Introduction

2.1 Humanizing wait queues

Waiting in a queue may be unavoidable and in these situations many individuals experience heightened anxiety, stress, and other emotions. Some stress can be mitigated by recognizing the humanity in the circumstance and being proactive with information.

2.1.1 Functional needs

• Informed about how long the wait is going to be.
• Not everyone can be physically present to wait or able to wait.
• Better understanding how the queue system works.
• Make better use of waiting time.
• A way to be able to leave the queue and rejoin without penalty in certain cases.

2.1.2 Clarifying questions

• Is there sufficient information being communicated to those in the queue?
• Is there a way to deal with edge cases such as disconnections or someone having to leave the queue and coming back?
• Is there an alternative to having to physically wait?
• Is there a way to seek help while in the queue? For example, can individuals ask questions and receive timely responses?

2.1.3 Practices

• Communicate how the queue system works, especially if it is not a first-come-first-served process.
• While waiting in the queue, provide opportunities for individuals to seek other forms of help such as information on community support groups, or other self-serve resources.
• Announce wait times or any changes to wait times in multiple modalities.
• Check-in with those waiting in the queue to see if they have any needs and be proactive with information.
• Manage expectations for those waiting in the queue by providing queue information so they can make informed decisions. Such information can include:
  • Average wait times
  • Position in the queue
  • Number being served
• Provide alternatives to waiting such as call-back service, waiting by proxy, self-serve resources, connections to community groups, and alternate services like telehealth, walk-in clinics, other nearby hospitals.
• Provide a way to gracefully deal with disconnects. Sometimes the disconnect can be due to technology or someone leaving the queue and needing to rejoin. Providing a graceful way of managing disconnects can be accomplished by registering those waiting in queue and asking if they want to rejoin at their previous position.

2.1.4 Software approaches

• Queue system that indicates position or progress through the queue, estimating the time remaining to be served, or the average wait time.
• Messaging system to allow the health care practitioner and patient to send notes to each other as the patient is in the queue.
• Allow individuals to document or record information for the practitioner while in queue, such as any needs or preferences, or any other contextual information that might be relevant (other related guideline: 2.4 Enhancing intake process to personalize service delivery below).
• Flexible wait queue that allows individuals to reconnect and resume their position in the queue or allowing someone to "step back" in the queue so others can go first. This can be useful if an individual needs to leave to take care of something and come back to the queue.

2.2 Pooling practitioner availability

Where appropriate, consider creating a wide pool of practitioners to be made available to help reduce referral wait times and increase better matching of practitioners to individuals. Reducing the time between a referral and the moment the individual is seen can be important to effectively observe a condition and alleviate an individual's anxiety. In the process, an individual can also be given a choice that best suits their needs and context. For example, they might want a specialist that is closer to their home but is a longer wait, compared to a specialist that can see them sooner but is further away.

2.2.1 Functional needs

• Reduced waiting time to see a referred specialist.
• Getting diagnosis and test results promptly.
• Have a condition observed while it is still presenting.
• Autonomy and choice - finding the right practitioner who fits individual needs and preferences.

2.2.2 Clarifying questions

• Is there a choice of referral that best suits an individual's needs?
• Does the individual have enough information to make an informed choice about the referral?
• Is there urgency in the situation to take into account?
• Can the process be improved by pooling resources or leveraging interoperability to make referrals more efficient?

2.2.3 Practices

• Allow an individual to express their needs and preferences to enable better matching of available practitioners.
• Create larger pools of choice: for example, a pool of specialist practitioners to share availability for appointments. This will give greater opportunity of matching practitioners to needs of individuals such as convenient locations or times, or cultural sensitivities.
• Allow individuals to see referrals sooner if sooner appointments spots become available.
• Choices may be limited depending on the urgency of the condition. In these situations, the lack choice should be communicated to the individual.

2.2.4 Software approaches

• Interoperability between appointment systems on different platforms to allow transferring patient to another system if a practitioner becomes available.
• Search function or assessment that can recommend different healthcare options that may be able to help with a specific issue based on different search criteria. Optionally these preferences can be saved and become part of the individual's personal needs and preferences profile.
• Database of practitioners, specialists, therapists that contains information that can be matched to individual search criteria. This information can include – location, spoken languages, schedule, office accessibility, etc.
• Automatic notification by email, phone, or other methods if appointments with specialists are available that may be closer, or with sooner availability.

2.2.5 Other related guidelines:

• 2.4 Enhancing intake process to personalize service delivery

2.3 Building and nurturing trust through feedback

It may be a challenge to build a trusting relationship, especially in a virtual visit setting. One way to build trust is to allow for individuals to give feedback about their healthcare experiences and for those experiences to lead to positive changes.

2.3.1 Functional needs

• Have a safe way of expressing healthcare experiences and have disclosed experiences lead to future improvements.
• Build a trusting relationship between an individual and the practitioner.

2.3.2 Clarifying questions

• Is there a way for individuals to give feedback on their virtual healthcare experience?
• Is there time and budget allowed for synthesizing feedback and formulating new approaches?
• Can the practitioner easily follow-up with individuals if needed?

2.3.3 Practices

• Provide options for different follow-up methods like a questionnaire or survey, or patient satisfaction email or phone call.
• Synthesize individual feedback – identify challenges, barriers, and positives. Discern where needs were not met and come up with new approaches and tools.
• Accept feedback as an opportunity to improve and build empathy by seeing situations from the another's perspective.

2.3.4 Software approaches

• An interface to allow individuals to submit feedback on their health care experience (such as a web form, email survey, etc.).
• If individual consents, have their feedback associated with their record as a way to improve and customize their care on subsequent visits.
• Have a repository or database of patient stories or feedback that can be reviewed and preserved for future use.

2.4 Enhancing intake process to personalize service delivery

If given the opportunity, some individuals will provide relevant information that can make virtual visits more efficient and effective. This information can be gathered during the patient intake process.

2.4.1 Functional needs

• Sufficient time provided to complete intake process such as completion of consent forms, intake forms, technology checklist, and any needed physical space setup (other related guideline: 1.2 Supports for using technology above).
• Share personal needs, preferences, and relevant contextual information to help create individualized virtual health-care experience.
• Not feeling rushed and being able to specify the need for more time.
• Understanding how to use the virtual visit software to attend any meetings.

2.4.2 Clarifying questions

• Does the individual have an opportunity and sufficient time to complete any necessary forms or tasks to prepare for the virtual visit?
• Does the individual have an opportunity to communicate their condition, concerns, and any other relevant information?
• Is the practitioner able to review intake information in advance to make any necessary adjustments to delivery of care?

2.4.3 Practices

• Provide forms and other pre-appointments tasks well in advance of appointment to give individuals time to properly complete them, seek help or translation.
• Develop a list of questions that can help shape a virtual healthcare experience that can be shared in advance. This could be questions related to technology access, digital literacy, needed supports, and other information.
• Review intake information in advance so personalization of care delivery can be considered and administered.
• In situations where digital literacy or technology is a barrier, improve intake and onramp experience by seeking to partner with the broader community. For example, collaborate with regional telehealth network, pharmacies, or community groups to be an onramp for virtual healthcare by providing ways to book appointments, complete forms, and receive other virtual healthcare information.

2.4.4 Software approaches

• Allowing patient to specify preferences and background information ahead of time to optimize and personalize appointment time.
• Store an individual's needs, preferences, and other relevant information so that it can be referenced to provide personalized care.
• Provide different ways for intake forms and assessments to be completed. Such as using a web form, completing a PDF, using email, or over the telephone.

2.5 Avoiding assumptions

Each individual's situations, contexts, personal history, and backgrounds is unique to themselves. Making assumptions about an individual's needs, abilities, understanding, etc. may limit the practitioner's ability to best assess and assist the patient.

2.5.1 Functional needs

• Participants need to understand each other and be able to effectively communicate and understand all necessary information.
• Preferences such as language should not be assumed based on region, background, culture, etc. Rather these should be informed and facilitated in advance (other related guideline: 2.4 Enhancing intake process to personalize service delivery above).

2.5.2 Clarifying questions

• Does the individual have an opportunity to request any necessary accommodations?
• Is the practitioner and clinic aware of and prepared to accommodate the patient's particular needs and preferences?
• Has the practitioner understood and recorded all information correctly?
• Does the individual have sufficient understanding of all that was discussed and communicated?
• Is the individual able to make informed decisions and follow up with any next steps?
• Is there a process and means for the individual to review information and follow up with questions and/or corrections?

2.5.3 Practices

• Budget time for a discovery process where parties explore and understand each other's understanding, preferences, needs, and abilities.
• Have ways for parties to confirm information to achieve a mutual understanding.
• Provide a way for individuals to follow up, during and after visit, to confirm that information provided was understood correctly, and that the practitioner's notes and understanding are correct.
• Provide a means for individuals to express their preferences in advance to help practitioners gain insight prior to the appointment and be prepared to facilitate the patient's needs and preferences.
• Provide support for an assistant / interpreter / supporter to help with communication if necessary.

2.5.4 Software approaches

• Allow individuals to specify preferences and background information like preferred language, cultural preferences, etc. ahead of time like during booking or intake process.
• Allow individuals to submit journals, logs, and other information that may provide context and insight to the practitioner.
• Provide access clinical notes and reports and allow individuals to submit any errors, clarifications, or questions.
• Provide a glossary and automated links to additional information and resources for all key terms and treatments mentioned in the clinical notes and reports.

2.6 Improving service by storing and sharing complimentary information

There are many situations where recording and sharing information can improve healthcare services provided and increase continuity of care between parties and jurisdictions.

2.6.1 Functional needs

• Continuity of care when transitioning between different practices, platforms, clinics, jurisdictions, etc.
• Specialists doing virtual visits may need to rely on general practitioner's examination or notes, which may require additional information.
• Understanding context, history, and other relevant information can provide valuable background information (other related guideline: 2.5 Avoiding assumptions).
• Ability for individual to track changes to health between appointments so different care providers can have better understanding.
• A way for individuals to make notes, annotate, and respond to items in their health history.

2.6.2 Clarifying questions

• Is the individual equipped with their own medical history (including evolving needs and preferences) to share with future medical situations and practitioners?
• Does the practitioner have time to review, understand, and apply the information from the individual's record?

2.6.3 Practices

• Allow for individual and their circle of care to record or annotate their own medical history that can move with them. This can be in analog (e.g., printed) or digital (e.g., stored on a personal device) forms.
• A way for individual, their circle of care, and practitioners to track and share timely information.
• Use information in advance to help personalize delivery of care.
• Include any intake questionnaires with personal record to provide additional context.
• Comply with privacy and security regulations and policies regarding storing and transmission of patient health information. If compliance is not possible, provide alternatives or resources to individuals to be able to record their health information.

2.6.4 Software approaches

• Medical log / journal both medical practitioner and patient contribute to which includes notes, annotations, documentation of needs, preferences, or experiences.
• Provide a way for an individual to take their healthcare information offline to be used in other situations.
• Use a common supported interchange format and method to improve interoperability across platforms.

2.7 Addressing financial barriers

Not everyone has access to the financial supports to cover necessary and recommended healthcare. Individuals may not have access to or enough coverage from private health insurance, access to government health insurance, or even valid identification.

2.7.1 Functional needs

• Access to medical support/services not covered by provincial and/or private health insurance.
  • Does not qualify for health insurance.
  • Treatments/procedures not covered.
• Provided with clear communication of additional financial costs, alternatives, and risks of not receiving the medical attention.

2.7.2 Clarifying questions

• Does the patient have adequate support to meet their financial needs?
• Does the patient have access to the recommended treatment?
• Are there alternative approaches the patient could explore?

2.7.3 Practices

• Provide options for free consultation services.
• Provide research material for self-guided information and treatment if possible.
• Connect individuals with different community groups, organizations, or programs that may be able to help financially for treatments and tests, or provide other forms of support such as transportation, food, housing, etc.
• Provide comprehensive list of costs related to virtual healthcare. Make list available and communicated clearly as part of consent. For example, a possible list might include fees for prescription refills, letters for adoption agencies or employers, or referrals to alternative medications and treatments.

2.7.4 Software approaches

• Provide resources to help connect patients to community groups that can help financially or provide services.
• Provide a way for individuals to search for medical practitioners based on price and insurance coverage.