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Practicing and Managing Complex Patients in the COVID-19 Era

A discussion with Dr. Andrew Vellathottam and Don Watts, President, Khure Health

The COVID-19 pandemic has made this year an incredibly challenging time for patients and the healthcare system – especially patients with rare and complex conditions. Don Watts, President of Khure Health sat down with Dr. Andrew Vellathottam, a family physician and FHO group lead in Scarborough, Ontario to learn how primary care physicians are adapting to practicing during COVID-19.

Don Watts: Iappreciate you taking the time to talk today Dr. Vellathottam.  We’re all so grateful to everyone in healthcare for all that is being done during these difficult times, and certainly to all primary care providers, like yourself, who have also had to make significant changes to practice management and patient care to ensure everyone’s safety  Let me start by asking you about some of the key challenges you have faced managing patient care since the onset of COVID-19?

Dr. Vellathottam: At the beginning of the pandemic, we were already a little ahead of the game. I had signed up and been using OTN to get virtual care going well before lockdown and had been doing phone appointments with patients before COVID-19 hit. For me it was about being more accessible to patients – bridging the gap of location and geography by enabling them to connect virtually. In the spring, as the first wave peaked, we were very comfortable with telephone/virtual based appointments. In those early days, in-person visits were definitely down but we were still able to keep up with paediatric vaccines as well as urgent visits that needed a quick assessment for treatment or referral. There were definitely some virtual visits that could have benefitted from being in person which did create some inefficiencies in terms of the practice – with something that would have taken one visit ended up having to take two.

DW: How are you managing risk of infection and transmission in your practice?

Dr. V: One of the ways that we managed risk early on was just to be mindful of what warranted a physical, in person visit. Especially now, as we enter this second wave, we are pulling back on visits. For example, we are aren’t doing annual health exams – the benefit of that kind of visit just doesn’t balance with the risk. We have also implemented strict protocols in accordance with public health guidance: call first, reducing touch points in the clinic, enforcing distancing as well as mandatory mask wearing for everyone in the clinic.

DW: How are you balancing the current risks with the needs of your complex or chronic care patients? What percentage of your practice do they represent?

Dr. V: Chronic and complex patients represent about 50% of my practice. We opened up to in-person treatment of our chronic care patients (diabetic, hyper-tension, heart disease, etc.) in June. It really is a balancing act to ensure they have the appropriate care while minimizing risk of exposure to the virus. Many of these patients have co-morbidities that would create serious complications if they were to contract COVID-19.

Our approach has been to combine what would have been multiple visits or touch points pre-COVID-19, to get as much done as possible in one visit: blood work, blood pressure, additional lab work, etc. We believe that if we can get them in once, reduce their touch points in the office and get everything done, we are giving these patients the best possible care to manage their conditions while minimizing risk to exposure.

DW: What role does technology play in your practice, especially when it comes to managing complex conditions and the potential impact of COVID-19 on their health?

Dr. V: We are actively reviewing our EMR and proactively calling patients who need to be managing their complex care. I am also a big fan of assistive technology to help me in proactively identifying high-risk patients and diagnosing some of the more complex and rarer conditions. There is a wealth of data in the EMR and technologies like artificial intelligence are very exciting because it can take all that information for every patient in the practice –  from reports, medication lists, lab work, patient history, and physician notes – and analyse it very quickly. I’m now using the Khure Health AI-enabled clinical dashboard that can take that data and match it against up-to-date diagnostic criteria to surface those patients who may be at greater risk of rare diseases, let me screen patients I just can’t put my finger on, and alert us to those patients who could be at very serious risk if they contract COVID-19. These tools are extremely helpful for physicians to be able to make accurate and timely diagnoses and limit disease progression.

DW: I’m grateful for your time today Dr. Vellathottam.  Last question!  What are the biggest lessons you have learned as you have adapted your practice this year?

Dr. V: It would be naïve to think that COVID-19 is the only virus we will have to deal with and it has really made us and community offices reflect on infection protocols and adapt to ensure we can manage patients, in particular complex and chronic care, high risk patients in the backdrop of a highly contagious, life-threatening viral infection. You can create an efficient practice with reduced exposure: taking care of things all at once, reducing your patients’ touch points, virtual and telephone appointments for simple things – these ongoing practices will make patient management and care much better from an infectious disease management perspective. I believe that these preventative infection controls will carry forward.

Khure Health’s AI-powered Clinical Intelligence Platform enables physicians to quickly understand patients at risk of a complex or rare disease and identify the right care pathways. For more information visit