AMES, Iowa — A telehealth visit may look simple — a few clicks, a camera and a conversation — but Iowa State University researcher Farzane Omidi knows the reality is far more complex. In virtual care, a dim lamp, a lagging microphone or an open door can quietly erode trust, empathy and even diagnostic accuracy.
When the pandemic limited in-person accessibility to medical care, health care systems around the world turned to telehealth. Even after the height of the pandemic, the shift has endured. While telehealth has expanded access and convenience, researchers are still working to understand what makes virtual care effective.
“Telehealth is a convenient way to deliver care to people across the world,” said Omidi, an assistant teaching professor in the interior design department in the College of Design. “But we still need more research to understand how environmental and technological factors influence communication quality and, ultimately, a patient’s quality of care.”
Omidi’s research is revealing just how much the environment and technology shape patient–provider interaction, a cornerstone of care that becomes harder to protect when the exam room exists in two places at once. In her literature review, “What Shapes Telehealth? The Role of Environment and Technology in Communication Quality,” Omidi highlights how factors such as visual setting, technological interfaces and environmental distractions can influence how patients and providers connect during virtual visits. The work was published in the Health Environments Research & Design Journal (HERD) and was co-authored by Debajyoti Pati from Texas Tech University.
She will discuss her work in the presentation, “What Happens to Care When the Doctor is on a Screen?” at 6 p.m. Tuesday, April 28, in the Memorial Union as part of the Iowa State Lectures Program.
Omidi’s academic path reflects a long-standing focus on patient-centered care, and her experience working as an architect has shaped her research on health care design, evidence-based design and human well-being. As telehealth becomes a routine part of health care delivery, Omidi’s work points to the need for intentional research and design to ensure that convenience does not come at the expense of communication — or care.
Patient-provider communication matters
Patient–provider communication (PPC) is one of the most consistently documented drivers of health care quality. Decades of research show that when patients and providers communicate clearly and empathetically, outcomes improve — from diagnostic accuracy and treatment adherence to emotional well-being and overall satisfaction with care. Shared understanding, mutual trust and sustained relationships form the backbone of effective healthcare delivery, Omidi said.
Omidi’s review builds on this foundation by asking how PPC functions when care moves online. Telehealth changes not just where care happens, but how patients and providers interact. Meaning is still exchanged, but often without the physical cues and shared environment that traditionally support understanding, trust and emotional connection.
Her work emphasizes that communication in health care goes far beyond information exchange. It includes recognizing patients’ emotional needs, supporting decision-making, protecting confidentiality and fostering a sense of psychological safety — all of which become more complex in virtual care settings.
Telehealth changes communication dynamics
Without a shared physical space, telehealth interactions rely almost entirely on verbal expression and limited visual cues transmitted through screens.
Omidi’s research identifies several ways communication is reshaped in telehealth:
• Loss of nonverbal cues such as body language, posture, facial expressions and subtle gestures that support rapport and empathy • Technical delays or glitches that interrupt conversational flow • Environmental constraints that limit how clearly participants can see or hear one another • Altered interaction patterns, including shorter visits and more provider-led conversations
“In-person consultations depend on multiple communication methods — not just spoken words, but embodied interaction. In telehealth, providers report feeling less control over nonverbal signaling and note that compensatory behaviors, such as exaggerated nodding or verbal affirmation, only partially address these limitations,” Omidi said.
These changes can reduce emotional immediacy, making it harder to establish rapport or convey compassion, especially during sensitive conversations.
Emotional connection and patient-centered care
Significant findings in Omidi’s research center around emotional connection. Both patients and providers report the lack of shared physical presence in telehealth affects empathy and human connection — essential components of the therapeutic relationship.
Providers noted the absence of physical gestures, such as sitting close or offering a comforting touch, which often communicate care without words. Some clinicians even reported avoiding delivering bad news via telehealth due to limited emotional feedback and reduced facial visibility.
“When we remove the shared physical space, we also remove many of the subtle cues that sustain empathy in clinical interactions. Telehealth doesn’t eliminate connection, but it does mean clinicians must be far more intentional, because relational care no longer happens by default,” Omidi said.
While telehealth improves access and efficiency, Omidi’s findings show these shifts can compromise the relational aspects of care if communication is not carefully supported.
The overlooked role of physical environment
A major contribution of Omidi’s research is reframing telehealth environments as active participants in communication rather than passive backdrops.
Telehealth replaces a shared exam room with three environments for the provider, patient and the digital space connecting them. Each influences communication quality.
Lighting, sound control, background, screen placement and privacy all affect how participants interpret verbal and nonverbal cues. For example, poor lighting can obscure facial expressions, reducing credibility and impairing diagnostic accuracy in visually dependent fields. Inadequate sound control leads to miscommunication and frustration.
Omidi’s research shows patients are also sensitive to environmental signals. An open door or visible interruption can reduce trust, while private settings encourage disclosure of sensitive information. Omidi found that design details matter: certificates of licensure displayed in a provider’s background helped reinforce professionalism and credibility.
“Each participant’s surroundings act as a backdrop that frames the interaction,” Omidi said. “Environmental cues directly influence comfort, psychological safety and communication effectiveness.”
Technology as a core component of communication
Technology fully mediates the telehealth encounter and functions as an extension of the environment itself. Omidi’s review expands the definition of technology beyond platforms to include devices such as cameras, microphones, computers and accessories.
Audio clarity, video resolution, camera placement and interface usability shape perceptions of empathy, attentiveness and presence. Poor quality can create impressions of distance or coldness, while high-quality connections support trust and engagement. Despite their importance, physical environment and technology are still often treated as secondary concerns in telehealth research and practice.
“Environmental factors affect patient understanding, satisfaction, engagement, feelings of trust and security, and adherence to treatment recommendations,” Omidi said. “Yet there are very few standardized guidelines for telehealth spaces.”
Implications for healthcare practice and policy
Omidi’s research points to the need for a shift in how telehealth is designed, evaluated and regulated. Her work supports:
• Elevating environment and technology design as integral components of care quality • Developing evidence-based design standards for telehealth settings • Encouraging interdisciplinary collaboration between health care, design and technology professionals
Omidi is building on her research to further test how environmental and technological variables affect communication and health outcomes. For her next study — expected to be published in the fall — she hopes to collaborate with patient and providers on design strategies to improve trust, engagement and communication.
While rooted in health care, Omidi noted the broader relevance of her findings. Online communication plays a critical role in education, legal services, crisis response and disaster communication — areas where clarity, trust, and emotional connection can have life-changing consequences.
“Telehealth care design can change people’s lives — and understanding communication is where that change begins.” — Farzane Omidi
