Enhancing patient experiences by integrating technology
By Brett P. Guist, DC
By Brett P. Guist, DC
Aside from the strain placed on the health care system, the pandemic saw many conservative care clinicians had their practices adversely impacted during the initial lockdown. Many healthcare providers were able to pivot to the use of telehealth, defined as “synchronous or asynchronous consultation using information and communication technologies such as telephone, video conferencing, or secure messaging” (Breton et al, 2021). This was originally done on an emergency basis to provide continued support for existing patients, as well as serve as a screening tool to determine if a patient’s condition met satisfactory conditions to be determined “emergent” and qualify them for in-person care. However, with time many practices have evolved into more of a hybrid model, incorporating elements of telehealth alongside traditional face-to-face interactions.
While there are various styles of practice for incorporating telehealth or other elements of technology, many patients have reported high levels of satisfaction with this style of care (Ramaswamy et al, 2020). Patients have reported high levels of satisfaction with the accessibility of care, which is potentially the most important metric for the usage of telemedicine (Ramaswamy et al, 2020). The increased reliance on technology has not always been positive, and presents several challenges including patient access to technology devices, concerns over technology knowledge, quality of care delivered (particularly with artificial intelligence applications), connectivity issues, and privacy concerns to name a few (Mohammed et al, 2021). Despite these concerns, a recent discussion paper from the Canadian Medical Association highlighted the desire by many Canadians to have increased access to medical services including through email, phone encounters, and with telemedicine.
As healthcare practitioners, we must embrace this shift towards telemedicine and new technology, and adopt a new way of thinking. This article highlights several aspects of technology that can be adapted into clinical practice. While some of the suggested technologies may be easier to implement, others may present barriers such as finances or technological prowess. Although I am reluctant to admit it, I am part of the millennial generation, and as an “elder millennial” I find myself struggling with certain types of technology at times. The technology highlighted in this article has an ease of use that I am hoping will help in terms of adoption for its usage. A quick caveat: Although I use several of these resources both in my practice and in my role as an instructor at the Canadian Memorial Chiropractic College, I do not have any financial stakes in these companies, and am not reimbursed for mentioning these technologies.
Electronic medical records
One of the easiest ways technology can be implemented into your practice is through the adoption of Electronic Medical Records (EMR). There are a variety of programs available for this purpose, but some that are may not be advisable due to various regulatory standards of practice. For example, Chiropractors in Ontario must abide several standards of practice include Standards of Practice S-02 (Record Keeping) and S-022 (Ownership, Storage, Security and Destruction of Records of Personal Health Information) for their records. These standards of practice mention patient privacy and technological security to help safeguard patient information.
Many EMR companies offer online training and demonstrations for you to determine if they could be a good fit for your practice. Be sure to check with your regulatory college and perhaps your malpractice carrier to ensure there are no issues prior to adopting a new EMR.
During the course of your clinical encounter, there are many possible touchpoints where technology can be included. I have already mentioned the use of an EMR service to help guide the process from intake through physical exam and charting, but there are other technologies that can be used. For instance, several apps are popular to use during the Physical Exam portion including:
- Goniometer Pro is a free app to measure range of motion. It can be used in-office or at home for patients to monitor their progress.
- PostureScreen Mobile is a paid posture analysis, body composition, and movement screening application. It can be used to capture images and measurements of a postural analysis during the physical exam. One benefit of this app is that it has some peer reviewed literature to validate its usage and is advertised as being HIPAA compliant.
- CoachNow is a paid motion capture application. It can be used to capture motion analysis during the physical exam. This can be used by practitioners who conduct movement screenings, gait analysis, or assess movement performance. It allows for side-by-side video comparisons, which can be useful during reevaluation to demonstrate improvements in technique and form.
- Complete Anatomy is a paid anatomy app that provides 3-dimensional renderings of the human body. This can be used during the report of findings to highlight the relevant anatomy. It offers the ability to layer through the body to show the interconnectedness of various anatomical structures.
While the physical exam is only one part of the clinical interaction, there are many other technologies and services that could be helpful when developing a treatment plan and delivering a report of findings. These include:
- ChiroUp. This is a web-based service that offers evidence-based information for physical examinations, research for treatment plans, rehabilitation, and much more.
- Canadian Chiropractic Guideline Initiative (CCGI). The CCGI is a free, online resource that offers resources for clinicians and patients. This includes: 1) Research summaries for various conditions including lumbar spinal stenosis, osteoarthritis, temporomandibular disorders, and many more; 2) Patient handouts to assist with education; 3) Outcome measures relevant to each condition to assist with re-evaluation and discharge; 4) Continuing education courses
- Physitrack. There are several online home exercise programs, Physitrack is one of these programs and it offers exercise selection, educational resources, and outcomes measures. One benefit to Physitrack is that it provides instructional videos that can be emailed directly to the patient.
One constant struggle for many practitioners is the ability to stay on top of the latest evidence. Many of the aforementioned applications offer resources to help stay up to date with emerging research. For example, ChiroUp offers emails to highlight various conditions and treatments. Complete Anatomy offers modules to develop clinical skills including an 8-hour course on kinesiology taping.
Both the CCGI and Research Review Service (RRS) offer podcasts that can be listened to during your commute to the office. There are a plethora of various health and wellness podcasts that can be found through your preferred resource (Spotify, Apple Podcasts, etc), so there’s no need to discuss them ad nauseam in this forum.
Other technological resources can be utilized to help patients monitor their progress at home. This includes some of the technology previously discussed including the goniometer application and Physitrack for home-based rehabilitation exercises. However, other pieces of technology may be valuable for patients. This includes a smart watch such as Fitbit, Garmin, or Apple Watch to track steps and other physical activity metrics. Few studies have been conducted that show the use of these types of wearable technology for patients living with specific conditions (Reeder and David, 2016). Although there is some debate about the accuracy and validity of the health metrics captured by these devices, they may promote a less sedentary lifestyle (Massoomi and Handberg, 2019).
A recent article from the British Medical Journal discussed the use of home pulse oximeter combined with telemedicine support (Greenhalgh et al, 2021). The use of this type of wearable technology could allow patients to monitor their blood oxygen levels and allow for medical decisions on when to seek additional support. In fact, both the UK guidelines as well as WHO guidance from January 2021 supported “…use of pulse oximetry monitoring at home as part of a package of care…” (Greenhalgh et al, 2021).
The authors of this study mention that it could exacerbate anxiety, so appropriate patient screening is important. However, the combination of at-home technology such as home oximetry and telehealth may enhance care and simultaneously decrease some of the strain on the healthcare system by conserving hospital beds and reducing the risk of nosocomial infections.
In summary, there are multiple touchpoints within a typical patient encounter that could offer an enhanced patient or healthcare worker experience by integrating various types of technology.
Bhatia RS, Chu C, Pang A, Tadrous M, Stamenova V, Cram P. Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study. CMAJ Open. 2021 Feb 17;9(1):E107-E114. doi: 10.9778/cmajo.20200311. PMID: 33597307; PMCID: PMC8034297.
Breton M, Sullivan EE, Deville-Stoetzel N, et al. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Fam Pract. 2021;22(1):192. Published 2021 Sep 26. doi:10.1186/s12875-021-01543-4
Canadian Medical Association. Virutal Care in Canada: Discussion Paper. CMA Health Summit. August 2019. https://www.cma.ca/sites/default/files/pdf/News/Virtual_Care_discussionpaper_v2EN.pdf
Greenhalgh T, Knight M, Inada-Kim M, Fulop N J, Leach J, Vindrola-Padros C et al. Remote management of covid-19 using home pulse oximetry and virtual ward support BMJ 2021; 372 :n677 doi:10.1136/bmj.n677
Hardcastle L, Ogbogu U. Virtual care: Enhancing access or harming care?. Healthcare Manage Forum. 2020;33(6):288-292. doi:10.1177/0840470420938818
Massoomi MR, Handberg EM. Increasing and Evolving Role of Smart Devices in Modern Medicine. Eur Cardiol. 2019;14(3):181-186. Published 2019 Dec 18 doi:10.15420/ecr.2019.02
Mohammed HT, Hyseni L, Bui V, et al. Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use. PLoS One. 2021;16(6):e0253665. Published 2021 Jun 24. doi:10.1371/journal.pone.0253665
Ramaswamy A, Yu M, Drangsholt S, Ng E, Culligan PJ, Schlegel PN, Hu JC Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study J Med Internet Res 2020;22(9):e20786 doi: 10.2196/20786
Reeder B, David A. Health at hand: A systematic review of smart watch uses for health and wellness. J Biomed Inform. 2016 Oct;63:269-276. doi: 10.1016/j.jbi.2016.09.001. Epub 2016 Sep 6. PMID: 27612974.
Wong A, Bhyat R, Srivastava S, Boiss Lomax L, Appireddy R. Patient Care During the COVID-19 Pandemic: Use of Virtual Care. J Med Internet Res. 2021;23(1):e20621. Published 2021 Jan 21. doi:10.2196/20621
Dr. Brett P. Guist graduated from CMCC in 2015 and is a chiropractor practicing out of The Centre for Fitness, Health, and Performance in Toronto, ON. In addition to his practice, he is an instructor at CMCC.