Telehealth Experience Research Articles

127. walking to the Virtual Era. Analysis of the Telehealth Experience in the Infectious Diseases Clinic During the COVID Pandemic

BackgroundThe COVID pandemic has changed and will continue changing the way we practice medicine. We sought to investigate the impact of telehealth (TH) in the delivery of healthcare in the general infectious diseases (GID), and HIV clinic during the COVID pandemic.The University of Rochester Medical Center is a major tertiary care and referral center for ID in upstate New York. From March through May of 2020, the clinics were closed, and nearly all visits were conducted by TH.MethodsWe surveyed (either by telephone or online) a total of 260 patients who participated in TH visits, with a mean age of 56 years in the HIV group and 59 years in the GID group. With a predominance of 62.8 of males v/s 37.2 of females.We collected information regarding the reason for the TH visits, access to technology, patient satisfaction, and preferences over in-person visits. We obtained the volume and no-show rate from prior years through EPIC. We evaluated compliance between in-person and TH visits using statistical analysis.ResultsWe found 93.4% of GID and 84.3% of HIV patients surveyed, either strongly agreed or somewhat agreed that their TH visit was as satisfactory as a clinic visit. 67.5% of GID and 63% of HIV patients agreed that the option of TH would increase their compliance rate in the future. The no-show rate during the TH period in the HIV group decreased from 23% to 5% compared to the previous year, while the no-show rate in GID decreased from 9% to 4%. These results were statistically significant with a P-value < 0.005 in both groups. ConclusionGID patients were more likely to have TH for hospital follow-up, follow-up of acute problems, and outpatient antibiotic therapy, compared to HIV patients, who more often had TH for chronic problems. GID patients were more likely to have the capability for televideo visits when compared to the HIV group, although this was not statistically significant. TH was statistically significant in improving patient compliance with appointments in both the HIV and ID clinics. Patients were overall highly satisfied with their TH experience and many patients also reported that continued availability of telemedicine would improve their compliance with appointments. Disclosures All Authors: No reported disclosures

Evolution of a Virtual Multidisciplinary Cleft and Craniofacial Team Clinic During the COVID-19 Pandemic: Children's Hospital Colorado Experience.

Multidisciplinary care in the era of COVID mitigation presented a unique opportunity to evolve a multidisciplinary Telehealth experience at the Children's Hospital Colorado. We describe our experience in developing unique programming to remain in compliance with an experience as recommended by the Parameters of Care while integrating information technology accessible via the electronic health record, multimedia adjuncts, and the integration of multiple institutional participants in creating a platform to offer care via Telehealth. Visit structure, planning, implementation, and advantages and disadvantages of the programming are discussed.

An Innovative Tai Chi and Qigong Telehealth Service in Supportive Cancer Care During the COVID-19 Pandemic and Beyond.

Supportive cancer care services, including acupuncture and Tai Chi and Qigong (TQ), are offered to cancer patients to manage cancer symptoms and/or treatment-related adverse effects and improve quality of life during and after standard care. Normal face-to-face acupuncture and TQ group services were suspended during the coronavirus (COVID-19) pandemic to reduce the risk of transmission of infection and meet social distancing restriction guidelines. This led to a sudden shift from face-to-face sessions to telehealth sessions in the health care system. We report patients' experiences of TQ telehealth services as a new initiative developed for cancer care. We found that delivery of TQ telehealth is feasible and resulted in increased overall patient satisfaction with cancer care services during the lockdown. The delivery of TQ telehealth experiences and challenges are discussed.

Telehealth Use in a Home-Based Dementia Care-Coordination Program

In the coming decades, greater numbers of people will either have Alzheimer’s Disease or a related dementia or will take care of a family member with dementia. The dementia syndromes are associated with increased risk of medical, social, and behavioral complications in both the person with dementia (PWD) and the caregiver (CG), many of which are preventable. These complications, and the dementia itself, can impede access to care and ultimately hasten residential care placement, which can be both undesirable and costly. A nearly universal unmet need in PWD/CG dyads is dementia-specific education. Therefore, it is vital we find ways to support and provide education to CG/PWD dyads to manage dementia in the community and home setting. MIND at Home is a dementia-care model developed and tested at Johns Hopkins University School of Medicine to minimize dementia complications and delay institutionalization by training non-clinical Memory Care Coordinators (MCCs) working under clinical supervision to support and guide PWD/CG dyads in the community. MCCs collaborate with CGs and PWDs in the community using an individualized care plan structured around the dyads’ specific dementia-related needs. This presentation will describe how the MIND at Home team used handheld tablets to connect MCCs to clinicians from participants’ homes, and will report on challenges encountered, strategies to address them, and participant and caregiver satisfaction with the telehealth experience.

People's Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study.

BackgroundIn response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits.ObjectiveThis study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic.MethodsA national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences.ResultsOf the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined.ConclusionsBased on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.

Caregiver Satisfaction with a Video Telehealth Home Safety Evaluation for Dementia.

Family caregivers are vital to telehealth-delivered dementia care. The objective of this mixed methods descriptive study conducted in the VA Bedford Healthcare System was to examine caregiver satisfaction with a video telehealth dementia home safety occupational therapy evaluation. Ten caregivers of Veterans with dementia participated. Ratings of caregiver satisfaction, measured by nine Likert scale items including ability to see and hear, were examined in relation to person and visit-related contextual factors extracted from research assistants' field notes, to develop an in-depth understanding of caregiver experience. Person factors included caregiver age and gender and Veteran cognitive status. Visit-related contextual factors included occurrence of technical glitches. Caregiver visit satisfaction was overall positive, with exceptions related to technological glitches and the presence of the person with dementia during the visit. Veteran cognitive status appeared to influence caregiver satisfaction. Implications of the study are that proactively addressing technical glitches and incorporating dementia stage-specific approaches may optimize caregivers' telehealth experience.

Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients.

Background:Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic.Methods:This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period.Results:In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference (P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887].Conclusions:Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.

Delivering rehabilitation services during the COVID-19 pandemic: How CAF Physiotherapy is using telehealth to ensure “physical and measurable solutions to maintain and enhance operational readiness, anywhere, anytime”

In response to COVID-19, the Canadian Armed Forces (CAF) activated Operation LASER, a force health protection strategy to preserve its operational capabilities. Operation LASER resulted in a quarantine of healthy CAF members to minimize the risk of contraction and transmission of COVID-19. The physical distancing inherent to quarantine challenged Canadian Forces Health Services to adapt its health care delivery. CAF Physiotherapy responded by integrating telehealth to maintain provision of essential primary health care services. A modified After-Action Report was used to capture preliminary telehealth experiences of Defence Team physiotherapists since the activation of Operation LASER. To date, seven Physiotherapy Officers and six civilian physiotherapists, have delivered a total of 196 assessments lasting an average of 45 minutes, and a total of 765 follow-ups lasting an average of 25 minutes. Most respondents reported no previous experience or formal training providing telehealth. Most respondents reported delivering telehealth by telephone and acknowledged challenges, including non-standardized patient instructions, inadequate equipment, unsuitable environments, and limited patient feedback. To maximize the quality of telehealth delivery, respondents recommended standardizing patient instructions, establishing suitable work environments, and using telephone headsets, videoconferencing, and digital exercise software. These recommendations are an investment in the capacity of CAF Physiotherapy to maintain rehabilitation services in the post-COVID-19 environment.

Delivering rehabilitation services during the COVID-19 pandemic: How CAF Physiotherapy is using telehealth to ensure “physical and measurable solutions to maintain and enhance operational readiness, anywhere, anytime”

In response to COVID-19, the Canadian Armed Forces (CAF) activated Operation LASER, a force health protection strategy to preserve its operational capabilities. Operation LASER resulted in a quarantine of healthy CAF members to minimize the risk of contraction and transmission of COVID-19. The physical distancing inherent to quarantine challenged Canadian Forces Health Services to adapt its health care delivery. CAF Physiotherapy responded by integrating telehealth to maintain provision of essential primary health care services. A modified After-Action Report was used to capture preliminary telehealth experiences of Defence Team physiotherapists since the activation of Operation LASER. To date, seven Physiotherapy Officers and six civilian physiotherapists, have delivered a total of 196 assessments lasting an average of 45 minutes, and a total of 765 follow-ups lasting an average of 25 minutes. Most respondents reported no previous experience or formal training providing telehealth. Most respondents reported delivering telehealth by telephone and acknowledged challenges, including non-standardized patient instructions, inadequate equipment, unsuitable environments, and limited patient feedback. To maximize the quality of telehealth delivery, respondents recommended standardizing patient instructions, establishing suitable work environments, and using telephone headsets, videoconferencing, and digital exercise software. These recommendations are an investment in the capacity of CAF Physiotherapy to maintain rehabilitation services in the post-COVID-19 environment.

Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework

BackgroundThe SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion of patients on optimum treatment). We sought to explain the trial’s findings in a qualitative evaluation.MethodsFifty-one people (25 patients, 3 carers, 18 clinicians, 4 additional researchers) were interviewed and observed in 7 UK trial sites in 2016–2018. We collected 110 pages of documents. The analysis was informed by the NASSS framework, a multi-level theoretical lens which considers non-adoption and abandonment of technologies by individuals and challenges to scale-up, spread and sustainability. In particular, we used NASSS to tease out why a ‘standardised’ socio-technical intervention played out differently in different sites.ResultsPatients’ experiences of the technology were largely positive, though influenced by the nature and severity of their illness. In each trial site, existing services, staffing levels, technical capacity and previous telehealth experiences influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some sites, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. Elsewhere, the new model was actively resisted and the technology little used. In one site, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service.ConclusionsComplex socio-technical interventions, even when implemented in a so-called standardised way with uniform inclusion and exclusion criteria, are inevitably implemented differently in different local settings because of how individual staff members interpret the technology and the trial protocol and because of the practical realities and path dependencies of local organisations. Site-specific iteration and embedding of a new technology-supported complex intervention may be required (in addition to co-design of the user interface) before such interventions are ready for testing in clinical trials.Trial registrationBMC ISRCTN Registry 86212709. Retrospectively registered on 5 September 2014

S1258 Telehealth in the Time of COVID-19: Gastroenterologists' Use and Attitudes

INTRODUCTION: Telehealth involves the use of electronic information and telecommunications to promote healthcare. Physician experience is critical in assessing the impact of telehealth on clinical outcomes and utilization. Gastroenterologists' use and attitudes towards telehealth are largely unknown. We aimed to identify gastroenterologists' professional attitudes towards their use of telehealth and its effect on patient care during the COVID-19 pandemic. METHODS: We performed a cross sectional survey of outpatient gastroenterologists and hepatologists at a single tertiary academic medical center in June 2020. Clinicians were invited to participate in an electronic survey. Survey questions involved either single or multiple categorical responses. RESULTS: A total of 46 respondents (51 ± 14 years old) participated, 70% of which were male. 44 (96%) respondents had no telehealth experience prior to the pandemic. Clinicians conducted 19 ± 13 visits weekly with a mean length of 24 ± 9 minutes. 88% of providers reported telehealth allowed for increased flexibility, both in patient scheduling and their personal lives. Telehealth was always or usually effective in addressing patients' clinical needs 91% of the time. 29 (63%) respondents estimated that 10% or fewer patients required in-person follow-up. Clinicians estimated 93% of patients desired the continued option of telehealth, and 42 (91%) providers wanted to continue telehealth in some capacity, conditional on reimbursement. Those interested would use telehealth for follow-up visits (28%), on a patient-by-patient basis (23%), or for new visits (20%). While 21 (46%) respondents felt that telehealth and in-person visits required equal effort, 16 (35%) felt telehealth required more effort. Reasons cited for telehealth requiring more effort included coordination of care (30%), technical difficulty for the patient (20%), and more charting (17%). CONCLUSION: While most clinicians had no telehealth experience before the pandemic, a majority were interested in using telehealth in the future, citing increased flexibility for both provider and patient. Physicians felt that telehealth was effective in addressing patients’ needs. However, many felt that telehealth required more effort, particularly in regard to coordination of care and technical difficulties. Newer telehealth platforms should address connectivity issues. Future studies should focus on patients’ attitudes towards telehealth, and the effect of telehealth on healthcare outcomes, utilization and costs.

Fostering Certainty in an Uncertain Era of Virtual Residency Interviews.

Fostering Certainty in an Uncertain Era of Virtual Residency Interviews.

Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices

Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices

Telehealth for delivery of haemophilia comprehensive care during the COVID-19 pandemic.

IntroductionThe COVID‐19 pandemic caused an unprecedented impact to haemophilia healthcare delivery. In particular, rapid implementation of telehealth solutions was required to ensure continued access to comprehensive care.AimsTo explore patient and healthcare provider (HCP) experience of telehealth in a European Haemophilia Comprehensive Care Centre.MethodA systematic evaluation was performed to survey patient and HCP experience and compare clinical activity levels with telehealth to in‐person attendances.ResultsPublic health measures implemented in March 2020 to reduce COVID‐19 spread resulted in a 63% decrease in medical/nursing clinic consultation activity compared to the same period in 2019. Implementation of digital care pathways resulted in marked increase in activity (52% greater than 2019). Importantly, enhanced patient engagement was noted, with a 60% reduction in non‐attendance rates. Survey of patients who had participated in medical/nursing teleconsultations demonstrated that teleconsultations improved access (79%), reduced inconvenience (82%), was easy to use (94%) and facilitated good communication with the HCP (97%). A survey exploring the telemedicine experience of HCPs, illustrated that HCPs were satisfied with teleconsultation and the majority (79%) would like to continue to offer teleconsultation as part of routine patient care. In addition to medical/nursing reviews, continued access to physiotherapy with virtual exercise classes for people with haemophilia and teleconsultation for acute dental issues was equally successful.ConclusionDuring an unprecedented public health emergency, telehealth has enabled continued access to specialized haemophilia comprehensive care. Our novel findings show that this alternative is acceptable to both patients and HCPs and offers future novel opportunities.

Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

The coronavirus disease 2019 (COVID-19) pandemic, technological advancements, regulatory waivers, and user acceptance have converged to boost telehealth activities. Due to the state of emergency, regulatory waivers in the United States have made it possible for providers to deliver and bill for services across state lines for new and established patients through Health Insurance Portability and Accountability Act (HIPAA)- and non–HIPAA-compliant platforms with home as the originating site and without geographic restrictions. Platforms have been developed or purchased to perform videoconferencing, and interdisciplinary dialysis teams have adapted to perform virtual visits. Telehealth experiences and challenges encountered by dialysis providers, clinicians, nurses, and patients have exposed health care disparities in areas such as access to care, bandwidth connectivity, availability of devices to perform telehealth, and socioeconomic and language barriers. Future directions in telehealth use, quality measures, and research in telehealth use need to be explored. Telehealth during the public health emergency has changed the practice of health care, with the post–COVID-19 world unlikely to resemble the prior era. The future impact of telehealth in patient care in the United States remains to be seen, especially in the context of the Advancing American Kidney Health Initiative.

My Telehealth Experience pre-COVID-19 and During COVID-19

My Telehealth Experience pre-COVID-19 and During COVID-19

Abstract PO-037: SKCC medical oncology telehealth experience during Covid-19 pandemic: Lessons learned and operational changes to leverage telehealth to maintain patient access

Abstract The purpose of this report is to share lessons learned at the Sidney Kimmel Cancer Center (SKCC) in response to the COVID-19 National Emergency, marked by expanding telehealth (TH) to decrease patient risk while maintaining access to care. TH utilization requires resources (smart phones/tablets, email, internet), and there are disparities in digital media access in our patient population. We learned from a digital literacy survey performed at the SKCC in 2018 that 30% of our patients used Android phones and &amp;gt; 60% of patients accessed the internet from a PC. Our EHR was built to support a “nonpandemic” level of TH visits, which increased in a short span from 29 visits in January 2020 to 1,700 visits in April 2020. Pre-COVID, the Jefferson TH office had 5 support employees to assist patients with TH. Though some patients needed support, the TH team had a manageable caseload. During the first weeks of the pandemic, the EHR TH software was updated to accommodate increased demand, requiring PC/mobile device upgrades/setting changes, which posed a potential barrier to care. In response to increased TH demand and need for support, the SKCC launched an oncology-dedicated Telehealth Task Force (TTF) to address barriers to TH access. Examples of TTF’s targeted patient solutions include set-up and delivery of smartphones, creating email accounts, disseminating instructions for TH use, and real- time assistance during TH visits. Daily protocol for support staff across the SKCC adapted to accommodate the increase in TH visits. Phone room staff experienced increased volume of scheduling requests to change in-person visits to TH, from 165 rescheduled in March 2020 to 431 in April 2020, and established new scripting and triage protocol. Administrative staff now follows up telephonically for TH visits. Providers noted challenges in completing TH visits within predetermined appointment length due to technical delays and increased time needed for novice users. The nurse’s role in the care team was vital in reinforcing to patients the availability of TTF supports prior to their TH visits and communicating appointment delays to improve patient experience. Providers noted the need to document at the point of care as support staff rely on this to schedule testing/follow-up visits. Supportive resources for TH were quickly appreciated, such as access to forms for timely documentation of treatment consent. The SKCC experienced an exponential rise in TH use and made critical workflow adjustments as well as creating a dedicated TTF to maintain access to care for oncology patients during an uncertain public health crisis. Citation Format: Avnish Bhatia, Lauren Waldman, Gregory Garber, Megan Sabonjian, Melissa Hunt, Janene Palidora, Amy Leader, Brooke Worster. SKCC medical oncology telehealth experience during Covid-19 pandemic: Lessons learned and operational changes to leverage telehealth to maintain patient access [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-037.

Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices.

Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.

Opportunities and challenges for telehealth within, and beyond, a pandemic

Opportunities and challenges for telehealth within, and beyond, a pandemic

Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study.

BackgroundTelehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices.ObjectiveThe objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study.MethodsUsability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions.ResultsDuring usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements.ConclusionsUsability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions.