Lessons for design of digital triage tools from family medicine providers' experiences with COVID-19 self-assessment tools

BackgroundDuring the COVID-19 pandemic, Ontario implemented a self-triage tool that assessed risk and directed users to care. Screening for entry to workplaces and schools was provincially mandated, allowing for adaptation to specific needs, often implemented with digital symptom checkers. Thus, self-assessment tools that looked similar, may have varied in purpose, and possibly in assessment criteria. ObjectiveThis study asks: what can we learn from family medicine providers experiences with, and perceptions of pandemic self-assessment tools, to inform design and use of self-triage tools for use in future pandemics and in family medicine more generally? MethodsWe conducted semi-structured interviews with 14 Ontario family medicine providers between April and June 2021. Interviews were transcribed and analyzed using grounded theory methods. ResultsAnalysis led to three Main Themes and eight Subthemes. Main Theme 1) Experiences with self-assessment tools exhibited consistencies, including Subthemes 1.1) Providers had much and varied experience with symptom checkers, but, 1.2) Little familiarity with Ontarios self-triage tool, thus 1.3) Pointed patients to locally developed self-assessment tools; Main Theme 2) Concerns were expressed about digital self-assessment tools, including Subthemes 2.1) Reporting accuracy, 2.2) Access and equity, and 2.3) Assessment efficacy; and Main Theme 3) Providers perceived potential value, including Subthemes 3.1) Pandemic self-assessment tools played a positive role in public health, and 3.2) More generally, digital self-triage tools can aid (not replace) provider triage. Key PointO_ST_ABSWhat is already known about this topicC_ST_ABSO_LIThere has been very little study of primary care provider experiences with digital self-assessment tools (i.e., symptom checkers and self-triage tools). C_LI What this study addsO_LI14 individual interviews elicited Ontario primary care provider experiences with symptom checkers and self-triage tools during the COVID-19 pandemic. C_LIO_LIProviders see value in pandemic self-assessment tools. For other conditions they are more open to self-assessment tools that aid clinical triage than they are to self-triage tools that would independently direct to care. C_LI How this study might affect research, practice or policyO_LIFor self-triage tools to be accepted they should: address conditions that dont require physical assessment, be designed with physicians, and be customizable and easily integrated into EMR systems. Providers will require evidence of efficacy and uninterrupted continuity of care before accepting the premise of self-triage tools that independently direct to care. C_LI ConclusionWhile some see potential for self-triage, others remain wary. Providers are more open to tools that gather information and aid clinical triage than to self-triage tools that independently direct to clinical care. To promote provider acceptance of self-triage tools, the tools should: 1) be designed for conditions where a physical exam is not necessary; 2) integrate easily with EMR systems; 3) be designed by physicians; and 4) be customizable to fit clinic needs and contexts so that they do not disrupt continuity of care on the way to reducing provider workload. Digital self-triage tools with these features, whether for future pandemics or family medicine generally, would be better positioned to offer the full benefits of digital-first self-triage to patients, providers, and population health management.