Introduction

These guidelines deal with factors that relate to accessing and interacting with virtual healthcare systems.

4.1 Virtual meeting connectivity

A primary tenet of a virtual healthcare is the ability to remotely connect patients and practitioners. It is important that the connection is stable, reliable, and available; with fallbacks provided in the event that the primary connection cannot be established or maintained.

4.1.1 Functional needs

• Practitioners and participants require reliable and sufficient network capability to connect to the virtual healthcare platform and perform all required functions.
• All parties should have the ability to easily recover from a dropped connection.
• There should be multiple modes of connecting patients and practitioners, e.g., video call, telephone, text chat.

4.1.2 Clarifying questions

• Is the patient able to choose their preferred method for communication?
• Is there a defined process for handling dropped or unavailable connections?
• Is the patient aware of and able to access the fallback solution?

4.1.3 Practices

• Flexibility in connection methods (lower bandwidth applications, telephone, mix phone and video stream)
• Allow patient to choose their preferred method of communication, and preferred fallback options.
• Have an agreed upon reconnection plan with participants.

4.1.4 Software approaches

• Monitor network quality and suggest and automate actions to improve connectivity.
• In the case of a dropped connection, the fallback method can be communicated in the interface, or via other communication method (e.g., e-mail or text).
• Allow the patient to indicate their communication preferences. Have a way of recording preferences in patient intake (other related guideline: 2.4 Enhancing intake process to personalize service delivery above).

4.2 Technology access

For an individual to engage in virtual healthcare there are technological requirements they need to satisfy. Communicating these requirements, providing different meeting options, and having flexible and robust systems can help minimize or remove technology barriers.

4.2.1 Functional needs

• The individual requires access to a device(s) with sufficient hardware and software capabilities. For example, a compatible computer, smartphone, camera, speakers, mic, telephone, functional connection/internet, etc.
• A variety of ways to access the virtual healthcare to accommodate different accessibility needs and preferences, which may change over time, vary depending on location, and be affected by other contexts.
• Flexibility in completing tasks using different or no technology. For example, being able to complete and submit a form in different ways.

4.2.2 Clarifying questions

• Are all necessary meeting features available to all individuals, regardless of the connecting technology? For example, does the mobile application have critical feature parity with the desktop version?
• Is the individual aware of technology requirements ahead of time?
• What options are available to individuals who do not have readily available access to required devices and software?
• Are there digital and analog ways of completing a task?

4.2.3 Practices

• Provide individuals with information about where devices can be borrowed or booked; such as a local library, community center, shelter, etc.
• Offer a spectrum of service options ranging from minimal / no-technology methods such as traditional telephone meetings, to meetings utilizing current consumer devices and virtual meeting applications.
• Provide multiple ways of completing tasks that use various levels of technology including no technology options. For example, a consent form can be completed using postal service, email attachment, web-form submission, or verbally at the appointment.

4.2.4 Software approaches

• Provide different ways of viewing and completing documents over the web, email, and printable copies.
• Where possible, automate or facilitate transmission of documentation to other healthcare providers on behalf of the individual such as prescriptions, referrals, requisitions, insurance claims etc. For example, prescriptions can automatically be submitted to their local pharmacy,

4.3 Technical literacy

Even with a suitable suite of hardware and software, there needs to be proper setup and usage to connect to the virtual healthcare platform. This may include technical knowledge to use devices and software, connect to the virtual healthcare platform, setup accessories (e.g., mic, speakers, camera, etc.), troubleshooting issues, and best practices for telecommunication. Issues may result in loss of connection, or an inability to communicate within the session.

4.3.1 Functional needs

• Be able to connect their supported devices or software to the virtual healthcare platform.
• Overcome any barriers or limitations that may arise connecting to or during the appointment.
• Sufficient knowledge or comfort with technology to be able to use the necessary the virtual healthcare platform.

4.3.2 Clarifying questions

• What connection is required to provide quality care? Are there alternatives if the connection fails?
• Is there support or information provided to the patient to guide on how to establish the connection to the virtual healthcare platform?
• Can information or resources be provided in advance that might help participants more comfortable or better prepared for the meeting?
• Is there someone available to support any issues that may arise?

4.3.3 Practices

• Inform clients of the technical requirements ahead of time and provide alternative methods or backup plans.
• Individuals may not be familiar with the device or technology have options to provide support as needed. This can be resources available that prepares participants in connecting to the virtual healthcare platform, as well as any configuration of software or hardware required.
• Provide guidance on improving audio quality if required. This may include steps to increase microphone gain, enabling echo cancellation, facing the microphone when speaking, or having participants use a headset and / or a high-quality mic. Audio quality may be hard to improving for some individuals depending on their ability, environment, or the tasks they are performing at the time.
• Advice should be given for the camera to frame the scene that is most important to the practitioner at the time. Predominantly this will be the faces of the participants to facilitate communication, lip reading, and facial expressions, but can be other subjects depending on what is to be observed. Moving the camera can be difficult for some individuals (other related guideline: 1.2 Supports for using technology above).
• Provide guidance on how to optimize the connection, including suggesting settings to improve performance like closing other running applications, or different environments like closer to the WiFi access point or plugging directly to the network using a cable.

4.3.4 Software approaches

• An interactive guide that steps client through different software settings that can help improve their experience, in particular audio, video, and connection quality. For example, this guide could include a demonstration of the effects of speech direction, ambient noise, and echo on audio quality.
• A tool that detects / analyses capabilities and reports possible improvements. If there are issues that cannot be resolved, the tool can provide other methods of interaction and meeting options. This tool can also be used ahead of time to test capabilities so adjustments or alternatives can be done advance.