Guide feedback from registered nurse

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.

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.

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?

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?

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.

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.

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.

Functional needs

• Additions 

  • callback option

  • e-mail back option

Software Approaches

• Additions

  • Robo-assistant that answers FAQs and generic questions

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?

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.

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?

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.

Clarifying questions

• Comments 

  • Is it possible to secure the connection to ensure that it doesn't disconnect?

Clarifying questions

• Additions 

  • What are the minimum requirements for connectivity?

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.

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.

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.

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.

Introduction

• Comments 

  • How often are contacts updated?

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?

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.

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