Designing Asynchronous Communication Tools for ...

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 $EVWUDFW Asynchronous communication outside the clinical setting has both enriched and complicated patient-clinician interactions. Many patients can now interact with a patient portal 24 hours a day, asking questions of their clinicians via secure message, checking lab results, ordering medication refills, or making appointments. However, the mode of communication (asynchronous) and the nature of the interaction (lacking tone or body language) strip valuable information from each side of patient-clinician asynchronous communication. Using interviews with 34 individuals who actively manage a chronic illness of their own, or for a child or partner, we elicited narratives about patients’ experiences and expectations for using asynchronous communication to address medical issues with their clinicians. Based on these perspectives, we present opportunities for designing asynchronous communication tools to better facilitate understanding of and coordination around care activities between patients and clinicians.  ,QWURGXFWLRQ $V\QFKURQRXVFRPPXQLFDWLRQEHWZHHQSDWLHQWVRUFDUHJLYHUVDQGPHPEHUVRIWKHLUFDUHWHDPVSK\VLFLDQVQXUVHV DQG PHGLFDO DVVLVWDQWV KHUHLQ UHIHUUHG WR DV ³FOLQLFLDQV´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²LQFOXGLQJ WKRVHIURPUDFLDODQGHWKQLFPLQRULW\EDFNJURXQGVDQGWKRVHZLWKORZHUOHYHOVRIHGXFDWLRQ²DUHDOVROHVVOLNHO\WR XVH SDWLHQW SRUWDOV UDLVLQJ FRQFHUQ WKDW FXUUHQW SRUWDO GHVLJQ DQG LPSOHPHQWDWLRQV DUH QRW HTXLWDEO\ DFFHVVLEOH WR WKRVH LQ QHHG  )LQDOO\ DV\QFKURQRXV FRPPXQLFDWLRQ RYHU SRUWDOV LV ODUJHO\ OLPLWHG E\ ZKDW LV SURYLGHG E\ FRPPHUFLDO(+5VDQGWKHSRVVLELOLWLHVRILQWHJUDWLQJZLWKH[LVWLQJPRGHOVRIFDUH  7RLPSURYHDV\QFKURQRXVFRPPXQLFDWLRQRYHUSDWLHQWSRUWDOVZHPXVWFRQVLGHUWKHSDWLHQW¶VSHUVSHFWLYHRIWKHLU XVHHIIHFWLYHQHVVDQGXVDELOLW\7KHGHVLJQRIDV\QFKURQRXVFRPPXQLFDWLRQVKRXOGDOLJQZLWKWKH(SVWHLQHWDO YLVLRQIRUSDWLHQWFHQWHUHGFDUHZKHUHFDUHVKRXOG³H[SORUHSDWLHQWV¶YDOXHVDQGSUHIHUHQFHVKHOSSDWLHQWVDQGWKHLU IDPLOLHV PDNH FOLQLFDO GHFLVLRQV IDFLOLWDWH DFFHVV WR DSSURSULDWH FDUH DQG HQDEOH SDWLHQWV WR IROORZ WKURXJK ZLWK RIWHQGLIILFXOWEHKDYLRUDOFKDQJHVQHHGHGWRPDLQWDLQRULPSURYHKHDOWK´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