Guide feedback from registered nurse

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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