Communication with our healthcare providers in-between visits is a powerful aspect of healthcare. This in-between visit communication and information sharing can help us make informed healthcare decisions and build our health literacy. Meaning we can find, understand and use information that helps us make informed health-related decisions for ourselves and our loved ones. 

We need and want our healthcare providers to develop an open, trusting rapport with us. At its core, medicine is a service industry, and providing patients with evidence-based information and improving communication leads to better service–better health for us, the patients.

With experience in patient-clinician communication, engagement, and education for almost 25 years, Geri Baumblatt understands how vital the exchange of information is between patients and health professionals. She identified the need to improve communication pathways with patients while developing online education with nurses. While teaching these healthcare professionals, she identified where the real need for education was — with patients.

Here’s Geri talking about her own experience:

“I had been in a very bad car accident my first year in grad school. So I had really been through the wringer. I’d go to physical therapy, do my exercises, do a return demonstration during the session, go home with a handout sheet with little stick figures to show you how to do the exercises at home. But I’d come back a week later and show my therapist how I’d been doing the exercise, and she’d say: ‘You weren’t pointing your toe down — so you were working the wrong muscles.’ And I’m thinking: where on the stick figure drawing was the toe pointing down? So you realize there are all these details you need help remembering “

This was a defining moment for Geri that brought her to the work she does today. She realized that good, well-vetted, and produced information for patients was a real gap she could help fill. Further, she became convinced that clinician-prescribed information is pivotal in ensuring better healthcare. She wanted to make it easy for clinicians and care teams to assign or e-prescribe videos, interactive decision aids, and checklists to patients. Her approach goes beyond referring people to reliable websites and hoping they find the information right for them.  Geri believes that when we as patients get the correct information, we can truly understand our health condition, treatment, and our role in our ongoing health. 

Today, the internet, smartphones, and super-fast broadband (for most of us) make sharing videos, photos, and other content easy and accessible.

What is asynchronous/In-between visit communication? 

The term “asynchronous” might sound a little formal or negative. After all, the word asynchronous means “not existing or happening at the same time,” which is the opposite of words with a more positive meaning like “harmonious” and “aligned.”

However, asynchronous, when used in the term “asynchronous communication,” is something that we do all the time, mostly with positive results. For example, we participate in asynchronous communication every time we send out a text, e-mail, or send video information to friends on social media or via email.

In healthcare, Baumblatt defines asynchronous communication as,

“Getting information and education before, after, or in-between visits with our healthcare providers as a path to better health.” So people look at and respond to the information when it’s convenient for them.

Unlike face-to-face or “synchronous” communication, asynchronous communications are about sending information that doesn’t require an immediate reply. For example, information placed onto websites, electronic reminders, and electronic assessments are all forms of asynchronous communication. 

The American TeleMedicine Association defines it this way: 

Asynchronous telehealth interactions allow patients and providers to communicate and exchange important health information when it’s most convenient for them. In contrast, synchronous telehealth interactions require patients and providers to communicate in “real-time.” 

Asynchronous communication is part of telehealth

More and more, healthcare professionals and patients alike find themselves relying on technology to communicate. Whether through video chat, text, or e-mail, technology makes it easier to meet healthcare needs without meeting face to face.

According to the Centers for Disease Control Prevention (CDC), the use of telehealth services grew 154% in 2020 when compared to the year before. The growth of accessible health care through telehealth also opened new communication options. For example, most people think of real-time, virtual visits with a physician as telehealth, but telehealth is so much more. Telehealth, using technology to provide healthcare from different locations, utilizes various asynchronous communication tools.

Here’s Baumblatt, “Clinicians need to hear from patients to truly tailor their care and help them be successful.” In-between visit communication –viewing and digesting information “prescribed” by our healthcare provider–helps us better understand our treatment and condition. When we have a grounding in the basic information about our condition, the time we spend with our providers can focus on treatment goals, preferences, and our overall care plan. Best of all, this in-between-visit communication will enable us to stay connected and linked to our providers.

Where and when is asynchronous/in-between communication most helpful?

When it comes to educating patients, Baumblatt sees asynchronous communication as an excellent means to pre-educate people about the basics of a treatment, condition, or diagnosis before a visit. This way, we can have better and more personalized conversations with our healthcare providers. 

There are three core reasons to ask for more information to review on our own in-between visits to:
1-Reinforce information after visits that we will be challenging to remember from a single conversation with our healthcare provider
2-Provide additional details on why and how to care for ourselves and 
3-Make it easy to share the same information with family members in a reliable way

Baumblatt uses the example of dietary sodium and fluids in relation to heart failure. She states, “It sounds straightforward, but people don’t understand why salt and fluids affect heart failure.” She says that patient education through asynchronous communication like videos or animation can help people understand why and how to manage. It’s often about hidden salt in sauces and canned goods – and not just salting your food.”

Here are a few examples of how and when asynchronous communication contributes to  our healthcare:

  • Clinicians can use care communication platforms to e-prescribe videos, decision aids, and other resources before or after appointments. We can watch these videos and read these resources at a convenient time when we can be focused. We can also take the time to prepare for our next conversation and note what we need to do to stick with the care plan.
  • During non-office hours, we can upload photographs of dermatology problems for our doctors. (one example)
  • We can log in information about blood pressure, blood sugar results, or food intake as part of ongoing monitoring. 
  • Using an online portal, we can ask questions during times that are most convenient for us, and doctors can take the time to respond.
  • After hospital discharge to home, rehab, or any transition of care, reviewing videos that reinforce discharge instructions can provide added clarity and opportunities for questions.
  • After an initial diagnosis when there are so many questions.

According to a 2021 article published in the Journal of Internet Medicine, asynchronous communication improved clinical outcomes, especially in chronic conditions like diabetes and high blood pressure.

Protip: Meet with your health care provider routinely, more so if you’re living with a chronic condition. Have your provider reiterate long-term healthcare goals and interventions. Like our bank account, our healthcare needs consistent monitoring and regular accounting to offer the best chances for success. Ask for information and updated recommendations that you can study or work on between visits, like videos, podcasts, or reading materials.

How does asynchronous communication work in healthcare?

Asynchronous communication works when there isn’t an emergency or need for immediate feedback. This type of communication works best when there is a need to deliver or exchange information, but a quick response isn’t needed. Asynchronous works well because it allows the information giver (healthcare professional) and receiver (you) to deliver or process the content without feeling pressed for time.

Baumblatt uses the example of a healthcare professional giving medical information through a video and stating, “I’ll send you a video that you can watch whenever you want to watch it, and then send me your questions.” This communication style offers you as the patient ample time to watch the video as often as you’d like and formulate meaningful questions in your own time. “People need time for information to register, to sink in and digest the content.”

Why do we want clinicians to “prescribe” information versus finding it ourselves via “Dr. Google?”

Baumblatt acknowledges the temptation to do our internet search versus reaching out and asking our clinicians to provide information.

Says Baumblatt, “we have to be careful. It’s hard to know if a site is reputable and free of bias.  If you look up information on Google or listen to a particular podcast, how do you know this person or organization is reliable? Are they trying to sell you something, or do they have a specific point of view that leaves out other options? Or the info can be good, but not right for your specific situation or at that point in your health journey.”

Information provided by your clinician gives you the peace of mind that the content is factual and suitable for you, instead of from unverifiable sources on the internet. 

Protip: When visiting a website, consider the source. Check the “about us” page and look for credentials. Evaluate who runs the website. For the most part, branches of government, a medical organization, or a university are reliable sources. Study the quality of the material and check for an editorial board. Anyone can make a website look legitimate, so be skeptical. When in doubt, ask your provider to vet the site. For more about evaluating internet health information, go to the U.S. National Library of Medicine. 

What about transitions from one care setting to another?

When moving from one care setting to another, it’s essential to ask the nurses and discharge planners to provide patient education well in advance.  Ask for videos whenever possible.  With the right information provided at the right time, you will know what to expect and what you will need to do in this next phase of our treatment and recovery.  Remember, getting this information while in the hospital is not the best way.

Here’s Baumblatt: “When you or a loved one is going home from any type of care setting (hospital, rehab, same-day surgery), there’s a lot you need to understand. And it’s very scary and overwhelming. And we know that the clinic, especially in the hospital, isn’t an ideal place to try and educate patients. People forget about 80% of what we tell them. And the 20% they remember might not be quite right. So people are disoriented, scared, confused, in pain, and maybe on medication. And we know that working memory just has very real limitations for what you can remember to do, like me with my physical therapy, once you get home.”

“However, it can be a good time to do some hands-on training for the family members and care partners to get them more comfortable with the care they’ll be helping with at home. Some hospitals are actively making them part of the care team.

Protip: if you or a loved one is going from hospital to home, ask for information that you can read or a video or other content that you can watch–well before discharge. Be sure that it’s all not simply spoken to you. Reiterate that you will be more able to retain the instructions if provided in advance. Let them know you want time to review, digest, and formulate questions at discharge. Then, with the detailed information in hand before the procedure, you can check it when your head is clear and ensure ample time to prepare.  Are you preparing for surgery? We have you covered!

What if my provider is not “prescribing” information?

Rather than going it alone with Dr. Google, Baumblatt encourages us to reach out to our clinicians. She advises us to ask our healthcare providers to direct us to websites or resources that are reliable and easy to understand. 

Protip: When our clinicians do recommend websites, ask them to be specific.  Are there specific pages or pieces of information that are right for you? Your clinician may have to get back to you, and that’s okay.
Baumblatt cautions the internet searchers among us to be wary of websites that might be promoting a product and to look at the site and assess how up-to-date it is, who created it, and do they have any other interests they might be pushing? Is this a reliable source of information? At the very least, she encourages us to ask our clinicians which websites potentially to avoid and which sites are most reputable.

Are online peer groups a beneficial way to get additional information?

Peer groups are most effective when it comes to their social aspect. They ease feelings of loneliness, foster resilience, and offer a trusted space to voice frustrations and concerns. However, Baumblatt cautions against using informal peer groups as the primary source of medical information. Sometimes the most vocal people in online groups represent the extremes–either those who have had an excellent experience or a bad experience.  The positive person wants to evangelize; the bad experience person wants to warn everyone. So it can be harder to get at what is a typical or common experience for a procedure or condition in these online forums.

Keep in mind, you can look for a trained peer mentor matched with your condition, age, etc. A peer mentor can be extremely helpful in building confidence and helping you to understand how to manage your condition or recovery. Geri has an excellent article on the Power of Peers where you can learn more.

Protip: Look for opportunities through advocacy groups for your specific condition and ask to be connected to a peer mentor program. For example, the Crohn’s and Colitis Association has a program called the Power of 2. Also, check to see if there is a knowledgeable, credentialed moderator for any of the groups that you find online. Groups with a credentialed moderator could be more beneficial than those that are strictly peer-peer with no moderation.

Tips for asking our healthcare providers for the information we need

Sometimes, it’s challenging for us to ask questions about our healthcare. We might feel intimidated, overwhelmed, or just don’t know where to start.

  1. Ask for a complete orientation to your condition. If you have an on going condition, you can do this once a year as a refresher.
  2. ask for resources that offer understandable information and explanations.
  3. If you have a chronic condition, ask your healthcare provider about the long-term effects, what care is necessary, and what you can do to prevent any complications.
  4. It’s okay to ask your provider to clarify or repeat information.
  5. Write down your questions and send them to our healthcare provider in advance when you can. Or hand them a written list of questions at the beginning of your visit.

Baumblatt gives the following recommendations:

Ask for a complete orientation to your condition. If you have an ongoing condition, you can do this once a year as a refresher.

Ask for resources that offer understandable information and explanations. 

 

Protip: Baumblatt reminds us, “we need to hear information multiple times to remember” – that is why reviewing information like videos and podcasts in-between visits is so important. We can then write down our questions and send those to our provider in advance of our appointment.

Communication is key

Healthcare shouldn’t end when you leave your appointments because your health doesn’t stop when you leave the exam room. Keeping the focus on your healthcare means utilizing any form of communication with your providers, whether through video visits, text, web portals, or website information. Asynchronous communication fills the void that face-to-face communication leaves and can help us prepare better for those conversations. Who hasn’t left an appointment with a clinician forgetting to ask a question or not precisely remembering the instructions or explanation of our condition and what we can do about it?

When you have credible information “prescribed” by your healthcare provider, you are confident you have the proper recommendations for your health and well-being.

Protip: Want to alert your healthcare provider to a free service that they can use for “prescribing” great information to you and their other patients? Check out this excellent explainer video that introduces Docola Docola allows clinicians to e-prescribe relevant education to patients. In addition, Docola has a library of credible patient education materials and tools developed by leading experts and academic medical centers.