Digital clinical encounters

Elwyn, Glyn; Barr, Paul; Piper, Sheri

doi:10.1136/bmj.k2061

Cited by 15 publications

(9 citation statements)

References 7 publications

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“…An adequate internet connection was considered an important prerequisite for using the new digital communication tool, but it is a societal rather than merely a health care concern. On the other hand, patient privacy and data security are very much health care concerns ( technology-organization ) [ 27 ]. Contrary to early studies from the beginning of the 21st century about patient-provider contacts via email in primary care, for example, where patients raised concerns about security and lost messages [ 28 ], patients in this study did not raise any cybersecurity or legal issues during the interviews.…”

Section: Discussionmentioning

confidence: 99%

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

Nilsson¹,

Sverker²,

Bendtsen³

et al. 2021

J Med Internet Res

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Background The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective This study aims to explore patients’ experiences using a chat-based and automated medical history–taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history–taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history–taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one’s time and reflect on one’s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service.

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Section: Discussionmentioning

confidence: 99%

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

Nilsson¹,

Sverker²,

Bendtsen³

et al. 2021

J Med Internet Res

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“…The potential applications of recordings are broad and growing. Advances in novel machine learning and natural language processing techniques open new avenues in medicine, such as automated documentation of clinical notes extracted from the recorded conversations to decrease provider burden 23. However, it is important to also consider the privacy and confidentiality implications of recordings, for example, recording and sharing of clinically sensitive conversations and medicolegal concerns of providers.…”

Section: Discussionmentioning

confidence: 99%

“…A lack of policies to guide the recording and sharing of clinical visits needs to be addressed,10 and findings from our project, both quantitative and qualitative, can contribute to this conversation. If managed securely as data in an electronic medical record, recordings could transform healthcare, providing more accurate clinical records and allowing patients and families to revisit medical information that is often forgotten 23…”

Section: Discussionmentioning

confidence: 99%

Heart sounds: a pilot randomised trial to determine the feasibility and acceptability of audio recordings to improve discharge communication for cardiology inpatients protocol

et al. 2019

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IntroductionIneffective hospital discharge communication can significantly impact patient understanding, safety and treatment adherence. This may be especially true for cardiology inpatients who leave the hospital with complex discharge plans delivered in a time-pressured discharge discussion. The goal of this pilot trial was to determine if providing supplemental audio-recorded discharge instructions is feasible and to explore its impact on cardiology patients' ability to understand and self-manage their care .Methods and analysisWe will conduct a parallel-group, randomised controlled trial in adult cardiology inpatients with balanced blocking by a physician. Patients (n=50) will be randomised to usual care (verbal discussion and written summary) or intervention (usual care, plus audio-recorded discharge discussion provided to patients on a portable electronic recording device). Enrolled patients will complete study assessments immediately prior to the discharge discussion, immediately postdischarge discussion and 1 week after hospital discharge by telephone. Primary outcomes include the proportion of eligible providers and inpatients who agree to take part in the trial, the proportion of inpatients who receive the audio recording in accordance with a fidelity checklist, and the proportion who use the audio recording. We will analyse preliminary data about the impact of audio recording on patient activation, health confidence, provider communication ability, adherence and 30-day readmissions.Ethics and disseminationThis trial was approved by The Committee for the Protection of Human Subjects (CPHS) at Dartmouth College (CPHS# 00031211). Findings will be disseminated in scientific journals and at meetings.Trial registration numberNCT03735342Protocol version1.0

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“…Previous studies of audio or video recording in the health care context have focused primarily on providing a hard copy of a recording to a patient, for example, a CD, cassette, or digital recorder [27]. In more recent developments, commercial apps have emerged that allow the recording, sharing, and tagging of audio recording; however, user-centered design of the app is rarely reported, and concerns about the collection and sharing of patient data have been raised [60].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach

Barr¹,

Haslett²,

Dannenberg³

et al. 2021

J Med Internet Res

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Background Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients’ primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one’s own recordings and others’ recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans.

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Digital clinical encounters

Abstract: Managed safely, digital recordings could transform healthcare

Cited by 15 publications

References 7 publications

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

Heart sounds: a pilot randomised trial to determine the feasibility and acceptability of audio recordings to improve discharge communication for cardiology inpatients protocol

An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach

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