Identifying Benefits, Concerns Around Virtual Home Assessments

This UK study looked at the use of telehealth to deliver virtual home assessments for occupational therapy services; the authors also created guidelines to support additional work in this area.

A recent study examined attitudes, barriers, and other factors that increase the chances of success of virtual assessment visits.

Most work around the user acceptance of telehealth comes from the patient or the health care provider perspective, as telehealth has mostly focused on clinical uses. Telehealth also could be used for assessment visits for patients who are discharged from facilities and are returning home, the authors noted.

The current study was carried out in the United Kingdom and looked at telehealth to deliver virtual home assessments for occupational therapy services. The authors also created guidelines to support additional work in this area.

Home visits are linked with a significant investment in cost and time, including arranging the visits, other logistics, the actual visit itself, travel time, and time spent writing reports.

In this study, the prototype technology for video consultation was simplified. It was not necessary to install an application or to register on a website; the patient clicked on a link sent via text message or email to start the visit. The link could also be shared with a caregiver if the patient need assistance.

On the occupational therapist side, they would see an interface that allowed them to see the patient's video feed, record audio or video, take screenshots, save digital notes, and control the patient's camera in order to fine-tune the images.

The researchers gathered various stakeholders, including occupational therapists, physical therapists, dieticians, nurses, and others, for workshops and a demonstration of a mock visit. Participants were asked for their thoughts about potential barriers to introducing the technology, potential benefits of using the technology, other ideas for the technology long-term to provide or enhance care, and ideas to further develop the technology to fill their needs.

Several barriers were identified, both for the technology used for the demonstration as well as broader concerns. The primary barrier related to security, including video connection, data storage, levels of access to the information, and sharing purposes. While a virtual, recorded assessment avoided duplication efforts and allow other providers and caregivers to view the data, concerns were raised about patient confidentiality and information governance.

Staff training was cited as another barrier; other barriers included the cost of the system, availability of information technology resources, and network reliability. Variability in any of these areas could exacerbate health inequalities, participants noted.

One social worker pointed out that many of the oldest adults are frail and may struggle with technology. In addition, not all patients have smartphones or a sufficient data plan.

Providers noted that even virtual visits conducted on a computer still require a private consultation room, as a group office setting with multiple staff members on multiple computers would not be appropriate and would violate patient confidentiality.

The lack of in-person contact would prevent therapists from checking furniture and other physical dimensions of the patients home. One participant was even worried that the patient on the other end of the connection might not even be in their actual home.

However, benefits were also recognized, including efficiency, reduced costs, and safety for the provider, as some pointed out they had visited dangerous or unclean homes in the past. For patients, a wider number in a larger geographic region could theoretically be served, and virtual assessments could also be helpful to patients with mobility issues.

If the idea of conducting virtual home assessments were to advance, certain guidelines would need to be in place, the authors noted. They proposed several, including ones related to security, guidance and help features, and offering more control to patients by deciding if they want to participate. In addition, the technology should enable multiple users and an ability to verify identity and location.

Reference

Lanfranchi V, Jones N, Read J, et al. User attitudes towards virtual home assessment technologies. J Med Eng Technol. Published online June 22, 2022. doi:10.1080/03091902.2022.2089250