Virtual healthcare guidelines redefine house calls

- Ottawa, Ontario

If your eyesight is weak, you can change the contrast on your computer or phone screen–or adjust font size and colour. You can add glossaries to words you find difficult. Have your system speak to you.

Customizable features such as these started out as modifications for those who had physical difficulties accessing parts of their devices. Decades later, that capability/inclusivity is commonplace and often taken for granted. But new barriers to accessibility are mounting as the COVID‑19 pandemic drives communications, health care, entertainment and other human activities farther into virtual territory. For example, nearly two‑thirds of Canadian organizations now have at least 60% of their workforce working remotely.

This is particularly relevant to the overburdened health‑care field. To meet the increasing health needs of Canadians during the pandemic, health care is moving online. Virtual health care takes the familiar concept of telehealth‑which is online visits with doctors‑into new frontiers. It uses digital tools that connect patients in real time to a network of health‑care professionals, labs, pharmacies and medical records. It also incorporates features such as translation and dictionaries. While it is an amazing resource for bringing health care into the home, virtual care can be a daunting proposition for some.

A 2018 survey by the Ontario Telemedicine Network found that more than 4 in 10 respondents would try virtual care if they could. But it does require some tech‑savvy, proper connectivity and trust in the technology.

"Our role is to facilitate adoption of this approach by demonstrating to Canadians that it will give everyone better access to health care," says Denis Laroche, Team Lead, Bio‑mechatronics at the National Research Council of Canada's (NRC) Medical Devices Research Centre. "We have launched a major initiative to set inclusivity guidelines for developers of virtual care platforms and applications." Software and hardware must be easy to use and take into account the needs of vulnerable populations with disabilities as well as language and literacy issues.

"As we've learned from the pandemic, a healthy society depends on how well we take care of people who are the most vulnerable," he says. "And this project approaches virtual health from that perspective."

The process

According to Laroche, inclusivity guidelines are used around the world by many organizations, including the Government of Canada. For example, departmental websites must follow standards for font sizes, navigation and terminology that help people with disabilities and special needs. But virtual health care is a whole new realm that calls for innovative approaches to guideline preparation.

"To establish the right guidelines for virtual health‑care developers, we need to identify existing standards from around the world that work in this context," he says. "As we collect these, we will prepare software to test on users with accessibility issues, and adjust or create new standards as required."

A key collaborator on this project is Toronto‑based OCAD University, home to the Inclusive Design Research Centre (IDRC), the largest facility of its kind in the world. IDRC Founder and Director Jutta Treviranus says that the centre's goal is to ensure that everyone can participate in shaping and using the technological systems and networks that are transforming and connecting our society.

"Individuals who use virtual health‑care systems have a diverse range of needs and capabilities, and the farther their needs diverge from the average, the more important it is to personalize their experience," said Professor Treviranus. "We want to create a range of options that match those needs: how the interface is controlled, how the information is presented and what feedback prompts are given." These all help to determine the success of patient interactions.

Treviranus adds that virtual health‑care systems allow users to set up and save their personal needs and preferences on desktops, mobile phones or tablets‑and take them anywhere. A patient might also establish a network that includes a family physician, a nutritionist for diet advice, a lab for tests, a pharmacist for prescriptions‑and language translation software. To reduce confusion and lighten the learning load, each person's preferences must therefore operate across many systems.

"Health interactions can be stressful, and tend to become more so as they become more urgent," she says. "We don't want the interface to add another layer of stress."

One research challenge is recruiting individuals who struggle with technology and the current health system to help design and test the virtual care guidelines. "This is a different approach that we expect will lead to innovative features and more flexibility to benefit all users," she says. "And the NRC has been quite open to trying this unique methodology."

Beyond the pandemic

While this collaborative project is part of the NRC's COVID‑19 Pandemic Response Challenge program, developing guidelines and technology is an iterative approach that will continue beyond this pandemic, and Laroche foresees the first test scenarios taking place in early 2021. He also expects that, with the boom in virtual health care, Canadian companies will be lining up to supply software, hardware and related services to the health‑care system.

"The guidelines will clearly indicate how inclusivity should be handled in the development process," he says. "They will also help purchasing authorities verify that products meet those established standards." And that's a healthy approach to caring for a community.