Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care

Abstract

Background: Video mediated meetings with patients were introduced in outpatient care at a hospital in Sweden. New behaviours and tasks emerged due to changes of roles, work processes and responsibilities. The study investigates effects of digital transformation, in this case how video visits in outpatient care change work processes and introduces new tasks, in order to further improve the concept of video visits.

Objective: Through real-time, social interactional features of preparing for and conducting video visits, the study examines clinicians' perceived limitations and disturbances, and how the conditions between patients and clinicians may change when using video visits instead of face-to-face meetings in outpatient care.

Methods: Qualitative methods have been used including 14 observations of video visits at two different clinics and 14 followup interviews with clinicians. Transcriptions of interviews and field notes were thematically analysed, discussed and synthesised into themes.

Results: Disturbances and limitations related to the technology were related to time; a flexibility to schedule the meeting unbound of place, frustrations when the other part was late for the scheduled meeting, and that more experienced users of video visits usually waited longer before logging in. They were also related to sound; problems getting the sound to work satisfactory during the video visits, and problems with the image. Disturbances and limitations related to the surroundings were related to both the patient's and the clinician's environment; the principle of video technology in itself may affect the experience and the content of the consultation, and the surrounding chosen changes the conditions for and reduces the participants' field of view.

Conclusions: We could see 1) a transformation of roles and responsibilities when turning from face-to-face meetings to video visits, 2) that video visits add new circumstances, with a risk of introducing disturbances and limitations, that in turn affects the content of the meeting, 3) that avoiding negative disturbances during a video visit, requires a sensibility from the clinician's side as well as a trust in the patient's judgement, 4) that both expected and unexpected disturbances and limitations during a video visit affect the clinician's behaviour, feelings, the content of the meeting and how the clinician's relate to the different components of the concept, and 5) that there is a change of roles introduced when conducting video visits, eg, the clinician taking the first line support if both (s)he and the patient encounter problems with the technology.

Keywords: Video visit, outpatient care, disturbance, perceived limitation, telemedicine, telehealth, ethnography.