A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study

Abstract

BackgroundMost electronic health (eHealth) interventions offered to patients serve a single purpose and lack integration with other tools or systems. This is problematic because the majority of patients experience comorbidity and chronic disease, see multiple specialists, and therefore have different needs regarding access to patient data, communication with peers or providers, and self-monitoring of vital signs. A multicomponent digital health cloud service that integrates data sharing, collection, and communication could facilitate patient-centered care in combination with a hospital patient portal and care professionals.ObjectiveThis study aimed to assess the feasibility and functionality of a new cloud-based and multicomponent outpatient clinic, the “Virtual Outpatient Clinic” (VOC).MethodsThe VOC consists of 6 digital tools that facilitate self-monitoring (blood pressure, weight, and pain) and communication with peers and providers (chat and videoconferencing) connected to a cloud-based platform and the hospital patient portal to facilitate access to (self-collected) medical data. In this proof-of-concept study, 10 patients from both Departments of Internal Medicine and Dermatology (N=20) used all options of the VOC for 6 weeks. An eNurse offered support to participants during the study. We assessed the feasibility, usage statistics, content, adherence, and identified technical issues. Moreover, we conducted qualitative interviews with all participants by following a standard interview guide to identify user experiences, including barriers, facilitators, and potential effects.ResultsMost participants successfully used all options of the VOC and were positive about different tools and apps and the integral availability of their information. The adherence was 37% (7/19) for weight scale, 58% (11/19) for blood pressure monitor, and 70% (14/20) and 85% (17/20) for pain score and daily questions, respectively. The adherence for personal health record was 65% (13/20) and 60% (12/20) for the patient portal system. Qualitative data showed that performance and effort expectancy scored high among participants, indicating that using the VOC is convenient, easy, and time-saving.ConclusionsThe VOC is a promising integrated Web-based technology that combines self-management, data sharing, and communication between patients and professionals. The system can be personalized by connecting various numbers of components, which could make it a relevant tool for other patient groups. Before a system, such as the VOC, can be implemented in daily practice, prospective studies focused on evaluating outcomes, costs, and patient-centeredness are needed.

The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review

“…With regard to country, 33 (70%) studies were based in the United States [ 17 , 18 , 20 , 21 , 31 , 32 , 34 , 43 - 46 , 49 , 60 ], three in Canada [ 35 , 36 , 50 ], three in the Netherlands [ 19 , 26 , 57 ], two in Finland [ 55 , 56 ], two in the United Kingdom [ 16 , 48 ], one in Australia [ 22 ], one in France [ 59 ], one in Israel [ 47 ], and one in Sweden [ 24 ].…”

“…The study designs were grouped into six categories according to the characteristics of the articles. Overall, 17 were descriptive quantitative studies [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], two were descriptive mixed-methods studies [32,33], 14 were observational hypothesis testing studies [20,[34][35][36][37][38][39][40][41][42][43][44][45][46], seven were descriptive qualitative studies [47][48][49][50][51][52][53], five were interventional studies, other than randomized controlled trials (RCTs) [54][55][56][57][58], and three were RCTs [59][60][61].…”

Health Care Professionals’ Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study

“…All in all, these create a mutual recognition of knowledge and experience between patients and health care professionals, including the recognition of patient preferences and health literacy—the latter in order to sustain a better understanding and engagement in health issues [ 30 , 31 ]. Digital tools, offering benefits such as the opportunity to describe one’s concerns, symptoms, and health issues at a time, place, and pace that suit oneself, appear on current evidence to be good for enhanced values in primary care [ 32 ]. Study findings indicate that staff favored patients’ appreciation and were willing to walk that extra mile to meet patient expectations, much like health care professionals who cautiously embrace digital have been found to favor increased efficiency, besides the prospect of providing patients with alternatives that align with their preferences [ 11 ].…”

Health Care Professionals’ Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study (Preprint)

“…All in all, these create a mutual recognition of knowledge and experience between patients and health care professionals, including the recognition of patient preferences and health literacy-the latter in order to sustain a better understanding and engagement in health issues [30,31]. Digital tools, offering benefits such as the opportunity to describe one's concerns, symptoms, and health issues at a time, place, and pace that suit oneself, appear on current evidence to be good for enhanced values in primary care [32]. Study findings indicate that staff favored patients' appreciation and were willing to walk that extra mile to meet patient expectations, much like health care professionals who cautiously embrace digital have been found to favor increased efficiency, besides the prospect of providing patients with alternatives that align with their preferences [11].…”