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Telehealth and the rise of contextual care


For the first time, clinicians have been able to get a “behind the scenes look” into their patient’s environment during telehealth visits

The explosive increase in the use of telehealth resulting from the COVID-19 pandemic has been a paradigm shift in changing how we think about the future of health care. During the first quarter of 2020, at the onset of the pandemic, the number of telehealth visits increased by 50% compared with the same period in 2019. This steep rise in the availability of virtual visits has likely helped prevent the spread of disease by keeping people out of crowded hospitals, and also enabled patients to connect with their doctors when most offices were closed.

Yet there is another benefit that is often overlooked. For the first time, clinicians have been able to get a “behind the scenes look” into their patient’s environment during telehealth visits. This can help them identify contextual clues, like background noises or living conditions, that could indicate particular impacts on a patient’s health and help determine a diagnosis or course of care. This has led to a new phenomenon in health care that organizations are just beginning to explore: contextual care.

According to the CDC, there are five primary categories that influence a person’s health: genetics, behavior, environmental and physical influences, medical care, and social factors. While in-office visits can offer providers insight into factors like behavior and genetics, it can be much harder to assess patients’ environmental and physical influences. Visibility into a patient’s living space can help providers identify social determinants of health (SDoH) that are impacting their wellbeing.

Moreover, because there are many environmental factors that patients may not even realize affect their health, they may neglect to mention certain relevant aspects of their lifestyle to their providers. Contextual care can help combat this problem by giving health care practitioners an insider’s view into patients’ living environments. Not only can they pick up on clues or signals based on what is going on in the background of a virtual care visit, but they can ask patients questions based on what they are observing and even ask patients to show them their medicine bottles or the inside of their refrigerator using their device’s camera.

Improving Care Based on Visual and Auditory Clues

Poor living conditions can be associated with a wide range of health conditions, such as respiratory infections, asthma, lead poisoning, injuries, and mental health concerns. All of these issues can have a significant impact on a patient’s comorbidities, and many of them may be overlooked in a typical appointment. Subtle visual or auditory signals that providers see or hear during a virtual visit can be useful for providing additional context about their lifestyle. For example, what are the patient’s living conditions like? Do they have many young children who can be overheard in the background? Does it appear as though they live in a rural area without convenient access to certain resources? Similarly, contextual care can offer clues about a patient’s general safety -- if they are living in dangerous or hostile conditions, providers may be able to pick up on cues during a virtual visit and intervene as appropriate.

Sharing the Home Environment Via Video

One struggle patients may encounter during in-person appointments is forgetting exactly which medications they are taking. Especially for people who have complex treatment regimens, it can be difficult to keep track of them all and report them accurately during medical visits. During virtual health care encounters, if a provider asks which prescriptions a patient takes, it could be as easy as running to the medicine cabinet to double-check the name and dosage. This enables patients to share more accurate, detailed descriptions and can result in more informed decision-making on the part of the provider. This is also applicable for patients on special diets. By scheduling at-home virtual care appointments, patients can easily provide a look into their kitchen cabinets or refrigerators to share what they’re purchasing and seek input from providers on how to better tailor their diets to their therapeutic needs.

The Broader Benefits of Virtual Care

In addition to providing insight about a patient’s access to healthy food, virtual care can provide new tools to help people better address other SDoH barriers such as a lack of accessible transportation. Every year, an estimated 3.6 million people in the United States do not receive medical care due to transportation barriers. Virtual services, such as nurse triage, can help a person determine whether they need in-person care or whether they can receive care via telemedicine, reducing the need for transportation. And, when patients do need to see a provider in-person, digital health tools can help create faster linkages to transportation like ridesharing services, or social services that provide transportation. When combined with the contextual care factors that providers have access to during virtual visits, patients have access to more well-rounded, personalized care that better serves their needs.

Contextual care and the benefits it offers can contribute significantly and positively to a patient’s health. From living conditions to diet and medications, patients deserve to have a deeper understanding of how their circumstances are impacting their wellbeing, and contextual care enables them to share more thorough and accurate information to those that can provide medical care and advice. With only 10 to 20 percent of a person’s health outcomes being attributed to medical care, and the remaining to societal, behavioral, and genetic factors, it is key that organizations begin to look at a person’s health from a holistic point of view, rather than a condition or disease-focused one.

As society looks for ways to improve the quality of and access to health care, especially for underserved populations, the ability for virtual care to offer important contextual clues that could improve a provider’s diagnosis and enhance the patient’s health should not be overlooked -- yet another reason why virtual care must remain accessible in a post-pandemic world.

Joe Martinez is senior director of virtual care at Pager

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