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Peeters KMM, Reichel LAM, Muris DMJ, Cals JWL. Family Physician-to-Hospital Specialist Electronic Consultation and Access to Hospital Care: A Systematic Review. JAMA Netw Open 2024; 7:e2351623. [PMID: 38214930 PMCID: PMC10787322 DOI: 10.1001/jamanetworkopen.2023.51623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Importance Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. Objective To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. Evidence Review A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. Findings The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. Conclusions and Relevance In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
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Affiliation(s)
- Ken M. M. Peeters
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Zuyderland Medical Centre, Sittard, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
| | - Loïs A. M. Reichel
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Dennis M. J. Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
- Public Health Service South Limburg, Heerlen, the Netherlands
| | - Jochen W. L. Cals
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Tabaeeian RA, Hajrahimi B, Khoshfetrat A. A systematic review of telemedicine systems use barriers: primary health care providers' perspective. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-07-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.
Design/methodology/approach
This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.
Findings
Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.
Originality/value
This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.
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3
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Hakimjavadi R, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Joschko J, Karunananthan S, Keely E, Liddy C. Electronic Consultation by Advanced Practice Nurses to Improve Access to Specialist Care for Older Adults. J Gerontol Nurs 2022; 48:33-40. [PMID: 35343843 DOI: 10.3928/00989134-20220307-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these practitioners use the service to improve access to care. All eConsults submitted by or to an APN in 2019 on behalf of patients aged ≥65 years were reviewed to identify examples from six settings representative of the range of advanced nursing practices. For each setting, a final case was chosen using an iterative process and stratified by specialty and type of advice. Included cases were assessed using a conceptual framework for health care access. Selected cases illustrate how APNs can be effective users of eConsults in a diversity of health care settings. The framework allowed for an in-depth study of access over the range of interactions that take place among patients, caregivers, providers, and the health care system. [Journal of Gerontological Nursing, 48(4), 33-40.].
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Ryder M, Gallagher P. A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland. J Nurs Manag 2022; 30:1053-1060. [PMID: 35307900 PMCID: PMC9314621 DOI: 10.1111/jonm.13602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/02/2022]
Abstract
Aim The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland. Background A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term. Method An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland. Results Sixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants. Conclusions This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized. Implications for Nursing Management Failure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin
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Vimalananda VG, Orlander JD, Afable MK, Fincke BG, Solch AK, Rinne ST, Kim EJ, Cutrona SL, Thomas DD, Strymish JL, Simon SR. Electronic consultations (E-consults) and their outcomes: a systematic review. J Am Med Inform Assoc 2021; 27:471-479. [PMID: 31621847 DOI: 10.1093/jamia/ocz185] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. MATERIALS AND METHODS We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. RESULTS We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. CONCLUSION Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Department of General Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa K Afable
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Quality, Safety and Value, Partners Healthcare System, Boston, Massachusetts, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eun Ji Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of General Internal Medicine, Zucker School of Medicine, Hofstra Northwell, Manhasset, New York, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Dylan D Thomas
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith L Strymish
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Department of Medicine and Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts, USA
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Oseran AS, Wasfy JH. Early experiences with cardiology electronic consults: A systematic review. Am Heart J 2019; 215:139-146. [PMID: 31325772 DOI: 10.1016/j.ahj.2019.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Abstract
Many health systems have begun implementing electronic consultation programs. The clinical and financial impact of these programs in cardiology and the potential for more widespread adoption remains unknown. OBJECTIVES To systematically review the current literature related to electronic consultation in cardiology. METHODS Following the PRISMA guidelines, we conducted a systematic review in August 2018 of English literature. We searched PubMed, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for studies related to electronic consultation in cardiology. RESULTS A total of 21 studies were included. Two of the studies were randomized controlled trials, 16 were quantitative studies with defined endpoints, and 3 were qualitative descriptions. Most studies were conducted in the United States and Canada. The available literature suggests cardiology e-consult programs can be implemented in different practice settings, have good patient and provider satisfaction, deliver greater and timelier access to outpatient cardiac care, and do so in a cost saving fashion. While studies suggest cardiology e-consultation is safe, there are no studies evaluating hard clinical outcomes. CONCLUSIONS Cardiology e-consults appear to be a promising tool for increasing access to outpatient cardiac care. Further investigation is required to evaluate the effects of cardiology electronic consultation on the quality of care. CONDENSED ABSTRACT Here we present the first systematic review of electronic consultation in cardiology. The available literature suggests cardiology e-consult programs can be implemented in different practice settings, have good patient and provider satisfaction, deliver greater and timelier access to outpatient cardiac care, and do so in a cost saving fashion. While studies suggest cardiology e-consultation is safe, there are no studies evaluating hard clinical outcomes. Overall, cardiology e-consults appear to be a promising tool for increasing access to outpatient cardiac care. Further investigation is required to evaluate the effects of cardiology electronic consultation on the quality of care.
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Affiliation(s)
- Andrew S Oseran
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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7
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Nabelsi V, Lévesque-Chouinard A, Liddy C, Dumas Pilon M. Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study. JMIR Med Inform 2019; 7:e13354. [PMID: 31293239 PMCID: PMC6652123 DOI: 10.2196/13354] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. OBJECTIVE The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). METHODS We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. RESULTS For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. CONCLUSIONS The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority.
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Affiliation(s)
- Véronique Nabelsi
- Département des Sciences Administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- Groupe de Médecine de Famille Universitaires de Gatineau du Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, ON, Canada.,CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Maxine Dumas Pilon
- Department of Family Medicine, McGill University, Montréal, QC, Canada.,Collège Québécois des Médecins de Famille, Montréal, QC, Canada
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8
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Liddy C, Moroz I, Mihan A, Nawar N, Keely E. A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide. Telemed J E Health 2019; 25:184-198. [DOI: 10.1089/tmj.2018.0005] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Nikhat Nawar
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Canada
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9
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Tuot DS, Liddy C, Vimalananda VG, Pecina J, Murphy EJ, Keely E, Simon SR, North F, Orlander JD, Chen AH. Evaluating diverse electronic consultation programs with a common framework. BMC Health Serv Res 2018; 18:814. [PMID: 30355346 PMCID: PMC6201558 DOI: 10.1186/s12913-018-3626-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background Electronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion. Methods Using a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems’ end-users. Results Organizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies. Conclusion A core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3626-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Delphine S Tuot
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA. .,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jennifer Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Murphy
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA.,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven R Simon
- Harvard Medical School, Boston, USA.,VA Boston Healthcare System, Boston, USA
| | - Frederick North
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay D Orlander
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, Boston, USA
| | - Alice Hm Chen
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA.,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Muse ED, Godino JG, Netting JF, Alexander JF, Moran HJ, Topol EJ. From second to hundredth opinion in medicine: A global consultation platform for physicians. NPJ Digit Med 2018; 1:55. [PMID: 31304334 PMCID: PMC6550165 DOI: 10.1038/s41746-018-0064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Serious medical diagnostic errors lead to adverse patient outcomes and increased healthcare costs. The use of virtual online consultation platforms may lead to better-informed physicians and reduce the incidence of diagnostic errors. Our aim was to assess the usage characteristics of an online, physician-to-physician, no-cost, medical consultation platform, Medscape Consult, from November 2015 through October 2017. Physicians creating original content were noted as “presenters” and those following up as “responders”. During the study period, 37,706 physician users generated a combined 117,346 presentations and responses. The physicians had an average age of 56 years and were from 171 countries on every continent. Over 90% of all presentations received responses with the median time to first response of 1.5 h. Overall, computer- and device-based medical consultation has the capacity to rapidly reach a global medical community and may play a role in the reduction of diagnostic errors.
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Affiliation(s)
- Evan D Muse
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
| | - Job G Godino
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,3University of California San Diego, La Jolla, CA USA
| | | | | | | | - Eric J Topol
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
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11
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Olayiwola JN, Potapov A, Gordon A, Jurado J, Magana C, Knox M, Tuot D. Electronic consultation impact from the primary care clinician perspective: Outcomes from a national sample. J Telemed Telecare 2018; 25:493-498. [DOI: 10.1177/1357633x18784416] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Electronic consultations (eConsults) provide asynchronous, store-and-forward communication between primary care clinicians (PCCs) and specialists using web-based platforms, electronic health records or mobile applications. eConsults have demonstrated benefits in many areas of the Quadruple Aim, including educational value for PCCs. In this study, we explored the connection between eConsults and the Quadruple Aim using a unique national dataset of PCC-reported eConsult outcomes. Methods We conducted a retrospective study analysing registry data from the RubiconMD electronic consultation platform used by PCCs in 34 US states. We analysed PCC-reported outcomes from eConsults that took place between March 2017 and January 2018. PCCs were asked to select one or more of the following options after each eConsult: improved care plan, educational, avoided unnecessary diagnostics/procedures, avoided referral altogether or to wrong specialty, or no effect. Results PCCs reported an outcome for 3872 eConsults. eConsults for dermatology, endocrinology, and haematology-oncology were most common. Over one in four PCCs reported that the eConsult avoided a referral altogether or to the wrong specialty (26.3%) and avoided unnecessary diagnostics/procedures (26.1%). In 75% of eConsults, PCCs reported an improved care plan. Fifty percent reported that the eConsult was educational. Discussion PCCs in diverse practice settings reported substantial benefits from eConsults. In over half of eConsults, PCCs reported that the eConsult avoided unnecessary diagnostics/procedures, avoided a referral altogether or avoided a referral to the wrong specialty. Findings suggest that eConsults demonstrate important educational benefits, but may also influence PCC decision-making in a way that yields tremendous cost-saving potential and improved patient experience.
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Affiliation(s)
| | | | | | | | | | - Margae Knox
- University of California San Francisco, CA, USA
| | - Delphine Tuot
- University of California San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
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12
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Linsenmeyer K, Strymish JM, Smith D, Brennan M, Gupta K. Electronic consults for improving vancomycin use. J Hosp Infect 2017; 99:158-159. [PMID: 29225053 DOI: 10.1016/j.jhin.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/01/2017] [Indexed: 12/19/2022]
Affiliation(s)
- K Linsenmeyer
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | - J M Strymish
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Harvard Medical School, Boston, MA, USA
| | - D Smith
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - M Brennan
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - K Gupta
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Boston University School of Medicine, Boston, MA, USA
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13
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Pecina JL, Wyatt KD, Comfere NI, Bernard ME, North F. Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care. JMIR Mhealth Uhealth 2017; 5:e165. [PMID: 29117934 PMCID: PMC5700409 DOI: 10.2196/mhealth.8257] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/30/2017] [Accepted: 09/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)-based mobile devices. OBJECTIVE The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. METHODS Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant). RESULTS During the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6%) were performed by a primary care clinician, and 27 (25.0%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22%) had a TD consultation before biopsy, and 10 (37%) of these biopsies were obtained by primary care clinicians. CONCLUSIONS Clinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults.
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Affiliation(s)
- Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kirk D Wyatt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nneka I Comfere
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States
| | - Matthew E Bernard
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Frederick North
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, United States
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14
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Hospitalist Versus Subspecialist Perspectives on Reasons, Timing, and Impact of Consultation. J Healthc Qual 2017; 39:367-378. [DOI: 10.1097/jhq.0000000000000064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Kwok J, Olayiwola JN, Knox M, Murphy EJ, Tuot DS. Electronic consultation system demonstrates educational benefit for primary care providers. J Telemed Telecare 2017; 24:465-472. [PMID: 28614974 DOI: 10.1177/1357633x17711822] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse practitioners, physician assistants, trainee physicians and less-experienced primary care providers report the greatest clinical educational benefit, particularly for conditions involving lab-based diagnosis and management.
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Affiliation(s)
- Jonas Kwok
- 1 School of Medicine, State University of New York Downstate, USA
| | - J Nwando Olayiwola
- 2 Department of Family Medicine, University of California, USA.,3 Center for Excellence in Primary care, University of California, USA
| | - Margae Knox
- 2 Department of Family Medicine, University of California, USA.,3 Center for Excellence in Primary care, University of California, USA
| | | | - Delphine S Tuot
- 4 Department of Medicine, University of California, USA.,5 Center for Innovation in Access and Quality, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, USA
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