Lessons from In-Person Care for Virtual Care Experience

A few weeks ago, I tried to schedule an appointment with a doctor through my primary care provider’s virtual care system—it was an extremely frustrating experience. First, there was no online scheduling option for the specific care I needed. Therefore, I waited until the next morning and called as soon as the office opened. Even then, I was on hold for 30 minutes before I had an appointment. After the appointment was set up, I received an online intake form. So I filled it out. 30 minutes later, a staff member separately sent me another identical intake form. So I filled it out…again.

When I joined my scheduled virtual appointment, the provider appeared on my screen dressed unprofessionally and accompanied by a lot of background noise. Without any introduction, they began asking me the same set of questions from the intake form I had already filled out twice. When I told them that I had already provided answers to these questions, they said “well, I have to do it again,” and continued typing away. During the five minutes we spent together, they constantly interrupted me and trivialized my conditions.

At the end of the appointment, I was given a referral for yet another appointment, with another provider, that was supposed to take place in a month. As you may have guessed, that appointment has not yet happened.

The promise and challenge of virtual care

It is no surprise that the COVID-19 pandemic has accelerated the adoption of virtual health care. Today’s consumers are increasingly dependent on telehealth appointments for primary care, behavioral health care, and some specialty care. This isn’t necessarily a bad thing: multiple studies have demonstrated the value propositions of virtual care in regard to increasing access, convenience and efficiency, while also delivering positive clinical outcomes. However, as my experience attests, virtual care has not yet “cracked the nut” in providing a valuable and satisfying experience to patients. In fact, the virtual care model poses a new set of challenges. 

Challenges for the virtual care ecosystem 

Quality of the visit. According to Stanford Medicine, despite high provider and patient satisfaction scores, technical limitations and system readiness challenges hindered visit quality and left some patients unprepared for virtual visits. Providers observed that patients with cognitive impairment, language barriers or technology access concerns experienced disproportionate challenges.

Difficulty in building emotional connections between providers and patients. Providers struggled with platform connectivity, the provider-directed patient self-exam, and establishing an emotional connection with patients. With less direct patient contact, some medical assistants (MAs) felt unfulfilled.

Uncertainty in patient engagement with virtual care post-pandemic. The pandemic has left many patients with no choice but to use virtual care, but Politico reports that telehealth usage has been on the decline since an initial spike in April. Telehealth visits comprised 14 percent of all doctors’ visits in mid-April, but this number fell to 7 percent in mid-June. Furthermore, some experts have speculated about a potential drop-off in telehealth usage after the pandemic, partly based on future insurance coverage policies regarding telehealth, but more importantly, on patients’ nostalgia towards in-person care. This is especially true for highly interactive and sensitive experiences such as behavioral health care. In a pre-pandemic survey, 62 percent of consumers said they would rather use virtual care for ongoing physical conditions—but only 25 percent said they would use telehealth for behavioral healthcare. 

To build an exceptional multi-channel care experience, we need to think about how virtual care can augment patients’ holistic experience with providers. We think there are opportunities to foster the empathy and emotional connection characteristic of in-person care within the virtual care experience.

To design for empathy, we must go beyond merely creating “web-side manner”—we must seek to replicate the key moments of in-person care in our virtual delivery systems. 

The in-person care moments that matter

From appointment set-up to post-visit support, a patient’s care journey is driven by complex emotional needs. The typical in-person care journey provides natural moments of human connection and recognition that address these needs, and which most current virtual care models fail to replicate. Thinking back to my last in-person care visit, I can easily identify them.

Before the visit, I felt a sense of urgency and anxiety about visiting the doctor and potentially receiving some bad news. But as I spoke with a calm and friendly staff member on the telephone to set up my visit, I felt less anxious. When I arrived at the office the day of my appointment, I was welcomed by the same staff member I had spoken with on the phone. They asked me to fill out some simple forms in the waiting room and told me how long it would be before the doctor finished seeing their current patient.

After a short time, a medical assistant called my name. They remembered me from my last visit, and we made small talk as they took me to the exam room. My doctor arrived promptly with my files in hand, giving me their undivided attention as they asked questions and referred to past visits to detect any changes in my symptoms or condition. They then conducted a hands-on examination, during which they asked more questions. After the exam, we discussed and documented the next steps in my care plan, and the doctor asked if I had any questions for them. I left the exam room feeling heard, confident that my physician understood my condition and my needs.

Before leaving the office, the staff helped me schedule my follow-up appointment and double-checked that I had no further questions about my doctor’s instructions or the visit. As I left, they waved and said cheerily, “see you in a few weeks.” By the time I arrived home, they had already emailed me a summary of my visit and a reminder of my next appointment. Three days before my scheduled visit, they called again to confirm.

From beginning to end, this in-person care journey is filled with moments of physical and human connection that addressed not only my medical needs, but my emotional needs. Instead of feeling confused, overlooked and frustrated, I felt assured, known and supported in my care journey.

How can we leverage digital tools and platforms to recreate these moments and experiences within the context of virtual care?

Designing for empathy in virtual care

There are some aspects of an in-person experience, such as the physical examination, that the virtual care delivery model will never be able to replace. But there are many opportunities to foster better connection and empathy throughout the virtual care process.

Before the visit:

Provide pre-appointment patient orientation. In our user research with patients, we often hear that the lack of a clear agenda and expectations prior to their visit escalates their anxiety. Stanford Medicine has addressed this problem with a practice they call “virtual rooming,” in which the care team staff contacts the patient via telephone or video call prior to their appointment in order to spend a few minutes setting the agenda for their visit, reviewing their health maintenance and medication history, and conducting behavioral health screening. This first point of human contact helps alleviate uncertainty and set patients up for success in their virtual care journey.

Enhance virtual waiting rooms. Patients also feel heightened anxiety when they are forced to stare at a blank webpage, waiting for the physician to arrive. But there are multiple ways to bring delight, empathy and connection into the virtual waiting room. One idea to do this is through personalized content. Because virtual care patients are already using a digital device, we can deploy interactive, personalized tools and content to engage and inform them during wait times. For example, the system could use the patient’s records to display educational videos about their specific condition or symptoms. Another approach is to help patients get to know the doctor. Waiting time can also be used to help patients feel more familiar with and connected to their physician. In addition to showing a provider’s credentials and diplomas, slides or videos could provide a window into their personalities, care philosophies and hobbies to build greater familiarity and trust.

Offer real-time status updates. Virtual care platforms could further reduce uncertainty and anxiety by providing periodic check-ins and status updates on how many people are currently waiting ahead and how long it will take to see a physician.

During the visit:

Reduce physician multi-tasking. Patients want to be heard and engaged by their physician. In many virtual visits, however, the provider is occupied with typing into their device instead of fully attending to what the patient is saying. Some providers employ medical scribes to relieve physicians from documentation and free them to spend more time with patients, but in a virtual care setting we also leverage digital tools to reduce distraction and help providers fully engage with patients. Apps such as Otter can record and transcribe meetings, as well as provide automated meeting notes and summaries with keywords and highlights. Additionally, innovations in interoperability can help alleviate providers’ administrative burden by pre-populating their documents with information from patient intake forms.

Incorporate visual aids and tools. In virtual care interactions, a clinician cannot touch the patient or physically illustrate conditions and procedures, hindering both emotional connection and patient comprehension. Through virtual platforms, providers can consider viewing educational videos or graphics together with their patients or using other tools such as a digital whiteboard to help patients better see and understand the causes, symptoms and effects of their conditions.

After the visit:

Add a human touch during follow up. Patients desire to feel remembered, cared for and supported by their provider between visits. By sending personalized audio or video messages to debrief appointments, schedule or provide reminders for future appointments, and check in on progress, providers can add a human touch to the digital experience, helping to make patients feel valued and connected to their care providers. 

Consider systems for sharing appointment recordings with patients. Instead of providing just an after-visit summary, providers could allow patients to opt-in to audio or video recordings of their virtual visits. These recordings could be shared with them afterward, providing rich detail that patients can revisit and helping to ensure no information gets lost during the referral process. This service would require additional initial legwork from the provider, however, as the Electronic Health Record systems that store these recordings would need to be HIPAA-compliant. 

Creative virtual care systems and platforms that recreate the emotional experiences and connections of in-person care are not easy. They require tight coordination between providers, operators, technologists and designers, along with re-setting expectations and preparing patients for a new way of engagement. Providing patients—especially seniors, non-English speakers and those who lack access to technology—with thorough support will be critical. We must also empower clinicians and care teams with easy-to-use and interoperable technology platforms, as well as training on how to adapt their communication and relationship-building strategies to virtual settings. 

It’s a lot to do, but we are excited to help elevate the human experience of virtual care through platforms and systems that leverage the power and flexibility of digital technology to combine the best of both in-person and virtual care.