Technology. Most of us consider it an indispensable part of our daily lives. We’ve learned to accept Wi-Fi glitches, program crashes and software updates even though they cause us frustration.
But many Americans, particularly older adults and individuals with disabilities, have difficulty adopting new technology—even when it can give them access to better health care.
Julie Faieta, assistant professor and researcher in the Department of Rehabilitation Science and Technology (RST), wants to change that.
Faieta notes that during the COVID-19 pandemic, the Department of Veterans Affairs (VA) distributed more than 80,000 iPads to veterans across the United States to increase access to care. They were equipped with a secure, HIPAA-compliant application called VA Video Connect (VVC), which enabled the veterans and their caregivers to participate in video conferences with health care providers.
However, there was no way of knowing who was likely to use the technology, or who needed help before receiving the iPad.
Today she is part of an interdisciplinary team working with the VA Pittsburgh Healthcare System (VAPHS), investigating ways to help older, home-bound veterans become more comfortable and adept at using the technology they were given.
“Our overarching goal is to remove barriers and facilitate better implementation of telehealth,” states Faieta
To do so, she leans into her background as a licensed clinical occupational therapist.
“As an occupational therapist, I take a patient-centered approach,” says Faieta. “My goal is to determine the needs of the patient and their readiness for telehealth visits while establishing ways to prepare and support them and their caregivers.”
“Providing patients with access to technology—especially older adults who may experience impactful barriers to telehealth like physical and/or cognitive impairments—is insufficient to drive adoption,” explains Faieta. “Beyond access, patients also need ongoing support, proper education and resources that help ensure they successfully adopt and use the technology.”
“If someone is not prepared to benefit, it’s probably going to have a negative impact,” she continues. “In fact, you might be adding to their frustration and discouragement.”
To help ensure veterans were comfortable using technology for telehealth visits, Faieta designed the VVC Match, an easy-to-use assessment tool that identifies the physical and cognitive functions required to successfully use the VVC app.
The assessment is designed to be delivered as a web based survey. Questions such as “Do you experience difficulty or discomfort when moving your eyes across a page or screen as though to read?” and “Are you able to read a magazine or text using corrected vision?” are intended to indicate whether certain accommodations need to be made in order to complete a successful call.
Faieta and her team broke down all the steps involved in using the iPad hardware, including how to manipulate the device, log in, adjust the volume, center the user within the camera scope, and start and end a VVC telehealth visit. They then identified 36 sub-steps required to complete a telehealth call. Using the Montreal Cognitive Assessment screening tool, they created a user profile that considers the accessibility needs, technology experiences and preferences of the veteran.
Faieta emphasizes that the assessment tool is not simply to qualify an individual as a good or bad candidate for telehealth, but rather to reflect their level of readiness to participate in a call.
“If the user score matches the requirements of the technology, there is a good probability that the veteran is ready, willing and able to complete a telehealth visit,” explains Faieta. “If there’s not a close match, we must then determine what further supports are needed.”
Dr. Steven M. Handler, associate professor of Geriatric Medicine, University of Pittsburgh, and director, Technology Enhancing Cognition and Health–Geriatrics Research, Education and Clinical Center (TECH-GRECC), VAPHS, says home-bound older veterans are particularly grateful for the care they receive via telemedicine.
“The VVC Match tool allows us to better identify those veterans who can ultimately use the VA-issued iPads that have the VVC app so they can increase their access to needed health care,” Handler continues. “Without such a tool, some veterans receive iPads, but don’t know how to use them.”
Faieta reports the preliminary assessments were well-received by veterans and their caregivers who are enrolled in the Pittsburgh VA’s Home-Based Primary Care program. She and her team presented the results during VA Research Week in May 2024 and are continuing to refine and calibrate the VVC Match tool for optimal use.
“Although the VVC Match tool was designed specifically for the VA telehealth app, the concept could easily extend to other health care apps,” says Faieta.
Handler agrees. “I believe that the general public, including many providers of clinical care, make assumptions about the digital literacy required to use telemedicine,” says Handler. “Having a better grasp of a patient’s digital literacy up front would reduce friction and contribute to a successful telehealth visit.”
