David Gordon had the opportunity to experience the modern health system he helped build last December when a blockage in his neck caused him to suffer a transient ischemic attack.

After the episode, his physician brought Gordon’s entire care team—and a latte—into his hospital room to discuss his options. The team had conferred, Gordon said and concluded that either surgery or a stent, could result in equally positive outcomes. His doctor wanted his input—and not just because he happened to be the director of the Karen S. Rheuban Center for Telehealth at the University of Virginia.

Gordon believes technology has enabled this more democratic approach to healthcare by bolstering regular communication between physicians and their patients. In spite of concerns that telehealth could seem cold or impersonal, many medical professionals are coming to the opposite conclusion. Digital communication with patients may open the door to more humane healthcare, so long as protocol ensure providers use technology to build more meaningful relationships with their patients

 

“We live in an era filled with communication capabilities,” Gordon said. “We can be in touch with each other in a million different ways. How are we going to use that to make sure that we are really communicating? Not just texting, but really connecting fully in a relationship?”

At the Veteran’s Health Administration, where patients scheduled more than 1 million video-based appointments and exchanged more than 15 million electronic messages last year, quality communication begins with patient choice, according to Neil Evans, who oversees the office of connected care for the Veterans Health Administration.

“Giving veterans options regarding how they want to engage in their healthcare is important to us,” Dr. Evans said. “A veteran can always choose to exclusively have traditional face-to-face visits if that is their preference—though many are choosing to receive care both in person and remotely.”

Similarly, Intermountain Healthcare has revised their patient intake forms to include a question about each patient’s preferred method of communication, according to Brian Wayling, who is the executive director of technology and development for the Utah-based health system. Patients who are comfortable using a smartphone receive regular messages about medications, upcoming procedures, and even exercise reminders via the health system’s patient engagement platform.

But even when patients prefer using technology to communicate with their doctors, Intermountain draws some lines. For sensitive conversations, Wayling said, Intermountain ensures that the patient’s primary care doctor, a family member, or caregiver is present in the room with them while they speak with their provider over video.

“That’s absolutely essential for us—no difficult conversations directly with the patient when they’re not prepared, or there’s no one there in person,” Wayling said. “Receiving news from a caregiver takes time to process, and you want to make sure that someone is there.”

John “Fred” Thomas, executive director of the Extension for Community Health Outcomes (ECHO) in Colorado, is of a similar mind as Wayling regarding sensitive conversations. But delivery always matters, he said, even with low-urgency matters such as a cold or sore throat. At ECHO, a Colorado-based nonprofit dedicated to improving access to healthcare through technology, partner physicians are coached on video chat etiquette to ensure good bedside manner, even when patients are miles away.

“We’re always mindful about how people present,” Thomas said. “If they’re a little wooden in their presentation in person, technology is going to exacerbate that….so be aware of what they wear, how much they move their hands around, how they look.”

ECHO Colorado encourages partner physicians to practice video conferencing beforehand to iron out important little details—if, for example, the camera is positioned wrong, it won’t look like the doctor is looking at the patient.

Thomas believes the notion that digital communication will make doctors seem uncaring is a myth. His own surveys, he said, suggest high levels of patient satisfaction.

Todd Allen, a PC Case Manager, saw similar results at Four Seasons, a North Carolina-based nonprofit focused on in-home palliative care. Although at first it seemed like text messaging a patient could seem cold and disconnected, he found that most of the 150 patients he manages prefer to have ready access to their care team via SMS.

“The thing is—when the patient finds they can reach their team with a text message, they feel like they’re not alone,” Allen said. “You don’t call and get a call back the next morning.”

The constant connection with their care team also empowers patients to make more decisions about their own health, Allen said. He recently had a cancer patient message him with a photo of a walker he’d like to have. Allen was able to order it for him almost immediately.

And while some physicians worry that giving patients ready access to them via text messaging could result in bombardment, Fasika Woreta, an assistant professor of ophthalmology at the Johns Hopkins Wilmer Eye Institute, said she’s found most patients are judicious in their use of SMS and email. She now routinely asks her patients to message or call her directly, particularly regarding urgent matters.

“I always have that as a backup, because you don’t want the patient to have a problem and not be able to reach you,” Woreta, said.

At the VA, Evans has come to similar conclusions about digital communication. Rather than decreasing the frequency of human interaction in healthcare, technology has actually reinforced the connections between doctors and their patients.

“The opportunity to interact more frequently about health matters, including in the intervals of time between traditional face-to-face visits, is something patients appreciate,” he said. “A responsive health care system that is conveniently available when needed, including through technologies such as telehealth and other remote interactions, is good for patients.”

 

Emma Penrod – Authoreo

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