Should A Technologist Be Part Of The Care Team?
Melek Somai MD, MPH and I recently wrote in a forthcoming article about the “bugs in the virtual clinic” about the role of technical challenges that patients and clinicians face that may impede virtual care.
There are several: wifi issues, video and audio troubleshooting, navigating mobile applications just to name a few. We have previously shown that these technical challenges disproportionately affect older people and those that are less socioeconomically advantaged.
While some may just say it is easier to come in to an office and not face those challenges, we know that requiring in-person care also brings challenges. Transportation, child care, time away from work. Even blood pressure is well known to be higher in office settings than home settings, regardless of a ‘white coat syndrome’ being present.
As many health systems, including ours, reinvests in workflows and technology for virtual care, what will be the most effective ways to support patients?
- More intuitive experiences: relentlessly pursue ease of use, making it easier for patients to access the appropriate digital service. Sending a direct text message to start a video visit, or enabling joining from one tap within an app. Details to check-in need to be assessed and contingency plans made. For example, we guide patients through an electronic check-in process that reviews medications, medical problems, collects co-payments, and confirms insurance, presence of workman’s compensation claims, and other required questions. These steps, while streamlining the staff’s work and providing an opportunity for patients to participate in ensuring their data are accurate, may present barriers to patients. Streamlining this process and enabling staff to support patients through this process are needed.
- In-person support: Similar to Oschner’s O-Bar or Apple’s Genius Bar, may we find ways to guide patients in how to use technology to increase confidence? In-person support may extend into conducting actual virtual care, such as a synchronous telemedicine/video visit. For example, community partnerships could enable patients to have virtual visits close to their home, such as in a local library, a local pharmacy, or within senior centers — each providing a quiet, private space and having a staff member or volunteer able to guide the patient through any technical challenges.
- Care team know-how: Health coaches are filling important spots within care teams to help translate medical information into actionable steps within the context of patient lives. Some newer primary care models like Iora Health’s are empaneling patients to coaches. Care teams also commonly have social workers to help patients navigate a myriad of community services and applications. When we surveyed our clinicians, their responses indicated that they were much more comfortable managing medical conditions than troubleshooting technology. Of course, that makes sense — doctors aren’t tech support. But are we able to either upskill our new trainees, particularly medical assistants and other patient-facing staff, so that they have more comfort and confidence in assisting patients? Or will there be a role for a technologist, one who is capable of helping patients access and use technology for telemedicine or remote monitoring? It will likely be difficult to have dedicated staff for this. One additional model may be to partner with companies that provide technical support already across healthcare and other industries so that patients have access when needed to such support.
As with many things in healthcare, we likely will need a multi-pronged strategy to overcome challenges. A combination of the possibilities discussed above are likely needed — some interventions working better for some patients than others.
What other support makes sense or should be tried? Please leave a comment.