Getting Care Teams Involved With New Communication Technology

If you’re involved in coordinating the care of complex patients, you know how crucial communication is. It’s something we talk about a lot on this blog, and for good reason.

Today, technology makes communication easier than ever before. The click of a key or the tap of a screen can connect two people across the globe.

Videoconferencing makes it possible for groups to work towards the same goals, with minimal confusion. In-home health monitoring equipment allows for patients to manage their conditions from the comfort of home and share that data digitally with their whole circle of care — easily and securely.

The potential for these tools to improve health care is enormous. This is particularly true in home and community care. When accurate patient information is available on demand, members of care teams can take quick, decisive action.

Unfortunately, many providers don’t see this value. There’s been plenty of hype surrounding health care technology, and it’s all too easy to dismiss it. In this post, we’ll look at some of the reasons for practitioner hesitation—and how care coordinators can overcome it.

Why Technology is Necessary

Care coordination can be frustrating. And one of the biggest frustrations is seeing delays occur when patient information is transferred too slowly.

In some ways, things are getting better. Health care leaders have begun to understand the importance of improving provider access to patient information. The rise of electronic medical records (EMRs) is a great example. These records centralize information, providing practitioners with complete, up-to-date medical histories when and where they need them.

Here in Ontario, coordinated care plans take things a step further for those with complex conditions. With the right digital technology, these documents can be accessed and updated electronically, along with a patient’s other medical records. Care team members and even the patient themselves can find whatever information they need—all in the same place.

Advances in digital technology have been key. No longer is sharing data a matter of scouring computer databases for raw information that’s difficult to interpret.

Now, user-friendly health care apps are revolutionizing medical care. These apps make it possible for care team members to transfer information quickly using their mobile devices. They can also be used to conduct videoconferences, allowing practitioners to ask one another questions and clarify points of confusion.

In the era of patient-centred care, communication technology also has the power to engage care recipients. Because many mobile apps have become so easy to use, connecting with a nurse, personal support worker (PSW), or other care provider can be as simple as tapping a picture on a tablet screen.

As a care coordination professional, you have a major role to play. By promoting the use of communication technology, you can increase the impact you have on patient health outcomes and quality of life.

Care Team Resistance

For those who deal with coordination challenges, the need for quicker, more efficient communication within care teams is obvious. But practitioners, family caregivers, and even patients may have trouble seeing how new technology can help.

Unfortunately, many people have the perception that digital solutions only makes things more complicated. It’s understandable. We can all relate to the feeling of being overwhelmed.

Our social media feeds provide constant streams of information—much of which is irrelevant to us. And there are times when searching for a specific piece of information online can lead to wasted hours.

Information and communication technologies designed for the health sector can lead to negative experiences, too. As just one example, the systems used to access EMRs are sometimes incompatible with one another. There are situations when a complex patient needs to see a new specialist. If this practitioner is outside of the patient’s network, she may be using a different system. As a result, she may be unable to read his EMR without doing a lot of extra work.

When technology fails to make things more efficient, many health care providers don’t see the point in going digital.

Of course, there are also those who are willing to act as technology pioneers, trying out new efficiency-enhancing technologies before judging them. As a care coordinator, you may fall into this camp.

For you, it’s about more than completing specific tasks. It’s about ensuring that many different types of tasks are performed in a timely manner, and that they contribute to a patient’s overall care. When the flow of information is poor, this just can’t happen.

Unfortunately, perceived learning curves can deter practitioners from adopting new technologies. Skeptical attitudes may also come from exposure to technology hype. Whatever the reason, reluctance to adopt isn’t uncommon.

Studies show that many nurses minimize or put off the use of information technology systems. Of course, this resistance isn’t confined to nurses. Any care team member might be hesitant to use a new app or system, thereby impeding the flow of information.

Tips for Getting Care Teams on Board

Doctor, nurse, pharmacist, family member. whatever role a practitioners or caregiver fills, she can serve as an early technology adopter. But first, she has to understand how it will make her better at helping her patient (or loved one).

As a care coordinator, you’re in a good position to advocate for improved communication. Often, this means encouraging the use of technological solutions that connect care teams and make it easy for members to share information.

In many cases, educating decision makers will be key. If the health care organization or service provider you work for doesn’t have a digital solution in place, those in charge will require the specific information in order to make an informed decision about adoption.

How will the technology you’re proposing simplify communication and care plan sharing? How much more efficiently are these processes likely to be carried out after implementation? Will the solution help with specific organization-wide goals?

Taking on an outside perspective is also important when you’re encouraging individual practitioners, as well as family members and patients. Will the proposed app, platform, or system change their daily routines? Are there concerns that it will be difficult to use?

If you’ve selected the right solution, risks will be minimal—or even nonexistent. The technology you suggest should be easy to use. Most importantly, it should offer real benefits to all involved.

Imagine telling a patient that she can contact you, her nurses, or her family members by tapping a familiar face on a tablet screen. Wouldn’t you like to tell a nurse that she can always access up-to-date information related to a patient’s medication and care regiments? And what about explaining to a specialist (a wound care expert, for example) that she can use videoconferencing to see more patients?

Helping care team members understand the benefits from their perspectives is ultimately good for patients.

A More Connected Future

Can care coordinators improve communication between practitioners, caregivers, and patients? At Aetonix, we believe the answer is yes. The result will be quicker, more efficient care delivery. And digital technology will play a crucial role in this transformation. Innovative healthcare technology has already proven to make a huge difference in the way healthcare practitioners and their patients communicate. It has also made an impact on how often patients need to be readmitted to the hospital. When their physician is accessible to reach for a quick question, it can prevent the need for a patient to go get checked in person or go to the emergency room.

This will continue to improve once care teams are able to see the benefits. The education and adoption process may be slow. But the best way to get it started is by finding the right communication technology for your organization—then talking to potential early adopters.

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COPD Education – Onboarding


To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Patient, Educator (Nurse, RT, the Physician could also be the educator)

One 60-90 min session with the Educator

  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
COPD Education – Continuous Maintenance


To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Patient, Educator (Nurse, RT or Physician)

A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
COPD Respiratory Status Follow-up


Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Patient, Educator (Nurse, RT or Physician)

Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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