action
  Equity and access	Ensure that local health service policies and infrastructure (physical space, dedicated rooms etc.) promote equitable access to virtual care services. Consideration of cultural, socio-economic, digital literacy, physical and technological disadvantage should be incorporated in strategies and service delivery plans.
  Aboriginal and Torres Strait Islander cultural safety	Create an environment that is safe for Aboriginal and Torres Strait Islander people, based on shared respect, meaning and knowledge. Ensure design, delivery and evaluation of virtual care models support self-determination for Aboriginal people.
  Service delivery and scope	Consideration of service delivery mechanism of virtual care e.g. whether standalone session or integrated into an existing clinic. Identification of which patients are in and out of scope for virtual care.
  Clinical and data workflows	Prior to implementation of virtual care service delivery, clinical and data workflows are mapped, and any differential requirements addressed to ensure that optimal service delivery is achieved.
  Reporting and funding	All virtual activity needs to be reported accurately to the Department of Health to ensure it is counted. Funding for virtual activity is either on an activity (NWAU) basis or through specific funding arrangements. Information regarding the requirements can be found in the Policy and funding guidelines for health services

• Evaluation and continuous improvement

  Core Principle 1 and 2

  As part of organisational governance and quality systems, it is expected that the health service undertakes ongoing monitoring and evaluation of the care provided through virtual care. Evaluation or validation will ensure delivery of virtual care across the sector meets the needs of citizens, providers and the broader health system. Governance processes to ensure ongoing monitoring of performance and outcomes of the virtual care models, will optimise innovation and delivery within a Learning Health System model. The evaluation framework should consider the Australian Charter of Healthcare Rights and include clinician support and education.

  This evaluation should be undertaken to ensure that the primary objectives identified are being met. The evaluation measures may include:

  • Target patient cohorts reached
  • Using genuinely participatory and culturally appropriate methods for gathering data and consulting Aboriginal and Torres Strait Islander community
  • Benefits of modality
  • Risks (clinical and system) and mitigations
  • Clinical outcome measures
  • Appropriateness for the needs of vulnerable groups
  • Patient and clinician satisfaction
  • Cost benefit analysis

  Recommended actions

  Pillar	Action
  Initiation and scaling of new models	New virtual care models are scaled with a plan to evaluate the benefits and harms, including (if applicable) the collection of data and qualitative insight from consumers and staff, taking into consideration the importance of data sovereignty.
  Regular performance review	The health service commits to submit timely and accurate data to the Department as per existing and new state-wide performance monitoring. The performance of virtual models of care delivered through partnered health services are reviewed collectively between those participating in delivery.
  Timely review of adverse events	In the event of an adverse event (including mortality, morbidity, delayed care and access barriers), cases are referred dedicated committee for clinical review and action.
  Accreditation	Virtual care models adhere to quality and safety standards recognised by the Department of Health Victoria.