Look around, it is coming. We are currently rushing into a post-digital era. The pace of technological change is zooming across society in an astonishing fashion (pun intended), and health care is not an exempt industry from this. It is nearly impossible these days for members of society to avoid touching a computer or handheld device over the course of 24 hours. Digital technology has officially become a unified backbone of our lives.
When I began the Primary Care Transformation Fellowship in the fall of 2019, I could not have predicted the upcoming expedited digital revolution which was to occur in full force. With the COVID-19 pandemic, we saw telehealth explode and digitalization of health care in a whole new light. Social distancing measures were adopted, thus communication within the electronic health record was suddenly challenged. Patients were pushed into figuring out how to utilize electronic portals to communicate with their health teams— both reaching out in regards of their fear for the disease and as well as best ways to manage their ongoing health needs.
My main focus for this fellowship was to improve digital communication in the electronic health record at my practice, and I certainly credit the global pandemic for getting more people on board with this concept. In a short period of time, primary care health systems needed to drastically modify current telehealth status. We had to develop methods to not only deploy a large number of telehealth appointments, but also arrange behavioral health interventions, crisis lines, and nurse help lines. We needed to adjust and adapt current workflow processes in patient portal communications to allow us to remotely meet our patient needs. The silver lining being many of these changes will be utilized for lasting care transformation.
Primary care was tasked with the challenge of maintaining and promoting population health amidst a catastrophe, and health care providers needed to act quickly to enable these capabilities. Virtual communication quickly became the principal means for not only acute and chronic disease management but also health promotion, patient education, and behavioral health services. Substantial investments had to be made in order to truly determine and understand our patient access needs. To keep patients engaged in their health, we had to continuously troubleshoot virtual interactions and telehealth capacity, leading to re-definition of workflows and workforce capacity to function with these new methods. Recognizing that health care is unique to each individual patient, we also had to consider those patients with limited capacity for virtual communications and how they could fit into these methods.
This digital health care revolution has generated obstacles, one of the most significant involves determining how to care for patients in the right place, at the right time, and in the right way. Additional challenges included simultaneously knowing exactly what care patients need but being unable to provide it due to constraints beyond our control. With these challenges, however, we have the opportunity to rethink patient-provider communication models to improve use of digital health portals. Effective use of electronic health care communication and technology can improve health care quality and safety as well as increase efficiency of health care delivery.
From a primary care perspective, the most valuable asset of this digital communication is the enhancement of provider-patient relationships. This is a known delicate balance, however, as inefficient use of electronic communication may lead to provider burnout, especially in the setting of ineffective workflows and lack of standardized protocols. Utilizing telehealth services during COVID-19 has allow our providers to connect with patients over the interval of time which exists in between in-person office visits. By strengthening these bonds of communication virtually, our patients feel more connected to their health team leading to a higher value delivery of care within the four walls of our family medicine clinic in real-time. We must remember that health care is not segmented into only individual encounters or moments in time, but rather it is a compilation of all the lifestyle and health choices which occur every single day.
Maribeth Kuntz is a fellow with the Primary Care Transformation Fellowship Program. Email maribeth.kuntz@duke.edu with questions.
Editor’s note: Blogs represent the opinion of the author, not the Department of Family Medicine and Community Health, or Duke University.