Advantages and Limitations of Replacing the Traditional Clinician-Patient Face-To-Face Interaction with Technology-Based Solutions

Posted: January 4th, 2023

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Advantages and Limitations of Replacing the Traditional Clinician-Patient Face-To-Face Interaction with Technology-Based Solutions

The relationship between the doctor and patient is an intricate one because the patient comes into the relationship in a disturbed state and has the desire to be more relaxed and to become more spiritually and emotionally relieved by the outcomes of the intervention or the interaction, which some would refer to as being healed. The health expert brings to the relationship or interaction a technical skill of disease processes and organ systems, as well as medical judgment, understanding and empathy of the patient’s concerns and needs, which appeal to many individuals who require these services. The study pays particular attention to the merits and demerits associated with technological forms of communication, and shows how the health sector may learn from the findings. The advancements in technology make it possible to embrace technological forms that allow people to express their feelings without any fears of intimidation, and make it possible to experience the effectiveness of not having to walk to the health institution. The study elaborates how despite the growth in technology and the communication benefits associated with the advancement so many people are still unable to use the electronic and digital platforms due to many reasons. The lessons acquired from the study present valuable insight into operators in the health sector who learn the importance of acquiring more information on how to improve communication with patients using technological avenues.

Review of Traditional and Technology-Based Solutions

Today, the use of digital communication is increasingly growing with more health practitioners embracing the technique over the traditional clinician-patient face-to-face interaction. The utilization of digital communications technologies, for instance is common in the UK where at least 90% of the country’s population have a mobile phone. The National Health Service (NHS) in the UK is increasingly adopting the use of digital communication platforms for communication between health care givers and their patients, presently focusing on the application of NHSmail2 that is specifically created to ease doctor-patient communication. Huxley et al. (2015) feel that technological forms of operation have become an essential aspect of medicinal practices today, and proceed to mention that the appropriate technology can make significant contributions with elevated efficiency, advanced quality and lowered costs. Some of the many merits technology can offer include the improvement of communication between health practitioners and their patients, advance medication safety, lowering potential medical blunders, improving reach to medical information and promoting patient-centric care.

Information and communication technologies (ICTs) are set to change how clinicians interact with their patients. ICTs comprise of all digital avenues and technologies that promote the electronic acquisition or capture, storage, dispensation, and transmission of information with the objective of promoting health, averting ailments, treating health problems, managing sever illnesses and encouraging many other clinical practices (Rouleau, Gagnon and Cote, 2015). Even though nurses form the largest group of health providers the practitioners serving in other capacities are now forced to cope up with the advancement of ICTs within the healthcare workforce, such as telecare technology that can have significant effects on nursing practices (Rouleau, Gagnon and Cote, 2015). Indeed, the use of telehealth has increased from about 35% in 2010 to 76% in 2017, which shows that more facilities are embracing modern technology to facilitate interaction with patients (Rouleau, Gagnon and Cote, 2015). The technologies transform the perceptions of presence and place and form distance between the patients and the providers (Rouleau, Gagnon and Cote, 2015). Consequently, ICTs create a situation where direct intervention cannot be offered in the conventional manner (face-to-face) that social workers often use.

Increase in the use of telehealth

Advantages

Clinician-patient communication are transforming, becoming more-customer centric, and increasingly health practitioners are encouraging flexible forms of consultations. Replacing conventional forms of communication with electronic approaches is beneficial because this advances convenience, choice and flexibility for both the patient and the clinician (Huxley et al. 2015). The World Health Organization (WHO) has set the goals for everyone to achieve affordable, acceptable and timely healthcare of desirable quality (Huxley et al., 2015). There is a prevalent expectation that the utilization of digital interaction between patients and clinicians will improve reach to care for everyone. A person or patient does not have to walk into a health center to get medical assistance because they can do that with the help of the available electronic and digital avenues such as the use of phones, the use of social media avenues such as Facebook, Twitter, Pinterest, Skype, Zoom, Baidu and Instagram, email and other available electronic forms of communication. Sometimes, some individuals have to walk or travel over long distances to seek medical intervention on issues they would effectively address without necessarily visiting the health institution.

Adequate facts suggest that interaction with technology-based solutions between clinicians and patients yield considerable positive outcome, which encourage various groups to pay considerable attention into the area. An advantage of substituting the conventional clinician-patient face-to-face communication with technology-based approaches is digital clinical interaction lowers the patients’ sense of intimidation and inhibition, and encourages patients to ask questions and disclose more information that would help the clinicians to give suitable intervention (Huxley et al., 2015). Patients seeking help for physical complications feel less shameful when using video link, which encourage them to ask more questions. Huxley et al. give the example of teenage girls who use email to willingly share their health issues and experiences with a health professional discussing issues that they would not really talk about face-to-face. The way people become more open when expressing their feelings over electronic platforms is in accordance with the description of the online disinhibition theory, which implies that people become more open and express themselves more freely, offering more information, and express themselves in cyberspace in ways that they would not when having a face-to-face interaction (Huxley et al., 2015). The eradication or minimization of the patient being seen going to the hospital or seeking assistance potentially eradicates the stigma, social disapproval and embarrassment that some patients may encounter at the healthcare facilities. Even though some reviewers have argued that face-to-face interactions are important for communicating matters touching on emotional issues, but other evidence shows that patients discuss their emotional issues with health practitioners via email and other electronic platforms, and are even able to share sensitive or embarrassing queries.

The advancement in technology makes telemedicine very appealing to both practitioners and patients. At least half of the medical institutions in China and other developed countries such as the Western nations use telemedicine to interact with clients. A study by eVisit (2018) discovered that nearly 89% of health practitioners in America have already started developing or executing a telemedicine plan into their firms. The study further reveals that healthcare practitioners in smaller health facilities as well as in independent practice are beginning to embrace telemedicine to become increasingly competitive at the local level, and to avoid losing patients (eVisit, 2018). Many facilities are switching to telemedicine because of the merits associated with the technological design. A benefit of telemedicine that appeals to many people is its cost effectiveness, thereby making it possible to save (eVisit, 2018). The health providers in this case and the patients do not have to make long trips to the health facility to seek for intervention, which makes it possible to save the money one would use to move to the hospital. The design is appealing, especially to health institutions because it makes it possible to attend to many clients at the same time as opposed to using face-to-face interaction where the social workers may be compelled to work with a single patient each time, considering the confidential nature of such practices. Attending to patients using telemedicine is more relevant now that the world is struggling to overcome Covid-19 by lessening bodily contacts as much as possible. A practitioner and a Covid-19 who is at home and want to seek guidance on how to manage the disease using pharmacological approaches can easily get instructions without having any fears of infecting the others. Organizations, therefore, should increase their investment in this area to make telemedicine more appealing and practical.

The use of technological-based apparatus to facilitate communication with clients increases patient participation and engagement, which is essential while offering medical care. The information on eVisit (2018) shows that when the patients are dedicated to their own healthcare aspirations, it becomes easier to achieve the desired healthcare objectives and to reduce costs. A health practitioner, for example, can call the patient and inform them about the upcoming visit and possibly brief the client what the meeting will entail. Informing patients what to expect in prior increases their chances of conducting relevant inquiries into how to respond to the questions and what to tell the practitioner that would help to address the issue in the most effective manner (eVisit, 2018). The other merit of engaging the clients through telemedicine is it becomes possible to uphold care appointments and appointments (eVisit, 2018). In addition, the virtual meetings help to reassure the clients that their health care providers are watchful and ready to attend to their needs. The opportunity also allows patients to ask questions in areas that require more clarity as well as to report signs that signify something bad to come (eVisit, 2018). Also important is that using telemedicine engages the patient in the way it becomes possible to follow up on appointments and make sure they are on the right path. Failing to engage patients in the decision making process, however, could have fatal outcome because the practitioner may not exactly know what interventions would help to address the concern in the most effective manner (eVisit, 2018). The patient may also not be as open as he or she would be when the healthcare worker gives them the chance to contribute towards the intervention process. It is imperative for the caregivers to use technological forms of communication to give their clients the chance to contribute towards what they think will alleviate the problem.

Limitations

Presently, the evidence for the effects of these technologies used to facilitate clinician-patient communication is not conclusive. Some researches indicate that one major concern associated with the use of technological components for communication between the doctors and patients is the issue of inequality in accessing the technological platforms that ease communication between patients and their caregivers as much as prior description illustrates that the marginalized groups have better chances of interacting with clinicians using technological platforms (Huxley et al., 2015). Critical examination reveals that whereas many people have access to technological services and devices, some do not get the opportunity. Some of the groups that are likely to be disadvantaged with the use of technology for communication purposes include the older people, individuals who do not speak English as their first language, those with no or little educational qualifications and those with learning disabilities or literacy problems have lower chances of engaging with technology in the most effective way, and have been identified to be less likely to utilize digital communication platforms or avenues for healthcare reasons (Huxley et al., 2015). Therefore, if the stakeholders are concerned with switching to digital avenues to enhance clinician–patient communication and replacing it with the present face-to-face consultations, it is vital to consider how the approach may seclude some people and use the information to take appropriate measures towards including everyone.

In addition, several individuals already experience considerable hardships accessing healthcare services and it is not clear what impact introducing technological forms of communication will have on them. The population groups comprising of individuals who already experience significant hurdles accessing healthcare include those with mental complications, those who are physically disabled, disadvantaged groups such as refugees, travelers, the homeless, and those who lack occupational flexibility such as those working as casual laborers (Huxley et al., 2015). Most of these disgruntled populations lack enough financial resources to access or purchase some of the technological tools and equipment that would allow them access care through technological platforms. Some lack the necessary education to allow them to interact with technology, which further impede communication. The homeless, people, for example, may not have the space to use internet effectively, and may not be in a position to own electronic gadgets such as smartphones that make it possible to interact with clinicians. The same happens with those suffering from mental illness who cannot tell the doctor how they feel through electronic platforms unless they have direct contact with the health practitioner. Available evidence further reveals that digital clinical communication can cause inequalities in reach to general attention and care for certain populations, such as the elderly people (Huxley et al., 2015). Some of the elderly people cannot use electronic on their own unless they get assistance because of the challenges a person develops once they grow old. An old person, for example, may not effectively use certain software on a smartphone or read or listen to the conversation without assistance. The inequalities associated with the use of electronic and digital forms of communication requires all concerned parties such as the government and health institutions to increase reach by improving electric and internet connection.

It appears from research that technology-based solutions, especially online communication has spread very slowly in clinical practice. Other than focusing on the communication with their patients, health centers now have to address the constraints that come with switching from the traditional aspects of communication (Tates et al., 2017).  Flodgren (2015) writes that while considerable developments have occurred in improving the nature of communication using technological avenues, some stumbling blocks still make it hard for practitioners to employ the advanced forms.  Flodgren (2015) proceeds to inform that many patients and providers alike still prefer the personal attention to the technological forms because not all procedures, even some that are simple cannot be conducted online. Several hindrances explain the stagnated diffusion of technology-based solutions in clinical practice Many institutions view the installation of technology-based forms of communication may be costly, thereby tend to be slow in their adoption of advanced systems (Tates et al., 2017). The challenge inhibits small health facilities from creating a system where technology aids in communication in a manner that is traceable, confidential and efficient. Some health facilities fear the heavy cost that come with the acquisition and installation of advanced systems such as artificial intelligence (AI) and virtual reality (VR) that revolutionize how firms interact with stakeholders. Other than the financial constraints, clinicians in different parts of the globe continue to raise their concerns about the advanced level of expertise needed to manage online communication (Tates et al., 2017). The healthcare providers in developing countries are likely to face the problem due to lack of training and exposure to sophisticated forms of communication. Inadequate knowledge, inexperience and little exposure to superior and effective forms of communication that would efficiently replace face-to-face interaction often lead to repulsion among members of staff and could result in poor outcome if the management does not intervene (Tates et al., 2017). Providers in some institutions that are yet to embrace technology are uncomfortable that focusing so much and managing the big data that occur with the use of the web and email expand their workload rather than ease their job. Some healthcare providers also think that having to handle the many messages while maintaining technology-based communication might not be clinically helpful and relevant.

The use of telemedicine raises concerns among stakeholders that the level of care continuity may fall, which requires the stakeholders to put adequate attention into how to improve the area.  Flodgren (2015) informs that in situations where patients are utilizing on-demand online services that link them with a random health practitioner, the level of care continuity depreciates. The problem with increasingly using telemedicine services is the primary caregiver may not have access to essential records from past visits, which denies them suitable information on what measures to take. Consequently, because lowered care continuity can depreciate quality of care, the providers of telemedicine must use suitable interventions to uphold suitable and reachable patient records. Nonetheless, as more health practitioners embrace appropriate telehealth mitigation measures to use with their clients, the level of care continuity will strengthen, thereby lowering the chances that clients end up at a facility where they seek quick medical attention or care. Practitioners, therefore, should consider how the use of telemedicine could disrupt their functions and take suitable measures to deal with the situation.

The security concerns emanating from the use of technological forms of interaction and the challenging reimbursement regulations and policies deny some health facilities suitable chance to enjoy the benefits of technological forms of interaction that are fast transforming how health institutions interact with their patients. Sometimes it is difficult to determine the safety on the information that people pass through online platforms, especially when they are confidential and their exposure could have detrimental impact. Many firms have already put in place measures to safeguard the information they store online, including the use of passwords and encryption methods, but despite the significant milestone in protecting electronic data, it is not advisable to be relaxed. Information passed through online avenues can be hacked by unauthorized persons who may use the information to commit identity crime or to solicit money from either the client or the health facility. It is imperative for health institutions, especially those that handle big data to ensure they have proper measures in place to curb possible cases of violation that could interfere with the nature or credibility of the stored or transmitted data. Other than the security threats that put many users at risk of losing valuable information, the health facilities that utilize advanced communication systems have to put up with the challenging policies and reimbursement regulations. The healthcare professionals should ensure that the technological approach they use meet the specific guidelines set by the governing body, and that they meet the privacy protection regulations that ensure no data is violated. The practitioners should understand what the policies say locally and how they compare at the national level. Failure to adhere to the policies put in place to guide the use of technology at the place of work could result in security concerns that could have detrimental impact on the group’s performance.

Email has received much support in the recent past as an effective and attractive alternative to the more conventional forms of communication due to several factors, but analysts feel that the mode presents several challenges that may not be helpful in the clinical setting. Katz and Moyer (2004) write that email is now utilized in nearly all areas of employment and many clinical workers and patients use it as well. In addition, email systems are now highly integrated and configured across different platforms, causing uninterrupted communication between different functional systems. Its expansive spread and flexibility make it appealing to healthcare providers and patients who are so bust and barely have the time to make phone calls (Katz and Moyer, 2004). Nonetheless, several significant issues with email affect its usage in clinical settings. A major concern with email is that it presents security-related concerns, with a main constraint being that it is hard to verify the sender of a message. Additionally, because email is hardly encrypted, the mails sent through the platform knowingly or accidentally can be intercepted and read by unauthorized individuals thereby contravening the requirements of the Accountability Act (1996) and Health Insurance Portability that require high levels of confidentiality when handling patient data and messages (Katz and Moyer, 2004). Email turns out to be ineffective because of its unstructured nature, which has high chances of generating incomplete or difficult to understand messages from different stakeholders including patients.

Because of the substantial constraints of email in health care facilities, institutions are growingly switching to web-based forms and tools of communication and solutions. Health centers now focus on web-based approaches because of the various merits it has over email, and are less likely to suffer the limitations of email. Web-based platforms, compared to email, have the capacity to switch and accumulate data in a structured and manageable retrieval way (Katz and Moyer, 2004). Web-based tools make it possible to track the communication, manage and evaluate data and offer the clinical setting the option to set or customize their interaction platforms. More health facilities are switching to web-based communication tools now that it is imperative to apply cost-effective mechanisms to achieve greater efficiency (Katz and Moyer, 2004). Also important is that web-based tools are more secure compared to email it is possible to deploy authentication procedures, and is it very hard to forward exchanged messages, unless with the application of sophisticated hacking techniques. These advantages, however, come at considerable price because the organization will have to increase its investment in technology, communication management and big data management to gain the full benefits of online clinician-patient interaction (Katz and Moyer, 2004). An additional appealing factor is that patients will be motivated and challenged as they learn how to use more intricate web systems and interfaces compared to conventional email in order to link to their healthcare workers (Katz and Moyer, 2004). The limitations associated with some technology communication avenues require further analysis to develop appropriate solutions and pass fundamental lessons to health organizations that use the tools that are likely to jeopardize their functions.

Application of the Face-to-Face Communication Approach

The demerits of technological based communication with clients require health practitioners to identify whether the face-to-face approach could have any significant impact on their operations and relationship with patients. The intervener and the patient may consider face-to-face communication because the perceptions of feelings and thoughts become more real. Craig (2008) writes that non-verbal cues are just as essential when interacting as the speech people often use. The facial expressions and body languages provide the practitioner and the client with essential information that they can use to determine the situation as well as make appropriate solutions. It may be essential to consider the face-to-face communication because the approach makes it possible to enhance engagement and innovation, particularly with regard to addressing the situation at hand. The face-to-face communication is suitable because it fosters engagement and participation, which is essential for patient satisfaction (Craig, 2008). Also important is that face-to-face communication offers a chance to undertake a clear and precise communication considering that the interaction is not subject to network problems as it would occur when using online or electronic platforms such as social media and phone (Craig, 2008). Any misconception that could arise when talking about serious health issues could cause severe effects that could create more harm on the intervention process. The clinician and the patient may also have to consider the face-to-face communication when they want to address sensitive matters such as family and reproductive issues. The many advantages that come with the face-to-face communication show that practitioners should not completely do away with the traditional approach, but rather consider when it could be appropriate.

Both the patient and the health practitioner while using the face-to-face method, however, have to be conversant with the basic communication model that would make it possible to transmit information across the partiers into the communication. An appropriate communication model that both parties should know to improve the outcome of the face-to-face interaction is the Shannon–Weaver framework that Claude Shannon and Warren Weaver formulated to emulate how telephone and the radio work. Both parties must understand how information moves from the source and is encoded into signals that pass through specific channels void of interference or noise that might affect the transmission of the signals (Craig, 2008). The practitioner and the client must know when using the face-to-face interaction method how the message moves through the channel to the receiver who reconstructs or decodes the speech sound to get the meaning. Some scholars argue that Shannon and Weaver’s model is effective because it gives all the parties into the conversation equal chance to express their ideas, but Craig (2008) thinks that the transmission model is inappropriate because it creates no room for contradicting interpretations and purposes, assumes that the parties into the communication are isolated, and hardly permits unequal power connections (McCornack and Ortiz 2017). The practitioner and the client can also improve the face-to-face interaction by knowing other models of communication such as the sender-message-channel-receiver (SMCR) and the transactional model that may also advance interaction over technological platforms (Craig, 2008). It is necessary to be conversant with the communication models because as it appears, the doctor or the patient may sometimes have to meet the other in person to address the health concern.

An illustration of the Shannon–Weaver communication framework

The Topic’s Healthcare Implications

The lessons acquired from analyzing the possible merits and demerits of technological versus the traditional clinician-patient face-to-face interaction have considerable impact on healthcare operations. The idea that digital clinician-patient interaction presents more chances for patients to present their problems without fear of intimidation requires health facilities to sensitize their workers about the need to embrace the concept, as well as offer training on how to use electronic avenues (Liu et al., 2007). The trainees should know how digital avenues allow marginalized groups to get access to general care and practice, and must know how digital interaction between patient and clinicians has the capacity to overcome barriers for several concerns, including issues of practical access, stigmatization, negative encounters with staff and healthcare workers and negative perception from other patients (Liu et al., 2007). The training should sensitize health workers about other related benefits of communicating using electronic avenues such as ease of use with patients who require higher level of confidentiality and provides advantages to individuals who may require an interpreter to express their feelings or to consult.

The research shows that achieving successful outcome when using technology to facilitate clinician-patient communication requires commitment from various stakeholders to achieve the best results. Health institutions, for example, learn the importance of allocating adequate financial and manpower resources to deal with the constraints that come with using technology (Greenhalgh et al., 2014). The health facilities may seek financial aid from various organizations and donors, as well as increase the budgetary allocation towards improving the use of technology for communication. The increased financial resources will help to hire more qualified personnel who will integrate the communication software and the organization’s system. 

The study is essential to practitioners in the health sector because it informs on the importance of considering when to use technological forms of communication as opposed to the traditional approach and vice versa. The doctors, for example, get to learn that it is not suitable to use technological forms of interaction in interior places where many people lack information on how such approaches work, or in places where internet connectivity is low and making online interaction may be impossible. The doctors should also know that using technological forms of interaction may not be effective in situations where electricity connection is a problem and most of the people depend on other sources of energy such as coal and firewood, as it mostly happens in the rural areas. In addition, the health workers should prefer the face-to-face interaction in situations where they need to examine the patients keenly and identify the suitable therapeutic or medical intervention that would ease their problems. Going ahead to use technological forms of interaction in places where few people do not access the communication devices and platforms may have improper effects on the intervention process, and both the doctor and the patient may miss essential information that would help to address the problem. A patient nursing a wound on his leg, for example, is better placed to visit the health facility to allow the doctor examine the progress and possible clean the affected part. Nonetheless, this would not be possible while interacting with the practitioner or the patient using electronic forms, which may only worsen the situation. Nonetheless, the emergence of mobile phones even in places that do not have internet connection to ease other forms of interactions such as through social media or through an organization website has increased interaction on matters that do not require physical visit to the health facility. It is imperative, therefore, to first make adequate comparisons and monitor the relevance of the adopted methods before progressing to install or apply any feature.

Further research is needed to know how digital and electronic communication impact on health care provision and reach to these essential services. The researches should offer more insight into the impact of digital and electronic clinician–patient interaction, and the possible merits and demerits of such forms of communication. The researchers should perform more studies on health institutions to find out how they use the technological apparatus that make it possible to interact with clients without coming in contact, and identify the main challenges that they experience. The identification will make it possible to carry out studies that come up with the suitable mitigation measures, and will equip practitioners with more insight into what it takes to perform better. Future research should emphasize on the need to sensitize patients on the merits of technological forms of interaction as opposed to the traditional face-to-face approach, and encourage them to use such avenues. The future research should evaluate the effects of new technology as opposed to the old forms and identify whether there is need to go back to their past approaches, or strictly use the new forms, or if it is necessary to alternate them depending on the situation.  Performing future research on the matter will offer appropriate information to advance the technological forms of communication that have already become so common in health institutions, and will provide the chance to know how things are likely to change even further. Knowing what could occur in the far future will help the medical facilities to make timely preparations, including hiring employees who have the necessary knowledge and techniques, acquiring the suitable devices to facilitate communication, and creating sensitization programs that target patients to inform them why using the latest forms of communication is much better compared with the old approaches. The future research, however, will be effective if it does not only impact on health practitioners and patients from specific places, but from all over the world to achieve a society where technology transforms how people seek medical aid from health practitioners.

Conclusion

The study illustrates that switching to technological forms of communication between the clinician and the patient has numerous benefits, but it is essential to consider the possible limitations that could interfere or affect the attempts to incorporate technology. The growth of technology presents numerous ways of interacting with patients and replacing the traditional interactive forms with technological platforms make it possible to get so much information from patients belonging to marginalized groups and would fear visiting the hospital, especially when they have to discuss sensitive issues that require uttermost privacy. The use of technology to communicate with patients cut unnecessary visits to the hospital, which makes electronic and digital communication quite impressive to many patients and healthcare givers. The study shows how the use of technology offers the chance for clients to contribute towards the intervention process by offering information that would help the intervener to take the suitable measures. Nonetheless, technological forms of communication between the clinicians and patients present several limitations, which could derail the attempts to interact via faster means that many perceive as being effective and reliable. A major challenge associated with technological ways of clinician-patient communication is not everyone can interact through such platforms, which create some form of inequality. People such as the poor, the illiterate and the old may not afford some of the electronic devices such as smartphones and computers to allow them communicate with health practitioners, while others such as those with mental problems may not use such platforms without adequate intervention. The benefits and limitations of using electronic forms of communication impact on the health sector in considerable ways, which require the stakeholders to take suitable measures to gain from the advantages and to overcome the limitations.

References

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 Flodgren, G. (2015). Interactive Telemedicine: Effects on Professional Practice and Health Care Outcomes. Cochrane Database System Review, doi: 10.1002/14651858.CD002098

Greenhalgh, T., et al. (2014). Virtual Online Consultations: Advantages and Limitations (VOCAL) Study. BMJ Open, 6(1), https://bmjopen.bmj.com/content/6/1/e009388

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Liu, X., et al. (2007). Doctor-Patient Communication: A Comparison between Telemedicine Consultation and Face-to-Face Consultation. Internal Medicine, 46(5), DOI: 10.2169/internalmedicine.46.1813

McCornack, S., and Ortiz J. (2017). Choice & Connections: An Introduction to Communication. New York, NY: Thomson Wadsworth.

Rouleau, G., Gagnon, M., and Cote, J. (2015). Impacts of Information and Communication Technologies on Nursing Care: An Overview of Systematic Reviews (Protocol).” System Review, doi: 10.1186/s13643-015-0062-y.

Tates, K., et al. (2017). The Effect of Screen-to-Screen versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients. Journal of Medical Internet Research, 19(12), doi: 10.2196/jmir.8033