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Abstract

Video-based care has become a routine part of outpatient care delivery, yet older adults continue to face barriers in accessing and engaging with this modality. This study analyzed the comments provided within 7155 patient experience surveys from adults aged ≥65 years across a large, multi-specialty medical practice to identify challenges experienced with video-based visits. Thematic analysis revealed the highest proportion of positive comments were related to experience with people (71%), while barriers were often related to technical issues with video tools (73%). Most comments related to processes were positive, often highlighting convenience (67%). Using design thinking, we mapped the patient journey and proposed both immediate solutions, such as testing environments and clearer instructions, and long-term innovations like voice-guided support and emotionally intelligent interfaces. Our findings suggest that while video visits offer convenience, they must be redesigned with older adults in mind to ensure equitable, effective, and human-centered care.

Plain language summary

Older adults face challenges using video visits for healthcare, including technical issues, confusing processes, and feeling less connected to providers. This study analyzed patient feedback and proposed solutions, like clearer instructions and voice-guided tools, to make video visits easier, more personal, and better suited to older patients’ needs.

Keywords

telemedicine patient experience digital health literacy user-centered design

Introduction

Video-based appointments with healthcare providers have become an integral part of clinical care since wide-spread implementation of telemedicine during the COVID-19 pandemic. Video-based care helps bridge a gap persisting among patients in need of healthcare services but experiencing diminished care access. Patients residing in rural or medically underserved areas, and experiencing transportation barriers, diminished socioeconomic status or physical disabilities can be uniquely served by video-based care.^1,2 In the United States, older adults are more likely to experience transportation barriers due to physical limitations, inability to drive, or lack of access to vehicles, and many older adults reside in rural or medically-underserved areas.^3,4 The intersection of these experienced barriers makes older adults prime beneficiaries of video-based medical care.

Although video-based medical care appears to be a good option for this population, research continues to demonstrate that older adults experience barriers to using video-based care. Older adults experience several patient-level barriers in their ability to connect to video-based care, including digital literacy related to operating video care platforms and troubleshooting audio and video issues.^5–8 Older adults also experience physical limitations in their ability to successfully engage with video-based medical care, including hearing, vision, memory, and motor impairments.^5,7,9 Evidence has demonstrated the instrumental role of caregivers in facilitating participation in video-based medical appointments among older adults,^6,8,10 and the enabling abilities of “on-demand” technical support to connection to and participation in video appointments.^8,11

As academic medical centers and multi-specialty clinical practices often leverage shared digital infrastructure to support video-based appointments, opportunity exists to understand the barriers experienced by older adults using video-based care across multiple general and specialty medical practices for multiple care needs. To date, most published studies have evaluated single specialties, such as geriatrics¹² or occupational therapy,^10,13 specific populations, such as patients of the US Veterans Health Administration^8,13 or individuals residing within independent or skilled living facilities.⁹ Additionally, assessments to date have been of limited sample sizes. No published studies were identified leveraging design thinking to advance current barriers experienced by older adults during video-based healthcare appointments into technical capabilities enabling ideal video-based healthcare appointments for older adults.

The present study aims to describe the barriers experienced by older adults who completed a video-based visit with a large, multi-specialty, integrated medical center, and to leverage design thinking to transform reported barriers into idealized procedures for video-based medical appointments. We analyzed responses from 7155 patient experience surveys collected following video-based appointments as part of routine clinical operations. Thematic analysis was used to identify, analyze, and report on patterns identified within the open-ended items as reported by patients after video-based appointments. Journey mapping was used to visualize the experiences of patients and to outline major barriers experienced across the video-appointment process. Design thinking was used under a human-centered framework to identify solutions to address major barriers across differing time horizons proposing short-term and long-term solutions.

Methods

Study Design, Setting, and Participants

We sought to describe the barriers experienced during video-based telemedicine visits following the incorporation of video-based care as a routine part of clinical practice. We first assessed trends in video visits as a portion of total outpatient visits for older adults across a large, multi-specialty medical practice. We then described the experience of video-based care as reported by older adults and performed a thematic analysis of barriers faced by this population as reported through routine patient experience surveys. Finally, we utilized human-centered design to describe the experience of older adults using video-based care for routine healthcare needs using patient journey mapping and recommend solutions following design synthesis. The setting for this investigation is a large, academic Department of Internal Medicine with outpatient practices located at Mayo Clinic in Rochester, Minnesota, USA. These practices see over 350 000 unique patients annually within the clinical divisions of community internal medical, endocrinology, gastroenterology, general internal medicine, geriatrics, hematology, hepatology, infectious disease, nephrology, occupational medicine, palliative care, preventive medicine, pulmonary, rheumatology, and sleep medicine. As the present study utilized de-identified information collected for routine clinical operations, the Mayo Clinic Institutional Review Board deemed this project to not be human subjects’ research.

Data Collection

Outpatient Video Visits

To understand the rate of video-based care provided to older adults over time, we extracted all completed visits from our scheduling software from January 1, 2018 to December 31, 2024 for all outpatient clinics within the Department of Internal Medicine. We compared visit rates by year to understand differences between in-person and video visits for patients aged ≥ 65 years. We also examined characteristics of patients aged ≥65 years who had a video visit in 2024 by patient experience survey completion.

Patient Comments Following Video-Based Visits

Routinely collected experience surveys as part of clinical care from January 1, 2024 to December 31, 2024, for patients aged ≥ 65 years were leveraged for this investigation. Patient experience surveys are deployed via a simple random sample of unique patients among eligible encounters for each provider, up to a maximum of 50 patients per month. Patients receive either a paper or email survey and a reminder delivered 1 week later. Sample exclusions include therapy and nurse-only visits, deceased, “Do Not Survey” list, and vulnerable patients. Once a patient is surveyed, they cannot be selected again for 30 days. A copy of the deployed survey instrument is included as Supplemental Appendix 1.

Data Analyses

Qualitative Analysis

Thematic analysis of patient comments was completed leveraging grounded theory. Open coding was used for the identification of initial themes for all comments included with returned patient experience surveys. We examined surveys received from patients aged ≥ 65 years, who had a telemedicine visit with a provider from any area of the entire Rochester Department of Medicine during January 1 to December 31, 2024. Comments in response to the prompt “Please tell us about anything that impressed you about your experience.” or to the prompt “Please tell us about anything that disappointed you about your experience.” were included for analysis. After removing general comments “Good,” “Great,” etc, keywords were derived from patient comments via close examination of responses, whereby recurring patterns and terms arose. Coding was performed to capture core messages included within patient comments, enabling data transformation into generalizable, theoretical elements describing the barriers experienced by patients engaging with Telemedicine visits. Iterative review of comments was performed until no new themes were identified, and when all coders agreed upon the identified themes. A completed Standards for Reporting Qualitative Research (SRQR) checklist is provided as Supplemental Appendix 2.

Research Team Descriptions and Reflexivity

Themes were derived from coded values. Qualitative analyses were performed by 5 analysts. Our research team comprises individuals with diverse backgrounds and experiences, enriching our study approach. Analyst A, a 45-year-old white male, brings extensive experience in statistical programming and remote work. Analyst B, a 51-year-old white male, contributes insights from sociology, psychology, and public health, informed by his personal caregiving experience. Analyst C, a Generation-Z white female with a degree in statistics, offers a fresh perspective on digital health and chronic conditions. Analyst D, a first-generation Asian American woman trained in public health science and epidemiology, provides a critical lens on healthcare access and equity. Analyst E, a 41-year old white female with advanced training in healthcare delivery science, brings a wealth of experience from public health and healthcare systems. Our collaboration is grounded in mutual respect and critical dialogue, allowing us to challenge assumptions and enrich interpretations. We recognize that our positionalities are not fixed and are committed to ongoing reflexivity throughout the research process.

Quantitative Analysis

Simple count (n) and proportion (%) are provided as descriptive statistics for all reported data. Age was compared using the Wilcoxon Rank Sum and categorical variables were compared using the Chi Square test for independence (Χ²). All data management and statistical analyses were performed using Statistical Analysis Software (SAS) Version 9.2 (Cary, NC). Results are considered significant if the P-value is less than .05.

Design Synthesis

Using a human-centered design framework, we translated key themes into a visual patient journey map that illustrates the patient experience from scheduling a video-based appointment to engaging with technology and participating in the visit. Journey maps can be used to highlight each stage of the experience and to pinpoint areas for improvement to inform the development of an ideal video-based visit experience.¹⁴ Notes from stakeholder sessions were consolidated and organized according to the relevant process steps, with repeated observations reinforcing data saturation.¹⁵ These insights, grounded in the team's understanding of outpatient practice workflows and validated by clinical team members, revealed systemic challenges throughout the patient journey. Guided by human-centered design principles, we generated targeted opportunities for improvement, each aligned with 1 of 3 conceptual pathways.¹⁵

To address immediate barriers experienced with video-based care, we applied the initial phases of design thinking: empathize, define, and ideate.¹⁴ This approach enabled rapid solution generation. Simultaneously, we extracted future-forward concepts of a video-based care experience, laying the grounded for transformative innovation to better meet the needs of patients in the future.¹⁶

Results

Rate of Video Visits for Older Adults Over Time

The rate of video-technology use for outpatient medical appointments for adults aged ≥ 65 years increased dramatically from around 1% prior to the Covid-19 pandemic in 2020, to more than 13% post-pandemic (Figure 1). Increased use of video-technology has remained above 13.5% of the total outpatient visits for those aged ≥ 65 years for the subsequent years.

Figure 1.

Rate of completed outpatient clinic visits completed in person (light grey bar) versus via video (dark grey) among patients aged ≥ 65 years across a large, multi-specialty academic medical center. Number of visits is provided along the y-axis with year provided along the x-axis. Volumes for in person clinic visits and video-based visits are provided, along with the rate of video-based visits as proportion of overall clinical volume in parentheses.

Patient Experience With Video Visits for Routine Outpatient Care

The Mayo Clinic Office of Patient Experience received 7155 responses to their routine patient experience surveys for video-based care among patients aged ≥ 65 years in 2024, out of a total of 56 966 unique patients seen across the Department of Medicine outpatient clinics (Supplemental Appendix 3). Most of our survey response population was male, of white race and non-Hispanic ethnicity, married or within a life partnership, residing within a location that is not local to our clinic site, and had completed college or post-graduate education. Our survey response population differed from the overall population seen based on age, gender, race, ethnicity, marital status, distance of primary residence from our clinic site, highest level of education achieved, and whether the patient was paneled within our primary health care practice.

Barriers Experienced by Older Adults With Video-Based Appointments

Three themes were identified via thematic analysis of 1012 comments provided within patient experience surveys of older adult patients following video-based appointments for routine care. Table 1 provides the proportion of comments associated with each sentiment (Positive, Negative, Mixed/Neutral) within each of the following themes:

People: individual preferences, relationships, healthcare team / staff

Process: login process, instructions, waiting room

Technology: connectivity, video, audio

Table 1.

Thematic Review of Patient Experience Surveys Provided by Older Adults who Participated in a Video-Based Outpatient Visit (N = 1012).

Theme	Response type	N(%)	Example comments
People	Positive	50 (71%)	“I'm always anxious about my zoom call. But after having a number of them all have gone extremely well.”
(N = 74 Responses)			“Several staff members provided excellent explanations and guidance to make the Zoom conference easy, efficient, and effective.”
			“No issues and the provider did a seamless visit sharing screens with relevant information so I could have a visual representation of what we were discussing and alternative treatments.”
	Negative	9 (13%)	“The technology was great and the connection was wonderful. It was too bad that the doctor severed any possibility of a personal connection.”
			“The provider is soft spoken and very monotone.”
			“He seemed to look down instead of at me during the visit.”
			“I was in clinic for my tests prior to my visit. I would have preferred to have a face-to-face office visit but was not offered the opportunity to choose.”
	Mixed/ Neutral	13 (19%)	“I prefer just telephonic conversation. I have already had multiple face to face meetings with [Doctor] and do not need zoom.”
			“I had to contact customer service because the prompt wasn't allowing me to start the video call. But they were very helpful and the problem resolved quickly.”
			“…Video/audio can never be the same as an in-person visit; no matter how good the picture quality, the physician only has a small, 2-dimensional image of the patient – not ideal for “reading” a patient. And the same is true of the patient – viewing a flat image on a flat screen is not the same as being face to face. There is an inherent clumsiness to the quality of interaction: first, one will start talking and the other will start talking, except that the first one wasn't done talking, so there's this awkward starting to talk and then stopping and waiting for the other to finish. But in the tradeoff of a video visit vs driving all the way to Rochester, it's still a win.”
Process	Positive	117 (67%)	“Excellent way for an annual checkup. Convenient when you don't live locally.”
			“It worked great. I like how you have a short pre-visit appointment with someone before [Doctor] gets on.”
(N = 177 Responses)			“Great use of telemedicine and saved me from driving over 500 miles and accomplished everything as if I were at the clinic in person. Excellent modality to use in these situations. Glad it's available and used appropriately.”
	Negative	39 (22%)	“It took 1 3/4 hours to connect. Once [Doctor] called, the visit was perfect. Help lines to connect me with video were ineffective. Very frustrating trying to connect for almost 2 hours.”
			“We did a phone call, sometimes our connections aren't that great.”
			“I'm always not clear about how to Join Meeting as I await the scheduled appointment time, so once again I entered the Zoom app too soon. It might help to have clearer instructions with Do's and Don'ts or an ALL CAPS warning about waiting for the pre-appointment set-up call in the portal, rather than getting into Zoom.”
	Mixed/ Neutral	21 (12%)	“Web Portal connections were tested and worked at the time of testing. When it was time for the video visit, It flashed in and out and wouldn't let me connect. I ended up having to do a phone visit. This isn't the first time I have had to uninstall and reinstall your app. It has some kind of glitch. I need to see the visuals the doctor wishes to present. It's a 4 1/2 hr drive each way to have in-person visits, so I'd prefer to have a portal that works well…”
			“The actual conversation with my caregiver went just fine. I did manage to maneuver through the steps to successfully access the scheduled meeting. I am a senior citizen with some technology skills but this process stressed me for days ahead of time. I didn’t know what to do if I couldn't get connected even though the directions were provided. Can there be another option, maybe a phone call, with step by step directions? Thanks!”
			“Initially, the message before the video conference started was “the host lost the connection.” I wasn't sure at that point if I should drop off and restart, but I stayed on, and eventually the connection was made.”
Technology	Positive	68 (28%)	“All technology worked very well. I appreciate working with the “check in” person first.”
			“IT staff coordinated connection for my husband to get another link to join appt. She was great.”
(N = 245 Responses)			“The video was very clear, both visually and in the audio. I feel as if I had almost the same experience as when I am able to see her in person.”
	Negative	101 (42%)	“Call was scheduled as a video conference. When I attempted to check in, I was denied account not able to have video conference.”
			“A number of times during the Zoom appointment, the video froze which put it out of sync with the audio. This made the conversation difficult to follow. It could have been my end that was the problem, or just a bad connection.
			“The audio was not good. Hard to hear at times and seemed to drop words if her voice was not completely facing the mic.”
	Mixed/ Neutral	76 (31%)	“I had trouble getting the video to work on my computer for some reason. The person trying to connect it up worked very hard to figure the problem. I could see her and hear her and she could hear me, but she could not see me. I think it had to do with an update my computer had just done. She did great to get things moved around so I was able to talk with the [Doctor] and make my visit happen.”
			“The sound was a bit muted. Someone with hearing issues may have had a problem. I could hear everything but had to strain a bit. It might be worth setting up a couple of spaces where doctors doing video calls have a good microphone and maybe better lighting. [Doctor]'s face was in a shadow. I LOVE being able to have a video conference, but I think your IT people can help you set up some spaces that will allow the experience to be more like sitting across from the doctor in his/her office. It's minor details but might be helpful.”
			“I tested the program before the visit and when the appt started the audio would not work in spite of my testing verifying it was fine on my end”

Among 74 responses in the “People” domain, 71% were positive, highlighting effective communication and enhanced understanding through visual aids. Patients reported that “Several staff members provided excellent explanations and guidance to make the Zoom conference easy, efficient, and effective.” and that “[Doctor] used a split screen to show previous data and helpful information. Those visuals increased my understanding.” Thirteen percent of respondents expressed dissatisfaction with the lack of personal connection, saying “The technology was great and the connection was wonderful. It was too bad that the doctor severed any possibility of a personal connection.” The “Process” domain, comprising 177 responses, showed a similarly high proportion of positive feedback (67%), emphasizing convenience and efficiency, an “Excellent way for an annual checkup. Convenient when you don't live locally.” Though 22% reported logistical frustrations, such as connection delays. “It took 1 3/4 hours to connect. Once [Doctor] called, the visit was perfect. Help lines to connect me with video were ineffective. Very frustrating trying to connect for almost 2 hours.” The “Technology” domain, with the largest response pool (N = 245), revealed a more critical perspective: only 28% of responses were positive, while 42% were negative, citing issues like video freezing and access denial. Two patients explained “Call was scheduled as a video conference. When I attempted to check in, I was denied account not able to have video conference.” And “A number of times during the Zoom appointment, the video froze which put it out of sync with the audio. This made the conversation difficult to follow. It could have been my end that was the problem, or just a bad connection.” Mixed or neutral sentiments were present across all domains, reflecting nuanced experiences. Additionally, the table identifies specific barriers encountered during virtual visits and proposes both short-term and idealized solutions, such as implementing hold music or visual countdowns to mitigate uncertainty during waiting times.

Design Synthesis and Proposed Solutions to Barriers Experienced by Older Adults

A summarized version of the journey experienced by patients as they schedule, prepare for, and attend their video-based outpatient appointments is depicted in Figure 2. The Scheduling phase includes self-scheduling or finalizing appointment details and confirming payment. In the Preparing phase, patients are instructed to download necessary communication tools and test their connection. The Connecting phase involves joining a virtual waiting room, checking in, and making any necessary appointment adjustments. Annotations highlight operational challenges and improvement opportunities, such as the need for alternative confirmation methods for patients without portal access, the potential for automated reminders, and the importance of proactive communication to mitigate technical barriers. Emphasis is placed on enhancing patient engagement, reducing barriers to access, and ensuring a seamless virtual care experience. Design synthesis and creation of short- and long-term, idealized solutions to address the common barriers reported by older adults following video-based appointments are reported in Table 2.

Figure 2.

Patient journey map of older adult experiences with video-based visits as part of routine clinical care.

Table 2.

Design Synthesis and Future Ideation of Solutions to Meet Barriers Experienced by Older Adults in Use of Video-Based Visits for Routine Clinical Care.

Theme	Experienced barrier	Short-term solution	Potential future solutions
People	Digital Literacy	Screen all patients for digital literacy using validated scales (eHEALS); Provide additional support and resources to patients with limited digital literacy, including community partnerships.	Voice-activated platforms that answer questions in real time, offer step-by-step guidance, and are freely available on existing devices and interfaces.
	Patient Technology Confidence / Anxiety Regarding Technological Aspects of Appointment	Testing or sandbox environments that allow patients / caregivers opportunity to simulate appointment experiences prior to scheduled appointment.	Normalize tech-related anxiety to help patients / caregivers know that it is common to feel unsure and that there are no negative consequences should the video-visit not go as planned; automatically enroll first-time video-visit patients into a navigator program whereby a person walks the patient / caregiver through the process during the visit.
	Privacy and Security Concerns	Prompting to recommend that the patient / caregiver are in an environment where they can speak about their health without concern over others overhearing; allow pause to relocate or reschedule.	Soundproofed booths or units designed for privacy and security within homes or community spaces; automatically enabled background-blurring, voice masking, or ambient noise suppression; secure, wearable technology that is set up to ensure privacy and focus.
	Lack of Personal Connection	Ongoing provider education to emphasize the importance of human-centered introductions and dialogue during video-based visits, including active listening and empathy with an emphasis on verbal affirmations as the physical environment is limited. Continue to use body language and hand signaling to communicate, despite video connection.	Personalized enhancements leveraging deep learning of patient / caregiver preferences, language, and tone; longitudinal digital memory that prompts providers of previous interactions to facilitate relationship continuity.
Process	Patient Portal Requirement	Automated patient portal enrollment verification at time of scheduling, and prior to appointment date.	Login-free options whereby patients receive secure links via their preferred contact method (ie, Email, text message) at the time of the appointment.
	Troubleshooting Audiovisual	Communicate and reiterate security and privacy measures in plain language at the time of the visit.	Brand-recognized organizations that are known for privacy and security in the digital healthcare delivery space.
	Uncertainty About Connection During Wait Time	Audio or visual cues that let the patient / caregiver know that they are logged in correctly and waiting (ie, hold music, clock indicating the anticipated time until the care team joins the appointment).	Wait-less solutions whereby patients / caregivers are prompted to join video-based visits when the care team is ready.
	Lack of Personal Connection	Optimize the environment for visual connection. Many patients prefer to see the provider's office as opposed to a virtual background distorting provider image.	Live sentiment analysis that runs during conversations allowing providers to understand the emotional environment of patient / caregiver; real-time empathy coaching for providers.
Technology	Troubleshooting Audiovisual	Learning management systems that provide step-by-step, interactive instructions personalized to individual user's current digital literacy.	Adaptive technology that automatically detects audiovisual issues and addresses the issues without the need for patient engagement; AI-enhanced audiovisual clarity featuring external noise suppression, voice enhancement of patients / caregivers and providers, and accurate lip-syncing to enhance non-verbal cuing.
	Troubleshooting Audiovisual	Tooltip-enabled interfaces or context-sensitive help systems that provide real-time support and guidance.	Real-time captions and transcripts for those with hearing impairments; magnification and visual contrast tools for enhancements for visual impairment.
	Multi-attendee Visit Issues (ie, guardian, interpreter)	Scheduling ability to have multiple attendees scheduled to attend a video-based appointment.	Single-click platforms that enable patients, caregivers, specialists, and others to join in a single, virtual space; role-based interfaces tailoring views for attendees. Patient controls over what information is shared with whom and when.

Discussion

Implications for Practice

Across our multi-specialty, outpatient practice, we observed an increased rate of video-based appointments among individuals aged ≥ 65 years of age during the Covid-19 pandemic, with consistent utilization of video-based care in the subsequent years as proportion of total care delivered. Thematic review of all patient-provided comments revealed insight into the people, process, and technology dynamics experienced by patients aged ≥ 65 years who completed a video-based visit for outpatient care in 2024. Patients described challenges establishing personal connection during video visits, loss of nonverbal cues, distracting virtual backgrounds, and perceived provider multitasking. Logistical issues with the process to log-in procedures and virtual “waiting rooms,” as well as technical issues with audiovisuals and internet connections, were also prominent.

To address these concerns, we propose immediate practice-level solutions, such as sandbox environments that allow patients to test the video visit prior to their appointment. Additionally, reducing virtual wait times and implementing messages of reassurance about connection status may improve patient experience with video visits. Providers can enhance engagement by adopting best practices for digital interactions, including warm greetings, active listening, and summarization. Screen-sharing and live chat features were positively received and should be leveraged to support patient understanding and personal connection.

Implications for Policy

The persistence of barriers among older adults since wide-scale adoption 5 years ago highlights the need for system-level interventions. Digital health literacy remains a critical determinant of telemedicine engagement,^5,7–9^,11 with many older adults expressing anxiety and difficulty navigating the multi-step processes currently in place.^9,13 We support the call for digital health literacy screening to be included as standard intake for all healthcare systems who utilize telemedicine.¹⁷ Such screening could identify patients in need of support to engage with video-based care and inform tailored interventions.

Equity in access to video-based care must be prioritized. Policies to promote inclusive design and outreach strategies to support patients across age groups could ensure video care systems are accessible and usable. As national medical societies continue to publish best practices to support digital models of care, guidelines should be expanded to include workflow redesigns that move the delivery of digital care beyond the traditional brick-and-mortal models.

Implications for Research

Much of the published literature to date reflects the experiences of early pandemic conditions, when video-based models of care were rapidly developed and deployed.⁸ Our findings contribute the experiences of older patients post-surge, demonstrating that barriers to video-based care for older adults persist. Future research should explore the role of innovative support options, like voice-activated digital navigators¹⁸ and real-time sentiment analysis tools.¹⁹ These technologies, already being used in education and ecommerce, may offer hands-free, intuitive support using voice-prompting to guide users through the use of digital tools and live analysis of conversations to identify negative emotions to immediate course correct when a patient's experience is challenged. Emerging technologies like these offer scaleable solutions to improve the healthcare experiences of older patients.

Additionally, research is needed to design and evaluate alternative workflow models that include novel aspects like asynchronous scheduling and wait-less video visits. Our study is among the first to report patient-reported challenges with virtual “waiting rooms,” including uncertainty about connection status and provider availability. Investigating the impact of clinical workflow design on patient experience and satisfaction will be essential as video-based care continues to evolve to greater meet the needs of people.

Strengths and Limitations

Our study included a large, randomly sampled survey (n = 7155) embedded within a large, multi-specialty clinical practice, enhancing the ecological validity of our findings. A mixed-methods approach, including design thinking and journey mapping, allows for actionable insights based on barriers experienced by older adults in use of video-based care. However, the cross-sectional nature of our study and reliance on self-reported barriers may introduce reporting bias. The response sample was from a single, tertiary healthcare system, which limits our generalizability. Our assessment for response bias shows that our respondents differed significantly than the patients seen at our outpatient practice at large, with overrepresentation of white, educated, married individuals. These factors may limit the generalizability of our findings across populations, particularly underserved groups. While our sample size increased our statistical power, the qualitative basis for our approach precluded our ability to adjust for differences across populations. Finally, while our findings align with existing literature, this study offers limited novelty but reenforces that the barriers experienced by patients during the initial surge in video-based care persist and have not been adequately addressed. Future research should include targeted recruitment to facilitate broader representativeness and understanding.

Conclusion

Video-based care has become a routine part of clinical care for older adults since the COVID-19 pandemic, yet persistent barriers continue to limit access and use. While prior studies have documented general challenges, particularly related to the time period closest to the pandemic, our work offers a novel synthesis of patient-reported barriers. By applying design thinking and journey mapping, we move beyond descriptive accounts to propose both immediate and long-term solutions. Our findings underscore the need for video-based care to evolve beyond traditional workflows and embrace user-centered design that prioritizes the unique needs of aging populations. This study contributes actionable insights that bridge the gap between patient experience and system-level innovation to inform digital delivery of healthcare into the future.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735261416449 - Supplemental material for From Barriers to Solutions: A Design Synthesis to Improve Video Visit Experience for Older Adults

Supplemental material, sj-docx-1-jpx-10.1177_23743735261416449 for From Barriers to Solutions: A Design Synthesis to Improve Video Visit Experience for Older Adults by Lindsey M. Philpot, Priya Ramar, Rachel E. Canning, Meredith A. DeZutter, Megan M. Dulohery Scrodin, Matthew G. Johnson, Daniel L. Roellinger and Jon O. Ebbert in Journal of Patient Experience

Supplemental Material

sj-docx-2-jpx-10.1177_23743735261416449 - Supplemental material for From Barriers to Solutions: A Design Synthesis to Improve Video Visit Experience for Older Adults

Supplemental material, sj-docx-2-jpx-10.1177_23743735261416449 for From Barriers to Solutions: A Design Synthesis to Improve Video Visit Experience for Older Adults by Lindsey M. Philpot, Priya Ramar, Rachel E. Canning, Meredith A. DeZutter, Megan M. Dulohery Scrodin, Matthew G. Johnson, Daniel L. Roellinger and Jon O. Ebbert in Journal of Patient Experience

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval,Statement of Human and Animal Rights

This project was reviewed by the Mayo Clinic Institutional Review Board (IRB) and was determined not to constitute human subjects research. The analysis was conducted using de-identified data collected during routine clinical operations, and therefore did not require IRB approval under federal regulations.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Statement of Informed Consent

Informed consent was not required for this project, as the analysis was conducted using de-identified data collected during routine clinical operations and was determined by the Mayo Clinic Institutional Review Board (IRB) not to constitute human subjects research.

ORCID iDs

Lindsey M. Philpot

Jon O. Ebbert

Supplemental Material

Supplemental material for this article is available online.

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