Acceptability, Feasibility, and Potential Effectiveness of Video-based Patient Records for Supporting Care Delivery for Older People With Frailty.

Around 10% of people aged over 65 years have frailty, rising to nearly 50% of those aged over 85 years, and frailty prevalence is expected to increase alongside the growth of the ageing population.

Older people with frailty commonly require input from multiple professionals across primary, secondary, and social care. Professional bodies including the British Geriatrics Society have advocated for responsible information sharing to ensure that older people with frailty are supported to age well. Yet, as patients move between different parts of the health and care service, communication between different professionals and different providers is frequently ineffective, assessments are duplicated, and carers are repeatedly asked to provide the same information. Poorly coordinated care is linked to avoidable complications, accelerated deconditioning, and loss of independence, as well as greater carer burden and increased costs to health and social care.

Much communication across professional and organisational boundaries takes place through written referrals and (increasingly) through shared electronic patient records. Electronic health records (EHRs) are voluminous, containing large quantities of unstructured text. This plethora of data, combined with variability in documentation practices and the propagation of erroneous information in the record, means clinicians face significant challenges retrieving information to support clinical assessment. Excessive time spent in the EHR system is known to be a major source of clinician dissatisfaction contributing to stress and burnout, but failure to retrieve relevant information can lead to medical errors and poor quality care. Moreover, while text is appropriate for communicating certain types of clinical information (for example, diagnoses, comorbidities, prescribed medications, allergies, etc), it is difficult to discern the nuances of a frail older patient's condition in relation to aspects such as functional ability, cognition, behavioural symptoms, and support needs from text narratives alone. Receiving professionals may be left wondering 'Is this normal for this patient?' It is vital that health and care professionals can recognise and track subtle changes to proactively manage avoidable deconditioning and deliver individualised, person-centred care. More sophisticated modes of documentation and communication are needed to improve patient assessment and care continuity across transitions of care.

In an age of smartphones, people are increasingly telling their stories using photographs and video recordings.Technological advances allow for a variety of video recording applications in healthcare but in practice these have largely been largely confined to research, education, and quality improvement. Researchers value the richness of video data that includes sound, environmental context, body language and facial expressions, thus facilitating objective, accurate documentation of behaviour. In medical education, video-recordings assist clinicians in recognising visual and auditory clues during clinical consultations that cannot be derived from text-based learning. Video-based surgical records have informed quality improvement initiatives through the provision of increased detail and nuance beyond what exists in written operative notes alone. A further clear advantage of video recording is the creation of a permanent visual patient record that can be reviewed repeatedly by multiple professionals, ultimately increasing the accuracy of clinical assessment and improving communication among multi-professional healthcare workers.

Nevertheless, ethico-legal concerns and patient confidentiality have historically limited the use of video-recording for direct care purposes. Early studies suggested that patients can feel censored or self-conscious in front of a camera and video recording can have a detrimental impact on the therapeutic relationship. However, over the last decade, the proliferation of smartphones had led to video recordings being captured in everyday life, and technological advances are supporting lawful collection, handling, and storage of visual data to protect people's privacy in line with data protection legislation.