A study published in Taylor & Francis Online explores the cultural, organisational and technical barriers, and the facilitators, to the adoption of telehealth technologies in Occupational Therapy (OT) services.
The study analysed the use of a video consultation prototype that enables audio/video home assessments through a computer browser. The patient receives a link to the webpage via text or email and the occupational therapist is supplied with an interface allowing them to record content, take digital notes, and take control of the patient’s camera to focus the video as needed for the assessment. The technology also supports simultaneous participation of multiple users, to allow family members or carers to join the sessions.
The main barrier identified by the researchers was that of security, in terms of the video connection, data storage, levels of access and sharing of information. They found that although one of the perceived main benefits of a virtual solution was the possibility to share information with other agencies and therefore reduce duplication, there were questions around how the system would allow this whilst respecting patient confidentiality and information governance.
Other barriers highlighted in the analysis included the training required for therapists to use the software and concerns around inequalities, particularly regarding availability of IT resources, reliability of network connection, and cost for patients and professionals. The researchers also found worries around reliability, as a virtual appointment limits the therapist’s ability to make use of sensory information, and patients or carers would have to supply information such as room size or height of counters themselves.
For health professionals, service efficiency was a key facilitator of the technology’s adoption. They noted that reduced travel and visit time would speed up the discharge process, therefore enabling them to carry out more visits and decrease their waiting lists.
They also highlighted safety of remote visits as an important facilitator, with several participants pointing out the safety risks attached to lone visits to people’s homes, dangerous or unhygienic homes, and the associated travel.
For patients, the ability to become more involved in the management of their own health was identified as a facilitator, along with the ability to better involve families or carers. Patients noted cost savings due to reduced travel, the benefits of increased service efficiencies (with therapists having more time to support patients with visits currently deemed non-essential), better support for patients with mobility issues, and the possibility of supporting patients across a larger geographical area. In addition, patients commented on the positive environmental impact of less travel.
Information-sharing was highlighted as a facilitator as well as a barrier; patients discussed how sharing visits between agencies would enable more integrated patient care.
The researchers then shared a number of guidelines on how the prototype technology could be designed to increase chances of adoption, based on participant discussion.
They suggested that security must not be invisible, with all participants expressing a desire to be visually reminded of security precautions in the interface. Guidance and help features should be customisable and multimodal to increase accessibility, and there should be multi-user support. Patients should have a sense of control, so that they can choose if they want to use the new virtual service. The technology should not leave a trace on the users’ devices; for example, images captured should not be saved to the users’ phone. Professionals should ensure that they carry out their virtual appointments in a professional environment, and the telehealth system should also have inbuilt strategies to enable confirmation of the patient’s identify and home location.
(2022) User attitudes towards virtual home assessment technologies, Journal of Medical Engineering & Technology, 46:6, 536-546, DOI: 10.1080/03091902.2022.2089250
