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Introduction

The project

has

team reached out to

four

some industry experts and practitioners to provide

initial

feedback on a draft version of the Guide for Reducing Barriers to Virtual Healthcare.

Their feedback is documented below.

Feedback from Alec Sison

Structure

Title suggestion:
- "Guide for Reducing Barriers to Virtual Healthcare" → "Guide for Barrier Reduction to Optimize Virtual Healthcare Delivery"
Table of Contents is hard to navigate/parse.
- Lots of repetition in structure/section names. e.g. each guideline has the same/similar sections listed.
- "Guidelines..." is the starting name for each Guideline category
  - perhaps flipping the order of the name "[person/group] Guideline"
    - "Guidelines concerning recipients of care" → "Recipients of Care Guidelines"
    - "Guidelines concerning practitioners" → "Healthcare Practitioner Guidelines"
    - etc.
Does the order of the guideline subsections (Functional need, Clarifying questions, Practices, Software approaches, also see) matter, and does the it make sense as is?
Practices subsection
- Is this supposed to address what is currently available or brainstorm new and alternative approaches? If the latter this would need continual updating as new therapies and treatment options become available)
- If this list becomes exhaustive overtime, would it make reading through all available therapies and treatments difficult.

Terms

In the Glossary for "Practitioner", suggested to change "medical practitioner" to "healthcare practitioner" to be more inclusive.
"Interaction of systems" section name is vague.
"Technical Literacy" section name. Is this the same as Technological literacy?
"Community" section name is ambiguous.

Values

Human Diversity
- Is it possible for the Guide to satisfy?
  - i.e. stating that everyone is unique but defining standards to address all those unique needs?

Guiding principles

Contextualization can individualize healthcare experiences
- How can individuals share contexts? forms, surveys, tests, etc.?
Understandability is fundamental to quality care
- Are individuals overwhelmed by too many questions, surveys and forms?

Guidelines

Place of Care

Functional needs
- Additions
  - comfort and security in a particular environment
  - may not receive adequate internet speeds to accommodate virtual visit
  - may not have adequate phone connectivity (e.g. rural area)
  - habits of always doing things in a particular way
    - seeing doctor in person vs new virtual healthcare method
Clarifying Questions
- Additions
  - Can anything be done to address lack of connectivity in the recipient of care's place of care
Software Approaches
- Comments
  - "Have a way for individuals to discover alternate locations for having virtual healthcare visits. This could be a searchable index of possible locations that match different criteria"
    - Assumes literacy (digital, etc.) to be able to search for alternative locations.
    - Assumes they know the area well enough to find suitable alternative locations.
    - Assumes their health permits the searching and discovery of alternative locations.

Physical supports for using technology

Functional needs
- Additions
  - Assistive technologies (e.g. hearing aids, corrective lenses, etc.)
  - blue light glasses
  - ergonomic devices if the technology requires repetition
Clarifying Questions
- Additions
  - Is there access/availability to ergonomic devices?
- Comments
  - Consider repetitive stress injuries from overuse of mouse and keyboard
Software Approaches
- Additions
  - Ensure dependability/reliability to prevent crashes due to overuse, bandwidth limits/throttling, etc.

Booking and attending a virtual meeting

Also see:
- Comments
  - Consider that the Personal Health Information Protection Act (PHIPA) is adhered to and that clients are aware that their information is safe and secure.

Humanizing wait queues

Functional needs
- Additions
  - callback option
  - e-mail back option
Software Approaches
- Additions
  - Robo-assistant that answers FAQs and generic questions

Building and nurturing trust through feedback

Clarifying Questions
- Comments
  - Who looks at the feedback?
  - How is the feedback used to inform future practices and delivery methods?
Software Approaches
- Comments
  - Can a simplified form (like a Likert scale or rating) be used to limit user fatigue?

Enhancing intake process to personalize service delivery

Clarifying Questions
- Comments
  - How much information is too much information?
    - How does the review of an exhaustive amount of information affect practitioners and their speed of delivery?
Software Approaches
- Comments
  - Keep forms easy to fill out. Prioritize speed over details, as details can be retrieved during the actual appointment.
    - This may also reduce the need to provide detailed information multiple times.

Improving service by storing and sharing complimentary information

Introduction
- Comments
  - Beware of potential privacy and security breaches of stored and shared patient information.
Practices
- Comments
  - If a patient is of sound judgement, having others within their circle of care decide on their behalf limits the patient's ability to advocate for themselves.
  - For patients who cannot advocate for themselves, this allows for substitute decision makers from their circle of care to advocate for them.
Software Approaches
- Comments
  - How feasible is this?
  - What if the journal is misplaced or stolen?
    - Is this a breach of privacy?

Addressing financial barriers

Functional needs
- Additions
  - Lower socioeconomic status preventing access to internet
  - rural settings
Practices
- Comments
  - Are resources easy to understand?
  - Are there options for various languages and formats?
Software Approaches
- Additions
  - Ensure dependability/reliability to prevent crashes due to overuse, bandwidth limits/throttling, etc.

Virtual meeting connectivity

Clarifying questions
- Comments
  - Is it possible to secure the connection to ensure that it doesn't disconnect?

Technical literacy

Clarifying questions
- Additions
  - What are the minimum requirements for connectivity?

Understandable communication

Functional needs
- Additions
  - Being ready to answer any and all questions asked to promote empowerment in health journey.
Clarifying questions
- Additions
  - Would the use of pictures be helpful?
Practices
- Additions
  - Provide "normal" ranges for lab values to promote understanding of the readings.

Provide extra opportunities for questions and feedback

Clarifying questions
- Comments
  - Will this information change with the next appointment?
  - What is the turnaround time reading feedback and implementing changes to foster a therapeutic relationship?
Software Approaches
- Additions
  - Include a summary of things discussed during the appointment to potentially allow the client to ask more questions for a deeper understanding for future appointments.

Encourage self-documentation and personal data logging

Clarifying questions
- Comments
  - Something like the health app on iOS that logs regular exercise activities, heart rates, etc.
Practices
- Additions
  - Possible integration of nutrition and meal planning with lab values and future medical testing.

Understandable healthcare processes

Clarifying questions
- Comments
  - Each person's illness trajectory may be different.
  - Ascribing a generalized sequence of events may do more harm than good if the patient is not at specific steps at particular times; causing them much anxiety and stress.

Establishing and expanding the circle of care

Introduction
- Comments
  - How often are contacts updated?

Nurture reassurance

Introduction
- Comments
  - Does this apply to the healthcare practitioner?
  - Who is cultivating a reassuring environment during virtual healthcare delivery?
Clarifying questions
- Comments
  - Who is responsible for this?

Welcoming and supporting caregiver involvement

Introduction
- Comments
  - How can this be promoted without the caregiver taking up too much responsibility and limiting the client's agency?
Clarifying questions
- Comments
  - If an unreasonable request is made with regards to support preferences, who has the final say?
Practices
- Comments
  - Consider financial constraints for engaging support services.
  - Consider mental capacity of clients requiring support.

Additional Guidelines

Healthcare practitioner hesitancy to adopt changing to virtual model

age of healthcare practitioner

refusal to learn new systems

difficulty assessing patients virtually

camera, computer and sound issues making it difficult to conduct thorough assessments virtually

The goal was to gather some initial feedback and impressions about the content, structure, and clarity of the Guide.

The feedback is recorded here for future work and improvements to the Guide, including helping formulate further plans for participatory co-design.

The questions asked

The following are 9 questions were asked so help guide experts in their feedback:

Did the Introduction, Values and Guiding Principles in the Guide document provide sufficient context for the Guidelines? Is there any information that was not covered that would be helpful?
Do you have any feedback on the structure and organization of the Guidelines? From your perspective would you organize them differently? How and why?
Did any of the information in the Guidelines feel non-applicable, incorrect or insufficient in the context of virtual care?
Is there any information you feel is missing from the Guidelines?
Is there any information you feel we should expand upon?
As we continue the work, whose feedback and participation would you like to see reflected in these Guidelines? Whose feedback do you wish was included or emphasized more? Is there a community, group, person or other we should engage in future Guideline work?
Naming the Guidelines is important for clarity and meaning. Please review the Guideline names and tell us from your perspective what you would change and what works well.
Do you have any feedback related to any of the language and terminology used in the Guidelines?
Do you have any other feedback that you would like to share?

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