Telehealth Practices and Patient DiagnosisArticle
29, Jun 2020. 11:48am
Virtual healthcare isn’t new to family nurse practitioner Courtney Farr. She established her own medical platform, House Calls Mobile, to provide accessible primary care for Californians in the Central Coast from the comfort of their home. Patients can access doctors and nurses for primary care inquiries by video conference from their smartphone, computer, or tablet.
In Farr’s 18+ years of healthcare experience, she’s found that making a complete diagnosis of a patient boils down to 80 percent dialogue and 20 percent physical exam. Based on a formula she developed for understanding her patients’ medical needs, House Calls Mobile lets Carr collect about 80 percent of the data on her patient checklist.
If there is a need for further consultation, Carr and her medical team refer the patient to a specialist.
Virtual instruments level-up virtual care
In order to achieve a more complete patient diagnosis, Carr created a virtual stethoscope and otoscope.
The instrument works just like a traditional stethoscope would—a doctor is able to listen to the patient’s heartbeat. A small disk resonator is placed against the chest, but instead of tubes connected to earpieces, a cord connects the instrument to a speaker. The physician, or in this case nurse practitioner, can hear the results on their side of the screen. The otoscope uses the same concept.
Both devices are still undergoing clinical trials to gain FDA approval. The devices aren’t new to the telehealth field, says Dr. Lindsey Faucette—an osteopathic family medicine physician (DO).
Dr. Faucette believes that another tool in a physician’s kit, virtual-visit or not, is building a relationship with the patient. This contributes to the patient’s medical history, which doctors rely on to make a diagnosis.
Faucette says that while healthcare providers can diagnose most ailments using telehealth, certain conditions such as abdominal pain or conducting heart and lung exams, currently need to be done in person. In the case of abdominal pain, she says it’s important for the healthcare provider to palpate the abdomen to determine whether or not there is a need for surgery.
Dr. Faucette said it’s more difficult to treat patients with comorbidities or elderly patients that are taking multiple medications. In these situations, she’d prefer to see patients in-person as well as by telehealth (if the latter is the patients’ preference).
Telehealth in different healthcare fields
For over 30 years Dr. Michael McGee has provided his patients with psychiatric and behavioral healthcare with a focus on compassion and convenience. He says, “Recovery is not just recovery through treatment; it’s recovery through integrated care for the mind, body, and spirit.”
His practice, WellMind, offers his patients the option of virtual visits. Dr. McGee began using telehealth services in 2015 when he moved the location of his practice. At the time the decision to offer telehealth was made because many of his patients still wanted to see him but didn’t want to take on the extra commute.
“Literature doesn’t show any difference between telehealth versus in-person in terms of looking at the outcome to treatment, so I don’t think there’s any difference in clinical outcomes,” Dr. McGee says.
According to a 2019 review for the Agency for Healthcare Research and Quality, found telehealth consultations do generally improve access to healthcare.
Dr. McGee agrees the only downside of telehealth is if a physician needs to conduct a physical exam or procedure. In telepsychiatry, he says he can’t administer medication or have patients fill out penciled evaluations. But psychiatrists, he said, almost never do physical exams, as a diagnosis is made on observation and patient history.
Use feedback to continually improve telehealth platforms
Telehealth platforms differ for different kinds of healthcare providers, just as the ways they use them do. But the perfect telehealth app, or platform doesn’t necessarily exist, according to Ben Lee, founder and CRO of Rootstrap—a global team of strategists that assist organizations to bring value to their service by developing innovative mobile, web, and cloud software.
The key to making an effective application, Lee said, is getting feedback from users to guide their work on updates and modifications.
“Once it’s in the hands of the users, that’s how you really learn,” he says.
The main challenge with getting that feedback, Lee says, is that, more often than not, doctors only use the platform to log on for virtual visits with patients. Developers need to get feedback from the doctor’s staff, who input patient information, schedule virtual appointments, and actively using the platform on a daily basis.
This not always the case. Consider the physician, therapist, or psychiatrist who runs their own practice. Those individuals are more hands-on with everyday administrative tasks, and will be more likely give the feedback it takes to get an end product that works for them.
Human-centered design is key
As with any technology platform, it’s vital the system is user friendly for both the patient and the physician. Keep in mind that some people may not be tech-savvy, and might have a hard time with downloads or the interactivity of the telehealth platform. Assuring that both parties can access and use the platform makes for a positive virtual-visit experience.
Overall, Telehealth platforms work well to increase access to health care, keep patients safe from contagious disease, and provide almost as much diagnostic information as office visits. But developers and practitioners are advised to continually monitor the interactions between doctors and patients and the technology to make improvements for even better outcomes.
Recently, one member of the EMPATH team, Louis Camassa, tried to schedule a telehealth appointment with Blue Shield via Teledoc—a telehealth provider. Camassa tried using the online platform to schedule an appointment five times with five different doctors to no avail. With each attempt, he scheduled an appointment but the healthcare provider on the other end declined because the day or time given conflicted with their schedule. The missing link in the scheduling system was a lack of communication with the physician—there wasn’t a way to send a message or email. For a platform with a market cap over $13B, it has room for improvement in regard to the patient experience.
Every technological experience should be designed with a deep understanding and focus on its users. Keeping a product centered on its users will not only attract more but extend product and brand loyalty.