What if Your Patient Is Technology-Challenged?

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

COVID-19 has forced healthcare organizations (HCOs) and medical practices to vastly speed up their adoption of technology for patient care. Patient portals and other tools enable visits for patients who have problems seeing physicians because of the pandemic or who prefer not to come to physician offices.

However, some patients find it significantly challenging to use this technology. Many patients are unfamiliar with a portal, a remote patient monitoring system, or a Bluetooth-enabled pulse oximeter — in addition to being uncertain about the medical aspects of a medical exam or treatment.

When ordering groceries or sending a check drawn on the bank, using an app is simple, because the user fully understands the objective. But healthcare has several complicating factors, including changes to patient health status, multipart treatment plans, drug interactions, coordination with providers, and dealing with insurance coverage.

It can get even more complicated when you're coordinating care with family members, caretakers, and other healthcare professionals. If technology is going to help you treat patients, the patient needs a clear and simple presentation of what he or she needs to do and know.

Can Your Patient Actually Use Your Tools and Technology?

The design of your patient portal, your website, and a phone app will play a huge role in how easily your patient can interact with your practice. A poorly designed portal will undermine your efforts to engage patients and could even create problems for patient safety.

For most tools, more is not necessarily better: a long list of wonderful features and options could make it too complex or confusing for many patients.

Cluttered screens, tiny buttons, and links that are hard to see within large blocks of text make it hard for your patients to use tools or portals. Patients also find it confusing and difficult to understand long written explanations of medical issues or treatment steps that don't focus on the patient's individual status, even though these explanations may include important information.

Take a close look at the tools or screens you want your patients to use. At the same time, you'll want to make sure that the workflow within your practice supports the technology. For example, your portal may have a button to immediately access a staff person on a screen, but that feature is only helpful if you have staff available to interact with the patient.

Similarly, having to click through four screens to access a telehealth visit will confuse your patients and increase telehealth no-shows. If your staff doesn't respond to patient questions or data gathered by the technology, you may wind up with more phone calls from patients or a missed opportunity to help a patient avoid a problem.

Here are ways you can help patients use your technology and prevent confusion:

Create short, targeted help tools and videos. These can show how to use the patient tools and technology, and they can be customized for different patient groups. Instead of a long video that covers many topics, it's better to have separate videos for each remote patient-monitoring device (as short as 1 to 4 minutes). For your help tools and videos,

• Create a video that addresses the key steps of your patient's medical visit, such as how to complete each health assessment questionnaire, how to send a message to your office, how to request a prescription, and how to view the treatment plan.

• Consider making videos that give instructions for specific diseases and care. For example, a video explaining the use of a spirometer would include a step-by-step demonstration that encourages the patient to follow along. Similarly, a video on blood pressure cuffs would have clear instructions on how to properly place the cuff and how to use it.

• Develop separate videos for each medical device, showing how each is used. For example, create separate videos for blood pressure cuffs on the wrist and the bicep.

• Make access to the videos easy and obvious. For example, have a link to the blood pressure cuff video on the blood pressure screen, or have a short video about tracking physical activities available on the treatment plan screen.

• Offer additional informational videos that give patients general information about their disease and condition.

• Present patient stories and testimonials (after getting signed permission from the patients). These can help patients better understand the practical aspects of their treatment and how technological tools and portals can help them.

Make buttons legible and write text that is easy to read. Many patients have smartphones and iPads with small screens. Larger displays are easier to see and may be less intimidating. Your technology should include a smartphone-friendly interface as well as a tablet- or iPad-friendly interface. Prominently display the key information.

Only include important and relevant information. The more information and clutter is shown, the less likely patients will focus on the really important issues. For example, some patient portals list items on the treatment plan without highlighting the important items in comparison to the informative or future orders. Don't include older information that confuses them.

Use consumer terminology. When you're giving treatment plans and care options, make sure to use words that the patient will understand and that are similar to the words you'd use when educating any patient or when you or your staff are giving verbal instructions.

Engaging Patients

The more your patient uses your tools or technology during their care, the more familiar they'll be with it and the more adept they'll become at using it. Using a portal once a year will not create familiarity with your tools or create a good working relationship.

Continuing exchanges of information and telehealth visits with patients increase patient familiarity and comfort with your technology.

Here are some ways to help patients become more comfortable with and familiar with your technology:

Use remote patient monitoring. Remote patient monitoring (RPM) involves gathering physiologic information, such as blood pressure, pulse oximetry measurements, and glucose levels, from patients on a periodic, even daily basis. Insurance companies pay for this service because it helps spot potential problems before they become more serious and more costly to treat.

Look into conditions you treat in which RPM would be helpful. Through RPM, patients could be sending information daily, and your HCO could be coordinating refinements to the patient's treatment plan based on daily information and trends over time. For example, a decrease in pulse oximetry levels could trigger a telehealth visit with a patient.

Use a health assessment questionnaire to engage your patients and reinforce important patient activities. A sample health assessment questionnaire can be found at ARHQ.gov. You may have several different questionnaires based on patient problems and treatment strategies. The questionnaire should be as concise as possible and target issues that would help your HCO understand the current health status of the patient and frame the next steps in patient service.

The data you receive can be used to provide follow-up services or even provision supplies, durable medical equipment, and prescriptions. Many patients face challenges in getting prescriptions and supplies in addition to presenting for planned check-ups and physicals.

Hold disease-specific group meetings. Group meeting technology, such as Zoom, can be used to conduct group meetings and provide information to at-risk patients. During online group patient meetings, you can give advice and guidance that can help offset the flood of rumors and false information about healthcare in general as well as COVID.

Offer general health information and conduct surveys. A medical organization or practice can present useful information on wearing a mask, social distancing, and other COVID issues as well as disease-specific guidance to help patients more effectively interact with the practice. You might find it useful to periodically conduct a survey to assess and highlight mitigation strategies for at-risk populations.

Send email and text messages. Your practice should have the option of sending the patient an email or text message with a link to the relevant information or for a telehealth visit. For example, 15 minutes before a scheduled telehealth visit, your technology may send a message reminding the patient of the visit. Text links are particularly helpful ― over 90% of text messages are read within 30 minutes of receipt.

How to Help Technology-Challenged Patients

Helping patients who have trouble with technology can be expensive and time consuming. Staff may spend a lot of time trying to train or support a patient who is struggling with technology.

Realistically, not every patient will be able to engage through your technology and tools. Some may not have a computer, laptop, or smartphone in their home or a reliable connection to the Internet. Other patients may have trouble affording devices such as tablets or services. Also important, not all smartphones, tablets, and computers may work with your technology base. (For patients who don't have or can't afford compatible technology, some state and local initiatives provide such tools to underserved and rural patients in response to the COVID pandemic.)

You may need to assess whether some patients are good candidates for using technology, based on their education, finances, or ability to follow instructions. For those who are not, stick with more frequent office visits and phone-based consultations.

If a patient is unable to use the available tools, document it in your patient record so that you or other clinicians can structure the patient's treatment plan in accordance with the patient's abilities.

Going forward, patients may prefer using COVID-driven telehealth services in their home over making a trip to the clinic. This change may become permanent. If you can put in the effort to ensure that your technologies are relevant and are targeted to the appropriate patients, you'll be able to provide better care during the COVID pandemic, and the COVID-driven changes may become permanent.

Sterling has disclosed no relevant financial relationships.

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