Representative quotes for each dimension of the BC Health Quality Matrix
| Dimension | Representative quote |
|---|---|
| Acceptability | By the time … a patient has been through going to the doctor, going to the hospital, getting blood work, getting this test and that test, it’s nice to be able to just [lie] back in the comfort of your own home and have someone come to you for a change. That what he [patient] felt like. He just felt “Oh, I don’t want to go see another doctor and do that travel. I just want to stay here.” (support person F) I try very hard during a telemedicine [session] to get past the fact that we’re not actually physically in each other’s presence, so I sort of act more. I’m really more active. I’m much more … demonstrative with my arms and so forth when I’m talking. I’m even doing it now while we’re talking [laughter] to really sort of try and engage. So, I do deliberately try and make it not just a telephone call with pictures. (assessor C) It’s pretty good, actually. It allows me to — obviously it’s slightly easier if I was in the room with the patient and any family member … they decided to bring, I can more easily detect the fact that a family member wants to add something, but I don’t find it obstructs. I can ask … “Is there anybody else who wants to add anything at this point?” … It requires a slightly different technique, but it doesn’t obstruct. (assessor C) If I hadn’t been there, she just would have been in a room by herself and … I said “We’ve got some water” and “Are you anxious?” and … I just tried to put her at ease … and then afterwards I think she just … to have a human there to kind of debrief and breathe with and … because they have a lot of anxiety, they feel like it’s a test … and it is, they are being tested for eligibility and … whether they meet the criteria. So … the witness role is there for safety, but I think it can also add a human support element, before and after. (administrator B) I think you establish more rapport when you go to meet someone in their home and you have more time for small talk, and, as we sort of mentioned, that nonverbal communication and speaking with their family, and I think you just have more time and space with an in-person consult than you do over telemedicine. (assessor B) I usually sit fairly close to the patient, so maybe there’s a little bit of … maybe I’m sort of doing that usual piece on behalf of the assessor in regard to … touching the patient, especially if [the patient has] expressed something really difficult … or [is] in tears. (administrator A) Eye contact is a bit difficult … because sometimes the way that cameras are tilted or the way that people hold their hands because they are kind of looking … they are looking at you, but they are looking at a void, too, and vice versa, I think it applies to both ends … and so … it takes maybe a touch more effort than if you were sitting across … from each other. (assessor G) |
| Appropriateness | Particularly when people are old and frail, the difficulty that they had was not being able to hear me well on the other end. Whereas when I’m in front of the other person, I can lean over to the correct ear that [the person] can hear best out of, or be more expressive in … body language … but that’s not possible on telemedicine. (assessor F) Obviously she [assessor] can’t … physically observe the swelling in my wife’s legs, for example … but as an initial consultation, her ability to do an assessment of [my wife’s] competence and her true desire and all of that, it was a perfectly legitimate tool. (support person G) |
| Accessibility | [The patient] wouldn’t have been able to do it otherwise, I don’t think, because he would have had to travel to Vancouver, and by the time the [general practitioner] got the paperwork and everything going … we had to be at a point where it’s imminent, so to then have him loaded up and taken to either [Vancouver Island] or Vancouver would have been an ordeal for him. It would have been exhausting. (support person F) I think that the access for the patient, in the setting that [the patient] chooses is … a real … benefit, and also … minimizes the disruption further … so that [the patient] doesn’t need to travel to a hospital setting, for example, and, similarly, it’s more accessible for the assessor, who also doesn’t need to be in a particular place. (administrator E) |
| Effectiveness | I find it’s shorter than with the face-to-face contacts because there aren’t as many cues to me to ask about further life issues or questions about knowing that person, so I find it restrictive in that sense. (assessor F) Sometimes patients are quite weak just because they’re tired, and whereas in a face-to-face [session] you can sort of manage that, [with] telemedicine, because there’s sort of a slight time imperative, or you can’t pause in the same way, I therefore may sometimes be a little less — I may explore threads or avenues less than I would … face-to-face. (assessor C) There’s kind of pressure, because it takes so much — it takes resources to coordinate telemedicine in terms of having someone available on the other end, you feel like you really want to be thorough and get the entire assessment done in one chunk, whereas [with] in-person assessments, I’ve gone back for some challenging cases 3 or 4 times, and you can spend 15 minutes with someone who has a short attention span or [less] energy. You can say, “Okay, that’s enough for today, we’ll come back another time and pick up where we left off,” but with telemedicine there’s kind of pressure to wrap it up and everything done in 1 session. (assessor B) |
| Safety | It seems ad hoc to use my personal device on my home Wi-Fi network, and I guess I’m not a tech expert, but … I wonder if there would ever be any security issues over network security or anything like that. (assessor B) I think that most of the people who are making this request for medical assistance in dying … [aren’t] worried about Russian hackers hearing their conversation, so this security — what are we talking about? That their family finds out? That’s irrelevant [with] telemedicine. Are we worried that some hacker on the Internet … can find out? I’m not sure that patients care, so I’m not exactly sure what the security risk is, so I’m not too concerned about it. But from a technological point of view, yeah, I don’t think they’re very safe, but I don’t think anyone minds. (assessor D) Ultimately it’s up to the patient, if the patient is comfortable with having a FaceTime or Skype assessment … then it’s up to [the patient]. … I don’t think that I should impose … again, this is sort of coming back to … patient autonomy, so if the patient is aware that there are potential risks … then [the patient has] the right to say no to a telemedicine assessment, but, again, I would put it on to the patient to decide if [he or she is] comfortable with a telemedicine assessment or not. (administrator A) Because patients are fully capable of exercising their own rights and also exercising their information right, it is advantageous that they are able to make use of more portable and even more accessible telemedicine services like FaceTime and Skype … which is not the case for more traditional, structural telemedicine services as one might find … between hospitals … having to go into an hospital to have that telemedicine service. … So I think that … we’ve pushed some boundaries about … telemedicine, and I think that’s been helpful. (administrator E) I see why it needs to be there so that we can ensure that someone is not under duress, but I do find it a bit of an invasion of … privacy, so I’m mixed about that requirement [for a witness]. I’m not sure that it actually helps us decide that there is no duress. I think that, if there’s duress, that witness could be part of the whole thing, so I don’t know that it actually is protective. I find it more of an invasion than a protection. (assessor D) The witness has to be a health professional, so I don’t have any problems at all with the idea of that person being present. They very often, in the communities I deal with… know the patient, so it’s very often somebody who has had professional interactions with the patient, and I don’t find that a problem. In any case, I understand the need for it, and it’s rather like a chaperone, if I’m doing an examination [for] a female patient, then I have a chaperone always. I don’t really have any choice in that because it’s for my protection. So, in this case, although the patient may not feel that [he or she] needs the protection of a health professional, I fully understand it. (assessor C) |
| Efficiency | It’s possible they could have flown me out to do an assessment one day and then the provision the next day, it probably still could have happened, but it certainly made things a lot easier to have telemedicine available to do the initial assessment in that case. (assessor B) The other cost is trying to track down a nurse or another medical professional to try and be with [the patient]. … That is a huge cost of phoning around to see if someone can be on the other end. … It’s really the biggest barrier for me. (assessor F) |
| Equity | In the early days, telemedicine was especially important for areas that were underserviced, and that continues in many places in this country where there are not assessors and providers. And telemedicine can be the difference for allowing access to this care for certain people in certain areas, and so I think it’s an incredibly powerful tool to allow access. (assessor D) |