Both patients and clinics have had to rapidly adopt to telehealth due to safety concerns associated with in-person visits. Last summer, we published a blog post highlighting common areas of concern that healthcare professionals (HCPs) have when using telehealth. We suspected a gap between clinicians’ needs and what telehealth products offered, so we set out to gain a better understanding of clinicians’ experiences. We hosted a focus group consisting of physicians working in various specialties across the United States. Participants included: a radiologist, pediatrician, endocrinologist, internist, family medicine resident, and a psychiatry resident. While this focus group was conducted pre-pandemic, the findings ring as true now as ever.
During this focus group, we also heard about design needs for electronic medical records (EMRs) features. Video conferencing, integrated messaging, and mobile access to EMRs allow physicians to connect with patients from nearly any location at any time, therefore creating an connectivity between telehealth and EMRs. Because of this, HCPs spoke about their needs for both technologies concurrently.
After this multidisciplinary group of HCPs dialed in, here is what we learned:
Clinical information and messaging are difficult to manage
- Too much information: Physicians said they are overwhelmed by the constant barrage of patient information they need to filter through daily (e.g. lab results, reports, orders). A radiologist stated that while the information in the electronic medical record is very helpful, physicians are “inundated” with it. A pediatrician in the group commented, “it’s hard to know what’s actually important to respond to first.”
- Inbox overload: With unlimited access to messaging and patient information, HCPs described the need to be constantly ‘on.’ Many indicated the only way to keep up was to use their personal time. One HCP commented that sometimes the inbox feels like a chatroom with the nurses. She felt that while the inbox was supposed to make things easier, instead it offered too much access and availability. Another physician found the EMR’s inbox to be annoying even though the tool itself is useful.
- Extra staff needed: It was noted that while EMRs may have eliminated the need for data-entry staff, there is now a need to hire dedicated people to manage the system due to sheer volume. One physician felt that the EMRs were not always efficient and hiring staff “like nurses that can put the data together and help package it up” might be useful.
- Conversations are sometimes necessary: HCPs expressed a preference for direct communication about emerging situations over receiving additional notifications or alerts. If a patient’s values are critical, the family resident explained that she wants a phone call from a nurse, so the nurse can receive orders and promptly treat the patient. The pediatrician in the group stated, “Having a conversation is usually needed.” She said that rather than working from what the system spits out, a conversation can clarify or correct a misunderstanding regarding patient information.
HCPs want to streamline data for their specialties
Generally, HCPs wanted EMRs, mobile apps, and other telehealth products to be streamlined and customizable specific to their area of practice. This could make the process of reviewing and managing the abundance of patient data easier.
HCPs desired a search feature in the EMR. One physician said that some employees do manage to customize her clinic’s EMR, but they basically “write code” to make shortcuts. She wanted the EMR to be more intuitive, so customizations could be accessible to people with a basic knowledge of technology.
Telehealth efficacy varies by practice area
Several specialists explained that telemedicine makes more sense to use in specific practices (ex. psychiatry, specialist follow-up appointments) than in primary care. An endocrinologist in the group commented that specialists often access information they need for consultations by looking at reports / notes from the initial visit (e.g., ER notes, admitting notes, chief complaints). Therefore, the specialist may not need to conduct a new physical evaluation, and a follow-up consultation could be easily facilitated by telehealth. A psychiatry resident added that psychiatry may be well-suited for telehealth visits because a remote interview with the patient is more comprehensive than a physical exam would be for that specialty.
On the other hand, an internist explained that, from his point of view, there is not enough research to understand the outcome of using telehealth as a regular or long-term treatment approach.
Ultimately, physicians expressed agreement that initial visits should typically be in-person when possible. A participant indicated that the overall impact of telehealth would improve efficiency, patient satisfaction, time, cost, effectiveness, and provider satisfaction.
The healthcare reimbursement system is not designed to support telehealth
The endocrinologist of the group commented that more systemic support is needed to use available technology. He pointed out that the healthcare system seems to support reimbursement for in-person visits, but money, time, and energy could be saved by using teleconferencing that is not currently covered by insurance. While the technology exists, the participant summarized, “Nobody’s gonna do it if you don’t get paid for it. We can’t just work for free.”
Telehealth is the best or only option in some cases
Telehealth is necessary for our current society, and it often creates opportunities for healthcare where it otherwise isn’t possible. For example, one participant emphasized that telehealth is hugely important in rural settings or in populations with limited transportation because the options for receiving care are often remote visits or nothing at all.
With the current pandemic, we are seeing the need for accessible and effective telehealth options more than ever. These findings highlight the importance of engaging the user groups into software design. Iteratively testing your product with the target user will provide key insights that can be quickly integrated into prototypes and designs. We must adapt, design, and continue improving telehealth so HCPs can spend less energy navigating tech and can focus on their true goal – caring for their patients. Engaging these users through a variety of user research methods when designing telehealth applications, process flows, and integration tools will support more widely adopted, safer, and user-friendly systems.