CULTURE OF TELEMEDICINE:EXPLAINING A NEW PARADIGM

By Sidney Shapiro

• “Telemedicine involves the provision of health care and sharing of medical knowledge using telecommunications technologies. Preventive, diagnostic, and therapeutic services, as well as patient education and assistance with self-management of health, can be provided via telemedicine.”

• Hatzakis, M.,Jr, Haselkorn, J., Williams, R., Turner, A., & Nichol, P. (2003). Telemedicine and the delivery of health services to veterans with multiple sclerosis. Journal of Rehabilitation Research and Development, 40(3), 265-82.

WHAT IS TELEMEDICINE?

• Technologies used for telehealth are not new, but are slowly making inroads to being used in healthcare.

• Source: http://www.imt.ie/news/latest-news/2011/10/telemedicine-service-similar-to-skyping.html

HOW IS IT USED

THE QUESTIONS:

What are the cultural and social expectations for a patient seeking

medical services in a clinic?

How does the use of telemedicine impact or change these expectations?

THE CLINIC:

We can use an example of a clinic in North Eastern

Ontario. It serves a number of patient populations. The clinic is new, and due to its location, the clinic primarily (80-90%) sees

patients via videoconferencing

technology using the Ontario Telemedicine

Network (OTN)

• A concept or framework that organizes and interprets information into a mental structure that represents some aspect of the world. People use schemata to organize current knowledge and provide a framework for future understanding. Examples of schemata include stereotypes, social roles, scripts, worldviews, and archetypes. In Piaget's theory of development, children adopt a series of schemas to understand the world.

Sources: Anderson, J.R. (1990). Cognitive psychology and its implications . New York, NY: Freeman.

WHAT IS A SCHEMA?

EXPECTATION OF WHAT A

CLINIC WOULD LOOK LIKE

OR SOMETHING LIKE THIS TO THE PATIENT COMING IN TO THE OFFICE

SOURCE:HTTP://WWW.UDEL.EDU/STUDENTHEALTH/SERVICES-FOR-STUDENTS/

MEDICAL_CLINIC.HTML

Perhaps this is what a patient would picture a

telehealth consult looking like

A dark room, however, is not what a patient is expecting. This is certainly not ideal

conditions for either the patient or the health care

provider Source: http://ex1lee.deviantart.com/art/Dark-Old-

room-144554885

• What Happens At A Telemedicine Appointment?• Once the patient has checked into the telemedicine site, usually inside a hospital, the local Telemedicine Coordinator will explain the process and the equipment to the patient. The patient may be asked to change into a hospital gown, depending on the type of appointment. The length of the appointment will vary depending on the discipline and Physician.

• Source: http://sunnybrook.ca/content/?page=care-telemed

SUNNYBROOK HEALTH SCIENCES

SUNNYBROOK LISTS THE EXPECTED “LOOK AND

FEEL” OF A TELEMEDICINE INTERACTION:

• What Happens At A Telemedicine Appointment? Contd

• Time-saving video technologies and electronic diagnostic equipment such as patient exam cameras and digital stethoscopes work together to allow patients to be assessed as if they were there in person. Typically, the Telemedicine Coordinator will stay in the room with the patient for the consultation, and sometimes the local Physician or Health Care Provider will attend as well. The patient is welcome to bring a family member or friend with them. The appointments take place in private, secure rooms and the examination can only be seen and heard by those involved in the consultation  - at both the patient's location and the consultant's site.

• Source: http://sunnybrook.ca/content/?page=care-telemed

SUNNYBROOK HEALTH SCIENCES

SUNNYBROOK LISTS THE EXPECTED “LOOK AND

FEEL” OF A TELEMEDICINE INTERACTION:

EXPECTATIONS IN A PARTICULAR SETTING, SUCH AS A MEDICAL

OFFICE

There are particular features of a patient visit

to a medical clinic. Patient expectations have an impact on healthcare

outcomes.

(E. Zebiene, E. Razgauskas, V. Basys, A. Baubiniene, R. Gurevicius, Z.

Padaiga and I. Svab. Meeting patient’s expectations in primary care

consultations in Lithuania. Int J Qual Health Care (2004) 16(1): 83-89.)

http://intqhc.oxfordjournals.org/content/16/1/83.full

1. Patient made an appointment, was told they would be seen by the doctor, following an initial assessment with a clinician. The receptionist used neutral language (eg. Your appointment to see the doctor will be on Monday at 2pm)

2. Patient came into the clinic and discussed medical issues with clinician, had a medical history taken, filled out paperwork and left a urine sample. At this visit the concept of “seeing the doctor” was reinforced for the second time.

Example: ADVERSE REACTIONS

3. Patient returned to the clinic several says later, was greeted by the receptionist, waited in the waiting room, and was brought into the doctor’s office. The small sized room had a teleconferencing video set up and displayed an image of the doctor in a dark room with red eyes and shadows.

4. The patient has a panic attack and ran out of the clinic.

ADVERSE REACTIONS

WHAT WENT WRONG?

1. There are a number of things that went wrong in this interaction

2. Not using terms to give patients an idea of what to expect. Use of language like: telemedicine, OTN (Ontario telemedicine Network), video conference, etc. or other indicators that the visit would be virtual.

3. Lighting and presentation are critical factors to properly using teleconferencing

4. Technological issues (such as speed and video signal corruption) can also be factors.

Implementing a number of changes, in light of this type of occurrence, dramatically changes the expectations of patients. It is important to understand the place of holistic integration of telemedicine technology in the clinical setting

CHANGING THE EXPECTED INTERACTION SCHEMA

ADDRESSING CRITICAL AREAS

• Creating a similar setting is practical (as it can be used in person as well) and a familiar concept for patients

• Managing expectations involves making telemedicine an everyday part of the clinic

EXPECTATIONS

•Working on an integrated strategy means that patients will receive multiple types of reinforcement that they will be using telemedicine in some form

PLANNING

ADDRESSING CRITICAL AREAS

• Having a communications policy developed which addresses the need to properly positioning telehealth technology with patients is critical to promoting comfort

COMMUNICATION

• Using telehealth specific words as part of patient/clinic communication is key to adapting the expectations of patients

TERMINOLOGY USED

• Display in the clinic outlining how patients are seen or a brochure which patients can read while waiting for their appointments

PRINTED MATERIALS / VIDEO

ADDRESSING CRITICAL AREAS

• At key points in the patient process, such as an intake history/interview, or during periodic visits, the idea of the technology used in the visit (or the possibility of such technology being used) can be reinforced.

CLINIC/PATIENT COMMUNICATION

• Patients will generally have a health care professional in the room with them while they are consulting a remote site via telemedicine, this connection could help acclimate the patient.

PRESENCE

THANK YOU