Who is your telehealth product for? A guide to telehealth service design for patient-specific needs.

The COVID-19 pandemic has tremendously encouraged the uptake of telehealth, including by many patient groups that have not been traditionally keen adopters of tech. This growth promises increased health access to remote communities, marginalized populations, and those with poor mobility. Yet, as we head towards a future where telemedicine becomes a form of standard care, how can we continue to support the care of vulnerable populations that could benefit most from remote care? 

Which populations need special consideration? 

Telehealth is the most popular among the younger population, women, people coming home from the hospital in urban areas, and those suffering from mood disorders. This does not stand out as a surprise - these groups often uptake technology relatively well. However, they are not the top users of healthcare. In fact, older adults, those with chronic diseases or multiple comorbidities, and low-income individuals (in proportion to their income) are the biggest customers in healthcare. 

Older Adults 

The demand for healthcare in older adults is likely to grow as our population ages, and life expectancy lengthens. Arguably, the most common types of geriatric consultations have great potential to be conducted virtually, such as routine follow-up of chronic conditions, medication reviews, and multi-disciplinary care coordination. 

However, older adults tend to struggle with telehealth platforms and technology. Internet and smart-device access, design challenges, and privacy and trust concerns act as the main barriers to telehealth services. Additionally, about 13.5% of adults aged 65 and older have impaired vision. How is software design and patient engagement being utilized to target this population? Continue below to find out!

Visual or Hearing Impairment 

Telehealth alleviates the need for visually impaired individuals to organize transportation and navigate unfamiliar settings to attend health appointments. For this population, it is crucial to have a telehealth platform that can utilize screen readers, magnification, and high contrast software. 

With telehealth, hearing impaired individuals have the option to connect their hearing devices directly to their preferred electronic devices (mobile, laptop, etc.). This connection creates a more comfortable experience for people who may otherwise have to sit in noisy waiting rooms filled with audio interference. Video consultations also allow individuals to see their health practitioners' faces without a face mask, which helps them with lip-reading. 

Low Income 

In a recent report, Medicaid patients were more likely to use telehealth in comparison to Medicare and private insurance users. This is unsurprising as telehealth allows patients to eliminate travel costs and increase flexibility for those with inconsistent work schedules. 

College degrees are thought to be 10 times more likely to utilize the full potential of technology compared to those with a high school education or lower. Lack of technological tools, stable internet, and digital literacy are major barriers that low-income individuals have to overcome in order to use telehealth services. 

Best Practices 

An All-Inclusive Platform

• Text: ensure that the text is a reasonable size, and contrasting colors are used for the ease of those visually impaired. 

• Device: Consider your target user's preferred device and utilize resources to ensure that those particular devices are user-friendly for the specific problems they encounter. 
• Audio vs. video: older adults >65 years were more likely to use audio-only consultations than video and audio. Ask the question - are video consultations absolutely necessary? What are the alternatives? 
• Simple interface: less (but relevant) is more. 
• Match a clinical workflow: to give your user a sense of familiarity, use a workflow and terminology that would match a clinical setting. For example, start with a pre-appointment assessment questionnaire -> let them go into a ‘waiting room’ (if required) -> consultation -> provide prescriptions and referral letters. 
• Least number of clicks: ensure that the user can find their way through the workflow with the least number of clicks. 
• Captioning: depending on the user, allow additional prompts that would guide them through the workflow if necessary. 

Increase Accessibility

• Utilize family members for support: encourage carers or family members to support users with lower digital literacy. 
• Allow third-party participation: including language and sign-language interpreters. For language interpreters, patients may prefer that the video component of the interpreter is disabled for privacy reasons. 
• Utilize support workers: technical support workers could be utilized to guide users in using the platform. Though this increases cost, overall cost-effectiveness is still increased as trained health practitioners and clinicians are not using valuable consultation time to untangle technological issues. 
• *Consider satellite clinics: health systems or bigger insurance companies could deploy satellite or mobile clinics with the required technology for telemedicine consultations to low-resource neighborhoods. Though patients would still have to travel locally to get to these clinics, this allows them to connect with remote specialists without long commutes. 

Information & Support

• Patient resources: add information to your platform to help those who struggle with technology. Consider alternative methods, such as video tutorials or a trial platform that they can attempt beforehand to minimize pre-consultation anxiety. 
• Consider who needs encouragement: it has been reported that those aged 65 and older express greater concerns about comfort using technology and being on video. Target your users and express encouragement in achieving specified technological goals. 
• Written information: clinicians and health practitioners should provide written information after the consultation, as they would face-to-face. This should be made available as soon as possible (like they would usually carry pieces of paper out of the consultation room). Send this to the patient or make it easily accessible so they can find and review the information whenever they want. 
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The potential for telehealth is limitless and will arguably create the most noticeable health outcomes for vulnerable patient groups. If you have any questions related to telehealth design and services or are interested in an all-in-one telehealth solution, please contact us. 

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