Initial Expert Feedback on the Guide

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