Background/Purpose: eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education, support, and tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational, creating informed, engaged, and empowered “patients as partners,” equipped to take part in shared decision-making, and effectively self-manage chronic illness.1 The objective of our study is to examine how eHealth affects patient-provider relationships, and its ethical and practical ramifications.

Methods: We interviewed healthcare professionals (HCPs) about their experiences with eHealth and its impact on the office visit. Eligible participants had a caseload with >25% of patients with arthritis and multi-morbidity, in order to address issues of managing complex chronic conditions and coordination of care. In-depth interviews used a flexible, semi-structured discussion guide, and follow-up interviews served to clarify and expand upon initial discussions. All interviews were audiotaped and transcribed verbatim. Constant comparisons and a narrative approach guided the analyses and a relational ethics conceptual lens was applied to the data to identify emergent issues.

Results: 12 HCPs (nurses, fellows, physician; 6 male, 6 female) participated. Years of practice varied from one to 29 (median = 13), and all worked in an urban or suburban setting. eHealth tools accessed most frequently were online educational resources for patients (used by all participants in some form), followed by online resources for HCPs like curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. HCPs generally did not see how social media could be useful to their practice. Analysis revealed 3 emergent themes: 1) HCPs shared some commonalities in how they conceptualized an “ideal” engaged patient as medically literate, bringing “useful” data to consultations, and whose evolution is largely a product of the rise of eHealth; 2) Fears of eHealth technology disrupting existing practice habits and uncertainty about liability and confidentiality issues were a barrier to the adoption of new technology; 3) Most HCPs saw eHealth tools as facilitating a shift towards a patient-provider relationship where shared decision-making is the new norm. Perceptions on the usefulness and impact of eHealth technologies varied from doubtful to enthusiastic. All declared a primary concern for best possible patient outcomes, and some saw eHealth as integral to reaching that goal.

Conclusion: HCPs see eHealth technologies broadly as agents of change, for better or for worse, however, the perceived direction of that change is neither clear nor uniform given the varied experiences of this group. The value of these technologies was largely assessed through a relational ethics perspective, as the patient-provider relationship and its outcomes remained the primary concern of all HCPs. ¹Townsend A et al. JMIR Res Protoc 2013;2(2):e38

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-ehealth-technologies-are-changing-the-office-visit-perspectives-from-healthcare-professionals-in-rheumatology/